Factores que intervienen en la práctica de los cuidados paliativos por enfermeras intensivistas / Factors involved in the practice of palliative care by intensivist nurses

Objetivo principal: Conocer los factores que intervienen en la práctica de los cuidados paliativos prestados por el personal de enfermería en las Unidades de Cuidados Intensivos (UCI). Metodología: Investigación cualitativa. Entrevistas realizadas entre noviembre y mayo de 2019 con 14 profesionales de enfermería de hospital privado de Salvador, Bahía, Brasil. Los datos se sistematizaron mediante análisis de contenido con enfoque de la Teoría del Final de la Vida del Pacífico. Resultados principales: Se identificaron como factores: Equipo Multiprofesional, Apoyo Familiar, Humanización del Cuidado en la UCI, Modelo Curativista, Definición de los criterios de cuidados paliativos. Conclusión principal: La atención a los pacientes en paliación es perjudicada por la falta de preparación emocional y de habilidades, que dificulta la inclusión familiar. Se valora el equipo multiprofesional y la inserción de paradigmas teóricos en el proceso de la enfermedad.(AU)

Objective: To know the factors involved in the practice of palliative care provided by nurses in Intensive Care Units (ICU). Methods: Qualitative research. Interviews conducted between November and May 2019 with fourteen nursing professionals from a private hospital in Salvador, Bahia, Brazil. The data were systematized through Content Analysis and analyzed by the Pacific End-of-Life Theory.Results: The factors: Multiprofessional team; Family support, Humanization of care in the ICU; Curativist model; Definition of PC criteria.Conclusions: The care of patients in palliation is impaired by the lack of emotional preparation and skills, which hinders family inclusion. The multiprofessional team and the insertion of theoretical paradigms in the disease process are valued.(AU)

Implementing nursing diagnoses and care for the spiritual dimension of people with cancer: educational actions.

OBJECTIVE: To establish the implementation of nursing diagnoses and care for the spiritual dimension of people with cancer. METHOD: Action research in a university hospital in the north-east of Brazil. Nine nurses and thirteen nursing technicians from the Onco-hematology and Bone Marrow Transplant Unit of this hospital took part. Data collection took place in four phases and involved the talking map technique, pedagogical workshops and a logbook. The groups' speeches were coded using Maxqda software, subjected to Braun and Clarke's thematic analysis and interpreted in the light of Paulo Freire's constructs. RESULTS: Phase 1 sought to apprehend the participants' prior knowledge on the subject; in phase 2, proposals emerged for spiritual care organized in the Nursing Process; in phase 3, the diagnoses and care plan for the spiritual dimension for clinical practice were contemplated; and in phase 4, through the final evaluation, it was possible to see the transformations that occurred in the nursing team's practice with the proposed implementation. CONCLUSION: The educational actions provided significant learning for the nursing team and the implementation of diagnoses and nursing care for the spiritual dimension of people with cancer.

Gene variations related to the hepatocellular carcinoma: Results from a field synopsis and Bayesian revaluation.

Hepatocellular carcinoma (HCC) is considered as the second cause of cancer-related deaths worldwide. Genetic variations are associated with HCC risk, an issue that has been the subject of several meta-analyses. However, meta-analyses have an important limitation on the likelihood of false positive data. Henceforth, this study aimed to assess the level of noteworthiness in the meta-analyses by means of a Bayesian approach. A systematic search was performed for meta-analyses with associations between gene polymorphisms and HCC. The calculations for the False-Positive Rate Probability (FPRP) and the Bayesian False Discovery Probability (BFDP) were performed to assess the noteworthiness with a statistical power of 1.2 and 1.5 of Odds Ratio at a prior probability of 10-3 and 10-5. The quality of studies was evaluated by the Venice criteria. As additional analyses, the gene-gene and protein-protein networks were designed for these genes and products. As results, we found 33 meta-analytic studies on 45 polymorphisms occurring in 35 genes. A total of 1,280 values for FPRP and BFDP were obtained. Seventy-five for FPRP (5.86%) and 95 for BFDP (14.79%) were noteworthy. In conclusion, the polymorphisms in CCND1, CTLA4, EGF, IL6, IL12A, KIF1B, MDM2, MICA, miR-499, MTHFR, PNPLA3, STAT4, TM6SF2, and XPD genes were considered as noteworthy biomarkers for HCC risk.

Implementing nursing diagnoses and care for the spiritual dimension of people with cancer: educational actions / Implementación de diagnósticos y cuidados de enfermería para la dimensión espiritual de las personas con cáncer: acciones educativas / Implementação de diagnósticos e cuidados de enfermagem à dimensão espiritual da pessoa com câncer: ações educativas

ABSTRACT Objective: To establish the implementation of nursing diagnoses and care for the spiritual dimension of people with cancer. Method: Action research in a university hospital in the north-east of Brazil. Nine nurses and thirteen nursing technicians from the Onco-hematology and Bone Marrow Transplant Unit of this hospital took part. Data collection took place in four phases and involved the talking map technique, pedagogical workshops and a logbook. The groups' speeches were coded using Maxqda software, subjected to Braun and Clarke's thematic analysis and interpreted in the light of Paulo Freire's constructs. Results: Phase 1 sought to apprehend the participants' prior knowledge on the subject; in phase 2, proposals emerged for spiritual care organized in the Nursing Process; in phase 3, the diagnoses and care plan for the spiritual dimension for clinical practice were contemplated; and in phase 4, through the final evaluation, it was possible to see the transformations that occurred in the nursing team's practice with the proposed implementation. Conclusion: The educational actions provided significant learning for the nursing team and the implementation of diagnoses and nursing care for the spiritual dimension of people with cancer.

RESUMEN Objetivo: Establecer la implementación de diagnósticos y cuidados de enfermería para la dimensión espiritual de personas con cáncer. Método: Investigación-acción en un hospital universitario del nordeste de Brasil. Participaron nueve enfermeros y trece técnicos de enfermería de la Unidad de Oncohematología y Trasplante de Médula Ósea de este hospital. La recogida de datos se realizó en cuatro fases e incluyó la técnica del mapa parlante, talleres pedagógicos y un cuaderno de bitácora. Los discursos de los grupos se codificaron con el programa Maxqda, se sometieron al análisis temático de Braun y Clarke y se interpretaron a la luz de los constructos de Paulo Freire. Resultados: La fase 1 buscó captar los conocimientos previos de los participantes sobre el tema; en la fase 2, surgieron propuestas de cuidados espirituales organizados en el Proceso de Enfermería; en la fase 3, se contemplaron los diagnósticos y el plan de cuidados de la dimensión espiritual para la práctica clínica; y en la fase 4, a través de la evaluación final, fue posible ver las transformaciones ocurridas en la práctica del equipo de enfermería con la implementación propuesta. Conclusión: Las acciones educativas proporcionaron aprendizajes significativos para el equipo de enfermería y la implementación de diagnósticos y cuidados de enfermería para la dimensión espiritual de las personas con cáncer.

RESUMO Objetivo: Estabelecer a implementação de diagnósticos e cuidados de enfermagem à dimensão espiritual da pessoa com câncer. Método: Pesquisa-ação, em um hospital universitário do Nordeste do Brasil. Participaram nove enfermeiros e treze técnicos de enfermagem da Unidade de Oncohematologia e Transplante de Medula Óssea do referido hospital. A coleta de dados aconteceu em quatro fases e envolveu a técnica do mapa falante, oficinas pedagógicas e o diário de bordo. As falas dos grupos foram codificadas com auxílio do software Maxqda, submetidas à análise temática de Braun e Clarke e interpretadas à luz dos construtos de Paulo Freire. Resultados: A fase 1 buscou apreender o saber prévio dos participantes sobre a temática; na fase 2, surgiram propostas para o cuidado espiritual organizado no Processo de Enfermagem; na fase 3, contemplou-se os diagnósticos e plano de cuidados à dimensão espiritual para a prática clínica; e na fase 4, através da avaliação final, foi possível constatar as transformações ocorridas na prática da equipe de enfermagem com a implementação proposta. Conclusão: As ações educativas proporcionaram a aprendizagem significativa da equipe de enfermagem e implementação dos diagnósticos e cuidados de enfermagem à dimensão espiritual da pessoa com câncer.

Food restriction reduces hepatic alterations associated with experimental periodontitis.

BACKGROUND: Periodontitis is a chronic inflammatory and multifactorial disease that affects the periodontal structures and can cause alterations in the hepatic tissue. The aim of the present study was to evaluate whether a diet with food restriction can decrease oral and liver alterations associated with ligature-induced periodontitis. METHODS: Twenty-four female Wistar rats were used in this study, randomized into three groups (n = 8 for each group): control (regular food); periodontitis (regular food + periodontitis induced with ligatures); and food restriction (diet with food restriction and periodontitis induction). The following periodontium parameters were analyzed tooth mobility (TM), probing pocket depth (PPD), gingival bleeding index (GBI), and alveolar bone height (ABH). In the liver, the levels of oxidative stress markers-malondialdehyde (MDA), glutathione (GSH), total cholesterol, and levels of myeloperoxidase (MPO) activity were measured. Liver samples were analyzed for histopathological score. In the blood tissue, the levels of enzymes alanine aminotransferase (ALT), aspartate aminotransferase (AST), glucose, total cholesterol, and the high-density lipoprotein (HDL) were also evaluated. RESULTS: The animals that received a diet with food restriction + periodontitis showed a decrease in hepatic histopathological score (P < 0.05) when compared with the periodontitis group, the same for glucose, total cholesterol, ALT, AST, and ABH data. The group with food restriction + periodontitis showed a decrease in the histopathological liver score (P < 0.05) compared with the group with periodontitis. CONCLUSION: This study revealed that food restriction reduced oral damages, as well as hepatic, blood and alveolar bone alterations associated with ligature-induced periodontitis in rats.

Respostas comportamentais apresentadas por longevos após internação na Unidade de Terapia Intensiva e retorno domiciliar / Respuestas comportamentales presentadas por longevos después de la hospitalización en la Unidad de Cuidados Intensivos y regreso al hogar / Behavioral responses presented by elderly people after hospitalization in the intensive care unit and return home

Resumo Objetivo identificar respostas comportamentais apresentadas por longevos no domicílio, após internação na Unidade de Terapia Intensiva e alta hospitalar. Método estudo qualitativo, realizado com pessoas de 80 anos ou mais. O cenário da coleta de dados foi a Unidade de Terapia Intensiva e o domicílio de longevos que estiveram internados na unidade, por meio de entrevista aberta. Para análise dos dados, utilizou-se o método de análise de conteúdo de Bardin, pautada na teoria de Adaptação de Callista Roy. Todos os cuidados éticos foram respeitados. Resultados emergiram-se duas categorias: Alterações do padrão de resposta às necessidades fisiológicas e perda de autonomia e Alterações psicossociais e comprometimento na realização de atividades cotidianas de lazer e laborais. Conclusão e implicações para a prática as respostas comportamentais foram relacionadas aos modos fisiológicos e psicossociais, que culminaram em dependência e perda de autonomia para realização das atividades básicas de vida. Perceberam-se dificuldades vivenciadas no retorno ao domicílio, que provocaram alterações significativas na realização de atividades cotidianas, evidenciando a necessidade de se iniciar o preparo para o retorno domiciliar, pela equipe multiprofissional, ainda durante a hospitalização. Espera-se que estratégias visando melhorias dos resultados de cuidados críticos sejam implementadas nessa população.

RESUMEN Objetivo identificar respuestas comportamentales presentadas por longevos en el domicilio después de internación en la Unidad de Cuidados Intensivos y alta hospitalaria. Método estudio cualitativo, realizado con personas de 80 años o más. El escenario de la recolección de datos fue la Unidad de Cuidados Intensivos y el domicilio de longevos que estuvieron internados en la unidad, por medio de entrevista abierta. Para el análisis de los datos se utilizó el método de análisis de contenido de Bardin, pautado en la teoría de Adaptación de Callista Roy. Todos los cuidados éticos fueron respetados. Resultados surgieron dos categorías: Alteraciones del patrón de respuesta a las necesidades fisiológicas y pérdida de autonomía y Alteraciones psicosociales y compromiso en la realización de actividades cotidianas de ocio y laborales. Conclusión e implicaciones para la práctica las respuestas comportamentales fueron relacionadas a los modos fisiológicos y psicosociales, que culminaron en dependencia y pérdida de autonomía en la realización de las actividades básicas de la vida. Se percibieron dificultades vividas en el retorno al domicilio, que provocaron alteraciones significativas en la realización de actividades cotidianas, revelando la necesidad de iniciar la preparación para el retorno domiciliar por el equipo multiprofesional aún durante la hospitalización. Se espera que estrategias que busquen mejoras de los resultados de cuidados críticos sean implementadas en esa población.

Abstract Objective to identify the behavioral responses presented by elderly people at home after hospitalization at the intensive care unit and hospital discharge. Method a qualitative study was conducted with people aged 80 years or older. The data collection setting was the intensive care unit and the homes of the elderly people hospitalized in the unit using open interviews. Data analysis consisted of Bardin's method of content analysis based on the Callista Roy adaptation model. All ethical aspects were respected. Results two categories emerged: changes in the pattern of response to physiological needs and loss of autonomy and psychosocial changes and impairment in performing daily leisure and work activities. Conclusion and implications for practice behavioral responses were related to physiological and psychosocial factors, culminating in dependence and loss of autonomy to perform basic life activities. Difficulties experienced in returning home were also noticed, which caused significant changes in daily activities, thereby evidencing the need for multidisciplinary teams to begin preparing for the return home during hospitalization. Strategies seeking to improve critical care outcomes are highly suggested to be implemented in this population.

Deposition of Immune Complexes in Gingival Tissues in the Presence of Periodontitis and Systemic Lupus Erythematosus.

Systemic lupus erythematosus (SLE) is a complex chronic autoimmune disease characterized by tissue damage and widespread inflammation in response to environmental challenges. Deposition of immune complexes in kidneys glomeruli are associated with lupus nephritis, determining SLE diagnosis. Periodontitis is a chronic inflammatory disease characterized by clinical attachment and bone loss, caused by a microbial challenge - host response interaction. Deposition of immune complex at gingival tissues is a common finding in the course of the disease. Considering that, the primary aim of this study is to investigate the deposition of immune complexes at gingival tissues of SLE patients compared to systemically healthy ones, correlating it to periodontal and systemic parameters. Twenty-five women diagnosed with SLE (SLE+) and 25 age-matched systemically healthy (SLE-) women were included in the study. Detailed information on overall patient's health were obtained from file records. Participants were screened for probing depth (PD), clinical attachment loss (CAL), gingival recession (REC), full-mouth bleeding score (FMBS) and plaque scores (FMPS). Bone loss was determined at panoramic X-ray images as the distance from cementenamel junction to alveolar crest (CEJ-AC). Gingival biopsies were obtained from the first 15 patients submitted to surgical periodontal therapy of each group, and were analyzed by optical microscopy and direct immunofluorescence to investigate the deposition of antigen-antibody complexes. Eleven (44%) patients were diagnosed with active SLE (SLE-A) and 14 (56%) with inactive SLE (LES-I). Mean PD, CAL and FMBS were significantly lower in SLE+ than SLE-(p < 0.05; Mann Whitney). The chronic use of low doses of immunosuppressants was associated with lower prevalence of CAL >3 mm. Immunofluorescence staining of markers of lupus nephritis and/or proteinuria was significantly increased in SLE+ compared to SLE-, even in the presence of periodontitis. These findings suggest that immunomodulatory drugs in SLE improves periodontal parameters. The greater deposition of antigen-antibody complexes in the gingival tissues of patients diagnosed with SLE may be a marker of disease activity, possibly complementing their diagnosis.

Polymorphisms in the interleukin genes and chronic periodontitis: A field synopsis and revaluation by Bayesian approaches.

Periodontitis is a high prevalent disease into the clinical dentistry. Genetic variations in interleukins (IL) genes were associated with chronic periodontitis (CP) and were focus of several meta-analyses. This study aimed to assess the noteworthiness in the meta-analyses by means of a Bayesian approach to determinate possible false report associations. A systematic search was performed for meta-analyses with associations between gene polymorphisms in interleukins and CP. The calculations for the False-Positive Rate Probability (FPRP) and the Bayesian False Discovery Probability (BFDP) were performed to assess the noteworthiness with a statistical power of 1.2 and 1.5 of Odds Ratio at a prior probability of 10-3 and 10-6. As results, eight meta-analyses approaching the IL1A/rs1800587, IL1B/rs1143634, IL1RN/rs2234663, IL4/rs2243250, IL6/rs1800795/rs1800796, IL17A/rs2275913 and IL18/rs1946518/rs187238 polymorphisms have been identified. Twenty-two from 270 calculations (8.15%) were noteworthy. Herein, we have identified the IL1A and IL1B polymorphisms as noteworthy biomarkers for CP susceptibility.

Deposition of immune complexes in gingival tissues in the presence of periodontitis and Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a complex chronic autoimmune disease characterized by tissue damage and widespread inflammation in response to environmental challenges. Deposition of immune complexes in kidneys glomeruli are associated with lupus nephritis, determining SLE diagnosis. Periodontitis is a chronic inflammatory disease characterized by clinical attachment and bone loss, caused by a microbial challenge ­ host response interaction. Deposition of immune complex at gingival tissues is a common finding in the course of the disease. Considering that, the primary aim of this study is to investigate the deposition of immune complexes at gingival tissues of SLE patients compared to systemically healthy ones, correlating it to periodontal and systemic parameters. Twenty-five women diagnosed with SLE (SLE+) and 25 age-matched systemically healthy (SLE­) women were included in the study. Detailed information on overall patient's health were obtained from file records. Participants were screened for probing depth (PD), clinical attachment loss (CAL), gingival recession (REC), full-mouth bleeding score (FMBS) and plaque scores (FMPS). Bone loss was determined at panoramic X-ray images as the distance from cementenamel junction to alveolar crest (CEJ-AC). Gingival biopsies were obtained from the first 15 patients submitted to surgical periodontal therapy of each group, and were analyzed by optical microscopy and direct immunofluorescence to investigate the deposition of antigen-antibody complexes. Eleven (44%) patients were diagnosed with active SLE (SLE-A) and 14 (56%) with inactive SLE (LES-I). Mean PD, CAL and FMBS were significantly lower in SLE+ than SLE­(p < 0.05; Mann Whitney). The chronic use of low doses of immunosuppressants was associated with lower prevalence of CAL >3 mm. Immunofluorescence staining of markers of lupus nephritis and/or proteinuria was significantly increased in SLE+ compared to SLE­, even in the presence of periodontitis. These findings suggest that immunomodulatory drugs in SLE improves periodontal parameters. The greater deposition of antigen-antibody complexes in the gingival tissues of patients diagnosed with SLE may be a marker of disease activity, possibly complementing their diagnosis.

Alpha-terpineol complexed with beta-cyclodextrin reduces damages caused by periodontitis in rats.

BACKGROUND AND OBJECTIVE: This study aimed to assess the effectiveness of the treatment with alpha-terpineol (αTPN) complexed with beta-cyclodextrin (ßCD) on oral, blood, and hepatic parameters in ligature-induced periodontitis. MATERIAL AND METHODS: Forty female rats were distributed among the following groups: control (vehicle solution), periodontitis (ligature + vehicle solution), 5 mg/kg of αTPN-ßCD (ligature), and 25 mg/kg of αTPN-ßCD (ligature). Compounds were administered daily via intraperitoneal injection over a 20-day period. Periodontitis was induced with the bilateral insertion of ligatures around the first lower molars of each rat. Oral parameters, as well as blood biomarkers, were measured: histopathological assessment of the hepatic tissue was carried out using light and transmission electron microscopy. RESULTS: The treatment with αTPN-ßCD significantly improved several oral parameters and blood biomarkers in comparison with rats with periodontitis. In addition, the treatment with αTPN-ßCD significantly ameliorated the steatosis score and reduced the number of lipid droplets and the amount of foamy cytoplasm in the hepatocytes of rats with periodontitis. CONCLUSION: The results obtained suggest that the treatment with αTPN-ßCD improves several oral and blood parameters in rats with experimental periodontitis. In addition, hepatic alterations caused by periodontitis were ameliorated in the rats treated with αTPN-ßCD.

Host-Microbial Interactions in Systemic Lupus Erythematosus and Periodontitis.

Background: Systemic lupus erythematosus (SLE) is a potentially fatal complex autoimmune disease, that is characterized by widespread inflammation manifesting tissue damage and comorbidities across the human body including heart, blood vessels, joints, skin, liver, kidneys, and periodontal tissues. The etiology of SLE is partially attributed to a deregulated inflammatory response to microbial dysbiosis and environmental changes. In the mouth, periodontal environment provides an optimal niche for local and systemic inflammation. Our aim was to evaluate the reciprocal impact of periodontal subgingival microbiome on SLE systemic inflammation. Methods: Ninety-one female subjects were recruited, including healthy (n = 31), SLE-inactive (n = 29), and SLE-active (n = 31). Patients were screened for probing depth, bleeding on probing, clinical attachment level, and classified according to CDC/AAP criteria with or without periodontal dysbiosis. Serum inflammatory cytokines were measured by human cytokine panel and a targeted pathogenic subgingival biofilm panel was examined by DNA-DNA checkerboard from subgingival plaque samples. Results: The results showed significant upregulation of serum proinflammatory cytokines in individuals with SLE when compared to controls. Stratification of subject's into SLE-inactive (I) and SLE-active (A) phenotypes or periodontitis and non-periodontitis groups provided new insights into SLE pathophysiology. Ten proinflammatory cytokines were upregulated in serum of SLE-I only and one in SLE-A only. Four molecules overlapped in SLE-A and SLE-I. Anti-inflammatory cytokines included IL-4 IL-10, which were upregulated in SLE-I sera (but not SLE-A), controlling clinical phenotypes. Out of 24 significant differential oral microbial abundances found in SLE, 14 unique subgingival bacteria profiles were found to be elevated in SLE. The most severe oral pathogens (Treponema denticola and Tannerella forsythia) showed increase abundances on SLE-A periodontal sites when compared to SLE-I and healthy controls. Inflammation as measured by cytokine-microbial correlations showed that periodontal pathogens dominating the environment increased proinflammatory cytokines systemically. Conclusions: Altogether, low-grade systemic inflammation that influenced SLE disease activity and severity was correlated to dysbiotic changes of the oral microbiota present in periodontal diseases.

Séries temporais de vítimas de queimaduras atendidas no Centro-Oeste e Nordeste do Brasil / Timeline of burn victims taken care in Brazil's Midwest and Northeast / Series temporales de víctimas de quemaduras atendidas en el Centro-oeste y Nordeste de Brasil

Objetivo: O objetivo foi avaliar séries temporais de vítimas de queimaduras atendidas nas regiões Centro-Oeste e Nordeste do Brasil, no período de 2014 a 2018. Método: Estudo descritivo com séries temporais referentes às internações hospitalares por queimaduras nas regiões Centro-Oeste e Nordeste do Brasil. Foi utilizado o Sistema de Informações Hospitalares do SUS (SIH-SUS), processados pelo Departamento de Informática do Sistema Único de Saúde- DATASUS, entre 2014 e 2018. Resultados: Entre 2014 e 2018 ocorreram 52.415 internações por queimaduras registradas pelos hospitais das regiões Centro-Oeste e Nordeste. O Nordeste apresentou as maiores taxas de internações em relação à Região Centro-Oeste, com predomínio do sexo masculino em ambas as regiões; a faixa etária mais acometida foi a de 1 a 9 anos no Nordeste e de 20 a 39 anos no Centro-Oeste; com relação à cor/raça, predominou a cor parda nas taxas de internações no Centro-Oeste e no Nordeste. Conclusão: Torna-se fundamental uma assistência à saúde eficiente desde a promoção até a reabilitação. Dessa forma, vale destacar que essas medidas devem ser direcionadas, prioritariamente, ao público mais acometido do estudo, que foi o do sexo masculino.

Objective: The objective was to evaluate timeline of burn victims taken care in Brazils Midwest and Northeast between 2014 and 2018. Methods: Descriptive study with a timeline in referral to the burn victims that are hospitalized at the hospital in the Midwest and Northeast regions of Brazil. It was used the Hospital Information System of SUS (HIS-SUS), processed by the IT Department of the Health Only System - DATASUS, between 2014 to 2018. Results: Between 2014 and 2018 there was 52,415 hospital check-ins in the Midwest and Northeast regions, all of those caused by burn. The Northeast presented the highest hospital care rates in relation to the Midwest Region, the victims are mainly men in both regions, in the Northeast the age average is from 1 to 9 years old, in the Midwest is from 20 to 39 years old, with regard to skin color or race, most victims are brown in the Midwest and Northeast. Conclusion: It is important an efficient health assistance starting with the health care going all the way to the rehabilitation. This way it is important to mention that those measures must be directed mainly to the to the most affected public, which is the male sex.

Objetivo: El objetivo fue evaluar series temporales de víctimas de quemaduras tratadas en las regiones del Medio Oeste y Nordeste de Brasil, en el período de 2014 a 2018. Método: Estudio descriptivo con series temporales respecto a los ingresos hospitalarios por quemaduras en las regiones del Medio Oeste y Nordeste de Brasil. Se utilizó el Sistema de Informaciones Hospitalarias del SUS (SIH-SUS), procesados por el Departamento de Informática del Sistema Único de Salud - DATASUS, entre 2014 y 2018. Resultados: Entre 2014 y 2018 hubo 52.415 ingresos por quemaduras registradas en los hospitales de las regiones del Medio Oeste y Nordeste. El Nordeste presentó las mayores tasas de ingresos en comparación con la región del Medio Oeste, con predominio del sexo masculino en ambas regiones; el rango de edad más acometido fue de 1 a 9 años en el Nordeste y de 20 a 39 años en el Medio Oeste, en relación al color/raza, predominó la parda en las tasas de ingresos en el Medio Oeste y Nordeste. Conclusión: Es fundamental una asistencia efectiva a la salud desde la promoción hasta la rehabilitación. De esta suerte, merece la pena resaltar que dichas medidas se deben dirigir, con prioridad, al público más afectado del estudio que fue el del sexo masculino.

High-fat diet aggravates the liver disease caused by periodontitis in rats.

BACKGROUND: Periodontitis is an inflammatory disease that causes periodontium and hepatic alterations. Liver disease is related to the intake of foods rich in fat and sugars (high-fat). The objective of this study was to evaluate whether a high-fat diet can aggravate the liver disease caused by ligature-induced periodontitis in rats. METHODS: Twenty-one female rats were divided into three groups (n = 7 in each group): control; periodontitis (periodontitis induced with ligature) and high-fat + periodontitis (received hypercaloric diet and induction of periodontitis). The rats were submitted to the analyses of the following periodontal parameters: gingival bleeding index (GBI), probing pocket depth (PPD), tooth mobility (TM), and alveolar bone height. In the hepatic tissue, the levels of malondialdehyde (MDA), glutathione (GSH), total cholesterol, and myeloperoxidase activity (MPO) were measured. Liver samples were also histopathologically evaluated. Finally, blood levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), glucose, total cholesterol, cholesterol high-density lipoprotein (HDL), and uric acid were measured. RESULTS: The high-fat + periodontitis group presented an increase in the steatosis score (P < 0.05) for the histopathologic evaluation, when compared with the periodontitis group. MDA, uric acid and ALT levels also increased, whereas GSH and HDL levels showed lower values. CONCLUSION: A high-fat diet aggravates the liver disease caused by ligature-induced periodontitis in rats.

Periodontitis causes abnormalities in the liver of rats.

BACKGROUND: Periodontitis not only causes injury to the periodontium, but also damages other tissues such as: articulate, renal, cardiac, and hepatic. The objective of this study was to investigate periodontitis induced alterations in liver function and structure using an experimental model. METHODS: Twenty female rats (Rattus norvegicus) were allocated into two groups: control and periodontitis. Gingival bleeding index and oxidative stress parameters and specific circulating biomarkers were measured. Immunohistochemistry was carried out using alkaline phosphatase (AlkP) staining of the liver. Hepatic tissues, cytokines, and lipid contents were measured. Histopathologic evaluation of the liver was carried out using light and electron microscopy. RESULTS: Liver histopathologic and immunohistochemistry assessment showed increase in steatosis score, and presence of binucleate hepatocytes and positive cells for AlkP in periodontitis versus control group. Ultrastructural evaluation showed significant increase in size and number of lipid droplets (LD), distance between the cisterns of rough endoplasmic reticulum (RER), mitochondria size, foamy cytoplasm, and glycogen accumulation in the liver of the periodontitis group compared with the control group. In addition, plasma levels of AlkP, high-density lipoprotein (HDL), triglycerides, and total cholesterol were also changed. CONCLUSION: Experimental periodontitis caused immunohistochemistry, histopathologic, ultrastructural, oxidative, and biochemical changes in the liver of rats.

Cuidado de enfermagem ao idoso com delirium em unidade intensiva / Nursing care for elderly patients with delirium in intensive care units

Objetivo: analisar as evidências da literatura científica acerca do cuidado de enfermagem na prevenção, detecção e manejo do delirium em idosos na Unidade de Terapia Intensiva. Método: trata-se de uma revisão integrativa em artigos publicados entre 2013 e 2018 nas bases MEDLINE, LILACS, BDENF e CINAHL. Analisaram-se os dados pela técnica de Análise de Conteúdo. Apresentaram-se os resultados em figuras. Resultados: encontraram-se seis artigos que atenderam ao objetivo do estudo, dos quais emergiram 2 categorias: 1. Prevenção, identificação e manejo do delirium realizado pela equipe de enfermagem à pessoa idosa na Unidade de Terapia Intensiva; 2. Importância da realização de intervenções educativas com a equipe de enfermagem na Unidade de Terapia Intensiva. Conclusão: constatou-se que os estudos analisados são incipientes. Aponta-se que as medidas não farmacológicas contribuem no combate da síndrome. Faz-se necessária a realização de educação permanente com a equipe de enfermagem a fim de prepará-la para prevenção, reconhecimento e manejo do delirium em idosos na unidade de terapia intensiva.(AU)

Objective: to analyze the evidence from the scientific literature about nursing care for prevention, detection and management of delirium in elderly patients in Intensive Care Units. Method: this is an integrative review of articles published between 2013 and 2018 available in the following databases: MEDLINE, LILACS, BDENF, and CINAHL. The data were analyzed through the Content Analysis technique. The results were presented in figures. Results: six articles met the objective of the study, from which two categories emerged: 1. Prevention, identification and management of delirium by the nursing team in elderly patients admitted to Intensive Care Units; 2. Importance of educational interventions with nursing teams in Intensive Care Units. Conclusion: it was observed that the studies analyzed are incipient. It is noteworthy that non-pharmacological measures contribute to the syndrome. It is necessary to carry out continuing education with nursing teams in order to prepare them for the prevention, recognition and management of delirium in elderly patients in intensive care units.(AU)

Objetivo: analizar las evidencias de la literatura científica acerca del cuidado de enfermería en la prevención, detección y manejo del delirium en adultos mayores en la Unidad de Terapia Intensiva. Método: se trata de una revisión integradora en artículos publicados entre 2013 y 2018 realizada en las bases MEDLINE, LILACS, BDENF y CINAHL. Se analizaron datos por medio de la técnica de Análisis de Contenido. Se presentaron los resultados en figuras. Resultados: se encontraron seis artículos que atendieron al objetivo del estudio, de los cuales surgieron 2 categorías: 1. Prevención, identificación y manejo del delirium realizado por el equipo de enfermería a la persona mayor en la Unidad de Terapia Intensiva; 2. Importancia de la realización de intervenciones educativas com el equipo de enfermeira en la Unidad de Terapia Intensiva. Conclusión: se constató que los estudios analizados son incipientes. Se apunta que las medidas no farmacológicas contribuyen en el combate del síndrome. Es necesaria la realización de educación permanente con el equipo de enfermería para perpararlo para prevención, reconocimiento y manejo del delirium en adultos mayores en la unidad de terapia intensiva.(AU)

Adaptação de longevos no domicílio após alta da unidade intensiva / Adaptation of the elderly at home after intensive unit discharge

Objetivo: investigar como ocorre a adaptação de longevos no domicílio após alta hospitalar de internamento na Unidade de Terapia Intensiva. Método: trata-se de estudo bibliográfico, descritivo, tipo revisão integrativa, entre 2013 e 2017, nas Bases de Dados: LILACS, MEDLINE via PubMed, CINAHL e no repositório PubMed. Utilizou-se a Análise de Conteúdo para categorizar os dados. Resultados: selecionaram-se dez estudos dos quais originaram três categorias temáticas: Sobrevida e mortalidade; Funcionalidade; Dificuldades, facilidades e necessidades do longevo que retorna ao domicílio após alta da Unidade de Terapia Intensiva. Conclusão: concluiu-se que longevos que vivenciam a internação em unidades críticas necessitam de cuidados específicos e continuados após o retorno ao domicílio, de cuidadores formais e informais, do apoio das redes de atenção à saúde, além de cuidados de transição durante o processo de hospitalização.(AU)

Objective: to investigate how the adaptation of the oldest old at home occurs after discharge from the Intensive Care Unit. Method: this is a descriptive bibliographic study, integrative review, between 2013 and 2017, in the Databases: LILACS, MEDLINE via PubMed, CINAHL. Content analysis was used to categorize the data. Results: ten studies were selected from which three thematic categories originated: Survival and mortality; Functionality; Difficulties, facilities and needs of the long-term returnee after discharge from the Intensive Care Unit. Conclusion: it was concluded that the elderly who experience hospitalization in critical units need specific and continued care after return home, formal and informal caregivers, support from health care networks, and transition care during the process of hospitalization.(AU)

Objetivo: investigar se ocurre la adaptación del anciano en el jogar después de alta de la Unidad de Cuidados Intensivos. Método: este es un estudio bibliográfico descriptivo, revisión integradora, entre 2013 y 2017, en las Bases de datos: LILACS, MEDLINE via PubMed, CINAHL. El análisis de contenido se utilizó para clasificar los datos. Resultados: se seleccionaron diez estudios de los cuales se originaron tres categorías temáticas: Supervivencia y mortalidad; Funcionalidad; Dificultades, instalaciones y necesidades del longevo que vuelve al hogar después del alta de la Unidad de Cuidados Intensivos. Conclusión: se concluyó que los ancianos que experimentan hospitalización en unidades críticas necesitan atención específica y continuada después del regreso a casa, de cuidadores formales e informales, del apoyo de redes de atención médica y atención de transición durante el proceso de hospitalización.(AU)

One or two ligatures inducing periodontitis are sufficient to cause fatty liver

BACKGROUND: Periodontitis is a chronic disease that due to an intense inflammatory response triggers systemic changes such as hepatic alterations. This study aimed to compare hepatic damage in rats that received experimental periodontitis at one or two periodontal sites with ligatures. MATERIAL AND METHODS: Eighteen rats were separated into three groups: control, without ligature; periodontitis 1, with one ligature; and periodontitis 2, with two ligatures. The following parameters were assessed: gingival bleeding index, probing pocket depth, tooth mobility, alveolar bone loss, malondialdehyde (MDA) and myeloperoxidase (MPO) activity in periodontal tissue; histopathological evaluation of hepatic tissue (steatosis score); glutathione levels (GSH), MDA, MPO, cholesterol and triglycerides in the liver; and serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). RESULTS: Periodontal evaluation data showed that the periodontitis model worked well. The groups with periodontitis did not differ significantly in relation to MPO activity and MDA levels in the gingival samples, but they were significantly different when compared with the control group. Steatosis was observed in the histological analysis of the groups with periodontitis, but between the periodontitis groups, two ligatures did not cause increase in steatosis score. The levels of GSH, MDA, total cholesterol and triglycerides in the hepatic tissue were not altered between groups with periodontitis, but they showed significant differences in comparison with the control group. The activity of MPO in hepatic tissue and serum levels of AST and ALT did not present significant difference among the three groups. CONCLUSIONS: In conclusion, our results demonstrated that one or two ligatures inducing periodontitis were both sufficient to cause fatty liver. Steatosis caused by two ligatures did not present larger extension and severity than steatosis caused by one ligature

Polymorphisms in interleukins 17A and 17F genes and periodontitis: results from a meta-analysis.

Polymorphisms in inflammatory genes such as interleukins 17A and 17F are associated with the risk of development of periodontitis, although the results remain contradictory. Hence, the aim of this study was perform a meta-analysis focusing on two polymorphisms (rs2275913 and rs763780) in interleukins 17A and 17F genes, respectively, in both chronic (CP) and aggressive periodontitis (AgP). A review in literature was performed in several databases for studies published before 25, September 2016. The meta-analysis was obtained through the review manager statistical software (version 5.2) with odds ratio (OR) calculation and funnel plot (P < 0.05) for heterogeneity, as well as the comprehensive meta-analysis software (version 3.3.070) for the assessment of publication bias. Seven articles with 1540 participants composed the results in which the mutant allele in the rs2275913 polymorphism did not present significant association with the risk of CP or AgP (OR 1.56, 95% CI 0.77, 3.15, P = 0.21; OR 1.12, 95% CI 0.05, 23.44, P = 0.94, respectively) nor was the mutant allele in rs763780 associated with the risk of CP (OR 1.19, 95% CI 0.80, 1.76, P = 0.39) or AgP (OR 1.07, 95% CI 0.63, 1.84, P = 0.79). No bias of publication was observed by Egger's and Begg's tests in any allelic evaluation. This meta-analysis showed a non-significant association between the polymorphisms rs2275913 and rs763780 in interleukins 17A and 17F genes and chronic and aggressive periodontitis in the allelic evaluation.

Genetic Factors and the Risk of Periodontitis Development: Findings from a Systematic Review Composed of 13 Studies of Meta-Analysis with 71,531 Participants.

Purpose. This work aimed to synthesize the results of recent meta-analysis focusing on polymorphism in inflammatory mediators and its relation with the risk of periodontitis development. Materials and Methods. A systematic search was conducted using databases for publications prior to October 2016. Three examiners extracted data from articles with a clear association between polymorphisms in the inflammatory mediator gene and the development of periodontitis through meta-analysis using the fixed or randomized statistical models to calculate the Odds Ratio with values of P < 0.05 considered significant. Results. A total of 13 meta-analysis articles with 25 polymorphisms in seven interleukins (IL-1A, IL-1B, IL-4, IL-6, IL-8, IL-10, and IL-18), three cellular receptors (Fcγ receptors: FCGR2A, FCGR3A, and FCGR3B), and five inflammatory mediators (COX-2, MMP-2, MMP-3, MMP-8, and MMP-9), with a total of 71,531 participants, approaching different classifications of the disease. Conclusion. The study demonstrated that polymorphisms in the IL-1A, IL-1B, IL-6, IL-10, MMP-3 (chronic form), and MMP-9 (chronic form) polymorphisms were significantly associated with the risk of developing periodontitis, whereas other polymorphisms in the IL-4, IL-8, IL-18, Fcγ, COX-2, MMP-2, MMP-3 (aggressive), MMP-8, and MMP-9 (aggressive) polymorphisms had no significant association with risk of developing periodontitis.

Avaliação clínica e microbiológica relacionada à doença periodontal em pacientes com lúpus eritematoso sistêmico / Clinical and microbiological analysis of parameters related to periodontal disease in systemic lupus erythematous patients

O lúpus eritematoso sistêmico (LES) é uma doença autoimune caracterizada por hiperatividade imunológica crônica pela ação de autoanticorpos que afetam diversos órgãos. Embora o uso crônico de imunossupressores predisponha o paciente a infecções, poucas pesquisas avaliaram uma possível associação entre doença periodontal e LES. Os objetivos deste trabalho foram investigar, por meio de estudo caso-controle, a prevalência e a gravidade da doença periodontal em pacientes com LES, e identificar e quantificar as principais bactérias periodontais presentes no biofilme subgengival. Foram incluídas 60 mulheres em atendimento no Setor de Reumatologia do Hospital Universitário de Brasília, de 20 a 65 anos de idade, sendo subdivididas em LES-A (ativo; n= 31) e LES-I (inativo; n=29). O grupo controle foi composto por 31 mulheres com os mesmos critérios de inclusão, porém sem doenças sistêmicas. As pacientes foram avaliadas quanto às medidas de profundidade de sondagem (P.S), perda de inserção clínica (PIC), índice de sangramento do sulco (ISS) e índice de placa (IPl) no exame inicial. Foram coletados biofilmes subgengivais dos quatro sítios mais profundos para identificação e quantificação de periodontopatógenos por meio de hibridação DNA-DNA checkerboard. Não houve diferenças estatisticamente entre os grupos relativamente aos parâmetros clínicos periodontais, exceto para o ISS, que foi menor no LESA (11,19% ± 14,62%) comparativamente ao grupo controle (17,30% ± 14,88%), porém sem diferenças quando comparado com o grupo LES-I (11,34% ± 11,59%). Houve baixa prevalência de bolsas periodontais, de PIC ≥ 4 mm e de espécies de Actinomyces em todos os grupos. Verificou-se aumento na contagem de bactérias do complexo vermelho no grupo LES-I (4,07 x 105; 95% CI: 0,16-0,79) em relação ao grupo controle (2,50 x 105; 95% CI: 1,23-3,77), com diferenças estatisticamente significante apenas referente ao grupo LES-A (p< 0,05; Kruskal Wallis pós-teste Dunn; 0,45 x 105; 95% CI: 0,16-0,79). Os resultados desse estudo demonstraram que os parâmetros periodontais são semelhantes entre pacientes com LES e grupo controle. O grupo de LES-I apresentou maior tempo dessa doença; aumento da contagem de microorganismos (especialmente dos complexos vermelho e verde em amostras de biofilme subgengival) e pior condição periodontal.(AU)

Systemic lupus erythematous (SLE) is an autoimmune disorder characterized by chronic immunological hyperactivity resultant from the action of autoantibodies, affecting many organs. Although the use of immune suppressors may predispose infections, few studies have investigated the prevalence and severity of periodontal disease in SLE patients. The aim of this study is to investigate the prevalence and severity of periodontal disease in SLE patients and the sub gingival levels of different pathogens. A total of 60 women attending of Brasília University Hospital, aged 18-65 years, were invited to participate in the study. SLE patients were allocated in two subgroups according with disease activity: SLE-A (active disease; n= 31) and SLE-I (inactive disease; n= 29). A number of 31 systemically healthy women at the same age range composed control group. Patients were clinically examined according to probing depth (PD), clinical attachment level (CAL), sulcular bleeding index (SBI) and plaque index (PLI) at baseline examination. Sub gingival biofilm samples were collected from the deepest four sites before periodontal treatment in order to identify and quantify the level of periodontopathogens by checkerboard DNA-DNA hybridization. No significant differences were found between groups in PD, CAL and PLI. Significant differences were observed in GBI between SLE-A (11,19% ± 14,62%) compared to controls (17,30% ± 14.88%), although with no differences when compared to SLE-I (11,34% ± 11,59%). There was a low prevalence of PD and attachment loss ≥ 4 mm at all groups. A low prevalence of Actinomyces was observed at all groups, with an increase in red complex species at LES-I (4,07 x 105; 95% CI: 0,16-0,79) compared to control (2,50 x 105; 95% CI: 1,23-3,77), although with significant differences (p< 0,05; Kruskal Wallis post hoc Dunn) only when compared to SLE-A (0,45 x 105; 95% CI: 0,16-0,79). These findings show no differences in the periodontal conditions of SLE compared to systemically healthy patients, except for a decrease in gingival bleeding index, especially at SLE-A. Reductions in microorganisms' count were observed at SLE-A, while an increase in bacterial count, especially at red and green complex, were observed at subgingival biofilm of SLE-I patients.(AU)