Streptococcal bacteraemia in patients submitted to hematopoietic stem cell transplantation: the role of tooth brushing and use of chlorhexidine.

A retrospective evaluation of 73 consecutive recipients of hematopoietic stem cell transplantation (HSCT) was conducted to investigated the role of oral care and incidence of streptococcal bacteremia in patients submitted to hematopoietic stem cell transplantation. Patients were retrospectively evaluated and divided into group A (GA=38) and group B (GB=35). During hospitalization patients from GA performed oral hygiene daily with extra soft toothbrush and toothpaste besides performing mouth cleaning with an ethanol-free 0.12% chlorhexidine solution tree times a day. In contrast GB patients performed mouth cleaning with extra soft toothbrush and toothpaste, but no chlorhexidine was used. Using the Chi square test it was observed that all patients from GA presented negative blood culture for alpha-hemolytic Streptococcus viridans and Candida albicans and only 1 patient without oral mucositis from GB presented positive blood cultures for Streptococcus intermedius (p=0.48). The results indicate that methodology used for oral care before the HSCT and the practice of tooth brushing during the period were effective in preventing streptococcal bacteremia. Moreover, our data suggest that the mouth cleaning with chlorhexidine during HSCT may be not mandatory.

Low-power laser in the prevention of induced oral mucositis in bone marrow transplantation patients: a randomized trial.

We investigated the clinical effects of low-power laser therapy (LPLT) on prevention and reduction of severity of conditioning-induced oral mucositis (OM) for hematopoietic stem cell transplantation (HSCT). We randomized 38 patients who underwent autologous (AT) or allogeneic (AL) HSCT. A diode InGaAlP was used, emitting light at 660 nm, 50 mW, and 4 J/cm2, measured at the fiberoptic end with 0.196 cm2 of section area. The evaluation of OM was done using the Oral Mucositis Assessment Scale (OMAS) and the World Health Organization (WHO) scale. In the LPLT group, 94.7% of patients had an OM grade (WHO) lower than or equal to grade 2, including 63.2% with grade 0 and 1, whereas in the controls group, 31.5% of patients had an OM grade lower than or equal to grade 2 (P < .001). Remarkably, the hazard ratio (HR) for grades 2, 3, and 4 OM was 0.41 (range, 0.22-0.75; P = .002) and for grades 3 and 4 it was 0.07 (range, 0.11-0.53; P < .001). Using OMAS by the calculation of ulcerous area, 5.3% of the laser group presented with ulcers of 9.1 cm2 to 18 cm2, whereas 73.6% of the control group presented with ulcers from 9.1 cm2 to 18 cm2 (P = .003). Our results indicate that the use of upfront LPLT in patients who have undergone HSCT is a powerful instrument in reducing the incidence of OM and is now standard in our center.

Aspectos histológicos da reparação tecidual por efeito do metotrexato em feridas cutâneas abertas: estudo experimental em ratas / Tissue reparation histology of open cutaneous wonds by metotrexate: experimental studies of female rats

Foi estudada a ação do metotrexato administrado por via intramuscular sobre a cicatrização de feridas cutâneas circulares abertas em ratas, do ponto de vista histológico. Foram operadas 36 ratas, Wistar, com peso médio de 250,0 gramas. Nos 18 animais do grupo-controle (Grupo 1) foi injetado soro fisiológico 0,9 porcento por via intramuscular, em volume equivalente ao necessário ao grupo tratado, no membro traseiro esquerdo, imediatamente após a confecção de uma ferida aberta de pele, provocada com vazador de 6mm de diâmetro no dorso do animal, a cerca de 5 cm das bordas inferiores dos pavilhões auriculares. No grupo-experimento (Grupo 2) realizou-se o mesmo procedimento cirúrgico do grupo-controle e administrou-se metotrexato (1 mg/kg de peso corpóreo) por via intramuscular na mesma localização anatômica...

Importância do registro em prontuário para implantaçäo de um sistema de informaçöes / Importance of the medical records to implantation of an information system

Os autores abordam a falta de registro em prontuário e salientam os problemas decorrentes deste procedimento, acarretando prejuízo, em especial no planejamento e na implantaçao de um sistema de informaçoes, através do qual se obtém uma série de vantagens, tais como: avaliaçao do trabalho profissional realizado e a possibilidade de determinaçao dos principais indicadores de saúde de uma populaçao.