Infecção hospitalar em pacientes cirúrgicos de hospital universitário

Objetivo: Analisar fatores intercorrentes e a incidência da infecção em pacientes operados no Hospital Universitário da UFRN. Métodos: Foram estudados, através de protocolo previamente estabelecido, 3.120 pacientes internados que se submeteram a procedimentos cirúrgicos no período de janeiro de 1999 a outubro de 2002. Resultados: O índice de infecção hospitalar foi de 5,9%, e a topografia de maior incidência foi a ferida operatória (3,7%). Infecção respiratória ocorreu em 1,2%, urinária em 0,6% e bacteremia em 0,1%. O índice de infecção comunitária foi de 9,2%, predominando infecção urinária (5%) e respiratória (2,1%). Quanto ao grau de contaminação das feridas operatórias, as feridas limpas (1479) apresentaram infecção em 2,9%, as feridas limpascontaminadas (1277) em 6,0% dos casos, as feridas contaminadas (270) em 15,1%, e as ferida infectadas (94) resultaram em infecção em 30,75% dos casos. Conclusão: Concluiu-se que a incidência de infecção cirúrgica foi compatível com os índices na literatura mundial. A partir desses dados, ratifica-se a importância de medidas de controle de infecção hospitalar de forma sistemática, como vem sendo realizado no hospital onde o estudo foi realizado

Técnica de curativo: estudo comparativo entre profissionais e estudantes de enfermagem

Comparar o desenvolvimento de profissionais e estudantes de enfermagem quanto à realização da técnica de curativo. Metodologia: estudo descritivo com abordagem quantitativa. A amostra foi escolhida através de amostragem por conveniência, tendo participado da pesquisa 14 profissionais de enfermagem, que foram observados no período de março a junho de 2009, e 24 estudantes de enfermagem, regularmente matriculados no último período do Curso de Graduação em Enfermagem da Universidade Federal da Paraíba, os quais foram observados no período de março e maio de 2010. O procedimento de coleta de dados foi efetuado através da observação não participante e preenchimento de um roteiro semi-estruturado, após a aprovação do Comitê de Ética em Pesquisa do Hospital Universitário Lauro Wanderley, sob Protocolo n. 011/09. Resultados: na maioria dos aspectos analisados, os estudantes se sobressaíram aos profissionais, principalmente com relação à lavagem das mãos, orientação do paciente e utilização de movimentos únicos para limpeza da ferida. Conclusão: os profissionais devem melhorar seu conhecimento, buscando atualização nessa área, e os estudantes devem ser supervisionados durante a realização do procedimento

Leitora-criadora: a experiência situada na construção dramatúrgica

This study has the purpose of investigating the term reader-creator , on the textual aspects of the dramatical works A Morte nos Olhos , A Memória Ferida and Na Outra Margem (2010) by Antonia Pereira Bezerra. In this sense, we propose an analysis of these works based on author‟s life experience as creative matter for a autofictional narrative, highlighting the relations between the autobiographical elements (LEJEUNE, 2008; DOSSE, 2009) and fictional elements in the construction of dramatic narratives. The theoretical analysis pervades the studies fields of Reception Aesthetics (ISER, 1996), memory (RICOUER, 2007) and narrative (RICOEUR, 2010), evidencing the relation between the author and the pursuit of her memories and life experiences, the matter to elaboration of writing. Then we intend thinking a reader-creator of herself, that at the same time she seeks in her memories the biographic aspects to her narrative, she converts this reality with the insertion of fictional elements from the imagination (SARTRE, 2008)

Evolução diagenética e caracterização dos reservatórios da seção devoniana na Bacia do Rio do Peixe-Nordeste do Brasil

The Rio do Peixe Basin represents a main basin of northeastern Brazil and pioneering work positioned the rocks of this basin in the Early Cretaceous. However, a recent study, based on integrated pollen analysis from three wells, found an unprecedented siliciclastic sedimentary section, in the region, of early Devonian age. Therefore, the present study aims a detailed petrographic and petrological analysis of this devonian section, in the Rio do Peixe Basin and proposes a diagenetic evolution, to understand the characteristics of the porous system, identify the main reservoir petrofacies with the main factors impacting on the quality of these rocks as reservoirs and a quick study on the provenance of this section. The petrographic study was based on samples obtained from subsurface and surface. The diagenetic evolution of petrofacies and its identification were based only on subsurface samples and the study of provenance was based on surface samples. The thin sections were prepared from sandstones, pelites and sandstones intercalated with pelites. The original detrital composition for this section is arcosean and the main diagenetic processes that affected these rocks occur in various depths and different conditions, which resulted in extensive diagenetic variety. The following processes were identified: early fracture and healing of grains; albitization of K-feldspar and plagioclase; siderite; precipitation of silica and feldspar; mechanical infiltration of clay and its transformation to illite/esmectite and illite; autigenesis of analcime; dissolution; autigenesis of chlorite; dolomite/ferrous dolomite/anquerite; apatite; calcite; pyrite; titanium minerals and iron oxide-hidroxide. The occurrence of a recently discovered volcanism, in the Rio do Peixe Basin, may have influenced the diagenetic evolution of this section. Three diagenetic stages affected the Devonian section: eo, meso and telodiagenesis. This section is compositionally quite feldspathic, indicating provenance from continental blocks, between transitional continental and uplift of the basement. From this study, we observed a wide heterogeneity in the role of the studied sandstones as reservoirs. Seven petrofacies were identified, taking into account the main diagenetic constituent responsible for the reduction of porosity. It is possible that the loss of original porosity was influenced by intense diagenesis in these rocks, where the main constituent for the loss of porosity are clays minerals, oxides and carbonate cement (calcite and dolomite)

Analise estrutural do galactano acidico dos ovos de pomacea lineata e avaliacao de suas atividades proliferativa e antiinflamatoria

The acidic galactan (AG) was obtained by extraction and proteolysis by acetone precipitation of the eggs of the mollusc Pomacea lineata. Its structure was elucidated by a combination of chemical analysis, the intrinsic viscosity and NMR spectroscopy 1D and 2D. Biological aspects of AG were evaluated by in vivo testing of healing and peritonitis induced (anti-inflammatory activity) and in vitro assays of cytotoxicity (MTT). This polymer showed a simple structure without the presence of sulfate and uronic acids in its structure. Its intrinsic viscosity and relative were evaluated at 0.44 ± 0.05 and 1.744± 0.07 dl.g-1. Spectroscopy showed that the AG has a constitution composed predominantly of β-D-galactosis, and β-D-glucosamine-NAcetil that comes in a smaller proportion in chain. The character of this acidic polysaccharide is given by the presence of pyruvate in the molecule, forming a cyclic acetal of six states, located in β-D-galactosis. The involvement of AG in the healing process was evaluated and the histological analysis revealed that there was so early in the process of healing, a great stimulation of macrophages with granuloma formation. Suggesting that AG may have promoted the advance of biological events required for tissue healing. In the trial of the GA-induced peritonitis showed dose dependent, demonstrating the anti-inflammatory effect at concentrations above 20 mg/kg, and confirming its inflammatory character and the concentration of 1mg/kg. In vitro tests used in the GA concentration of 1000 μg/mL showed proliferative activity by stimulating the growth of 3T3 cells, corroborating the findings in vivo and demonstrating the absence of cytotoxic activity

Avaliação da qualidade da assistência a pessoas com úlceras venosas atendidas na estratégia saúde da família

A úlcera venosa constitui importante problema de saúde pública, gera repercussão social, econômica e mudanças nos hábitos de vida, dor, sofrimento, acarretando diminuição da qualidade de vida. O estudo objetivou avaliar a assistência prestada às pessoas com úlceras venosas atendidas pela Estratégia Saúde da Família. É um estudo analítico, transversal e quantitativo, realizado com 59 pessoas com úlceras venosas, atendidas em 36 unidades da Estratégia Saúde da Família. O estudo obteve aprovação do projeto de pesquisa pelo Comitê de Ética da Universidade Federal de Alagoas. Para a coleta dos dados utilizou-se instrumento testado, entrevista, exame físico e informações dos prontuários. Os dados foram organizados em planilha do Microsoft Excel 2007, exportados e analisados em software estatístico por meio de estatística descritiva e inferencial, considerando nível de significância estatística de ρ-valor < 0,05. As pessoas com úlcera venosa eram do sexo feminino (71,2%), ≥ 60 anos (67,8%) e estavam em tratamento > 1 ano (69,5%). Possuíam tempo de lesão > 6 meses (64,4%), dor na úlcera/membro (86,4%) e leito com ≤ 30% de granulação/epitelização (78,0%). A qualidade da assistência foi ruim (< 5 aspectos positivos) em 57,6% (ρ=0,000) e os aspectos que mais interferiram foram as seguintes inadequações: profissional que acompanha/realiza curativo (ρ=0,002, coeficiente de contingência (CC) =0,458, razão de chance (RC) =13,9), produtos nos últimos 30 dias (ρ=0,038, cc=0,334, RC=7,3) e acesso a consulta com angiologista (ρ=0,041, cc=0,305, RC=4,1). Os aspectos clínicos que contribuíram para o aumento do tempo de assistência foram: tempo de lesão >6 meses (ρ<0,001), dor (ρ=0,043), recidiva (ρ<0,001); nos aspectos assistenciais: inadequação dos produtos com 83,1% (ρ=0,036). Essas características dificultaram a cicatrização tecidual, prolongando o tempo de tratamento das lesões,que podem ter contribuído para a cronicidade das úlceras

Caracterização de superfícies de titânio modificado por oxidação à plasma

Recent years have seen a significant growth in surface modifications in titanium implants, resulting in shorter healing times in regions with low bone density. Among the different techniques, subtraction by chemical agents to increase oxidation has been applied for surface treatment of dental implants. However, this technique is generally unable to remove undesirable oxides, formed spontaneously during machining of titanium parts, raising costs due to additional decontamination stages. In order to solve this problem, the present study used plasma as an energy source to both remove these oxides and oxidize the titanium surface. In this respect, Ti disks were treated by hollow cathode discharge, using a variable DC power supply and vacuum system. Samples were previously submitted to a cleaning process using an atmosphere of Ar, H2 and a mixture of both, for 20 and 60 min. The most efficient cleaning condition was used for oxidation in a mixture of argon (60%) and oxygen (40%) until reaching a pressure of 2.2 mbar for 60 min at 500°C. Surfaces were characterized by scanning electron microscopy (SEM), X-ray diffraction (XRD), atomic force microscopy (AFM), adhesion and cell proliferation. SEM showed less cell spreading and a larger number of projections orfilopodia in the treated samples compared to the control sample. AFM revealed surface defects in the treated samples, with varied geometry between peaks and valleys. Biological assays showed no significant difference in cell adhesion between treated surfaces and the control. With respect to cell proliferation, the treated surface exhibited improved performance when compared to the control sample. We concluded that the process was efficient in removing primary oxides as well as in oxidizing titanium surfaces

Intraoperative topical administration of mitomycin C, in different concentrations, on the cicatrization of mioplasties of the dorsal rectus of rabbits

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

Casearia sylvestris na permeabilidade gástrica à sacarose em equinos submetidos a protocolo de indução de úlcera gástrica

Estudos em animais de laboratório sugerem um efeito antiulcerogênico do extrato de Casearia sylvestris. Esse extrato ainda não foi estudado para a profilaxia e/ou o tratamento de úlceras gástricas em equinos. Para avaliar a influência do extrato de C. sylvestris na permeabilidade gástrica à sacarose, seis equinos adultos foram submetidos a modelo de indução de úlceras gástricas. Os animais foram submetidos ao teste de permeabilidade à sacarose antes e ao término do protocolo de restrição alimentar intermitente, para detecção de ulceração gástrica. Durante os sete dias da indução, os animais foram submetidos a tratamentos diários via sondagem nasogástrica com extrato de C. sylvestris (9mg kg-1 de peso corpóreo) ou veículo (ágar). Após intervalo de 32 dias em piquete, para permitir a cicatrização das úlceras induzidas, cada animal foi submetido novamente ao protocolo de indução de úlcera gástrica, e os tratamentos foram alternados. Dessa forma, cada animal foi submetido a ambos os tratamentos em períodos distintos. A concentração de sacarose na urina foi determinada para cada amostra obtida, por cromatografia líquida de alto desempenho e detecção amperométrica pulsátil. Não foram observadas alterações nos exames clínicos e hemogramas. O tratamento com o extrato de C. sylvestris evitou o aumento da concentração de sacarose urinária (P<0,05) quando comparado ao veículo, sugerindo um efeito antiulcerogênico gástrico em equinos. Estudos mais amplos incluindo gastroscopia são necessários para avaliar a possibilidade de usar o extrato para a profilaxia e/ou o tratamento das úlceras gástricas em equinos.

Reparação de feridas cutâneas de roedores da espécie Calomys callosus, tratadas com hidrocarboneto alifático: aspectos morfométricos, morfológicos e histológicos

O efeito cicatrizante do hidrocarboneto alifático foi pesquisado através da aplicação diária em feridas cutâneas, cirurgicamente provocadas, em roedores da espécie Calomys callosus. As feridas dos animais foram analisadas sob os aspectos macroscópicos e histológicos transcorridos 3, 7, 14 e 21 dias de tratamento e comparado com o uso de solução fisiológica a 0,9%. O hidrocarboneto alifático antecipou a cicatrização ao diminuir a umidade, aumentar a formação do tecido de granulação e a neovascularização, conduzindo à reepitelização.

Effects of ethyl-cyanoacrylate and octyl-cyanoacrylate on experimental corneal lesions in rabbits

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Morfometria de fibroblastos e fibrócitos durante o processo cicatricial na pele de coelhos da raça Nova Zelândia Branco tratados com calêndula

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

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

Evidências de validação de um protocolo para assistência às pessoas com úlceras venosas em serviços de alta complexidade

Venous ulcers are lesions resulting from chronic venous insufficiency, venous valvular abnormalities and venous thrombosis. Its occurrence has been growing with the increase in life expectancy of the world population. Considered as fundamental aspects in the approach to the person with venous ulcer care with the interdisciplinary approach, adoption of protocol-specific knowledge, technical skill, coordination between levels of care complexity of the Health System and active participation of patients and their families, a holistic perspective. The construction of a clinical protocol for people with venous ulcers can help professionals of high complexity services in patient assessment and the establishment of quality care in a systematic way and focused on the factors that interfere with wound healing. Thus, this study aimed to analyze the evidence of validation of a clinical protocol for people with venous ulcers treated at high-complexity services. This is a methodological study with a quantitative approach, developed in three stages: literature review, evidence of content validity and evidence of validation in the clinical context. Approved by the Federal University of Rio Grande do Norte Research Ethics Committee (Opinion: 147.452 and CAAE: 07556312.0.0000.5537). The literature review was conducted in August and September 2012, becoming the basis for the construction of the protocol. Then the evidence of content validity, which included 53 judges (experts) selected by the Lattes platform to evaluate the protocol items was performed. The judges were contacted by e-mail and rated the protocol via Google Docs . After analyzing the ratios obtained in this step, which reported kappa between 0.75 and 0.96 and between 0.80 and 0.98 IVC, and the suggestions of the judges, the protocol was adjusted and subjected to empirical evidence to validate the clinical setting at the University Hospital Onofre Lopes in Natal / RN. Evidence of validation in the clinical setting involved 4 judges who acted in pairs (paired) evaluated 32 patients with venous ulcers in the clinical context of high complexity. In both stages, we used the Kappa Index and Content Validity Index to analyze the responses of the judges. The parameters set as acceptable for these indices were: Kappa ≥ 0.61 and Content Validity Index > 0.80. Any evidence of content validity, as evidence of validation in the clinical context, the protocol items that have not reached Kappa and Content Validity Index established indices were excluded and some items were modified or added after suggestions. The process of content validation evidence and evidence of validation in the clinical setting allowed the improvement of the protocol for the care of people with venous ulcers initially proposed. The initial version of the protocol, built from the literature, contained 15 categories and 108 items; after evidence of content validity, remained the reduction to 15 categories with 91 items; the final version, clinically validated, is composed of the same 15 categories, 76 items. The protocol was validated in its content and in the clinical aspect, so we accepted the alternative hypothesis in the study. This protocol may contribute to the care system, allowing tailor behaviors and promote greater resolution in the treatment of people with venous ulcers in health services of high complexity

Integridade tissular de pacientes com úlceras venosas: um estudo baseado na Classificação dos Resultados de Enfermagem

The venous ulcer is an epidemiological problem of high prevalence, causing disability and dependence. Assess the tissue impairment level of patients with venous lesions, within a nursing referential, is relevant for the implementation of a directed assistance to specific clientele. Thus, this work aims to characterize the health status regarding the integrity the lower limbs skin of patients with venous ulcers, according to the of tissue integrity outcome indicators from the Nursing Outcomes Classification. A cross-sectional study conducted in a university hospital in Natal - Rio Grande do Norte. The sample consisted of 50 participants, selected through consecutive sampling. Data collection occurred through a interview and physical examination form and a operational definitions tool for indicators of the nursing Tissue Integrity outcome directed to patients with venous ulcer, applied from February to June 2012. Data analysis was done by descriptive statistics and nonparametric tests (Spearman, Kruskal-Wallis and Mann-Whitney tests). The project was approved by the Research Ethics Committee with protocol 608/11 and Presentation Certificate to Ethical Consideration No. 0038.0.294.000-11. The results were presented using three scientific articles derivatives of research. It was found that the indicators show moderate impairment, light and not impaired, as the median. The respondents had an average of 59.72 years, 66% female, 50% were retired, 60% with a partner, 44% had arterial hypertension, 26% allergies, 20% diabetes mellitus, 96% were sedentary, 14% drank alcohol and 6% were smokers. There was a statistically significant correlation of low intensity between age and hydration (p=0.032; rs=-0.304) and skin desquamation (p=0.026; rs=-0.316), family income and necrosis (p=0.012; rs=-0.353); Ankle Brachial Index and tissue perfusion (p=0,044; rs=-0,329); Diabetes Mellitus and texture (p=0.015) and tissue perfusion (p=0.026); allergy and texture (p=0.034), physical activity and hydration (p=0.034), smoking and thickness (p=0.018), and alcohol consumption and exudate (p=0.045). We conclude that the patients had light to moderate impairment, indicating a good state of health on the integrity of the skin of the lower limbs, according to the indicators of the outcome of tissue integrity Classification Nursing Outcomes valued in the present study. It is believed that the evaluation of impairment tissue using a self-nursing system and its relation with socioeconomic, clinical and risk factors are unique tools in the care planning and in the wound healing