Análise crítica sobre a utilização do Epi-No na gestação e parto / Critical analysis on the use of Epi-No in pregnancy and delivery

Atualmente são reportados métodos que poderiam favorecer o alongamento e prevenir as lesões do assoalho pélvico no parto vaginal, como a massagem perineal e o balão Epi-No. Esse dispositivo é bem aceito pelas pacientes, mas seus resultados para prevenção de episiotomias e lesões perineais são controversos. O objetivo desse estudo foi avaliar o propósito, método, frequência, ensino/orientação e resultados da utilização do Epi-No durante a gestação e parto. Foi elaborada uma revisão narrativa com levantamento de bibliografia disponível sobre o uso do Epi-No nas bases de dados PUBMED, BVS e SciELO em português e inglês. 837 artigos foram encontrados, nos quais apenas 9 atenderam aos critérios de inclusão. Informações desses artigos foram sintetizadas em quadros que contemplaram os aspectos considerados pertinentes. Fatores como o tempo, período, posicionamento e processo de ensino/orientação devem ser melhor descritos e padronizados para que seja possível investigar a eficácia de seu uso nos desfechos perineais no parto vaginal.

Currently methods are reported that favor the stretching and prevent pelvic floor injuries in vaginal delivery, such as perineal massage and the Epi-No balloon. This device is well accepted by patients but results for prevention of episiotomy and perineal lesions at birth are controversial. The aim of this study was to evaluate the purpose, method, frequency, teaching/guidance of the use of the Epi-No during pregnancy and childbirth. A narrative review was prepared with a survey of available literature about the use of the Epi-No during pregnancy and childbirth in PUBMED, BVS and SciELO databases in Portuguese and English. 837 articles were found, only 9 articles met the inclusion criteria established. Information from papers were summarized in tables covering the relevant aspects. Factors such as the time, period, positioning and the process of teaching/guidance should be better described and standardized, so it would be possible to investigate the effectiveness of its use in the outcomes in the perineal vaginal delivery.

Photobiomodulation and bone healing in diabetic rats: evaluation of bone response using a tibial defect experimental model.

Diabetes mellitus (DM) leads to a delay in bone healing. Thus, some therapeutic approaches have been used to accelerate the process of bone repair such as photobiomodulation (PBM). Therefore, the present study aimed to evaluate the effects of PBM, in different fluences, in bone repair in an experimental model of tibial bone defects in diabetic rats. Sixty-four Wistar rats were submitted to a surgical procedure to perform bone defect and distributed in four groups: diabetic control group (DCG), diabetic laser group 30 J/cm(2) (L30), diabetic laser group 60 J/cm(2) (L60), and diabetic laser group 120 J/cm(2) (L120). A 808 nm Ga-Al-As (DMC Equipment, São Carlos, SP, Brazil) laser, 100 mW; 0.028 cm(2); 3.57 W/cm(2); 30, 60, and 120 J/cm(2); 0.84, 1.68, and 3.36 J; 8, 16, and 33 s was used. Animals were euthanized 15 and 30 days after the surgery. Histological, morphometric, immunohistochemistry, and biomechanical analyses were performed. In the histological and morphometric evaluation, all laser-treated groups showed a better histological pattern and a higher amount of newly formed bone compared to DCG. An intense RUNX2 immunoexpression was observed in the laser-treated groups, 15 days after the surgery. Receptor activator of nuclear factor κ-ß ligand (RANK-L) immunohistochemistry analysis showed a significant decrease in the immunoreactivity for L30 and L120, 30 days after surgery. There was no statistical difference in the biomechanical analysis among the groups. In conclusion, PBM, in all fluences used, showed an osteogenic potential in bone healing of diabetic rats.