Prehospital blood transfusion in Brazil: results of the first year of implementation in an emergency medical service.

INTRODUCTION: Hemorrhagic shock is the main cause of death in the prehospital environment, which highlights the need to standardize measures aiming at bleeding control and volume replacement in this environment. In Brazil, the first prehospital packed red blood cell transfusion service started in September 2020, in Bragança Paulista, state of São Paulo. OBJECTIVES: Describe the trends and characteristics of patients who received prehospital transfusions prior to hospital treatment during the first year of operation. METHODS: A retrospective data review was made of all patients who received transfusions from the mobile intensive care unit in Bragança Paulista over one year. RESULTS: In this period, 19 patients were transfused. Since activation, the average response time was 20 min. The mean shock indexes before and after blood transfusion were 2.16 and 1.1, respectively. During the course of the 1st year of prehospital transfusions, no blood was wasted and there were no adverse effects. CONCLUSION: Introduction of the prehospital packed red blood cell transfusion service was successful, with significant improvement in hemodynamic parameters.

Development and Characterization of High-Absorption Microencapsulated Organic Propolis EPP-AF® Extract (i-CAPs).

The demand for organic and functional food continues to increase yearly. Among the available functional foods, propolis is a bee product that has various beneficial properties, including antimicrobial, antioxidant, and anti-inflammatory activities. However, it generally is only available in ethanol solution, which has poor bioavailability, as it is relatively insoluble in water. The use of such ethanol extracts is often objectionable because of the alcohol content and because they have a strong and striking taste. Development of alternatives that can efficiently and safely increase solubility in water, and that meet organic production specifications, has been a challenge. To address these concerns, microcapsules were developed using spray-dryer technology from an emulsion based on EPP-AF® propolis and gum arabic (i-CAPS). These propolis-loaded microcapsules were characterized using FT-IR, SEM, TGA, HPLC, and spectrophotometric techniques, along with determination of antimicrobial, antioxidant, antitumor, anti-inflammatory, and antihypercholesterolemic activities, as well as permeability in in vitro models. The production system resulted in microcapsules with a spherical shape and an encapsulation efficiency of 93.7 ± 0.7%. They had IC50s of 2.654 ± 0.062 and 7.342 ± 0.058 µg/mL by FRAP and DPPH antioxidant methods, respectively. The EPP-AF® i-CAPS also had superior antimicrobial activity against Gram-positive bacteria. Antitumor activity was calculated based on the concentration that inhibited 50% of growth of AGS, Caco-2, and MCF-7 cell strains, giving results of 154.0 ± 1.0, 117 ± 1.0, and 271.0 ± 25 µg/mL, respectively. The microcapsule presentation reduced the permeation of cholesterol by 53.7%, demonstrating antihypercholesterolemic activity, and it improved the permeability of p-coumaric acid and artepillin C. The IC50 for NO production in RAW 264.7 cells was 59.0 ± 0.1 µg/mL. These findings demonstrate the potential of this new propolis product as a food and pharmaceutical ingredient, though additional studies are recommended to validate the safety of proposed dosages.

Leveraging Plasma Membrane Repair Therapeutics for Treating Neurodegenerative Diseases.

Plasma membrane repair is an essential cellular mechanism that reseals membrane disruptions after a variety of insults, and compromised repair capacity can contribute to the progression of many diseases. Neurodegenerative diseases are marked by membrane damage from many sources, reduced membrane integrity, elevated intracellular calcium concentrations, enhanced reactive oxygen species production, mitochondrial dysfunction, and widespread neuronal death. While the toxic intracellular effects of these changes in cellular physiology have been defined, the specific mechanism of neuronal death in certain neurodegenerative diseases remains unclear. An abundance of recent evidence indicates that neuronal membrane damage and pore formation in the membrane are key contributors to neurodegenerative disease pathogenesis. In this review, we have outlined evidence supporting the hypothesis that membrane damage is a contributor to neurodegenerative diseases and that therapeutically enhancing membrane repair can potentially combat neuronal death.

Antimicrobial Formulation of a Bacterial Nanocellulose/Propolis-Containing Photosensitizer for Biomedical Applications.

With the aim of contributing to the development of more efficient materials for wound care, new topical formulations based on bacterial nanocellulose (BNC) hydrogels containing propolis were produced. Characterizations confirmed the incorporation of propolis into the BNC matrix, maintaining its structure and properties. Rheological analysis confirmed that the hydrogels showed thixotropic behavior appropriate for topical application. Chromatographic profiles showed sustained release of propolis biomarkers for at least 20 h. The formulations did not present mutagenicity. For application in photodynamic inactivation (PDI), BNC/propolis hydrogels were prepared with the photosensitizers methylene blue (MB). Spectroscopy and confocal fluorescence microscopy confirmed the interaction of MB and propolis in BNC hydrogels, as well as the formation of a new composite material. In the antibacterial assays, formulations containing MB and propolis significantly reduced Staphylococcus aureus growth. In the presence of light, BNC/MB hydrogels completely inhibited the microorganism. Therefore, the results suggest potential materials for the prevention or treatment of Staphylococcus aureus infections in wounds.

Review of Bacterial Nanocellulose as Suitable Substrate for Conformable and Flexible Organic Light-Emitting Diodes.

As the development of nanotechnology progresses, organic electronics have gained momentum in recent years, and the production and rapid development of electronic devices based on organic semiconductors, such as organic light-emitting diodes (OLEDs), organic photovoltaic cells (OPVs), and organic field effect transistors (OFETs), among others, have excelled. Their uses extend to the fabrication of intelligent screens for televisions and portable devices, due to their flexibility and versatility. Lately, great efforts have been reported in the literature to use them in the biomedical field, such as in photodynamic therapy. In tandem, there has been considerable interest in the design of advanced materials originating from natural sources. Bacterial nanocellulose (BNC) is a natural polymer synthesized by many microorganisms, notably by non-pathogenic strains of Komagataeibacter (K. xylinus, K. hansenii, and K. rhaeticus). BNC shows distinct physical and mechanical properties, including its insolubility, rapid biodegradability, tensile strength, elasticity, durability, and nontoxic and nonallergenic features, which make BNC ideal for many areas, including active and intelligent food packaging, sensors, water remediation, drug delivery, wound healing, and as conformable/flexible substrates for application in organic electronics. Here, we review BNC production methods, properties, and applications, focusing on electronic devices, especially OLEDs and flexible OLEDs (FOLEDs). Furthermore, we discuss the future progress of BNC-based flexible substrate nanocomposites.

Cuidados de enfermagem e manifestações clínicas de gestantes HIV positivo: revisão da literatura / Nursing care and clinical manifestations of hiv positive pregnant women: literature review / Atención de enfermería y manifestaciones clínicas de mujeres embarazadas positivas al vih: revisión de la literatura

Objetivo: identificar os cuidados de enfermagem necessários às gestantes com HIV partindo das manifestações clínicas encontradas em revisão da literatura. Método: revisão na literatura realizada na Biblioteca Virtual de Saúde e na Medline/Pubmed, entre abril e junho do ano 2021.Resultados: quanto aos cuidados de enfermagem 24(50%) referiram acompanhar e orientar no tratamento da terapia antirretroviral; 14(29,2%) orientar quanto aos cuidados; principal manifestação clínica/alteração com 13(27%) foi o medo do julgamento, transmissão vertical, efeitos da terapia antirretroviral, de morrer, de infecções oportunistas, estigma, discriminação, complicação obstétrica. Quanto aos diagnósticos de enfermagem destaca-se o medo relacionado a cenário pouco conhecido evidenciado por apreensão, sensação de medo e foco direcionado para a fonte do medo. Conclusão: os cuidados de enfermagem direcionados a gestante diagnosticada com HIV contribuirão para uma assistência mais assertiva, eficaz, inclusiva e respeitosa.

Objective: to identify the necessary nursing care for pregnant women with HIV based on clinical manifestations found in a literature review. Method: literature review conducted in the Virtual Health Library and Medline/Pubmed, between April and June 2021. Results: regarding nursing care, 24 (50%) reported following and guiding the treatment of antiretroviral therapy; 14(29.2%) provide guidance regarding care; main clinical manifestation/alteration with 13 (27%) was fear of judgment, vertical transmission, effects of antiretroviral therapy, dying, opportunistic infections, stigma, discrimination, obstetric complications. As for the nursing diagnoses, the fear related to a little-known scenario, evidenced by apprehension, feeling of fear and focus directed to the source of fear stands out. Conclusion: nursing care aimed at pregnant women diagnosed with HIV will contribute to a more assertive, effective, inclusive and respectful care.

Objetivo: identificar los cuidados de enfermería necesarios para la gestante con VIH, a partir de las manifestaciones clínicas encontradas en una revisión de la literatura. Método: revisión de la literatura realizada en la Biblioteca Virtual en Salud y Medline / Pubmed, entre abril y junio de 2021. Resultados: en el cuidado de enfermería, 24 (50%) refirieron seguir y orientar el tratamiento de la terapia antirretroviral; 14 (29,2%) brindan orientación sobre la atención; La principal manifestación / alteración clínica con 13 (27%) fue miedo al juicio, transmisión vertical, efectos de la terapia antirretroviral, muerte, infecciones oportunistas, estigma, discriminación, complicaciones obstétricas. En cuanto a los diagnósticos de enfermería, destaca el miedo relacionado con un escenario poco conocido, evidenciado por aprensión, sentimiento de miedo y enfoque dirigido a la fuente del miedo. Conclusión: la atención de enfermería dirigida a la gestante diagnosticada con VIH contribuirá a una atención más asertiva, eficaz, inclusiva y respetuosa.

Aspectos dos cuidados de enfermagem frente as minorias sexuais e de gênero: revisão da literatura / Aspects of nursing care in front of sexual and gender minorities: literature review / Aspectos de la atención de enfermería frente a las minorías sexuales y de género: revisión de la literatura

Objetivo: descrever cuidados de enfermagem frente às minorias sexuais e de gênero com base em revisão da literatura. Método: pesquisa de revisão da literatura realizada nos meses de julho a outubro do ano 2021, na Biblioteca Virtual em Saúde, com amostra de 93 artigos. Resultados: os cuidados de enfermagem as minorias sexuais e de gênero devem incluir: conhecer, implementar e ter políticas públicas, protocolos, encaminhamentos e fluxos bem estabelecidos, resolutivos e não discriminatórios, facilitando o acesso a todos os níveis de atendimento à saúde; criar um ambiente acolhedor, seguro e inclusivo em todos os ambientes do serviço de saúde; criar grupos de apoio abordando saúde, direitos, empreendedorismo, educação; notificar e assistir a vítima de violência; ensinar, capacitar e treinar profissionais/estudantes de enfermagem. Conclusão: a enfermagem deve estar capacitada para atender de forma respeitosa, humana e livre de julgamentos.

Objective: to describe nursing care for sexual and gender minorities based on a literature review. Method: literature review research carried out from July to October 2021, in the Virtual Health Library, with a sample of 93 articles. Results: nursing care for sexual and gender minorities should include: knowing, implementing and having public policies, protocols, referrals and well-established, resolute and non-discriminatory flows, facilitating access to all levels of health care; create a welcoming, safe and inclusive environment in all health service settings; create support groups addressing health, rights, entrepreneurship, education; notify and assist the victim of violence; teach, train and train nursing professionals/students. Conclusion: nursing must be able to provide care in a respectful, humane and judgment-free way.

Objetivo: describir el cuidado de enfermería a las minorías sexuales y de género a partir de una revisión de la literatura. Método:investigación de revisión de literatura realizada de julio a octubre de 2021, en la Biblioteca Virtual en Salud, con una muestra de 93 artículos. Resultados: la atención de enfermería a las minorías sexuales y de género debe incluir: conocer, implementar y disponer de políticas públicas, protocolos, derivaciones y flujos bien establecidos, resolutivos y no discriminatorios, facilitando el acceso a todos los niveles de atención en salud; crear un entorno acogedor, seguro e inclusivo en todos los entornos de servicios de salud; crear grupos de apoyo que aborden la salud, los derechos, el espíritu empresarial, la educación; notificar y asistir a la víctima de la violencia; enseñar, capacitar y capacitar a profesionales/estudiantes de enfermería. Conclusión: la enfermería debe ser capaz de brindar cuidados de forma respetuosa, humana y libre de juicios.

Evolução da cicatrização de lesões por pressão em tratamento com hidrogel à base de biopolímeros / Evolution of wound healing by pressure in biopolymer hydrogel treatment / Evolución de la cicatrización de lesiones por presión en el tratamiento con hidrógel de biopolímero

Introdução: Lesões por pressão têm evolução geralmente rápida, podem levar ao desenvolvimento de infecções de partes moles e demandam tratamento específico e prolongado. Objetivo: Avaliar a eficácia do hidrogel à base de celulose bacteriana no processo cicatricial de lesões por pressão. Material e Método: Estudo descritivo, observacional e prospectivo de abordagem quantitativa. Amostra composta de três pacientes com lesões por pressão de estágios III e IV, atendidos pela Secretaria de Saúde numa cidade do interior paulista. Os dados foram coletados de junho a julho de 2019 e as lesões avaliadas semanalmente. No tratamento se utilizou cobertura de hidrogel à base de celulose bacteriana, para a avaliação do processo cicatricial utilizou-se a escala de Bates-Jensen Wound Assessment Tool e as Classificações dos Resultados de Enfermagem. Os dados foram analisados pelo programa Excel. Parecer 3.337.831. Resultados: A evolução cicatricial mostrou-se adequada e significativa a cada visita, diminuindo o escore da maioria dos indicadores analisados. Conclusão: Todas as lesões apresentaram desbridamento autolítico, facilitando a remoção dos tecidos desvitalizados, além de diminuir o tamanho e a profundidade ao promover o desenvolvimento de tecido de granulação.(AU)

Introduction: Pressure injuries have generally rapid evolution, may lead to the development of soft tissue infections and require specific and prolonged treatment. Objective: To evaluate the effectiveness of hydrogel based on bacterial cellulose in the cicatricial process of pressure injuries. Material and Method: Descriptive, observational and prospective study of quantitative approach. A composite sample of three patients with stage III and IV pressure injuries, attended by the Department of Health in a city in the interior of the state of São Paulo. Data were collected from June to July 2019 and lesions were evaluated weekly. The treatment used hydrogel coverage based on bacterial cellulose, the Bates-Jensen Wound Assessment Tool and the Classification of Nursing Results were used to evaluate the cicatricial process. The data were analyzed by the Excel program. Results: The cicatricial evolution was adequate and significant at each visit, decreasing the score of most indicators analyzed. Conclusion: All lesions presented autolytic debridement, facilitating the removal of devitalized tissues, besides decreasing the size and depth while promoting the development of granulation tissue.(AU)

Introducción: Las lesiones por presión tienen una evolución generalmente rápida, pueden conducir al desarrollo de infecciones de tejidos blandos y requieren un tratamiento específico y prolongado. Objetivo: Evaluar la efectividad del hidrogel a base de celulosa bacteriana en el proceso de curación de lesiones por presión. Material y método: Estudio descriptivo, observacional y prospectivo con enfoque cuantitativo. Muestra compuesta por tres pacientes con lesiones por presión estadios III y IV, atendidos por el Departamento de Salud de una ciudad del interior de São Paulo. Los datos se recopilaron de junio a julio de 2019 y las lesiones se evaluaron semanalmente. En el tratamiento se utilizó una cubierta de hidrogel a base de celulosa bacteriana y la valoración del proceso de cicatrización mediante la Herramienta de Evaluación de Heridas Bates-Jensen y las Clasificaciones de Resultados de Enfermería. Datos analizados por el programa Excel. Opinión 3.337.831. Resultados: La evolución de la cicatrización se mostró adecuada y significativa en cada visita, disminuyendo la puntuación de la mayoría de los indicadores analizados. Conclusión: Todas las lesiones presentaron desbridamiento autolítico, facilitando la remoción de tejidos desvitalizados, además de disminuir el tamaño y profundidad al promover el desarrollo de tejido de granulación.(AU)

Medida indireta da pressão arterial em membros inferiores: revisão integrativa / Indirect blood pressure measurement in lower limbs: an integrative review

Introdução: A medida indireta da pressão arterial nos membros superiores, em determinadas situações, pode ser contraindicada, como em casos de utilização de cateteres vasculares, presença de linfedema, Trombose Venosa Profunda (TVP) ou fístulas arteriovenosas. Assim, um local alternativo para a medida da pressão arterial pode ser os membros inferiores, mais especificamente a coxa, a panturrilha ou o tornozelo. Objetivo: Sintetizar o conhecimento sobre a medida indireta da pressão arterial nos membros inferiores. Método: Trata-se de uma revisão integrativa da literatura. A estratégia de busca utilizou os seguintes descritores controlados: Ankle, Arterial Pressure, Blood Pressure, Blood Pressure Determination, Blood Pressure Measurement, Leg, Lower Extremity, Lower limb, Thigh. Sendo adaptada e realizada a busca no mês de junho de 2020, sem limite de período de publicação, em seis bases de dados eletrônicas: Academic Search Premier, CINAHL, Embase, PubMed, LILACS, Scopus e Web of Science. Foram identificadas 3.047 referências, das quais 1.523 duplicatas. Assim, do total de 1.524 citações, 1.478 foram excluídas após a leitura de título e resumo. Dessa forma, 46 estudos primários foram elegíveis para a leitura na íntegra, sendo 34 estudos excluídos, pois não respondiam à questão de pesquisa ou eram estudos de revisão. Adicionalmente, foi realizada a busca manual (handsearching) nas referências dos estudos primários incluídos, a qual resultou na inclusão de 11 estudos primários. A amostra final da revisão foi constituída por 23 estudos primários. Resultados: Os estudos foram analisados e integrados em três categorias temáticas: 1) comparação de valores de PA; 2) comparação de métodos de medida da PA; e 3) recomendações de especialistas. Utilizou-se a classificação de hierarquia dos níveis de evidência para estudos de intervenção proposta por Melnik-Fineout (2010), resultando em 18 estudos classificados como nível de evidência VI e cinco como nível de evidência VII. Quanto às características dos estudos, todos foram publicados no idioma inglês (n=23), sendo 21 publicados pela comunidade médica e dois por profissionais não médicos - um engenheiro e um enfermeiro. Conclusão: A medida da pressão arterial nos membros inferiores pode ser realizada tanto com aparelho aneroide quanto oscilométrico. Na coxa, a literatura enfatiza que se deve utilizar o manguito grande (18 centímetros de largura) e no tornozelo o manguito padrão (12 centímetros de largura), com o paciente em posição supina ou prona. Os valores de diferença média da pressão arterial sistólica encontrados na perna ou no braço variaram de 11,2 a 36,5 milímetros de mercúrio quando comparados nos estudos analisados. Tais resultados sugerem que o tornozelo e a coxa são alternativas viáveis quando a medida indireta da pressão arterial não pode ser realizada no braço, entretanto, não devem ser utilizadas como substitutas devido à discrepância dos valores encontrados e suas importâncias na prática clínica. Nos casos em que o membro inferior for a única opção disponível, a medida da pressão arterial preferencialmente deve ser realizada no tornozelo, dado que, na coxa, há relatos de desconforto e dor, o que pode influenciar nos valores de pressão arterial encontrados

Introduction: The indirect measurement of blood pressure in the upper limbs, in certain situations, may be contraindicated, as in cases of use of vascular catheters, presence of lymphedema, Deep Vein Thrombosis (TVP - Trombose Venosa Profunda) or arteriovenous fistulas. Thus, an alternative location for measuring blood pressure may be the lower limbs, more specifically the thigh, calf or ankle. Objective: To synthesize the knowledge about the indirect measurement of blood pressure in the lower limbs. Method: This is an integrative review of the literature. The search strategy used the following controlled descriptors: Ankle, Arterial Pressure, Blood Pressure, Blood Pressure Determination, Blood Pressure Measurement, Leg, Lower Extremity, Lower Limb, Thigh. The search was adapted and performed in June 2020, with no publication period limit, in six electronic databases: Academic Search Premier, CINAHL, Embase, Pubmed, LILACS, Scopus and Web of Science. 3,047 references were identified, of which 1,523 were duplicates. Thus, out of a total of 1,524 citations, 1,478 were excluded after reading the title and abstract. Thus, 46 primary studies were eligible for reading in their entirety, and 34 studies were excluded because they did not answer the research question or were review studies. Additionally, a handsearching was performed in the references of the primary studies included, which resulted in the inclusion of 11 primary studies. The final sample of the review consisted of 23 primary studies. Results: The studies were analyzed and integrated into three thematic categories: 1) comparison of blood pressure values; 2) comparison of blood pressure measurement methods; and 3) expert recommendations. The classification of hierarchical levels of evidence was used for intervention studies proposed by Melnik-Fineout (2010), resulting in 18 studies classified as evidence level VI and five as evidence level VII. As for the characteristics of the studies, all were published in the English language (n=23), 21 published by the medical community and two by non-medical professionals - an engineer and a nurse. Conclusion: The measurement of blood pressure in the lower limbs can be performed with both aneroid and oscillometric apparatus. In the thigh, the literature emphasizes that one should use the large cuff (18 centimeters wide) and in the ankle the standard cuff (12 centimeters wide), with the patient in supine or prone position. The mean difference of systolic blood pressure found in the leg or arm ranged from 11.2 to 36.5 millimeters of mercury when compared in the studies analyzed. These results suggest that the ankle and thigh are viable alternatives when indirect blood pressure measurement cannot be performed on the arm, however, they should not be used as substitutes due to the discrepancy of the values found and their importance in clinical practice. In cases where the lower limb is the only available option, the measurement of blood pressure should preferably be performed on the ankle, given that, on the thigh, there are reports of discomfort and pain, which may influence the blood pressure values found

Antimicrobial Orthodontic Wires Coated with Silver Nanoparticles

Abstract Conventional orthodontic treatment with the use of stainless steel may be detrimental to oral health by promoting demineralizing lesions appearance and increasing adhesion and formation of bacterial biofilm, inducing the development of cavities. An alternative that has been researched to reduce the side effects of orthodontic treatment is the coating of materials with antimicrobial nanoparticles. Nanometric- sized particles increase their surface area and contact with the microbial membrane, consequently intensifying their bacteriostatic and bactericidal effect. In this work, hydrothermal synthesis, a "green" process was used to attach silver nanoparticles (AgNPs) to the surface of two different brands of orthodontic wires. The coated materials were analyzed for their physicochemical properties by scanning electron microscopy (SEM), X-ray diffraction (XRD) and differential scanning calorimetry (DSC), which showed the distribution of AgNPs along the wires without modifying their properties. In the microbiological test, one of the brands showed a statistically significant difference in microbial adhesion and biofilm formation by Staphylococcus aureus and Streptococcus mutans. Results lead to the conclusion that antimicrobial orthodontic wires coated with silver nanoparticles through hydrothermal synthesis is a promising material for the improvement of orthodontic treatment.

Elaboração e avaliação de manual educativo sobre estimulação neuropsicomotora: estratégia de conhecimento para pais e/ou cuidadores de crianças com fissuras labiopalatinas e/ou síndromes associadas / Elaboration and evaluation of an educational manual on neuropsychomotive stimulation: knowledge strategy for parents and / or caregivers of children with labiopalatinal fissures and / or associated syndromes

Introdução: bebês que nascem com anomalias craniofaciais e/ou síndromes associadas normalmente necessitam de cuidados especiais. A presença da família é essencial para garantir os cuidados com o bebê, podendo nessa capacitação, ser utilizado um recurso como um manual. Objetivo: elaborar e avaliar a eficácia de um manual educativo da área de terapia ocupacional (TO), sobre as técnicas de estimulação neuropsicomotora, a partir da análise de juízes e do conhecimento adquirido pelos pais e/ou cuidadores de crianças com fissuras labiopalatinas e/ou síndromes associadas. Material e método: Foi elaborado e desenvolvido um manual de orientações para pais/cuidadores sobre a estimulação do desenvolvimento neuropsicomotor de crianças com FLP e/ou síndromes associadas, voltado para crianças na faixa etária de zero a um ano de idade com fissuras labiopalatinas e/ou síndromes associadas,e o mesmo foi submetido à análise de juízes para a indicação de sugestões sobre a adequação da linguagem, dos aspectos técnicos, das imagens e de apresentação. Após adequações, o manual foi utilizado porutilizado por 7 pais e/ou cuidadores. Esta etapa foi durante um mês, na Unidade de Cuidados Especiais (UCE) do Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo, Bauru/ SP (HRAC/USP) em três etapas: pré-intervenção, orientações e intervenções e, pós-intervenções. Os pais e/ou cuidadores responderam a um questionário na pré-intervenção e pós-intervenção para verificar conhecimentos e aquisição dos mesmos por meio de escores de acertos. As respostas das perguntas realizadas. Os questionários foram tabuladoas e foi realizada a comparação do momento pré e pós-intervenção: através do Teste T-pareado (nível de significância de 0,05%). Resultados: em todos os aspectos analisados pelos juízes foram sugeridos alterações, especialmente quanto anos itens, linguagem, aspectos técnicos e imagens. Quanto a análise do conhecimento adquidoradquirido pelos pais e/ou cuidadores, e no pré-teste a porcentagem era de aproximadamente 7,1 acertos enquanto no pós-teste era 9,1. Conclusão: o manual educativo foi eficaz como estratégia de conhecimento.

Introduction: babies born with craniofacial anomalies and / or associated syndromes usually require special care. The presence of the family is essential to ensure the care of the baby. Objective: to elaborate and evaluate the effectiveness of an educational manual in the area of occupational therapy (OT) on neuropsychomotor stimulation techniques, based on the analysis of judges and knowledge acquired by parents and / or caregivers of children with cleft palate and / or syndromes associated. Method: a manual aimed at children in the age group of zero to one year old with cleft lip and palate and / or associated syndromes, was submitted to the analysis of judges for suggestions on the adequacy of the language, technical aspects, images and presentation. After adjustments, the manual was used by 7 parents and / or caregivers for one month in the Special Care Unit (UCE) of the Hospital of Rehabilitation of Craniofacial Anomalies of the University of São Paulo, Bauru / SP (HRAC / USP) in three stages: Pre-intervention, guidelines and interventions, and postinterventions. Parents and / or caregivers answered a questionnaire in the pre-intervention and post-intervention to verify knowledge and their acquisition by means of scores of correct answers. The questionnaires were tabulated and compared using the paired T-test (significance level 0.05%). Results: all aspects analyzed by the judges were suggested changes, especially in the language items, technical aspects and images. As for the analysis of the knowledge acquired by the parents and / or caregivers in the pre-test the percentage was approximately 7.1 hits while in the post-test was 9.1. Conclusions: the educational manual was effective as a knowledge strategy.

Large reduction in volume with the intensive treatment of lymphedema: reduction of fluids?

The aim of this study is to report on the intensive treatment of lymphedema of the legs demonstrating a large reduction in volume in a short period of time. The case of a 29-year-old female patient, who developed the most serious form of lymphedema, associated with verrucosities of the leg and genitalia is reported. Elephantiasis evolved after surgery and radiotherapy. The patient was treated at the Clinica Godoy in Sao Jose do Rio Preto, Brazil using an intensive course of treatment. Baseline and then daily evaluations of the leg perimeter and body weight were performed during treatment. Intensive treatment for 8 hours daily was performed on an outpatient basis using manual and mechanical (RAGodoy device, São Jose do Rio Preto, São Paulo-Brazil) lymph drainage and the continuous use of a compression garment made of a cotton-polyester textile and adjusted every 3 hours. A reduction of 31 kg was seen in 10 days (over 2 weeks); in the first few days, the patient lost 6 kg per day. Due to the excess of skin, the length of intensive treatment sessions was reduced to avoid the compression garment causing a tourniquet effect, the size of the compression stocking was only adjusted once per day and daily walks were included in the treatment program. After 1 month, the size of the leg was reduced by another 4 kg. Intensive lymphedema treatment is an option that rapidly reduces edema, and constant use of low-stretch compression maintains the result achieved and continues to reduce the swelling.