Úlceras de pressão: um estudo com pacientes de unidade de terapia intensiva

To characterize patients according to gender, age category, internment time, diagnostical hypothesis and location of the pressure ulcer; to identify the susceptibility conditions, intrinsical and extrinsical factors present on ICU patients and to verify on the existence of association between the susceptibility conditions and the intrinsecal and extrinsecal factors on the occurrence of PU. Methods: It is a descriptive study, of longitudinal design of the panel type, with quantitative approach, performed on two ICU s of a private hospital located in Natal/RN, with 40 patients interned at these units. The data collection was performed on all three shifts through a structured observation and physical exam of the patients' skin form seeking to identify the presence of PU. Results: The greatest occurence of PU was on individuals of the male gender (70%) when compared to the female gender (30%), that difference being statistically significant (p=0,0267), with the male gender presenting 4,3 times greater chance of developing PU than the female; the predominant age category was from 60 years of age on (85%), 60,0% presented 1 to 2 PU s after 7 (seven) days of permanence in the ICU s, the predominant diagnostical hypothesis on the patients with PU were the respiratory diseases (42,3%) and the most frequent locations of PU were the sacral region (40,0%) and heels (36,0%). 25 PU s of stage I were diagnosed on 50,0% of the followed patients, with general incidence of 50,0% on both ICUs. from the 88 variables researched, 75 were identified on the patients from the study, being the predominant conditions (anemia, hypotension, leukocytosis, other diseases hypertension blood pressure, cardiac insuffience, pneumonia - and ansiolythic), the intrinsecal factors (diminished muscular strenght and/or mass, discrete edema, totally compromised mobile coordination and total inability for movement on the bed) and the extrinsecal factors (inadequate mattress type, permanence on a single position for >2 hours, shearing/friction force, bed clothes with folds that leave marks on the body, pressure force) predominated on patients with PU. The male gender variables (p=0,0267,OR=4,3), sedation (p=0,0006,OR=4,1), psychomotive agitation (p=0,0375,OR=5,8) and leukocytosis (p=0,0285,OR=5,0) presented a significant statistical diference when analyzed independently. We verified an association of 17,3%, statistically significant (p=0,0384), between the susceptibility conditions (anemia, leukocytosis and hypotension), the intrinsecal factors (age equal or above 60 years, diminished/absent pain sensibility and smooth, fine or delicate skin) and the extrinsecal factors (inadequate mattress, pressure forces, shearing/friction force, permanence on a single position for more than 2 hours, elevation between 30 to 45 degrees and inadequate bed clothes' conditions), with a chance ratio of 4,6 times the risk of occurrence of PU on the patients that presented the referred association. Conclusion: The incidence of PU detected on the ICU-interned patients was high and we made evident the existence of association between the susceptibility conditions, the intrinsecal and extrinsecal factors on the occurrence of PU s on the ICUinterned patients, and thus we accept the alternative hypothesis proposed on the study

Composição centesimal da carne de cordeiros submetidos a dietas com diferentes teores de concentrado

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Aspectos quantitativos de carcaças de bovinos de diferentes raças, alimentados com diferentes níveis de energia

Objetivou-se avaliar as características quantitativas da carcaça de bovinos machos não castrados, terminados em confinamento e abatidos aos 13-14 meses de idade. Foram utilizados 16 bezerros com nove meses de idade e peso médio inicial de 220 kg (oito Aberdeen Angus - AA e oito Hereford - HE), submetidos a dois níveis de energia (3,07 e 3,18 Mcal/kg de MS). O desenho experimental foi inteiramente casualizado, em arranjo fatorial 2 x 2 (duas raças e dois níveis de energia). O volumoso utilizado foi a silagem de milho, com 36% de grãos na matéria seca (MS). O concentrado nos tratamentos de menor nível de energia participou com 12% e naqueles de maior nível, com 32% da MS da dieta. Os animais foram abatidos quando, por estimativa, as carcaças apresentaram, na média, um mínimo de 190 kg. Os animais AA apresentaram maior rendimento de carcaça quente (54,95 contra 53,75%), maior comprimento de perna (64,12 contra 62,12 cm) e maior área do músculo Longissimus/100 kg de carcaça (29,31 contra 27,41 cm²). Os animais que receberam o maior nível de energia na dieta apresentaram maior comprimento de perna (71,75 contra 64,50 cm) e melhor conformação da carcaça (11,25 contra 10,12 pontos). Observou-se interação significativa entre raça e nível de energia para a espessura de gordura subcutânea, sendo a maior espessura verificada nas carcaças dos animais HE, que receberam o menor nível de energia.

Restrição alimentar em caprinos: rendimento, cortes comerciais e composição da carcaça

Com o objetivo de estudar o efeito da restrição alimentar sobre as características da carcaça de caprinos leiteiros, realizou-se um experimento utilizando 27 cabritos castrados da raça Saanen. Os animais (PV inicial de 20 kg) foram distribuídos nos tratamentos alimentação à vontade e 30 e 60% de restrição, sendo abatidos aos 35 kg de PV. Foram avaliados o rendimento comercial e biológico, os cortes comerciais, a área de olho-de-lombo e a composição tecidual da perna. O rendimento biológico não foi afetado pela restrição alimentar, mas o comercial diminuiu com o aumento da restrição. A elevação no nível de restrição alimentar promoveu diminuição do lombo e da 6ª a 13ª costelas e aumento da paleta e do pescoço, proporcionalmente à meia-carcaça. A proporção de ossos aumentou e a de gordura total diminuiu com o aumento da restrição. O tecido muscular não foi afetado pela restrição. A restrição alimentar de até 30% não prejudicou a qualidade da carcaça de caprinos leiteiros.

Relative development of tissues, commercial meat cuts and live weight components in Saanen goats

Objetivando avaliar o desenvolvimento relativo dos componentes do peso vivo (PV), dos cortes comerciais e dos tecidos da carcaça, utilizaram-se 40 cabritos Saanen. Os animais foram abatidos ao atingir 5,0; 12,5; 20,0; 27,5 e 35,0 kg de PV e a carcaça foi seccionada em paleta, pescoço, 1ª a 5ª costelas, 6ª a 13ª costelas, peito/fralda, lombo e perna. A perna foi dissecada em ossos, músculos e gordura. Utilizou-se a equação alométrica Y=aXb para estimar o desenvolvimento relativo. O crescimento do tecido ósseo foi precoce, o do tecido muscular intermediário e o da gordura crescimento tardio, uma vez que a gordura subcutânea é depositada mais tardiamente. Os cortes comerciais apresentaram coeficiente de alometria isogônico, com exceção do corte da 6ª a 13ª costelas e do peito/fralda. O desenvolvimento da carcaça e dos não-componentes da carcaça acompanhou o peso de corpo vazio. Cabritos com 35 kg de PV possuem proporção de músculos e relação músculo:osso adequadas, mas apresentam proporção de gordura maior que a observada nos animais abatidos com 20 kg de PV.

Efeito da restrição alimentar sobre algumas características de carcaça de cabritos F1 Boer X Saanen

Objetivou-se com este trabalho avaliar o efeito da restrição alimentar nas características de carcaça de cabritos F1 Boer x Saanen. Foram utilizados 21 cabritos, pesando 15 kg de PV, distribuídos em três tratamentos (0, 30 e 60% de restrição). O consumo dos animais do tratamento 0% de restrição determinavam o consumo dos animais dos tratamentos 30 e 60% de restrição. Quando os animais do nível de restrição 0% atingiam 25 kg, estes juntamente com seus pares foram submetidos a jejum de sólido de 24 h e de líquido de 16 h. O abate ocorreu mediante descarga elétrica, seguido de sangria e retirada dos órgãos. Os ganhos de peso foram de 211,03, 126,15 e 11,71g/dia; a eficiência alimentar de 0,20, 0,18 e de 0,03; os pesos de abate de 25,44, 20,91 e 15,82kg para os tratamentos 0, 30 e 60% de restrição, respectivamente. O rendimento de carcaça quente, de carcaça fria e biológico não foram influenciados pela restrição alimentar. Somente a proporção da paleta e a do lombo foram influenciados pela restrição alimentar, com aumento linear do rendimento da paleta e decréscimo linear do rendimento do lombo. Houve efeito da restrição na redução do rendimento de gordura e aumento da proporção de osso. A restrição alimentar em níveis moderados, permitiu a obtenção de carcaças de boa qualidade, com bom rendimento, elevada proporção de músculo e baixa participação de gordura e, dependendo da relação custo:benefício, pode tornar-se boa alternativa para o produtor.

Características quantitativas da carcaça de cordeiros deslanados Morada Nova em função da relação volumoso:concentrado na dieta

Com o objetivo de avaliar a influência da relação volumoso:concentrado sobre a composição tecidual e os rendimentos de carcaça e de cortes comerciais de cordeiros Morada Nova em confinamento, utilizaram-se 18 cordeiros com peso vivo (PV) inicial de 15 kg, distribuídos em seis grupos de três animais (um em cada dieta), de acordo com a relação volumoso(V):concentrado(C): 40:60, 55:45 e 70:30. Foram avaliados os pesos de corpo vazio (PCV), de carcaça quente (PCQ) e de carcaça fria (PCF), a partir dos quais foram calculados os rendimentos biológico (RB), de carcaça quente (RCQ) e de carcaça fria (RCF) e a perda de peso por resfriamento (PPR). A carcaça foi dividida em cinco cortes cárneos (perna, lombo, costelas, paleta e pescoço), os quais foram pesados para cálculo de seus rendimentos em relação ao peso da meia-carcaça. A perna foi dissecada em músculo, osso e gordura e os pesos desses tecidos foram expressos em peso absoluto e em porcentagem da perna. Calcularam-se as relações músculo:osso e músculo:gordura, o índice de musculosidade da perna (IMP) e a área de olho-de-lombo (AOL). O aumento de 30 para 60% de concentrado na dieta elevou os rendimentos de carcaça quente e carcaça fria, assim como o rendimento biológico. Os crescentes teores de concentrado na dieta não afetaram a porcentagem de músculo na perna, mas proporcionaram maior deposição de gordura e maior área de olho-de-lombo.

CAD e engenharia reversa como ferramentas de auxílio na fabricação de cartuchos para próteses ortopédicas

The manufacturing of above and below-knee prosthesis starts by taking surfac measurements of the patient s residual limb. This demands the making of a cartridg with appropriate fitting and customized to the profile of each patient. The traditiona process in public hospitals in Brazil begins with the completion of a record file (according to law nº388, of July 28, 1999 by the ministry of the health) for obtaining o the prosthesis, where it is identified the amputation level, equipment type, fitting type material, measures etc. Nowadays, that work is covered by the Brazilian Nationa Health Service (SUS) and is accomplished in a manual way being used commo measuring tapes characterizing a quite rudimentary, handmade work and without an accuracy.In this dissertation it is presented the development of a computer integrate tool that it include CAD theory, for visualization of both above and below-knee prosthesis in 3D (i.e. OrtoCAD), as well as, the design and the construction a low cos electro-mechanic 3D scanner (EMS). This apparatus is capable to automatically obtain geometric information of the stump or of the healthy leg while ensuring smalle uncertainty degree for all measurements. The methodology is based on reverse engineering concepts so that the EMS output is fed into the above mentioned academi CAD software in charge of the 3D computer graphics reconstruction of the residualimb s negative plaster cast or even the healthy leg s mirror image. The obtained results demonstrate that the proposed model is valid, because it allows the structura analysis to be performed based on the requested loads, boundary conditions, material chosen and wall thickness. Furthermore it allows the manufacturing of a prosthesis cartridge meeting high accuracy engineering patterns with consequent improvement in the quality of the overall production process

Desenvolvimento de métodos construtivos e de novos materiais empregados na confecção de cartuchos de próteses de membros inferiores

The manufacture of prostheses for lower limb amputees (transfemural and transtibial) requires the preparation of a cartridge with appropriate and custom fit to the profile of each patient. The traditional process to the patients, mainly in public hospitals in Brazil, begins with the completion of a form where types of equipment, plugins, measures, levels of amputation etc. are identified. Currently, such work is carried out manually using a common metric tape and caliper of wood to take the measures of the stump, featuring a very rudimentary, and with a high degree of uncertainty geometry of the final product. To address this problem, it was necessary to act in two simultaneously and correlated directions. Originally, it was developed an integrated tool for viewing 3D CAD for transfemoral types of prostheses and transtibial called OrtoCAD I. At the same time, it was necessary to design and build a reader Mechanical equipment (sort of three-dimensional scanner simplified) able to obtain, automatically and with accuracy, the geometric information of either of the stump or the healthy leg. The methodology includes the application of concepts of reverse engineering to computationally generate the representation of the stump and/or the reverse image of the healthy member. The materials used in the manufacturing of prostheses nor always obey to a technical scientific criteria, because, if by one way it meets the criteria of resistance, by the other, it brings serious problems mainly due to excess of weight. This causes to the user various disorders due to lack of conformity. That problem was addressed with the creation of a hybrid composite material for the manufacture of cartridges of prostheses. Using the Reader Fitter and OrtoCAD, the new composite material, which aggregates the mechanical properties of strength and rigidity on important parameters such as low weight and low cost, it can be defined in its better way. Besides, it brings a reduction of up steps in the current processes of manufacturing or even the feasibility of using new processes, in the industries, in order to obtain the prostheses. In this sense, the hybridization of the composite with the combination of natural and synthetic fibers can be a viable solution to the challenges offered above

Adaptação eletrônica de um leitor mecânico de coto, investigação e desenvolvimento de interface CAD

Due to advances in the manufacturing process of orthopedic prostheses, the need for better quality shape reading techniques (i.e. with less uncertainty) of the residual limb of amputees became a challenge. To overcome these problems means to be able in obtaining accurate geometry information of the limb and, consequently, better manufacturing processes of both transfemural and transtibial prosthetic sockets. The key point for this task is to customize these readings trying to be as faithful as possible to the real profile of each patient. Within this context, firstly two prototype versions (α and β) of a 3D mechanical scanner for reading residual limbs shape based on reverse engineering techniques were designed. Prototype β is an improved version of prototype α, despite remaining working in analogical mode. Both prototypes are capable of producing a CAD representation of the limb via appropriated graphical sheets and were conceived to work purely by mechanical means. The first results were encouraging as they were able to achieve a great decrease concerning the degree of uncertainty of measurements when compared to traditional methods that are very inaccurate and outdated. For instance, it's not unusual to see these archaic methods in action by making use of ordinary home kind measure-tapes for exploring the limb's shape. Although prototype β improved the readings, it still required someone to input the plotted points (i.e. those marked in disk shape graphical sheets) to an academic CAD software called OrtoCAD. This task is performed by manual typing which is time consuming and carries very limited reliability. Furthermore, the number of coordinates obtained from the purely mechanical system is limited to sub-divisions of the graphical sheet (it records a point every 10 degrees with a resolution of one millimeter). These drawbacks were overcome by designing the second release of prototype β in which it was developed an electronic variation of the reading table components now capable of performing an automatic reading (i.e. no human intervention in digital mode). An interface software (i.e. drive) was built to facilitate data transfer. Much better results were obtained meaning less degree of uncertainty (it records a point every 2 degrees with a resolution of 1/10 mm). Additionally, it was proposed an algorithm to convert the CAD geometry, used by OrtoCAD, to an appropriate format and enabling the use of rapid prototyping equipment aiming future automation of the manufacturing process of prosthetic sockets.

Efeitos da inclinação da esteira na marcha de indivíduos hemiparéticos crônicos

Objective: To examine the effects of treadmill inclinations on the walking of hemiparetic chronic subjects. Design: Observational descriptive study. Location: Laboratory of human movement analysis. Participants: Eighteen subjects, 10 men and 8 women were evaluated, with a mean age of 55.3 ± 9.3 years and the time since the injury of about 36 ± 22.8 months. Intervention: Not applicable. Main Outcome Measures: All subjects were evaluated for functional independence (Functional Independence Measure - FIM) and balance (Berg Balance Scale). Angular variations of the hips, knees and ankles in the sagittal plane were observed, as well as the speed of the movement (m/s), cadence (steps/min), stride length (m), cycle time (s), step time on the paretic leg and on the non-paretic leg (s), support phase time and balance phase time on the paretic leg (s) and the ratio of symmetry inter-limb as subjects walked on a treadmill at three conditions of inclination (0%, 5% and 10% ). Results: There were angular increases in the initial contact of the hip, knee and ankle, amplitude increase in the hip between 0% and 10% (37.83 ± 5.23 versus 41.12 ± 5.63, p < 0,001) and 5% and 10% (38.80 ± 5.96 versus 41.12 ± 5.63, p = 0,002), amplitude increases in the knee between 0% and 10% (47.51 ± 15.07 versus 50, 30 ± 12.82, p = 0,040), extension decreases in the hip, dorsiflexion increases in the balance phase and in the time of support phase from 0% to 5% (0.83 ± 0.21 versus 0.87 ± 0, 20, p = 0,011) and 0% and 10% (0.83 ± 0.21 versus 0.88 ± 0.23, p = 0,021). Conclusion: The treadmill inclination promoted angle changes as such as the increase of the angle of the hip, knee and ankle during the initial contact and the balance phase and the increase of the range of motion of the hip and knee; furthermore, it also promoted the increase of the support time of the paretic lower limb

Aprendizagem motora baseada em demonstrações de movimento biológico

O objetivo deste estudo foi avaliar o processo de aprendizagem motora de uma habilidade complexa da Ginástica Artística a partir da observação de demonstrações de modelos de pontos de luz e vídeo. Dezesseis participantes divididas em grupos dos respectivos modelos executaram um pré-teste, seguido de 100 tentativas de uma parada de mãos, igualmente distribuídas em blocos de 10 tentativas em dois dias, alternando períodos de demonstração e prática, com um teste de retenção após um dia. Cinemática de braço, tronco e perna das participantes possibilitaram análise da semelhança entre a coordenação de cada participante e do modelo e do tempo de movimento; a performance das participantes também foi avaliada por duas especialistas em Ginástica Artística. Ambas as análises indicaram que os grupos não diferiram. Os resultados são discutidos em termos da hipótese de suficiência de informação nos modelos de movimento biológico particularmente aplicada ao processo de aprendizagem de habilidades motoras complexas.

Efeitos do ultrassom terapêutico sobre parâmetros morfométricos e clínicos e método de extração de metaloproteinases em sujeitos com úlceras venosas

Venous wounds cause physical, psychological and financial problems that impact the quality of life of patients. Treatment alternatives are investigated in order to reduce healthcare costs and improve quality of life of people affected by this problem. Physical resources, such as therapeutic ultrasound (US), are being considered in the treatment of ulcers as a potential healing agent. This study aimed to investigate the application of US as a treatment for venous ulcers. Subjects were divided into two groups: US group, where treatment consisted of 5 sessions of pulsed US (3 MHz, 1W/cm²) associated with compression and kinesiotherapy; and sham group, where individuals went through the same procedures, but with sham US therapy. Subjects were evaluated for wound size by planimetry and digital photography, visual analogue scale for pain, quality of life by the questionnaires SF- 36 and VEINES-QoL/Sym and enzymatic activity of metalloproteinases 2 and 9 by zymography. It was observed mean reduction in wound area of 41.58±53.8% for the US group and 63.47±37.2% for the placebo group, maintenance of quality of life scores in the US group and significant improvement (p<0.05) in the placebo group by VEINES questionnaire. It was observed decreased perception of pain in the placebo group. Sample feasibility for analysis of the protein activity of metalloproteinases 2 and 9 by zymography collected by swab method was also confirmed. Our data did not give us evidence to support the theory that the US accelerates healing of venous ulcers in a short-term analysis. However, we observed that standard care associated with compression therapy and kinesiotherapy were able to significantly shorten the progression of chronic venous ulcers

Efeitos do tratamento com Hidrogel na cicatrização de úlceras venosas de membros inferiores: revisão sistemática

Chronic venous disease (CVD) is evident among the chronic diseases and affects the elderly population and primarily is responsible for leg ulcers in this population. The use of dressings in the care of a venous ulcer is a fundamental part of the treatment for healing, however, evidence to assist in choosing the best dressing is scarce. The main objective of this study was to evaluate the effectiveness of treatment with hydrogel in the healing of venous ulcers using search methods, synthesis of information and statistical research through a systematic review and meta-analysis. Randomized controlled trials were selected in the following databases: CENTRAL; DARE; NHS EED; MEDLINE; EMBASE; CINAHL. Beyond these databases three websites were consulted to identify ongoing studies: ClinicalTrials.gov, OMS ICTRP e ISRCTN. The primary outcomes were analyzed: complete wound healing, incidence of wound infection and the secondary were: changes in ulcer size, time to ulcer healing, recurrence of ulcer, quality of life of participants, pain and costs of treatment. Four studies are currently included in the review with a total of 250 participants. The use of hydrogel appears to be superior to conventional dressing, gauze soaked in saline, for the healing of venous leg ulcers; 16/30 patients showed complete healing of ulcers (RR 5,33, 95%CI [1,73,16,42]). The alginate gel was shown to be more effective when compared to the hydrogel dressing in reduction of the wound area; 61,2% (± 26,2%) with alginate e 19,4% (± 24,3%) with hydrogel at the end of four weeks of treatment. Manuka honey has shown to be similar to the hydrogel dressings in percentage of area reduction. This review demonstrated that there is no evidence available about the effectiveness of the hydrogel compared to other types of dressings on the healing of venous leg ulcers of the lower limbs, thus demonstrating the need of future studies to assist health professionals in choosing the correct dressing.

Diclofenac sodium and Imipenem action on rat intestinal mucosa: a biomechanical and histological study

OBJETIVO: Avaliar as alterações histológicas e biomecânicas do diclofenaco de sódio na mucosa intestinal do rato e a associação com o uso de Imipenem. MÉTODOS: Foram estudados 240 ratos Wistar distribuídos aleatoriamente em quatro grupos experimentais: GI: 60 ratos tratados com injeção IM de soro fisiológico 0,9%; GII: 60 ratos tratados com injeção IM de diclofenaco de sódio na dose de 6mg/kg de peso por 4 dias; GIII: 60 ratos tratados com injeção IM de Imipenem na dose de 30 mg/kg de peso por 4 dias; GIV: 60 ratos tratados com injeção IM de soro fisiológico e diclofenaco de sódio nas doses acima. em cada grupo os animais foram posteriormente divididos em 4 momentos de 15 animais em cada um para sacrifício, respectivamente, no 4º, 7º, 14º e 21º dias após o início do tratamento. As alterações da cavidade abdominal, assim como as características histológicas e de força de ruptura do intestino delgado foram analisadas em cada momento, em cada grupo. RESULTADOS: Não foram encontradas alterações histológicas e biomecânicas nos animais do Grupo I nesse estudo. Lesões ulceradas na mucosa do intestino delgado foram observadas nos animais tratados com diclofenaco de sódio, assim como diminuição da força de ruptura. As lesões ulceradas encontradas foram prevenidas pelo uso de Imipenem. CONCLUSÃO: O diclofenaco de sódio induz lesões ulceradas na mucosa intestinal do rato que podem ser prevenidas pelo uso de Imipenem.