Oral hygiene in intensive care unit patients with photodynamic therapy: study protocol for randomised controlled trial.

BACKGROUND: In intensive care units (ICUs), nosocomial infections are prevalent conditions and they have been related to high mortality indexes. Some studies have suggested that inefficient oral hygiene and ventilator-associated pneumonia (VAP) are related. Nowadays, in the Brazilian public health system there is no well-defined protocol for oral hygiene in an ICU. Due to the drawbacks of the use of antibiotics, photodynamic therapy (PDT) has emerged as an interesting technique in order to reduce antimicrobial-resistant pathogens. Methylene blue (MB) is the most common chemical agent for PDT in Brazil. However, new formulations for improved effectiveness are still lacking. The objective of this study is to evaluate the use of an MB mouthwash as an effective oral-hygiene procedure in an ICU and to show that oral hygiene using PDT with MB mouthwash may reduce VAP frequency to rates similar to, or higher than, chlorhexidine. METHODS: Phase 1 will evaluate the most effective cleaning procedure, while phase 2 will correlate oral hygiene to VAP incidence. At the start of phase 1, the ICU patients will be randomly allocated into three different groups (10 patients/group): the efficacy of chlorhexidine, classical MB-PDT, and mouthwash MB-PDT will all be measured for the quantification of viable bacteria, both pre- and post-treatment, by a Reverse Transcription Polymerase Chain Reaction (RT-PCR). In phase 2, the most effective procedure found in phase 1 and a mechanical cleaning with filtered water will be carried out daily, once a day, over 5 days, with a total of 52 ICU patients randomly allocated into the two groups. The clinical records will be evaluated in order to find any pneumonic diagnoses. DISCUSSION: Since a variety of bacterial species are related to VAP, a universal primer for bacteria will be used in order to quantify the total bacteria count in the participants' samples. In order to quantify only the living bacteria before DNA extraction, the samples will be treated with propidium monoazide. This will infiltrate the dead bacteria and will intercalate the DNA bases, avoiding their DNA amplification. This will be the first trial to evaluate MB-PDT in a mouthwash formula that can increase the effectiveness due to the control of MB aggregation. The results of this study will be able to generate an easy and low-cost protocol to be used in an ICU for the Brazilian public health system. TRIAL REGISTRATION: This protocol was approved by the Research Ethics Committee of the Conjunto Hospitalar do Mandaqui (1.317.834, CAAE: 49273515.9.3001.5551) and it was registered in Registro Brasileiro de Ensaios Clínicos (ReBEC number: RBR-94bvrc;). First received: 12 July 2015; 1st version 6 June 2016. Data will be published in a peer-reviewed journal.

Higienização bucal com digluconato de clorexidina e extrato etanólico de própolis em pacientes de Unidade de Terapia Intensiva (UTI) de um hospital público na cidade de São Paulo - Brasil / Oral higiene with chlordexdine digluconate and ethanol extract of propolis in patients in the Intensive Care Unit (ICU) of public hospital in São Paulo - Brazil

Focos de infecção na boca têm sido relacionados com o comprometimento da saúde do corpo do indivíduo, despertando o interesse de médicos e dentistas. A infecção é uma complicação frequente e de elevada mortalidade nos pacientes internados em Unidade de Terapia Intensiva. Estes pacientes na maioria das vezes, não possuem higienização bucal adequada, possivelmente pelo desconhecimento de técnicas adequadas pelas equipes de terapia intensiva, e pela ausência do relacionamento odontologia e enfermagem. Pesquisas com produtos naturais visam o tratamento efetivo destas infecções. Na odontologia, tem-se estudado a atividade farmacológica do extrato de própolis em algumas situações, como: gengivites, periodontites, aftas, mumificação pulpar. Também, tem sido usado em curativos pré e pós-cirúrgicos e em tratamentos da candidíase, herpes labial e higiene bucal, devido à capacidade antisséptica e cicatrizante em indivíduos internados em hospitais. O objetivo deste trabalho foi estudar a higienização bucal com água filtrada, digluconato de clorexidina a 0,12% e extrato etanólico de própolis a 6% em pacientes internados na UTI e a atividade do digluconato de clorexidina a 0,12% e do extrato etanólico de própolis a 6% sobres leveduras e em doses subinibitórias sobre a produção de exoenzimas proteinase e fosfolipase e as características fenotípicas (franjas). Foram estudados 150 pacientes, divididos em 3 grupos de 50 pacientes para cada substância. Antes da higienização foi realizado um exame clínico da boca em seguida duas coletas para o isolamento de leveduras uma antes e outra após a higienização. As leveduras isoladas foram identificadas por meio do Kit API 20C AUX. Para avaliação in vitro da atividade antifúngica do digluconato de clorexidina a 0,12% e do extrato etanólico de própolis a 20% utilizou-se a técnica de microdiluição em meio RPMI 1640. O digluconato de clorexidina a 0,12% e o extrato etanólico de própolis a 6% inibiram...

Foci of infection in the mouth have been related to the impairment of the general health of the individual, arousing the interest of physicians and dentists. Infection is a frequent complication with high mortality rates in patients hospitalized in the Intensive Care Unit (ICU). These patients often do not have adequate oral hygiene, possibly due to lack of appropriate techniques for the intensive therapy teams, and the absence of relationship between dentists and nurses. Research on natural products targets the effective treatment of these infections. In dentistry it has been studied the pharmacological activity of propolis extract in some situations , such as gingivitis , periodontitis , oral ulcers, pulp mummification. Also, it has been used in pre-and post-surgical dressings and treatments of candidiasis, oral herpes and oral hygiene, due to the antiseptic and healing capacity in hospitalized individuals. The aim of this study was to evaluate oral hygiene with filtered water, chlorhexidine digluconate 0.12% and ethanol extract of propolis to 6% in ICU patients and the activity of chlorhexidine gluconate 0.12% and the ethanol extract 6% propolis envelopes yeast and subinibitory doses on the production of protease and phospholipase exoenzyme and phenotypic characteristics (fringes). 150 patients divided into 3 groups of 50 patients were studied for each substance. A clinical examination was performed before cleaning the mouth and then two samples for the isolation of yeasts was done one before and one after the cleaning. The yeasts were identified by the API 20C AUX kit. To evaluate the in vitro antifungal activity of chlorhexidine gluconate 0.12% and the ethanol extract of propolis 20% used the microdilution in RPMI 1640 The chlorhexidine gluconate 0.12% and the ethanol extract 6% propolis inhibited the yeast crecimento the third day after the...

Reflexão discente sobre a futura prática médica através da integração com a equipe de saúde da família na graduação / Students' views on future medical practice by means of undergraduate integration in a family healthcare team

Metodologias ativas de ensino-aprendizagem apontam a necessidade de colocar o aluno em contato com o paciente e suas necessidades desde o início do curso médico. A reflexão sobre a realidade por meio da problematização assume papel fundamental, juntamente com uma visão humanística do paciente, conhecendo, entendendo e respeitando a complexidade deste. Assim, este trabalho teve por objetivo investigar como a inserção longitudinal de estudantes de Medicina em cenários comunitários de Atenção Básica à saúde poderia influenciar sua formação. Mediante entrevistas, observou-se que o contato com a comunidade - particularmente em visitas domiciliárias, acompanhando agentes comunitários de saúde - resultou em profundas reflexões sobre a inserção social dos sujeitos como alunos e futuros profissionais.

Active methodology in medical education points to the necessity of placing medical students in touch with patients and their needs right from the beginning of their course. Reflecting on reality through problematization and a humanistic view of the patient play an important role in understanding and respecting patients in their complexity. This study's main objective was to investigate how the longitudinal insertion of medical students into the reality of community primary healthcare may influence their humanistic views of their patients. By analyzing answers given in interviews, we were able to observe that contact with the community - particularly via home visits with "Community Health Agents" - has led to the development of profound reflection on the social insertion of students and future doctors.