Episiotomy healing assessment: Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) scale reliability / Avaliação da cicatrização da episiotomia: confiabilidade da escala REEDA (Redness, Oedema, Ecchymosis, Discharge, Approximation) / Evaluación de la curación de episiotomía: confiabilidad de la escala de Enrojecimiento, Edema, Equimosis, Drenaje, Aproximación (REEDA)

OBJECTIVE: to analyse the Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) scale reliability when evaluating perineal healing after a normal delivery with a right mediolateral episiotomy. METHOD: observational study based on data from a clinical trial conducted with 54 randomly selected women, who had their perineal healing assessed at four time points, from 6 hours to 10 days after delivery, by nurses trained in the use of this scale. The kappa coefficient was used in the reliability analysis of the REEDA scale. RESULTS: the results indicate good agreement in the evaluation of the discharge item (0.75< Kappa ≥0.88), marginal and good agreement in the first three assessments of oedema (0.16< Kappa ≥0.46), marginal agreement in the evaluation of ecchymosis (0.25< Kappa ≥0.42) and good agreement regarding redness (0.46< Kappa ≥0.66). For the item coaptation, the agreement decreased from excellent in the first assessment to good in the last assessment. In the fourth evaluation, the assessment of all items displayed excellent or good agreement among the evaluators. CONCLUSION: the difference in the scores among the evaluators when applying the scale indicates that this tool must be improved to allow an accurate assessment of the episiotomy healing process. .

OBJETIVO: analisar a confiabilidade da escala REEDA (Redness, Oedema, Ecchymosis, Discharge, Approximation) para avaliar a cicatrização do períneo após parto vaginal com episiotomia médio-lateral direita. MÉTODO: estudo observacional, baseado em dados coletados em ensaio clínico, conduzido com 54 mulheres, selecionadas aleatoriamente. As mesmas tiveram o processo de cicatrização perineal avaliado em quatro momentos (de 6 horas a 10 dias após o parto), por enfermeiras treinadas para o uso da escala. O coeficiente kappa foi usado para análise de confiabilidade da escala REEDA. RESULTADOS: os resultados indicam bom nível de concordância na avaliação do item secreção (0,75< Kappa ≥0,88), concordância boa e marginal em relação ao item equimose (0,25< Kappa ≥0,42), e bom nível de concordância em relação à hiperemia (0,46< Kappa ≥0,66). O nível de concordância referente à avaliação do item coaptação diminuiu de excelente, na primeira avaliação, para bom, na última avaliação. CONCLUSÃO: a diferença entre as pontuações atribuídas pelas avaliadoras na aplicação da escala indica que o instrumento precisa ser melhorado, para permitir avaliações mais precisas do processo de cicatrização da episiotomia. .

OBJETIVO: analizar la confiabilidad de la escala de Enrojecimiento, Edema, Equimosis, Drenaje, Aproximación (REEDA) en la evaluación de la curación perineal tras parto normal con episiotomía mediolateral derecha. MÉTODO: estudio observacional con base en datos de un ensayo clínico conducido con 54 mujeres elegidas de forma aleatoria, con evaluación de su curación perineal en cuatro momentos, entre 6 horas y 10 días después del parto, por enfermeras capacitadas en el uso de esta escala. El coeficiente de kappa fue utilizado en el análisis de confiabilidad de la escala REEDA. RESULTADOS: los resultados indican buena concordancia en la evaluación del ítem drenaje (0,75< Kappa ≥0,88), concordancia marginal y buena en las primeras tres evaluaciones de edema (0,16< Kappa ≥0,46), concordancia marginal en la evaluación de equimosis (0,25< Kappa ≥0,42) y buena concordancia sobre enrojecimiento (0,46< Kappa ≥0,66). Para el ítem coaptación, la concordancia disminuyó de excelente en la primera evaluación hasta buena en la última. En el cuarto momento, la evaluación de todos los ítems mostró concordancia excelente o buena entre los evaluadores. CONCLUSIÓN: la diferencia en las notas entre los evaluadores en la aplicación de la escala indica que esta herramienta debe ser mejorada para permitir una evaluación correcta del proceso de curación de la episiotomía. .

Abnormal lipid metabolism in collagen-induced arthritis rat model: In vitro, high resolution NMR spectroscopy based analysis.

Collagen-induced arthritis (CIA) was induced in female Wistar rats by intradermal injection of porcine immunization grade native collagen type II (Chondrex). Development and progression of CIA was monitored by studying histopathological, radiographical and biochemical features of arthritic manifestations in the knee joints, hind limb and blood plasma. In addition, oxidative stress status of arthritic animals was determined by measuring lipid peroxidation and the antioxidant enzymes: catalase, superoxide dismutase and glutathione peroxidase. High resolution proton NMR spectroscopy was employed for the analysis of lipid components in the lipid extracts of the joint tissue and plasma of collagen-induced arthritic and control rats. Triglyceride levels showed significant decreases in plasma (1.7 times) but were unchanged in the joint tissue of CIA rats as compared to control. One-dimensional proton NMR spectra showed a 6.2 times reduction in the quantity of choline-containing phospholipids in the plasma of CIA as compared to control rats. There was a 1.6 times elevation of choline-containing phospholipids in the joint tissue of CIA rats as compared to controls. Induction of arthritis showed a 4.0 times reduction in the level of total cholesterol in the plasma and 1.6 times elevation in the joint tissue of CIA rats as compared to controls. The ratio of saturated fatty acids to unsaturated fatty acids was 1.5 times significantly higher in joint tissue and 2.1 times significantly higher in plasma of CIA rats as compared to controls. The results demonstrated significantly altered lipid patterns in the joint tissue and plasma of collagen-induced arthritic rats as detected by one- and two-dimensional NMR spectroscopy compared with controls.

Cytotoxicity of bovine and porcine collagen membranes in mononuclear cells

This study compared the cytotoxicity and the release of nitric oxide induced by collagen membranes in human mononuclear cells. Peripheral blood was collected from each patient and the separation of mononuclear cells was performed by Ficoll. Then, 2x10(5) cells were plated in 48-well culture plates under the membranes in triplicate. The polystyrene surface was used as negative control. Cell viability was assessed by measuring mitochondrial activity (MTT) at 4, 12 and 24 h, with dosage levels of nitrite by the Griess method for the same periods. Data had non-normal distribution and were analyzed by the Kruskal-Wallis test (p<0.05). Statistically significant differences (p<0.05) were observed between the membranes and the control in the experimental period, although there was a significant reduction in viability over time (p<0.01). At 4 and 12 h, the porcine membrane induced a higher release of nitrite compared with the control and bovine membrane, respectively (p<0.01), and this difference was maintained at 24 h (p<0.05). This in vitro study showed that the porcine collagen membrane induces an increased production of proinflammatory mediators by mononuclear cells in the first hours of contact, decreasing with time.

Neste estudo foi comparada a citoxicidade e a liberação de nitrito induzidos por membranas de colágeno bovino e suíno em células mononucleares humanas. Foram coletados sangue periférico de cada paciente, e realizada separação de mononucleares por gradiente de Ficoll. Um total de 2x10(5) células foram plaqueadas em placas de cultura de 48 poços sob as membranas, em triplicata. O poço sem membrana serviu como controle negativo. A viabilidade celular foi avaliada medindo a atividade mitocondrial (MTT) em 4,12 e 24 h, com dosagens dos níveis de nitrito pelo método de Griess nos mesmos períodos. As amostras não apresentaram distribuição normal, sendo realizado o teste de Kruskal-Wallis (p<0,05). Foram observadas diferenças estatisticamente significantes entre as membranas e o controle nos período analisados (p<0,05), embora tenha ocorrido redução da viabilidade em função do tempo (p<0,01). Em 4 e 12 h a membrana suína induziu maior liberação de nitrito comparado ao controle e à membrana bovina, respectivamente (p<0,01). Tal diferença foi mantida em 24 h (p<0,05). Este estudo in vitro demonstrou que a membrana colágena suína induz uma maior produção de mediador pró-inflamatório pelas células mononucleares nas primeiras horas de contato, diminuindo com o tempo.