Peristomal dermatitis: treatment with green banana peel (Musa sapientum) powder / Dermatite periestomal: tratamento com pó de casca de banana verde (Musa sapientum)

Objective: To develop green banana peel (Musa sapientum) powder for the treatment of peristomal dermatitis, and to evaluate its effectiveness and healing time. Methods: A clinical, analytical and longitudinal study. In total, 44 volunteers of both genders, aged>18 years, with intestinal ostomy, who presented peristomal dermatitis, participated in the research. The sample was divided into two groups: the study group used a powder containing 10% of green banana peel, and the control group used ostomy powder. The research was approved by the Ethics in Research Committees (Comitês de Ética em Pesquisa, CEP, in Portuguese) under opinion n° 2.381.904. Results: The healing time of the study group was shorter than that of the control group (p=0.022). To analyze the results, we used the two-sample t-test (mean days until healing for both study groups). Conclusion: The powder containing 10% of green banana peel was developed, and effective healing of the peristomal dermatitis was observed. Compared to the ostomy powder, it presented a shorter healing time. (AU)

Objetivo: Desenvolver o pó composto da casca da banana verde (Musa sapientum) para o tratamento de dermatite periestomal, e avaliar a eficácia e o tempo de cicatrização. Métodos: Estudo clínico, analítico e longitudinal. Participaram da pesquisa 44 voluntários, de ambos os gêneros, maiores de 18 anos, com estomias intestinais, e que apresentavam dermatite periestomal. A amostra foi dividida em dois grupos: o grupo de estudo usou umpó que continha 10% de casca de banana verde, e o grupo de controle usou pó para estomia. A pesquisa foi aprovada pelos Comitês de Ética em Pesquisa (CEP), sob o parecer n° 2.381.904. Resultados: O tempo de cicatrização do grupo de estudo foimenor do que o do grupo de controle (p=0.022). Para a análise dos resultados, empregou-se o teste t para duas amostras (média de dias de cicatrização de ambos os grupos). Conclusão: Desenvolveu-se o pó contendo 10% de casca de banana verde, e observouse cicatrização eficaz da dermatite periestomal. Em comparação com o pó para estomia, apresentou tempo menor até a cicatrização. (AU)

Vacinação no Brasil: reflexão bioética sobre acessibilidade / Vaccination in Brazil: bioethical reflection on accessibility / Vacunación en Brasil: una reflexión bioética sobre la accesibilidad

Resumo As vacinas têm grande influência na saúde pública por sua efetividade e relação custo-benefício favorável. Entretanto, com o surgimento de novos imunizantes indisponíveis na rede pública, torna-se necessário discutir o acesso da sociedade em geral. O objetivo deste trabalho foi identificar o significado da vacinação para profissionais e população, assim como abordar a questão do acesso à imunização fora da rede pública de saúde, enfatizando a vulnerabilidade social. Foram entrevistados médicos e cidadãos leigos, e os dados foram analisados a partir de metodologia qualitativa exploratória e do discurso do sujeito coletivo. O sistema vacinal brasileiro foi entendido pelos entrevistados como bom de maneira geral, sendo as principais críticas voltadas à falta de informações e insumos. Quanto ao acesso, os dados sugerem correlação com fatores econômicos, abrindo espaço para discussões bioéticas sobre a vulnerabilidade social da maior parte da população, que não tem condições de pagar por essas imunizações.

Abstract Vaccines have a strong influence on public health because of their effectiveness and favorable cost-benefit ratio. However, with new vaccines unavailable in the public system, the access by society in general must be discussed. This study aimed to identify the meaning of vaccination for the population and physicians, and address the issue of access to vaccines outside the public health system, emphasizing social vulnerability. Physicians and members of society were interviewed, and the data was analyzed using an exploratory qualitative methodology and the collective subject speech. The Brazilian immunization system was seen by respondents as good in general, with the main criticisms directed at information and the lack of vaccines. As for accessibility, data suggests a correlation with economic factors, generating bioethical discussions about the social vulnerability of most of society that cannot afford vaccination.

Resumen Las vacunas ejercen una gran influencia sobre la salud pública debido a su efectividad y a una relación costo-beneficio favorable. Sin embargo, con el surgimiento de nuevas vacunas indisponibles en la red pública, se hace necesario discutir el acceso de la sociedad a este servicio. El objetivo de este trabajo fue identificar el significado de la vacunación para la población y los médicos, y abordar la cuestión del acceso a la inmunización fuera de la red pública de salud, haciendo hincapié en la vulnerabilidad social. Con base en una metodología cualitativa exploratoria y en el discurso del sujeto colectivo, se entrevistó a médicos y a ciudadanos legos. El sistema brasileño de vacunas fue considerado por los entrevistados como bueno de manera general. Las principales críticas se refieren a la información y a la falta de insumos. Respecto al acceso, los datos sugieren que existe una correlación con factores económicos, lo que crea un espacio para discusiones bioéticas sobre la vulnerabilidad social de la mayor parte de la sociedad, que no tiene condiciones de pagar por estas inmunizaciones.

Reflections on the Terminality of Life with Undergraduate Medical Students / Reflexões sobre a Terminalidade da Vida com Acadêmicos de Medicina

Abstract: Introduction: Death and dying are daily relevant themes for health care professionals and medical students. Nonetheless, since their first years of graduation, students are contrived to supplant the holistic conception of human beings and life in favor of enhancing the technical aspects of the medical profession. Methods: Therefore, in face of the few opportunities to enquire about these future professionals' feelings and comprehensions toward life terminality, we pursued their perceptions through the application of a semi-structured questionnaire. Ten students from each year of the medical course at UNIVAS were interviewed, encompassing 60 scholars. Students should be regularly enrolled in the medical course, as well as give their consent, by signing the Consent Term, to participate in the study. The interviews took place at the institution and the material containing students' responses was fully destroyed afterwards. Their responses were analyzed based on the Discourse of the Collective Subject Method. Results: The idea of terminality being properly the "end of life" was paramount among the years, situation with which a great amount of the scholars (58%) admitted not being prepared to deal with, due to the lack of reflections about death, its psychological aspects and repercussions in the academic context. Interestingly, about 16% of the scholars considered themselves prepared to deal with someone's death, although they were not prepared to intervene in the actual process. This is reinforced by the fact that students must deal with the real scenario of giving undesirable news without previously being prepared to do so, by means of reflecting upon a hypothetical related to the "life-death binomial". Conclusion: Thus, it seems necessary to create spaces in the curriculum that yield not only theoretical-practical but also affective support in situations related to terminality. The proposal of a theoretical-practical education based on palliative care amid the learning programs would shape confident attitudes of future health care professionals towards care.

Resumo Introdução: A morte e o morrer são temas pertinentes ao cotidiano de profissionais de saúde e ao processo de aprendizagem de acadêmicos de Medicina; entretanto, desde os primeiros anos da graduação, o estudante é obrigado a suplantar a concepção holística do ser humano e da vida em prol da supervalorização dos fundamentos técnico-científicos da profissão. Métodos: Nesse sentido, diante das poucas oportunidades de questionar os sentimentos e a compreensão desses futuros profissionais com relação à terminalidade da vida, buscou-se conhecer suas percepções por meio da aplicação de um questionário semiestruturado. Foram entrevistados dez acadêmicos de cada ano do curso de Medicina da Univás, totalizando 60 alunos. Para inclusão no estudo, os estudantes deveriam estar regularmente matriculados no curso, aceitando, por livre-arbítrio, participar da pesquisa por meio da assinatura do Termo de Consentimento Livre e Esclarecido (TCLE). As entrevistas foram gravadas nas dependências da instituição e o material contendo a fala dos participantes foi posteriormente descartado. Para análise das respostas, utilizou-se o método do Discurso do Sujeito Coletivo. Resultados: Foi suscitada, de maneira preponderante em todos os anos, a concepção de terminalidade como sendo propriamente o "fim da vida", situação com a qual parcela considerável dos entrevistados (58%) dizia não se sentir preparada para lidar por conta da escassez de reflexões sobre a morte, seus aspectos psicológicos e suas repercussões no contexto médico-acadêmico. Curiosamente, cerca de 16% dos acadêmicos consideravam-se preparados para vivenciar a morte de alguém, mas não para serem intervencionistas no processo; isso é sustentado pelo fato de que os estudantes têm de lidar com o cenário real de transmissão de más notícias, sem antes passar por situações hipotéticas e reflexivas envolvendo o "binômio vida e morte". Conclusão: Sendo assim, parece necessária a criação de espaços na grade curricular que forneçam apoio não apenas teórico-prático, mas também afetivo das questões envolvendo a terminalidade. A proposta de educação teórico-prática relativa aos cuidados paliativos inserida na grade curricular lapidaria a confiança e atitude dos futuros profissionais perante o cuidado.

Repair of surgical wounds in rats using a 10% unripe Musa sapientum peel gel

PURPOSE:To investigate the efficacy of a 10% gel of unripe banana (Musa sapientum) peel in treating surgical wounds in rats.METHODS:A longitudinal, prospective, randomized triple-blind study was conducted with 60 Wistar rats (Rattus norvegicus albinus) weighing approximately 400g. The animals were randomly divided into: control group (treated with gel containing no active ingredient) and study group (treated with 10% gel of unripe banana peel). The gel was applied every three days to a 4x4-cm surgical wound created on the back of each animal (day 0) in both groups. Tissue samples were collected for histological analysis on days 14, 21 and 28.RESULTS:On day 14, more extensive vascular proliferation (p=0.023), presence of mononuclear cells (p=0.000), fibroblast proliferation (p=0.012), re-epithelialization (p=0.000), and decreased presence of polymorphonuclear cells (p=0.010) were observed in the study group than in controls. No significant between-group difference in the presence of polymorphonuclear cells was found on day 21. Fibroblast proliferation was significantly greater (p=0.006) in the study group than in the control group on day 28.CONCLUSION:The 10% gel of unripe banana peel showed anti-inflammatory activity and stimulated wound healing in rat skin when compared with a gel containing no active ingredient.

Evaluating the effectiveness of the customized Unna boot when treating patients with venous ulcers.

BACKGROUND: Lower limb ulcers are a serious medical and socioeconomic problem throughout the world. One type of chronic wound of the lower extremities is the venous ulcer. Therapeutic methods for treating venous ulcer include the use of the Unna boot. OBJECTIVES: To evaluate the effectiveness of the customized Unna boot in the treatment of venous ulcers and to monitor the subsequent development and healing of the lesions. METHODS: Prospective exploratory and quantitative longitudinal study, conducted at the "Outpatients Department (Wound Care) of the Grupo da Fraternidade Espírita Irmão Alexandre" in the city of Pouso Alegre (MG), Brazil, in 2008. The sample consisted of 32 patients with venous ulcers who underwent treatment with the Unna boot and 11 patients (control group), who used a simple bandage application. The patients'lesions were monitored over a three month period. RESULTS: The average age of the predominently female (65.1%) patients was 61.88. From observing the differences in healing times at the three evaluation stages, it was clear that after the initial evaluation the wound area decreased in Groups 1 and 2 (p>0.05). CONCLUSION: The use of the customized Unna boot contributes to quicker healing. However, over a period of three months the simple bandage applications were seen to be just as effective as the Unna boot method.

Evaluating the effectiveness of the customized Unna boot when treating patients with venous ulcers* / A avaliação da eficácia da bota de Unna artesanal no tratamento de pacientes portadores de úlceras venosas

Lower limb ulcers are a serious medical and socioeconomic problem throughout the world. One type of chronic wound of the lower extremities is the venous ulcer. Therapeutic methods for treating venous ulcer include the use of the Unna boot. To evaluate the effectiveness of the customized Unna boot in the treatment of venous ulcers and to monitor the subsequent development and healing of the lesions. Prospective exploratory and quantitative longitudinal study, conducted at the "Outpatients Department (Wound Care) of the Grupo da Fraternidade Espírita Irmão Alexandre" in the city of Pouso Alegre (MG), Brazil, in 2008. The sample consisted of 32 patients with venous ulcers who underwent treatment with the Unna boot and 11 patients (control group), who used a simple bandage application. The patients'lesions were monitored over a three month period. The average age of the predominently female (65.1%) patients was 61.88. From observing the differences in healing times at the three evaluation stages, it was clear that after the initial evaluation the wound area decreased in Groups 1 and 2 (p>0.05). The use of the customized Unna boot contributes to quicker healing. However, over a period of three months the simple bandage applications were seen to be just as effective as the Unna boot method. .

As úlceras de membros inferiores constituem um sério problema médico e socioeconómico mundial. Um tipo de ferida crónica dos membros inferiores é a úlcera venosa. Dentre os métodos terapêuticos encontra-se o curativo bota de Unna artesanal. Avaliar a eficácia do uso da bota de Unna artesanal no tratamento de úlceras venosas e acompanhar o desenvolvimento da cicatrização das feridas. Estudo do tipo longitudinal e prospectivo, de caráter exploratório e quantitativo, realizado no ambulatório de feridas do Grupo da Fraternidade Espírita Irmão Alexandre na cidade de Pouso Alegre - MG, no ano de 2008. A amostra foi composta de 32 pacientes portadores de úlceras venosas que realizavam o tratamento com bota de Unna e de 11, grupo controle, que utilizaram curativo simples. As lesões dos pacientes foram acompanhadas por um período de três meses. A idade média das pessoas foi de 61,88 anos, predominando o sexo feminino (65,1%). Observando-se as diferenças nos tempos de cicatrização das feridas, em relação aos três momentos de avaliação, evidenciou-se que após a avaliação inicial houve diminuição da área da ferida, semelhante tanto para o grupo 1 como para o grupo 2 (p>0,05). A utilização da Bota de Unna artesanal contribui para aceleração no processo cicatricial, porém quando comparada com o curativo simples apresentou semelhante eficiência que este, quando analisada por um período de três meses. .

Unripe Musa sapientum peel in the healing of surgical wounds in rats.

PURPOSE: To assess the effects of unripe Musa sapientum peel on the healing of surgical wounds in rats. METHODS: One hundred and twenty Wistar rats were divided into two treatment groups of 60 animals each: the control group (gel without the active ingredient) and experimental group (4% Musa sapientum peel gel). A 4 x 4 cm surgical wound was created on the back of each animal. The wound was cleaned daily with 0.9% saline, treated with 4% gel or natrosol gel (control), and covered with gauze. Animals from both groups were sacrificed after seven, 14 and 21 days of treatment; the tissue from the wound site was removed together with a margin of normal skin for histological analysis. RESULTS: No significant differences in wound contraction rates (p=0.982) were found between time points (seven, 14 and 21 days of treatment) in both groups. However, a significantly higher wound contraction rate was observed in the control group on day 21 compared with the experimental group (p=0.029). There were no significant differences in histomorphological features between groups. The experimental group showed an increased number of polymorphonuclear cells on day 7, with a significant reduction on day 21 (p=0.026). CONCLUSION: The use of 4% unripe Musa sapientum peel gel on surgical wounds in rats resulted in an increased number of polymorphonuclear cells on day 7, reduced wound contraction, reduced vascular proliferation and increased concentration of collagen fibers on day 21.

Unripe Musa sapientum peel in the healing of surgical wounds in rats

PURPOSE: To assess the effects of unripe Musa sapientum peel on the healing of surgical wounds in rats. METHODS: One hundred and twenty Wistar rats were divided into two treatment groups of 60 animals each: the control group (gel without the active ingredient) and experimental group (4% Musa sapientum peel gel). A 4 x 4 cm surgical wound was created on the back of each animal. The wound was cleaned daily with 0.9% saline, treated with 4% gel or natrosol gel (control), and covered with gauze. Animals from both groups were sacrificed after seven, 14 and 21 days of treatment; the tissue from the wound site was removed together with a margin of normal skin for histological analysis. RESULTS: No significant differences in wound contraction rates (p=0.982) were found between time points (seven, 14 and 21 days of treatment) in both groups. However, a significantly higher wound contraction rate was observed in the control group on day 21 compared with the experimental group (p=0.029). There were no significant differences in histomorphological features between groups. The experimental group showed an increased number of polymorphonuclear cells on day 7, with a significant reduction on day 21 (p=0.026). CONCLUSION: The use of 4% unripe Musa sapientum peel gel on surgical wounds in rats resulted in an increased number of polymorphonuclear cells on day 7, reduced wound contraction, reduced vascular proliferation and increased concentration of collagen fibers on day 21.

Gel from unripe Musa sapientum peel to repair surgical wounds in rats / Gel da casca de Musa sapientum verde no reparo de lesões operatórias em ratos

PURPOSE: To determine the optimum concentration of a gel obtained from unripe banana (Musa sapientum) peel for wound treatment in rats. METHODS: A randomized triple blind study was conducted with 40 Wistar rats, which were divided into 4 groups: CG, control group; G2 percent, 2 percent gel concentration group; G4 percent, 4 percent gel concentration group; and G10 percent, 10 percent gel concentration group. The banana peel gel was applied daily, for 7 days, to a 4-cm² wound created on the back of each animal of all groups. After this period, the wounds were biopsied. Statistical analysis was carried out using the Kruskal-Wallis test complemented by the Student-Newman-Keuls test. RESULTS: Macroscopic examination revealed that partial epithelialization occurred in all groups. Wound contraction was also observed in all groups and ranged from 1.38 to 1.57 mm in the study groups, and from 1.03 to 1.10 mm in the control group, with significant differences (p < 0.05) between the groups: CG and G10 percent, G2 percent and G4 percent, G2 percent and G10 percent. The interquartile deviation was smaller between the groups CG and G4 percent. CONCLUSION: The 4 percent gel obtained from unripe banana peel (G4 percent) resulted in better epithelialization of wounds healed by secondary intention compared with other gel concentrations.

OBJETIVO: Avaliar a concentração ideal do gel da casca de Musa sapientum verde no tratamento de feridas em ratos. MÉTODOS: Estudo randomizado, triplo cego, com 40 ratos da linhagem Wistar divididos em quatro grupos: GC controle, G2 por cento gel a 2 por cento, G4 por cento gel a 4 por cento, G10 por cento gel a 10 por cento. Realizou-se aplicação diária do gel nas diferentes concentrações, durante sete dias, em uma ferida de 4 cm² realizada no dorso de cada rato. Após este período, as lesões foram biopsiadas. Para analise dos dados utilizou-se o teste de Kruskal-Wallis complementado pelo teste de Student-Newman-Keuls. RESULTADOS: Os achados macroscópicos demonstraram reepitelização parcial em todos os grupos. A contração da área da ferida variou entre 1,38 a 1,57 mm nos grupos de estudo, e entre 1,03 a 1,10 mm no grupo controle. Houve diferença significante (p < 0,05) entre os grupos: GC e G10 por cento, G2 por cento e G4 por cento, G2 por cento e G10 por cento, sendo o desvio interquartílico menor entre os grupos GC e G4 por cento. CONCLUSÃO: O gel a 4 por cento da casca de M. sapientum verde promoveu maior área de epitelização em feridas com cicatrização por segunda intenção, em relação ao gel nas outras concentrações testadas.

Gel from unripe Musa sapientum peel to repair surgical wounds in rats.

PURPOSE: To determine the optimum concentration of a gel obtained from unripe banana (Musa sapientum) peel for wound treatment in rats. METHODS: A randomized triple blind study was conducted with 40 Wistar rats, which were divided into 4 groups: CG, control group; G2%, 2% gel concentration group; G4%, 4% gel concentration group; and G10%, 10 % gel concentration group. The banana peel gel was applied daily, for 7 days, to a 4-cm(2) wound created on the back of each animal of all groups. After this period, the wounds were biopsied. Statistical analysis was carried out using the Kruskal-Wallis test complemented by the Student-Newman-Keuls test. RESULTS: Macroscopic examination revealed that partial epithelialization occurred in all groups. Wound contraction was also observed in all groups and ranged from 1.38 to 1.57 mm in the study groups, and from 1.03 to 1.10 mm in the control group, with significant differences (p < 0.05) between the groups: CG and G10%, G2% and G4%, G2% and G10%. The interquartile deviation was smaller between the groups CG and G4%. CONCLUSION: The 4% gel obtained from unripe banana peel (G4%) resulted in better epithelialization of wounds healed by secondary intention compared with other gel concentrations.