Reprocessamento de pinças de alta resolução para corte e coagulação / High-resolution tweezers for cutting and coagulation reprocessing

INTRODUÇÃO: Diversos estudos demonstraram as vantagens clínicas da utilização dos instrumentos de alta resolução em cirurgia, com a redução do tempo operatório, fácil manuseio e efetividade nas incisões, assim como menor geração de fumaça e danos térmicos teciduais. OBJETIVO: Demonstrar a viabilidade técnica de reutilização das pinças de alta resolução para corte e coagulação teoricamente recomendadas para uso único. MÉTODO: Foi avaliada a eficácia da limpeza, garantia do processo de esterilização e qualidade funcional do material. O processo foi aplicado em quatro pinças da marca Ligasure- Valleylab. Cada uma foi identificada com fitas autoclaváveis de cores diferentes para rastreamento. Duas foram submetidas diretamente à limpeza após a primeira utilização e nas outras duas foi coletado, antes desta limpeza, material para a primeira cultura. Todas as pinças passaram por processo de limpeza antes da esterilização. Em seguida foram esterilizadas em peróxido de hidrogênio. Após o processo de esterilização foi colhida, de cada pinça, cultura em meio de solução fisiológica. Após esta coleta todas as pinças foram testadas por um cirurgião quanto à sua atuação em uma amostra de carne bovina. Randomicamente, a cada teste o pesquisador contaminava uma pinça com cepas de Pseudomonas aeroginosa, Staphylococcus aureus e Candida albicans. Este processo foi repetido por quatro vezes. O material foi encaminhado ao laboratório e semeado em meio de cultura passível de identificação microbiológica. Para controle de qualidade todos os testes biológicos, químicos e certificados de qualidade dos produtos utilizados no processo foram anexados. RESULTADOS: Os resultados de todas as culturas foram negativos e a funcionabilidade preservada nas quatro reutilizações. CONCLUSÃO: Quanto à funcionabilidade, as pinças podem ser utilizadas por no mínimo até quatro vezes, que foi o número de vezes testado neste experimento. Portanto, ela pode ser utilizada por cinco vezes, sendo a primeira vinda de fábrica e mais quatro após reprocessamento.

INTRODUCTION: Several studies have demonstrated the clinical benefits of the use of high resolution instruments in surgery, with reduction in the operative time, easy handling and effectiveness in the incisions, as well as lower smoke generation and thermal tissue damage. AIM: To demonstrate the technical feasibility of reusing devices of high resolution for cutting and coagulation, theoretically recommended for single use. METHOD: Was evaluated the efficacy of cleaning, sterilization process and functional quality of the material. The process was applied in four tweezers brand Ligasure - Valleylab. Each was identified with ribbons of different colors autoclavable for tracking. Two were submitted directly to the cleaning after the first use and from the other two were collected samples of this cleaning for the first culture. All tweezers passed through the cleaning process prior to sterilization. Then were sterilized in hydrogen peroxide. After the sterilization process, was taken material from the devices and put it on saline solution for culture. After, the tweezers were tested by a surgeon to analyze its performance in a sample of beef. Randomly at each test the researcher contaminated tweezers with strains of Pseudomonas aeruginosa, Staphylococcus aureus and Candida albicans. This process was repeated four times. The material was sent to the laboratory and seeded in culture medium capable of microbiological identification. For quality control tests all biological, chemical and quality certification of products used in the process were attached. RESULTS: The results of all cultures were negative, and functionality was preserved in the four reuses. CONCLUSION: As to the functionality, the tweezers may be used at least four times, the number of times tested in this experiment. Therefore, it can be used for five times, the first coming from the factory and four more after reprocessing.

Occupational therapy in spinocerebellar ataxia type 3: an open-label trial

Occupational therapy (OT) is a profession concerned with promoting health and well-being through occupation, by enabling handicapped people to participate in the activities of everyday life. OT is part of the clinical rehabilitation of progressive genetic neurodegenerative diseases such as spinocerebellar ataxias; however, its effects have never been determined in these diseases. Our aim was to investigate the effect of OT on both physical disabilities and depressive symptoms of spinocerebellar ataxia type 3 (SCA3) patients. Genomically diagnosed SCA3 patients older than 18 years were invited to participate in the study. Disability, as evaluated by functional independence measurement and Barthel incapacitation score, Hamilton Rating Scale for Depression, and World Health Organization Quality of Life questionnaire (WHOQOL-BREF), was determined at baseline and after 3 and 6 months of treatment. Twenty-six patients agreed to participate in the study. All were treated because OT prevents blinding of a control group. Fifteen sessions of rehabilitative OT were applied over a period of 6 months. Difficult access to food, clothing, personal hygiene, and leisure were some of the main disabilities focused by these patients. After this treatment, disability scores and quality of life were stable, and the Hamilton scores for depression improved. Since no medication was started up to 6 months before or during OT, this improvement was related to our intervention. No association was found between these endpoints and a CAG tract of the MJD1 gene (CAGn), age, age of onset, or neurological scores at baseline (Spearman test). Although the possibly temporary stabilization of the downhill disabilities as an effect of OT remains to be established, its clear effect on depressive symptoms confirms the recommendation of OT to any patient with SCA3 or spinocerebellar ataxia.