Sistematização de curativos para o tratamento clínico das feridas

O tratamento das feridas cutâneas inclui métodos clínicos e cirúrgicos, sendo o curativo um dos tratamentos clínicos mais frequentemente utilizados. Um vasto arsenal terapêutico composto por curativos passivos ou com princípios ativos é capaz de auxiliar na reparação do tegumento em diversas situações. Curativos visam a melhorar as condições do leito da ferida, podendo ser, em algumas ocasiões, o próprio tratamento definitivo, mas em muitas situações constituem apenas uma etapa intermediária para o tratamento cirúrgico. Curativos inteligentes e biológicos são hoje mais bem classificados como substitutos cutâneos e não serão considerados neste artigo. A escolha do curativo a ser utilizado deve ser baseada no conhecimento das bases fisiopatológicas da cicatrização e da reparação tecidual, sem nunca esquecer o quadro sistêmico do paciente.

Pós-operatório de queiloplastia e palatoplastia: dúvidas dos cuidadores

Objetivo: identificar as principais dúvidas dos cuidadores de crianças com fissura labiopalatina sobre os cuidados pós-operatórios das cirurgias de queiloplastia e palatoplastia. Método: estudo transversal, descritivo, de abordagem quantitativa, realizado na Unidade de Internação do Hospital de Reabilitação de Anomalias Craniofaciais. A população foi composta por cuidadores de crianças com fissura labiopalatina submetidas à queiloplastia ou palatoplastia. A amostra constou de 50 indivíduos selecionados consecutivamente, sendo 25 cuidadores de crianças submetidas à queiloplastia e 25 das submetidas à palatoplastia, que se encontravam hospitalizadas para a realização destas cirurgias. A coleta de dados ocorreu durante a consulta de enfermagem préoperatória e as dúvidas foram categorizadas por similaridade. Os dados foram submetidos à análise estatística descritiva. Resultados: em relação à queiloplastia, as dúvidas foram sobre a alimentação (36%), higienização e cicatrização (24% cada), dor e infecção (8% cada). Quanto à palatoplastia, as dúvidas foram sobre a alimentação (48%), higienização (24%), dor (16%), sangramento (8%) e infecção (4%). Conclusões: as dúvidas que prevaleceram foram sobre a alimentação, higienização e a prevenção de complicações pós-operatórias, incluindo dor, sangramento e infecção. Nesse contexto, foi evidenciada a necessidade de enfatizar a função educativa do enfermeiro, por meio da promoção de esclarecimentos e de uma comunicação adequada acerca dos cuidados pós-operatórios.

Low temperatures reduce skin healing in the Jacaré do Pantanal (Caiman yacare, Daudin 1802)

Studies of skin wound healing in crocodilians are necessary given the frequent occurrence of cannibalism in intensive farming systems. Air temperature affects tissue recovery because crocodilians are ectothermic. Therefore, the kinetics of skin wound healing in Caiman yacare were examined at temperatures of 33°C and 23°C. Sixteen caiman were selected and divided into two groups of eight maintained at 23°C or 33°C. The studied individuals' scars were photographed after 1, 2, 3, 7, 15 and 30 days of the experimental conditions, and samples were collected for histological processing after 3, 7, 15 and 30 days. Macroscopically, the blood clot (heterophilic granuloma) noticeably remained in place covering the wound longer for the caiman kept at 23°C. Microscopically, the temperature of 23°C slowed epidermal migration and skin repair. Comparatively, new blood vessels, labeled using von Willebrand factor (vWF) antibody staining, were more frequently found in the scars of the 33°C group. The collagen fibers in the dermis were denser in the 33°C treatment. Considering the delayed healing at 23°C, producers are recommended to keep wounded animals at 33°C, especially when tanks are cold, to enable rapid wound closure and better repair of collagen fibers because such lesions tend to compromise the use of their skin as leather.

Utilização de agentes biológicos no tratamento do lúpus eritematoso cutâneo

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Cuidar no parto : prática de episiotomia

Enquadramento – A episiotomia é uma incisão feita no períneo para aumentar o canal vaginal com o objetivo de evitar outros traumas perineais durante o parto. No entanto, esta prática, por si só, já se considera um trauma perineal pelo corte em estruturas que podem desencadear problemas futuros. A Organização Mundial de Saúde (1996) recomenda a utilização limitada da episiotomia uma vez que não existem evidências credíveis de que a utilização generalizada ou de rotina desta prática tenha um efeito benéfico. Objetivos: Demonstrar evidência científica dos determinantes da prática de episiotomia seletiva em mulheres com parto normal/eutócico; identificar a prevalência de episiotomia; analisar os fatores (variáveis sociodemográficas, variáveis relativas ao recém-nascido, variáveis contextuais da gravidez e contextuais do parto) que influenciam na ocorrência de episiotomia. Métodos: O estudo empírico I seguiu a metodologia de revisão sistemática da literatura. Efetuou-se uma pesquisa na EBSCO, PubMed, SciELO, RCAAP de estudos publicados entre janeiro de 2008 e 23 de dezembro de 2014. Os estudos encontrados foram avaliados tendo em consideração os critérios de inclusão previamente estabelecidos. Dois revisores avaliaram a qualidade dos estudos a incluir utilizando a grelha para avaliação crítica de um estudo descrevendo um ensaio clínico prospetivo, aleatorizado e controlado de Carneiro (2008). Após avaliação crítica da qualidade, foram incluídos no corpus do estudo 4 artigos nos quais se obteve um score entre 87,5% e 95%. O estudo empírico II enquadra-se num estudo quantitativo, transversal, descritivo e retrospetivo, desenvolvido no serviço de Obstetrícia do Centro Hospitalar Cova da Beira, segundo um processo de amostragem não probabilística por conveniência (n = 382). A recolha de dados efetuou-se através da consulta dos processos clínicos das mulheres com idade ≥ 18 anos que tiveram um parto vaginal com feto vivo após as 37 semanas de gestação. Resultados: Evidência de que a episiotomia não deve ser realizada de forma rotineira, cujo uso deve restringir-se a situações clínicas específicas. A episiotomia seletiva, comparada com a episiotomia de rotina, está relacionada com um menor risco de trauma do períneo posterior, a uma menor necessidade de sutura e a menos complicações na cicatrização. Amostra constituída por 382 mulheres, na faixa etária dos 18-46 anos. Apenas, não se procedeu à episiotomia em 41,7% da amostra, apontando para a presença da episiotomia seletiva. Número significativo de mulheres com parto eutócico (80,5%), com sutura (95,0%), laceração de grau I (64,9%), dor perineal (89,1%) sujeitas a episiotomia (58,3%). A maioria dos recém-nascidos nasceram com peso normal (92,3%), com um valor expressivo de mulheres sujeitas a episiotomia (91,4%). Ainda se constatou a existência de casos, apesar de reduzidos, em que o recém-nascido nasceu macrossómico (5,4%), tendo-se recorrido igualmente a esta prática. Não há uma associação direta entre a realização de episiotomia e os scores do APGAR. Conclusão: Face a estes resultados e com base na evidência científica disponível que recomenda, desde há vários anos, que se faça um uso seletivo da episiotomia, sugere-se que os profissionais de saúde estejam mais despertos para esta realidade, de modo a que se possam anular as resistências e as barreiras de mudanças por parte dos mesmos face ao uso seletivo da episiotomia. Para promover essa mudança de comportamentos é importante não só mostrar as evidências científicas, bem como transpô-las para a prática, capacitando os profissionais de saúde, sobretudo os enfermeiros, na sua atuação. Palavras-chave: Parto Normal/eutócico; Episiotomia; Episiotomia seletiva; Episiotomia de rotina.

Tratamentos periodontais em diabéticos

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

Complicações pós-cirúrgicas em pacientes com diabetes mellitus

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

A utilização da microcirurgia no desempenho de excelência nas diferentes especialidades clínicas da medicina dentária moderna

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

Paciente odontopediátrico portador de diabetes

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

Evidências de validade de conteúdo de instrumentos para o cuidado à pessoa com lesão cutânea

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES

Autoeficácia e qualidade de vida de pessoas com úlcera venosa

Venous ulcers (UV) are the result of deep venous insufficiency or obstruction leading to venous hypertension in the lower limbs and lesions. Self-efficacy is the belief in the ability to successfully perform a given task or exhibit behavior that leads to a desirable outcome. Nursing needs to know and explore the influence of self-efficacy on quality of life (QOL) of people with UV, seeking to exercise holistic care. Thus, this study aimed to analyze the correlation of self-efficacy for pain control and functionality with the QOL of people with UV in primary health care. It is a cross-sectional, analytical, quantitative study with people with UV in family health strategy and mixed units in Natal / RN. We used the instruments: sociodemographic and health questionnaire, domains self-efficacy for pain control and self-efficacy for functionality of Scale of Self-Efficacy for Chronic Pain (SFCD) and the Charing Cross Venous Ulcer Questionnaire (CCVUQ). The sample included 101 people in the self-efficacy scale for functionality and 89 in self-efficacy for pain, for twelve patients reported no pain at the time of collection, and therefore were excluded from the application of the scale of selfefficacy for pain. The project was approved by the ethics committee of the Federal University of Rio Grande do Norte (CAAE No. 07556312.0.0000.5537), serving Resolution 466/12. Women predominated (66.3%), elderly (61.4%), married or in a stable relationship (63.4%), low income (90.1%) and education (85.1%), inactive (75.2%), associated chronic diseases (60.4%), more than six hours of sleep / day (82.2%), non-drinkers / smokers (80.2%), chronic injury (73.3%) and moderate to severe pain (76.2%). Self-efficacy for pain (mean 67.3, SD 26.6) was less committed to the self-efficacy for functionality (mean 59.4 SD 25.9), with statistical difference (pvalue = 0.011). No significant associations were found between self-efficacy for pain control and functionality with the sociodemographic and health characteristics. When considering the total mean CCVUQ (mean 52.1, SD 16.6), QOL of respondents tended to worsen, with the aesthetic domain the most committed (mean 57.6, SD 24.0), followed by emotional state (mean 57.0, SD 25.7), social interaction (mean 48.4, SD 21.4) and household activities (mean 43.6, SD 23.3) . We found negative and significant correlations between self-efficacy for pain and CCVUQ total score (r = -0,324; p = 0,001), the social interaction domain (r = -0,278; p = 0,008), household activities (r = - 0,285; p = 0,007) and state emotional (r = -0,247; p = 0,019). Likewise, between selfefficacy for functionality and the CCVUQ total score (r = -0,553; p < 0,001), the social interaction domain (r = -0,553; p < 0,001), household activities (r = -0,594; p < 0,001) and emotional status (r = -0,259; p = 0,009). The aesthetic domain showed negative correlation but weak and not significant with self-efficacy for pain (r = -0, 155; p = 0,147) and functionality (r = -0,189; p = 0,058). It became evident the correlation between self-efficacy for pain control and functionality and the domains social interaction, household activities and emotional state, the quality of life of people with UV

Avaliação do efeito do extrato hidroalcoólico das folhas de Anacardium occidentale L. em ratos submetidos à colite ulcerativa

Ulcerative colitis is a chronic disease characterized by inflammation in the intestinal mucosa, in most cases affects the colon and rectum. The therapeutic drugs are used as aminosalicylates and glucocorticosteroids, but due to the low response and the various side effects caused by them, reveals the need to search for new sources of useful compounds in the treatment of this disease.The species Anacardium occidentale popularly known as cashew, has been used for centuries in folk medicine in the healing aid of skin and mucosa lesions.Recent studies show its expressive antiulcerogenic effect, what we instigated to assess the effect of the extract of A. occidentaleleaves in rats with acute ulcerative colitis, therefore, 42 rats were used male Wistar, divided into 06 groups, and Negative Control (C) Positive Control (C +), treated with Sulfasalazine (Sz500) and treated with Extract A. occidentale at doses of 50 (Ao50), 100 (Ao100) and 200 mg / kg (Ao200).All groups were submitted to experimental colitis Ulcerative except C-, moreover, C- and C + received saline via gavage for 7 consecutive days while the other groups received their respective treatments.Euthanasia of animals took place on the 8th day in which it was collected intestinal colon sample for later analysis macroscopic, histopathological, morphometric and biochemistry, as well as complementary collection of blood and liver tissue. The extract is rich in saponins and phenolic compounds such as flavonoids (quercetin and kaempferol) and tannins.When the Sz500 groups and 100 showed significant protection to damage to lipids and proteins, among the groups subjected to experimental ulcerative colitis, the animals Ao100 group obtained the lowest score in all parameters analyzed.Treatment with 100 mg / kg of A. occidentale extract seems to have a combination of antiinflammatory, antioxidant, bactericidal and anabolic promoted by the bioactive compounds present in the extract.However, it is necessary to investigate harder treating dose of 100mg / kg to higher doses compared to elucidate more properly the best therapeutic dosage ulcerative colitis.

Efeitos da terapia laser de baixa intensidade associada ao exercício aeróbio no reparo de tenotomia do tendão de aquiles de ratos diabéticos

Diabetes Mellitus (DM ) is a complex disease that requires continuous medical care for the reduction of risk factors in addition to glycemic control. The typical hyperglycemia of this disease produces glycosylation of proteins and so the consequence is the accumulation of glycosylation final products in various human tissues, among them, the tendon. The aerobic exercise (AE) and the low level laser therapy (LLLT) have been used to treat tendinopathies in individuals with or without DM. Objective: The aim of this study was to watch the effect of the LLLT and the AE, in association, in partial tenotomy of the tissue repair of the Achilles tendon (AT) of diabetic rats. Methods: 91 animals were utilized and divided in to the following groups: control group (GC), injured control group (GCL), diabetic group (GD), diabetic group LLLT (GD – TLBI), diabetic group trained (GD - EX) and diabetic group trained laser (GD-EX+TLBI). The animals were submitted to intervention with AE, using a protocol with a progressive increase of time (12 to 60 min) and speed of (4 to 9 m/min), and the LLLT (660 nm laser, 10mW, 4 J/cm², single point for 16 seconds, three times for week). It was analyzed morphological, biomechanical and molecular characteristics. For data showing normal distribution was used one-way ANOVA test and post hoc Tukey and data without normal distribution was used Mann Whitney test and post hoc Dunn's. It was accepted p <0.05 for statistical significance Results: The biomechanical tests indicated major improvement in the GC and GD-EX+TLBI groups when compared with the diabetic groups in the following variables: maximum load, strain, absorbed energy, stress, cross section area, elastic modulus and energy density (p<0.05). The analysis through molecular biology indicated that the association of aerobic exercise and LLLT generated an increase of the collagen I gene expression and modulated the expression of the MMP2 and MMP9 (p<0.05). No observed any major improvement in the morphological variable studied. Conclusion: the LLLT associated with aerobic exercise promotes and increase of the mechanical properties, in the control of collagen I gene expression and of the MMP2 and MMP9 of the diabetic rats.

Medium change monitoring using ambient seismic noise and coda wave interferometry: examples from intraplate NE Brazil and the Mid-Atlantic Ridge

This thesis presents and discusses the results of ambient seismic noise correlation for two different environments: intraplate and Mid-Atlantic Ridge. The coda wave interferometry method has also been tested for the intraplate data. Ambient noise correlation is a method that allows to retrieve the structural response between two receivers from ambient noise records, as if one of the station was a virtual source. It has been largely used in seismology to image the subsurface and to monitor structural changes associated mostly with volcanic eruptions and large earthquakes. In the intraplate study, we were able to detect localized structural changes related to a small earthquake swarm, which main event is mR 3.7, North-East of Brazil. We also showed that the 1-bit normalization and spectral whitening result on the loss of waveform details and that the phase auto-correlation, which is amplitude unbiased, seems to be more sensitive and robust for our analysis of a small earthquake swarm. The analysis of 6 months of data using cross-correlations detect clear medium changes soon after the main event while the auto-correlations detect changes essentially after 1 month. It could be explained by fluid pressure redistribution which can be initiated by hydromechanical changes and opened path ways to shallower depth levels due to later occurring earthquakes. In the Mid-Atlantic Ridge study, we investigate structural changes associated with a mb 4.9 earthquake in the region of the Saint Paul transform fault. The data have been recorded by a single broadband seismic station located at less than 200 km from the Mid-Atlantic ridge. The results of the phase auto-correlation for a 5-month period, show a strong co-seismic medium change followed by a relatively fast post-seismic recovery. This medium change is likely related to the damages caused by the earthquake’s ground shaking. The healing process (filling of the new cracks) that lasted 60 days can be decomposed in two phases, a fast recovery (70% in ~30 days) in the early post-seismic stage and a relatively slow recovery later (30% in ~30 days). In the coda wave interferometry study, we monitor temporal changes of the subsurface caused by the small intraplate earthquake swarm mentioned previously. The method was first validated with synthetics data. We were able to detect a change of 2.5% in the source position and a 15% decrease of the scatterers’ amount. Then, from the real data, we observed a rapid decorrelation of the seismic coda after the mR 3.7 seismic event. This indicates a rapid change of the subsurface in the fault’s region induced by the earthquake.

Medium change monitoring using ambient seismic noise and coda wave interferometry: examples from intraplate NE Brazil and the Mid-Atlantic Ridge

This thesis presents and discusses the results of ambient seismic noise correlation for two different environments: intraplate and Mid-Atlantic Ridge. The coda wave interferometry method has also been tested for the intraplate data. Ambient noise correlation is a method that allows to retrieve the structural response between two receivers from ambient noise records, as if one of the station was a virtual source. It has been largely used in seismology to image the subsurface and to monitor structural changes associated mostly with volcanic eruptions and large earthquakes. In the intraplate study, we were able to detect localized structural changes related to a small earthquake swarm, which main event is mR 3.7, North-East of Brazil. We also showed that the 1-bit normalization and spectral whitening result on the loss of waveform details and that the phase auto-correlation, which is amplitude unbiased, seems to be more sensitive and robust for our analysis of a small earthquake swarm. The analysis of 6 months of data using cross-correlations detect clear medium changes soon after the main event while the auto-correlations detect changes essentially after 1 month. It could be explained by fluid pressure redistribution which can be initiated by hydromechanical changes and opened path ways to shallower depth levels due to later occurring earthquakes. In the Mid-Atlantic Ridge study, we investigate structural changes associated with a mb 4.9 earthquake in the region of the Saint Paul transform fault. The data have been recorded by a single broadband seismic station located at less than 200 km from the Mid-Atlantic ridge. The results of the phase auto-correlation for a 5-month period, show a strong co-seismic medium change followed by a relatively fast post-seismic recovery. This medium change is likely related to the damages caused by the earthquake’s ground shaking. The healing process (filling of the new cracks) that lasted 60 days can be decomposed in two phases, a fast recovery (70% in ~30 days) in the early post-seismic stage and a relatively slow recovery later (30% in ~30 days). In the coda wave interferometry study, we monitor temporal changes of the subsurface caused by the small intraplate earthquake swarm mentioned previously. The method was first validated with synthetics data. We were able to detect a change of 2.5% in the source position and a 15% decrease of the scatterers’ amount. Then, from the real data, we observed a rapid decorrelation of the seismic coda after the mR 3.7 seismic event. This indicates a rapid change of the subsurface in the fault’s region induced by the earthquake.