Normative Data of Handgrip Strength in Macedonian Children and Adolescents According to Chronological and Biological Age / Datos Normativos de la Fuerza de Prensión Manual en Niños y Adolescentes Macedonios Según la Edad Cronológica y Biológica

SUMMARY: The handgrip strength is used as a means of individual's health prediction during life. It is used as an indicator of the nutrition status, bone fragility, presence of sarcopenia and it correlates with certain diseases and clinical complications. The research goal was to analyze the results of the hand dynamometry test, based on the chronological and biological age, and to offer normative and referent standards about children and adolescents from the Republic of North Macedonia. The study was conducted on a sample of 4031 respondents of both sexes at the age 6-14 years. In order to achieve the research goals, the measured characteristics were of the weight, height, sitting height and handgrip strength. The body mass index and biological maturity values (APHV) were obtained by using formulas. On the basis of the obtained results, it can be concluded that statistically significant differences in handgrip strength are established between the boys and girls of all age categories. Also, statistically significant differences between boys and girls are established in the hand dynamometry test of all APHV levels. In general, the use of the APHV allows a better categorization of the performance of the studied children and adolescents. With boys, the correlation between the chronological age and test was 68 %, and with girls - 77 %. The normative referent standards of the hand dynamometry test are presented in percentiles for both sexes. Thye hand dynamometry test's results during childhood and adolescence should be analyzed and interpret on the basis of biological age, and not on the chronological age. These tools can help specialists who work with children and adolescents in ethnic and epidemiological context.

La fuerza de prensión se utiliza como medio para predecir la salud del individuo durante la vida. Se utiliza como indicador del estado nutricional, fragilidad ósea, presencia de sarcopenia y se correlaciona con determinadas enfermedades y complicaciones clínicas. El objetivo de la investigación fue analizar los resultados de la prueba de dinamometría manual, con base en la edad cronológica y biológica, y ofrecer estándares normativos y referentes sobre niños y adolescentes de la República de Macedonia del Norte. El estudio se realizó en una muestra de 4031 encuestados de ambos sexos con edades comprendidas entre 6 y 14 años. Para lograr los objetivos de la investigación, las características medidas fueron el peso, la altura, la altura al sentarse y la fuerza de prensión. El índice de masa corporal y los valores de madurez biológica (APHV) se obtuvieron mediante fórmulas. Sobre la base de los resultados obtenidos, se puede concluir que se establecen diferencias estadísticamente significativas en la fuerza de prensión manual entre niños y niñas de todas las categorías de edad. Asimismo, se establecen diferencias estadísticamente significativas entre niños y niñas en la prueba de dinamometría manual de todos los niveles APHV. En general, el uso del APHV permite una mejor categorización del desempeño de los niños y adolescentes estudiados. En los niños, la correlación entre la edad cronológica y la prueba fue del 68 %, y en las niñas, del 77 %. Los estándares normativos referentes de la prueba de dinamometría manual se presentan en percentiles para ambos sexos. Los resultados de la prueba de dinamometría manual durante la infancia y la adolescencia deben analizarse e interpretarse en función de la edad biológica y no de la edad cronológica. Estas herramientas pueden ayudar a los especialistas que trabajan con niños y adolescentes en un contexto étnico y epidemiológico.

Progresión de los componentes de la presión arterial y la correlación con las medidas antropométricas y laboratoriales en adultos jóvenes / Progression of blood pressure components and correlation with anthropometric and laboratory measurements in young adults

Introducción: La presencia de hipertensión arterial en población joven aumenta el riesgo de eventos cardiovasculares en la mediana edad y como consecuencia una morbimortalidad prematura. El propósito de este estudio es evaluar la progresión de los componentes de la presión arterial y la correlación con las medidas antropométricas y laboratoriales en estudiantes de la Universidad Nacional de Asunción- Paraguay. Materiales y métodos: Se realizó un estudio descriptivo correlacional, longitudinal, prospectivo, desde el año 2013 hasta el año 2017 evaluando al inicio 284 universitarios y 240 al final de las carreras. Se midieron variables sociodemográficas, antropométricas, presión arterial, determinaciones bioquímicas. La progresión de los componentes de la presión arterial, de las variables antropométricas y clínicas se calcularon mediante la prueba T de muestras relacionadas. La correlación de la presión arterial sistólica y presión arterial diastólica con las variables antropométricas y laboratoriales con la correlación de Pearson. Resultados: La progresión de los componentes de la presión arterial presentó una diferencia estadísticamente significativa en la presión arterial sistólica, presión arterial diastólica y presión de pulso. En relación con las características antropométricas y clínicas de los estudiantes se encontró una diferencia estadísticamente significativa entre la medición inicial y final en el peso, perímetro abdominal, glicemia, insulina, colesterol total, colesterol de alta densidad, colesterol de baja densidad, triglicéridos y proteína C reactiva. La correlación más importante encontrada entre las medidas antropométricas con la presión arterial sistólica y presión arterial diastólica fue la circunferencia abdominal. Conclusión: Se encontró aumento de la tendencia de la presión arterial y de otros factores de riesgo cardiovascular en universitarios.

Introduction: The presence of arterial hypertension in young population increases the risk of cardiovascular events in middle age and as a consequence premature morbimortality. The purpose of this study was to evaluate the progression of blood pressure components and the correlation with anthropometric and laboratory measurements in students of the National University of Asuncion, Paraguay. Materials and methods: A descriptive correlational, longitudinal, prospective, descriptive study was conducted from 2013 to 2017 evaluating at the beginning 284 undergraduates and 240 at the end of the careers. Sociodemographic variables, anthropometric variables, blood pressure, biochemical determinations were measured. The progression of blood pressure components, anthropometric and clinical variables were calculated using the related samples t-test. The correlation of systolic blood pressure and diastolic blood pressure with anthropometric and laboratory variables was correlated with Pearson's correlation. Results: The progression of blood pressure components presented a statistically significant difference in systolic blood pressure, diastolic blood pressure and pulse pressure. In relation to the anthropometric and clinical characteristics of the students, a statistically significant difference was found between the initial and final measurements in weight, abdominal perimeter, glycemia, insulin, total cholesterol, high-density cholesterol, low-density cholesterol, triglycerides, and C-reactive protein. The most important correlation found between anthropometric measurements with systolic blood pressure and diastolic blood pressure was abdominal circumference. Conclusion: An increase in the trend of blood pressure and other cardiovascular risk factors was found in university students.

Notificações de incidentes relacionados à segurança do paciente em hospital universitário sentinela / Notificaciones de incidentes relacionados con la seguridad del paciente en un hospital universitario centinela / Notifications of incidents related to patient safety in a sentinel university hospital

RESUMO Objetivo: analisar as notificações de incidentes relacionados à segurança do paciente em hospital universitário público sentinela. Método: Pesquisa retrospectiva, quantitativa, realizada em hospital universitário localizado no Sul do Brasil. Foram analisadas 760 notificações de incidentes ocorridos nos anos de 2015 a 2017 encaminhadas ao setor de gerência de risco da instituição. Os dados foram coletados de maio a agosto de 2018. A análise estatística descritiva se realizou com o auxílio do Statistical Package for the Social Sciences versão 20.0. Resultados: os incidentes notificados foram lesão por pressão (64,0%), seguida de quedas (25,0%), erro de medicação (9,7%), identificação incorreta do paciente (1,0%) e incidentes nos procedimentos cirúrgicos (0,3%). O período matutino, profissional enfermeiro e a unidade de terapia intensiva adulto foram os que mais realizaram as notificações. O evento adverso mais notificado estava relacionado ao erro de medicação (50,7%) seguido de quedas (26,8%). Conclusão: os resultados deste estudo contribuem para aumentar o interesse na análise dos dados de incidentes e eventos adversos, bem como para definir ou refinar as estratégias de melhoria da segurança do paciente.

RESUMEN Objetivo: analizar las notificaciones de incidentes relacionados con la seguridad del paciente en hospital universitario público centinela. Método: investigación retrospectiva, cuantitativa, realizada en hospital universitario ubicado en el Sur de Brasil. Se analizaron 760 notificaciones de incidentes ocurridos en los años 2015 a 2017 dirigidas al sector de gestión de riesgos de la institución. Los datos se recopilaron de mayo a agosto de 2018. El análisis estadístico descriptivo se realizó con la ayuda del Statistical Package for the Social Sciences versión 20.0. Resultados: los incidentes notificados fueron lesión por presión (64,0%), seguida de caídas (25,0%), error de medicación (9,7%), identificación incorrecta del paciente (1,0%) e incidentes en los procedimientos quirúrgicos (0,3%). Los que más realizaron las notificaciones fueron el profesional enfermero, período matutino y la unidad de cuidados intensivos adulto. El evento adverso más notificado estaba relacionado con el error de medicación (50,7%) seguido de caídas (26,8%). Conclusión: los resultados de este estudio contribuyen a aumentar el interés en el análisis de los datos de incidentes y eventos adversos, así como para definir o refinar las estrategias de mejora de la seguridad del paciente.

ABSTRACT Objective: to analyze the notifications of incidents related to patient safety in a sentinel public university hospital. Method: retrospective, quantitative research conducted in a university hospital located in southern Brazil. It analyzed 760 notifications of incidents that occurred in the years 2015 to 2017 forwarded to the risk management sector of the institution. Data was collected from May to August 2018. Descriptive statistical analysis was performed using the Statistical Package for the Social Sciences version 20.0. Results: the incidents reported were pressure ulcers (64.0%), followed by falls (25.0%), medication errors (9.7%), incorrect patient identification (1.0%) and incidents in surgical procedures (0.3%). The morning period, nursing professionals and adult intensive care unit were the ones that made the most notifications. The most reported adverse event was related to medication error (50.7%) followed by falls (26.8%). Conclusion: the results of this study contribute to increasing interest in the analysis of incident and adverse event data, and to defining or refining strategies to improve patient safety.

Assessment of apical pressures at different automated irrigant flow rates: an ex vivo study based on computational fluid dynamic analysis / Avaliação de pressões apicais em diferentes taxas de fluxo irrigante automatizadas: um estudo ex vivo baseado em análise dinâmica de fluidos computacionais

Objective: The current study aimed at assessing the induced apical pressure at various simulated irrigant flow rates. Materials and Methods: Forty eight freshly extracted single-rooted premolars were decoronated and prepared to size 30 0.04 taper using HY-Flex CM rotary file system and were scanned using cone-beam computed tomography (CBCT). The scanned images were reconstructed to three-dimensional Computer-aided design models (CAD) and the 3D needle was also reconstructed. Finally, simulations were done by placing the 30 gauge open-ended needle 3 mm short of the working length. Results: There was a statistically significant difference (p<0.05) among the different groups compared. 1 ml/min flow rate induced the least apical pressures (p<0.05) as compared to the other types. Conclusion: 1 ml/min flow rates induced the least apical pressures when open-ended needles are used for irrigation.(AU)

Objetivo: O presente estudo teve como objetivo avaliar a indução de pressão apical em várias taxas de fluxo irrigante simuladas. Material e Métodos: Quarenta e oito raízes de pré-molares unirradiculares recém extraídos tiveram suas coroas removidas, foram preparados para uma conicidade de tamanho 30 0.04 através de um sistema rotatório de limas HYFlex CM e foram escaneados via tomografia computadorizada cone-beam (CBCT). As imagens escaneadas e as agulhas para irrigação foram reconstruídas em modelos tridimensionais de design assistido por computador (CAD). Ao final, foram feitas simulações através de agulhas de calibre 30 e 3 mm a menos que o comprimento de trabalho. Resultados: Houve diferença estatisticamente significativa (p<0.05) entre os diferentes grupos. A taxa de fluxo de 1 ml/min induziu as menores pressões apicais (p<0.05) quando comparada às demais taxas. Conclusão: Taxas de fluxo de 1 ml/min induziram as menores pressões apicais quando agulhas de ponta aberta foram utilizadas para irrigação (AU)

Mayor presión y área de contacto en reparación transósea cruzada de manguito rotador versus reparación simple / Increased pressure and contact area in rotator cuff crossed versus simple transosseous repair

OBJETIVO: Comparar la presión y el área de contacto en la interfase tendón-huella de una reparación realizada con suturas transóseas simples y cruzadas. MÉTODOS: Se utilizaron doce hombros de cordero para simular una rotura de manguito rotador. Se midió el área de contacto en la interfase tendón-huella con láminas sensibles a presión; luego, se midió la presión con un sensor digital. Se registró la presión basal durante la aplicación de carga cíclica y al final de la intervención. Se compararon 2 reparaciones: 2 túneles transóseos con nudos simples (TOS; n = 6) y 2 túneles transóseos con nudos cruzados (TOC; n = 6), utilizando FiberWire #2. Se realizaron 1.400 ciclos, con una frecuencia 2,5 Hz y una carga de 5 N. Se utilizó la prueba de Mann-Whitney, y ae consideraron significativos valores de p < 0,05. RESULTADOS: La reparación TOS presentó un 50,9 ± 12,7% distribución de presiones en comparación con 72,2 ± 5,3% en la reparación TOC (p < 0,009). La presión promedio en la reparación TOS fue 0,7 ± 0,1 MPa en comparación con 1,1 ± 0,2 MPa en la reparación TOC (p < 0,007). La reparación TOS registró una presión basal de 5,3 ± 5,3 N, presión final de 3,8 ± 4,6 N, y una variación de 51,7 ± 38%. La reparación TOC registró una presión basal de 10,7 ± 1,8 N, presión final de 12,9 ± 8,7 N, y una variación de 114,9 ± 65,9% (p < 0,044; p < 0,022; y p < 0,017, respectivamente). CONCLUSIÓN: La reparación TOC presenta mayor presión a nivel de la interfase tendón-hueso, menor pérdida de fuerza de contacto ante cargas cíclicas, y una mejor distribución de fuerza en la huella al comparar con la reparación TOS, lo que se podría traducir en mejor cicatrización tendínea.

OBJETIVE: To compare the pressure and contact area at the tendon-footprint interface of a repair performed with simple and crossed transosseous sutures. METHODS: Twelve lamb shoulders were used to simulate a rotator cuff tear. The contact area at the tendon-footprint interface was measured with pressure-sensitive films; then, the pressure was measured with a digital sensor. The baseline pressure was recorded during the application of a cyclic load and at the end of the intervention. A total of 2 repairs were compared: 2 transosseous sutures with single knots (STO; n = 6) and 2 transosseous sutures with crossed knots (TOC; n = 6) using FiberWire #2. In total, 1,400 cycles were performed, with a frequency of 2.5 Hz and a load of 5 N. The Mann-Whitney test was used. Values of p < 0.05 were considered significant.RESULTS: The TOS repair presented 50.9 ± 12.7% of pressure distribution compared to 72.2 ± 5.3% in the TOC repair (p < 0.009). The mean pressure in the TOS repair was of 0.7 ± 0.1 MPa compared to 1.1 ± 0.2 MPa in the TOC repair (p < 0.007). The TOS repair registered a basal pressure of 5.3 ± 5.3 N, a final pressure of 3.8 ± 4.6 N, and a variation of 51.7 ± 38%. The TOC repair registered a basal pressure of 10.7 ± 1.8 N, a final pressure of 12.9 ± 8.7 N, and a variation of 114.9 ± 65.9% (p < 0.044; p < 0.022; and p < 0.017 respectively).CONCLUSION: The TOC repair presents higher pressure at the tendon-bone interface, less loss of contact force under cyclic loads, and a better distribution of force on the footprint when compared with the TOS repair, which could translate into better tendon healing.

Presión y área de contacto en reparación de manguito rotador: una revisión sistemática / Pressure and contact area in rotator cuff repair: a systematic review

OBJETIVO Proporcionar una sinopsis exhaustiva y un análisis de los estudios biomecánicos sobre la magnitud y distribución de la presión en la interfase tendón-huella de las roturas del manguito rotador, informadas en la literatura en los últimos cinco años. MÉTODOS La investigación se realizó de acuerdo con los métodos descritos en el Manual Cochrane. Los resultados se informan de acuerdo con el consenso de Ítems Preferidos de Reporte en Revisiones Sistemáticas y Metaanálisis (Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PRISMA, en inglés). La búsqueda se realizó el 1er de junio de 2020. Se identificaron e incluyeron estudios ex vivo de ciencia básica y estudios biomecánicos publicados, que evaluaran la magnitud y distribución de la presión en la interfase tendón-huella de las roturas del manguito rotador reparadas entre enero de 2015 y junio de 2020. Se realizaron búsquedas sistemáticas en las bases de datos MEDLINE, Embase, Scopus y Google Scholar utilizando los términos y operadores booleanos: (Rotator Cuff OR Supraspinatus OR Infraspinatus OR Subscapularis OR Teres Minor) AND Pressure AND Footprint. En la base de datos Embase, respetando su sintaxis, se utilizó: Rotator Cuff AND Pressure AND Footprint. RESULTADOS Un total de 15 de los 87 artículos encontrados cumplieron con todos los criterios de elegibilidad y se incluyeron en el análisis. CONCLUSIÓN La presión y área de contacto sería optimizada biomecánicamente con una reparación transósea de doble fila equivalente, sin nudos en la hilera medial, y con el uso de cintas para su ejecución, conceptos de reparación específica para roturas delaminadas, y limitación de la abducción en el postoperatorio inmediato.

OBJETIVE To provide a comprehensive synopsis and analysis of biomechanical studies on the magnitude and distribution of pressure at the tendon-footprint interface of rotator cuff tears reported in the literature in the last five years. METHODS The research was performed according to the methods described in the Cochrane Manual. The results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) consensus. The search was performed on June 1st, 2020. We identified and included ex vivo basic science studies and published biomechanical studies that evaluated the magnitude and distribution of pressure at the tendon-footprint interface of rotator cuff tears repaired between January 2015 and June 2020. Systematic searches on the MEDLINE, Embase, Scopus and Google Scholar databases were performed using the terms and Boolean operators: (Rotator Cuff OR Supraspinatus OR Infraspinatus OR Subscapularis OR Teres Minor) AND Pressure AND Footprint. In the Embase database, respecting its syntax, the following was used: Rotator Cuff AND Pressure AND Footprint. RESULTS In total, 15 of the 87 articles found fulfilled all the eligibility criteria and were included in the analysis. CONCLUSION The pressure and contact area would be biomechanically optimized with an equivalent transosseous double-row repair, without knots in the medial row, and with the use of tapes for its execution, specific repair concepts for delaminated tears, and a limitation of abduction in the immediate postoperative period.

Respostas pressóricas faringeana, esofágica e do esfíncter esofagiano a tarefas vocais à luz da manometria de alta resolução / Pharyngeal, upper esophageal sphincteric and esophageal pressures responses related to vocal tasks at the light of high resolution manometry

ABSTRACT BACKGROUND: High-resolution manometry (HRM) represents a potential tool for measuring pharyngoesophageal phonation pressures. OBJECTIVE: This study aims to evaluate pharyngeal, esophageal upper sphincteric and esophageal pressures during different phonation tasks. METHODS: 12 (six males, mean age 27 years) professional singers underwent HRM and produced four different vocal tasks at low, medium and high vocal loudness: vowel /ae/, ascending five note scale, word /hey/ and word /go/. Pressures were measured at pharynx, upper esophageal sphincter (UES) and esophagus. Visual analysis of the HRM topographic plots were performed. RESULTS: Esophageal pressures are higher during vocalization than at rest. Pharyngeal and UES phonation pressures does not differ significantly from rest pressures. Visual analysis of the topographic plots showed an important UES pressure increasement during phonation. CONCLUSION: HRM is a valuable tool for measuring pharyngoesophageal pressures during phonation. Esophageal pressures are higher during phonation than at rest and tend to increase with vocal loudness increment. The topographic plot provides additional data about phonatory mechanism physiology, especially at the UES region.

RESUMO CONTEXTO: A manometria de alta resolução (MAR) é uma ferramenta de grande potencial para mensuração das pressões faringoesofágicas durante a fonação. OBJETIVO: O estudo visa avaliar pressões faringianas, do esfíncter esofagiano superior e do esôfago durante manobras fonatórias. MÉTODOS: Doze (seis homens, idade média 27 anos) cantores profissionais foram submetidos à MAR e produziram quatro tarefas vocais em intensidade baixa, média e alta: vogal / ae /, escala ascendente de cinco notas, palavras /hey/ e /go/. Pressões aos níveis da faringe, esfíncter esofagiano superior e esôfago foram aferidas além de análise visual dos traçados. RESULTADOS: Pressões esofágicas foram maiores na vocalização que no repouso. Pressões da faringe e esfíncter esofagiano superior durante a fonação não foram diferentes que no repouso. Análise visual dos traçados mostrou importante incremento da pressão do esfíncter durante a fonação. CONCLUSÃO: MAR é uma ferramenta valiosa para mensurar as pressões faringoesofágicas durante a fonação. Pressões esofágicas são maiores durante a fonação que no repouso e tendem a aumentar com maior intensidade sonora. Análise visual dos traçados mostram dados adicionais sobre a fisiologia do mecanismo da fonação, especialmente na região do esfíncter esofagiano superior.

EndoFLIP: una nueva tecnología / EndoFLIP: a new technology

Resumen Mediante la distensión de un balón con líquido conductor, la sonda de imagen luminal funcional endoluminal (EndoFLIP) evalúa las propiedades biomecánicas como la distensibilidad, volumen, presión e inclusive diámetros de regiones esfinterianas como la unión gastroesofágica, píloro y ano. La mayor evidencia en la utilidad clínica de la EndoFLIP está en los trastornos de motilidad esofágica, principalmente para identificar acalasia cuando la manometría esofágica de alta resolución y otras imágenes no logran diagnosticarla e inclusive, mediante el programa de FLIP 2.0, caracteriza la acalasia en subtipos a partir de patrones de motilidad del esófago distal en respuesta a la distensión. Se ha demostrado recientemente que la EndoFLIP tiene un rol diagnóstico, pronóstico o terapéutico en otras patologías como la esofagitis eosinofílica, reflujo gastroesofágico, gastroparesia, durante la fundoplicatura y dilatación esofágica.

Abstract EndoFLIP evaluates biomechanical properties such as distensibility, volume, pressure, and even diameters of sphincter regions like the gastroesophageal junction, pylorus, and anus, by distending a balloon with a conductive medium. The best evidence of the clinical utility of EndoFLIP is observed in esophageal motility disorders, mainly when identifying achalasia when high-resolution esophageal manometry and other images fail to diagnose it. Even EndoFLIP 2.0 characterizes achalasia into subtypes based on distal esophageal motility patterns in response to distention. Recently, it has been shown that this system has a diagnostic, prognostic and/or therapeutic role in other diseases such as eosinophilic esophagitis, gastroesophageal reflux, and gastroparesis, and during fundoplication and esophageal dilation.

High pressure endoscopic irrigation: impact on renal histology

ABSTRACT Purpose: High intra-renal pressures during flexible ureteroscopy have been associated with adverse renal tissue changes as well as pyelovenous backflow. Our objective was to investigate the effect of various intra-renal pressures on histologic changes and fluid extravasation during simulated ureteroscopy. Materials and Methods: Twenty-four juvenile pig kidneys with intact ureters were cannulated with an Olympus flexible ureteroscope with and without a ureteral access sheath and subjected to India ink-infused saline irrigation for 30 minutes at constant pressures ranging from sphygmomanometer settings of 50mm, 100mm and 200mmHg. Renal tissue samples were collected, processed and stained, and were evaluated by a blinded pathologist for depth of ink penetration into renal parenchyma as a percentage of total parenchymal thickness from urothelium to renal capsule. Results: The mean percentage of tissue penetration for kidneys with ink present in the cortical tubules at sphygmomanometer pressure settings of 50, 100, and 200mm Hg without a ureteral access sheath was 33.1, 31.0 and 99.3%, respectively and with ureteral access sheath was 0, 0 and 18.8%, respectively. Overall, kidneys with an access sheath demonstrated a smaller mean tissue penetration among all pressure compared to kidneys without a sheath (6.3% vs. 54.5%, p=0.0354). Of kidneys with sheath placement, 11% demonstrated any ink compared to 56% of kidneys without sheath placement. Conclusions: Pressurized endoscopic irrigation leads to significant extravasation of fluid into the renal parenchyma. Higher intra-renal pressures were associated with increased penetration of irrigant during ureteroscopy in an ex-vivo porcine model.

Presión en la reparación de manguito rotador con suturas transóseas y Mason-Allen modificado / Pressure on the rotator cuff repair with transosseous sutures and modified Mason-Allen

OBJETIVO:Comparar el promedio de curva de presión de contacto y el porcentaje de presión de contacto residual final en la interfase tendón-huella de una reparación transósea (TO) realizada con nudos cruzados y una configuración Mason-Allen modificada (MAM). MÉTODOS: Se utilizaron ocho hombros de cordero para simular una rotura de manguito rotador. Se midió la presión con un sensor digital. Se registró la presión basal durante la aplicación de carga cíclica y al final de la intervención. Se compararon dos reparaciones: dos túneles TOs con nudos cruzados (TOCs) (n » 4) y dos puntos MAMs (n » 4) utilizando suturas MaxBraid #2 (Zimmer Biomet, Warsaw, IN, EEUU). Se realizaron 1.000 ciclos, con una frecuencia de 2 Hz y una carga de 30 N. Se utilizó el test de t de Student, y se consideraron significativos valores de p < 0,05. RESULTADOS: El promedio de curva de presión de contacto en las piezas que fueron reparadas con suturas TOCs fue de 86,01 8,43%, mientras que con MAM fue de 73,28 12,01% (p < 0,0004). El promedio del porcentaje residual al final del ciclado fue de 71,57% para suturas TOCs y de 51,19% para MAM (p < 0,05). CONCLUSION: La reparación TOC presenta mayor promedio de curva de presión de contacto y mayor porcentaje de presión de contacto residual final en la interfase tendón-huella que la reparación con sutura MAM luego de carga cíclica estandarizada, lo que podría traducirse en una mejor cicatrización del tendón. NIVEL DE EVIDENCIA: Estudio de ciencia básica.

OBJECTIVE: To compare the average contact pressure curve and the percentage of final residual contact pressure at the tendon-footprint interphase of a transosseous (TO) repair performed with crossover sutures or a modified Mason-Allen (MMA) configuration. METHODS: Eight lamb shoulders were used to simulate a rotator cuff tear. The pressure was measured with a digital sensor. The baseline pressure was recorded during the application of the cyclic load and at the end of the intervention. Two repairs were compared: 2 crossover TO (CTO) sutures (n » 4) and 2 MMA sutures MMA (n » 4), using MaxBraid #2 (Zimmer Biomet, Warsaw, IN, US) sutures. A thousand cycles were performed, with a frequency of 2 Hz and a 30-N load. The Student t-test was used, and significance was set at p < 0.05. RESULTS: The average contact pressure curve was of 86.01 8.43% for parts repaired with CTO sutures, and of 73.28 12.01% for those repaired with MMA sutures (p < 0.0004). The mean residual percentage at the end of cycling was of 71.57% for CTO sutures, and of 51.19% for MMA sutures (p < 0.05). CONCLUSION: The CTO repair shows a higher average contact pressure curve and a higher percentage of final residual contact pressure at the tendon-footprint interphase than the MMA suture repair after standardized cyclic loading, potentially resulting in improved tendon healing. LEVEL OF EVIDENCE: Basic Science Study.

Manejo de la presión del cuff en usuarios adultos con vía aérea artificial por profesionales de salud en Chile / Management of the cuff pressure in patients with an artificial airway by health professionals in Chile

Existen diferentes recomendaciones internacionales sobre el rango de presión delcuff para utilizar en usuarios adultos con vía aérea artificial. Algunas instituciones de salud chilenas han creado sus protocolos de vía aérea basadas en dichas recomendaciones, ya que no existe una guía nacional. Se desarrolló una revisiónbibliográficaen la Universidad de Southampton, Reino Unido,para determinar el rango adecuado de presión delcuff siendo entre 20-30 cmH2O. Posteriormente, se creó un cuestionario online válido y confiable en español en la Universidad de Southampton, Reino Unido,para ser aplicado en Chile. El objetivo de este estudio es analizar las respuestas emanadas de los profesionales de salud en Chile sobre el manejo de la presión delcuff en pacientes adultos con vía aérea artificial. Es un estudio analítico, observacional y transversal. Consistió en analizar las respuestas de enfermeros, kinesiólogos y fonoaudiólogos con experiencia en pacientes con vía aérea artificialtras aplicar el cuestionario. Los resultados muestran que la técnica objetiva fue ampliamente utilizada de forma aislada (58%) en comparación al uso exclusivo de subjetivas (7%). La presión mínima fue de 25 cmH2O mientras que la máxima fue de 34 cmH2O, rango mayor a lo reportado por la evidencia. Solo un 38% declaró la existencia de protocolo en su trabajo. Hubo diferencia estadísticamente significativa entre las presiones máximas usadas y las recomendadas en dichos protocolos (p=0,029). Se concluye que los participantes en Chile mostraron un manejo poco seguro de la presión delcuff en pacientes adultos con vía aérea artificial que puede generar riesgos asociados a cuffssobre o sub insuflados. Se sugiere desarrollar una guía Ministerial.

There are different international recommendations on the cuff pressure range for the management of adult patients with an artificial airway. Some Chilean health institutions have developed their own airway management protocols based on these recommendations due to the lack of a national guide. A literature review wasundertaken at the University of Southampton, U.K., to determine the appropriate cuff pressure range. Results found that this is between 20-30 cmH2O. Afterwards, a valid and reliable online questionnaire was developed in Spanish at the University of Southampton for application in Chile. The aim of this study is to analyse the cuff pressure management of adult patients with an artificial airway performed by non-medical health professionals in Chile. An analytical, observational and cross-sectional study was performed. A database which contained the responses of nurses, physiotherapists and speech therapists with experience attending adult patients with an artificial airway in Chile was analysed. Results show that 58% of the participants used exclusively the objective technique whilst 7% only used subjective techniques. The minimum and maximum pressures used were 25 and 34 cmH2O respectively, which were higher than the recommended range. 38% of the participants declared that there was an existing protocol at their workplace. There was a significant difference between the maximum pressures used by the clinicians and the pressures recommended on the protocols (p=.029). In conclusion, the participants showed a poor manage of the cuff pressure which could create risks linked with over-inflated or under-inflated cuffs. It is suggested to develop a national guide.

Abordaje holístico de las lesiones por presión en la persona mayor: Caso clínico / Holistic approach to pressure injuries in the elderly: Clinical case

Se expone un caso clínico de una paciente de 88 años cursando una hospitalización domiciliaria de larga estadía, por múltiples lesiones por presión, tras su seguimiento presenta una merma en su recuperación, por lo que un profesional de enfermería de hospitalización domiciliaria realiza una visita domiciliaria integral que evidencia múltiples elementos que precisan un abordaje holístico de la situación. Para su abordaje se utilizó el marco teórico de Virginia Henderson, que facilitó la elección del diagnóstico en la cuidadora de Cansancio del rol de cuidador, lo cual permitió que la situación lograra ser abordada satisfactoriamente. CONCLUSIÓN: se relevó la importancia de un manejo holístico en las lesiones por presión, que debe considerar la dimensión social en la que está inmerso el paciente, junto a un manejo interdisciplinario, preparación profesional y abordaje precoz del probable impacto económico en estos pacientes.

A clinical case of an 88-year-old patient undergoing a long-term home hospitalization due to multiple pressure injuries is presented. After follow-up, she presents a decline in her recovery, so a home hospitalization nursing professional performs a comprehensive home visit that shows multiple elements that require a holistic approach to the situation. For its approach, the theoretical framework of Virginia Henderson was used, which facilitated the choice of the diagnosis in the caregiver of Tiredness from the caregiver role, which allowed the situation to be satisfactorily addressed. CONCLUSION: the importance of a holistic management of pressure injuries was highlighted, which must consider the social dimension in which the patient is immersed, together with an interdisciplinary management, professional preparation, and an early approach to the probable economic impact on these patients.

Do papel do treinador ao ambiente competitivo no futebol infantil: o que está em jogo? / From coaches' roles to the competitive environment in children's football: what's at play? / Del papel del entrenador al entorno competitivo en el fútbol infantil: ¿qué está en juego?

Resumo Esta pesquisa teve como objetivo averiguar a percepção dos treinadores sobre o papel do treinador e o ambiente competitivo no futebol da categoria sub-10. Foram realizadas entrevistas semiestruturadas com 12 treinadores e observadas cinco partidas das fases finais da competição. Os resultados evidenciam que os treinadores reconhecem o seu papel formador, mas não orientam as suas intervenções para valores e competências mais adequados para essa etapa de formação. Os treinadores percebem a competição como um ambiente de aprendizagem, reconhecendo o jogo e a competição como ambientes de pressão inerentes a outras tarefas da vida, mas salientam que em muitas situações esse ambiente de pressão se torna excessivo, por conta do comportamento dos adultos. Assim, os propósitos dos adultos são sobrepostos às possibilidades de experiência e aprendizado das crianças na competição.

Abstract This study examines coaches' views about their role in the U-10 football competitive environment. Semi-structured interviews were conducted with 12 coaches, and 5 matches of the final stages of the competition were observed. The results show that coaches recognize their educational role but do not focus on values and the most appropriate skills in that stage of training. Coaches perceive competition as a learning environment, recognizing the game and competition as a pressure environment inherent to other tasks in life, but they stress that this pressure environment often becomes excessive due to the behavior of adults. Thus, adults' purposes are often superimposed on children's possibilities for experiencing and learning in competition.

Resumen La investigación tuvo como objetivo conocer la percepción de los entrenadores sobre su papel y el ambiente competitivo en el fútbol de la categoría sub-10. Se realizaron entrevistas semiestructuradas con 12 entrenadores y se observaron cinco partidos de la fase final de una competición en nivel estatal. Los resultados muestran que los entrenadores reconocen su papel como formadores, pero no orientan sus intervenciones hacia el desarrollo de valores y habilidades más apropiados en esta etapa de formación deportiva. Los entrenadores perciben la competición como un ambiente de aprendizaje, así como reconocen los partidos como un ambiente de presión inherente a otras tareas de la vida, pero destacan que en muchas situaciones ese ambiente de presión se vuelve excesivo, debido al comportamiento de los adultos. Así, los propósitos de los adultos a menudo se superponen a las posibilidades de experiencia y aprendizaje de los niños en la competición.

Fisiología respiratoria mecánica de la respiración / Mechanics breathing

El trabajo respiratorio se ejerce en una estructura cerrada donde se encuentran los pulmones, estos son sometidos a cambios de presiones determinados por la musculatura pulmonar en las diferentes fases del ciclo respiratorio, lo que generará gradientes y permite la entrada y salida de aire. Se suman a ello el calibre de las vías aéreas, el tipo de flujo, las características de las vías aéreas y del surfactante pulmonar, que determinan un menor o mayor trabajo respiratorio según la condición fisiológica.

The work of breathing is exerted in a closed structure where the lungs are located. These are subjected to pressure changes determined by the pulmonary musculature in the different phases of the respiratory cycle, which will generate gradients and allow the entry and exit of air. In addition to the aforesaid, airway calibre, type of flow, airway characteristics and pulmonary surfactant determine less or more work of breathing depending on the physiological condition.

Condições de trabalho no cultivo da cana-de-açúcar no Brasil e repercussões sobre a saúde dos canavieiros / Working conditions in sugarcane crops in Brazil and their effects on workers' health

Objetivo: analisar as condições de trabalho na cultura de cana-de-açúcar no Brasil e as suas repercussões na saúde do trabalhador. Métodos: revisão de literatura realizada nas bases LILACS, PubMed/MEDLINE e SciELO. Foram incluídos estudos originais publicados em português, inglês e espanhol, de 1970 a 2018. Resultados: inicialmente foram identificados 622 estudos e, após a aplicação dos critérios de exclusão, 69 artigos foram selecionados para a revisão. A análise dos trabalhos evidenciou o sistemático descumprimento das normas trabalhistas, previdenciárias e de saúde. Os estudos constataram ausências de intervalos de descanso, jornadas excessivas de trabalho, deficiência na distribuição dos equipamentos de proteção individual (EPIs) e na oferta de treinamentos para o seu uso, precariedade da distribuição e orientação sobre uso de repositores hidroeletrolíticos, inadequadas condições dos alojamentos e da alimentação dos trabalhadores, pressões e conflitos existentes no ambiente de trabalho, vínculos de trabalho precários, baixos salários e pagamento por produção. Exaustão física e psíquica dos trabalhadores, afecções musculoesqueléticas e articulares, hipertermia e acidentes de trabalho são comuns. Conclusão: as condições de trabalho nas lavouras de cana-deaçúcar, aliadas às diferentes vulnerabilidades existentes nos territórios, levam ao adoecimento e à morte, demonstrando que frequentemente os interesses econômicos se sobrepõem aos cuidados com a saúde dos trabalhadores

Objective: to analyze the working conditions in sugarcane crops in Brazil and their effects on workers' health. Methods: it consists of a literature review conducted at LILACS, PubMed/MEDLINE, and SciELO databases. We searched original articles published from 1970 to 2018 in Portuguese, English, and Spanish. Results: from the 622 studies identified, 69 met the inclusion criteria and were selected for review. Their analysis indicate the systematic non-compliance with labor, social security, and health standards. The studies evinced lack of work breaks and excessive working hours; deficiency in the distribution of personal protective equipment (PPE) and in the offering of training for its use; precarious distribution and orientation on electrolyte replenisher use; inadequate housing and feeding conditions; pressures and conflicts in the work environment; precarious work relationships; low wages; and production-based pay. Physical and mental exhaustion, musculoskeletal and joint disorders, hyperthermia, and occupational injuries are common among these workers. Conclusion: the working conditions in sugarcane plantations, associated to different territories vulnerabilities, promote illnesses and death, indicating that economic interests often overlap with workers' health

Biomecânica da língua durante a deglutição após laringectomia total: revisão integrativa / Biomechanics of the tongue during swallowing after total laryngectomy: an integrative review

RESUMO Objetivo Sintetizar o estado do conhecimento científico sobre biomecânica da língua durante a deglutição após laringectomia total. Estratégia de pesquisa Formulou-se a questão PICO e combinações de descritores e termos livres para busca nas bases de dados PubMed/Medline, EMBASE, LILACS e SciELO. Critérios de seleção incluíram-se artigos nos idiomas português, inglês ou espanhol; sem limite de tempo; com resultados sobre a biomecânica da língua durante a deglutição em laringectomizados totais; e estudos do tipo ensaio clínico randomizado ou não randomizado, coorte, caso controle, transversal, série de casos e estudos de caso. Análise dos dados analisou-se ano, país, população, objetivo, delineamento do estudo, instrumentos de avaliação, principais desfechos e qualidade metodológica. Resultados Foram incluídos quatro estudos realizados nos Estados Unidos, um na Austrália e um no Brasil, publicados entre 1986 e 2014. Em todos os estudos incluídos a biomecânica da língua foi um desfecho secundário. A maioria dos artigos teve baixa qualidade metodológica, com amostras pequenas, predomínio do sexo masculino e desenho transversal prevalente. Os instrumentos de avaliação foram videofluoroscopia, manometria, acelerômetro ou dispositivo para captar pressão de língua. Resultados principais indicaram mais força de propulsão da base de língua para superar a alta resistência da neofaringe ao fluxo do bolo alimentar; redução do contato e pressão entre base de língua e parede posterior da faringe; resíduo em base de língua após deglutição; pressão aumentada e resistência reduzida da língua oral. Conclusão Existem indícios de movimentos compensatórios de língua durante a deglutição após laringectomia total, porém, as evidências científicas são insuficientes.

ABSTRACT Purpose To synthesize the state of scientific knowledge about biomechanics of the tongue during swallowing after total laryngectomy. Research strategy The PICO question and combinations of descriptors and single terms were formulated in the PubMed/Medline, EMBASE, LILACS, and SciELO databases. Selection criteria Articles in Portuguese, English, or Spanish were included, without time limit, with results on the biomechanics of the tongue during swallowing and total laryngectomy, and studies on randomized or non-randomized clinical trials, cohort, case control, cross-sectional, case series, and case studies. Data analysis year, country, population, objective, study design, assessment methods, main outcomes, and methodological quality were analyzed. Results There were four studies in the United States, one in Australia, and one in Brazil, all published between 1986 and 2014. In all studies, the biomechanics of the tongue was the secondary outcome. Most articles had low methodological quality, small samples, predominance of the male gender, and a prevalent cross-sectional design. The assessment instruments were fluoroscopy, manometry, accelerometer or a device to capture tongue pressure. Main results indicated a higher propulsion force of the tongue base to overcome the high resistance of the neopharynx to the bolus flow, reduced contact and pressure between the base of the tongue and the posterior pharyngeal wall, residues in the tongue base after swallowing, increased pressure, and reduced resistance of the oral tongue. Conclusion There are indications of compensatory tongue movements during swallowing after total laryngectomy; however, the scientific evidence is insufficient.

Biomechanical evaluation of a new femoral stem design for total hip replacement in a canine model

ABSTRACT Purpose To evaluate the biomechanical properties of a novel total hip replacement femoral stem. Methods Eight pairs of femurs from dog cadavers were used. The femurs were separated into different groups. A novel femoral stem with a convex proximal portion (Stem B) was biomechanically evaluated and compared to awell-known veterinary collared stem (Stem A). Femoral stems were inserted into the contralateral femurs from the same dog, forming 16 constructs. A flexo-compression load was applied on the axial axis of each sample. Maximum strength, deflection, stiffness, and energy absorption were analysed. Results Group B constructs showed significantly higher values (p ? 0.05) for the variables, except stiffness. The mean maximum strength was 1,347 ± 357 N for Group A and 1,805 ± 123 N for Group B (p ? 0.0069). The mean deflection was5.54 ± 2.63 mm for Group A and 10.03 ± 3.99 mm for Group B (p ? 0.0056). For the energy variable, the force was 6,203 ± 3,488 N/mm for Group A and 12,885 ± 5,056 N/mm for Group B (p ? 0.0054). Stem B had greater maximum strength, deflection, and energy. Conclusions The new stem was effective in neutralizing the impact of axial flexion-compression stresses during biomechanical tests in cadaveric models.

Máscara termoplástica recubierta de silicona para el manejo de la cicatriz hipertrófica facial / Silicone coated thermoplastic mask for management of hypertrophic facial scars

Resumen Las quemaduras secundarias a agresión física con intención de desfigurar, torturar o incluso asesinar, se han convertido en un motivo de consulta común en el siglo XXI, siendo Bangladesh el país con la más alta incidencia en el mundo. Colombia es uno de los países con mayor incidencia a nivel de Latinoamérica. La mayoría de las lesiones ocurre en áreas expuestas como el rostro y se acompaña de graves secuelas físicas, estéticas y funcionales. Se realiza la presentación de caso de una paciente de 35 años con quemaduras de tercer grado en región frontal, periocular, malar bilateral, nasal, labial superior y pabellón auricular derecho, manejada con injertos de piel, quien posteriormente desarrolla cicatriz hipertrófica. Se describe el tratamiento con máscara termoplástica elaborada por los profesionales tratantes, con cubierta interna de silicona, fabricada sobre molde a medida y ajustada con bandas elásticas; integrando en un único dispositivo removible, cómodo y de bajo costo, diferentes alternativas terapéuticas que logran modular efectivamente el proceso de cicatrización y por su simplicidad favorecen la adherencia al tratamiento, la cual es indispensable para obtener resultados satisfactorios. MED.UIS.2020;33(3): 49-58

Abstract Burns secondary to physical aggression with the intention of disfiguring, torturing or even murdering, have become a common reason for consultation in the 21st century, with Bangladesh being the country with the highest incidence in the world. Colombia is one of the countries with the highest incidence in Latin America. Most injuries occur in exposed areas such as the face and are accompanied by serious physical, aesthetic and functional sequelae. We present the case of a 35-year-old patient with third degree burns in the frontal, periocular, bilateral malar, nasal, upper labial and right ear region, managed with skin grafts, who later developed a hypertrophic scar. The treatment with a thermoplastic mask made by the treating professionals is described, with an internal silicone cover, made on a custom mold and adjusted with elastic bands; integrating in a single removable, comfortable and low-cost device, different therapeutic alternatives that manage to effectively modulate the healing process and, due to their simplicity, favor adherence to treatment, which is essential to obtain satisfactory results. MED.UIS.2020;33(3): 49-58

Endotracheal tube cuff pressure increases in patients undergoing shoulder arthroscopy: a single cohort study / Aumento da pressão do balonete do tubo endotraqueal em pacientes submetidos a artroscopia do ombro: estudo de coorte

Abstract Background and objectives Several airway complications can occur during shoulder arthroscopy including airway obstruction, pleural puncture, and subcutaneous emphysema. It was hypothesized that the irrigation fluid used during a shoulder arthroscopic procedure might increase the cuff pressure of the endotracheal tube, which can cause edema and ischemic damage to the endotracheal mucosa. Therefore, this study aimed to evaluate the relationship between irrigation fluid and endotracheal tube cuff pressures. Methods Forty patients aged 20 to 70 years with an American Society of Anesthesiologists (ASA) score I or II, scheduled for elective arthroscopic shoulder surgery under general anesthesia, participated in our study. We recorded endotracheal tube cuff pressures and neck circumferences every hour from the start of the operation. We also recorded the total duration of the anesthesia, operation, and the total volume of fluid used for irrigation. Results A positive correlation was shown between endotracheal tube cuff pressures and the amount of irrigation fluid (r = 0.385, 95% CI 0.084 to 0.62, p = 0.0141). The endotracheal tube cuff pressure significantly increased at 2 and 3 hours after starting the operation (p = 0.0368 and p = 0.0245, respectively). However, neck circumference showed no significant difference. Conclusions Endotracheal tube cuff pressures increased with operation time and with increased volumes of irrigation fluid used in patients who underwent shoulder arthroscopy. We recommend close monitoring of endotracheal tube cuff pressures during shoulder arthroscopy, especially during long operations using a large amount of irrigation fluid, to prevent complications caused by raised cuff pressures.

Resumo Justificativa e objetivos Diversas complicações das vias aéreas podem ocorrer durante a artroscopia do ombro, incluindo obstrução das vias aéreas, punção pleural e enfisema subcutâneo. Levantou‐se a hipótese de que o fluido de irrigação utilizado durante artroscopia do ombro possa aumentar a pressão do balonete do tubo endotraqueal, podendo causar edema e lesão isquêmica na mucosa traqueal. Portanto, este estudo teve como objetivo avaliar a relação entre o fluido de irrigação e a pressão do balonete do tubo endotraqueal. Métodos Participaram do estudo 40 pacientes com idades entre 20 e 70 anos com classificação do estado físico I ou II da American Society of Anesthesiologists (ASA), programados para cirurgia artroscópica do ombro, eletiva e sob anestesia geral. Registramos as pressões do balonete do tubo endotraqueal e as circunferências do pescoço a cada hora, a partir do início da cirurgia. Também registramos a duração anestésica e cirúrgica, assim como o volume total de líquido de irrigação empregado. Resultados Foi encontrada correlação positiva entre a pressão do balonete do tubo endotraqueal e a quantidade de líquido de irrigação (r = 0,385; 95% IC 0,084 a 0,62; p = 0,0141). A pressão do balonete do tubo endotraqueal registrou aumento significante 2 e 3 horas após o início da cirurgia (p = 0,0368 e p = 0,0245, respectivamente). No entanto, a circunferência do pescoço não mostrou diferença significante. Conclusões As pressões do balonete do tubo endotraqueal aumentaram com o tempo de cirurgia e com o aumento do volume de líquido de irrigação utilizado em pacientes submetidos a artroscopia do ombro. Recomendamos a monitorização rigorosa da pressão do balonete do tubo endotraqueal durante artroscopia do ombro, especialmente nos procedimentos longos em que grandes volumes de fluido de irrigação são empregados, para evitar complicações causadas por pressões elevadas do balonete.

Proceso enfermero aplicado a un paciente con úlceras por presión / Nursing process applied to a patient with pressure ulcers / Processo de enfermagem aplicado a um paciente com úlcera por pressão

Resumen Las escaras (también llamadas úlceras por presión y úlceras de decúbito) son lesiones en la piel y el tejido inferior, resultan de una presión prolongada sobre la misma. En la mayoría de los casos, se manifiestan en la piel que recubre las partes óseas del cuerpo, como talones, tobillos, caderas y coxis. Las personas que corren mayor riesgo de tener escaras tienen limitada su capacidad para cambiar de posición o pasan la mayor parte del tiempo en una cama o una silla de ruedas. Pueden desarrollarse en el transcurso de horas o días, la mayoría se curan con tratamiento, pero algunas nunca se curan completamente. El proceso enfermero es una herramienta metodológica a través del cual Enfermería puede apoyar al paciente y/o familiar en brindar cuidados y educación en la prevención y atención de las úlceras por presión. En México, dos estudios metacéntricos reportan que la prevalencia cruda de UPP es del 12,94% y del 17%, respectivamente. El presente caso se trata de una mujer adulto mayor, en edad extrema (81 años), atendida por su familiar, con regular adherencia a su tratamiento terapéutico y de cuidados, pasa la mayor parte del tiempo en cama, movilización regular aunque con buena higiene, con una escara de región sacra limpia en estadio ll, la paciente y familiar muestra disponibilidad y motivación para aprender acciones de cuidado y prevención adoptar cambios en los hábitos de vida, ser más saludable además mejorar la salud familiar.

Abstract Bedsores (also called pressure ulcers and pressure sores) are lesions on the skin and lower tissue, resulting from prolonged pressure on it. In most cases, they manifest on the skin that covers the bony parts of the body, such as heels, ankles, hips and coccyx. People who are most at risk for bedsores have limited ability to change position or spend most of their time in a bed or wheelchair. They can develop over the course of hours or days, most heal with treatment, but some are never completely cured. The nursing process is a methodological tool through which Nursing can support the patient and / or family in providing care and education in the prevention and care of pressure ulcers. In Mexico, two metacentric studies report that the crude prevalence of PU is 12.94% and 17%, respectively. The present case is about an elderly woman, (81 years), cared for by her relative, with regular adherence to her therapeutic and care treatment, spends most of the time in bed, regular mobilization although with good hygiene, with a clean sacral region eschar in stage II, the patient and family member show availability and motivation to learn care and prevention actions, adopt changes in life habits, be healthier and improve family health.

Resumo Escaras (também chamadas de úlceras de pressão e escaras) são lesões na pele e nos tecidos inferiores, resultantes de pressão prolongada sobre ela. Na maioria dos casos, eles se manifestam na pele que cobre as partes ósseas do corpo, como calcanhares, tornozelos, quadris e cóccix. Pessoas com maior risco de escaras têm capacidade limitada de mudar de posição ou de passar a maior parte do tempo em uma cama ou cadeira de rodas. Eles podem se desenvolver ao longo de horas ou dias, a maioria cura com tratamento, mas alguns nunca estão completamente curados. O processo de enfermagem é uma ferramenta metodológica por meio da qual a Enfermagem pode apoiar o paciente e / ou família na prestação de cuidados e educação na prevenção e cuidado das úlceras por pressão. No México, dois estudos metacêntricos relatam que a prevalência bruta de UP é de 12,94% e 17% 4, respectivamente. O presente caso se refere a uma idosa, em extrema idade (81 anos), cuidada por seu familiar, com adesão regular ao seu tratamento terapêutico e assistencial, passa a maior parte do tempo acamada, mobilização regular, porém, com boa higiene com uma escara limpa da região sacral em estágio II, o paciente e seu familiar demonstram disponibilidade e motivação para aprender ações de cuidado e prevenção, adotar mudanças de hábitos de vida, ter mais saúde e melhorar a saúde da família.