Individual and mutual effects of diabetes, hypertension, and obesity on acute respiratory distress syndrome mortality rates in clinical patients: a multicentre study.

Patients with comorbidities are more vulnerable to severe clinical cases of acute respiratory distress syndrome (ARDS) and COVID-19 require complex health care. To analyse the association between the individual and combined effects of diabetes, hypertension, and obesity on ARDS mortality rates among patients receiving clinical care. A multicentre study encompassing retrospective data analysis and conducted with 21,121 patients from 6,723 health services across Brazil, during the 2020-2022 time period. The sample group consisted of clinical patients of both sexes and different age groups who received clinical care and showed at least one comorbidity. The data collected were analysed using binary logistic regressions and the Chi-square test. The overall mortality rate was 38.7%, with a higher predominance among males (p < 0.001), mixed-race individuals (p < 0.001), and older adults (p < 0.001). The main comorbidity variables associated with and leading to death from ARDS were arterial hypertension (p < 0.001), diabetes mellitus (p < 0.001), diabetes mellitus and arterial hypertension (p < 0.001), cardiovascular diseases (p < 0.001) and obesity (p < 0.001). Both the patients who progressed to recovery (48.4%) and to death (20.5%) presented only one comorbidity (χ2 (1,749) = 8, p < 0.001), respectively. The isolated comorbidities with the greatest impact on death outcomes were diabetes (95% CI 2.48-3.05, p < 0.001), followed by obesity (95% CI 1.85-2.41, p < 0.001) and hypertension (95% CI 1.05-1.22, p < 0.001), even after adjusting for sex and number of simultaneous comorbidities. Diabetes and obesity, as isolated conditions, had a greater influence on the number of deaths of clinical patients with ARDS compared to those with mutual diagnosis of diabetes, hypertension and obesity.

Benefícios da ozonioterapia no tratamento de úlceras nos pés em pessoas com diabetes mellitus / Benefits of ozone therapy in the treatment of foot ulcers in people with diabetes mellitus / Beneficios de la ozonoterapia em el tratamento de las úlceras del pie en personas com diabetes mellitus

Objetivo:Identificar os benefícios da ozonioterapia no tratamento de úlceras nos pés de pessoas com diabetes mellitus. Métodos: Revisão de literatura realizada nas bases de dados CINAHL, CochraneLibrary, LILACS, PUBMED, SciELO, SCOPUS e Web of Science, no período de abril a maio de 2020. Em cada base de dados, os descritores controlados foram delimitados nos Descritores em Ciências da Saúde e Medical Subject Headings, definidas as palavras-chaves: Ozônio (Ozone) e Pé Diabético (Diabeticfoot), com auxílio do operador booleano AND. Resultados:Houve a seleção de 14 estudos primários. A maioria dos estudos possui nível II de evidência, publicados em inglês, em distintos periódicos, oriundos de diversas partes do mundo. Foram identificados 15 benefícios da ozonioterapia para o tratamento de úlceras nos pés, com predomínio de aumento do tecido de granulação e intensificação no progresso do reparo tecidual. Conclusão: O uso da ozonioterapia apresentou diversos benefícios no progresso do reparo tecidual de úlceras nos pés em pessoas com diabetes, aumentando o tecido de granulação, promovendo atividades antissépticas e bactericidas e prevenindo o estresse oxidativo.

Objetivo:Identificar os benefícios da ozonioterapia no tratamento de úlceras nos pés de pessoas com diabetes mellitus. Métodos: Revisão de literatura realizada nas bases de dados CINAHL, CochraneLibrary, LILACS, PUBMED, SciELO, SCOPUS e Web of Science, no período de abril a maio de 2020. Em cada base de dados, os descritores controlados foram delimitados nos Descritores em Ciências da Saúde e Medical Subject Headings, definidas as palavras-chaves: Ozônio (Ozone) e Pé Diabético (Diabeticfoot), com auxílio do operador booleano AND. Resultados:Houve a seleção de 14 estudos primários. A maioria dos estudos possui nível II de evidência, publicados em inglês, em distintos periódicos, oriundos de diversas partes do mundo. Foram identificados 15 benefícios da ozonioterapia para o tratamento de úlceras nos pés, com predomínio de aumento do tecido de granulação e intensificação no progresso do reparo tecidual. Conclusão: O uso da ozonioterapia apresentou diversos benefícios no progresso do reparo tecidual de úlceras nos pés em pessoas com diabetes, aumentando o tecido de granulação, promovendo atividades antissépticas e bactericidas e prevenindo o estresse oxidativo.

Objetivo: Identificar los beneficios de la ozonoterapia en le tratamiento de las úlceras del pie em personas con diabetes mellitus. Método: Revisión de la literature realizada en las bases de datos CINAHL, Cochrane Library, LILACS, PUBMED, SciELO, SCOPUS y Web of Science en le período de abril a mayo de 2020. En cada base de datos los descriptors controlados se delimitaron en los Descriptores de Ciencias Salud y Medicina. Encabezados de material, palabras claves definidas: ozono (ozono), pie diabético (pie diabético), con la ayuda del operador booleano AND. Resultados: Hubo una selección de 14 estudios primarios. La mayoría de los estudios tienen evidencia de nivel II, publicada en inglés, en diferentes revistas, de diferentes partes del mundo. Se identificaron 15 beneficios de la ozonoterapia para el tratamiento de las úlceras del pie, con predominio del aumento del tejido de granulación e intensificación en el avance de la reparación tisular. Conclusión: El uso de la ozonoterapia present varios beneficios en el avance en la reparación tisular de las úlceras del en personas con diabetes, aumento del tejido de granulación, promovió actividades antisépticas y bactecidas, previniendo el estrés oxidative.

Virtual reality in pain relief during chronic wound dressing change.

OBJECTIVE: To assess the effect of virtual reality in pain relief during chronic wound dressing change. METHOD: This is an experimental study carried out with 17 participants, in a stomatherapy clinic in Ceará, Brazil, from June to December 2019, using the virtual reality glasses Oculus Go®. Sociodemographic and clinical information, as well as of lifestyle, and characteristics of the lesions were collected. A faces scale and a visual analogue scale were used for pain assessment, behavioral aspects assessment, satisfaction, and discomfort with Oculus Go®. The Chi-square, McNemar, and Wilcoxon tests were used. The study was approved under opinion No. 2.649.144/2019. RESULTS: There was a reduction in pain during dressing change with Oculus Go®. Participants with Oculus Go® manifested less pain during (p < 0.001) and after (p < 0.001) dressing change; and had lower heart rate before (p = 0.044) and after (p = 0.001) the procedure. There were significant differences between groups in systolic (p = 0.012) and diastolic (p = 0.004) blood pressure values after dressing. Virtual reality did not cause any discomfort and participants were satisfied. CONCLUSION: Virtual reality showed positive effects in pain relief during chronic wound dressing change.

Virtual reality in pain relief during chronic wound dressing change / Realidad Virtual en el alivio del dolor durante el cambio de vendajes de heridas crónicas / Realidade virtual no alívio da dor durante a troca de curativos de feridas crônicas

ABSTRACT Objective: To assess the effect of virtual reality in pain relief during chronic wound dressing change. Method: This is an experimental study carried out with 17 participants, in a stomatherapy clinic in Ceará, Brazil, from June to December 2019, using the virtual reality glasses Oculus Go®. Sociodemographic and clinical information, as well as of lifestyle, and characteristics of the lesions were collected. A faces scale and a visual analogue scale were used for pain assessment, behavioral aspects assessment, satisfaction, and discomfort with Oculus Go®. The Chi-square, McNemar, and Wilcoxon tests were used. The study was approved under opinion No. 2.649.144/2019. Results: There was a reduction in pain during dressing change with Oculus Go®. Participants with Oculus Go® manifested less pain during (p < 0.001) and after (p < 0.001) dressing change; and had lower heart rate before (p = 0.044) and after (p = 0.001) the procedure. There were significant differences between groups in systolic (p = 0.012) and diastolic (p = 0.004) blood pressure values after dressing. Virtual reality did not cause any discomfort and participants were satisfied. Conclusion: Virtual reality showed positive effects in pain relief during chronic wound dressing change.

RESUMEN Objetivo: Evaluar el efecto de la realidad virtual en el alivio del dolor durante el cambio de vendajes de heridas crónicas. Método: Estudio experimental realizado con 17 participantes, en ambulatorio de estomaterapia en Ceará, Brasil, de junio a diciembre de 2019, con utilización de gafas de realidad virtual Oculus Go ®. Fue posible reunir informaciones sociodemográficas, clínicas, hábitos de vida y características de las lesiones. Fueron utilizadas la escala de faces y la visual analógica para evaluar el dolor, se realizó una evaluación de aspectos comportamentales, de satisfacción e incómodo del Oculus Go ®. Fueron utilizados los testes Chi-cuadrado, McNemar y Wilcoxon. El estudio fue aprobado bajo la licencia de nº 2.649.144/2019. Resultados: Hubo reducción del dolor en el cambio de vendaje con Oculus Go ®. Los participantes con Oculus Go ® manifestaron menos dolor durante (p < 0,001) y después (p < 0,001) del cambio de vendajes; y presentaron menor frecuencia cardíaca antes (p = 0,044) y después (p = 0,001) del procedimiento. Hubo diferencias significativas entre los grupos en los valores de la tensión arterial sistólica (p = 0,012) y diastólica (p=0,004) después del vendaje. La realidad virtual no generó incómodo y los participantes demostraron satisfacción. Conclusión: La realidad virtual presentó efectos positivos en el alivio del dolor durante el cambio de vendajes de heridas crónicas.

RESUMO Objetivo: Avaliar o efeito da realidade virtual no alívio da dor durante a troca de curativos de feridas crônicas. Método: Estudo experimental realizado com 17 participantes, em ambulatório de estomaterapia no Ceará, Brasil, de junho a dezembro de 2019, com utilização de óculos de realidade virtual Oculus Go ®. Coletaram-se informações sociodemográficas, clínicas, de hábitos de vida e sobre as características das lesões. Utilizou-se escala de faces e visual analógica para avaliação da dor, avaliação de aspectos comportamentais, satisfação e incômodo do Oculus Go ®. Utilizaram-se os testes Qui-quadrado, McNemar e Wilcoxon. O estudo foi aprovado sob parecer de nº 2.649.144/2019. Resultados: Houve redução da dor na troca de curativo com Oculus Go ®. Os participantes com Oculus Go ® manifestaram menos dor durante (p < 0,001) e após (p < 0,001) a troca de curativos; e apresentaram menor frequência cardíaca antes (p = 0,044) e após (p = 0,001) o procedimento. Houve diferenças significativas entre os grupos nos valores da pressão arterial sistólica (p = 0,012) e diastólica (p = 0,004) após o curativo. A realidade virtual não causou incômodo e os participantes mostraram-se satisfeitos. Conclusão: A realidade virtual apresentou efeitos positivos no alívio da dor durante a troca de curativos de feridas crônicas.

Efeitos da laserterapia de baixa intensidade na cicatrização de úlceras nos pés em pessoas com diabetes mellitus / Effects of low-level laser therapy on the healing of foot ulcers in people with diabetes mellitus

Objetivo: Identificar os efeitos da laserterapia de baixa intensidade na cicatrização do pé diabético. Método: Revisão sistemática nas bases de dados PubMed, LILACS, SciELO, CINAHL, Cochrane, Web of Science e Scopus, em que foram identificados 73 artigos, dos quais seis foram incluídos na amostra final, após verificação dos critérios de elegibilidade. Resultados: Os artigos apontaram como efeitos da laserterapia a efetividade na progressão do processo de reparo tecidual do pé diabético, alívio da dor, ação antiinflamatória, aumento da perfusão tecidual da lesão e melhora da resposta vascular e do sistema nervoso. Conclusão: O laser é uma terapia adjuvante que pode acelerar o processo de cicatrização da lesão, diminuir a dor, melhorar a neovascularização e, assim, minimizar o risco de complicações, como amputação do membro inferior e melhora da qualidade de vida de pessoas com diabetes e integridade da pele prejudicada.

Clinical and histopathological findings of cutaneous manifestations of COVID-19 patients.

Coronavirus disease (COVID-19) became pandemic since this is a disease with a high infection rate. The study's object is to identify clinical and histopathological findings of cutaneous manifestations of COVID-19 patients. The evidence was analyzed in PubMed, CINAHL, Cochrane, Web of Science, and Scopus, with the search strategy (covid 19 OR covid-19 OR corona OR coronavirus OR sars-cov-2) AND (cutaneous or cutaneous manifestations OR), and 17 studies were included, involving 351 cases with COVID19 and skin manifestations. The lesions were classified mainly as maculopapular, erythematous, vesicular, and urticarial. Histopathological analyses suggest a predominance of spongiosis, perivascular infiltrate of lymphocytes, and thrombogenic vasculopathy.

Analysis of Portuguese language blogs about bariatric surgery: key doubts of internauts regarding the postoperative period.

BACKGROUND: The Internet, particularly blogs have become an important tool for patients to disseminate and exchange information on a variety of health topics, including bariatric surgery. By virtue of its interactivity being free of judgement from health care providers, blogs expose gaps in patients' knowledge and understanding. PURPOSE: This study analyzes the main doubts expressed in blogs by patients in the postoperative period of bariatric surgery. METHOD: This is a qualitative exploratory study of 11 blogs of patients, who underwent bariatric surgery, that were available on the Internet between October 2013 and May 2017. The data were collected through a structured instrument and analyzed according to Bardin's suggestions. The sampling method used was intentional. RESULTS: Evolution of diet, weight loss, plateau effect, weight regain, physical exercises, physiological changes, complications, use of contraceptive and pregnancy were the main areas of concern. CONCLUSION: More needs to be done to educate and prepare bariatric patients for the postoperative period. The content found in blogs serves towards building better links with patients, helps them make better decisions, and provides them an opportunity to be active participants in their own treatment.

The effect of flour from the rind of the yellow passion fruit on glycemic control of people with diabetes mellitus type 2: a randomized clinical trial.

BACKGROUND: The single or combined use of herbal and dietary products with medications has shown benefits in the metabolic modulation of carbohydrates, in the restoring of the function of pancreatic beta cells, and in insulin resistance. To analyze the effect of the use of flour made from the rind of the yellow passion fruit on the glycemic control of people with diabetes mellitus type 2. METHODS: An open, prospective, randomized clinical trial was undertaken with 54 participants over an eight-week period. The participants from the case group were advised to ingest 12 g of the flour, three times daily; before breakfast, lunch and dinner. RESULTS: After eight weeks of use of the flour made from the rind of the yellow passion fruit, we did not identify significant statistical differences in the values for capillary blood glucose (p = 0.562), fasting blood glucose (p = 0.268) or glycated hemoglobin (p = 0.229) between the study groups. In the case group, we identified an increase (29.6%-37%) of the people with normal HbA1c; however, this did not have statistical relevance (p = 0.274). DISCUSSION: Based in our findings, we believe it is important to extend the time of exposure to the intervention and increase the rigor in the monitoring of adherence in future studies on this topic. Only in this way will we be able to make confident inferences in relation to the use of flour made from the rind of theyellow passion fruit as a therapeutic tool for glycemic and/or metabolic control in persons with DM 2. CONCLUSIONS: In the sample in question, the use of the flour made from the rind of the yellow passion fruit, over an eight-week period, did not improve the glycemic control of people with type 2 diabetes. Trial registration: U1111.1187.3616. Registered 6 September, retrospectively registered, in the Brazilian Clinical Trials Registry.

[Assessment of bariatric surgery results]. / Avaliação dos resultados da cirurgia bariátrica.

The objective was to evaluate the results of bariatric surgery in patients in the late postoperative period using the Bariatric Analysis and Reporting Outcome System (BAROS). This cross-sectional study was conducted from November 2011 to June 2012 at a hospital in the state of Ceará, Brazil. Data were collected from 92 patients using the BAROS protocol, which analyzes weight loss, improved comorbidities, complications, reoperations and Quality of Life (QoL). Data were analysed using the chi-squared test, Fischer's exact test and the Mann-Whitney test. There was a reduction in the Body Mass Index (47.2±6.8 kg/m2 in the pre-operatory and 31.3±5.0 kg/m2 after surgery, p<0.001). The comorbidity with the highest resolution was arterial hypertension (p<0.001), and QV improved in 94.6% of patients. The main complications were hair loss, incisional hernia and cholelithiasis. The surgery provided satisfactory weight loss and improvements in the comorbidities associated to a better QL. Use of the BAROS protocol allows nurses to plan interventions and maintain the good results.

[Vulnerability of adolescent students to STD / HIV in Imperatriz - Maranhao]. / Vulnerabilidade de adolescentes escolares as DST/HIV, em Imperatriz-Maranhão.

The aim of this study was to investigate the vulnerability of adolescent students related to sexually transmitted diseases (STD) and the human immunodeficiency virus (HIV), identifying the main risk behaviors and prevention. This quantitative, cross-sectional study was performed in three public schools in Imperatriz--Maranhão, with 295 adolescents, using a structured questionnaire. The results show that: most young people (86.3%) who used a condom the last time they had intercourse, usually keep this practice, 82.8% of adolescents who understand the concept of HIV protect themselves against these infections and believe the main form of contamination is through sex, infected blood or through the placental barrier. We conclude that most teenager participants showed coherent knowledge about sexual practices and risk behaviors that make them vulnerable to STD/HIK presenting a positive aspect for the prevention of these diseases.

[Construction of an educational technology for teaching about nursing on peripheral venipuncture]. / Construção de uma tecnologia educacional para o ensino de enfermagem sobre punção venosa periférica.

The aim of the study was to describe the construction of a course on peripheral venipuncture using the Information and Communication Technologies. This is a methodological research, developed at the Federal University of Ceara from January to March 2012. The construction phases are: the analysis, design and development according to the theoretical framework of Galvis-Panqueva. In the analysis, objectives, content target audience, the study environment and technology infrastructure were delimited. During the design phase the environment interface and navigation structure of the course were evaluated. The development consisted in the materialization of all that was designed in the previous phase Once all three phases of construction of the course were conducted it was available in the Virtual Learning Environment SOLAR. The finalproduct of the course is presented as support of nursing students and consequently the training of future nurses in their care practice on peripheral venipuncture.

Drug interactions in Brazilian type 2 diabetes patients.

The aim of this paper is to identify the prevalence of the most frequent drug interactions in patients using oral antidiabéticos and their association with capillary glucose and medication adherence. In total, 579 type 2 diabetes mellitus patients from 12 health institutions in Fortaleza, Brazil were interviewed in 2009. A form was applied, including questions on medication use, comorbidities, lifestyle, body mass index and random capillary glucose. Results revealed that 26.7% used five or more different drugs simultaneously and daily. Statistically significant drug interactions occurred between antidiabéticos and diuretics, angiotensin-converting enzyme inhibitors, anti-lipidaemics and corticoids. No significant association was found between polypharmacy, medication adherence and glucose. It is important for nurses, in consensus with other health professionals, to consider the possibility of other drugs that mean less risk for diabetes patients' glucose control or of increased antidiabetics doses.

[Maternal risk factors for premature births in a public maternity hospital in Imperatriz-MA]. / Fatores de risco maternos para prematuridade em uma maternidade pública de Imperatriz-MA.

Despite advances in obstetrics, prematurity is still a major public health problem because of the neonatal morbidity and mortality it causes. The objective of this study was to investigate maternal risk factorsfor premature births in a public maternity in the city of Imperatriz-MA. A cross-sectional comparative study was conducted with 116 mothers, through structured interviews. The data were analyzed using Epi-Info version 3.5.1. The variables that showed statistically significant association with preterm delivery were monthly income below two minimum wages (p = 0.046), stress during pregnancy (p = 0.027), primiparity (p = 0.044), absent or inadequate prenatal care (p <0.001) and clinical complications in pregnancy (p<0.001). The results show that the maternal risk factors implicated in prematurity are related mainly with lifestyle, socioeconomic and clinical variables, and prenatal care.

[Using the braden scale and photographs to assess pressure ulcer risk]. / O uso da escala de Braden e fotografias na avaliação do risco para úlceras por pressão.

The objective of this paper was to identify critically ill patients at risk for pressure ulcer (PU) using the Braden scale and digital photographs. A sample of 42 subjects was evaluated for 15 days, between March and June 2009, in Fortaleza, Brazil. A total of 47 lesions were identified, 23 (48.9%) as stage I and 24 (51.1%) as stage II. It is necessary for nurses to become familiar with and adopt the technologies used to assess and treat PU in order to lessen the negative effects of this public health problem.

[Nursing diagnoses for patients at risk of developing pressure ulcer]. / Diagnósticos de enfermagem para pacientes em risco de desenvolver úlcera por pressão.

This cross-sectional study aimed to identify nursing diagnoses in critical patients at risk of developing pressure ulcer. It was carried out at an Intensive Care Unit in Fortaleza-CE, Brazil, using an intentional sample of thirteen subjects at risk of pressure ulcer, evaluated according to the Waterlow scale. In total, 45 nursing diagnoses were evidenced, seventeen of which were clinically significant for the development of pressure ulcer. The frequency levels for nine of these nursing diagnoses were ≥ 80%, mainly: Impaired skin integrity (100%), Impaired walking (87%), Impaired swallowing (80%), Impaired bed mobility (80%) and Impaired gas exchange (80%). The knowledge of those nursing diagnoses is important in detecting the effects and clinical basis of skin lesions.