Trombose venosa profunda de membros inferiores em pacientes com covid-19 / Deep vein thrombosis of lower limbs in patients with COVID-19

Resumo Com o avanço do conhecimento, a covid-19 passou a ser considerada uma doença do sistema respiratório, podendo ter comprometimento multissistêmico. Analisou-se a prevalência de trombose venosa profunda (TVP) em membros inferiores em pacientes acometidos pela covid-19 através de uma pesquisa de revisão integrativa, considerando o período de 2019 a 2022. Os procedimentos utilizados para a seleção dos artigos foram identificação das palavras-chave, elaboração da estratégia de busca, consulta em bases de dados e exclusão dos artigos em duplicata e outros. A exclusão foi feita com base nos seguintes critérios: artigos sobre complicações vasculares arteriais em membros inferiores, pesquisas laboratoriais, relatos de casos referentes a complicações venosas e arteriais em outros sítios e artigos não relacionados ao desfecho de TVP. Do total de 284 artigos, foram incluídos 42. Observou-se grande variabilidade na prevalência de TVP em pacientes com covid-19 (0,43 a 60,87%). Sugere-se que a ocorrência de TVP em pacientes com covid-19 está associada à gravidade desta doença.

Abstract As knowledge has accumulated, COVID-19 has come to be considered a disease of the respiratory system that can also cause multisystemic involvement. This study analyzed the prevalence of deep venous thrombosis (DVT) in the lower limbs of patients with COVID-19 by conducting an integrative review of the literature published from 2019 to 2022. The procedures involved in article selection were identification of keywords, definition of the search strategy, consultation of databases, and exclusion of duplicate articles and others that did not meet the review objectives. Exclusion of articles was based on the following exclusion criteria: articles on arterial vascular complications involving the lower limbs, laboratory experiments, cases reports describing venous and arterial complications involving other sites, and articles unrelated to the outcome of interest: DVT. A total of 284 articles were identified, 42 of which were included. There was considerable variability in the prevalence of DVT among patients with COVID-19 (range: 0.43 to 60.87%). The findings suggest that occurrence of DVT in patients with COVID-19 is associated with disease severity.

Positive perception and efficacy of compression stockings for prevention of lower limb edema in pregnant women.

Background: Pregnancy is characterized by physiological changes that can contribute to development of varicose veins, venous insufficiency, and leg edema. Objectives: To evaluate the effect of compression stocking on lower limb edema in pregnant women and their perceptions of wearing them. Methods: This was a randomized, controlled, prospective, parallel, blinded clinical trial conducted with 60 pregnant women randomly distributed into two groups: an intervention group (n = 30) wearing compression stockings and a control group (n = 30). Standardized ankle and calf measurements were taken of all 120 lower limbs using a tape measure. At the end of the study, a questionnaire was administered to identify perceived difficulties and advantages related to wearing compression stockings. Results: Pregnant women in the intervention group had a significantly smaller increase (p < 0.05) in calf and ankle diameters compared to those in the control group. The mean differences from the beginning to the end of gestation in the diameters of the right calf, left calf, right ankle, and left ankle respectively were 0.30 cm, 0.30 cm, 0.15, cm and 0.15 cm in the intervention group and 1.95 cm, 1.95 cm, 1.73 cm, and 1.87 cm in the control group. Most of the pregnant women had no difficulty wearing the compression stockings and all reported that they felt a difference in leg symptoms and would wear stockings again. Conclusions: Compression stockings were effective for preventing lower limb edema in pregnant women, who had a positive perception of wearing them.

Percepção positiva e eficácia das meias de compressão na prevenção de edema em membros inferiores de gestantes / Positive perception and efficacy of compression stockings for prevention of lower limb edema in pregnant women

Resumo Contexto A gravidez é caracterizada por mudanças fisiológicas que podem contribuir para o desenvolvimento de varizes, insuficiência venosa e edema das pernas. Objetivos Avaliar o efeito das meias de compressão em edema de membros inferiores e a percepção sobre o uso por gestantes. Métodos Trata-se de um ensaio clínico randomizado, controlado, prospectivo, paralelo e cego realizado com 60 mulheres grávidas distribuídas aleatoriamente em dois grupos: grupo intervenção (n = 30), que usou meias de compressão, e grupo controle (n = 30). Foram realizadas medições padronizadas de tornozelo e panturrilha, empregando-se fita métrica, em todos os 120 membros inferiores. No final do estudo, foi aplicado também um questionário para verificação das dificuldades e vantagens percebidas com relação ao uso das meias de compressão. Resultados As gestantes do grupo intervenção apresentaram aumento significativamente menor (p < 0,05) nos diâmetros de panturrilha e tornozelo em relação ao grupo controle. As diferenças médias, no início e no final da gestação, nos diâmetros de panturrilha direita, panturrilha esquerda, tornozelo direito e tornozelo esquerdo foram de, respectivamente, 0,30 cm, 0,30 cm, 0,15 cm e 0,15 cm no grupo intervenção e 1,95 cm, 1,95 cm, 1,73 cm e 1,87 cm no grupo controle. A maioria das gestantes não teve dificuldade para utilizar as meias de compressão, e todas relataram que sentiram diferença nos sintomas das pernas e que usariam as meias novamente. Conclusões As meias de compressão foram eficazes na prevenção de edema em membros inferiores de gestantes, as quais apresentaram percepção positiva quanto à sua utilização.

Abstract Background Pregnancy is characterized by physiological changes that can contribute to development of varicose veins, venous insufficiency, and leg edema. Objectives To evaluate the effect of compression stocking on lower limb edema in pregnant women and their perceptions of wearing them. Methods This was a randomized, controlled, prospective, parallel, blinded clinical trial conducted with 60 pregnant women randomly distributed into two groups: an intervention group (n = 30) wearing compression stockings and a control group (n = 30). Standardized ankle and calf measurements were taken of all 120 lower limbs using a tape measure. At the end of the study, a questionnaire was administered to identify perceived difficulties and advantages related to wearing compression stockings. Results Pregnant women in the intervention group had a significantly smaller increase (p < 0.05) in calf and ankle diameters compared to those in the control group. The mean differences from the beginning to the end of gestation in the diameters of the right calf, left calf, right ankle, and left ankle respectively were 0.30 cm, 0.30 cm, 0.15, cm and 0.15 cm in the intervention group and 1.95 cm, 1.95 cm, 1.73 cm, and 1.87 cm in the control group. Most of the pregnant women had no difficulty wearing the compression stockings and all reported that they felt a difference in leg symptoms and would wear stockings again. Conclusions Compression stockings were effective for preventing lower limb edema in pregnant women, who had a positive perception of wearing them.

Automedicação e Saúde Pública: dimensionamento dos fatores de risco e comportamentos de saúde / Self-medication and Public Health: a study of risk factors and health-related behavior

O objetivo deste estudo foi caracterizar a prática da automedicação na população adulta, bem como, investigar os fatores de risco e os comportamentos individuais de saúde.Trata-se de um estudo epidemiológico,transversal, realizado na atenção primária em saúde no Brasil. Como instrumento da coleta foi utilizado um inquérito semiestruturado e dimensionado em blocos temáticos. Para estatística foram empregadas a análise bivariada e regressão logística binomial. Dos 537 entrevistados, 42,83% relataram ter feito uso de medicamentos sem prescrição no período de 15 dias. Verificaram-se associações entre a variável dependente e enxaqueca (OR=3,347); presença de dor atualmente (OR=2,189); uso do medicamento sob influência de familiares (OR=2,431); falta de leitura da bula (OR=1,682) e ausência de atividades de lazer (OR=4,335). Conclui-se que mais da metade dos usuários da atenção primária à saúde no Brasil, fez uso de medicamentos sem a prescrição.

This study characterized and measured self-medication in adult population, as well as identified possible associations between lifestyle and risk factors for the use of over-the-counter medications. This is an epidemiological, cross-sectional study, carried out in the primary health care of a city in Brazil. The data collection instrument was a semi-structured survey grouped into thematic blocks. The statistical analysis included a bivariate analysis and a binomial logistic regression provided the statistics. Of the 537 participants, 42.83% reported having used medication without a prescription in the last 15 days. There were associations between the dependent variable and migraine (OR = 3.347); current pain (OR = 2.189); use of medications under the influence of family members (OR = 2.431); not reading drugs' leaflet (OR = 1.682); and lack of leisure activities (OR = 4.335). A significant part of users of primary health care self-medicated.

The representation of HIV/AIDS and hepatitis B in the dentistry context.

INTRODUCTION: HIV/AIDS and hepatitis B are diseases with major epidemiological and social impacts, with important effects in the dentistry context. This study aimed to compare the knowledge, presence, and manifestation of discriminatory and stigmatizing acts of dental surgeons, dental assistants, and dental students concerning social representations of HIV/AIDS and hepatitis B. METHODOLOGY: This cross-sectional, quantitative study was carried out in Brazil with primary health care dental surgeons (n = 219) and dental assistants (n = 152) in 40 municipalities and dental students of a public university (n = 179). The z-test for proportions (p ≤ 0.05) was used for data analysis to compare the three groups. RESULTS: We found statistically significant differences regarding knowledge about HIV/AIDS and hepatitis B, with a higher percentage of correct answers by dental surgeons (97.7%). Regarding infection, the fear of contracting HIV/AIDS was more representative, whereas hepatitis B was more mentioned concerning the risk of infection. In general, only 30.7% and 42.2% of individuals would accept care from professionals with HIV/AIDS and hepatitis B, respectively; assistants and students had the higher proportion of refusal of care. Also, a higher proportion of assistants (47.4%) believed there are different conducts in the care of patients with HIV and hepatitis B. CONCLUSIONS: The knowledge of individuals about infectious diseases is still inconsistent, especially among dental assistants and students. Moreover, these groups showed a silent and hidden presence and manifestation of discriminatory and stigmatizing attitudes, with greater representativeness for HIV/AIDS.

Sífilis na gravidez: perfil e fatores sociodemográficos associados na Região Noroeste do Estado de São Paulo / Syphilis in Pregnancy: Profile and Associated Factors in the Northwest Region of São Paulo State

O Brasil está enfrentando uma epidemia de sífilis. No ciclo gravídico-puerperal, a sífilis possui grande incidência, sendo assim considerada um problema de saúde pública. Este trabalho teve como objetivo realizar a análise temporal e de incidência dos casos gestacionais e congênitos de sífilis em 28 municípios da região noroeste paulista. Trata-se de um estudo observacional, epidemiológico e ecológico desenvolvido com dados secundários coletados entre 2010 e 2017 nas bases públicas do SINAN e SINASC. Os casos relatados de sífilis gestacional/congênita foram descritos conforme as variáveis sociodemográficas, e testes de associação qui-quadrado realizados ao nível de significância de 5%. Encontraram-se 350 casos de sífilis gestacional e 164 casos de sífilis congênita; a taxa média de transmissão vertical foi de 44,09%; parceiros tiveram baixa adesão ao tratamento; e 86,59% das gestantes fizeram pré-natal. Conclui-se que a taxa de transmissão vertical da sífilis é alta, e poucos parceiros de grávidas aderem ao tratamento.

Brazil is undergoing an epidemic of syphilis. In the pregnancy-puerperal cycle, syphilis has a high incidence and is considered a public health problem. This study aimed to perform the temporal and incidence analysis of gestational and congenital syphilis cases in 28 municipalities in the northwest region of the state of São Paulo. This was an observational, epidemiological, ecological study carried out with secondary data collected between 2010 and 2017 in public databases of SINAN and SINASC. The reported cases of gestational/congenital syphilis were described according to sociodemographic variables and chi-square association tests were applied at a significance level of 5%. There were 350 cases of gestational syphilis and 164 cases of congenital syphilis; the average vertical transmission rate was 44.09%; partners had low adherence to treatment; and 86.59% pregnant women attended prenatal care. It can be concluded that vertical transmission rate of syphilis is high, and few partners of pregnant women adhere to the treatment.

A cross-sectional study on dental surgeons' immune status against hepatitis B virus in the Public Health System.

Hepatitis B is a severe public health problem. The main world health centers have discussed it due to its pandemic proportion, high pathogenicity and infectivity. This study aimed to determine the immunization profile of dental surgeons - against hepatitis B virus (HBV) in the Public Health System (PHS) through the detection of anti-HBsAg antibodies by immunochromatography and associations with dental surgeons' social and educational profile, factors related to professional knowledge and practices. This is a cross-sectional study on the prevalence of vaccination and immune status to HBV in dentists of Sao Paulo State PHS. Data collection occurred in three stages: questionnaire application, analysis of adhesion to the vaccination protocol and anti-HBsAg tests. Statistical analysis used the Bivariate Analysis and the Binary Logistic Regression. From the total of 219 interviewees, 74.9% reported having received three doses of the vaccine, but 35.6% were not immune to HBV. The dependent variable was associated with years in the public service (years) (OR [Odds Ratio]=1.04; 95% CI 1.00-1.08); knowledge on the subject (OR=6.93; 95% CI 1.39-34.40); incorrect answer concerning the etiological agent of the disease (OR=2.60; 95% CI 1.30-5.22); ignorance on the number of vaccine doses that have been administered (OR=3.43; 95% CI 1.14-10.30); and less than three doses of the vaccine in the immunization schedule (OR=8.76; 95% CI 3.50-21.91). A considerable portion of professionals non-immune to the HBV were found. We concluded that knowledge, years of practice and completion of the vaccination schedule (three doses) affected dental surgeons' immune status to HBV.

Pre- and postoperative evaluation by photoplethysmography in patients receiving surgery for lower-limb varicose veins.

Objective. To evaluate the effectiveness of surgery in treating primary varicose veins in the lower limbs by photoplethysmography (PPG) and duplex mapping (DM). Method. Forty-eight lower limbs were clinically evaluated according to the CEAP classification system and subjected to PPG and DM exams. Each limb had a venous refill time (VRT) of <20 seconds and a normal deep vein system (DVS) by DM. Results. The mean pre- and postoperative VRTs were 13.79 and 26.43 seconds, respectively (P < 0.0001). After surgery, 42 limbs (87.50%) had normal results by PPG (VRT > 20 seconds). Four limbs (8.33%) showed improved VRTs, but the VRTs did not reach 20 seconds. In the 2 limbs (4.17%) that maintained their original VRTs, the DM exams showed the presence of insufficient perforating veins. Conclusion. In most cases, PPG allows for a satisfactory evaluation of the outcome of varicose vein surgery.

Métodos de diagnóstico não-invasivos para avaliação da insuficiência venosa dos membros inferiores: [revisão] / Noninvasive diagnostic methods to evaluate venous insufficiency of the lower limbs: [review]

A avaliação clínica dos membros inferiores na insuficiência venosa por si só não identifica os sistemas envolvidos ou os níveis anatômicos, sendo necessários exames complementares. Esses exames podem ser invasivos ou não-invasivos. Os invasivos, como flebografia e pressão venosa ambulatória, apesar de terem boa acurácia, trazem desconforto e complicações. Dentre os não-invasivos, destacam-se: Doppler ultra-som de ondas contínuas, fotopletismografia, pletismografia a ar e mapeamento dúplex. O Doppler ultra-som avalia a velocidade do fluxo sangüíneo de maneira indireta. A fotopletismografia avalia o tempo de reenchimento venoso, fornecendo um parâmetro objetivo de quantificação do refluxo venoso. A pletismografia a ar permite quantificar a redução ou não da capacitância, o refluxo e o desempenho da bomba muscular da panturrilha. O dúplex é considerado padrão-ouro dentre os não-invasivos, porque permite uma avaliação quantitativa e qualitativa, fornecendo informações anatômicas e funcionais, dando avaliação mais completa e detalhada dos sistemas venosos profundo e superficial.

Clinical evaluation of lower limbs of patients with venous insufficiency alone may not identify involved systems or anatomical sites, thus complementary tests are needed. These tests can be invasive or noninvasive. Invasive tests, such as phlebography and ambulatory venous pressure, despite being accurate, may produce discomfort and complications. Some of the most used noninvasive tests are continuous wave Doppler ultrasound, photoplethysmography, air plethysmography and duplex scanning. Doppler ultrasound assesses blood flow velocity indirectly. Photoplethysmography assesses venous refilling time, providing an objective parameter of venous reflux quantification. Air plethysmography allows quantification of reduction in venous capacitance, reflux and performance of the calf muscle pump. Duplex is considered a gold standard among noninvasive methods, because it allows quantitative and qualitative evaluation, supplying anatomical and functional information, thus providing a more complete and detailed evaluation of both deep and superficial venous system.