New grafted PLA-g-PEG polymeric nanoparticles used to improve bioavailability of oral drugs.

Les nanoparticules (NPs) de polymère ont montré des résultats prometteurs pour leur utilisation comme système de transport de médicaments pour une libération contrôlée du médicament, ainsi que pour du ciblage. La biodisponibilité des médicaments administrés oralement pourrait être limitée par un processus de sécrétion intestinale, qui pourrait par la suite être concilié par la glycoprotéine P (P-gp). La dispersion de la Famotidine (modèle de médicament) à l’intérieur des nanoparticules (NPs) pegylées a été évaluée afin d’augmenter la biodisponibilité avec du polyéthylène glycol (PEG), qui est connu comme un inhibiteur de P-gp. L’hypothèse de cette étude est que l’encapsulation de la Famotidine (un substrat de P-gp) à l’intérieur des NPs préparées à partir de PEG-g-PLA pourrait inhiber la fonction P-gp. La première partie de cette étude avait pour but de synthétiser quatre copolymères de PEG greffés sur un acide polylactide (PLA) et sur un squelette de polymère (PLA-g-PEG), avec des ratios de 1% et 5% (ratio molaire de PEG vs acide lactique monomère) de soit 750, soit 2000 Da de masse moléculaire. Ces polymères ont été employés afin de préparer des NPs chargés de Famotidine qui possède une faible perméabilité et une solubilité aqueuse relativement basse. Les NPs préparées ont été analysées pour leur principaux paramètres physicochimiques tels que la taille et la distribution de la taille, la charge de surface (Potentiel Zeta), la morphologie, l’efficacité d’encapsulation, le pourcentage résiduel en alcool polyvinylique (PVA) adsorbé à la surface des NPs, les propriétés thermiques, la structure cristalline et la libération du médicament. De même, les formules de NPs ont été testées in vitro sur des cellules CaCo-2 afin dʼévaluer la perméabilité bidirectionnelle de la Famotidine. Généralement, les NPs préparées à partir de polymères greffés PLA-g-5%PEG ont montré une augmentation de la perméabilité du médicament, ce par l’inhibition de l’efflux de P-gp de la Famotidine dans le modèle CaCo-2 in vitro. Les résultats ont montré une baisse significative de la sécrétion de la Famotidine de la membrane basolatéral à apical lorsque la Famotidine était encapsulée dans des NPs préparées à partir de greffes de 5% PEG de 750 ou 2000 Da, de même que pour d’autres combinaisons de mélanges physiques contenant du PEG5%. La deuxième partie de cette étude est à propos de ces NPs chargées qui démontrent des résultats prometteurs en termes de perméabilité et d’inhibition d’efflux de P-gp, et qui ont été choises pour développer une forme orale solide. La granulation sèche a été employée pour densifier les NPs, afin de développer des comprimés des deux formules sélectionnées de NPs. Les comprimés à base de NPs ont démontré un temps de désintégration rapide (moins d’une minute) et une libération similaire à la Famotidine trouvée sur le marché. Les résultats de l’étude du transport de comprimés à base de NPs étaient cohérents avec les résultats des formules de NPs en termes d’inhibition de P-gp, ce qui explique pourquoi le processus de fabrication du comprimé n’a pas eu d’effet sur les NPs. Mis ensemble, ces résultats montrent que l’encapsulation dans une NP de polymère pegylé pourrait être une stratégie prometteuse pour l’amélioration de la biodisponibilité des substrats de P-gp.

Lesiones laríngeas post-intubación en adultos y su relación con el tiempo de intubación: Estudio de nasofibrolaringoscopia diagnóstica

Objetivo: Determinar las lesiones laríngeas post-intubación endotraqueal en la unidad de cuidado intensivo (UCI) y cirugía ambulatoria y evaluar su asociación con respecto al tiempo de intubación y otras variables clínico-demográficas en un hospital universitario. Materiales y métodos: Estudio de cohorte analítico incluyendo 60 pacientes (30 de UCI y 30 de cirugía ambulatoria) a quienes se les realizó nasofibrolaringoscopia a las 24 horas post-extubación y a las 3 semanas de control y se registran las lesiones laríngeas encontradas. Resultados: En la primera endoscopia el 70% de los pacientes de cirugía ambulatoria presentaban al menos una lesión laríngea con un promedio de duración de intubación de 0.12 días DS±0.05 desapareciendo todas las lesiones en la segunda endoscopia. En el análisis del grupo de UCI se encontraron lesiones en el 76.6% de los pacientes con un promedio de duración de intubación de 6.0 días DS±3.3. La presencia de edema en pacientes con intubación prolongada por más de 6 días mostró diferencias estadísticamente significativa con respecto al grupo con menos días de intubación (RR 3.048, 95% IC 0.9-9.3, P=0.03) al igual que con antecedente de EPOC (P=0.032) y APACHE II mayor de 17 (RR 1.8, 95% IC 1.114-3.0, P=0.013). EPOC tiene una diferencia estadísticamente significativa con hiperemia (P=0.02) y granuloma (P=0.019). En la segunda endoscopia se encontró mayor frecuencia de hiperemia en los pacientes con intubación prolongada (>6 días) con una diferencia estadísticamente significativa (P=0.01). Conclusión: La intubación prolongada se encuentra asociada a la aparición edema e hiperemia en la laringe. EPOC y puntaje superior de APACHE II se relacionan con hiperemia y granulomas glóticos.

Evaluation of the Larval Therapy in the Healing Process of Infected Wounds with Pseudomonas Aeruginosa in Rabbits

Introduction. During the last two decades the larval therapy has reemerged as a safe and reliable alternative for the healing of cutaneous ulcers that do not respond to the conventional treatments. Objective. To evaluate the use of the larvae of Lucilia sericata as a treatment for infected wounds with Pseudomonas aeruginosa in an animal model. Materials and methods. Twelve rabbits were randomly distributed in 3 groups: the first group was treated with larval therapy; the second was treated with antibiotics therapy and to the third no treatment was applied, therefore was established as a control group. To each animal a wound was artificially induced, and then a suspension of P. aeruginosa was inoculated into the lesion. Finally, every rabbit was evaluated until the infection development was recognized and treatment was set up for the first two groups according with the protocols mentioned above. Macroscopic evaluation of the wounds was based on the presence of edema, exudates, bad odor, inflammation around the wound and the presence of granulation tissue. The healing process was evaluated by monitoring histological changes in the dermal tissue. Results. Differences in the time required for wound healing were observed between the first group treated with larval therapy (10 days) and the second group treated with conventional antibiotics therapy (20 days). Conclusion. The L. sericata larva is and efficient tool as a therapy for infected wounds with P. aeruginosa.

Biological nutrient removal in SBR technology: from floccular to granular sludge

Biological nutrient removal has been studied and applied for decades in order to remove nitrogen and phosphorus from wastewater. However, more anthropogenic uses and the continued demand for water have forced the facilities to operate at their maximum capacity. Therefore, the goal of this thesis is to obtain more compact systems for nutrient removal from domestic wastewater. In this sense, optimization and long-term stabilization of high volume exchange ratios reactors, treating higher volumes of wastewater, have been investigated. With the same target, aerobic granular sludge was proposed as a reliable alternative to reduce space and increase loading rates in treatment plants. However, the low organic loading rate from low-strength influents (less than 1 Kg COD•m-3d-1) results in slower granular formation and a longer time to reach a steady state. Because of that, different methodologies and operational conditions were investigated in order to enhance granulation and nutrient removal from domestic wastewater.

Enteric coated spheres produced by extrusion/spheronization provide effective gastric protection and efficient release of live therapeutic bacteria

We present a novel but simple enteric coated sphere formulation containing probiotic bacteria (Lactobacillus casei). Oral delivery of live bacterial cells (LBC) requires live cells to survive firstly manufacturing processes and secondly GI microbicidal defenses including gastric acid. We incorporated live L. casei directly in the granulation liquid, followed by granulation, extrusion, spheronization, drying and spray coating to produce dried live probiotic spheres. A blend of MCC, calcium-crosslinked alginate, and lactose was developed that gave improved live cell survival during manufacturing, and gave excellent protection from gastric acid plus rapid release in intestinal conditions. No significant loss of viability was observed in all steps except drying, which resulted in approximately 1 log loss of viable cells. Eudragit coating was used to protect dried live cells from acid, and microcrystalline cellulose (MCC) was combined with sodium alginate to achieve efficient sphere disintegration leading to rapid and complete bacterial cell release in intestinal conditions. Viability and release of L. casei was evaluated in vitro in simulated GI conditions. Uncoated spheres gave partial acid protection, but enteric coated spheres effectively protected dried probiotic LBC from acid for 2 h, and subsequently released all viable cells within 1h of transfer into simulated intestinal fluid.

Selection of operational parameters for the production of instant soy protein isolate by pulsed fluid bed agglomeration

The objective of this study was to select the optimal operational conditions for the production of instant soy protein isolate (SPI) by pulsed fluid bed agglomeration. The spray-dried SPI was characterized as being a cohesive powder, presenting cracks and channeling formation during its fluidization (Geldart type A). The process was carried out in a pulsed fluid bed, and aqueous maltodextrin solution was used as liquid binder. Air pulsation, at a frequency of 600 rpm, was used to fluidize the cohesive SPI particles and to allow agglomeration to occur. Seventeen tests were performed according to a central composite design. Independent variables were (i) feed flow rate (0.5-3.5 g/min), (ii) atomizing air pressure (0.5-1.5 bar) and (iii) binder concentration (10-50%). Mean particle diameter, process yield and product moisture were analyzed as responses. Surface response analysis led to the selection of optimal operational parameters, following which larger granules with low moisture content and high process yield were produced. Product transformations were also evaluated by the analysis of size distribution, flowability, cohesiveness and wettability. When compared to raw material, agglomerated particles were more porous and had a more irregular shape, presenting a wetting time decrease, free-flow improvement and cohesiveness reduction. (C) 2010 Elsevier B.V. All rights reserved.

Route to turbulence in a trapped Bose-Einstein condensate

We have studied a Bose-Einstein condensate of (87)Rb atoms under an oscillatory excitation. For a fixed frequency of excitation, we have explored how the values of amplitude and time of excitation must be combined in order to produce quantum turbulence in the condensate. Depending on the combination of these parameters different behaviors are observed in the sample. For the lowest values of time and amplitude of excitation, we observe a bending of the main axis of the cloud. Increasing the amplitude of excitation we observe an increasing number of vortices. The vortex state can evolve into the turbulent regime if the parameters of excitation are driven up to a certain set of combinations. If the value of the parameters of these combinations is exceeded, all vorticity disappears and the condensate enters into a different regime which we have identified as the granular phase. Our results are summarized in a diagram of amplitude versus time of excitation in which the different structures can be identified. We also present numerical simulations of the Gross-Pitaevskii equation which support our observations. (C) 2011 by Astro Ltd. Published exclusively by WILEY-VCH Verlag GmbH & Co. KGaA

Estudo da viabilidade técnica da utilização de escórias de aciaria do processo LD como adição em cimentos

A reciclagem de resíduos apresenta-se como uma alternativa adequada com relação à preservação dos recursos naturais e do meio ambiente. As escórias de aciaria são resíduos siderúrgicos originados na fabricação do aço, e são geradas em grandes quantidades. Estes resíduos são estocados nos pátios siderúrgicos, onde permanecem, na sua maioria, sem qualquer destino. Normalmente, as escórias de aciaria são volumetricamente instáveis, apresentando características expansivas, e por esta razão, a aplicação das mesmas em materiais de construção torna-se restrita. Esta pesquisa tem como objetivo estudar a viabilidade técnica do uso das escórias de aciaria LD como adição em cimentos, propondo um método de estabilização por meio de granulação por resfriamento brusco destas escórias, buscando, desta forma, a eliminação do fenômeno da expansão, e visando a melhoria das características destes resíduos. No processo de estabilização, a escória líquida foi granulada em uma usina siderúrgica. Estudos complementares de granulação foram realizados nos laboratórios da UFRGS, empregando-se escórias refundidas. A granulação por resfriamento brusco favoreceu a redução do CaOlivre, a eliminação do MgO na forma de periclásio, e a eliminação do bC2S das escórias, considerados agentes causadores da expansão. No entanto, a elevada basicidade da escória LD dificulta a formação da estrutura vítrea e a separação da fração metálica após o resfriamento brusco. Foram realizados ensaios de expansão das escórias, atividade pozolânica, e resistência mecânica de argamassas com escórias granuladas. O resfriamento brusco proporcionou a eliminação da expansão e o desenvolvimento das propriedades pozolânicas/cimentícias da escória granulada. Como adição em cimentos, do ponto de vista da resistência mecânica, as argamassas compostas com escórias granuladas e clínquer apresentaram níveis de resistência à compressão axial compatíveis com as especificações referentes ao cimento Portland composto, apesar destes resultados serem inferiores aos obtidos para as argamassas de referência.

Colesteatomas adquiridos : análise comparativa da perimatriz entre pacientes pediátricos e adultos

Introdução: Os colesteatomas podem ocorrer tanto em crianças como em adultos, porém nas crianças pareceriam ter um crescimento mais agressivo e extenso. A atividade das colagenases poderia explicar este perfil. Objetivo: Comparar, histologicamente, a perimatriz de colesteatomas adquiridos de crianças com os de adultos. Métodos: Foram estudados 74 colesteatomas, 35 pediátricos, coletados em cirurgias otológicas, fixados em formol 10% e processados pelas técnicas histológicas habituais. Foram preparadas uma lâmina em Hematoxilina-Eosina (HE) e outra em Picrossírios, de cada amostra, e analisadas ao microscópio óptico. A leitura foi “cega”, efetuada por meio de imagens digitais, no software ImagePro Plus. A análise estatística foi realizada através dos coeficientes de correlação de Pearson e Spearman e dos testes t e χ2, sendo considerados como estatisticamente significativos os valores de P<0,05. Resultados: Dos 74 colesteatomas coletados, 17 - sete do grupo pediátrico e dez do adulto - foram excluídos por não terem presença de matriz e perimatriz nas lâminas processadas. A média±dp da idade, no grupo pediátrico, foi de 12,85±3,63; e no adulto, 33,69±13,10. Na análise histológica, o número médio de camadas de células epiteliais da matriz foi igual a oito, nos dois grupos, 60% das amostras apresentavam inflamação, de moderada a acentuada; quanto à fibrose, nas crianças, 71,4% e nos adultos, 62,1%; o granuloma apareceu em 10,7% e 13,8%, respectivamente; a presença de epitélio cubóide simples delimitando a perimatriz foi encontrada em 29% dos infantis e 14% dos adultos, entretanto, nenhuma dessas variáveis apresentou diferença estatisticamente significativas quando comparadas por faixa etária (P>0,05). Quanto à espessura da perimatriz, no grupo pediátrico, as medianas (intervalo interquartil) dos parâmetros foram: média=79 (41 a 259); mediana=77 (40 a 265); soma=1.588 (831 a 5.185); delta=82 (44 a 248); mínimo=53 (16 a 165) e máximo=127 (64 a 398); já no grupo de adultos foram: média=83 (26 a 174); mediana=68 (30 a 181); soma=1.801 (558 a 3.867); delta=92 (45 a 190); mínimo=27 (12 a 100) e máximo=136 (53 a 280). O coeficiente de Spearman mostrou correlação inversa, moderada, entre a espessura da perimatriz e a idade; também houve correlação, forte, entre a espessura da perimatriz e o número de camadas da matriz, porém não houve correlação entre essa com a idade. Conclusão: Histologicamente, a perimatriz de colesteatomas adquiridos, de crianças e adultos, vista à microscopia óptica, apresenta-se como um tecido conjuntivo denso de espessura variável (intra e interpacientes), que, por vezes, exibe infiltrado inflamatório linfoplasmocitário e/ou tecido de granulação e reação de corpo estranho; em alguns casos é delimitada em plano profundo por epitélio cubóide simples. Há correlação inversa, de fraca a moderada, entre o tamanho da perimatriz, medida em micrômetros e a idade do paciente na data da cirurgia. O grau de inflamação da perimatriz apresenta correlação, de moderada a forte, com a espessura da perimatriz. As espessuras da matriz e da perimatriz estão fortemente correlacionadas.

Compósitos de matriz metálica à base níquel com adição de TaC e NbC produzidos via metalurgia do pó

Carbide reinforced metallic alloys potentially improve some important mechanical properties required for the overall use of important engineering materials such as steel and nickel. Nevertheless, improved performance is achieved not only by composition enhancement but also by adequate processing techniques, such as novel sintering methods in the case of powder metallurgy. The method minimizes energy losses in addition to providing uniform heating during sintering. Thus, the general objective of this study was to evaluate the density, hardness, flexural strength, dilatometric behavior and to analyze the microstructure of metal matrix composites based nickel with addition of carbides of tantalum and / or niobium when sintered in a conventional furnace and Plasma assisted debinding and sintering (PADS). Initially, were defineds best parameters of granulation, screening and mixing procedure. After, mixtures of carbonyl Ni and 5%, 10% and 15 wt.% NbC and TaC were prepared in a Y-type mixer under wet conditions during 60 minutes. The mixtures were then dried and granulated using 1.5 wt. % paraffin diluted in hexane. Granulates were cold pressed under 600 MPa. Paraffin was then removed from the pressed pellets during a pre-sintering process carried out in a tubular furnace at 500 °C during 30 min. The heating rate was 3 ºC/min. The pellets were then sintered using either a plasma assisted reactor or a conventional resistive tubular furnace. For both methods, the heating rate was set to 8 ºC/min up to 1150 °C. The holding time was 60 minutes. The microstructure of the sintered samples was evaluated by SEM. Brinell hardness tests were also carried out. The results revealed that higher density and higher hardness values were observed in the plasma-assisted sintered samples. Hardness increased with the concentration of carbides in the Ni-matrix. The flexural strength also increased by adding the carbides. The decline was larger for the sample with addition of 5% 5% TaC and NbC. In general, compositions containing added carbide 10% showed less porous and more uniform distribution of carbides in the nickel matrix microstructural appearance. Thus, both added carbide and plasma sintering improved density, hardness, flexural strength and microstructural appearance of the composites

Efetividade da terapia fisica descongestiva na cicatrização de úlceras venosas

A venous ulcer is the most serious clinical manifestation of chronic venous failure, and the most frequent in lower limbs, accounting for 70% of all ulcers. Patients may suffer from this infirmity for several years without healing of the lesion if treatment is inadequate. The aim of this investigation was to verify the effectiveness of decongestive physical therapy in the healing of venous ulcers. This is a quasi-experimental, interventionist study, with paired, non-probabilistic sampling, composed of 50 patients divided into two groups: control and intervention, each composed of 25 patients. Both groups were identically treated for six months with daily dressings and the latter also underwent complex physical therapy consisting of a combination of the following techniques: manual lymphatic drainage, compression bandaging, lower limb elevation, myolymphokinetic exercises and skin care. The study was approved (Protocol no. 59/2007) by the Ethics Committee of the State University of Southeast Bahia. The Mann-Whitney and Chi-square tests were applied for data analysis. After statistical analysis the patients who underwent therapy showed a statistically significant difference with respect to wound contraction starting in the second month of treatment. Compared to the control, the intervention group showed a greater reduction in both pain and edema starting in the third and fourth month of therapy, respectively. To reinforce these findings, the mean percentage of tissue present at the base of the ulcer (granulation/fibrin ratio) was calculated. The intervention group showed greater granulation at the base of the ulcer compared to the control, significant from the second month of treatment on. It was observed in this study that lymphotherapy, when compared between the intervention and control groups, accelerated the healing process, and reduced pain and edema in the affected limbs. It is expected, therefore, that these results widen scientific knowledge and we suggest that this therapy be used 78 not only to reduce lymphedema, but also as a treatment option for venous ulcers, given its easy application and low cost. The data, therefore, demonstrated the importance of basic care on the part of a multiprofessional and transdisciplinary health team involved in the healing process of these infirmities, thereby contributing to better quality of life in these individuals

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.

Pitiose cutânea equina de localização atípica tratada topicamente com solução de anfotericina B e DMSO

Background: Cutaneous lesions by Pythium insidiosum infection are commonly observed in horses, especially in those living at flooded environments. Equine pythiosis is characterized by the development of tumoral masses that are frequently located at distal limbs, ventral abdomen, thorax, breast and face. The lesions are usually granulomatous, serosanguineous and ulcerated, most often destroyed by self-mutilation due to the intense pruritus. The proposed treatment includes surgical excision followed by antifungal drugs administration, which can be done systemically or topically. Amphotericin B and dimethyl sulfoxide (DMSO) in association has been successfully used for cutaneous pythiosis topical treatment due to the DMSO property to carry any substance through plasmatic membranes.Case: The present report concerns a 12-year-old mixed breed gelding presenting with self-mutilation of a tumoral mass located at the left flank. The owners reported that the horse had initially presented a small wound that had evolved to a 20-cm in diameter mass in 4 weeks. Tissue samples were collected, processed and stained by the Gomori's methenamine silver (GMS) method. The histopathological analysis revealed Pythium insidiosum hyphae in a granulomatous tissue, especially located at peripheral region, where kunkers were present. Surgical excision of the mass followed by cauterization was indicated as initial treatment, and due to financial reasons, the owners elected only the topical antifungal therapy to control the fungus infection after surgery. Flunixin meglumine was also administrated for five days aiming the control of pain and inflammation. The wound was cleaned with povidone-iodine solution and rinsed with a solution containing, 50 mg, of amphotericin B in 10 mL of sterile water and 10 mL of DMSO. This procedure was carried Out twice a day. The wound healed fast due to an excellent centripetal epithelialization. and the horse was discharged after 64 days showing only 5% of the initial wound area. The owner reported by telephone the complete healing and hair growth 10 days after discharge.Discussion: Despite the atypical location of the tumoral lesion described at the present report, the history and clinical manifestations, especially the intense pruritus, showed similarity with other characteristic reports of equine cutaneous pythiosis. The diagnosis was confirmed by the histopathological examination showing hyphae structures, as described to be evidences of the presence of Pythium insidiosum in the tissue. The surgical procedure was the first step to provide remission of clinical signs, and one day after surgery the pruritus desapeared. After excision of the granulomatous tissue and cauterization, daily topical administration of amphotericin B associated with DMSO was effective in destroying the infectious agent, as observed by the excellent epithelization. A pink granulation tissue grew up providing an ideal surface for epithelial migration and the healing process progressed quickly. Centripetal epithelialization reduced the wound area until 3% of the initial area in 64 days of treatment, when the remaining wound was found almost completely healed and covered with hair. At the present report, the horse presenting pythiosis was only topically treated. The recommended therapy using amphotericin B and DMSO solution was effective, economically viable and low risk, considering that the systemic antifungal therapy usually suggested is expensive and extremely nephrotoxic. The atypical location of the lesion on the left flank shows that any anatomical region can be affected by the fungus, since the conditions for its development were present.

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).

Qualidade da assistência e o conhecimento sobre o direito à saúde das pessoas com úlcera venosa crônica

The study aimed to identify the quality of care and knowledge of health rights of people with chronic venous ulcers (VU) in Brasilian National Health Care System (SUS). It is a cross-sectional study, with quantitative approach, performed at the University Hospital Onofre Lopes (HUOL). The study was approved by the Ethics Committee of HUOL (CAAE nº 0148.0.051.000-10). The sample by accessibility was composed for 30 people with VU treated at the outpatient surgical clinic of HUOL. For data collection we used a structured questionnaire composed of two parts: sociodemographic characteristics and of health, of care and the clinical course of VU; and knowledge of people with VU about the rights of health. The results were processed using SPSS 15.0 and analyzed by descriptive statistics. Given the characterizations sociodemographic and health presented, we identified a clientele of users with VU predominantly female (76,7%), aged from 60 years (66,7%), married/ stable union (60,0%), low education level (83,3%), family income lower than a minimum wage (73,3%), unemployeds and with chronic diseases (53,3%), sleep greater than or equal to 6 hours (76,7%) and were not alcoholics or smokers (93,3%). In relation to clinical conditions, were shown the presence of one or more relapses of VU (73,3%), predominance of granulation tissue/epithelialization in the bed of VU (60,0%), exudate serosanguineous (43,3%), in quantity medium/large (60,0%), with no predominance of presence or absence of odor (50,0%), all patients with tissue loss in grade III / IV, no signs of infection (73,3%) and presence of intense pain (50,0%). In the last 30 days the main venue of achievement of dressing was the HUOL (100,0%), the main compression therapy used was the Unna boot (60,0%) and on inability to perform the dressing on the unit were the own patients who made the exchange at home (40,0%). The majority of respondents listed out more positive factors associated with quality of care (56,7%) were satisfied with the care of SUS (76,7%), claimed to have knowledge about their rights (70,0%), but at the same time did not know the meaning of the acronym SUS (90,0%) and classified their level of information as inappropriate (70,0%). We realize that people with VU identified as good the quality of care and demonstrated inadequate knowledge about their rights to health in the SUS, but showed interest in acquiring more information. The basic rights to entry in the SUS are constitutionally guaranteed and need to be disseminated in order to make them known to the population, so it can be implemented and ensured a greater resolution assistance in treating this type of injury