Evaluation of pentoxifylline and ferrous sulfate for treatment of lower limb venous ulcers.

BACKGROUND: Venous ulcers (VU) are the most advanced stage of chronic venous disease (CVD) of the lower limbs. They are frequently associated with episodes of hemorrhage that can provoke chronic anemia (CA), delaying healing. There are no studies in the literature analyzing the prevalence of CA among patients with VU of the lower limbs and few studies have analyzed use of pentoxifylline to treat VU of the lower limbs. OBJECTIVES: To evaluate the prevalence of CA in patients with lower limb VU and responses to treatment with ferrous sulfate (SF) compared with a combination of SF plus pentoxifylline as adjuvant treatment for VU of the lower limbs. METHODS: A total of 67 patients with lower limb VU were recruited from a Lymphedema and Angiodysplasia Clinic at the Hospital das Clínicas, Recife, PE, Brazil. After initial clinical and laboratory assessments, patients diagnosed with CA were randomized into one of two groups: a control group, given SF (900 mg/day oral route), or a study group, treated with SF (900 mg/day oral route) and pentoxifylline (1,200 mg/day). All were reassessed after 90 days. RESULTS: Twenty-seven patients (40%) had CA. After treatment, increases were observed in hemoglobin and hematocrit levels, iron kinetics had improved, and both depth and area of VU had reduced in both groups, without statistically significant differences. CONCLUSIONS: A high prevalence of anemia was detected in the study population. The combination of SF and pentoxifylline was not more effective than SF alone for adjuvant treatment of VU of the lower limbs.

Artificial sphincter "BR - SL - AS 904" in the treatment of urinary incontinence after radical prostatectomy: efficacy, practicality and safety in a prospective and multicenter study.

PURPOSE: The objective of the present study is to test the efficiency and practicality of a new artificial sphincter "BR - SL - AS - 904" in the control of urinary incontinence in post - PR patients and to evaluate their complications. PATIENTS AND METHODS: Fifteen patients with incontinence after one year of radical prostatectomy were included prospectively. All patients underwent artificial urethral sphincter (AUS) implant "BR - SL - AS - 904" according to established technique. Independent variables such as free urinary flow, PAD weight test, ICIQ - SF score and urinary symptoms through the IPSS score were compared in different follow-up moments. RESULTS: Patients submitted to AUS implantation did not present trans - operative or post - operative complications related to the surgical act such as: infection, hematoma, erosion or urinary retention. Device was inert to the body during the follow-up, showing an excellent adaptation of the patients, besides the easy handling. The mean age was 68.20 years 40% of the patients had systemic arterial hypertension, 6.7% diabetes mellitus, 6.7% were hypertensive and diabetic, 13.4% were hypertensive, had diabetes and hypercholesterolemia and 26.7% patients had no comorbidities. It was evidenced that the urinary flow peak during the follow-up remained stable. Decreased averages and median PAD weight test were 135.19 to 75.72 and 106.00 to 23.50, respectively. The IPSS score decreased and the quality of life increased (12.33 to 3.40 and 2.50 to 3.20 respectively). The ICQF - SF questionnaire score also showed a decrease, ranging from 16, 71 to 7.33. CONCLUSION: The artificial sphincter implant "BR - SL - AS 904" was reproducible, safe and effective in the control of urinary incontinence in post - PR patients.

Biocompatible bacterial cellulose membrane in dural defect repair of rat.

Duraplasty is necessary in nearly 30% of all neurological surgeries. Different tissues and materials have been evaluated in dura mater repair or as dural substitutes in neurosurgery. The aim was to evaluate the biocompatibility of the bacterial cellulose (BC) membranes, produced from sugarcane molasses, for dural defect repair in rats. Forty adults males Wistar rats divided into two groups: a control (ePTFE) and an experimental (BC). Bilateral frontoparietal craniectomy was performed, and a dural defect was created. The arachnoid underlying defect was disrupted with a narrow hook. The animals were observed for 120 days. There were no cases of infection, cerebrospinal fluid fistulae, delayed hemorrhages, behavior disturbances, seizures and palsies. The BC membrane showed to have suitable biocompatibility properties, was not induced immune reaction, nor chronic inflammatory response and absence of neurotoxicity signals.

A new material to prevent urethral damage after implantation of artificial devices: an experimental study.

OBJECTIVE: To validate the application of the bacterial cellulose (BC) membrane as a protecting bar-rier to the urethra. MATERIALS AND METHODS: Forty female Wistar rats (four groups of 10): Group 1 (sham), the urethra was dissected as in previous groups and nothing applied around; Group 2, received a 0.7cm strip of the BC applied around the urethra just below the bladder neck; Group 3, received a silicon strip with the same dimensions as in group 2; Group 4, had a combination of 2 and 3 groups being the silicon strip applied over the cellulosic material. Half of the animals in each group were killed at 4 and 8 months. Bladder and urethra were fixed in formalin for histological analysis. RESULTS: Inflammatory infiltrates were more intense at 4 months at lymphonodes (80% Grade 2), statistically different in the group 2 compared with groups 1 (p=0.0044) and 3 (p=0.0154). At 8 months, all samples were classified as grade 1 indicating a less intense inflammatory reaction in all groups. In group 2, at 8 months, there was a reduction in epithelial thickness (30±1µm) when com-pared to groups 1 (p=0.0001) and 3 (p<0.0001). Angiogenesis was present in groups 2 and 4 and absent in group 3. In BC implant, at 4 and 8 months, it was significant when comparing groups 4 with 1 (p=0.0159). CONCLUSION: BC membrane was well integrated to the urethral wall promoting tissue remodeling and strengthening based on morphometric and histological results and may be a future option to prevent urethral damage.

Bioprosthetic mesh of bacterial cellulose for treatment of abdominal muscle aponeurotic defect in rat model.

The use of meshes for treatment of hernias continues to draw attention of surgeons and the industry in the search of an ideal prosthesis. The purpose of this work is to use meshes manufactured from bacterial cellulose, evaluate their organic tissue interaction and compare with an expanded polytetrafluorethylene (ePTFE's) prosthesis used to repair acute defect of muscle aponeurotic induced in rats. Forty-five male Wistar rats were classified using the following criteria: (1) surgical repair of acute muscle aponeurotic defect with perforated bacterial cellulose film (PBC; n = 18); (2) compact bacterial cellulose film (CBC; n = 12) and (3) ePTFE; (n = 15). After postoperative period, rectangles (2 × 3 cm) including prosthesis, muscles and peritoneum were collected for biomechanical, histological and stereological analysis. In all cases, the maximum acceptable error probability for rejecting the null hypothesis was 5 %. Between PBC and CBC samples, the variables of strain (P = 0.011) and elasticity (P = 0.035) were statistically different. The same was found between CBC and ePTFE (elasticity, P = 0.000; strain, P = 0.009). PBC differed from CBC for giant cells (P = 0.001) and new blood vessels (P = 0.000). In conclusion, there was biological integration and biomechanical elasticity of PBC; therefore, we think this option should be considered as a new alternative biomaterial for use as a bio prosthesis.

A wet dressing for male genital surgery: A phase II clinical trial.

PURPOSE: This study was to confirm the safety and efficacy of BC dressing when used in surgical male wound healing at the urogenital area. METHODS: Open, non-controlled clinical study of phase II. A total of 141 patients, among those children, adolescents and adults with hypospadias (112), epispadias (04), phymosis (13) and Peyronie's disease (12) that had a BC dressing applied over the operated area after surgery. A written informed consent was obtained from all participants. Study exclusion criteria were patients with other alternative treatment indications due to the severity, extent of the injury or the underlying disease. The outcomes evaluated were efficacy, safe and complete healing. The costs were discussed. RESULTS: In 68% patients, the BC dressing fell off spontaneously. The BC was removed without complications in 13% of patients at the outpatient clinic during the follow-up visit and 17% not reported the time of removal. In 3% of the cases, the dressing fell off early. Complete healing was observed between 8th and 10th days after surgery. The BC dressings have shown a good tolerance by all the patients and there were no reports of serious adverse events. CONCLUSION: The bacterial cellulose dressings have shown efficacy, safety and that can be considered as a satisfactory alternative for postoperative wound healing in urogenital area and with low cost.

Biocompatibility and cutaneous reactivity of cellulosic polysaccharide film in induced skin wounds in rats.

The development of a skin substitute suitable for immediately performing the function of the lost dermis and epidermis could result in a positive impact on the treatment of patients with extensive skin lesions. A biopolymer film was applied to skin wounds to investigate the biocompatibility and cutaneous reaction and to test its activity as a mechanical barrier and conductor in the healing process. Forty Wistar rats of both sexes were used in the present study. Two excisions were performed in the dorsal part of the skin flaps. The polysaccharide film was applied over one of the incisions and other incision was washed with saline. The time spent for complete healing of both lesions was virtually the same in both groups, during 21 days of observation. The film remained attached to the bed of the exposed wound for an average period of 6 days. There were no statistically significant differences with regard to lesion measurement area at assessment times of 2nd, 7th and 14th postoperative days. At day 21, the scar area showed a significant difference (0.0229). After 40 days, all wounds were completely healed. No statistically significant differences were found between the histological parameters assessed in the experimental and control groups. The cellulosic polysaccharide film integrated well with the tissue showing high biocompatibility and low skin reactivity.

Analysis of the degree of implementation of Health Academy Program in a Brazilian midsize town.

In 2011, the Brazilian Minister for Health created the Health Academy Program (Programa Academia da Saúde) as a strategy to promote health and healthy lifestyles. However, the official standards do not seem to be clear enough to support the implementation program in the towns. The aim of this study was to analyse the degree of Health Academy Program implementation in a Brazilian midsize town Vitória de Santo Antão, Pernambuco State, in 2018. This is an evaluative study that carry out a normative approach, considering the dimensions of structure and process related to work process. The research is divided into: (1) elaboration of the theoretical model of evaluation, through the validation of the logical model; (2) verification of the level of implementation, through an interview with workers and managers. The cut-off scores for classification of implementation levels were: (1) incipient: > 0 < 33.3%; (2) intermediate: > 33.3 < 66.6%; (3) advanced: > 66.6%. The level of implementation was considered intermediate (37.54%). The score of the structure was higher (54.76%) than the process (26.06%). The low level of Health Academy Program implementation, especially related to the multi-professional articulation and the difficult connection with other sectors or social actors, shows the necessity of reorganization of the actions.

Secondary lower limbs lymphedema in patients with Chikungunya fever.

Chikungunya fever (CHIKF) is an arbovirus characterized by acute fever, myalgia and polyarthralgia. Lymphedema in the lower limbs (LL) was observed in several patients during an outbreak of CHIKF in the state of Pernambuco (Brazil) in 2016. No reports on lymphatic vessels disease due to CHIKF have been described. The aim of the study was to follow lymphatic abnormalities in the LL of 16 patients with CHIKF, using lymphoscintigraphy.An observational, prospective study with patients in the acute phase of CHIKF (confirmed serological diagnosis) with LL edema submitted to clinical evaluation and lymphoscintigraphy at baseline and after 90 days.Sixteen patients (81% females) participated in this study. All patients presented with lower limb lymphedema, being 15 (94%) bilateral. Of the 31 limbs affected by lymphedema, 24 (77%) presented abnormalities in lymphatic drainage by lymphoscintigraphy. The delay to visualize pelvic lymph nodes was the most frequent lymphoscintigraphic abnormality, observed in 16 (51,6%) LL. Nine (56%) patients were clinically reevaluated after 90 days, and all 18 LL remained with lymphedema. A second lymphoscintigraphy showed persistent abnormalities in 13 (72%) of the 18 LL.CHIKF can lead to lymphedema, and lymphedema may persist or progress after 3 months of the acute phases of the disease.

Bacterial cellulose biopolymer film and gel dressing for the treatment of ischemic wounds after lower limb revascularization. / Curativo com filme e gel de biopolímero de celulose bacteriana no tratamento de feridas isquêmicas após revascularização de membros inferiores.

OBJECTIVE: to evaluate the use of a bacterial cellulose biopolymer film and gel dressing in the treatment of patients with ischemic wounds submitted to lower limb revascularization. METHODS: we conducted a randomized clinical trial in the Angiology and Vascular Surgery outpatient clinic of the Clinics Hospital of the Federal University of Pernambuco, between January 2017 and December 2018. We followed 24 patients after lower limb revascularization, divided into two groups: Experimental, treated with bacterial cellulose biopolymer film and gel, and Control, treated with essential fatty acids. Patients attended weekly appointments to change dressings and had their wound healing processes evaluated over a period of 90 days. RESULTS: the reduction of the ischemic wounds' areas after 30 days was 4.3cm2 (55%) on average for the experimental group, and the 5.5cm2 (48.5%) for the control group (p>0.05). The complete healing rate at 90 days was 34.8%, 50% in the experimental group and 18.2% in the control group (p=0.053). CONCLUSION: the bacterial cellulose biopolymer film associated with gel can be used as a dressing in the treatment of ischemic wounds of patients undergoing revascularization of the lower limbs.

OBJETIVO: avaliar o uso do curativo de filme e gel de biopolímero de celulose bacteriana no tratamento de pacientes com feridas isquêmicas submetidos à revascularização dos membros inferiores. MÉTODOS: ensaio clínico randomizado realizado no ambulatório de Angiologia e Cirurgia Vascular do Hospital das Clínicas da Universidade Federal de Pernambuco, entre janeiro de 2017 e dezembro de 2018. Foram acompanhados 24 pacientes após revascularização de membros inferiores, divididos em dois grupos: Experimental, tratado com filme e gel de biopolímero de celulose bacteriana, e Controle, tratado com ácidos graxos essenciais. Os pacientes foram acompanhados em consultas semanais para troca dos curativos e o processo de cicatrização das feridas foi avaliado em um período de 90 dias. RESULTADOS: a redução da área das feridas isquêmicas no período de 30 dias foi de 4,3cm2 (55%), em média, para o grupo experimental, e de 5,5cm2 (48,5%) para o grupo controle (p>0,05). A taxa de cicatrização completa, em 90 dias, foi de 34,8%, sendo 50% no grupo experimental e 18,2% no grupo controle (p=0,053). CONCLUSÃO: o filme de biopolímero de celulose bacteriana associada a gel pode ser utilizado como curativo no tratamento de feridas isquêmicas de pacientes submetidos à revascularização de membros inferiores.

Effects of bacterial cellulose gel on the anorectal resting pressures in rats submitted to anal sphincter injury.

The aim of this study is to evaluate if a gel of bacterial cellulose gel can revert the loss of anal resting pressure after anorectum sphincter injury in rat model, elected as a model to simulate fecal incontinence. Thirty-nine animals were equally divided into three groups: Control (CG), Sphincter injury plus Saline injection (SG) and Sphincter injury plus Bacterial Cellulose Gel injection (BCG). Anal pressure at rest was assessed for all animal in the three groups using anorectum manometry. Saline and Gel groups were subject to anorectum sphincter injury to reduce the anal pressure at rest. Fifteen days later Saline or Gel was injected into the anorectum, according to their groups. Sixty days later first manometry, the anorectum of all animals were removed and processed histologically. The CG group showed maintenance of their mean anorectal resting pressure levels; SG presented a fall in their mean anorectal resting pressure. The BCG presented a significant elevation of the mean anorectal resting pressure levels, surpassing the pressure of CG. The gel of bacterial cellulose remained at the injection site and was neovascularized, colonized by fibroblasts and dense conjunctive tissue. Those data suggest that BC can be used as a future filling agent treatment for fecal incontinence in clinical trial protocols.

Efficacy of bacterial cellulose membrane for the treatment of lower limbs chronic varicose ulcers: a randomized and controlled trial.

Objective: to evaluate the efficacy of Bacterial Cellulose (BC) membrane dressings in the treatment of lower limb venous ulcers. Methods: we carried out a prospective, randomized, controlled study of 25 patients with chronic venous ulcer disease in the lower limbs from the Angiology and Vascular Surgery Service of the Federal University of Pernambuco Hospital and from the Salgado Polyclinic of the County Health Department, Caruaru, Pernambuco. We randomly assigned patients to two groups: control group, receiving dressings with triglyceride oil (11 patients) and experimental group, treated with BC membrane (14 patients). We followed the patients for a period of 120 days. Results: There was a reduction in the wound area in both groups. There were no infections or reactions to the product in any of the groups. Patients in the BC group showed decreased pain and earlier discontinuation of analgesic use. Conclusion: BC membrane can be used as a dressing for the treatment of varicose ulcers of the lower limbs.

Objetivo: avaliar a eficácia de curativos com membrana de Celulose Bacteriana (CB) no tratamento de úlceras venosas de membros inferiores. Métodos: estudo prospectivo, randomizado e controlado de 25 pacientes com úlceras decorrentes de doença venosa crônica nos membros inferiores provenientes do Serviço de Angiologia e Cirurgia Vascular do Hospital de Clínicas da Universidade Federal de Pernambuco e da Policlínica do Salgado da Secretaria Municipal de Saúde, Caruaru, Pernambuco. Os pacientes foram distribuídos aleatoriamente em dois grupos: grupo controle, que recebeu curativos com óleo de triglicerídeos (11 pacientes) e grupo experimental, tratado com membrana de CB (14 pacientes). Os pacientes foram acompanhados por um período de 120 dias. Resultados: houve uma redução na área de ferida em ambos os grupos. Não houve infecção ou reações ao produto em nenhum dos grupos. Pacientes do grupo CB mostraram diminuição da dor e interrupção mais precoce do uso de analgésicos Conclusão: a membrana de CB pode ser usada como curativo para o tratamento de úlceras varicosas dos membros inferiores.

Lymphoscintigraphic abnormalities in the contralateral lower limbs of patients with unilateral lymphedema.

OBJECTIVE: The contralateral limbs of patients with unilateral lymphedema in the lower limbs (LLs) can exhibit abnormal lymphatic circulation, even in the absence of lymphedema. This idea is based on a number of reports that have studied isolated cases using lymphoscintigraphy. It is likely that these patients previously had some form of lymphopathy, and the lymphedema arose after the action of some external factor. However, there are no studies in the literature that adequately assess the asymptomatic contralateral limbs of these patients or address the prevalence and characteristics of the abnormal lymphatic circulation in these limbs. The aim of this study was to assess the prevalence of abnormal lymphatic circulation in the asymptomatic contralateral limbs of patients with unilateral lymphedema of the LL. METHODS: Forty-three patients from the angiology and vascular surgery ward of the Hospital das Clínicas da Universidade Federal de Pernambuco with unilateral lymphedema of the LL underwent lymphoscintigraphy. All patients received a subcutaneous injection of 0.2 mL (74 MBq) of a solution of dextran 70 labeled with technetium Tc 99m in the first interdigital space of each foot. Images were obtained on two occasions: 10 minutes and 1 hour after the injection. The study design was transversal prospective. RESULTS: Among the 43 asymptomatic LLs, 30 (70%) showed abnormal lymphatic circulation. The lymphoscintigraphic abnormalities found were the following: reduced visualization of the lymphatic vessels and lymph nodes during 1 hour (83%), collateral circulation (30%), visualization of the inguinal and pelvic lymph nodes after at least 1 hour (30%), visualization of the popliteal lymph nodes (20%), dilation and lymphatic tortuosity (20%), and dermal backflow (10%). CONCLUSIONS: In this study,70% of the patients with unilateral lymphedema of the LL had some form of lymphopathy in the contralateral limb during the lymphoscintigraphic examination. These findings could favor the early treatment of these patients to prevent the disease from progressing to its most severe stage.

Nutritional supplementation with arginine protects radiation-induced effects. An experimental study.

PURPOSE:: To investigate the protective effect of L-arginine on the prostate (nonneoplasic) of rats with radiation-induced injury. METHODS:: Twenty-nine Wistar rats, male adult, allocated into three groups: Control group (C) was not exposed to irradiation (n=10); Radiated group (R) had undergone pelvic irradiation (n=10); Supplemented and radiated group (R+S) had undergone pelvic irradiation plus L-arginine supplementation (n=9). The animals were observed for signs of toxicity. After euthanization, the prostate was dissected under magnification and stained by hematoxylin and eosin to study acinar structures and stained with Picrosirius red for collagen analysis. RESULTS:: After radiation exposure, all animals presented diarrhea, but supplementation with L-arginine reduced this effect. The weight gain in the R+S group was significantly higher than in the C and R groups. In the R+S group the collagen density and the prostate acinar area was similar to the R and C groups. Epithelial height was significantly reduced in group R compared with group C (p<0.0001). When comparing the group R+S with R, a statistical difference was observed to be present (p<0.0001). CONCLUSIONS:: Pelvic radiation promotes systemic effects and some structural modifications in the ventral prostate of rats. These modifications can be prevented by oral supplementation with L-arginine.

Treatment of tympanic membrane perforation using bacterial cellulose: a randomized controlled trial.

INTRODUCTION: Promising treatments for tympanic membrane perforation closure have been studied. Therapies derived from tissue engineering probably eliminate the need for conventional surgery. Bacterial cellulose is presented as an alternative that is safe, biocompatible, and has low toxicity. OBJECTIVES: To investigate the effect on healing of direct application of a bacterial cellulose graft on the tympanic membrane compared to the conventional approach with autologous fascia. METHODS: Randomized controlled trial. Forty patients with tympanic membrane perforations secondary to chronic otitis media were included, and were randomly assigned to an experimental group (20), treated with a bacterial cellulose graft (BC) and control group (20), treated with autologous temporal fascia (fascia). We evaluated the surgical time, hospital stay, time of epithelialization and the rate of tympanic perforation closure. Hospital costs were compared. The statistical significance level accepted was established at p<0.05. RESULTS: The closure of perforations was similar in both groups. The average operation time in the fascia group was 76.50 min versus 14.06 min bacterial cellulose in the group (p=0.0001). The hospital cost by the Brazilian public health system was R$ 600.00 for the bacterial cellulose group, and R$ 7778.00 for the fascia group (p=0.0001). CONCLUSION: Bacterial cellulose grafts promoted the closure of the tympanic membrane perforations, and were demonstrated to be innovative, effective, safe, minimally invasive, efficacious and to have a very low cost.

Analysis of the degree of implementation of Health Academy Program in a Brazilian midsize town / Análise do grau de implementação do Programa Academia da Saúde em uma cidade brasileira de porte médio / Análisis del grado de implementación del Programa Academia de la Salud en una ciudad de tamaño medio brasileña

In 2011, the Brazilian Minister for Health created the Health Academy Program (Programa Academia da Saúde) as a strategy to promote health and healthy lifestyles. However, the official standards do not seem to be clear enough to support the implementation program in the towns. The aim of this study was to analyse the degree of Health Academy Program implementation in a Brazilian midsize town Vitória de Santo Antão, Pernambuco State, in 2018. This is an evaluative study that carry out a normative approach, considering the dimensions of structure and process related to work process. The research is divided into: (1) elaboration of the theoretical model of evaluation, through the validation of the logical model; (2) verification of the level of implementation, through an interview with workers and managers. The cut-off scores for classification of implementation levels were: (1) incipient: > 0 < 33.3%; (2) intermediate: > 33.3 < 66.6%; (3) advanced: > 66.6%. The level of implementation was considered intermediate (37.54%). The score of the structure was higher (54.76%) than the process (26.06%). The low level of Health Academy Program implementation, especially related to the multi-professional articulation and the difficult connection with other sectors or social actors, shows the necessity of reorganization of the actions.

Em 2011, o Ministério da Saúde criou o Programa Academia da Saúde como estratégia para promover a saúde e estilos de vida saudáveis. Entretanto, as normas oficiais não parecem ser suficientemente claras para apoiar a implementação do programa nas cidades. O estudo teve como objetivo analisar o grau de implementação do Programa Academia da Saúde em uma cidade brasileira de porte médio, Vitória de Santo Antão, Pernambuco, em 2018. É um estudo avaliativo com abordagem normativa, considerando as dimensões de estrutura e processo relacionadas ao processo de trabalho. O estudo é divido em dois passos: (1) a elaboração de um modelo teórico de avaliação, através da validação do modelo lógico e (2) a verificação do nível de implementação através de entrevistas com os profissionais e gestores. Os pontos de corte para a classificação dos níveis de implementação foram: (1) incipiente: > 0 < 33,3%; (2) intermediário: > 33,3 < 66,6%; (3) avançado > 66,6%. O grau de implantação foi considerado intermediário (37,54%). A pontuação da estrutura foi mais alta (54,76%) que a do processo (26,06%). O nível baixo de implementação do Programa Academia da Saúde, principalmente relacionado a problemas de articulação multi-profissional e à dificuldade de articulação com os outros setores e atores da sociedade, mostra a necessidade de reorganização das ações.

El ministro brasileño de salud creó en 2011 el Programa Academia de la Salud (Programa Academia da Saúde) como estrategia para promover la salud y estilos de vida saludables. Sin embargo, los estándares oficiales no parecen estar lo suficientemente claros para apoyar la implementación del programa en las ciudades. El objetivo de este estudio fue analizar el grado de implementación del Programa Academia de la Salud en un pueblo de tamaño medio en Brasil (Vitória de Santo Antão, Pernambuco) en 2018. Es un estudio evaluativo, con un enfoque normativo, que considera las dimensiones de la estructura y proceso relacionado con el sistema laboral. La investigación está dividida en dos pasos: (1) elaboración del modelo teórico de evaluación, a través de la validación del modelo lógico; (2) verificación del nivel de implementación, mediante una entrevista con trabajadores y gestores. Las puntuaciones de corte para la clasificación de implementación por niveles fueron: (1) incipiente: > 0 y < 33,3%; (2) intermedios: > 33,3 y < 66,6%; (3) avanzados: > 66,6%. El nivel de implementación fue considerado intermedio (37,54%). La puntuación de la estructura fue mayor (54,76%) que el proceso (26,06%). El bajo nivel de implementación del Programa Academia de la Salud, especialmente relacionado con la coordinación multiprofesional, y la difícil conexión con otros sectores o actores de la sociedad, muestra la necesidad de una reorganización de las acciones.

Avaliação da pentoxifilina e do sulfato ferroso no tratamento da úlcera varicosa dos membros inferiores / Evaluation of pentoxifylline and ferrous sulfate for treatment of lower limb venous ulcers

Resumo Contexto A úlcera varicosa (UV) é o estágio mais avançado da doença venosa crônica (DVC) dos membros inferiores (MMII), frequentemente associada a episódios de hemorragia que podem provocar anemia crônica (AC) e retardar a sua cicatrização. Não há, na literatura, trabalhos que avaliem a prevalência da AC nos portadores de UV dos MMII, e poucos trabalhos analisam o uso da pentoxifilina no tratamento das UV dos MMII. Objetivos Avaliar a prevalência da AC nos pacientes portadores de UV de MMII e a resposta terapêutica ao sulfato ferroso (SF) e a associação da pentoxifilina com SF no tratamento adjuvante das UV dos MMII. Métodos Foram avaliados 67 pacientes portadores de UV de MMII atendidos no ambulatório de Cirurgia Vascular do Hospital das Clínicas, Recife, PE. Após as avaliações clínica e laboratorial iniciais, os pacientes diagnosticados com AC foram randomizados em dois grupos: o grupo controle, que recebeu SF (900 mg/dia via oral), e o grupo de estudo, tratado com SF (900 mg/dia via oral) e pentoxifilina (1.200 mg/dia). Todos foram reavaliados após 90 dias. Resultados Entre os pacientes avaliados, 27 (40%) apresentavam AC. Após o tratamento, foram observados aumento dos níveis de hemoglobina e de hematócrito e melhora das taxas da cinética do ferro, assim como a diminuição da profundidade e da área das UV em ambos os grupos, sem diferença estatística. Conclusões Foi encontrada alta prevalência de anemia na população estudada. A associação do SF com a pentoxifilina não se mostrou mais eficaz do que o emprego isolado do SF no tratamento adjuvante da UV dos MMII.

Abstract Background Venous ulcers (VU) are the most advanced stage of chronic venous disease (CVD) of the lower limbs. They are frequently associated with episodes of hemorrhage that can provoke chronic anemia (CA), delaying healing. There are no studies in the literature analyzing the prevalence of CA among patients with VU of the lower limbs and few studies have analyzed use of pentoxifylline to treat VU of the lower limbs. Objectives To evaluate the prevalence of CA in patients with lower limb VU and responses to treatment with ferrous sulfate (SF) compared with a combination of SF plus pentoxifylline as adjuvant treatment for VU of the lower limbs. Methods A total of 67 patients with lower limb VU were recruited from a Lymphedema and Angiodysplasia Clinic at the Hospital das Clínicas, Recife, PE, Brazil. After initial clinical and laboratory assessments, patients diagnosed with CA were randomized into one of two groups: a control group, given SF (900 mg/day oral route), or a study group, treated with SF (900 mg/day oral route) and pentoxifylline (1,200 mg/day). All were reassessed after 90 days. Results Twenty-seven patients (40%) had CA. After treatment, increases were observed in hemoglobin and hematocrit levels, iron kinetics had improved, and both depth and area of VU had reduced in both groups, without statistically significant differences. Conclusions A high prevalence of anemia was detected in the study population. The combination of SF and pentoxifylline was not more effective than SF alone for adjuvant treatment of VU of the lower limbs.

Acute toxicity, cytotoxicity, genotoxicity and antigenotoxic effects of a cellulosic exopolysaccharide obtained from sugarcane molasses.

The acute toxicity, cytotoxicity, genotoxicity and antigenotoxic effects of BC were studied. Cytotoxicity of BC was evaluated in cultured C3A hepatoma cells (HepG2/C3A) using a lactate dehydrogenase (LDH) activity assay. Acute toxicity was tested in adults Wistar rats treated with a single dose of BC. The genotoxicity of BC was evaluated in vivo by the micronucleus assay. BC (0.33-170 µg/mL) added to C3A cell culture medium caused no elevation in LDH release over the background level recorded in untreated cell wells. The treatment with the BC in a single oral dose (2000 mg/kg body weight) caused no deaths or signs of toxicity. BC attenuated CP-induced and inhibition the incidence of MNPCE (female: 46.94%; male: 22.7%) and increased the ratio of PCE/NCE (female: 46.10%; male: 35.25%). There was no alteration in the LDH release in the wells where C3A cells were treated with increasing concentrations of BC compared to the wells where the cells received the cell culture medium only (background of approximately 20% cell death), indicated that in the dose range tested BC was not cytotoxic. BC was not cytotoxic, genotoxic or acutely toxic. BC attenuated CP-induced genotoxic and myelotoxic effects.

Deleterious effects of prepubertal corticosterone treatment on rat prostate.

PURPOSE: To investigate the structural and functional changes induced by corticosterone (CORT) in the ventral prostrate (VP) of rats in order to study chronic stress effects in the prepubertal phase. METHODS: Wistar rats received daily saline or CORT injections during the pubertal period from the 5th to 25th day of postnatal life. The animals were distributed into four groups: 1 - Control (n=5); 2 - Control 99mTc-P (n=5); 3 - Treated with CORT (n=14); 4 - Treated with CORT and 99mTc-P (n=10). All rats were sacrificed at two months of age. Technical tissue uptakes of 99mTc-P were used to evaluate the functional and stereological methods for morphological analysis. RESULTS: Acini distribution in the group treated with CORT differed significantly (p<0.0001) from the control. The control group's epithelial average height (10.01±0.24 microns) was statistically significant (p<0.0001) from rats treated with CORT (19.27±0.73microns). The collagen distribution was lower in the treated group (2.79%) when compared to control (3.97%). The radioactivity percentage in the groups marked with 99mTc-P (%Ati/g) did not demonstrate a statistically significant difference (p=0.285897). CONCLUSION: Chronic administration of corticosterone in prepubertal rats causes changes in their acinar structure and their ventral prostate stroma, indicating possible deleterious effects of this hormone.

A dinâmica das infecções relacionadas à assistência à saúde utilizando a metodologia tracer e a modelagem por redes complexas / The route of healthcare-associated infections using tracer methodology and modeling by complex networks / La dinámica de las infecciones relacionadas con la asistencia a la salud utilizando la metodología tracer y el modelado por redes complejas

Justificativa e Objetivos: no Brasil, infecções de sítio cirúrgico (ISC) compreendem aproximadamente 15% das infecções relacionadas à assistência à saúde (IRAS). Este estudo avaliou a dinâmica das infecções por meio da metodologia tracer, alinhada à análise por redes complexas, utilizando o rastreamento de um paciente (caso) que foi submetido à cirurgia (cenário). Métodos: estudo de caso, de natureza observacional, abordagem descritiva, com avaliação transversal e retrospectiva, pelo rastreamento e análise do prontuário de um paciente submetido a procedimentos cirúrgicos, utilizando a metodologia tracer, sob a ótica das redes complexas, no Hospital das Clínicas, Universidade Federal de Pernambuco. Resultados: mulher, 65 anos, submetida à descompressão, artrodese e retirada de enxerto (doador) em ilíaco esquerdo. Readmitida com osteomielite do ilíaco esquerdo, evoluindo com piora do estado geral, seguido de óbito. O fator de prioridade (PFP) relacionado ao caso foi o procedimento cirúrgico para retirada do enxerto no ilíaco esquerdo pela clínica ortopédica. De acordo com o Manual Brasileiro de Acreditação Hospitalar, os padrões obrigatórios e aplicáveis, segundo o perfil do hospital, apresentam os seguintes percentuais de conformidade para o nível 1 (78,7%), nível 2(82,4%) e no nível 3 (51,7%). Utilizando as redes complexas e considerando que os profissionais são potenciais carreadores da disseminação das infecções aos suscetíveis e são preditores da propagação da ISC (cenário 2/hipótese 2), somado à falta de estrutura para higienização das mãos (cenário 3/hipótese 3), observou-se que há maior chance de ISC ter ocorrido nos setores da enfermaria e UTI. Conclusões: a provável propagação das IRAS está relacionada aos profissionais e à estrutura físico-funcional necessária para prestação da assistência segura.(AU)

Background and Objectives: surgical site infections (SSI) comprise approximately 15% of healthcare-associated infections (HAIs) in Brazil. This study assessed the route of infections using tracer methodology, aligned with analysis by complex networks, by tracing a patient (case) who underwent surgery (scenario). Methods: an observational and descriptive case study, with cross-sectional and retrospective assessment, by tracing and analyzing the medical records of a patient who underwent surgical procedures. Tracer methodology was used from the perspective of complex networks at Hospital das Clínicas, Universidade Federal de Pernambuco. Results: a woman, 65 years old, submitted to decompression, arthrodesis, and graft removal (donor) in the left iliac. Readmitted with left iliac osteomyelitis, worsening in general condition, followed by death. The priority factor (PFP) related to the case was the surgical procedure to remove the graft in the left iliac, by the orthopedic clinic. According to the Brazilian Manual of Hospital Accreditation, the mandatory and applicable standards according to hospital profile have the following percentages of conformity for level 1 (78.7%), level 2 (82.4%), and level 3 (51.7%). Using complex networks and considering that professionals are potential carriers of the spread of infections and are predictors of the spread of SSI (scenario 2/hypothesis 2) plus the lack of structure for hand hygiene (scenario 3/hypothesis 3), it was observed that there is a greater chance that SSI occurred in ward and ICU. Conclusions: the probable spread of HAIs is related to professionals and the physical-functional structure necessary to provide safe care.(AU)

Justificación y objetivos: en Brasil, la ocurrencia de infecciones en pacientes hospitalizados es aproximadamente 15%, y, por eso, la importancia de estudiar la dinámica de las infecciones hospitalarias. Este estudio evaluó la dinámica de las infecciones utilizando la metodología tracer, alineada con el análisis por redes complejas, a partir del rastreo de un paciente (caso) sometido a procedimientos quirúrgicos (escenario). Métodos: estudio de caso, de naturaleza observacional, abordaje descriptivo, con evaluación transversal y retrospectiva, a partir del rastreo individual utilizando la metodología tracer, a través del análisis de prontuario de un paciente sometido a procedimientos quirúrgicos en la Clínica de Ortopedia, Hospital das Clínicas, Universidade Federal de Pernambuco. Resultados: una mujer, 65 años, sometida a descompresión, artrodesis y retirada de injerto en ilíaco izquierdo. Leído con osteomielitis del ilíaco izquierdo, evolucionando con empeoramiento progresivo del estado general, seguido de muerte. El factor de prioridad (PFP) relacionado con el caso fue el procedimiento quirúrgico para la extracción del injerto en el ilíaco izquierdo, por la clínica ortopédica. Los porcentajes de conformidad en el nivel 1 correspondió al 78,7%, en el nivel 2 fue 82,4% y en el nivel 3, 51,7%. A partir del análisis por redes complejas, se observó que hay mayor probabilidad de que la diseminación de la infección esté relacionada con el conjunto de contactos, siendo los profesionales los potenciales portadores de las infecciones a los susceptibles, en los sectores de la enfermería y UTI, siendo éste el predictor de la propagación de la infección de sitio quirúrgico (Escenario 2/Hipótesis 2) y/o la falta de estructura para higienización de las manos (Escenario 3/Hipótesis 3). Conclusiones: las fuerzas que impulsan las infecciones hospitalarias están relacionadas a los cuidadores ya la estructura físico-funcional necesaria para el desarrollo de la asistencia a la salud.(AU)