Prevalencia de úlceras por presión en el servicio de clínica médica del Hospital Geriátrico Juana Francisca Cabral / Prevalence of pressure ulcers in the medical clinic service of the Juana Francisca Cabral Geriatric Hospital

La seguridad de los pacientes se constituye en una prioridad en la gestión de calidad del cuidado que se brinda, de ahí la importancia de reflexionar sobre la magnitud que tiene el problema de eventos adversos, para prevenir su ocurrenciay progresar en acciones que garanticen una práctica segura en los últimos años se trabaja activamente para disminuir las lesiones atribuibles a los procesos de atención sanitaria, como es el caso de las úlceras por presión. Objetivo: Estimar la prevalencia de Ulcera por presión en pacientesgeriátricos, internados en el Servicio Clínica Médica del Hospital Geriátrico Juana F Cabral. Método: se realizó un estudio de tipo cuantitativo, descriptivo, retrospectivo, transversal y observacional a 60 Pacientes internados en el servicio de Clínica médica. Resultados:Se observó una prevalencia de úlcera por presión del 40% con predominio del 56% en la movilidad parcial, con un tipo de estado nutricional hipotrófica (56,7%). En la localización se observó que el 54.8 %, se presentó en la zona sacra, con predominancia del 45 % en estadio II. Conclusión: Las úlceras por presión son un problema de salud presente en el servicio de internación Clínica Médica del Hospital Geriátrico Juana F Cabral, con una prevalencia del 40%, de acuerdo a los datos obtenidos, se encuentran muy por arriba de la prevalencia encontrada en la bibliografía nacional, la cual hace referencia a un 12% en instituciones de salud de la provincia de Tucumán.

Summary: Patient safety is a priority in the quality management of care provided, hence the importance of reflecting on the magnitude of the problem of adverse events, to prevent its occurrence and progress in actions that guarantee a practice Safe in recent years is actively working to reduce injuries attributable to health care processes, as is the case of pressure ulcers. Objective: To estimate the prevalence of pressure ulcers in geriatric patients admitted to the medical clinic of Juana F Cabral Hospital. Method: a quantitative, descriptive, retrospective, transversal and observational study was carried out on 60 patients hospitalized in the Medical Clinic service. Results: A prevalence of pressure ulcer was 40%, with a 56%prevalence of partial mobility, with a hypotrophic nutritional status (56.7%). In the localization it was observed that 54.8% presented in the sacral zone, with predominance of 45% in stage II. Conclusion: Pressure ulcers are a health problem present in the clinical internment service. The Juana F Cabral geriatric hospital, with a prevalence of 40%, according to the data obtained, is well above the prevalence found in the national bibliography, which refers to 12% in health institutions in the province of Tucumán

Resumo: A segurança dos pacientes é uma prioridade na gestão de qualidade de atendimento que é prestado, daí a importância da reflexão sobre a magnitude que tem o problema de eventos adversos, para impedir a sua ocorrência e progresso em ações que garantam uma prática segura nos últimos anos a trabalhar activamente para reduzir as lesões atribuíveis a processos de cuidados de saúde, tais como úlceras de pressão. Objetivo: estimar a prevalência de úlceras de pressão em pacientes idosos internados no serviço de clínica médica Geriátrica Hospital Juana F Cabral. Método: Um estudo quantitativo de 60 pacientes internados tipo de serviço de clínica médica observacional, descritivo e retrospectivo foi realizado. Resultados: A prevalência de úlceras de pressão foi observada prevalência de 40% de 56% na mobilidade parcial, com um tipo de estado nutricional hipotróficas (56,7%) com. No local foi observado que 54,8% ocorreram na região sacral, com uma predominância de 45% no estágio II. Conclusão: As úlceras de pressão são um problema de saúde presente no internamento Clínica Médica hospital geriátrico Juana F Cabral, com uma prevalência de 40%, de acordo com dados obtidos estão bem acima da prevalência encontrada em a bibliografia nacional, que se refere a 12% em instituições de saúde na província de Tucumán

Preliminary studies of gastroprotective effect of Celtis iguanaea (Jacq.) Sargent leaves (Ulmaceae).

Antiulcerogenic activity of crude ethanolic extract of Celtis iguanaea leaves (CEE) was observed with experimental models such as ethanol, indomethacin, stress and pyloric ligation-induced gastric ulcers. Results obtained from indomethacin-induced ulcer showed the hexane fraction (HF) as the active fraction of CEE. This fraction inhibits the gastric acid secretion, increasing the gastric pH, decreasing the gastric acidity and total gastric contents. Neither the CEE nor the HF alters intestinal motility, thereby excluding a cholinergic antagonist mechanism. Further studies need to be conducted with HF in order to elucidate the active principle and the pharmacological mechanism involved.

Diclofenac sodium and Imipenem action on rat intestinal mucosa: a biomechanical and histological study.

PURPOSE: To study diclofenac sodium induced histological and mechanical alterations and their prevention with Imipenem in rat intestine. METHODS: Male Wistar rats (n=240) were randomly assigned to four experimental groups: GI: n=60 treated with 0.9% saline IM; GII: n=60 treated with 6 mg/kg body weight diclofenac sodium IM for four days; GIII: n=60 treated with 30 mg/kg body weight Imipenem IM for four days, and GIV n=60 treated with diclofenac sodium plus Imipenem at the above doses IM for 4 days. Each group was further divided into 4 subgroups of 15 rats each and sacrificed at 4, 7, 14, and 21 days of follow-up, respectively. Abdominal cavity macroscopy and histology, and small bowel breaking strength were analyzed at each sacrifice moment. RESULTS: There were no histological or mechanical alterations in normal control rats throughout the study. Ulcerated lesions in intestinal mucosa were observed and breaking strength decreased in all diclofenac sodium treated rats. Ulcerated lesions in intestinal mucosa were prevented by Imipenem in all rats. CONCLUSION: Diclofenac sodium induced ulcerated lesions in rat intestinal mucosa can be prevented by Imipenem treatment.

Diclofenac sodium and Imipenem action on rat intestinal mucosa: a biomechanical and histological study / Ação do Diclofenaco de sódio e Imipenem na mucosa intestinal do rato: estudo biomecânico e histológico

PURPOSE: To study diclofenac sodium induced histological and mechanical alterations and their prevention with Imipenem in rat intestine. METHODS: Male Wistar rats (n=240) were randomly assigned to four experimental groups: GI: n=60 treated with 0.9 percent saline IM; GII: n=60 treated with 6mg/kg body weight diclofenac sodium IM for four days; GIII: n=60 treated with 30mg/kg body weight Imipenem IM for four days, and GIV n=60 treated with diclofenac sodium plus Imipenem at the above doses IM for 4 days. Each group was further divided into 4 subgroups of 15 rats each and sacrificed at 4, 7, 14, and 21 days of follow-up, respectively. Abdominal cavity macroscopy and histology, and small bowel breaking strength were analyzed at each sacrifice moment. RESULTS: There were no histological or mechanical alterations in normal control rats throughout the study. Ulcerated lesions in intestinal mucosa were observed and breaking strength decreased in all diclofenac sodium treated rats. Ulcerated lesions in intestinal mucosa were prevented by Imipenem in all rats. CONCLUSION: Diclofenac sodium induced ulcerated lesions in rat intestinal mucosa can be prevented by Imipenem treatment.

OBJETIVO: Avaliar as alterações histológicas e biomecânicas do diclofenaco de sódio na mucosa intestinal do rato e a associação com o uso de Imipenem. MÉTODOS: Foram estudados 240 ratos Wistar distribuídos aleatoriamente em quatro grupos experimentais: GI: 60 ratos tratados com injeção IM de soro fisiológico 0,9 por cento; GII: 60 ratos tratados com injeção IM de diclofenaco de sódio na dose de 6mg/kg de peso por 4 dias; GIII: 60 ratos tratados com injeção IM de Imipenem na dose de 30 mg/kg de peso por 4 dias; GIV: 60 ratos tratados com injeção IM de soro fisiológico e diclofenaco de sódio nas doses acima. Em cada grupo os animais foram posteriormente divididos em 4 momentos de 15 animais em cada um para sacrifício, respectivamente, no 4º, 7º, 14º e 21º dias após o início do tratamento. As alterações da cavidade abdominal, assim como as características histológicas e de força de ruptura do intestino delgado foram analisadas em cada momento, em cada grupo. RESULTADOS: Não foram encontradas alterações histológicas e biomecânicas nos animais do Grupo I nesse estudo. Lesões ulceradas na mucosa do intestino delgado foram observadas nos animais tratados com diclofenaco de sódio, assim como diminuição da força de ruptura. As lesões ulceradas encontradas foram prevenidas pelo uso de Imipenem. CONCLUSÃO: O diclofenaco de sódio induz lesões ulceradas na mucosa intestinal do rato que podem ser prevenidas pelo uso de Imipenem.

Diclofenac sodium and Imipenem action on rat intestinal mucosa: a biomechanical and histological study / Ação do Diclofenaco de sódio e Imipenem na mucosa intestinal do rato: estudo biomecânico e histológico

PURPOSE: To study diclofenac sodium induced histological and mechanical alterations and their prevention with Imipenem in rat intestine. METHODS: Male Wistar rats (n=240) were randomly assigned to four experimental groups: GI: n=60 treated with 0.9 percent saline IM; GII: n=60 treated with 6mg/kg body weight diclofenac sodium IM for four days; GIII: n=60 treated with 30mg/kg body weight Imipenem IM for four days, and GIV n=60 treated with diclofenac sodium plus Imipenem at the above doses IM for 4 days. Each group was further divided into 4 subgroups of 15 rats each and sacrificed at 4, 7, 14, and 21 days of follow-up, respectively. Abdominal cavity macroscopy and histology, and small bowel breaking strength were analyzed at each sacrifice moment. RESULTS: There were no histological or mechanical alterations in normal control rats throughout the study. Ulcerated lesions in intestinal mucosa were observed and breaking strength decreased in all diclofenac sodium treated rats. Ulcerated lesions in intestinal mucosa were prevented by Imipenem in all rats. CONCLUSION: Diclofenac sodium induced ulcerated lesions in rat intestinal mucosa can be prevented by Imipenem treatment.(AU)

OBJETIVO: Avaliar as alterações histológicas e biomecânicas do diclofenaco de sódio na mucosa intestinal do rato e a associação com o uso de Imipenem. MÉTODOS: Foram estudados 240 ratos Wistar distribuídos aleatoriamente em quatro grupos experimentais: GI: 60 ratos tratados com injeção IM de soro fisiológico 0,9 por cento; GII: 60 ratos tratados com injeção IM de diclofenaco de sódio na dose de 6mg/kg de peso por 4 dias; GIII: 60 ratos tratados com injeção IM de Imipenem na dose de 30 mg/kg de peso por 4 dias; GIV: 60 ratos tratados com injeção IM de soro fisiológico e diclofenaco de sódio nas doses acima. Em cada grupo os animais foram posteriormente divididos em 4 momentos de 15 animais em cada um para sacrifício, respectivamente, no 4º, 7º, 14º e 21º dias após o início do tratamento. As alterações da cavidade abdominal, assim como as características histológicas e de força de ruptura do intestino delgado foram analisadas em cada momento, em cada grupo. RESULTADOS: Não foram encontradas alterações histológicas e biomecânicas nos animais do Grupo I nesse estudo. Lesões ulceradas na mucosa do intestino delgado foram observadas nos animais tratados com diclofenaco de sódio, assim como diminuição da força de ruptura. As lesões ulceradas encontradas foram prevenidas pelo uso de Imipenem. CONCLUSÃO: O diclofenaco de sódio induz lesões ulceradas na mucosa intestinal do rato que podem ser prevenidas pelo uso de Imipenem.(AU)

Luminal esophageal temperature monitoring with a deflectable esophageal temperature probe and intracardiac echocardiography may reduce esophageal injury during atrial fibrillation ablation procedures: results of a pilot study.

BACKGROUND: Luminal esophageal temperature (LET) monitoring is one strategy to minimize esophageal injury during atrial fibrillation ablation procedures. However, esophageal ulceration and fistulas have been reported despite adequate LET monitoring. The objective of this study was to assess a novel approach to LET monitoring with a deflectable LET probe on the rate of esophageal injury in patients undergoing atrial fibrillation ablation. METHODS AND RESULTS: Forty-five consecutive patients undergoing an atrial fibrillation ablation procedure followed by esophageal endoscopy were included in this prospective observational pilot study. LET monitoring was performed with a 7F deflectable ablation catheter that was positioned as close as possible to the site of left atrial ablation using the deflectable component of the catheter guided by visualization of its position on intracardiac echocardiography. Ablation in the posterior left atrial was limited to 25 W and terminated when the LET increased 2°C from baseline. Endoscopy was performed 1 to 2 days after the procedure. All patients had at least 1 LET elevation >2°C necessitating cessation of ablation. Deflection of the LET probe was needed to accurately measure LET in 5% of patients when ablating near the left pulmonary veins, whereas deflection of the LET probe was necessary in 88% of patients when ablating near the right pulmonary veins. The average maximum increase in LET was 2.5±1.5°C. No patients had esophageal thermal injury on follow-up endoscopy. CONCLUSIONS: A strategy of optimal LET probe placement using a deflectable LET probe and intracardiac echocardiography guidance, combined with cessation of radiofrequency ablation with a 2°C rise in LET, may reduce esophageal thermal injury during left atrial ablation procedures.

Lucilia eximia (Diptera: Calliphoridae), una nueva alternativa para la terapia larval y reporte de casos en Colombia / Lucilia eximia (Diptera: Calliphoridae), a new alternative for maggot therapy: case series report

La terapia larval es utilizada desde los años 30 del siglo pasado para la remoción del tejido necrótico en el tratamiento de úlceras crónicas infectadas logrando con ello promover la formación de tejido granuloso para el crecimiento de piel sana; especialmente a partir de la aparición de la resistencia a los antibióticos se la reconoce como una alternativa eficaz. Se presentan los resultados de la aplicación de la terapia larval en 42 pacientes con úlceras de diferentes orígenes, utilizando, como una nueva alternativa en larviterapia, la especie Lucilia eximia. Se presenta documentación fotográfica de la aplicación de esta terapia en cuatro casos.

Larval therapy is used in the treatment of infected chronic wounds by allowing the removal ofnecrotic tissue, which induces the formation of granular tissue and the growth of healthy skin.Considering the increasing prevalence of antibiotic resistance, this type of therapy may be an effectivealternative in the management of infected chronic wounds. In this article we report the use ofmaggot therapy using the Lucilia eximia species in 42 patients with chronic skin wounds associatedto different pathologies including: venous and arterial ulcers, diabetic foot, sickle cell disease,vasculopathy, elephantiasis, Berger disease, pyoderma gangrenosum (PG), traumatic wounds, erysipelas, and hospital acquired infections. Four cases are depicted photographically.

Prevenção de complicações nos pés de pessoas com diabetes mellitus: Proposta de cuidado / Preventing feet complications in people with diabetes mellitus: A health care proposal

Objetivo: Avaliar uma proposta de cuidado para pessoas com diabetes mellitus tipo 2 atendidas em unidades de atenção secundaria da saúde na rede pública, com ênfase na prevenção de lesão nos pés. Material e metodo: tratase de um ensaio clínico randomizado, com 12 meses de seguimento e avaliações semestrais referentes ao conhecimento sobre o diabetes; dos cuidados com os pés e calçados; condições dermatológicas dos pés; uso de calçados apropriados; controle metabólico (Glicemia, HbA1C, Colesterol Total, HDL, Trigliceridios) e da pressao arterial. Participaram do estudo 101 pessoas, sendo 49 do grupo intervenção, os quais participaram de um programa educativo visando o auto-cuidado durante seis semanas e, após esse periodo, houve seguimento individual mensal pelo enfermeiro para cuidados dos seus pés e reforço das necessidades educativas. O grupo controle recebeu cuidados rotineiros. Resultados: na primeira avaliação observou-se melhora nas variáveis relacionadas ao conhecimento sobre diabetes (p=0,005) e cuidados com os pés (p<0,000). Na segunda avaliação, ambas as variáveis mantiveram-se estáveis (p<0,0000), além de melhora nas condições dermatológicas dos pés (p<0,000) e no uso de calçados apropriados (p=0,0005). O controle metabólico e a pressão arterial não mostraram alterações no decorrer do estudo. Conclusão: o estudo mostrou a importância de monitorar os fatores desencadeantes de risco para complicações nos pés entre pessoas de baixo risco. Destacou também, a relevância do reforço na educação e seguimento da pessoa com diabetes.

Objectives: to evaluate a health care proposal for patients with type 2 diabetes mellitus attended at two public secondary health care units, emphasizing the prevention of foot lesions. Material an method: it is a randomized clinical study, consisting of a 12-month follow up and evaluations every semester regarding diabetes knowledge; foot and footwear care; dermatologic conditions of the foot; using appropriate footwear; controlling metabolism (Glucose, HbA1C, Total Cholesterol, HDL, Triglycerides) and blood pressure. There were 101 participants, 49 of which comprised the intervention group by participating in a six-week group education program aimed at self-care. After this period, patients attended monthly individual follow-ups for foot care and continuing education. Followups were held by nurses. The control group received regular health care. Results: in the first evaluation, an improvement was observed regarding variables associated with diabetes knowledge (p=0.005) and foot care (p<0.000). In the second evaluation, both variables remained stable ((p<0.000), and there was improvement in the dermatologic condition of the feet (p<0.000) and use of appropriate footwear (p=0.005). There were no changes in metabolism and blood pressure control throughout the study. Conclusion: monitoring risk factors of feet complications is important among people at low risk. Moreover, continuing education reinforcement and follow-up are essential for people with diabetes.

Reopening of the gastroduodenal pylorus after its closure in rats.

BACKGROUND: Duodenal injury occurs in 3% to 12% of patients with abdominal trauma. The best procedure to treat major duodenal ruptures continues to be a challenge. The purpose of the present study was to analyze differences between the time of gastroduodenal pylorus reopening after its closure with different suture materials and to verify the influence of vagotomy on local tissue changes. METHODS: Thirty rats were submitted to closure of the gastroduodenal pylorus and gastrojejunal anastomosis. The animals were divided into three groups (n = 10) according to the type of suture material used: plain catgut, polyglycolic acid, and polypropylene. Half of the animals in each group (n = 5) were also submitted to truncal vagotomy. Postoperative assessment included weekly abdominal X-ray following intragastric contrast injection until re-establishment of the gastroduodenal transit or for a maximum period of 4 wk. At the end of the follow-up period, the pyloric regions and the gastrojejunal anastomosis were removed for histological analysis. The groups were compared by the Kaplan-Meier test, with the level of significance set at P < 0.05. RESULTS: The polypropylene suture maintained the pylorus closed for a longer period of time (36.3 +/- 11.6 d) (P < 0.05). No difference was observed between the polyglycolic acid suture (25.8 +/- 14.2 d) and the plain catgut suture (18.7 +/- 10.2 d). Vagotomy did not influence the time of pyloric reopening, but was associated with a less intense gastric inflammatory reaction. CONCLUSIONS: The nonabsorbable suture was the most adequate for exclusion of pyloric transit. Vagotomy had no influence on the time of pyloric reopening but reduced gastric inflammation.

Estudo fitoquímico e biológico do cambucá Plinia edulis ( Vell. ) Sobral - Myrtaceae / Phytochemical and Biological Studies of cambucá - Plinia edulis ( Vell. ) Sobral Myrtaceae

Plinia edulis (Myrtaceae), espécie arbórea popularmente conhecida como cambucá, é nativa da Mata Atlântica brasileira. Apesar do emprego na medicina tradicional em diversas moléstias, incluindo distúrbios gástricos, não existem estudos relacionando as atividades biológicas e os constituintes químicos da espécie. Esta tese relata a avaliação da gastroproteção, da atividade antioxidante, da citotoxicidade e da mutagenicidade do extrato etanol/água de folhas de P. edulis e das frações. Com o objetivo de correlacionar os metabólitos secundários com a eficácia da droga vegetal na medicina tradicional, o extrato foi submetido à partição e posterior fracionamento cromatográfico. O extrato apresentou atividade gastroprotetora significativa em modelo de indução de úlceras por etanol acidificado em ratos em doses de 100, 200 e 400 mg/kg via oral, sendo mais ativo que o fármaco de referência lansoprazol. Entre as frações, a hexânica (100 mg/kg p.o.) foi a mais eficaz, mas apresentou menor atividade do que o extrato bruto. A gastroproteção do ácido ursólico também foi avaliada, mas embora outros triterpenos sejam conhecidos como gastroprotetores, o ácido ursólico (50 mg/kg p.o.) reduziu a área lesionada, mas não apresentou atividade significativa no modelo empregado. O extrato não evidenciou mutagenicidade na concentração de 20 mg/placa no Ensaio de Ames e apresentou atividade antioxidante pronunciada, com CE50 de 5,75 µg/mL no ensaio com DPPH e valor de ORAC de 3.948 µmol de Trolox/g de extrato. O extrato e as frações foram avaliados quanto à citotoxicidade em linhagens de células tumorais humanas de UACC62 (melanoma), MCF-7 (mama), NCI 460 (pulmão), OVCAR03 (ovário), PC-03 (próstata), HT-29 (cólon), 786-0 (rins), NCI-ADR (mama com fenótipo de resistência a múltiplos fármacos) e linhagem de células normais de ovário de hamster chinês (CHO) in vitro. O extrato e as frações apresentaram citotoxicidade seletiva dose-dependente em células cancerígenas e atividade proliferativa em células normais. A partir das frações de hexano e acetato de etila foram identificados ß-amirina, lupeol, ß-sitosterol, ácido oleanólico, ácido ursólico, ácido maslínico, ácido corosólico, galato de etila, ácido gálico, quercitrina, miricitrina e quercetina por meio de análises espectrométricas. Estes resultados dão suporte à utilização popular desta espécie e estão provavelmente associados à presença dos flavonóides e triterpenos identificados no extrato

Plinia edulis (Myrtaceae), an arboreous species popularly known as cambucá, is native in Brazilian Atlantic Rain Forest. Despite its traditional uses in many diseases, which include gastric disorders, no reports are available on the relationship between the biological activities of its extract and its chemical constituents. This thesis reports the evaluations of the the aqueous ethanol extract of leaves of P. edulis and its fractions on gastroprotective effect, antioxidant capacity, cytotoxicity and mutagenicity of. In order to correlate the secondary metabolites and the efficacy of the crude drug in traditional medicine, the extract was submitted to solvent partition followed by chromatographic fractionation. The extract exhibited significant gastroprotective effect on HCl/ethanol-induced ulcers in rats at doses of 100, 200 and 400 mg/kg p.o., even more active than the reference drug lansoprazole. Among the fractions, the hexane fraction (100 mg/kg p.o.) was the most effective, but showed lower activity than the crude extract. In addition, the gastroprotective effect of ursolic acid was evaluated. Although others triterpenes are well known as gastroprotective agents, ursolic acid (50 mg/kg p.o.) reduced the lesion area, but did not show significant activity on this model. The extract did not show mutagenicity at the concentration of 20 mg/plate in the Ames test and exhibited high antioxidant activity, with EC50 of 5.75 µg/mL on the DPPH assay and ORAC value of 3948 µmol Trolox/g of extract. The extract and its fractions were evaluated for cytotoxic activity against human tumour cell lines as UACC62 (melanoma), MCF-7 (breast), NCI 460 (lung, non-small cells), OVCAR03 (ovarian), PC-03 (prostate), HT-29 (colon), 786-0 (renal), NCI-ADR (breast expressing phenotype multiple drugs resistance) and CHO (Chinese Hamster Ovary) normal cell line in vitro. The extract and its fractions showed selectively dose-dependent cytotoxicity against cancer cells and proliferative activity in normal cells. The hexane and ethyl acetate fractions yielded ß-amyrin, lupeol, ß-sitosterol, oleanolic acid, ursolic acid, maslinic acid, corosolic acid, ethyl gallate, gallic acid, quercitrin, myricitrin and quercetin, which were identified based on spectrometric analyses. These results provide scientific support to the traditional use of this species, which are probably associated with the flavonoids and triterpenoids identified in the extract

Ambulatório de Reparo de Feridas - perfil da clientela com feridas crônicas. Um estudo prospectivo / Ambulatory care of wounds – clients' profile with chronic lesion. A prospective study

This study aims to characterize the clients porters of tissue lesion chronic which are attended in the Repair of Wound Ambulatory of Antonio Pedro University Hospital Aid Center (HUAP), in view of the following variables: age, sex, education, the basic disease, type of wound, time and location of the wound from its beginnings. It is a quantitative, descriptive and exploratory nature study approved by the Ethic in Search Committee (CEP-CCM/HUAP), being developed among 39 injury porter patients attended by the nurse consult, from May 2006 to April 2007. The results show that the population of the study is mostly male (51%), aged from 40 to 59 years (54%) and with incomplete middle (junior high) school (61%). With relation to clinical aspects, 28% get Mellitus Diabetes associated to Systemical Arterial Hypertension, 31% of them presented Mellitus Diabetes and 29% arterial hypertension; 85% having lesion upon the low members, being that 40% were caused by vein ulcers and 33% by diabetes ulcers; 27% showed the lesion from 1 year to 4 year. It was concluded that the systematic monitoring of wounded patients is fundamental not only to treat the wound but also to control basic illnesses and prevent complications. We recommend that new studies be carried out to obtain a more representative profile of this population in the different levels of attention for the health.

O presente estudo tem por objetivo caracterizar a clientela portadora de lesões tissulares crônicas atendida no Ambulatório de Reparo de Feridas do Hospital Universitário Antônio Pedro (HUAP), segundo as variáveis: idade, sexo, escolaridade, doença de base, tipo de ferida, localização da ferida e tempo desde o seu surgimento. Trata-se de um estudo quantitativo de natureza descritiva e exploratória, aprovado pelo Comitê de Ética em Pesquisa (CEP-CCM/HUAP) desenvolvido com 39 pacientes portadores de feridas crônicas, atendidos na consulta de enfermagem, durante o período de maio de 2006 a abril de 2007. Os resultados mostram que no serviço de saúde em questão, o perfil identificado caracterizou-se por indivíduos em sua maioria, do sexo masculino (51%), com faixa etária entre 40 e 59 anos de idade (54%) e primeiro grau incompleto (61%). Quanto dados clínicos, 28% dos pacientes possui Diabetes Mellitus associado à Hipertensão Arterial Sistêmica, 31% deles apresentavam Diabetes Mellitus e 29% hipertensão arterial; 85% com lesão nos membros inferiores, sendo que 40% eram de úlceras venosas e 33% de úlceras diabéticas; com um tempo de evolução superior a um ano e inferior a quatro anos, em 30% dos casos. Concluiu-se que o acompanhamento sistemático do paciente com lesão é fundamental para que se estabeleça não só o tratamento da ferida, mas o controle das doenças de base e prevenção de complicações. Recomenda-se a realização de novos estudos para se obter um perfil mais representativo desta população nos diversos níveis de atenção à saúde.

Evaluation of Baccharis trimera and Davilla rugosa in tests for adaptogen activity.

Baccharis trimera (Asteraceae) and Davilla rugosa (Dilleniaceae) are used popularly as tonics, aphrodisiacs and for stomach ailments, among other uses. Hydroalcohol extracts of the aerial parts of both plants were investigated with regard to their chemical constitution and their pharmacological activity in tests that evaluate adaptogen activity. Alkaloids, flavonoids, saponins, polyphenols/tannins and coumarins were identified in both extracts, while lignans were found only in the extract of Davilla rugosa. This extract presented also a marked antioxidant activity and exerted a moderate antiulcer effect in rats submitted to cold immobilization stress. It did not, however, inhibit the increase in the levels of ACTH and corticosterone induced by stress. Moreover, the Davilla rugosa did not improve the physical performance of mice submitted to forced exercise and the learning time of old rats in the T-maze, neither did it reduce the blood viscosity of the old animals. Conversely, the Baccharis trimera extract only presented a moderate antioxidant activity, without any positive effect on the other tests. These results point to the absence of an adaptogen activity of Baccharis trimera, with some effects that could be related to such an activity as regards the Davilla rugosa.

Profilaxia para úlcera de estresse nas unidades de terapia intensiva: estudo observacional multicêntrico / Stress ulcer prophylaxis in intensive care units: an observational multicenter study

JUSTIFICATIVA E OBJETIVOS: O sangramento digestivo por úlcera de estresse (SDUE) é uma complicação grave dos pacientes criticamente doentes e com necessidade de profilaxia baseada em critérios literários definidos. O objetivo deste estudo foi revisar o uso de profilaxia para SDUE em UTI do Estado do Rio Grande do Sul, comparando os resultados com as evidências atuais da literatura. MÉTODO: Estudo transversal realizado em um único dia, com coleta de dados de todos os pacientes internados em 21 unidades de terapia intensiva (UTI). Para análise dos dados, os pacientes foram distribuídos em três subgrupos (alto, médio e baixo risco de SDUE). RESULTADOS: Foram analisados 235 pacientes internados, com média de idade de 57,7 ± 19,5 anos e tempo médio de internação em UTI de 13 ± 19,7 dias. Os motivos de internação mais freqüentes foram sepse (26 por cento) e pós-operatório de grandes cirurgias (16,2 por cento). Da totalidade, 73 por cento eram de alto risco para SDUE, 21,5 por cento de risco intermediário e 5,5 por cento de baixo risco. Dos 187 pacientes de alto risco, 139 estavam usando bloqueadores para SDUE (60 por cento com bloqueadores histaminérgicos (BH2) e 39 por cento com inibidor de bomba de prótons (IBP) para profilaxia (60 por cento). Não recebiam profilaxia, apesar de indicada, 25,7 por cento destes pacientes de alto risco. Dos 55 pacientes de risco intermediário para SDUE, 70,9 por cento recebiam profilaxia (22 com BH2 e 17 com IBP) e dos 14 pacientes de baixo risco, 71 por cento recebiam profilaxia (6 com BH2 e 4 com IBP). CONCLUSÕES: Este artigo traduziu a ausência de estratificação de risco para SDUE nas UTI do Estado, além da indicação de fármacos gastro-protetores sem critérios precisos para o seu emprego.

BACKGROUND AND OBJECTIVES: Gastrointestinal bleeding due to stress ulcer (GB) complicates critical disease, and must be received prophylaxis based on defined criteria. To evaluate the GB prophylaxis in Intensive Care Units (ICU), and to compare with the guidelines. METHODS: We carried out a cross-sectional multicenter study in 21 medical-surgical ICU in Brazil to investigate this issue. For data analysis, these were distributed in 3 sub-groups (high, moderate and low risk for GB). RESULTS: 235 patients were evaluated, with mean age of 57.7 ± 19.5 years and days on ICU 13 ± 19.7. The more common admission ICU diagnoses were sepsis (26 percent) and postoperative (16.2 percent) patients. Seventy-three (73 percent) of the patients were GB high risk, 21.5 percent moderate and 5.5 percent low risk. Of the 187 high risk patients, 139 were receiving GB prophylaxis (60 percent with histamine blockers (HB2) and 39 percent with proton pump inhibitors (PPI). Of these patients, 25.7 percent did not receive GU prophylaxis, although indicated it. Of the 55 moderate risk patients, 70.9 percent wer e receiving GU prophylaxis (22 with HB2 and 17 with PPI). Of the 14 low risk patients, 71 percent were using GU prophylaxis (6 with HB2 and 4 with PPI). CONCLUSIONS: Almost 80 percent of the patients made use of GB prophylactic drugs, with no agreement GU risk stratification. This study demonstrated the no adequate GU prophylaxis in the Brazilian ICU.

Comparison of the gastroprotective effect of a diterpene lactone isolated from Croton cajucara with its synthetic derivatives.

The effect of three new derivatives from dehydrocrotonin (DHC-compound I) on gastric damage in different animal models including gastric ulceration induced by a necrotic agent and hypothermic restrained-stress was studied: compound II (produced by reducing the cyclohexenone moiety of DHC with NaBH(4)); compound III (produced by reducing the carbonyls with LiAlH(4)); and compound IV (produced by transforming the lactone moiety into an amide). Their structures were confirmed on the basis of chemical and physicochemical evidence. When previously administered (p.o.) at a dose of 100mg/kg, compound II significantly (P<0.01) reduced gastric injury induced by HCl/ethanol (78%) and indomethacin (88%) better than did reference compound I (48 and 43%, respectively). But the anti-ulcerogenic activity of compound II was completely abolished by the stress-induced ulcer. Reduction of carbonyls with LiAlH(4) (compound III) caused decreased activity, markedly when no protective effect in any of the models was applied (P>0.05). However, compound IV, in which the lactone moiety was changed into an amide, when administered at the same dose (100mg/kg, p.o.), was more effective. The presence of a lactone moiety or Michael acceptor is probably essential for the anti-ulcerogenic effect of these compounds.

Failure of early treatment of cutaneous leishmaniasis in preventing the development of an ulcer.

The clinical characteristics and treatment outcome were determined for 26 patients who presented with early-stage cutaneous leishmaniasis. Illness duration ranged from 8 to 20 days, and the commonest clinical presentation was the presence of a papule with small central crust on a lower extremity. Prominent regional adenopathy was found in 22 (85%) of 26 patients. The results of an intradermal skin test for Leishmania were positive for 96% of those patients, and results of serologic testing were positive for 61% of patients tested. Ten (46%) of 22 patients for whom follow-up data were available developed enlargement and ulceration of the lesion despite early antimony therapy and required additional courses of treatment. Histopathological studies of samples from the lesions of 3 patients showed vasculitis. These data show that early therapy for cutaneous leishmaniasis does not prevent the development of an ulcer in one-half of patients. This unfavorable outcome underlines the relevance of local exacerbated inflammatory and immune response in the pathogenesis of the disease.