Avaliação da pentoxifilina e do sulfato ferroso no tratamento da úlcera varicosa dos membros inferiores / Evaluation of pentoxifylline and ferrous sulfate for treatment of lower limb venous ulcers

Resumo Contexto A úlcera varicosa (UV) é o estágio mais avançado da doença venosa crônica (DVC) dos membros inferiores (MMII), frequentemente associada a episódios de hemorragia que podem provocar anemia crônica (AC) e retardar a sua cicatrização. Não há, na literatura, trabalhos que avaliem a prevalência da AC nos portadores de UV dos MMII, e poucos trabalhos analisam o uso da pentoxifilina no tratamento das UV dos MMII. Objetivos Avaliar a prevalência da AC nos pacientes portadores de UV de MMII e a resposta terapêutica ao sulfato ferroso (SF) e a associação da pentoxifilina com SF no tratamento adjuvante das UV dos MMII. Métodos Foram avaliados 67 pacientes portadores de UV de MMII atendidos no ambulatório de Cirurgia Vascular do Hospital das Clínicas, Recife, PE. Após as avaliações clínica e laboratorial iniciais, os pacientes diagnosticados com AC foram randomizados em dois grupos: o grupo controle, que recebeu SF (900 mg/dia via oral), e o grupo de estudo, tratado com SF (900 mg/dia via oral) e pentoxifilina (1.200 mg/dia). Todos foram reavaliados após 90 dias. Resultados Entre os pacientes avaliados, 27 (40%) apresentavam AC. Após o tratamento, foram observados aumento dos níveis de hemoglobina e de hematócrito e melhora das taxas da cinética do ferro, assim como a diminuição da profundidade e da área das UV em ambos os grupos, sem diferença estatística. Conclusões Foi encontrada alta prevalência de anemia na população estudada. A associação do SF com a pentoxifilina não se mostrou mais eficaz do que o emprego isolado do SF no tratamento adjuvante da UV dos MMII.

Abstract Background Venous ulcers (VU) are the most advanced stage of chronic venous disease (CVD) of the lower limbs. They are frequently associated with episodes of hemorrhage that can provoke chronic anemia (CA), delaying healing. There are no studies in the literature analyzing the prevalence of CA among patients with VU of the lower limbs and few studies have analyzed use of pentoxifylline to treat VU of the lower limbs. Objectives To evaluate the prevalence of CA in patients with lower limb VU and responses to treatment with ferrous sulfate (SF) compared with a combination of SF plus pentoxifylline as adjuvant treatment for VU of the lower limbs. Methods A total of 67 patients with lower limb VU were recruited from a Lymphedema and Angiodysplasia Clinic at the Hospital das Clínicas, Recife, PE, Brazil. After initial clinical and laboratory assessments, patients diagnosed with CA were randomized into one of two groups: a control group, given SF (900 mg/day oral route), or a study group, treated with SF (900 mg/day oral route) and pentoxifylline (1,200 mg/day). All were reassessed after 90 days. Results Twenty-seven patients (40%) had CA. After treatment, increases were observed in hemoglobin and hematocrit levels, iron kinetics had improved, and both depth and area of VU had reduced in both groups, without statistically significant differences. Conclusions A high prevalence of anemia was detected in the study population. The combination of SF and pentoxifylline was not more effective than SF alone for adjuvant treatment of VU of the lower limbs.

Analysis of the degree of implementation of Health Academy Program in a Brazilian midsize town / Análise do grau de implementação do Programa Academia da Saúde em uma cidade brasileira de porte médio / Análisis del grado de implementación del Programa Academia de la Salud en una ciudad de tamaño medio brasileña

In 2011, the Brazilian Minister for Health created the Health Academy Program (Programa Academia da Saúde) as a strategy to promote health and healthy lifestyles. However, the official standards do not seem to be clear enough to support the implementation program in the towns. The aim of this study was to analyse the degree of Health Academy Program implementation in a Brazilian midsize town Vitória de Santo Antão, Pernambuco State, in 2018. This is an evaluative study that carry out a normative approach, considering the dimensions of structure and process related to work process. The research is divided into: (1) elaboration of the theoretical model of evaluation, through the validation of the logical model; (2) verification of the level of implementation, through an interview with workers and managers. The cut-off scores for classification of implementation levels were: (1) incipient: > 0 < 33.3%; (2) intermediate: > 33.3 < 66.6%; (3) advanced: > 66.6%. The level of implementation was considered intermediate (37.54%). The score of the structure was higher (54.76%) than the process (26.06%). The low level of Health Academy Program implementation, especially related to the multi-professional articulation and the difficult connection with other sectors or social actors, shows the necessity of reorganization of the actions.

Em 2011, o Ministério da Saúde criou o Programa Academia da Saúde como estratégia para promover a saúde e estilos de vida saudáveis. Entretanto, as normas oficiais não parecem ser suficientemente claras para apoiar a implementação do programa nas cidades. O estudo teve como objetivo analisar o grau de implementação do Programa Academia da Saúde em uma cidade brasileira de porte médio, Vitória de Santo Antão, Pernambuco, em 2018. É um estudo avaliativo com abordagem normativa, considerando as dimensões de estrutura e processo relacionadas ao processo de trabalho. O estudo é divido em dois passos: (1) a elaboração de um modelo teórico de avaliação, através da validação do modelo lógico e (2) a verificação do nível de implementação através de entrevistas com os profissionais e gestores. Os pontos de corte para a classificação dos níveis de implementação foram: (1) incipiente: > 0 < 33,3%; (2) intermediário: > 33,3 < 66,6%; (3) avançado > 66,6%. O grau de implantação foi considerado intermediário (37,54%). A pontuação da estrutura foi mais alta (54,76%) que a do processo (26,06%). O nível baixo de implementação do Programa Academia da Saúde, principalmente relacionado a problemas de articulação multi-profissional e à dificuldade de articulação com os outros setores e atores da sociedade, mostra a necessidade de reorganização das ações.

El ministro brasileño de salud creó en 2011 el Programa Academia de la Salud (Programa Academia da Saúde) como estrategia para promover la salud y estilos de vida saludables. Sin embargo, los estándares oficiales no parecen estar lo suficientemente claros para apoyar la implementación del programa en las ciudades. El objetivo de este estudio fue analizar el grado de implementación del Programa Academia de la Salud en un pueblo de tamaño medio en Brasil (Vitória de Santo Antão, Pernambuco) en 2018. Es un estudio evaluativo, con un enfoque normativo, que considera las dimensiones de la estructura y proceso relacionado con el sistema laboral. La investigación está dividida en dos pasos: (1) elaboración del modelo teórico de evaluación, a través de la validación del modelo lógico; (2) verificación del nivel de implementación, mediante una entrevista con trabajadores y gestores. Las puntuaciones de corte para la clasificación de implementación por niveles fueron: (1) incipiente: > 0 y < 33,3%; (2) intermedios: > 33,3 y < 66,6%; (3) avanzados: > 66,6%. El nivel de implementación fue considerado intermedio (37,54%). La puntuación de la estructura fue mayor (54,76%) que el proceso (26,06%). El bajo nivel de implementación del Programa Academia de la Salud, especialmente relacionado con la coordinación multiprofesional, y la difícil conexión con otros sectores o actores de la sociedad, muestra la necesidad de una reorganización de las acciones.

A dinâmica das infecções relacionadas à assistência à saúde utilizando a metodologia tracer e a modelagem por redes complexas / The route of healthcare-associated infections using tracer methodology and modeling by complex networks / La dinámica de las infecciones relacionadas con la asistencia a la salud utilizando la metodología tracer y el modelado por redes complejas

Justificativa e Objetivos: no Brasil, infecções de sítio cirúrgico (ISC) compreendem aproximadamente 15% das infecções relacionadas à assistência à saúde (IRAS). Este estudo avaliou a dinâmica das infecções por meio da metodologia tracer, alinhada à análise por redes complexas, utilizando o rastreamento de um paciente (caso) que foi submetido à cirurgia (cenário). Métodos: estudo de caso, de natureza observacional, abordagem descritiva, com avaliação transversal e retrospectiva, pelo rastreamento e análise do prontuário de um paciente submetido a procedimentos cirúrgicos, utilizando a metodologia tracer, sob a ótica das redes complexas, no Hospital das Clínicas, Universidade Federal de Pernambuco. Resultados: mulher, 65 anos, submetida à descompressão, artrodese e retirada de enxerto (doador) em ilíaco esquerdo. Readmitida com osteomielite do ilíaco esquerdo, evoluindo com piora do estado geral, seguido de óbito. O fator de prioridade (PFP) relacionado ao caso foi o procedimento cirúrgico para retirada do enxerto no ilíaco esquerdo pela clínica ortopédica. De acordo com o Manual Brasileiro de Acreditação Hospitalar, os padrões obrigatórios e aplicáveis, segundo o perfil do hospital, apresentam os seguintes percentuais de conformidade para o nível 1 (78,7%), nível 2(82,4%) e no nível 3 (51,7%). Utilizando as redes complexas e considerando que os profissionais são potenciais carreadores da disseminação das infecções aos suscetíveis e são preditores da propagação da ISC (cenário 2/hipótese 2), somado à falta de estrutura para higienização das mãos (cenário 3/hipótese 3), observou-se que há maior chance de ISC ter ocorrido nos setores da enfermaria e UTI. Conclusões: a provável propagação das IRAS está relacionada aos profissionais e à estrutura físico-funcional necessária para prestação da assistência segura.(AU)

Background and Objectives: surgical site infections (SSI) comprise approximately 15% of healthcare-associated infections (HAIs) in Brazil. This study assessed the route of infections using tracer methodology, aligned with analysis by complex networks, by tracing a patient (case) who underwent surgery (scenario). Methods: an observational and descriptive case study, with cross-sectional and retrospective assessment, by tracing and analyzing the medical records of a patient who underwent surgical procedures. Tracer methodology was used from the perspective of complex networks at Hospital das Clínicas, Universidade Federal de Pernambuco. Results: a woman, 65 years old, submitted to decompression, arthrodesis, and graft removal (donor) in the left iliac. Readmitted with left iliac osteomyelitis, worsening in general condition, followed by death. The priority factor (PFP) related to the case was the surgical procedure to remove the graft in the left iliac, by the orthopedic clinic. According to the Brazilian Manual of Hospital Accreditation, the mandatory and applicable standards according to hospital profile have the following percentages of conformity for level 1 (78.7%), level 2 (82.4%), and level 3 (51.7%). Using complex networks and considering that professionals are potential carriers of the spread of infections and are predictors of the spread of SSI (scenario 2/hypothesis 2) plus the lack of structure for hand hygiene (scenario 3/hypothesis 3), it was observed that there is a greater chance that SSI occurred in ward and ICU. Conclusions: the probable spread of HAIs is related to professionals and the physical-functional structure necessary to provide safe care.(AU)

Justificación y objetivos: en Brasil, la ocurrencia de infecciones en pacientes hospitalizados es aproximadamente 15%, y, por eso, la importancia de estudiar la dinámica de las infecciones hospitalarias. Este estudio evaluó la dinámica de las infecciones utilizando la metodología tracer, alineada con el análisis por redes complejas, a partir del rastreo de un paciente (caso) sometido a procedimientos quirúrgicos (escenario). Métodos: estudio de caso, de naturaleza observacional, abordaje descriptivo, con evaluación transversal y retrospectiva, a partir del rastreo individual utilizando la metodología tracer, a través del análisis de prontuario de un paciente sometido a procedimientos quirúrgicos en la Clínica de Ortopedia, Hospital das Clínicas, Universidade Federal de Pernambuco. Resultados: una mujer, 65 años, sometida a descompresión, artrodesis y retirada de injerto en ilíaco izquierdo. Leído con osteomielitis del ilíaco izquierdo, evolucionando con empeoramiento progresivo del estado general, seguido de muerte. El factor de prioridad (PFP) relacionado con el caso fue el procedimiento quirúrgico para la extracción del injerto en el ilíaco izquierdo, por la clínica ortopédica. Los porcentajes de conformidad en el nivel 1 correspondió al 78,7%, en el nivel 2 fue 82,4% y en el nivel 3, 51,7%. A partir del análisis por redes complejas, se observó que hay mayor probabilidad de que la diseminación de la infección esté relacionada con el conjunto de contactos, siendo los profesionales los potenciales portadores de las infecciones a los susceptibles, en los sectores de la enfermería y UTI, siendo éste el predictor de la propagación de la infección de sitio quirúrgico (Escenario 2/Hipótesis 2) y/o la falta de estructura para higienización de las manos (Escenario 3/Hipótesis 3). Conclusiones: las fuerzas que impulsan las infecciones hospitalarias están relacionadas a los cuidadores ya la estructura físico-funcional necesaria para el desarrollo de la asistencia a la salud.(AU)

Curativo com filme e gel de biopolímero de celulose bacteriana no tratamento de feridas isquêmicas após revascularização de membros inferiores / Bacterial cellulose biopolymer film and gel dressing for the treatment of ischemic wounds after lower limb revascularization

RESUMO Objetivo: avaliar o uso do curativo de filme e gel de biopolímero de celulose bacteriana no tratamento de pacientes com feridas isquêmicas submetidos à revascularização dos membros inferiores. Métodos: ensaio clínico randomizado realizado no ambulatório de Angiologia e Cirurgia Vascular do Hospital das Clínicas da Universidade Federal de Pernambuco, entre janeiro de 2017 e dezembro de 2018. Foram acompanhados 24 pacientes após revascularização de membros inferiores, divididos em dois grupos: Experimental, tratado com filme e gel de biopolímero de celulose bacteriana, e Controle, tratado com ácidos graxos essenciais. Os pacientes foram acompanhados em consultas semanais para troca dos curativos e o processo de cicatrização das feridas foi avaliado em um período de 90 dias. Resultados: a redução da área das feridas isquêmicas no período de 30 dias foi de 4,3cm2 (55%), em média, para o grupo experimental, e de 5,5cm2 (48,5%) para o grupo controle (p>0,05). A taxa de cicatrização completa, em 90 dias, foi de 34,8%, sendo 50% no grupo experimental e 18,2% no grupo controle (p=0,053). Conclusão: o filme de biopolímero de celulose bacteriana associada a gel pode ser utilizado como curativo no tratamento de feridas isquêmicas de pacientes submetidos à revascularização de membros inferiores

ABSTRACT Objective: to evaluate the use of a bacterial cellulose biopolymer film and gel dressing in the treatment of patients with ischemic wounds submitted to lower limb revascularization. Methods: we conducted a randomized clinical trial in the Angiology and Vascular Surgery outpatient clinic of the Clinics Hospital of the Federal University of Pernambuco, between January 2017 and December 2018. We followed 24 patients after lower limb revascularization, divided into two groups: Experimental, treated with bacterial cellulose biopolymer film and gel, and Control, treated with essential fatty acids. Patients attended weekly appointments to change dressings and had their wound healing processes evaluated over a period of 90 days. Results: the reduction of the ischemic wounds' areas after 30 days was 4.3cm2 (55%) on average for the experimental group, and the 5.5cm2 (48.5%) for the control group (p>0.05). The complete healing rate at 90 days was 34.8%, 50% in the experimental group and 18.2% in the control group (p=0.053). Conclusion: the bacterial cellulose biopolymer film associated with gel can be used as a dressing in the treatment of ischemic wounds of patients undergoing revascularization of the lower limbs.

Artificial sphincter "BR - SL - AS 904" in the treatment of urinary incontinence after radical prostatectomy: efficacy, practicality and safety in a prospective and multicenter study

ABSTRACT Purpose: The objective of the present study is to test the efficiency and practicality of a new artificial sphincter "BR - SL - AS - 904" in the control of urinary incontinence in post - PR patients and to evaluate their complications. Patients and Methods: Fifteen patients with incontinence after one year of radical prostatectomy were included prospectively. All patients underwent artificial urethral sphincter (AUS) implant "BR - SL - AS - 904" according to established technique. Independent variables such as free urinary flow, PAD weight test, ICIQ - SF score and urinary symptoms through the IPSS score were compared in different follow-up moments. Results: Patients submitted to AUS implantation did not present trans - operative or post - operative complications related to the surgical act such as: infection, hematoma, erosion or urinary retention. Device was inert to the body during the follow-up, showing an excellent adaptation of the patients, besides the easy handling. The mean age was 68.20 years 40% of the patients had systemic arterial hypertension, 6.7% diabetes mellitus, 6.7% were hypertensive and diabetic, 13.4% were hypertensive, had diabetes and hypercholesterolemia and 26.7% patients had no comorbidities. It was evidenced that the urinary flow peak during the follow-up remained stable. Decreased averages and median PAD weight test were 135.19 to 75.72 and 106.00 to 23.50, respectively. The IPSS score decreased and the quality of life increased (12.33 to 3.40 and 2.50 to 3.20 respectively). The ICQF - SF questionnaire score also showed a decrease, ranging from 16, 71 to 7.33. Conclusion: The artificial sphincter implant "BR - SL - AS 904" was reproducible, safe and effective in the control of urinary incontinence in post - PR patients.

A new material to prevent urethral damage after implantation of artificial devices: an experimental study

ABSTRACT Objective To validate the application of the bacterial cellulose (BC) membrane as a protecting barrier to the urethra. Materials and Methods Forty female Wistar rats (four groups of 10): Group 1 (sham), the urethra was dissected as in previous groups and nothing applied around; Group 2, received a 0.7cm strip of the BC applied around the urethra just below the bladder neck; Group 3, received a silicon strip with the same dimensions as in group 2; Group 4, had a combination of 2 and 3 groups being the silicon strip applied over the cellulosic material. Half of the animals in each group were killed at 4 and 8 months. Bladder and urethra were fixed in formalin for histological analysis. Results Inflammatory infiltrates were more intense at 4 months at lymphonodes (80% Grade 2), statistically different in the group 2 compared with groups 1 (p=0.0044) and 3 (p=0.0154). At 8 months, all samples were classified as grade 1 indicating a less intense inflammatory reaction in all groups. In group 2, at 8 months, there was a reduction in epithelial thickness (30±1μm) when com-pared to groups 1 (p=0.0001) and 3 (p<0.0001). Angiogenesis was present in groups 2 and 4 and absent in group 3. In BC implant, at 4 and 8 months, it was significant when comparing groups 4 with 1 (p=0.0159). Conclusion BC membrane was well integrated to the urethral wall promoting tissue remodeling and strengthening based on morphometric and histological results and may be a future option to prevent urethral damage.

Efficacy of bacterial cellulose membrane for the treatment of lower limbs chronic varicose ulcers: a randomized and controlled trial / Eficácia da membrana de celulose bacteriana no tratamento de úlceras venosas de membros inferiores: estudo randomizado e controlado

ABSTRACT Objective: to evaluate the efficacy of Bacterial Cellulose (BC) membrane dressings in the treatment of lower limb venous ulcers. Methods: we carried out a prospective, randomized, controlled study of 25 patients with chronic venous ulcer disease in the lower limbs from the Angiology and Vascular Surgery Service of the Federal University of Pernambuco Hospital and from the Salgado Polyclinic of the County Health Department, Caruaru, Pernambuco. We randomly assigned patients to two groups: control group, receiving dressings with triglyceride oil (11 patients) and experimental group, treated with BC membrane (14 patients). We followed the patients for a period of 120 days. Results: There was a reduction in the wound area in both groups. There were no infections or reactions to the product in any of the groups. Patients in the BC group showed decreased pain and earlier discontinuation of analgesic use. Conclusion: BC membrane can be used as a dressing for the treatment of varicose ulcers of the lower limbs.

RESUMO Objetivo: avaliar a eficácia de curativos com membrana de Celulose Bacteriana (CB) no tratamento de úlceras venosas de membros inferiores. Métodos: estudo prospectivo, randomizado e controlado de 25 pacientes com úlceras decorrentes de doença venosa crônica nos membros inferiores provenientes do Serviço de Angiologia e Cirurgia Vascular do Hospital de Clínicas da Universidade Federal de Pernambuco e da Policlínica do Salgado da Secretaria Municipal de Saúde, Caruaru, Pernambuco. Os pacientes foram distribuídos aleatoriamente em dois grupos: grupo controle, que recebeu curativos com óleo de triglicerídeos (11 pacientes) e grupo experimental, tratado com membrana de CB (14 pacientes). Os pacientes foram acompanhados por um período de 120 dias. Resultados: houve uma redução na área de ferida em ambos os grupos. Não houve infecção ou reações ao produto em nenhum dos grupos. Pacientes do grupo CB mostraram diminuição da dor e interrupção mais precoce do uso de analgésicos. Conclusão: a membrana de CB pode ser usada como curativo para o tratamento de úlceras varicosas dos membros inferiores.

A wet dressing for male genital surgery: A phase II clinical trial

ABSTRACT Purpose: This study was to confirm the safety and efficacy of BC dressing when used in surgical male wound healing at the urogenital area. Methods: Open, non-controlled clinical study of phase II. A total of 141 patients, among those children, adolescents and adults with hypospadias (112), epispadias (04), phymosis (13) and Peyronie's disease (12) that had a BC dressing applied over the operated area after surgery. A written informed consent was obtained from all participants. Study exclusion criteria were patients with other alternative treatment indications due to the severity, extent of the injury or the underlying disease. The outcomes evaluated were efficacy, safe and complete healing. The costs were discussed. Results: In 68% patients, the BC dressing fell off spontaneously. The BC was removed without complications in 13% of patients at the outpatient clinic during the follow-up visit and 17% not reported the time of removal. In 3% of the cases, the dressing fell off early. Complete healing was observed between 8th and 10th days after surgery. The BC dressings have shown a good tolerance by all the patients and there were no reports of serious adverse events. Conclusion: The bacterial cellulose dressings have shown efficacy, safety and that can be considered as a satisfactory alternative for postoperative wound healing in urogenital area and with low cost.

Nutritional supplementation with arginine protects radiation-induced effects. An experimental study

ABSTRACT PURPOSE: To investigate the protective effect of L-arginine on the prostate (nonneoplasic) of rats with radiation-induced injury. METHODS: Twenty-nine Wistar rats, male adult, allocated into three groups: Control group (C) was not exposed to irradiation (n=10); Radiated group (R) had undergone pelvic irradiation (n=10); Supplemented and radiated group (R+S) had undergone pelvic irradiation plus L-arginine supplementation (n=9). The animals were observed for signs of toxicity. After euthanization, the prostate was dissected under magnification and stained by hematoxylin and eosin to study acinar structures and stained with Picrosirius red for collagen analysis. RESULTS: After radiation exposure, all animals presented diarrhea, but supplementation with L-arginine reduced this effect. The weight gain in the R+S group was significantly higher than in the C and R groups. In the R+S group the collagen density and the prostate acinar area was similar to the R and C groups. Epithelial height was significantly reduced in group R compared with group C (p<0.0001). When comparing the group R+S with R, a statistical difference was observed to be present (p<0.0001). CONCLUSIONS: Pelvic radiation promotes systemic effects and some structural modifications in the ventral prostate of rats. These modifications can be prevented by oral supplementation with L-arginine.

Treatment of tympanic membrane perforation using bacterial cellulose: a randomized controlled trial / Tratamento do tímpano perfurado com enxerto de celulose bacteriana: ensaio clínico controlado e randomizado

ABSTRACT INTRODUCTION: Promising treatments for tympanic membrane perforation closure have been studied. Therapies derived from tissue engineering probably eliminate the need for conventional surgery. Bacterial cellulose is presented as an alternative that is safe, biocompatible, and has low toxicity. OBJECTIVES: To investigate the effect on healing of direct application of a bacterial cellulose graft on the tympanic membrane compared to the conventional approach with autologous fascia. METHODS: Randomized controlled trial. Forty patients with tympanic membrane perforations secondary to chronic otitis media were included, and were randomly assigned to an experimental group (20), treated with a bacterial cellulose graft (BC) and control group (20), treated with autologous temporal fascia (fascia). We evaluated the surgical time, hospital stay, time of epithelialization and the rate of tympanic perforation closure. Hospital costs were compared. The statistical significance level accepted was established at p < 0.05. RESULTS: The closure of perforations was similar in both groups. The average operation time in the fascia group was 76.50 min versus 14.06 min bacterial cellulose in the group (p = 0.0001). The hospital cost by the Brazilian public health system was R$ 600.00 for the bacterial cellulose group, and R$ 7778.00 for the fascia group (p = 0.0001). CONCLUSION: Bacterial cellulose grafts promoted the closure of the tympanic membrane perforations, and were demonstrated to be innovative, effective, safe, minimally invasive, efficacious and to have a very low cost.

RESUMO INTRODUÇÃO: Tratamentos promissores para o fechamento da perfuração da membrana timpânica vêm sendo estudados. Terapias provenientes de engenharia de tecidos provavelmente eliminarão a necessidade de uma intervenção cirúrgica convencional. A celulose bacteriana apresenta-se como uma alternativa por ser segura, de baixa toxicidade, biocompatível. OBJETIVOS: Investigar o efeito da aplicação direta do enxerto da celulose bacteriana na cicatrização de perfurações da membrana timpânica, comparado ao procedimento convencional com fáscia autóloga. MÉTODO: Incluíram-se 40 pacientes com perfuração da membrana timpânica por otite média crônica simples. Randomizados de 1 a 40, onde os ímpares (20) foram tratados com enxerto de celulose bacteriana (CB), e os pares (20), com enxerto de fáscia temporal autóloga (fáscia). Estudo clínico controlado e randomizado. O tempo cirúrgico e de hospitalização foram o tempo de epitelização e custos hospitalares. RESULTADOS: O fechamento das perfurações foi semelhante nos dois grupos. O tempo médio da cirurgia no grupo fáscia foi de 76,50 minutos e de 14,06 minutos no grupo com celulose bacteriana (p = 0,0001). O custo hospitalar pela tabela do SUS foi de R$ 600,00 para o grupo CB e R$ 7.778,00 para o grupo fáscia (p = 0,0001). CONCLUSÃO: A celulose bacteriana promoveu o fechamento da perfuração do tímpano, mostrando-se inovador, seguro, eficaz, efetivo, minimamente invasivo e de baixo custo.

Deleterious effects of prepubertal corticosterone treatment on rat prostate

PURPOSE:To investigate the structural and functional changes induced by corticosterone (CORT) in the ventral prostrate (VP) of rats in order to study chronic stress effects in the prepubertal phase.METHODS:Wistar rats received daily saline or CORT injections during the pubertal period from the 5th to 25th day of postnatal life. The animals were distributed into four groups: 1 - Control (n=5); 2 - Control 99mTc-P (n=5); 3 - Treated with CORT (n=14); 4 - Treated with CORT and 99mTc-P (n=10). All rats were sacrificed at two months of age. Technical tissue uptakes of 99mTc-P were used to evaluate the functional and stereological methods for morphological analysis.RESULTS:Acini distribution in the group treated with CORT differed significantly (p 0.0001) from the control. The control group's epithelial average height (10.01±0.24 microns) was statistically significant (p 0.0001) from rats treated with CORT (19.27±0.73microns). The collagen distribution was lower in the treated group (2.79%) when compared to control (3.97%). The radioactivity percentage in the groups marked with 99mTc-P (%Ati/g) did not demonstrate a statistically significant difference (p=0.285897).CONCLUSION:Chronic administration of corticosterone in prepubertal rats causes changes in their acinar structure and their ventral prostate stroma, indicating possible deleterious effects of this hormone.

Deleterious effects of prepubertal corticosterone treatment on rat prostate

PURPOSE: To investigate the structural and functional changes induced by corticosterone (CORT) in the ventral prostrate (VP) of rats in order to study chronic stress effects in the prepubertal phase. METHODS: Wistar rats received daily saline or CORT injections during the pubertal period from the 5th to 25th day of postnatal life. The animals were distributed into four groups: 1 - Control (n=5); 2 - Control 99mTc-P (n=5); 3 - Treated with CORT (n=14); 4 - Treated with CORT and 99mTc-P (n=10). All rats were sacrificed at two months of age. Technical tissue uptakes of 99mTc-P were used to evaluate the functional and stereological methods for morphological analysis. RESULTS: Acini distribution in the group treated with CORT differed significantly (p<0.0001) from the control. The control group's epithelial average height (10.01±0.24 microns) was statistically significant (p<0.0001) from rats treated with CORT (19.27±0.73microns). The collagen distribution was lower in the treated group (2.79%) when compared to control (3.97%). The radioactivity percentage in the groups marked with 99mTc-P (%Ati/g) did not demonstrate a statistically significant difference (p=0.285897). CONCLUSION: Chronic administration of corticosterone in prepubertal rats causes changes in their acinar structure and their ventral prostate stroma, indicating possible deleterious effects of this hormone. .

Biocompatibility of the bacterial cellulose hydrogel in subcutaneous tissue of rabbits

PURPOSE: To evaluate the biocompatibility and local sensibility reaction to bacterial cellulose hydrogel (0.8%) implanted in subcutaneous tissue of rabbits. METHODS: Fifteen New Zeland rabbits were randomly allocated into three groups: T1, 7 days, T2, 21 days, and T3, 84 days. The new material was implanted in the subcutaneous tissue of the ear; on the scalp over the periosteum; and on the outer and inner surfaces of the thighs, in the aponeurosis of the muscle. At 7, 21 and 84 postoperative days, the material was collected for histological study. The clinical signs, inflammatory response, angiogenesis and fibrogenesis were variables used for analysis of the biocompatibility and biological reactivity to BCH. Analyses were performed with an AXIO(r) Imager. The statistical tests were performed using the GraphPad Prism 5.0 program(r) RESULTS: The intensity of the inflammatory infiltrate, considering the different cell types (PMN, LMN and GC), was statistically significant, with group T1 different from groups T2 and T3 (p = 0.0124 and p <0.0001, respectively) and T2 different from the T3 group (p = 0.0007). Fibrogenesis grade 1 was the most prevalent in groups T1 (55.4%) and T2 (44.6%). The formation of neovascularization in the group was identified in 84.4% of samples. CONCLUSION: Bacterial cellulose hydrogel (0.8%) is biocompatible, integrating with the subcutaneous tissue of rabbits and inducing tissue remodeling. .

Efeitos da suplementação oral com L-arginina e L-glutamina sobre a próstata ventral de ratos submetidos à irradiação / Effects of oral supplementation with L-arginine and L-glutamine on the ventral prostate of rats subjected to irradiation

O objetivo deste trabalho foi verificar o possível efeito protetor da L-glutamina e da L-arginina sobre a próstata ventral de ratos quando administradas por gavagem. Procurou-se simular as condições clinicas de pacientes submetidos à radioterapia pélvica tendo como órgão alvo outro órgão pélvico que não a próstata. Foram analisados os efeitos desta irradiação sobre a próstata considerando este órgão como normal. Foram utilizados ratos Wistar divididos em quatro grupos: Controle, animais não submetidos à irradiação (n=10); Irradiado, submetidos à irradiação abdominal e sem suplementação adicional de aminoácido por 21 dias (n=10); Irradiado + L-glutamina, submetidos à irradiação abdominal e com suplementação adicional de L-glutamina por 21 dias (n=10); e Irradiado + L-arginina, submetidos à irradiação abdominal e com suplementação adicional de L-arginina por 21 dias (n=9). Os grupos foram mantidos em condições padrão de laboratório durante todas as etapas do experimento. Os animais submetidos à irradiação abdominal receberam uma dose única de 1000 cGy no dia 8 da experimentação. A L-glutamina e a L-arginina foram dissolvidas em água destilada e administrada por gavagem através da agulha IC-810®. As próstatas foram removidas e processadas para inclusão em parafina. Foram estudados os seguintes parâmetros: estrutura acinar (área dos ácinos e altura do epitélio) e colágeno analisados por métodos morfométricos e peso corporal. O ganho de peso nos grupos suplementados foi significativamente maior se comparado ao grupo irradiado. Houve redução da altura do epitélio no grupo irradiado quando comparado ao controle. A altura do epitélio no grupo suplementado com L-arginina foi significativamente maior do que nos grupos irradiado e suplementado com L-glutamina. Houve diminuição, de aproximadamente 18%, da área dos ácinos no grupo suplementado com L-glutamina. Já no grupo suplementado com L-arginina o valor foi similar ao do controle. O efeito da L-glutamina...

The aim of this study was to investigate the possible protective effect of L-glutamine and L-arginine on the rat ventral prostate when administered by gavage. We tried to simulate the clinical conditions of patients undergoing pelvic radiotherapy as with other pelvic organ target organ than the prostate. We analyzed the effects of irradiation on prostate considering this organ as normal. Wistar rats were divided into four groups: Control, animals not exposed to irradiation (n=10); Irradiated, submitted to abdominal irradiation and without additional amino acid supplementation (n=10); Irradiated + L-glutamine, submitted abdominal irradiation and additional supplementation with L-glutamine for 21 days (n=10), and Irradiated + L-arginine, underwent abdominal irradiation and additional supplementation with L-arginine for 21 days (n=9). The groups were kept under standard laboratory conditions during all stages of the experiment. The animals underwent abdominal irradiation received a single dose of 1000 cGy in eight days of trial. L-glutamine and L-arginine were dissolved in distilled water and administered by gavage needle through the IC-810®. The prostates were removed and processed for paraffin embedding. We studied the following parameters: acinar structure (area of acini and epithelial height) and collagen analyzed by morphometric methods and body weight. Weight gain in the supplemented groups was significantly higher compared to the irradiated group. There was a reduction in epithelial height in the irradiated group compared to control. The height of the epithelium in the group supplemented with L-arginine was significantly higher than in irradiated and supplemented with L-glutamine. There was a decrease of approximately 18% of the area of the lobes in the group supplemented with L-glutamine. In the group supplemented with L-arginine was similar to the value of control. The effect of L-glutamine on the prostatic parenchyma was to keep the collagen...

Aspectos psicossociais associados ao câncer de mama e à qualidade de vida / Psychosocial aspects linked to breast cancer and the quality of life

Trata-se de uma pesquisa de campo de caráter exploratório e de abordagem qualitativa. O objetivo deste estudo foi investigara os fatores psicológicos e sociais das mulheres com câncer de mama que interferem na sua qualidade de vida. Os dados foram coletados através de questionário com perguntas fechadas, constituindo-se de quatro etapas: a Escala Analógica Visual de Faces; a coleta de dados demográficos e socioeconômicos; histórico da cliente; o modelo do General Comfort Questionaire na versão adaptada. Os dados foram analisados utilizando o software estatístico R. Com os resultados podemos considerar que a tristeza, o medo e o deconforto são superados com o apoio de familiares, amigos e equipe de saúde.

Estudo da embriotoxicidade da beta-ionona em ratos / Study of the embryotoxic of beta-ionona in the rat

Beta-ionona (4-[2,6,6-trimethyl-1-cyclohexen-1-1yl]-3-buten-2-one; CAS 79-77-6) é um sesquiterpeno degradado (C13) encontrado nos óleos essenciais de uma variedade de plantas, entre os quais o óleo de violeta. Este composto tem sido usado na indústria, como intermediário na síntese de fragrâncias, vitamina A e como aditivo alimentar, sobretudo na indústria de vinhos. O objetivo deste estudo foi avaliar o potencial embriotóxico da beta-ionona que, em estudos anteriores, mostrou claros indícios de induzir embrioletalidade em ratos. Ratas Wistar foram tratadas por entubação gástrica com beta-ionona (125, 250, 500 e 1000 mg/kg de peso corporal/dia) ou apenas com veículo (óleo de milho), entre os dias 6 e 15 de gravidez. No dia 21, as fêmeas foram sacrificadas por inalação de CO2 e submetidas à cesárea. O útero gravídico foi pesado com todo seu conteúdo. (...) Neste nível de dose, a beta-ionona também afetou adversamente o desenvolvimento embrionário, causando embrioletalidade, evidenciada pelo aumento de perdas peri-implantação e pelo discreto aumento na proporção de reabsorções por implantações. Ainda em relação ao efeito embrioletal da beta-ionona observado neste estudo, pode-se dizer que as fêmeas foram mais suscetíveis do que os machos. No presente estudo, não foram encontrados indícios de retardo do crescimento intra-uterino induzido pelo exposição in utero à beta-ionona, nem aumento na incidência de alterações estruturais de vísceras ou esqueléticas em nenhum dos níveis de dose estudados. Os dados deste estudo indicaram que a beta-ionona não é teratogênica em ratos, uma vez que não houve aumento na freqüência de malformações viscerais e/ou esqueléticas em conseqüência à exposição in utero a este composto.