[Effect of the implementation of a guideline for venous thromboembolism prophylaxis in surgical patients]. / Efeito da implementação de diretriz para profilaxia de tromboembolismo venoso em pacientes cirúrgicos.

INTRODUCTION: Effective strategies for prevention of venous thromboembolism (VTE) are widely available, but still remain underused, mainly in our country. OBJECTIVE: Our aim was to verify whether the implementation of a guideline for VTE prophylaxis for surgical patients influenced the prescription of prophylaxis by the medical staff. METHODS: This was a retrospective preintervention-postintervention study. Charts of 150 patients before guideline implementation (BGI) and 150 after (AGI) were randomized among all patients admitted during one year in each period. INCLUSION CRITERIA: >40 years-old, major abdominal or orthopedic surgeries. EXCLUSION CRITERIA: Incomplete files and use of anticoagulants for any reason at admission. Data registered: demographic data, reference to VTE risk factors, VTE prophylaxis prescription, diagnosis of deep venous thrombosis or pulmonary embolism during hospitalization. Results. The two groups, BGI and AGI were similar for demographic data and duration of prophylaxis (5.6 x 6.6 days). Frequency of prophylaxis in percentages was BGI x AGI respectively, before surgery: pharmacologic prophylaxis (PP), 6 x 9; graduated compression stockings (GCS), 4 x 3; intermittent pneumatic compression (IPC), 2 x 3. After surgery: PP, 53 x 53; GCS, 23 x 40 (P<0.05); IPC, 26 x 32. Including all patients, prophylaxis was prescribed for 60.5% BGI and 66.5% AGI, but was considered adequate only in 34% BGI and 32% AGI. CONCLUSION: Adoption of a guideline, although increasing concern about prophylaxis, expressed by greater use of GCS, only minimally improved quality of prophylaxis , indicating that other active and continuous interventions are necessary to enforce compliance.

Exploring the in vivo wound healing effects of a recombinant hemolin from the caterpillar Lonomia obliqua.

BACKGROUND: Hemolin proteins are cell adhesion molecules from lepidopterans involved in a wide range of cell interactions concerning their adhesion properties. However, hemolin's roles in cell proliferation and wound healing are not fully elucidated. It has been recently reported that rLosac, a recombinant hemolin from the caterpillar Lonomia obliqua, presents antiapoptotic activity and is capable of improving in vitro wound healing. Therefore, this study aimed to explore rLosac's in vivo effects using a skin wound healing model in rats. METHODS: Circular full-thickness wounds in the rat dorsum skin were treated either with rLosac, or with saline (control), allowing healing by keeping the wounds occluded and moist. During the wound healing, the following tissue regeneration parameters were evaluated: wound closure and collagen content. Furthermore, tissue sections were subjected to histological and immunohistochemical analyses. RESULTS: The rLosac treatment has demonstrated its capacity to improve wound healing, as reflected in findings of a larger number of activated fibroblasts, proliferation of epithelial cells, increase of collagen type 1, and decrease of inflammatory infiltrate. CONCLUSION: The findings have indicated the rLosac protein as a very promising molecule for the development of new wound-healing formulations.

Effects of compounds from Passiflora edulis Sims f. flavicarpa juice on blood coagulation and on proteolytic enzymes.

Passion fruit (Passiflora edulis Sims f. flavicarpa) is popularly known for its sedative and calming properties and is consumed as a fresh fruit or as a juice. The clinical observation of blood incoagulability associated with excessive consumption of passion fruit juice, in a patient treated with warfarin, prompted the current study to investigate in vitro the presence of blood clotting inhibitors in Passiflora edulis Sims f. flavicarpa extract. After purification process, two compounds of distinct molecular weight and inhibitory action were better characterized. One is a trypsin inhibitor similar to inhibitors from Bowman-Birk family, named PeTI-I12, and other is a compound active in coagulation that prolongs aPTT and PT, but does not change TT. The aim of this study is to provide evidence that passion fruit extract's components play a role on hemostasis and therefore may be relevant in the handling of patients treated with anticoagulants or suffering hemorrhagic diseases.

Exploring the in vivo wound healing effects of a recombinant hemolin from the caterpillar Lonomia obliqua

Background Hemolin proteins are cell adhesion molecules from lepidopterans involved in a wide range of cell interactions concerning their adhesion properties. However, hemolin's roles in cell proliferation and wound healing are not fully elucidated. It has been recently reported that rLosac, a recombinant hemolin from the caterpillar Lonomia obliqua, presents antiapoptotic activity and is capable of improving in vitro wound healing. Therefore, this study aimed to explore rLosac's in vivo effects using a skin wound healing model in rats. Methods Circular full-thickness wounds in the rat dorsum skin were treated either with rLosac, or with saline (control), allowing healing by keeping the wounds occluded and moist. During the wound healing, the following tissue regeneration parameters were evaluated: wound closure and collagen content. Furthermore, tissue sections were subjected to histological and immunohistochemical analyses. Results The rLosac treatment has demonstrated its capacity to improve wound healing, as reflected in findings of a larger number of activated fibroblasts, proliferation of epithelial cells, increase of collagen type 1, and decrease of inflammatory infiltrate. Conclusion The findings have indicated the rLosac protein as a very promising molecule for the development of new wound-healing formulations.(AU)

Exploring the in vivo wound healing effects of a recombinant hemolin from the caterpillar Lonomia obliqua

Hemolin proteins are cell adhesion molecules from lepidopterans involved in a wide range of cell interactions concerning their adhesion properties. However, hemolins roles in cell proliferation and wound healing are not fully elucidated. It has been recently reported that rLosac, a recombinant hemolin from the caterpillar Lonomia obliqua, presents antiapoptotic activity and is capable of improving in vitro wound healing. Therefore, this study aimed to explore rLosacs in vivo effects using a skin wound healing model in rats. Methods Circular full-thickness wounds in the rat dorsum skin were treated either with rLosac, or with saline (control), allowing healing by keeping the wounds occluded and moist. During the wound healing, the following tissue regeneration parameters were evaluated: wound closure and collagen content. Furthermore, tissue sections were subjected to histological and immunohistochemical analyses. Results The rLosac treatment has demonstrated its capacity to improve wound healing, as reflected in findings of a larger number of activated fibroblasts, proliferation of epithelial cells, increase of collagen type 1, and decrease of inflammatory infiltrate. Conclusion The findings have indicated the rLosac protein as a very promising molecule for the development of new wound-healing formulations.

Efeito da implementação de diretriz para profilaxia de tromboembolismo venoso em pacientes cirúrgicos / Effect of the implementation of a guideline for venous thromboembolism prophylaxis in surgical patients

INTRODUÇÃO: Estratégias efetivas para profilaxia do tromboembolismo venoso (TEV) são amplamente disponíveis, mas são ainda subutilizadas, principalmente no nosso meio. OBJETIVO: Avaliar o efeito da implementação de diretriz para profilaxia do TEV, em pacientes cirúrgicos, sobre a conduta da equipe de saúde na prescrição dessa profilaxia. Método. Estudo retrospectivo pré-intervenção - pós-intervenção. Prontuários de 150 pacientes antes e 150 depois da implementação de uma diretriz para a profilaxia (AID e DID) foram sorteados dentre pacientes de mais de 40 anos internados para cirurgia maior abdominal ou ortopédica. Foram registrados dados demográficos, referência a risco de TEV no prontuário, prescrição de profilaxia para TEV e diagnóstico de TEV durante a internação. RESULTADOS: Não houve diferença entre os dois grupos, AID e DID, quanto aos dados demográficos e ao tempo de profilaxia (5,6 x 6,6 dias). A frequência de profilaxia AID x DID antes da cirurgia foi: profilaxia farmacológica (PF), 6 por cento x 9 por cento; meias de compressão graduada (MCG), 4 por cento x 3 por cento; compressão pneumática intermitente (CPI), 2 por cento x 3 por cento. Após cirurgia: PF 53 por cento x 53 por cento; MCG, 23 por cento x 40 por cento (P<0,05); CPI, 26 por cento x 32 por cento . No total, AP, foi prescrita profilaxia para 60,5 por cento dos pacientes AID e para 66,5 por cento DID, mas a profilaxia foi considerada adequada em 34 por cento dos pacientes AID e em 32 por cento DID. Conclusão. A adoção do protocolo, embora com maior a preocupação com a profilaxia, traduzida pelo aumento na prescrição de MCG, melhorou minimamente sua qualidade, indicando a necessidade de outras intervenções ativas e contínuas para aumentar a aderência ao mesmo.

INTRODUCTION: Effective strategies for prevention of venous thromboembolism (VTE) are widely available, but still remain underused, mainly in our country. OBJECTIVE: Our aim was to verify whether the implementation of a guideline for VTE prophylaxis for surgical patients influenced the prescription of prophylaxis by the medical staff. METHODS: This was a retrospective preintervention-postintervention study. Charts of 150 patients before guideline implementation (BGI) and 150 after (AGI) were randomized among all patients admitted during one year in each period. Inclusion criteria: >40 years-old, major abdominal or orthopedic surgeries. Exclusion criteria: Incomplete files and use of anticoagulants for any reason at admission. Data registered: demographic data, reference to VTE risk factors, VTE prophylaxis prescription, diagnosis of deep venous thrombosis or pulmonary embolism during hospitalization. Results. The two groups, BGI and AGI were similar for demographic data and duration of prophylaxis (5.6 x 6.6 days). Frequency of prophylaxis in percentages was BGI x AGI respectively, before surgery: pharmacologic prophylaxis (PP), 6 x 9; graduated compression stockings (GCS), 4 x 3; intermittent pneumatic compression (IPC), 2 x 3. After surgery: PP, 53 x 53; GCS, 23 x 40 (P<0.05); IPC, 26 x 32. Including all patients, prophylaxis was prescribed for 60.5 percent BGI and 66.5 percent AGI, but was considered adequate only in 34 percent BGI and 32 percent AGI. CONCLUSION: Adoption of a guideline, although increasing concern about prophylaxis, expressed by greater use of GCS, only minimally improved quality of prophylaxis , indicating that other active and continuous interventions are necessary to enforce compliance.