ABSTRACT
BACKGROUND: A total of 14.5% of cancer patients develop malignant neoplastic wounds (MNW), characterised as friable, exudative, fetid, bleeding, and painful. Some studies report that all patients with MNW experience pain, but there is lack of scientific evidence to support their treatment. OBJECTIVE: To map and examine the existing evidence on topical therapies to manage pain in adult patients with MNW. METHOD: A scoping review protocol was designed, according to the Joanna Briggs Institute (JBI) methodology. The databases CINAHL, LILACS, Embase, Scopus, Web of Science, PubMed, Cochrane, NICE, Scopus, JBISRIR and the grey literature, for searching published and unpublished studies in English, Portuguese and Spanish. The selection will be made by at least two reviewers. The summary of the results will be narrative, with graphs and tables. Qualitative and quantitative studies and reviews will be included, describing the use of topical pain therapies in patients with MNW. CONCLUSION: This study will allow to classify and discuss the available topical therapies, and to recommend future primary studies.
INTRODUCCIÓN: El 14,5% de los pacientes con cáncer desarrolla heridas neoplásicas malignas (HNM), caracterizadas como friables, exudativas, fétidas, sangrantes y dolorosas. Algunos estudios reportan que todos los pacientes con HNM experimentan dolor, pero hay escasez de evidencia científica para fundamentar su tratamiento. OBJETIVO: Mapear y examinar la evidencia existente sobre terapias tópicas para manejar el dolor en pacientes adultos con HNM. MÉTODO: Se diseñó un protocolo de revisión de alcance, de acuerdo con la metodología del Joanna Briggs Institute (JBI). Serán consultadas las bases de datos CINAHL, LILACS, Embase, Scopus, Web of Science, PubMed, Cochrane, NICE, Scopus, JBISRIR y la literatura gris, para la búsqueda de estudios publicados y no publicados en inglés, portugués y español. La selección estará a cargo de, al menos, dos revisores. La síntesis de los resultados será narrativa, con gráficos y tablas. Se incluirán estudios cualitativos, cuantitativos y revisiones, que describan el uso de terapias tópicas para el dolor en pacientes con HNM. CONCLUSIÓN: Este estudio permitirá clasificar y discutir las terapias tópicas disponibles, y recomendar futuros estudios primarios.
Subject(s)
Neoplasms , Pain Management , Adult , Ethnicity , Humans , Review Literature as TopicABSTRACT
Introdução: Pacientes com câncer, principalmente de mama e cabeça e pescoço, podem desenvolver feridas neoplásicas malignas (FNM) como uma importante complicação. As FNM são lesões friáveis, exsudativas, fétidas e dolorosas que impactam negativamente na qualidade de vida das pessoas. Estudos mostram que todos os pacientes com FNM apresentam dor nessas lesões, a maioria com intensidade moderada a grave. A literatura tem estabelecido recomendações para o cuidado de pacientes com FNM visando ao gerenciamento ou controle dos sintomas porém embasadas em escassas evidências. Objetivo: Examinar e mapear e as evidências existentes sobre as terapias tópicas utilizadas para o controle da dor em FNM. Métodos: Revisão de escopo, conduzida de acordo com a metodologia do Joanna Briggs Institute (JBI). Foram pesquisadas as publicações nos bancos de dados CINAHL, LILACS, Embase, Scopus, Web of science e PubMed, Cochrane, NICE, Scopus, JBISRIR e literatura cinzenta, em inglês, português e espanhol e sem delimitação de tempo. Esta revisão considerou estudos realizados com pacientes, a partir de 18 anos de idade, com dor em FNM. A busca foi realizada em três etapas. Após as buscas, todos os registros identificados foram agrupados e enviados para Mendeley (MendeleyLtd., Elsevier, Holanda). Os títulos e resumos foram examinados por dois revisores independentes. Os dados foram extraídos usando uma ferramenta de extração de dados desenvolvida pelos revisores. Após a extração dos dados, realizou-se uma reunião entre os revisores para a análise dos dados e organização das categorias que deles emergiram. Resultados: Incluíram-se 70 publicações compostas por 32 Revisões não Sistemáticas de Literatura - RNS, 20 Estudos de casos - EC, seis Ensaios Clínicos Randomizados - ECR, três Coortes Retrospectivas - CP, três Revisões Sistemáticas - RS, três Guidelines, dois Surveys e uma Coorte Retrospectiva - CR que evidenciaram 20 propostas de terapias tópicas para controle de dor em FNM, assim categorizadas: Terapias Tópicas Aplicadas nas FNM (Coberturas (41 / 58,6%), Drogas analgésicas (39 / 55,7%), Substâncias antimicrobianas (18 / 25,7%), Crioterapia (4 / 5,7%) e Terapia por Pressão Negativa (3 / 4,3%) e Terapias Tópicas aplicadas na Pele Peri-Ferida (Protetores de pele (11 / 15,7%)). A dor não foi avaliada em 68,5% dos estudos. Conclusão: Muitas são as terapias tópicas descritas nesta revisão de escopo (70 publicações incluídas) para o controle de dor em FNM, principalmente do tipo RNS (32/ 45,7%) e mesmo EC (20/ 28,5%). No entanto, existem poucos estudos primários de intervenção voltados especificamente para a avaliação da sua eficácia, com metodologias consideradas inadequadas para sustentar a prática clínica, evidenciando a necessidade de novos estudos com delineamentos mais robustos. Implicações para a prática clínica e pesquisa: Esta revisão de escopo contribui para a sistematização dos achados acerca do controle da dor em FNM, sintoma bastante frequente na plêiade que acompanha essa condição tão impactante sobre a qualidade de vida e final de vida dos pacientes por ela acometidos. Seus resultados certamente possibilitam a implementação mais adequada de atenção multiprofissional a esses pacientes bem como mostram as lacunas de investigação para suporte a uma prática mais segura.
Introduction: Cancer patients, especially breast and head and neck, can develop malignant fungating wounds (MFW) as an important complication. MFW are friable, exudative, fetid, and painful lesions that negatively impact people\'s quality of life. Studies show that all patients with MFW have pain in these lesions, the majority with moderate to severe intensity. The literature has established recommendations for the care of patients with MFW aiming at the management or control of symptoms but based on little evidence. Objective: Examine and map and the existing evidence on topical therapies used to control pain in NFM. Methods: Scoping review, conducted according to the Joanna Briggs Institute (JBI) methodology. Publications were searched in the CINAHL, LILACS, Embase, Scopus, Web of Science and PubMed, Cochrane, NICE, Scopus, JBISRIR, and gray literature databases in English, Portuguese and Spanish and without time limits. This review considered studies carried out with patients, from 18 years of age, with pain in NMF. The search was carried out in three stages. After the searches, all identified records were grouped and sent to Mendeley (MendeleyLtd., Elsevier, Netherlands). Titles and abstracts were examined by two independent reviewers. The data were extracted using a data extraction tool developed by the reviewers. After extracting the data, a meeting was held between the reviewers to analyze the data and organize the categories that emerged from them. Results: 70 publications comprising 32 non-systematic literature reviews - RNS, 20 case studies - EC, six randomized clinical trials - ECR, three retrospective cohorts - CP, three systematic reviews - RS, three guidelines, two Surveys, and a Retrospective Cohort - CR that showed 20 proposals for topical therapies for pain control in FNM, categorized as follows: Topical Therapies Applied in MFW (Dressing (41 / 58.6%), Analgesic Drugs (39 / 55.7%), Substances antimicrobials (18 / 25.7%), Cryotherapy (4 / 5.7%) and Negative Pressure Therapy (3 / 4.3%) and Topical Therapies applied to Peri-Wound Skin (Skin Protectors (11/15, 7%)). Pain has not been evaluated in 68.5% of the studies. Conclusion: There are many topical therapies described in this scoping review (70 publications included) for pain control in NFM, mainly of the RNS type (32 / 45.7%) and even EC (20 / 28.5%). However, there are few primary studies interventions aimed specifically at assessing their effectiveness, with methodologies considered inadequate to support clinical practice, highlighting the need for further studies with more robust designs. Implications for clinical practice and research: This scoping review contributes to the systematization of the findings of pain control in MFW, a very common symptom in the crowd that accompanies this condition that has such an impact on the quality of life and end of life of patients through it affected. Its results certainly enable the most appropriate implementation of multi-professional care for these patients, as well as showing the research gaps to support a safer practice.
Subject(s)
Pain , Administration, Cutaneous , Neoplasms , Wounds and Injuries , Nursing , Enterostomal TherapyABSTRACT
Canine atopic dermatitis (CAD) is a genetically predisposed inflammatory, chronic and pruritic skin disease, which has an incompletely understood pathogenesis in dogs. The pathogenic view of CAD involves theories about epidermal disfunction where a higher penetration of allergens and microbes overstimulates the local immunity. Clinical signs involve pruritus in different sites and secondary infections. Due to its complexity, therapeutic approaches aim to reduce antigenic exposure, prevent overstimulation of immune system, strengthen the epidermal barrier, control secondary infections, wash and moisten the skin, reduce inflammation and modify the immune response. In this review, it was reported the case of a dog, five years old, diagnosed with canine atopic dermatitis and treated with topical medication.
Subject(s)
Animals , Dogs , Dogs/injuries , Dermatitis, Atopic/therapy , Dermatitis, Atopic/veterinaryABSTRACT
Canine atopic dermatitis (CAD) is a genetically predisposed inflammatory, chronic and pruritic skin disease, which has an incompletely understood pathogenesis in dogs. The pathogenic view of CAD involves theories about epidermal disfunction where a higher penetration of allergens and microbes overstimulates the local immunity. Clinical signs involve pruritus in different sites and secondary infections. Due to its complexity, therapeutic approaches aim to reduce antigenic exposure, prevent overstimulation of immune system, strengthen the epidermal barrier, control secondary infections, wash and moisten the skin, reduce inflammation and modify the immune response. In this review, it was reported the case of a dog, five years old, diagnosed with canine atopic dermatitis and treated with topical medication.(AU)
Subject(s)
Animals , Dogs , Dermatitis, Atopic/therapy , Dermatitis, Atopic/veterinary , Dogs/injuriesABSTRACT
Feridas abertas são lesões que não podem ser suturadas promovendo a cicatrização por primeira intenção,em virtude do nível de contaminação, lesão tecidual profunda, baixa viabilidade tecidual e/ou comprometimentovascular. Essas lesões são decorrentes de traumas lacerantes, mordeduras, queimadurase deiscência de suturas nos mais diversos procedimentos cirúrgicos. O tratamento consiste em limpezae debridamento, terapias tópicas e bandagens. Este estudo tem como objetivo realizar uma revisão deliteratura sobre os principais métodos utilizados no tratamento das feridas abertas em cães e gatos.
Open wounds are lesions that cant be sutured to promote healing by first intention, because of the contaminationlevel deep tissue injury, low tissue viability and / or vascular compromise. These lesions arecaused by lacerating injuries, bites, burns and suture dehiscence in various surgical procedures. Treatmentconsists of cleansing and debridement, topical therapies and wraps. This study aims to conduct aliterature review on the main methods used in the treatment of open wounds in dogs and cats.
Subject(s)
Animals , Cats , Dogs , Wounds, Penetrating , Wound HealingABSTRACT
Feridas abertas são lesões que não podem ser suturadas promovendo a cicatrização por primeira intenção,em virtude do nível de contaminação, lesão tecidual profunda, baixa viabilidade tecidual e/ou comprometimentovascular. Essas lesões são decorrentes de traumas lacerantes, mordeduras, queimadurase deiscência de suturas nos mais diversos procedimentos cirúrgicos. O tratamento consiste em limpezae debridamento, terapias tópicas e bandagens. Este estudo tem como objetivo realizar uma revisão deliteratura sobre os principais métodos utilizados no tratamento das feridas abertas em cães e gatos.AU
Open wounds are lesions that cant be sutured to promote healing by first intention, because of the contaminationlevel deep tissue injury, low tissue viability and / or vascular compromise. These lesions arecaused by lacerating injuries, bites, burns and suture dehiscence in various surgical procedures. Treatmentconsists of cleansing and debridement, topical therapies and wraps. This study aims to conduct aliterature review on the main methods used in the treatment of open wounds in dogs and cats.AU
Subject(s)
Animals , Cats , Dogs , Wounds, Penetrating , Wound HealingABSTRACT
Objetivo: Determinar la eficacia de la terapia tópica antioxidante en el tratamiento del vitíligo generalizado de inicio reciente. Material y métodos: Ensayo clínico aleatorizado, doble ciego, controlado con placebo. Los pacientes con vitíligo generalizado de inicio reciente fueron distribuidos aleatoriamente en dos grupos. Grupo de estudio: recibió terapia tópica reciente fueron distribuidos aleatoriamente en dos grupos. Grupo de estudio: recibió terapia tópica antioxidante aplicada en las lesiones cada 12 horas por 30 días. Grupo placebo: recibió terapia tópica con una sustancia carente de actividad farmacológica. La terapia tópica antioxidante estuvo compuesta fundamentalmente por pseudocatalasa activada por luz solar, luego de la aplicación se indicó a los pacientes exposición solar diaria por un período de 30 minutos. Al cabo de 10 semanas de tratamiento se evaluó si hubo re pigmentación, y se comparó los niveles pre y pos tratamiento de malonildialdehido (indicador de per oxidación lipídica) en lesiones cutáneas. Resultados: Al término del tratamiento los valores de MDA en lesiones del grupo que recibió terapia tópica antioxidante mostraron un incremento significativo del 24.5 por ciento con respecto a los valores basales (p=0.035); los valores del grupo placebo también mostraron un incremento significativo del 21.6 por ciento en los valores de MDA con respecto a la medición basal (p menor que 0.001). La evolución clínica mostró re pigmentación parcial de la lesiones en 16.6 por ciento de pacientes que recibieron terapia tópica antioxidante y en 6.6 por ciento de pacientes que recibieron placebo para lo cual no existió diferencia significativa (p = 0.206). En ningún paciente de ambos grupos se observó re pigmentación total de las lesiones. Conclusiones: Nuestros hallazgos en la muestra estudiada demuestran que la terapia tópica antioxidante no es eficaz en el tratamiento del vitíligo generalizado de inicio reciente y no reduce el estrés oxidativo.
Objective: To determine the efficacy of topical antioxidant therapy in the treatment of generalized vitiligo of recent onset. Material and methods: Randomized trial, double-blind, controlled with placebo. Patients with generalized vitiligo of recent onset were randomly distributed in two groups. Study group: They received topical antioxidant therapy applied in lesions each 12 hours for 30 days. Placebo group: They received topical therapy with a substance devoid of pharmacological activity. The topical antioxidant therapy was consisted primarily by pseudocatalasa activated by solar light, after the application, daily solar exposure was indicated to patients by a period of 30 minutes. After 10 weeks of treatment, repigmentation was evaluated whether there and pre and and post treatments of malonyldialdheyde (MDA) levels were compared in cutaneous lesion. Results: At the end of the treatment, values of MDA in lesions of group that receives topical antioxidant therapy showed a significant increase of 24.5 per cent with respect of basal values (p = 0.035); values of placebo group also showed a significant increase of 21.6 per cent in values of MDA with respect to basal measure (p minor that 0.001). Clinical evolution showed partial repigmentation of lesion in 16.6 per cent of patients that received topical antioxidant therapy and in 6.6 per cent of patients that received placebo for which there was no significant difference (p = 0.206). In no one patient of both groups we saw total repigmentation of lesion. Conclusions: Our findings in the sample studied showed that topical antioxidant therapy is not efficacy in the treatment of generalized vitiligo of recent onset and do not reduce the oxidative stress in cutaneous lesions.