Measuring the levels of knowledge and attitudes regarding advance directives of families of patients admitted in UERMMMCI: A descriptive cross-sectional study / The Health Sciences Journal

INTRODUCTION@#Advance directives are documents by which a person makes provisions for health care decisions in the event that, in the future, that person becomes unable to make those decisions. There is a lack of studies on the knowledge and understanding towards advance directives among patients and their families. The purpose of this study is to address this lack of research regarding advance directives by measuring the level of knowledge and attitudes of families of hospitalized patients.@*METHODS@#A descriptive, cross-sectional study design was used to describe the attitudes and the level of knowledge on advance directives of the families of patients. Data were collected directly by the researchers via assisted questionnaires. Descriptive statistics and frequencies were reported.@*RESULTS@#A total of 79 participants consisting of immediate family members of patients from UERMMMCI were enrolled. Only 24% reported having discussed advance directives with the patient's physician. Those respondents whose families had no discussion with their physician about advance directives had the same score as those who had. Overall, 61% of participants have only medium to low knowledge of advance directives, while 70% have positive attitudes regarding advance directives.@*CONCLUSION@#The study showed that the family members of patients had a reasonable understanding of advance directives in terms of basic knowledge, and positive attitudes on advance directives. Those who denied having discussed advance directives were comparable in the knowledge of advance directives with those who did.

A clinical follow-up of 35 Brazilian patients with Prader-Willi Syndrome

OBJECTIVE: Prader-Willi Syndrome is a common etiology of syndromic obesity that is typically caused by either a paternal microdeletion of a region in chromosome 15 (microdeletions) or a maternal uniparental disomy of this chromosome. The purpose of this study was to describe the most significant clinical features of 35 Brazilian patients with molecularly confirmed Prader-Willi syndrome and to determine the effects of growth hormone treatment on clinical outcomes. METHODS: A retrospective study was performed based on the medical records of a cohort of 35 patients diagnosed with Prader-Willi syndrome. The main clinical characteristics were compared between the group of patients presenting with microdeletions and the group presenting with maternal uniparental disomy of chromosome 15. Curves for height/length, weight and body mass index were constructed and compared between Prader-Willi syndrome patients treated with and without growth hormone to determine how growth hormone treatment affected body composition. The curves for these patient groups were also compared with curves for the normal population. RESULTS: No significant differences were identified between patients with microdeletions and patients with maternal uniparental disomy for any of the clinical parameters measured. Growth hormone treatment considerably improved the control of weight gain and body mass index for female patients but had no effect on either parameter in male patients. Growth hormone treatment did not affect height/length in either gender. CONCLUSION: The prevalence rates of several clinical features in this study are in agreement with the rates reported in the literature. Additionally, we found modest benefits of growth hormone treatment but failed to demonstrate differences between patients with microdeletions and those with maternal uniparental disomy. The control of weight gain in patients with Prader-Willi syndrome is complex and does not depend exclusively on growth hormone treatment.

Efeito da pedra umes no processo de cicatrização tecidual. Estudo histológico em dorso de ratos / Effect of postassium alumina on wound healing. Histological study in rats

O uso de cristais de alúmen de potássio, conhecidos popularmente como pedra umes, é bastante difundido entre a população que frequenta postos públicos de atendimento odontológico, após pequenas cirurgias, como irrigante local e agente hemostático. O objetivo deste trabalho foi avaliar histologicamente o efeito do uso da pedra umes no reparo tecidual de feridas produzidas no dorso de ratos. Quinze ratos da raça Wistar foram divididos aleatoriamente em três grupos de cinco animais cada, de acordo com o tempo do período experimental: Grupo 1 (n = 5) sacrificados no 1º dia; Grupo 2 (n = 5) sacrificados no 7º dia e grupo 3 (n = 5) sacrificados no 14º dia. Quatro feridas foram realizadas com um bisturi tipo punch no dorso dos animais, sendo irrigadas uma vez ao dia, com uma das quatro substâncias: soro, clorexidina, pedra umes segundo diluição do fabricante, pedra umes segundo diluição de uso popular. Os resultados após 24 horas da aplicação da pedra umes sugerem um atraso na cicatrização, provavelmente devido ao seu potencial hemostático, porém nos demais períodos experimentais nenhuma diferença foi constatada entre os grupos. A pedra umes parece ser prejudicial no período inicial do processo de cicatrização, porém não apresenta nenhuma influência em seus eventos subsequentes

The use of potassium alumina is widely spread among the population. They frequently use it after minor surgical procedures, as a local irrigating solution, for bleeding control. The goal of the present work was to evaluate histologically the effects of two different dilutions of pedra umes at the healing response on experimental wounds in rats and to compare them with two other agents commonly used after surgical procedures: chlorhexidine and saline solution. Fifteen rats (Wistar rats) were divided into 3 groups accordingly to the day they were sacrificed: Group 1 (n=5), sacrificed at 1º day; Group 2 (n=5) sacrificed at the 7º day and e group 3 (n=5) sacrificed at the 14º day. Four wounds were made at their dorsum and irrigated once a day with one of the four substances: saline solution, chlorhexidine, potassium alumina diluted accordingly to the manufacturer recommendation and potassium alumina diluted in a popular used manner. The results suggested that wound healing may be delayed by the use of the potassium alumina at 1st day, however no difference was found between test (potassium alumina in two different dilutions) and control groups (saline and chlorhexidine) at the other experimental times.

Diagnosis of patients with Prader-Willi and Angelman Syndromes: the importance of an overall investigation

Seventy-two patients with clinical diagnoses of Prader-Willi (PWS; n = 28 patients) or Angelman syndromes (AS; n = 44 patients) were submitted to chromosome analysis, SNRPN-SNURF exon 1 methylation assay, and microsatellite genotyping. Analysis of the methylation pattern confirmed the PWS diagnosis in 18 out of 28 patients and the AS diagnosis in 20 out of 44 patients. FISH and microsatellite analysis detected a deletion in 30 patients (14 PWS and 16 AS). Eight patients had normal FISH results (4 PWS and 4 AS); microsatellite markers showed that these patients had a uniparental disomy (UPD). Based on this study, we propose a strategy for the routine diagnosis of these syndromes that consists of the following steps: 1) methylation analysis, which does not require parental samples; 2) microsatellite genotyping of patient and parents to differentiate deletions, UPD and imprinting mutations; and 3) FISH for otherwise uninformative cases, and whenever parental samples are not available. Of the 34 patients whose PWS or AS diagnoses were not confirmed by laboratory tests, five presented a small extra marker chromosome, identified in three of them as an inv dup(15). One AS patient carried a balanced t(15;15) translocation associated with paternal UPD. Therefore G-banded chromosome analysis should be performed on all such patients, to detect possible structural rearrangements