Prevalence of pressure injury and associated factors in hospitalized adult patients with cancer.

INTRODUCTION: Hospitalized cancer patients experience limitations in their daily activities resulting from the severity of their condition. Such changes alter patients' sensory perception and hinder their mobility, thus predisposing them to the development of PI. OBJECTIVE: The goal of this study was to analyze the prevalence of PI and associated factors in hospitalized cancer patients. MATERIALS AND METHODS: This observational, epidemiological, cross-sectional, descriptive study was carried out in the inpatient and ICU settings of an oncological hospital in São Paulo, Brazil. RESULTS: A total of 341 patients who met the inclusion criteria and agreed to participate in the study were interviewed and assessed. Data obtained in the interviews were analyzed for logistic regression analysis. Pressure injury prevalence was 10% (34 patients). The use of disposable diapers was significantly associated with the development of PI, with a 6.077 increased chance of PI in such patients in the ICU setting. In this epidemiologic study of 341 hospitalized cancer patients, the prevalence of PI was 10%. The use of disposable diapers was the only factor associated with the presence of PI after logistic regression analysis. CONCLUSION: Knowing the risk factors of this specific population was essential to implement actions and optimize indications of disposable diaper use. There is an absence of epidemiologic records due to limited publications available on the subject; creating a program to prevent PI development within the inpatient, assisted population.

The prevalence of skin lesions and associated factors in hospitalised adult patients with cancer.

OBJECTIVE: To assess the prevalence of skin lesions and evaluate the clinical and sociodemographic factors associated with their presence in hospitalised patients. METHOD: This descriptive, cross-sectional, correlational study was performed in inpatient units and intensive care units of a cancer hospital in São Paulo, Brazil, after approval by the Institutional Research Ethics Committee. Data from hospitalised adult patients with cancer were collected during physical examinations and from medical records. A Chi-squared test, univariate analysis, a logistic regression model with results expressed as odds ratio (OR) and 95% confidence intervals (CI), and Classification and Regression Tree (CART) analysis were used to evaluate the data. RESULTS: Of 341 patients, 80 had skin lesions, equating to an overall prevalence of 23.5%. The skin lesions included pressure injuries (10%), incontinence-associated dermatitis (6.7%), skin tears (6.5%), malignant wounds (3.8%) and complicated surgical wounds (3.2%). The factors associated with skin lesions in cancer patients were the use of disposable nappies (OR: 4.436) and age (59.1±15.1 years), according to the CART analysis, and the wearing of nappies (OR: 4.466, p<0.001), presence of ecchymosis (OR: 2.532, p<0.001) and infection (OR: 6.449, p=0.040), according to multiple regression analysis. CONCLUSION: This study contributed to knowledge about prevalence and associated factors of skin lesions in hospitalised patients with cancer, allowing the implementation of preventive measures.

The prevalence of skin tears and associated factors in hospitalised patients with cancer.

OBJECTIVE: Oncology patients are vulnerable to skin breakdown. The primary purpose of this study was to estimate the prevalence of skin tears (STs) in hospitalised patients with cancer and to explore related sociodemographic and clinical factors. METHOD: This was an observational, epidemiological, cross-sectional study conducted in an oncology hospital in the city of São Paulo. All STs were classified using the STAR Classification adapted and validated for Brazil. RESULTS: Of the 341 patients evaluated, 22 had STs, equating to a prevalence of 6.5%. A higher number of STs were noted on the lower limbs (26.9%) than on other body areas. The main factors associated with STs were the use of anticoagulants, the presence of ecchymosis and the use of incontinence briefs. CONCLUSION: This study contributed to a better understanding of the epidemiology of STs in hospitalised patients with cancer, as well as its associated factors. Results may inform nursing professionals with regard to the need to develop prevention strategies and early interventions.

Cultural Adaptation and Validation of the Ostomy Adjustment Inventory-23 for Brazil.

The Ostomy Adjustment Inventory-23 (OAI-23) was developed in English to measure the social and psychological adaptation of individuals who underwent ostomy surgeries. PURPOSE: The aim of the current study was to culturally adapt and test the measurement properties of a Brazilian Portuguese adapted version of the OAI-23. METHODS: The original version of the OAI-23 was composed of 23 questions distributed into the following 4 factors: acceptance, anxiety/preoccupation, social engagement, and anger. The OAI-23 was translated into Portuguese, reviewed by a committee of expert reviewers, pretested on a focus group, and back-translated. Using convenience sampling methods, patients who were treated at specialized health centers located in different parts of Brazil were invited to complete a demographic and health history questionnaire, the Janis and Field Self-Esteem Scale, and the adapted version of OAI-23 to assess its reliability, convergent construct validity, and discriminant construct validity. RESULTS: A total of 191 patients with a mean age of 58.9 years (SD = 14.7) (74.1% with colostomies, 19.6% with ileostomies, and 6.3% with urostomies) participated in the study. The Brazilian Portuguese adapted version of the OAI-23 had a Cronbach's alpha coefficient of 0.846 and an intra-class correlation coefficient of 0.903 (P < .001). Significant correlations between OAI-23 scores and self-esteem scale scores confirmed the convergent construct validity, and the instrument was able to discriminate patients' adjustment according to age. CONCLUSION: The adapted version of the OAI-23 proved to be reliable and valid for use in Brazil; this represents the first instrument capable of assessing psychosocial adaptation of patients with stomas in that country.

Effectiveness of the use of non-woven face mask to prevent coronavirus infections in the general population: a rapid systematic review. / Eficácia da máscara facial (TNT) na população para a prevenção de infecções por coronavírus: revisão sistemática.

OBJECTIVES: to evaluate the effectiveness of non-woven face masks for the prevention of respiratory infections (MERS CoV, SARS-CoV, and SARS-CoV-2) in the population. METHODS: search in Medline, Embase, Cinahl, The Cochrane Library, Trip databases. Google Scholar, Rayyan and medRxiv were also consulted for complementary results. No filters related to date, language or publication status were applied. Titles and abstracts were screened, and later, full texts were evaluated. RESULTS: three studies were included: a randomized cluster clinical trial and two systematic reviews. The clinical trial indicates a potential benefit of medical masks to control the source of clinical respiratory disease infection. In one of the systematic reviews, it was not possible to establish a conclusive relationship between the use of the mask and protection against respiratory infection. Finally, another systematic review indicated that masks are effective in preventing the spread of respiratory viruses. CONCLUSION: Evidence points to the potential benefit of standard non-woven face masks. For the current pandemic scenario of COVID-19, education on the appropriate use of masks associated with individual protection measures is recommended.

Eficácia da máscara facial (TNT) na população para a prevenção de infecções por coronavírus: revisão sistemática / Effectiveness of the use of non-woven face mask to prevent coronavirus infections in the general population: a rapid systematic review

Resumo O objetivo deste artigo é avaliar a eficácia das máscaras faciais padrão tecido não tecido (TNT) para a prevenção de doenças respiratórias (MERS CoV, SARS-CoV e SARS-CoV-2) na população. Foi realizada busca nas bases de dados Medline, Embase, Cinahl, The Cochrane Library, Trip. Também busca complementar no Google Acadêmico, Rayyan e medRxiv. Não foram aplicados filtros relacionados a data, idioma ou status de publicação. Títulos e resumos foram rastreados e, posteriormente, textos completos foram avaliados. Foram incluídos três estudos: um ensaio clínico randomizado tipo cluster e duas revisões sistemáticas. O ensaio clínico indica benefício potencial de máscaras médicas para controle da fonte de infecção, para a doença respiratória clínica. Em uma das revisões sistemáticas, não foi possível estabelecer relação conclusiva entre uso da máscara e proteção contra infecção respiratória. Por fim, outra revisão sistemática demonstrou que máscaras são eficazes na prevenção da propagação de vírus respiratórios. As evidências apontam para benefício potencial das máscaras faciais padrão TNT. Para o cenário atual de pandemia por COVID 19, recomenda-se educação sobre uso adequado de máscaras, associado a medidas individuais de proteção.

Abstract Objectives: to evaluate the effectiveness of non-woven face masks for the prevention of respiratory infections (MERS CoV, SARS-CoV, and SARS-CoV-2) in the population. Methods: search in Medline, Embase, Cinahl, The Cochrane Library, Trip databases. Google Scholar, Rayyan and medRxiv were also consulted for complementary results. No filters related to date, language or publication status were applied. Titles and abstracts were screened, and later, full texts were evaluated. Results: three studies were included: a randomized cluster clinical trial and two systematic reviews. The clinical trial indicates a potential benefit of medical masks to control the source of clinical respiratory disease infection. In one of the systematic reviews, it was not possible to establish a conclusive relationship between the use of the mask and protection against respiratory infection. Finally, another systematic review indicated that masks are effective in preventing the spread of respiratory viruses. Conclusion: Evidence points to the potential benefit of standard non-woven face masks. For the current pandemic scenario of COVID-19, education on the appropriate use of masks associated with individual protection measures is recommended.

Out-of-hospital deliveries: A case-control study.

AIM: To identify the factors, risks, and mortality associated with unplanned out-of-hospital births. MATERIAL AND METHODS: This observational, retrospective, case-control study was conducted between 2005 and 2013 through a review of medical records from the hospital network of a county of Brazil. Mother-child dyads were divided into in-hospital births and unplanned out-of-hospital births. For hypothesis testing involving quantitative variables, parametric and nonparametric methods (t-test or Mann-Whitney test, respectively) were used as appropriate after ascertaining normality of distribution via the Kolmogorov-Smirnov or Shapiro-Wilk tests. The chi-square test, Fisher's exact test, odds ratios, and 95% confidence intervals were used to assess the relationship between categorical variables. A binary logistic regression was applied for pooled analysis of those variables that, when analyzed in isolation, had significant p-values on hypothesis testing. In all tests, p-values <0.05 were considered statistically significant. RESULTS: Of the 420 records, 117 corresponded to out-of-hospital births dyads. Mothers were predominantly nonwhite (p<0.001), with a history of inadequate antenatal care (p<0.001), multiparous (p<0.001), aged >25 years (p=0.031), and had more puerperal complications (p<0.001). Their newborns had low birth weight (Odds Ratios: 2.22; 95% CI: [1.4-3.4]; p<0.001), higher morbidity (p=0.009), a higher rate of admission to neonatal intensive care and stepdown units (p=0.030), and prolonged length of stay (p<0.001). CONCLUSION: The risk of maternal and neonatal complications, as well as the neonatal mortality rate, were higher for unplanned out-of-hospital deliveries. It occurred predominantly in nonwhite, older, multiparous women who had received incomplete antenatal care and who lived far from perinatal care centers.

Polyhexanide Versus Metronidazole for Odor Management in Malignant (Fungating) Wounds: A Double-Blinded, Randomized, Clinical Trial.

PURPOSE: The aim of this study was to compare the effects of 0.2% polyhexamethylene biguanide (PHMB) to 0.8% metronidazole on malignant wound (MW) odor, health-related quality of life (HRQOL), and pain upon application. DESIGN: A double-blinded, randomized, clinical trial. SUBJECTS AND SETTING: Twenty-four patients with malodorous MWs hospitalized in a referral cancer center in Sao Paulo, Brazil, participated in the trial. METHODS: Participants were randomly allocated to treatment with 0.8% metronidazole solution (control group) or 0.2% PHMB (experimental group). Study outcomes were measured at baseline (day 0), 4 days, and 8 days. The primary end point was the odor that was measured in terms of its intensity, quality, and impact on participants during the study period. Health-related quality of life was measured with the Ferrans and Powers Quality of Life Index-Wounds Version (FPQLI-WV) on day 0 and on the day when odor was completely eliminated as per evaluation by the investigators. Pain intensity related to application of the control and experimental solutions was measured as a secondary outcome using a scale of 0 to 10. RESULTS: Twenty patients (83.3%) were classified as having "no wound odor" at 4 days, and 100% achieved no wound odor by day 8 (P < .001). Odor control in patients with MW significantly influenced their general HRQOL (P = .002). We found no difference in odor elimination, or HRQOL, when patients managed with PHMB were compared to those managed with metronidazole. There were no statistically significant differences over time in pain measurement between the 2 groups. CONCLUSIONS: Both PHMB and metronidazole significantly reduced odor in malodorous MWs within 4 days. Neither solution was found to be more effective than the other in the magnitude of odor reduction or its effect on condition-specific HRQOL.

[Controlling wound odor with metronidazole: a systematic review]. / Controle do odor de feridas com metronidazol: revisão sistemática.

OBJECTIVE: Verifying the evidence of therapeutic efficacy in the topical application of metronidazole for controlling wound odor. METHODS: A systematic literature review, according to the Cochrane Collaboration recommendations. RESULTS: 329 articles were identified in the Cochrane, LILACS, SciELO, CINAHL and PubMed databases, with 14 of them being included in the final sample. Two of the studies were double-blind randomized clinical trial studies. CONCLUSION: The actual effectiveness of metronidazole in controlling wound odor cannot yet be evidenced due to the absence of strong evidence from studies on the subject, despite clinical practice recommending its benefits.

Controlling wound odor with metronidazole: a systematic review / Control del olor de heridas con metronidazol: revisión sistemática / Controle do odor de feridas com metronidazol: revisão sistemática

AbstractOBJECTIVEVerifying the evidence of therapeutic efficacy in the topical application of metronidazole for controlling wound odor.METHODSA systematic literature review, according to the Cochrane Collaboration recommendations.RESULTS329 articles were identified in the Cochrane, LILACS, SciELO, CINAHL and PubMed databases, with 14 of them being included in the final sample. Two of the studies were double-blind randomized clinical trial studies.CONCLUSIONThe actual effectiveness of metronidazole in controlling wound odor cannot yet be evidenced due to the absence of strong evidence from studies on the subject, despite clinical practice recommending its benefits.

ResumenOBJETIVOVerificar las evidencias de la aplicación tópica de metronidazol en la efectividad terapéutica para el control del olor de heridas.MÉTODORevisión sistemática de literatura, según las recomendaciones de la Cochrane Collaboration.RESULTADOSSe identificaron 329 artículos en las bases de datos Cochrane, LILACS, ScIELO, Cinahl y PubMed, incluyéndose 14 de ellos en la muestra final. De esos, dos estudios son del tipo ensayo clínico, randomizado y doble ciego.CONCLUSIÓNEn virtud de la ausencia de estudios de fuerte evidencia acerca de la efectividad del metronidazol en el control del olor en heridas, aún no se puede evidenciar su real efectividad para dicho fin, pese a que la práctica clínica recomiende sus beneficios.

ResumoOBJETIVOVerificar as evidências da aplicação tópica de metronidazol na eficácia terapêutica para controle de odor de feridas. Método: Revisão sistemática de literatura, segundo as recomendações da Cochrane Collaboration .RESULTADOSIdentificaram-se 329 artigos nas bases de dados Cochrane, LILACS, ScIELO, Cinahl e PubMed, incluindo-se 14 deles na amostra final. Desses, dois estudos são do tipo ensaio clínico, randomizado e duplo-cego.CONCLUSÃODevido à ausência de estudos de forte evidência sobre a eficácia do metronidazol no controle de odor em feridas, ainda não se pode evidenciar a sua real eficácia para tal objetivo, apesar da prática clínica recomendar seus benefícios.

Verificação da qualidade microbiológica e das condições de acondicionamento do arroz cozido no ambiente doméstico / Verification of microbiological quality and storage conditions of cooked rice in the domestic use

o objetivo geral da presente pesquisa foi analisar a qualidade microbiológica do arroz de uso doméstico em diferentes condições no pós-preparo. De acordo com orientação da legislação brasileira, foram realizados ensaios microbiológicos para detecção de B. cereus, Estafilococos coagulase positiva e Salmonella sp. Adicionalmente, analisaram-se aeróbios mesófilos e psicrotróficos e bolores/leveduras. Os resultados encontrados estavam dentro dos padrões de qualidade exigidos pela legislação e literatura, sendo as condições de acondicionamento seguras em relação ao aspecto higienicossanitário. (AU)

The overall objective of this research was to analyze the microbiological quality of rice for domestic use in different conditions in the post-preparation. Under guidance of Brazilian legislation, microbiological assays for detection of B. cereus, coagulase positive Staphylococcus and Salmonella were performed. Additionally, we analyzed aerobic mesophilic and psychrotrophic, fungi/yeast. The results were within the quality standards required by law and literature, and safe conditions of packaging in relation to the hygienic and sanitary aspects. (AU)

Qualidade e segurança microbiológica de derivados lácteos fermentados de origem bovina produzidos no Distrito Federal, Brasil / Quality and microbiological safety of fermented bovine dairy produced in Federal District, Brazil

Considerando a crescente importância dos derivados lácteos fermentados no mercado nacional e a escassez de dados no Distrito Federal (DF), foi avaliada a qualidade e a segurança microbiológica destes produtos no DF e sua adequação aos padrões vigentes. O estudo foi desenvolvido em cinco laticínios sendo coletadas 105 amostras de derivados lácteos fermentados correspondentes a 21 lotes (n=5 por lote), com 65 amostras de iogurte, 20 de coalhada e 20 de bebida láctea fermentada. Todas as amostras foram submetidas à contagem de aeróbios mesófilos, psicrotróficos, coliformes a 35°C, Escherichia coli, Staphylococcus coagulase positivo, Salmonella spp., bolores, leveduras e bactérias ácido-láticas viáveis (BAL). Do total de lotes analisados, 62% foram considerados aceitáveis segundo as Instruções Normativas n° 46/2007 e n° 16/2005. Em ordem de qualidade, a bebida láctea fermentada foi a que apresentou mais lotes aptos ao consumo (75%), seguido do iogurte (61,5%) e, por último, da coalhada (50%). Por unidades amostrais, os resultados demonstraram que: 17% amostras de iogurtes, 15% de coalhada e 20% de bebida láctea fermentada apresentaram contagens de CT acima do permitido; 11% amostras de iogurtes e 30% de bebida láctea fermentada apresentaram contagens de BAL abaixo dos limites mínimos específicos; e 61% amostras de iogurtes e 30% de coalhada estavam com contagens de bolores e leveduras acima do permitido. Nenhuma amostra apresentou desenvolvimento de E. coli ou de Salmonella spp. Apesar da ausência de perigos microbiológicos nas amostras analisadas, o estudo realizado indica problemas na produção desses derivados no DF que podem estar relacionadas a deficiências na higiene dos processos, sendo necessário maior rigor nos controles de qualidade dos laticínios e na fiscalização das indústrias.(AU)

Considering the growing importance of fermented dairy products in the domestic market and the scarcity of data in the Federal District (DF), it was evaluated the quality and microbiological safety of these products in the DF and its adaptation to current standards. The study was conducted in five dairy being collected 105 samples of fermented dairy products corresponding to 21 lots (n = 5 per lot), with 65 samples of yogurt, 20 of curd and 20 of fermented dairy drink. All samples were submitted to a count of aerobic mesophilic, psychrotrophic, coliforms at 35 ° C, Escherichia coli, Staphylococcus coagulase positive, Salmonella spp., molds, yeasts and viable lactic acid bacteria (BAL). The total lots analyzed, 62% were considered acceptable under the Regulatory Instructions n ° 46/2007 and n ° 16/2005. In order of quality, fermented dairy drink was the one with lots more apt to consumption (75%) followed by yoghurt (61.5%) and, lastly, curd (50%). For samples units, the results showed that: 17% of yoghurt samples, 15% of curd and 20% of fermented dairy drink showed scores above the allowed CT; 11% of yoghurt samples and 30% of fermented dairy drink showed BAL counts below specific minimum limits; and 61% samples of yogurt and curd were 30% of curd was with yeasts and molds counts above permitted. No samples showed the development of E. coli or Salmonella spp. Despite the absence of microbiological hazards in the samples analyzed, the study indicates problems in the production of these products in the DF that may be related to deficiencies in hygienic of the processes, most rigor in the quality controls of dairy and oversight of industries is needed.(AU)

[CT scanners in the Brazilian Unified National Health System: installed capacity and utilization]. / Capacidade de produção e grau de utilização de tomógrafo computadorizado no Sistema Único de Saúde.

This study analyzes the supply and use of computed tomography scanners (CT) in the Brazilian Unified National Health System (SUS) according to State and administrative levels in the year 2009. Secondary data were used to estimate the installed CT capacity in public healthcare facilities and in private services outsourced by the SUS and calculated the rate of utilization. Average national CT utilization was less than 10%. The public sector showed lower CT use than the private sector outsourced by the SUS. The number of CT tests in the SUS was less than half the number produced in developed countries. The results thus suggest the need for further studies on management practices with high-technology equipment in order to improve allocation of current and future public resources in supplying CT tests.

Capacidade de produção e grau de utilização de tomógrafo computadorizado no Sistema Único de Saúde / CT scanners in the Brazilian Unified National Health System: installed capacity and utilization / Capacidad de producción y grado de utilización del tomógrafo computarizado en el Sistema Único de Salud brasileño

O objetivo deste estudo foi analisar a distribuição da oferta da tomografia computadorizada e o grau de utilização do tomógrafo computadorizado (TC) no Sistema Único de Saúde (SUS), por estado e esfera administrativa, no ano de 2009. Utilizando dados secundários, estimou-se a capacidade de produção dos tomógrafos públicos e privados disponíveis ao SUS e calculou-se o grau de utilização dos mesmos. Os resultados mostraram que o grau de utilização dos TCs dos prestadores SUS possui uma média nacional abaixo de 10% e que o setor público tem o menor grau de utilização do TC, em comparação com o setor privado conveniado ao SUS. Foi observado que a produção de exames por TC no SUS é menor do que a metade da produção obtida em países desenvolvidos. Assim, os resultados sugerem a necessidade de um aprofundamento nos estudos das práticas de gestão tecnológica desses equipamentos, uma vez que é possível uma melhor alocação dos recursos públicos necessários à produção de tomografias computadorizadas.

This study analyzes the supply and use of computed tomography scanners (CT) in the Brazilian Unified National Health System (SUS) according to State and administrative levels in the year 2009. Secondary data were used to estimate the installed CT capacity in public healthcare facilities and in private services outsourced by the SUS and calculated the rate of utilization. Average national CT utilization was less than 10%. The public sector showed lower CT use than the private sector outsourced by the SUS. The number of CT tests in the SUS was less than half the number produced in developed countries. The results thus suggest the need for further studies on management practices with high-technology equipment in order to improve allocation of current and future public resources in supplying CT tests.

El objetivo de este estudio fue analizar la distribución de la oferta de tomografía computarizada y el grado de utilización del tomógrafo computarizado (TC) en el Sistema Único de Salud (SUS) brasileño, en los diferentes estados y niveles administrativos, durante 2009. Se utilizaron datos secundarios, se evaluó la capacidad de producción de tomógrafos públicos y privados, disponibles para el SUS, y se calculó el grado de utilización de los mismos. Los resultados mostraron que la utilización de los tomógrafos contratados por el SUS tienen un promedio nacional menor al 10% y que el sector público tiene un menor grado de utilización del TC, en comparación con el sector privado contratado por el SUS. Se observó que la producción de exámenes por TC en el SUS es menor que la mitad de la producción observada en los países desarrollados. De esta forma, los resultados sugieren la necesidad de profundizar en las investigaciones sobre prácticas de gestión de esos equipos, ya que puede ser posible una mejor utilización de los recursos públicos necesarios para la producción de tomografías computarizadas.

Controle do odor de feridas neoplásicas malignas com metronidazol: revisão sistemática / Metronidazole for odor control in malignant wounds: systematic review

Introdução: Feridas neoplásicas malignas (FNM) são resultantes da invasão direta do câncer na pele que, ao se exteriorizarem, adquirem características de ferida. Com incidência variando de 0,6 a 9,0%, são mais comuns nos cânceres de mama e cabeça e pescoço. Dentre os sinais e sintomas, destaca-se o odor que tem sido descrito como intolerável e nauseante, acarretando impacto negativo sobre o paciente, familiares e equipe de saúde. O odor em FNM ocorre em consequência da interação das microbiotas aeróbica e anaeróbica que colonizam e infectam as feridas. Objetivando reduzir a carga microbiana local e, assim, controlar o odor, tem-se descrito o uso de antissépticos e antibióticos tópicos, dentre os quais destaca-se o metronidazol. Objetivo: Identificar as evidências científicas sobre a utilização do metronidazol para controle do odor em FNM, por meio de revisão sistemática (RS) de ensaios clínicos controlados e não controlados. Método: A partir da questão norteadora do estudo: Qual a eficácia da terapia tópica de metronidazol para o controle do odor em feridas neoplásicas malignas?, realizou-se a busca dos artigos nas bases de dados BIREME, LILACS, COCHRANE, CINAHL e EMBASE, com auxílio da estratégia PICO, utilizando-se descritores indexados e não indexados. Os estudos foram selecionados por duas pesquisadoras de forma independente e os estudos incluídos na RS foram analisados segundo o enunciado CONSORT, grau de recomendação e nível de evidência. Para o estudo randomizado utilizou-se também a Escala de Jadad. Resultados: Recuperaram-se 384 artigos, sendo selecionados 14 para leitura na íntegra, sendo incluídos, ao final, apenas três estudos na RS.Destes, um estudo é randomizado (grau de evidência e recomendação = 2b, Jadad = 2) e dois não são controlados (grau de evidência 4 para ambos). Quanto ao método de avaliação e/ou classificação do odor, não se identificou um instrumento formal, sendo empregada apenas escala analógica de 0 a 10 ou presença/ausência de odor. O tempo necessário para o emprego da terapia tópica foi de 1 a 14 dias, com troca do curativo 1 ou 2 vezes ao dia; e a aplicação do metronidazol foi em gel de 0,75% a 0,8%. Os estudos não mencionaram ou descreveram reações adversas. Os estudos apresentam limitações e fragilidades metodológicas importantes, destacando-se as amostras reduzidas e a falta de descrição de aspectos como o cegamento e randomização no único estudo randomizado, além dos procedimentos empregados nos curativos, dentre outros. Conclusão: Apesar dos três estudos concluírem que o metronidazol tópico é eficaz no controle do odor em FNM, não há forte evidência científica para corroborar essa eficácia.

Introduction: Malignant wounds (MW) are the result of direct invasion of cancer in the skin that, when exteriorized, acquire characteristics of the wound. With an incidence ranging from 0.6 to 9.0%, are more common in breast and head and neck . Among the signs and symptoms, there is the odor that has been described as intolerable and sickening, causing negative impact on the patient, family and healthcare team. The MW odor occurs as a result of the interaction of aerobic and anaerobic bacteria that colonize and infect wounds. In order to reduce local microbial load and thus control the odor, there has been described the use of topical antiseptics and antibiotics, among which stands out metronidazole. Objective: To identify the scientific evidence on the use of metronidazole for odor control in MW, through systematic review (SR) of randomized controlled trials and uncontrolled. Method: From the main question of the study: \"What is the efficacy of topical metronidazole therapy for odor control in malignant neoplastic wounds,\" there was the search for articles in the databases MEDLINE, LILACS, Cochrane Library, CINAHL database and EMBASE, using the PICO strategy, using descriptors indexed and unindexed. Studies were selected by two researchers independently and studies included in the RS were analyzed according to the CONSORT statement, strength of recommendation and level of evidence. For the randomized study also used the Jadad Scale. Results: 384 articles were recovered, 14 were selected for full reading, being included in the end, only three studies in SR. Of these, a study is randomized (level of evidence and recommendation= 2b, Jadad= 2) and two are not controlled (evidence grade 4 for both). As to the method of assessment and / or classification of odor, did not identify a formal instrument, being used only analog scale of 0 to 10, or the presence / absence of odor.The time required for the use of topical therapy was 1 to 14 days, with change of the dressing 1 or 2 times a day, and the application of metronidazole was 0.75% gel 0.8%. Studies have not mentioned or described adverse reactions. The studies have important methodological limitations and weaknesses, highlighting the small sample size and lack of description of aspects such as blinding and randomization in the only randomized, besides the procedures used in dressings, among others. Conclusion: Although the three studies conclude that topical metronidazole is effective in controlling odor in MW, there is no strong scientific evidence to support its effectiveness.

Qualidade e segurança microbiológica de derivados lácteos fermentados de origem bovina produzidos no Distrito Federal, Brasil / Quality and microbiological safety of fermented bovine dairy produced in Federal District, Brazil

Considerando a crescente importância dos derivados lácteos fermentados no mercado nacional e a escassez de dados no Distrito Federal (DF), foi avaliada a qualidade e a segurança microbiológica destes produtos no DF e sua adequação aos padrões vigentes. O estudo foi desenvolvido em cinco laticínios sendo coletadas 105 amostras de derivados lácteos fermentados correspondentes a 21 lotes (n=5 por lote), com 65 amostras de iogurte, 20 de coalhada e 20 de bebida láctea fermentada. Todas as amostras foram submetidas à contagem de aeróbios mesófilos, psicrotróficos, coliformes a 35°C, Escherichia coli, Staphylococcus coagulase positivo, Salmonella spp., bolores, leveduras e bactérias ácido-láticas viáveis (BAL). Do total de lotes analisados, 62% foram considerados aceitáveis segundo as Instruções Normativas n° 46/2007 e n° 16/2005. Em ordem de qualidade, a bebida láctea fermentada foi a que apresentou mais lotes aptos ao consumo (75%), seguido do iogurte (61,5%) e, por último, da coalhada (50%). Por unidades amostrais, os resultados demonstraram que: 17% amostras de iogurtes, 15% de coalhada e 20% de bebida láctea fermentada apresentaram contagens de CT acima do permitido; 11% amostras de iogurtes e 30% de bebida láctea fermentada apresentaram contagens de BAL abaixo dos limites mínimos específicos; e 61% amostras de iogurtes e 30% de coalhada estavam com contagens de bolores e leveduras acima do permitido. Nenhuma amostra apresentou desenvolvimento de E. coli ou de Salmonella spp. Apesar da ausência de perigos microbiológicos nas amostras analisadas, o estudo realizado indica problemas na produção desses derivados no DF que podem estar relacionadas a deficiências na higiene dos processos, sendo necessário maior rigor nos controles de qualidade dos laticínios e na fiscalização das indústrias.

Considering the growing importance of fermented dairy products in the domestic market and the scarcity of data in the Federal District (DF), it was evaluated the quality and microbiological safety of these products in the DF and its adaptation to current standards. The study was conducted in five dairy being collected 105 samples of fermented dairy products corresponding to 21 lots (n = 5 per lot), with 65 samples of yogurt, 20 of curd and 20 of fermented dairy drink. All samples were submitted to a count of aerobic mesophilic, psychrotrophic, coliforms at 35 ° C, Escherichia coli, Staphylococcus coagulase positive, Salmonella spp., molds, yeasts and viable lactic acid bacteria (BAL). The total lots analyzed, 62% were considered acceptable under the Regulatory Instructions n ° 46/2007 and n ° 16/2005. In order of quality, fermented dairy drink was the one with lots more apt to consumption (75%) followed by yoghurt (61.5%) and, lastly, curd (50%). For samples units, the results showed that: 17% of yoghurt samples, 15% of curd and 20% of fermented dairy drink showed scores above the allowed CT; 11% of yoghurt samples and 30% of fermented dairy drink showed BAL counts below specific minimum limits; and 61% samples of yogurt and curd were 30% of curd was with yeasts and molds counts above permitted. No samples showed the development of E. coli or Salmonella spp. Despite the absence of microbiological hazards in the samples analyzed, the study indicates problems in the production of these products in the DF that may be related to deficiencies in hygienic of the processes, most rigor in the quality controls of dairy and oversight of industries is needed.

Evidence on the use of platelet-rich plasma for diabetic ulcer: a systematic review.

The aim of topical wound treatment is to favor efficient, rapid, and safe healing. The platelet-rich plasma (PRP) has been used for wound treatment since it contains various platelet growth factors. The objective of the present study was to collect evidence regarding the use of PRP for the topical treatment of chronic leg ulcers. For this purpose, a systematic review of the literature was performed according to the steps recommended by the Cochrane Collaboration with studies published until July 2008. Among 18 selected studies, 7 (39%) of these studies were randomized clinical. Five of the seven randomized clinical trials studied ulcers of diabetic etiology. The results of meta-analysis showed that PRP favors the healing process (95% CI: 2.94-20.31). In conclusion, the present systematic review and meta-analysis show that there is a scientific evidence regarding favorable outcomes of the use of PRP for the treatment of diabetic ulcer.

Terapia tópica de úlceras crônicas de perna com plasma rico em plaquetas - PRP: revisão sistemática da literatura / The tropical treatment on leg chronic ulcer with platelet rich plasma: a systematic review

O tratamento tópico de feridas visa favorecer um processo de cicatrização eficaz, rápido e seguro. Como uma das opções, o Plasma Rico em Plaquetas – PRP - um concentrado de plaquetas obtido por meio de centrifugação sanguínea ou aférese, vem sendo também utilizado no tratamento de feridas por conter os fatores de crescimento plaquetários. Visto que se trata de uma terapia inovadora, este estudo objetivou buscar as evidências sobre o seu uso na terapia tópica de feridas crônicas de perna. Para tanto, realizou-se revisão sistemática de literatura, seguindo-se as etapas preconizadas pela Colaboração Cochrane. Os estudos foram levantados até 2006, por meio dos descritores platelet rich plasma, platelet derived growth factor, platelet gel, platelet releasate, platelet lysate, CT-102 activated supernatant, wound healing, chronic wound, foot ulcer, diabetic foot, e varicose ulcer, utilizando diferentes combinações, conforme a base de dados consultada (Cochrane, PubMed, Lilacs, Embase e Cinahal). Para a análise da validade interna dos estudos, empregaram-se: a Escala de Jadad, Escala de Avaliação do Grau de Recomendação e Evidência e Escala de Avaliação do Controle das Variáveis. De 56 estudos pré-selecionados, chegou-se à amostra de 18 ensaios clínicos, indexados, principalmente, no PubMed/ Medline (17 / 94,5%), originários dos EUA (12 / 66,6%) e publicados em língua inglesa. Desses, sete (39%) eram ensaios clínicos randomizados, que obtiveram forte recomendação (A) e nívelde evidência alto. A partir das metanálises desses ensaios randomizados, em diferentes combinações, os resultados mostraram que o PRP favorece o processo de cicatrização (IC95% 1,84 - 7,41), principalmente em úlceras diabéticas (IC95% 2,94 - 20,31), e quando utilizado como CT-102 (IC95% 2,70-41,40). Concluindo, esta revisão sistemática e metanálise mostram que há evidências científicas sobre os ) resultados favoráveis do uso do PRP em feridas crônicas de perna, principalmente as de etiologia diabética.

The wound topical treatment stimulates an effective, fast and safe wound healing. The platelet rich plasma (PRP) – a concentrated of platelets obtained from centrifugation or single apheresis, has been used as the treatment of wounds because it contains platelet derived growth factor. Being a new therapy, the aim of this study is to show some evidence about the effectiveness of PRP on the healing of chronic wound leg. To this test, a systematic review was conducted, as the recommendation of the Cochrane Library. The studies were screened until 2006 using some key words: platelet rich plasma, platelet derived growth factor, platelet gel, platelet releasate, platelet lysate, CT-102 activated supernatant, wound healing, chronic wound, foot ulcer, diabetic foot, and varicose ulcer; with different combinations, according to data base (Cochrane, PubMed, Lilacs, Embase e Cinahal). From 56 studies, 18 were clinical trials, specially found in PubMed (17 / 94,5%), originated in USA (12 / 66,6%) and published in English. Seven (39%) were clinical trials randomized , classified as a strong recommendation (A) with high evidence level. The meta-analysis of these randomized trials, shows the PRP promotion in wound healing (CI 95% 1,84-7,41), mainly in diabetic ulcer (CI 95% 2,70-41,40). To sum up, this study provides a scientific evidence on repair of chronic wound leg, mainly diabetic ulcer, using PRP.