Physical methods for the treatment of fever in critically ill patients: a randomized controlled trial / Métodos físicos para tratamiento de fiebre en pacientes críticos: ensayo clínico controlado randomizado / Métodos físicos para tratamento de febre em pacientes críticos: ensaio clínico controlado randomizado

Abstract OBJECTIVE To evaluate the effects of physical methods of reducing body temperature (ice pack and warm compression) in critically ill patients with fever. METHOD A randomized clinical trial involving 102 adult patients with tympanic temperature ≥ 38.3°C of an infectious focus, and randomized into three groups: Intervention I - ice pack associated with antipyretic; Intervention II - warm compress associated with antipyretic; and Control - antipyretic. Tympanic temperature was measured at 15 minute intervals for 3 hours. The effect of the interventions was evaluated through the Mann-Whitney test and Survival Analysis. "Effect size" calculation was carried out. RESULTS Patients in the intervention groups I and II presented greater reduction in body temperature. The group of patients receiving intervention I presented tympanic temperature below 38.3°C at 45 minutes of monitoring, while the value for control group was lower than 38.3°C starting at 60 minutes, and those who received intervention II had values lower than 38.3°C at 75 minutes of monitoring. CONCLUSION No statistically significant difference was found between the interventions, but with the intervention group I patients showed greater reduction in tympanic temperature compared to the other groups. Brazilian Registry of Clinical Trials: RBR-2k3kbq

Resumen OBJETIVO Evaluar el efecto de métodos físicos (bolsa de hielo y compresa tibia) en la reducción de la temperatura corporal de pacientes críticos con fiebre. MÉTODO Ensayo clínico randomizado con 102 pacientes adultos y temperatura timpánica ≥ 38,3°C de foco infeccioso, aleatorizados en tres grupos: Intervención I ‒ bolsa de hielo asociada con antitérmico; Intervención II ‒ compresa tibia asociada con antitérmico; y Control ‒ antitérmico. La temperatura timpánica fue medida en intervalos de 15 minutos durante 3 horas. El efecto de las intervenciones fue evaluado por la prueba Mann-Whitney y Análisis de Supervivencia. Se hizo el cálculo del "Effect size". RESULTADOS Los pacientes de los grupos Intervención I y II presentaron mayor reducción en la temperatura corporal. A partir de 45 minutos de seguimiento el grupo de pacientes que recibió la Intervención I presentó valor de la temperatura timpánica inferior a 38,3°C; los del grupo control, valor menor que 38,3°C a partir de 60 minutos; y los que recibieron la Intervención II, valor menor que 38,3°C con 75 minutos de seguimiento. CONCLUSIÓN No fue encontrada diferencia estadística significativa entre las intervenciones, sin embargo los pacientes del grupo Intervención I presentaron mayor reducción de la temperatura timpánica con relación a los demás grupos. Registro Brasileño de Ensayos Clínicos: RBR-2k3kbq

Resumo OBJETIVO Avaliar o efeito de métodos físicos (bolsa de gelo e compressa morna) na redução da temperatura corporal de pacientes críticos com febre. MÉTODO Ensaio clínico randomizado com 102 pacientes adultos e temperatura timpânica ≥ 38,3°C de foco infeccioso, aleatorizados em três grupos: Intervenção I ‒ bolsa de gelo associada a antitérmico; Intervenção II ‒ compressa morna associada a antitérmico; e Controle ‒ antitérmico. A temperatura timpânica foi mensurada em intervalos de 15 minutos durante 3 horas. O efeito das intervenções foi avaliado pelo teste Mann-Whitney e Análise de Sobrevivência. Cálculo do "Effect size" foi procedido. RESULTADOS Os pacientes dos grupos Intervenção I e II apresentaram maior redução na temperatura corporal. A partir de 45 minutos de acompanhamento o grupo de pacientes que recebeu a Intervenção I apresentou valor da temperatura timpânica inferior a 38,3°C, os do grupo controle valor menor que 38,3°C a partir de 60 minutos e os que receberam a Intervenção II, valor menor que 38,3°C com 75 minutos de acompanhamento. CONCLUSÃO Não foi encontrada diferença estatística significativa entre as intervenções, porém os pacientes do grupo Intervenção I apresentaram maior redução da temperatura timpânica em relação aos demais grupos. Registro Brasileiro de Ensaios Clínicos: RBR-2k3kbq

The use of superficial heat for treatment of temporomandibular disorders: an integrative review / O emprego do calor superficial para tratamento das disfunções temporomandibulares: uma revisão integrativa

Purpose: To perform an integrative review of scientific bibliographic production on the use of superficial heat treatment for temporomandibular disorders. Research strategy : Literature review was accomplished on PubMed, LiLACS, SciELO, Bireme, Web of Science, and BBO databases. The following descriptors were used: hot temperature, hyperthermia induced, heat transference, temporomandibular joint, temporomandibular joint disorders, temporomandibular joint dysfunction syndrome, and their equivalents in Portuguese and Spanish. Selection criteria : Articles that addressed the superficial heat for the treatment of temporomandibular disorders, published in English, Spanish, or Portuguese, between 1980 and 2013. Data analysis : The following data were collected: technique of applying superficial heat, duration of application, stimulated body area, temperature of the stimulus, frequency of application, and benefits. Results : initially, 211 studies were found, but just 13 contemplated the proposed selection criteria. Data were tabulated and presented in chronological order. Conclusion: Several techniques for superficial heat application on treatment of temporomandibular disorders were found in the literature. The moist heat was the most widely used technique. Many studies suggested the application of heat for at least 20 minutes once a day. Most authors recommended the application of heat in facial and cervical regions. The heat treatment resulted in significant relief of pain, reduced muscle tension, improved function of the mandible, and increased mouth opening. .

Objetivo: Realizar revisão integrativa sobre a produção científica referente ao emprego do calor superficial para tratamento das disfunções temporomandibulares. Estratégia de pesquisa: Foi realizado levantamento na literatura nas bases de dados PubMed, LiLACS, SciELO, Bireme, Web of Science e BBO. Os termos utilizados foram: temperatura alta, transferência de calor, articulação temporomandibular, transtornos da articulação temporomandibular, síndrome da disfunção da articulação temporomandibular e seus correspondentes em inglês e espanhol. Critérios de seleção: Foram incluídos artigos que abordaram o calor superficial no tratamento das disfunções temporomandibulares, publicados em inglês, espanhol ou português, no período de 1980 a 2013. Análise dos dados: Foram considerados: técnica de aplicação de calor superficial, duração de aplicação, área corporal estimulada, temperatura do estímulo, frequência de realização e benefícios. Resultados: inicialmente, foram encontrados 211 estudos, dos quais 13 contemplaram os critérios de seleção propostos. Os dados foram tabulados e apresentados em ordem cronológica. Conclusão: Várias técnicas de aplicação de calor superficial para tratamento das disfunções temporomandibulares foram encontradas na literatura. O calor úmido foi a modalidade mais empregada. Muitos estudos sugerem a aplicação de calor por 20 minutos, e a frequência mínima foi uma vez ao dia. A maioria dos autores recomenda a aplicação do calor nas regiões facial e cervical. O tratamento com calor apresentou benefícios como alívio da dor, redução da tensão muscular, melhora das funções da mandíbula e aumento da abertura de boca. .

Avaliação da citotoxicidade do composto de inclusão de erlotinibe em hidroxipropil-beta-ciclodextrina e da hipertermia associada à cisplatina / Evaluation of cytotoxicity of erlotinib/hydroxypropyl-beta-cyclodextrin inclusion compound and of hyperthermia associated to cisplatin

Estratégias amplamente utilizadas para potencializar os efeitos citotóxicos de moléculas antitumorais com o objetivo de reduzir a dose aplicada e os efeitos colaterais são a inclusão molecular e a associação da quimioterapia com a hipertermia. No presente trabalho foram estudadas estas duas estratégias, sendo a primeira a inclusão molecular que é muito utilizada para aumentar a solubilidade, a absorção e a disponibilidade de moléculas; e a segunda, a hipertermia que é uma proposta de tratamento do câncer no qual as células do tumor são afetadas pela elevação da temperatura local, podendo ser associada com a quimioterapia para potencializar os efeitos dessa técnica. Para a inclusão molecular usou-se a hidroxipropil-¿-ciclodextrina (HP-¿-CD) a fim de aumentar a solubilidade, a absorção e a disponibilidade do erlotinibe (ERL), caracterizou-se fisico-quimicamente, e avaliou-se a citotoxicidade e a apoptosein vitro, e a angiogênese inflamatória in vivo em camundongos Swiss. Para avaliar o efeito citotóxico da hipertermia (aquecimento a 42°C ou 43°C por 1h) associada à cisplatina utilizou-se linhagens de câncer de mama triplo-negativos (MDA-MB-231, MDA-MB-436, MDA-MB-468 e HCC-1937), linhagens de câncer de colo do útero (ME-180 e SiHa) e linhagens de câncer de pulmão (A549 e H460). A caracterização físico-química mostrou a formação do complexo de inclusão em estado sólido e aquoso, e com uma razão molar entre o ERL e HP-¿-CD preferencialmente de 1:1. O estudo de solubilidade de fases mostrou um diagrama do tipo AL e a calorimetria de titulação isotérmica e a espectrometria de ressonância magnética nuclear, efeito Overhauser nuclear suportam essa formação...

Strategies widely used to potentiate the cytotoxic effects of antitumor molecules with the aim of reduce the applied dose and side effects are molecular inclusion and the combination of chemotherapy with hyperthermia. In this thesis, these two strategies were studied, the first molecular inclusion that is widely used to enhance solubility, absorption and availability molecules; and the second, hyperthermia which is a proposal for treatment of cancer where the tumor cells are affected by local temperature elevation and can be associated with chemotherapy to enhance the effects of this technique. For molecular inclusion used to hydroxypropyl--cyclodextrin (HP--CD) to enhance solubility, absorption and availability of erlotinib (ERL), was characterized physico chemically and evaluated the in vitro cytotoxicity and apoptosis, and in vivo inflammatory angiogenesis in Swiss mice. To evaluate the cytotoxic of hyperthermia (heating to 42°C or 43°C for 1h) associated with cisplatin was used triple-negative breast cancer cell lines (MDA-MB-231, MDA-MB-436, MDA-MB-468 and HCC-1937), cervical cancer cell lines (ME-180 and SiHa) and lung cancer cell lines (A549 and H460). The physico-chemical characterization showed the formation of the inclusion complex in solid and aqueous state and with a molar ratio between the ERL and HP--CD preferably 1:1. Phase-solubility ...

Dacriocistocele congênita: relato de caso e conduta / Congenital dacryocystocele: case report and treatment

A dacriocistocele representa uma rara anomalia congênita da região medial da órbita, causada pela obstrução distal (ao nível da válvula de Hasner) e proximal (ao nível da válvula de Rosenmüller) da via lacrimal, com subsequente dilatação do saco lacrimal. Recebe o nome de mucocele, quando seu conteúdo representa muco, ou amniocele, quando o seu conteúdo é preenchido por fluido amniótico. Acomete somente 0.1% das crianças, com obstrução do ducto lácrimonasal, sendo comumente unilateral e mais frequente no sexo feminino e com predisposição familiar. O diagnóstico é realizado pelas características clínicas: lesão cística tensa, abaixo do tendão cantal medial, de coloração azulacinzentada, rósea ou vermelha acompanhada por epífora desde o nascimento. No entanto podemos utilizar exames de imagem para diagnosticar esta anomalia congênita tais como: tomografia computadorizada, ressonância magnética e ultrassonografia.

The dacryocystocele represents a rare congenital anomaly in the medial region of the orbit caused by distal obstruction (Hasner valve) and proximal (valve Rosenmüller) of the lacrimal system causing dilation of the lacrimal sac. Mucocele is called when the content is mucus and amniocele when the content is filled with amniótico fluid. The incidence is only 0.1% in children with nasolacrimal duct obstruction. It is commonly unilateral and more frequent in women with familial predisposition. The diagnosis is made by clinical features: tense cystic lesion below the medial canthal tendon, blue-gray, pink or red color with epiphora since birth. However we can use image tests to diagnose this congenital anomaly such as tomography computerized, magnetic resonance and ultrasonography.

Evaluation and comparison of anti-Candida effect of heat cure polymethylmethacrylate resin enforced with silver nanoparticles and conventional heat cure resins: An in vitro study.

Recent years have been dominated by research in nano science. Dentistry is no exception and there is increased research on nanoparticles in dentistry. Complete dentures increase the carriage of Candida in healthy patients, and the proliferation of C. albicans can be associated with denture-induced stomatitis. Purpose: To evaluate the anti-Candida effect of heat cure denture base resins reinforced with Ag° in the ratio of 4:1, 3:1, 2:1 (Groups B, C, and D, respectively) to the weight of denture base resins. Materials and Methods: Ag° were synthesized by chemical reduction method, incorporated into the polymer powder according to the ratio for each group, subjected to polymerization and microbial assay was calculated for the reference C. albicans strains by agar diffusion method for the incubation period of 24 h. Results: Group D showed multifold decrease in the colony-forming units. Conclusion: The antimicrobial effect of silver could be used vividly in the denture base for immunocompromised and geriatric patients.

Variación de la temperatura intradiscal por efecto de la terapia térmica con radiofrecuencia: Estudio en cadáveres / Intradiscal temperature variation resulting from radiofrequency thermal therapy: Cadaver study

Introducción: La discopatía es una de las causas más comunes del dolor lumbar. La nueva era de tratamientos para la degeneración discal implica el uso de tecnologías térmicas mínimamente invasivas, que permiten la remodelación del colágeno y la destrucción de nociceptores anulares. Sin embargo, es necesaria una mejor comprensión de la fisiopatología del tratamiento. El propósito de este estudio fue medir la variación de la temperatura intradiscal luego del procedimiento de termodiscoplastía. Material y métodos: Se tomó un espécimen de columna vertebral de cadáver humano, y se dividió en bloques formados por dos placas intervertebrales y un disco intacto. Se aplicó radiofrecuencia en cinco puntos y con tres intervalos de tiempo diferentes. Se midió la temperatura en cada una de las combinaciones. Las unidades se pesaron antes y después del tratamiento. Por último se expuso el disco y se midió el tensamiento alcanzado con cada aplicación de temperatura. Los datos se analizaron con el programa SPSS. Resultados: Se obtuvo una disminución del peso en promedio de 1.4 g (SD 0.599), con valores entre 0.5 y 2.6 gramos. Se encontraron temperaturas medias de 37.6 ºC en el reborde posterior del anillo y una variación de temperatura en promedio de 3.0 ºC (SD 6.407). En promedio se logró un tensamiento de 1.4 mm para todos los bloques en conjunto. Discusión: Los resultados obtenidos muestran la efectividad de la termodiscoplastía con radiofrecuencia dentro de los parámetros de seguridad. Los valores de temperatura con radiofrecuencia fueron más bajos que los encontrados en estudios comparables. El peso y el tensamiento permiten verificar el efecto de encogimiento y deshidratación del disco; este reporte constituye una eficaz herramienta para definir parámetros de tiempos para la aplicación de la tecnología.

Introduction: Disc disease is one of the most common causes of lumbar pain. The new era of treatments for degenerative disc disease involves the use of minimally-invasive thermal technologies allowing for collagen remodeling and destruction of nociceptors in the annulus. However, a better understanding of the treatment pathophysiology is needed. The purpose of this study was to measure intradiscal temperature variation after thermodiscoplasty. Material and methods: A human cadaver spine specimen was obtained and divided into blocks, each composed of two intervertebral plates and an intact disc. Radiofrequency was applied at five spots with three different time intervals. Temperature was measured in each of the combinations. Units were weighed before and after treatment. Finally, the disc was exposed and the tightening achieved with each radiofrequency application was measured. Data were analyzed with the SPSS software. Results: The mean weight reduction obtained was 1.4 g on average (SD 0.599), with values between 0.5 and 2.6 grams. Mean temperature in the posterior rim of the annulus was 37.6 ºC and mean temperature variation was 3.0 ºC (SD 6.407). Mean tightening achieved in all blocks overall was 1.4 mm. Discussion: The results obtained show the effectiveness of radiofrequency thermodiscoplasty when performed within the safety parameters. Temperature values with radiofrequency were lower than those found in comparable studies. The weight and the tightening show the effect of disc shrinking and dehydration. This report is an effective tool to define time parameters for the application of this technology.

Role of hysterectomy and its alternatives in benign uterine diseases.

There is a rising trend of hysterectomy rate as too frequently it is being performed now for conditions like symptomatic fibroids and dysfunctional uterine bleeding which can be treated alternatively. Hysterectomy, as with all other major surgeries, is also associated with increased mortality and morbidity risks. Various medical and surgical lines of management, other than hysterectomy, are presently accessible for the above conditions. Availability of safer and newer treatment options is great boon for women with changing attitudes towards child-bearing and uterine conservation.

Standard guidelines of care: laser and IPL hair reduction.

Laser-assisted hair removal, Laser hair removal, Laser and light-assisted hair removal, Laser and light-assisted, long-term hair reduction, IPL photodepilation, LHE photodepilation; all these are acceptable synonyms. Laser (Ruby, Nd Yag, Alexandrite, Diode), intense pulse light, light and heat energy system are the different light-/Laser-based systems used for hair removal; each have its advantages and disadvantages. The word "LONG-TERM HAIR REDUCTION" should be used rather than permanent hair removal. Patient counseling is essential about the need for multiple sessions. PHYSICIANS' QUALIFICATIONS: Laser hair removal may be practiced by any dermatologist, who has received adequate background training during postgraduation or later at a centre that provides education and training in Lasers or in focused workshops providing such training. The dermatologist should have adequate knowledge of the machines, the parameters and aftercare. The physician may allow the actual procedure to be performed under his/her direct supervision by a trained nurse assistant/junior doctor. However, the final responsibility for the procedure would lie with the physician. FACILITY: The procedure may be performed in the physician's minor procedure room. Investigations to rule out any underlying cause for hair growth are important; concurrent drug therapy may be needed. Laser parameters vary with area, type of hair, and the machine used. Full knowledge about the machine and cooling system is important. Future maintenance treatments may be needed.

Avaliação da eficácia dos métodos de esterilização de cones de papel absorvente / Evaluation of the effectivesses of the sterilization methdos - in the cones of absorbent paper

O objetivo do trabalho foi verificar a eficácia dos métodos de esterilização - forno de Pasteur, aparelho de esferas de vidro Hot wave e pastilhas de paraformaldeido - nos cones de papel absorvente. Foram utilzados cones de papel de diferentes marcas e quatro espécimes de microorganismos: Escherichial coli, Staphylococcus aureus, Bacillus stearothermophilus, Candida albicans. O trabalho constou de três fases: I - Inicialmente, procurou-se verificar as condições de apresentação dos cones em caixas de embalagens, utilizando-os em meios de cultura BHI, colocada em estufa a 37ºC/48 horas e, após crescimento das colônias em placa de Ágar sangue, foram feitos esfregaços e corados pelo Gram, para identificação morfológica dos microorganismos utilizados nesse experimento II - Posteriormente, em segunda fase, retiraram-se outros conesw das mesmas caixas, submetendo-se-os aos meios de esterilização sob os métodos de calor seco e pelo meio químico de valor de formaldeído. III - Finalmente, utilizaram-se cones contaminados por quatro espécimes de microrganismos, a saber: E.coli, S.aureus, Bacillus stearothermophilis, C.albicans, submetendo-os aos mesmos processos da fase II. Após avaliação dos resultados, pode-se concluir que: a)Não se pode considerar estéreis os cones de papel absorventes existentes nas embalagens para pronto uso; b)a esterilização dos cones de papel absorventes pelo calor soco foi eficiente no forno de Pasteur, embora prejudique a sua estrutura; c) não se comprovou esterilização no esterilizador rápido de esferas de vidro Hot wave; d) método químico, utilizando pastilha de paraformaldeído, foi eficaz na esterilização dos cones de papel absorvente, além de não danificar sua estrutura física

Results of temperature-controlled radiofrequency tissue volume reduction for the turbinate hypertrophy.

OBJECTIVES: To assess the efficacy of temperature-controlled radiofrequency tissue volume reduction (RFTVR) for the inferior turbinate. RESEARCH DESIGNS: Prospective, single-blinded, experimental clinical trial. METHOD: Twenty patients with nasal obstruction secondary to inferior turbinate hypertrophy were enrolled. Nasal obstruction was compared between before and after the treatment (at 1-3 days, 1 week and 6-8 weeks) of RFTVR using subjective symptom scores, physical findings and videotape images. RESULTS: Improvement of nasal symptoms was observed as early as 1 week after the operation. However, significant improvement was obtained at 6-8 weeks. CONCLUSION: RFTVR for the turbinate may be useful as an alternative approach for the treatment of chronic turbinate hypertrophy.

Immediate treatment of frostbite using rapid rewarming in tea decoction followed by combined therapy of pentoxifylline, aspirin & vitamin C.

BACKGROUND & OBJECTIVES: Frostbite, the severest form of cold injury is a serious medical problem for our Armed Forces operating in the snow bound areas at high altitude. Effects of treatment by rapid rewarming in tea decoction followed by combined therapy of pentoxifylline, aspirin and vitamin C were evaluated in amelioration of tissue damage due to experimentally induced frostbite in rats. METHODS: Experiments were conducted in 2 groups (25 each) of albino rats (control i.e., untreated and experimental i.e., treated). Frostbite was produced experimentally in all the animals by exposing one of the hind limbs at -12 +/- 1 degree C with wind flow 25-30 lit/min for 30 min in a freezing-machine, with simultaneous recordings of rectal and ambient temperatures. The degree of tissue damage was assessed after 10 days. Following cold exposure, neither external thawing nor any medication was given to the animals of the control group; while the exposed limb of the experimental animals was rewarmed in tea decoction maintained at 37-39 degrees C for 30 min immediately after cold exposure, with simultaneous oral ingestion of warm tea decoction. These animals were also given pentoxifylline (40 mg/kg), aspirin (5 mg/kg) and vitamin C (50 mg/kg) twice daily orally for the next 7 days. RESULTS: In the control group, 68 per cent animals suffered from severe (56%) to very severe (12%) frostbite, while the remaining 32 per cent had moderate frostbite. No animals of this group could escape injury or suffered anything less than moderate frostbite; whereas 52 per cent of experimental animals escaped injury (no frostbite) and 32 and 16 per cent suffered only with primary and moderate degree of injury, respectively. None from this group suffered from severe or very severe frostbite. INTERPRETATION & CONCLUSION: It is evident from the study that this combined therapy resulted in significant improvement in the degree of tissue preservation and proved to be highly beneficial as an immediate treatment of frostbite in rats. The combined pharmacological properties of these drugs might have altered the haemorrheologic status of blood and produced curative beneficial effect in improving tissue survival. Clinical studies are required for confirmation of these beneficial effects in humans, which has already been taken up.

Fontes de calor utilizadas em técnicas de clareamento de dentes / Heart sources used in dental bleaching techniques

Os autores apresentam uma revisão de literatura relacionando as fontes de calor utilizadas em clareamento de dentes

Osteoartritis de la articulación temporomandibular. Parte III: manifestaciones histopatológicas, clínicas, serológicas y radiográficas, tratamiento y pronóstico / Osteoarthritis affecting the temporomandibular joint. Part III

En la osteoartritis de la articulación temporomandibular el aspecto macroscópico del cartílago sufre algunas modificaciones, histológicamente hay una pérdida de proteoglicanos, una desintegración de la red de fibras colágeno y una degeneración grasa. La zona del hueso subyacente sufre modificaciones, ocurren microfracturas y un aumento en la densidad ósea. Se pueden formar osteofitos. La formación de nuevo hueso puede ser liso, esclerótico o eburnado. Se discuten otros cambios estructurales. Los hallazgos clínicos pueden incluir dolor a la palpación, limitación, crepitación de los movimientos con desviación hacia el lado afectado y evidencia radiográfica de cambios estructurales. El mejor manejo de la mayoría de los pacientes con osteoartritis de la articulación temporomandibular es a través de un tratamiento conservador y no invasivo

Actualización en esterilización / Sterilization: up-to date

Los autores presentan una perspectiva general sobre las propiedades, características y condiciones de los métodos de esterilización más usados y de los materiales susceptibles de ser esterilizados