Stability of surgically assisted rapid palatal expansion with and without retention analyzed by 3-dimensional imaging.

INTRODUCTION: Surgically assisted rapid palatal expansion (SARPE) is the procedure of choice for treatment of adults with transverse maxillary deficiency greater than 7 mm. There is no consensus about the dentoskeletal effect of an orthodontic retainer on the outcome of SARPE. Our objective was to assess the effectiveness of an orthodontic retainer on dentoskeletal stability. METHODS: Ninety digitized dental casts of 30 adults undergoing SARPE were divided into 2 groups-no retention (n = 15) and retention (n = 15)-and assessed. The dental casts were obtained at 3 checkpoints: (1) 7 days on average before SARPE (preoperatively), (2) 4 months after expansion, and (3) 10 months after expansion was completed. The retention patients received a transpalatal arch just after expander removal, at checkpoint 2. The transpalatal arch was kept for 10 months after completion of the expansion (checkpoint 3 and end of the study). The dental casts were scanned with a Vivid 9i 3D laser scanner (Konica Minolta, Wayne, NJ). The distances measured were premolar and molar intercusp distances, premolar and molar intercervical distances, premolar and molar inter-WALA (Will Andrews and Lawrence Andrews) ridge distances, and palate height at the maxillary first molar. RESULTS: The planned maxillary expansion was within the expected amount (P <0.05). Palatal height at the 4-month checkpoint decreased by 0.79 mm (4.38%) (P <0.001) and again at the 10-month checkpoint by 0.38 mm (0.98%) (P >0.05) but not significantly in both groups. The premolar intercusp distance had a relapse at checkpoint 3 of 1.84 mm (7.18%) (P <0.001) in the no-retention group. Both groups had average relapses of 0.95 mm in the premolar intercervical distances, of 0.88 mm in the premolar inter-WALA ridge distances, of 1.04 mm in the molar intercusp distances, of 0.74 mm in the molar intercervical distances, and of 0.84 mm in the molar inter-WALA ridge distances (P <0.05) at checkpoint 3. CONCLUSIONS: The analysis of relapse in both groups suggests that the use of a transpalatal arch as a retaining device does not improve dento-osseous stability.

Burn Specific Health Scale - Brief - Brazil and International Classification of Functioning, Disability and Health in Burn Patients.

With better burn trauma survival rates, quality of life and functionality have become important outcomes in the evaluation of burn patients. The objective of this study was to evaluate the quality of life of burn survivors using the Burn Specific Health Scale-Brief-Br and their function and health using the International Classification of Functioning Disability and Health (ICF) in order to assess whether there is a correlation in the results obtained between the two instruments. A cross-sectional study with 80 burn patients who underwent outpatient follow-up was completed. Quality of life was assessed using the BSHS-B-Br, an instrument translated and validated in Brazilian Portuguese. Based on ICF category concepts, a data collection tool was used with "yes" and "no" answers. A "yes" answer represented the "8" qualifier, indicating a problem without a specific order of magnitude. Both instruments were self-applied in standardized conditions without complications during the process. Results were analyzed through Spearman's rank correlation coefficients. The BSHS-B-Br had an average score of 127.12 (SD ± 23.03). The correlation was moderate between the total BSHS-B-Br score and the answers of ICF for body functions (r = -.53; P < .001) and environmental factors (r = -.50; P < .001). It was weak for body structures (r = -.47; P < .001) and for activities and participation (r = -.43; P < .001). This study found a moderate correlation between the results of the Burn Specific Health Scale - Brief - Brazil and the International Classification of Functioning, Disability and Health for burn patients showing that both instruments provide complementary information about burned patients.

Development of a Manual on the Technique of Applying the Unna Boot in Patients With Venous Leg Ulcers.

INTRODUCTION: Providing adequate care for people with venous leg ulcers (VLUs) can be a challenge. Numerous publications have discussed the importance of compression therapies on the treatment of VLUs, but few have described the necessary materials and techniques for applying the Unna boot, contributing to the underutilization of this therapy. The use of manuals is one of the strategies in the training of health professionals. OBJECTIVE: The aim of this study was to develop and validate a manual on the technique of applying the Unna boot in patients with VLUs. The manual was created to improve the education and training of health professionals in the control of chronic VLUs. MATERIALS AND METHODS: This was a descriptive study involving 3 stages. The selection of content for the manual was based on a literature review of articles in the Portuguese, Spanish, and English languages published from January 2000 through December 2018, in which 8 key terms were searched across the Cochrane Library, MEDLINE, and SciELO databases, and Google Scholar search engine. The text, illustrations, and layout design of the manual as well as a video demonstration of the technique were created. The manual then was validated for content by an expert panel using the Delphi Technique and the content validity index (CVI). RESULTS: The manual showed an overall CVI of 0.98 after 2 rounds of consultation and its content, presentation, and relevance were rated as very adequate by the expert panel. The final version of the manual features 29 pages of text and illustrations and includes a video demonstration of the technique. CONCLUSIONS: A manual on the technique of applying the Unna boot in patients with VLUs was developed and validated for content by an expert panel.

 Health-related Quality of Life and Depression in Older Patients With Pressure Ulcers.

UNLABELLED:  Objectives. To evaluate health-related quality of life (HRQoL) and depression in older patients with pressure ulcers who were living at home in the community. METHODS: A cross-sectional analytical study conducted in southern Minas Gerais, Brazil. Forty-two outpatients 60 years and older, showing no cognitive deficit who were living in the community, participated in the study. They were divided into two groups: the study group (21 patients with pressure ulcers), and control group (21 patients without pressure ulcers). The instruments Mini-Mental State Examination (MMSE), Medical Outcomes Study 36-Item Short Form Health Survey questionnaire (SF-36), and 15-item Geriatric Depression Scale (GDS-15) were used, respectively, to identify cognitive impairment, and assess HRQoL and depression. RESULTS: Among the 36 pressure ulcers detected on examination, Stage II ulcers were the most common finding (50%), and the sacral region was the most common location (44.5%). Patients with pressure ulcers had significantly lower HRQoL scores than controls in all SF-36 domains, with the lowest scores being reported for physical functioning, role physical and role emotional (P <0.0001). Seventeen (80.9%) of the patients in the study group were identified as having depression (P = 0.002). CONCLUSION: A high rate of depression (GDS-15) was found in elderly patients with pressure ulcers, who also reported lower HRQoL scores in all SF-36 domains compared with controls.

Pressure Ulcer Risk Factors Among the Elderly Living in Long-term Institutions .

UNLABELLED:  Although many intrinsic and extrinsic risk factors are involved, pressure is the most important factor in the development of pressure ulcers. The elderly are more susceptible to the development of these skin lesions as a result of changes associated with the aging process. The aim of this study was to identify the risk factors for pressure ulcers in the elderly living in long-term institutions. METHODS: An analytic cross-sectional study of 40 patients age 60 years and older with pressure ulcers was conducted in six long-term institutions for the elderly (LTIE) in the West Side of São Paulo, Brazil. The present study evaluates pressure ulcers and their associated risk factors. Statistical analysis was performed using Pearson's chi-square test, Student's t-test, and Fisher's exact test. RESULTS: A statistically significant association between the risk factors evaluated in this study and the development of pressure ulcers in the sample was not found. According to the Braden scale, 67.5% of the patients were at high risk for pressure ulcer development. Fifty-one pressure ulcers were detected, with the majority (56.2%) being located in the sacral region. In the present study, more than 50% of the patients had low sensory perception, mobility, nutrition, and friction and shear subscales scores. The most prevalent risk factors were advanced age (mean, 83.8 years), length of stay that exceeded 31 months, white skin, neuromotor and skeletal muscle disorders, urinary and fecal incontinence, and continuous use of sedatives, analgesics, and hypotensives. CONCLUSION: The knowledge of risk factors is essential for healthcare professionals in planning effective prevention programs that target the elderly living in LTIE.

Microarray as a new tool to study hypertrophic and keloid scarring.

UNLABELLED:  Background. Normal wound healing results from a complex set of reactions between blood cells, skin cells, and biochemical mediators including pro- and anti-inflammatory molecules, growth factors, cytokines, hormones, and vitamins. As this cascade of reactions is ultimately regulated by the coordinated expression and silencing of numerous genes, the gene expression analysis of hypertrophic and keloid scarring (HS and KS, respectively) should provide important information and improve our understanding of HS and KS pathophysiology. Microarray is a new tool that can shed light on the complex genetic background that regulates pathologic scarring. This review will describe basic principles of microarray technique for wound care professionals and explain how this technology is contributing to a better understanding of HS and KS biology. METHODS: A brief review of the literature on microarray in HS and KS over the last 7 years was conducted. RESULTS: The inter-experiment comparisons are somewhat difficult because of differences in the probes used, diverse source of samples, different time points of wound healing, and in-vivo or ex-vivo analysis. Wound healing gene expression must be studied in an environment where all cells and mediators could show how the regulatory network functions. CONCLUSION: All results confirmed previous findings about HS and KS related to over-expression of collagen or extracellular matrix (ECM) genes. One conclusion after this initial approach is that a standardized animal model, probe, and software for data analyses to compare results would increase the understanding of HS and KS pathophysiology.

Development of an Illustrated Guide to Techniques of Dressing Application in the Patient With Burns.

INTRODUCTION: Burns are complex, difficult-to-treat wounds associated with high rates of morbidity and mortality. OBJECTIVE: The aim of this study is to develop and validate an illustrated guide to techniques of dressing application for use in the initial management of the patient with burn wounds. METHODS: The construction of the illustrated guide was based on a literature review conducted of publications between 2001 to 2017 in MEDLINE/PubMed, Scientific Electronic Library Online, Cochrane Library, and Google Scholar. No similar work was found in the literature. Standardized photographs were taken using a manikin to illustrate the step-by-step procedures. The content validity of the illustrated guide was assessed by a panel of 7 burn specialists through a questionnaire in the search for a consensus opinion according to the Delphi technique. The questionnaire assessed 3 main components: Objective, Structure and Presentation, and Relevance of the guide. RESULTS: The final version of the illustrated guide showed an excellent overall content validity index (CVI) of 0.99. The CVI was 1.0 for the component Objective, 0.98 for Structure and Presentation, and 1.0 for Relevance. The guide has 79 pages, 86 illustrations, and 10 chapters on techniques of dressing application for patients with burn wounds. Topics including material preparation, gowning and gloving procedures, and techniques of dressing application for different parts of the body were addressed. CONCLUSIONS: An illustrated guide for dressing application in burn wounds was developed and validated for content by an expert panel.

Development of a Manual for the Prevention and Treatment of Skin Tears.

A skin tear is a partial-thickness wound whose main characteristic is the presence of a skin flap. There are many contributing factors to skin tears, but few practical guidelines are available in the literature for their prevention and management. OBJECTIVE: The aim of this study is to develop a manual for the prevention and treatment of skin tear injuries. METHODS: A literature review on skin tears was conducted. The manual was organized into 7 chapters of topics of interest to health care professionals. Its content validity was assessed in 2 rounds of consultation by 7 health professionals with a master's or doctoral degree who were experienced in skin lesions. RESULTS: The manual was successfully validated for content by the expert panel. The content validity index (CVI) was 0.96 for the topic Objective, 0.96 for Structure and Presentation, and 0.93 for Relevance. The final version of the manual showed an excellent overall CVI of 0.95. CONCLUSIONS: A content-validated manual for the prevention and treatment of skin tears was created to guide nursing professionals in the management of patients with skin tears, which contributes to the identification of risk factors and development of preventive measures.

Hydrocellular Foam Versus Hydrocolloid Plate in the Prevention of Pressure Injuries.

INTRODUCTION: Pressure injury is one of the most prevalent skin injuries and a great challenge in the hospital environment. The implementation of preventive measures contributes to reducing its occurrence. OBJECTIVE: This study compares the protective effect of 2 adhesive dressings used in the prevention of pressure injuries in at-risk patients. MATERIALS AND METHODS: This case series was conducted at a university hospital in southeastern Brazil with 80 hospitalized adult patients at risk for pressure injuries, as per the Braden Scale for Predicting Pressure Sore Risk. Patients were randomized to preventive intervention with either hydrocellular foam (n = 40) or hydrocolloid plate (n = 40) dressing, which was applied to the intact skin over the sacrum and trochanters and changed weekly over 8 weeks. RESULTS: Of the patients, 56.5% were women, 64.5% were 60 years of age or older, 58.1% were admitted to an intensive care unit, and 63.9% were at high risk for pressure injuries. None of the patients developed a pressure injury. However, the presence of blanchable erythema, desquamation, pruritus, discomfort during dressing removal, and skin damage caused by the strong adhesiveness of the dressings were observed in both groups. In the hydrocolloid plate group, patients reported significantly more discomfort during dressing removal due to its strong adhesion to the skin (P = .004) than those in the hydrocellular foam group. CONCLUSIONS: Standard preventive measures combined with the use of either hydrocellular foam or hydrocolloid plate contributed to the prevention of pressure injuries in at-risk patients, with hydrocolloid plate being associated with significantly more discomfort during dressing removal.

Intravenous iron sucrose versus oral iron administration for the postoperative treatment of post-bariatric abdominoplasty anaemia: an open-label, randomised, superiority trial in Brazil.

BACKGROUND: Anaemia and iron deficiency are common after post-bariatric abdominoplasty, which can involve removal of large areas of skin with associated blood loss. Because the oral absorbability of iron is reduced after bariatric surgery (through reduced intake, reduction of gastric acid secretion for conjugation of iron, and separation of the iron-absorptive areas of the duodenum and jejunum), it has been hypothesised that postoperative intravenous iron supplementation might be used to treat anaemia and iron deficiency in patients submitted to post-bariatric plastic surgeries. We aimed to assess whether intravenous iron administered postoperatively in post-bariatric abdominoplasty could result in increased blood haemoglobin concentrations compared with oral iron supplementation. METHODS: In this open-label, randomised, superiority trial, we recruited women aged 18-55 years undergoing post-bariatric abdominoplasty at two public tertiary referral hospitals in São Paulo, Brazil. Eligible women had been treated for previous obesity with bariatric surgery using the vertical banded gastroplasty technique with Roux-en-Y gastric bypass by laparotomy; had grade III contour deformity via the Pittsburgh rating scale; and had a post-bariatric body-mass index (BMI) lower than 32 kg/m2, with stabilised weight loss for at least 6 months. Women were randomly assigned (1:1) to receive postoperative iron supplementation with two intravenous infusions of 200 mg of iron sucrose (intravenous group) or 100 mg of iron polymaltose complex orally twice a day for 8 weeks (oral group). The primary outcome in both groups was blood haemoglobin concentration at postoperative day 56 after abdominoplasty, with a minimum clinically relevant difference of 1·5 g/dL. Analyses were performed on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov, number NCT01857011, and the Brazilian Clinical Trials Registry, number RBR-2JGRKQ. The trial is completed. FINDINGS: From April 7, 2014, to June 27, 2016, 102 post-bariatric patients were assessed for eligibility. 56 patients were eligible and were randomly assigned, with 28 allocated to each group. Mean baseline haemoglobin concentration was slightly higher in the oral group than in the intravenous group (12·71 g/dL [SD 1·06] vs 12·24 g/L [1·09]), and by post-operative day 56 was 12·54 g/dL (SD 1·18) and 12·80 g/dL (0·81), respectively (mean difference of 0·26 g/dL, 95% CI -0·28 to 0·80; p=0·009 in favour of the intravenous group). The minimum clinically relevant difference in concentrations was not reached. No adverse events were recorded in the intravenous group, whereas in the oral group, constipation was recorded in five (18%) patients, diarrhoea in three (11%), and nausea in one (4%) patient. INTERPRETATION: Postoperative intravenous administration of iron increased haemoglobin concentrations at 56 days post-operatively and reduced iron deficiency, without adverse events. Although superiority of intravenous iron was not shown, intravenous administration might be useful in post-bariatric patients, especially in those who have body-contouring treatment involving a second surgery within a short period of time. Larger trials, and trials using higher intravenous doses of iron, are needed to further assess the potential efficacy and safety of intravenous iron administration after post-bariatric plastic surgery. FUNDING: The São Paulo Research Foundation (FAPESP).

Health-related Quality of Life and Self-esteem Among Burn Patients.

Pyoderma gangrenosum is an unusual cause of skin ulcerations that wound specialists must be prepared to recognize. There is no diagnostic test since it is a diagnosis of exclusion, and if the disease is not recognized it can quickly become much worse. Pathergy, whereby a lesion begins or worsens due to trauma, such as a scrape, bite, debridement, surgery, or biopsy, is seen with pyoderma and requires special consideration. This case series and review will summarize the salient features of pyoderma and its treatment with an emphasis on the controversial role of surgery with pyoderma.

Avaliação clínica e epidemiológica do paciente com feridas em uma unidade prisional do Estado de São Paulo / Clinical and epidemiological evaluation of patients with wounds in a prison unit in the State of São Paulo

Resumo Objetivo: O objetivo do estudo é realizar levantamento de dados clínicos e epidemiológicos dos pacientes com feridas em uma unidade do sistema prisional no estado de São Paulo. Metodologia: Estudo retrospectivo e descritivo onde foram coletados dados dos prontuários de uma unidade prisional anotados em livros de registros e prontuários de saúde entre janeiro de 2015 e janeiro de 2016. Resultados: Foram analisados 52 prontuários de pacientes com feridas. Todos os pacientes eram do sexo masculino, sendo 51,92 % brancos e 53,85 % possuíam entre 30-39 anos. Foram encontradas lesões de 10 etiologias diferentes, sendo as queimaduras as mais frequentes (22,95 %), seguidas de lesões por pressão (21,31 %). A doença mais constante nos pacientes em tratamento de feridas foi lesão medular. Conclusão: Os pacientes com feridas no sistema prisional eram em sua maior parte brancos, do sexo masculino, com idade média de 37,21 anos, sendo mais frequentes as queimaduras e as lesões por pressão.

Resumen Objetivo: Realizar el levantamiento de los datos clínicos y epidemiológicos de los pacientes con heridas en una unidad del sistema penitenciario en el estado de São Paulo. Metodología: Estudio retrospec-tivo-descriptivo donde se recolectan datos de los prontuarios de una unidad penitenciaria registrados en libro-acta y prontuarios de salud entre enero de 2015 y enero de 2016. Resultados: Fueron analizados 52 prontuarios de pacientes con heridas. Todos los pacientes fueron del sexo masculino, 51,92 % blancos, 53,85 % tenían entre 30-39 años. Se encontraron lesiones de 10 etiologías diferentes, siendo las quemaduras las más frecuentes 22,95 %, seguidas de lesiones por presión 21,31 %. La enfermedad más común de los pacientes en tratamiento de heridas fue lesión medular. Conclusión: Los pacientes con heridas en el sistema penitenciario eran en su mayor parte blancos, todos del sexo masculino, con una edad media de 37,21 años, siendo más frecuentes las quemaduras y las lesiones por presión.

Abstract Objective: To perform the lifting of the epidemiological and clinical data of patients with wounds in a unit of the prison system in the State of São Paulo. Methodology: Retrospective and descriptive study where there are collected data of compendium of a prison unit registered in a record book and health compendium between January 2015 and January 2016. Results: 52 compendia of patients with wounds were analyzed. All patients were male, 51.92 % white, 53.85 % were between 30 and 39 years old. Injuries of 10 different etiologies were found, being burns the most frequent (22.95 %), followed by lesions by pressure (21.31 %). The most common disease among patients in treatment of wounds was spinal cord injury. Conclusion: In the prison system, patients with wounds are predominantly white, all male, with an average age of 37.21 years old, being more frequent burns and injuries by pressure.

Feelings of powerlessness in patients with diabetic foot ulcers.

UNLABELLED: The purpose of this study was to assess feelings of powerlessness in patients with diabetic foot ulcers. Chronic wounds affect the emotional state of patients, who may experience negative emotions including a sense of loss and powerlessness. The assessment of these feeling should contribute to the planning of interventions aimed at minimizing the impact of diabetic foot ulcers on the daily lives of these patients. METHODS: Fifty patients ≥ 18 years of age with type 1 or type 2 diabetes and foot ulcers were selected from 2 outpatient wound-care clinics to participate in the study. Of these patients, 50% were 61-70 years old, 72% were women, 74% were smokers, 10% were alcoholics, 40% had a diabetic foot ulcer for 3-6 years, and 22% for 7-10 years. Wound odor and exudate were present in 82% of patients. Individuals who were unable to respond to a questionnaire due to physical or cognitive deficit were excluded. All participants responded to the Powerlessness Assessment Tool for adult patients (PAT), with scores ranging from 12-60, with higher scores corresponding to feelings of more intense powerlessness. RESULTS: Total PAT scores ranged from 31-40 for 5 (10%) patients, 51-60 for 28 (56%) patients and from 41-50 for 17 (34%) patients. All patients reported total and subscale PAT scores ≥ 34 (moderate to high scores), with a mean total score of 50.12. The maximum PAT score of 60 was reported on the "self-perception of decision-making capacity" domain. CONCLUSION: These results indicate that patients with diabetic foot ulcers had strong feelings of powerlessness.

The effect of Zafirlukast on capsule formation in post-radiation silicone implants.

Currently, breast cancer represents the most common indication for mastectomy with negative influence on personal perception, sexuality and partnership. Since the introduction of breast implants, silicone, and saline breast implantation have become one of the most common procedures performed by plastic surgeons, not only for aesthetic reasons but also for reconstructive purposes. These women will ultimately be faced with the prospect of capsular contracture. This is especially true in patients receiving radiation therapy, where irradiation increases the risk of complications, capsular contracture and may compromise a favorable aesthetic result. Despite the capsular contracture is the most common complication for both aesthetic and reconstructive breast surgery, the treatment have remained unsolved. Leukotriene antagonists (LTRAs) have emerged as effective prophylactic agents in the management of reactive airway diseases, and recently they have used as an off label prophylactic agent against the capsular contracture after breast augmentation. However up to now there is no any experimental research or clinical study in the medical literature about the effect of Zafirlukast on the capsular formation around irradiated silicone implants.

Health-related quality of life and self-esteem in patients with diabetic foot ulcers: results of a cross-sectional comparative study.

To evaluate health-related quality of life (HRQoL) and self-esteem in patients with diabetic foot ulcers (DFUs), a cross-sectional, comparative study was conducted among 35 consecutive patients with diabetes mellitus (DM) attending outpatient clinics in Pouso Alegre, Brazil. Fifteen (15) patients with and 20 without a DFU participated in the study. Demographic variables were obtained and HRQoL and self-esteem were assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and Rosenberg Self-Esteem Scale. In both groups, 80% of patients were women. Average age did not differ significantly between the DFU and control groups (average 56 [SD 8.42] and 52 years [SD 6.68], respectively) but disease duration was significantly longer (P < 0.001) in the DFU (mean 12 years, range 3 to 24 years) than in the control group (mean 8 years, range 1 to 21 years). Mean HRQoL scores in all domains were lower in the DFU than in the control group with significant differences in the following domains: physical functioning (P = 0.043), role physical (P = 0.003), social functioning (P = 0.022), and role emotional (P = 0.001). Self-esteem scores were similar in both groups. The results of this study confirm that patient HRQoL is negatively affected by the presence of a DFU. Wound prevention programs for patients with DM may help reduce the scope of this problem while DFU treatment programs that include psychological support may improve patient QoL.

Qualidade de vida e capacidade funcional em pacientes com úlcera arterial / Quality of life and functional ability in patients with arterial ulcers

Resumo Objetivo: Avaliar a Qualidade de Vida (QV) e a capacidade funcional em pacientes com Doença Arterial Periférica (DAP) e Úlceras Arteriais (UA). Metodologia: Estudo clínico descritivo e transversal, realizado no Sul de Minas Gerais, Brasil. Sessenta pacientes adultos alocados em três grupos -grupo DAP com UA, grupo DAP sem UA e grupo controle, sem DAP e sem UA- foram entrevistados, utilizando-se os questionários Health Assessment Questionnaire (HAQ) e o Short Form-36 Health Survey (SF-36) para medir a capacidade funcional e a QV, respectivamente. Para a comparação entre os grupos, foi utilizado o teste de Kruskal-Wallis. Resultados: Quarenta e dois participantes (70%) são mulheres e a idade média foi de 63 anos. Os pacientes com DAP, com ou sem UA, apresentaram incapacidade funcional significativamente maior que pacientes sem DAP (p < 0,01) nos componentes relacionados a deambulação, uso de utensílios domésticos, higiene e apreensão/sustentação de objetos. Os pacientes com DAP, com ou sem lesões, apresentaram SF-36 escores significativamente mais baixos -menor QV- nos domínios Capacidade funcional, Aspectos físicos, Dor corporal, Vitalidade, Aspectos sociais e Aspecto emocional do SF-36 em relação ao grupo controle (p < 0,001). Também foram observadas diferenças significativas (p < 0,001) entre o grupo controle e o grupo com DAP e UA nos domínios Estado geral de saúde e Saúde mental. Conclusão: Os pacientes com DAP, com ou sem úlcera, apresentaram redução na capacidade de realização de algumas atividades cotidianas, além de baixos níveis de QV quando comparados aos pacientes sem a doença.

Objetivo: Evaluar la Calidad de Vida (CV) y la capacidad funcional en pacientes con Enfermedad Arterial Periférica ( EAP) y Úlceras Arteriales (UA). Metodología: Estudio clínico descriptivo y transversal, realizado en el sur de Minas Gerais, Brasil. Sesenta pacientes adultos asignados en tres grupos -grupo EAP con UA, grupo EAP sin UA y grupo de control sin EAP y UA- fueron entrevistados, para lo cual se hizo uso de las escalas Health Assessment Questionnaire (HAQ) y el Short Form-36 Health Survey (SF-36) que evalúan la capacidad física y la calidad de vida, respectivamente. Para las comparaciones entre los grupos, se utilizó la prueba de Kruskal-Wallis. Resultados: Cuarenta y dos participantes (70%) son mujeres y la edad media fue de 63 años. Los pacientes con EAP, con o sin UA, presentaron limitación funcional significativamente mayor que los pacientes sin PAD (p < 0,01) en componentes relacionados con el andar, el uso de utensilios domésticos, la higiene y el alcance/agarre de objetos. Los pacientes con PAD, con o sin lesiones, tenían puntuaciones significativamente más bajas de SF-36 -CV inferior- en las dimensiones Función física, Rol físico, Dolor corporal, Vitalidad, Función social y Rol emocional en comparación con los pacientes del grupo control (p < 0,001). También se observaron diferencias significativas entre el grupo control y el grupo con EAP y au en las dimensiones Salud general y Salud mental. Conclusión: Los pacientes con EAP, con o sin úlcera, mostraron dificultad para realizar algunas actividades cotidianas, así como baja calidad de vida en comparación con los pacientes sin la enfermedad.

Objective: To assess Quality of Life (QOL) and functional ability in patients with Peripheral Arterial Disease (PAD) and Arterial Ulcers (AUS). Methodology: Descriptive and cross-sectional clinical study, conducted in Southern Minas Gerais, Brazil. Sixty adult patients allocated in three groups -group PAD with aus, group PAD without aus, and control group, without both PAD and aus- were interviewed using the scales Health Assessment Questionnaire (HAQ) and Short Form-36 Health Survey (SF-36), which assess physical disability and quality of live, respectively. The Krus-kal-Wallis test was used in order to compare the groups. Results: Forty-two participants (70%) are women, and the mean age was 63 years old. Patients with PAD, with or without aus, had significantly greater disability than patients without PAD (p < 0.01) on components related to walking, use of household utensils, hygiene, and reach/grip of objects. Patients with PAD, with or without lesions, reported significantly lower SF-36 scores -lower QOL- on Physical functioning, Role physical, Bodily pain, Vitality, Social functioning, and Role emotional domains, in comparison to patients from the control group (p < 0.001). Significant differences were also observed between the control group and the group with PAD and aus on the General health and Mental health domains. Conclusion: Patients with PAD, with or without AUS, reported difficulty in performing some activities of daily living and impaired QOL in comparison to patients without the disease.

Prevalence of pressure ulcers in a Brazilian hospital: results of a cross-sectional study.

Technological advances in recent decades have extended survival time of critically ill hospitalized patients but their unstable physiological state and limited mobility increase their risk for pressure ulcers. On two different days (June 16 and October 20, 2004), pressure ulcer prevalence in patients hospitalized at the São Paulo Hospital, Brazil was assessed. On study day 1, 43 of the 376 inpatients (prevalence, 11.4%) and on study day 2, 35 of 340 inpatients (prevalence, 10.3%) had pressure ulcers. No significant differences in patient or ulcer characteristics between the two study days were observed. Ulcer prevalence was highest among patients in the intensive care unit (average 32.7%). Most patients had one ulcer (61.5%), classified as Stage II (47%), located in the sacral area (47%), and were considered at high risk according to their Braden Scale scores (60% had a score ≤ 11). The results obtained were not unexpected and confirmed the need to improve quality of care by establishing pressure ulcer prevention protocols. Additional studies to optimize prevention efforts and improve the existing evidence-base are necessary, especially in patient care units with high pressure ulcer rates.

Classification of midpalatal suture opening after surgically assisted rapid maxillary expansion using computed tomography.

OBJECTIVE: The aim of this study was to classify the opening of the midpalatal suture (MPS) after surgically assisted rapid maxillary expansion (SARME) with disjunction of the pterygomaxillary suture through computed tomography (CT) analysis. STUDY DESIGN: Seventy adults with bilateral transverse deficiency of the maxilla underwent SARME with pterygomaxillary disjunction. Seventy tomographies were performed before the surgery and 70 were performed after the final activation. The Hass appliance was used in 29 patients and Hyrax in 41 patients. The MPS opening was classified into 2 types: type I, total MPS opening from the anterior nasal spine to the posterior nasal spine, and type II, total MPS opening from the anterior nasal spine to the transverse palatine suture, with partial or nonexistent opening posterior to transverse palatine suture. RESULTS: Type I opening was observed in 22 patients (31.5%), and type II opening in 48 patients (68.5%). In 5 cases, the opening posterior to the transverse palatine suture was paramedian. CONCLUSION: Computed tomography allows the evaluation and classification of midpalatal suture openings after SARME with pterygomaxillary disjunction in type I (total) and type II (partial) MPS openings.

Magnesium sulphate given topically by iontophoresis for viability of random skin flaps in rats.

Our aim was to assess the effects of magnesium sulphate given by iontophoresis on the viability of random skin flaps in rats. Endovenous magnesium sulphate is used to treat pre-eclampsia and diseases of blood vessels. Iontophoresis is an electrotherapeutic method which has shown satisfactory results in controlling ischaemia within the boundaries of the area in which it was given. Forty-five adult male Wistar rats, weighing 300 to 440 g were randomly divided into three groups of 15 animals each: random skin flap (control); random skin flap treated with magnesium sulphate without electrical stimulation; and random skin flap treated with magnesium sulphate with electrical stimulation of 4 mA for 20 minutes. The treatments were applied immediately after the operation and repeated on the following two days. The percentage of necrotic area was measured on the seventh postoperative day using a paper template. For each group, the mean percentage of flap necrosis was as follows: control, 46%; magnesium sulphate without electrical stimulation, 34%; and magnesium sulphate with electrical stimulation, 42%. There was no significant difference among the groups (p = 0.18). Magnesium sulphate given by iontophoresis does not increase the viability of random skin flaps in rats.