In Brazil, there is no published article that measures the expense of this condition for the health system. There are international studies that show that treating a pressure ulcer is significantly more expensive than preventing it. The purpose of this article is to describe the incidence of patients with hospitalization related to pressure ulcers, in the city of São Paulo, in the period of the 1st increase in cases of COVID - 19 (March 2020 to December 2020), as well as the related expense with these hospitalizations.
Catastrophic anti phospholipid syndrome or CAPS for short, is a rare, devastating form of antiphospholipid syndrome that is characterized by successive multiple thrombi and multiorgan failure. One of the complications of antiphospholipid syndrome is nonbacterial thrombotic endocarditis or marantic endocarditis. Due to the nonspecific presentation of multiorgan failure it is difficult to have an early diagnosis. We are presenting a case of catastrophic anti phospholipid syndrome with superimposed aspergillus infection
Objective: To evaluate new techniques and improvements in surgical instruments related to intestinal anastomosis procedures. Methods: A search was conducted on the free database of patents from the National Institute of Industrial Patent Office (INPI) and The United States Patent and Trademark Office (USPTO). Were analyzed all occurrences between 2012 and 2016 related to experimental surgery and intestinal anastomosis. The requests for patents were examined individually and the data collected was the nationality of the applicant, if was physical (PP) or legal (LP) person and if was innovation or invention. At the end, a comparative analysis between the two institutions was performed. Results: In INPI was found only 5 occurrences. All of them were deposited by legal entity and were inventions. In addition, only one was a national request. In USPTO database, 65 occurrences met the inclusion criteria. Of these, 48 were national applications and only 5 were filed by physical person. Conclusion: More requests were found in US database, predominating national trustee and greater solicitation to inventions than Brazilian database. The main applications for patents are invention of surgical instruments, the development of new biological glues and improvement of mechanical sutures. Keywords: patents, gastroenterology, surgical anastomosis.
Introduction: blood transfusion consists of the administration of blood components intravenously in clinical or surgical treatments. In the preoperative period, it is performed with the objective of improving tissue oxygenation, as well as promoting hemodynamic and hemostatic balance. Objective: to understand nursing care in the transfusion of blood components to surgical patients in the perioperative period. Method: this is a descriptive and exploratory study with a qualitative approach. Grounded Theory was used, with constant comparative analysis. A total of 18 nurses and 28 nursing technicians from a university hospital took part in the study. Data were collected between October 2019 and February 2020, through a sociodemographic questionnaire and semi-structured interviews. Results: the study resulted in the central category nursing care during transfusion, which gave rise to the categories: caring for before transfusion; caring for during transfusion; and caring for after transfusion, which were discussed according to the standardized nursing methodology. Conclusion: it was understood that nursing care is planned and implemented following an ordering of practices in a logical sequence due to the characteristics of the procedure in the perioperative period. Nurses demand indirect care; in contrast, nursing technicians engage in direct patient care.
Background: since its discovery as the etiological agent of the Acquired Immune Deficiency Syndrome (AIDS), the Human Immunodeficiency Virus (HIV) has infected 75.7 million people worldwide Due to the specific characteristics of the Brazilian population, it is considered that spirituality, or spiritual well-being, is an important factor in the way individuals face the HIV/AIDS problematic and its consequences. To understand the spirituality of living with HIV in the light of Neuman's Systems Model. Method: qualitative, descriptive-exploratory research in the light of the Systems Model proposed by Betty Neuman. Data collection took place between the months of March and August 2016 in an outpatient clinic specialized in the treatment of patients with HIV/AIDS of a university hospital located in the city of Recife, Pernambuco, Brazil. Thirty people living with HIV participated in the study. The data were collected through a questionnaire and an interview with a semi-structured script and underwent categorical content analysis. Results: the understanding of spirituality in living with HIV is presented in three categories: the discovery of the diagnosis and the initial reactions: stressors that affect the lines of defense; the spiritual and religious search: protection when stressors penetrate the lines of defense; and the influence of faith combined with ART in living with HIV: dynamic relationship of the variable spirituality with the other variables. Conclusion: the applicability of the theory can provide important gains to the patient living with HIV/AIDS, generating a way to ensure the strengthening and establishment of lines of defense during their daily lives, and thus maintaining the balance of the patient's system, as well as the harmonic relationship between its variables and the environment.
Background: chest pain, of multicausal etiology, associated with a cardiac cause or not, is one of the most frequently presented symptoms by patients in Emergency Care Units. Despite its high prevalence in health services, there is still a deficiency in care standardization, which raises difficulties in acute coronary syndrome diagnosis and delay in treatment. The objective was to assess the efficiency of professional training of nursing teams in Emergency Care Units on the use of a flowchart to care for patients with chest pain. Methods and Findings: this educational intervention study was conducted with 25 nursing team professionals. It has been developed in four steps: Step 1 referred to prior application of the validated research instrument. Step 2 comprised training to use the flowchart with an expository lesson on care of patients with chest pain and guidance regarding the flowchart to be implemented. Step 3 reapplied the validated instrument after class. Step 4 reapplied the instrument after 2 months of training for flowchart implementation. When comparing the results of the instrument applied to nursing team professionals, post-training and follow-up performance surpassed that of pre-training. It was observed that professionals with less than five years of experience showed better performance. This study had as limitation the small sample of health professionals participating in the offered training. Conclusion: training was satisfactory and significant, and professionals demonstrated content assimilation, obtaining higher scores than at the beginning of the research.
Background: Prevalence of allergic bronchopulmonary aspergillosis (ABPA) in asthmatic adults is estimated in 2,5%, what matches to more than 4.8 million of patients around the world; from those, more than 1.4 million are only in Latin America. Most patients with the disease are immunocompetent and present themselves with a poorly controlled asthma, secretive cough and recurrent pneumonia. It’s curiously sensible to glucocorticoids, so early diagnosis and treatment may prevent bronchiectasis; otherwise, if it isn’t recognized soon, may lead to ending stage pulmonary fibrosis. First described by Hinson in 1952, even after almost seven decades, it’s still hardly recognized and treated. Methods and Findings: A case report was performed through clinical follow up of a patient evaluated in a Brazilian hospital diagnosed with ABPA after four years of poorly controlled asthma after even being in ICU and mechanic ventilation support. The patient presented eosinophilia high serum IgE, central bronchiectasis and positive prick test for Aspergillus fumigatus. There was also performed a integrative research of all the studies published in Brazil since the first case report in 1989. There were researched the platforms PubMed, BVS (that covers MedLine and LILACS bases), Scielo, Cochrane, JAMA, NEJM and LANCET using the descriptors “allergic bronchopulmonary aspergillosis” and “Brazil”. There was found 17 articles about ABPA, 10 meeting the inclusion criteria. Of those, only 4 covered clinical and epidemiological features of ABPA in asthmatic patients. Conclusions: There are very few studies on ABPA in Brazil in the last 30 years. More research in the country is needed to make this diagnostic possibility part of severe asthma differential and lead the patients to earlier diagnosis.
Objective: To identify the scientific evidence of the literature on social support for adolescents with HIV / AIDS. Methods: An integrative review was carried out in the LILACS, BDENF and MEDLINE / PubMed databases, conducted in January 2017. Results: 12 articles, published between 2005 and 2015, were selected and analyzed, which pointed to the importance of social support to adolescents living with HIV / AIDS. It’s important to highlight the particular importance of support from relatives and non-relatives, especially regarding to health services and non-governmental organizations. Conclusions: The support offered by both family members and institutions is considered a potentiating factor in physical, social and psychological health, in positive behaviors and in coping with the condition of living with HIV and AIDS.
Background: The evaluation of leprosy patients requires a careful dermatological and neurological examination in order to monitor the possible damage to the peripheral nerves. This study focused on evaluate the sensitivity at the time of diagnosis and discharge of leprosy patients from Dermatology Department of the State University of the State of Pará. Methods and Findings: this is a longitudinal, retrospective and descriptive study based on medical records that presented neurological assessment and degree of physical disability of 30 patients assisted at a referral service between 2016 and 2019, applying descriptive statistical analysis. Concerning neural involvement, 88.89% of the patients with neural damage were male, 100% of patients in this group were multibacillary (p-value: 0.02), 42.8% were borderliners (p-value: 0.04), 88.8% had some type of leprosy reaction (p-value: 0.02) and 44.4% of the patients had a diagnosis of leprosy with more than one year of disease evolution; most patients with neural involvement (N = 16) had more than one nerve affected, with the right tibial nerve being the most affected (24.14%); It was noted that a considerable portion of multibacillary patients did not improve or worsened (75%), and the borderline form was the one with the worst prognosis, showing 50% of patients did not respond to treatment. Conclusions: Most of the patients with neural damage were multibacillary, and borderliners, with many of those without presenting improvement, or showing worsening of clinical condition after multidrug therapy. Thus, it is highlighted the primary role of longitudinal assessment of those patients, in view of the possibility of chronification and sequel development.
Purposes: We conducted a cross-sectional descriptive study to evaluate the knowledge and practices of fall prevention among nurses in four departments in 7A Military Hospital, Ho Chi Minh City, Vietnam. Subjects and methods: Sixty-two nurses in four departments were chosen to fulfill pre-designed questionnaires, and their daily fall preventive practices were observed. Results: There were 40.3% of nurses achieve good knowledge of fall prevention. In practice, 22.5% of nurses had proper compliance, and 77.4% had not. 82.3% of nurses claimed to update fall prevention knowledge often, and 87.1% demanded training for fall prevention. Nurses in the surgical department group had more knowledge of fall prevention than nurses in the internal medicine group of departments (68.7% vs. 10.0%, p<0.05). Female nurses had higher fall risk compliances than males (78.3% vs. 37.5%, P<0.05). Conclusion: Training for nurses in fall preventive knowledge and practices are needed in 7A Military Hospital. Keywords: fall preventive; nurses; questionnaires; risk compliances.
Objective: The aim of the present study was to analyze the legislation relating to individuals with disabilities in Latin America, focusing on the definition of individuals with disabilities and how they are certified as such. Method: In this investigation, the legal provisions in force in Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Dominican Republic, Uruguay and Venezuela were retrieved via the internet. It was then sought to identify the following: the specificity of guarantees of human rights and fundamental freedoms for individuals with disabilities, in line with the United Nations Convention on the Rights of Persons with Disabilities; the definition of disability and individuals with disability; what criteria are applied, i.e. whether a specific table, the International Classification of Functioning (ICF) or the International Classification of Diseases (ICD) is used; and whether the disability is assessed in a biomedical or biopsychosocial manner, i.e. whether this is done solely by a doctor or is a multiprofessional assessment, and whether, if done by a doctor, there is any support through psychological or social worker evaluation when necessary. Results: With the exception of Cuba, for which no specific legislation was found, the legislation dealing with individuals with disabilities in the other Latin American countries investigated in this study has been constructed in line with the main provisions of the United Nations Convention on the Rights of Persons with Disabilities. In Bolivia, Chile, Colombia, Ecuador, El Salvador, Guatemala, Honduras, Panama, Dominican Republic, Uruguay and Venezuela, disabilities are assessed and certified through tables or the ICD or ICF. Biopsychosocial assessments are made by doctors in Bolivia, El Salvador, Guatemala, Honduras, Uruguay and Venezuela. In Brazil, Chile and Ecuador, social assessments are made by other professionals to support evaluations made by doctors. In Argentina, Colombia, Costa Rica, Haiti and Panama, the assessment is biomedical. In relation to the other countries, it was not possible to understand, from the legislation, how disabilities are assessed. Conclusion: This study demonstrated that the laws in the countries examined here all have the purpose of guaranteeing fundamental rights and freedoms for individual with disabilities through public policies. Their aim is to enable equality of opportunity in the fields of healthcare, rehabilitation, education, work, leisure, culture and justice, in accordance with the principles recommended in the United Nations Convention on the Rights of Persons with Disabilities. Out of all the countries investigated, social assessments by professionals of other specialties to support medical evaluations are only required in three of them; tables or the ICD or ICF are used in assessing and certifying disabilities in eleven of them; the biopsychosocial assessment is made by doctors in six of them; and the assessment is biomedical in another five countries. In the remainder, the assessment criteria were not made clear through the legislation examined.
Objective: To describe and analyze characteristics of cases of spinal cord Trauma (SCT) among traffic accident victims admitted to a referral hospital. Method: Descriptive, analytical, cross-sectional study with quantitative approach, developed in the city of Campina Grande, in the state of Paraíba, Brazil. The population consists of 1,884 medical records of patients admitted to hospital after damage caused by traffic accidents from January to December 2016. Data were analyzed using descriptive and inferential statistics, adopting a significance level of 5%. Results: Among the victims of traffic accidents, there was a male predominance (85.4%). The most affected age group was 21 to 30 years (29%). Accidents involving motorcyclists were predominant (82.9%) and 43 victims (2.3%) suffered spinal injury. Among these ones, there was a prevalence of males (86%), in the age group between 21 and 30 years (35.7%). In 30 cases (69.8%), the victims had spinal injuries. The cervical level (55.8%) was dominant. In addition, 46.7% of the victims were classified as ASIA and there were 9 cases (30%) of paraplegia and 1 case (3.3%) of tetraplegia. A bivariate analysis revealed a significant association between the variable presence of SCT and type of accident (p <0.001), use of cervical collar (p <0.005), injuries in other anatomical regions (p <0.001), surgical treatment (p < 0.001) and outcome of the patient’s situation (p <0.005). Conclusions: Among the victims of traffic accidents and SCT there was a predominance of males, young individuals and motorcyclists. Keywords: Epidemiology. Traffic-accidents. Public health. Spinal injuries. Spinal cord trauma.
Introduction: Tetanus has a worldwide distribution and high lethality. The goal of this study was to characterize the tetanus cases confirmed in Pernambuco and identify factors associated with death in these patients. Methods: Cross-sectional, with internal comparison groups. For data analysis we used the chi-square test and Pearson estimated the odds ratios and their respective confidence intervals at 95%. Multivariate analysis was applied to multiple logistic regression Results: The incidence of tetanus ranged between 0.65 and 2.79 cases per 100,000 inhabitants with higher involvement of adults, male and city population. Only 13.8% had received the vaccine and 23.4% received it as prophylaxis. The average mortality rate was 20.4%. In multivariate analysis, presented neck stiffness as a symptom (p = 0.029), which was associated with increased mortality. Conclusion: There is a need for greater investment in the prevention of the disease, both in immunization coverage and in the application of prophylaxis. Despite the hospitalization guarantee with proper care, there was an increase in tetanus mortality, suggesting that more specific studies should be conducted to investigate what may have influenced this change. Special attention should be offered to cases that presented neck stiffness as a symptom, because these groups have a higher chance of progressing to death.
Purposes: Evaluate the quality of life and the associated factors in people living with HIV. Methods: This is a cross-sectional study with a quantitative approach and random sample selection, carried out in two Specialized Assistance Services, with 356 people living with HIV. The comparison between the domain scores was performed using the student t test, ANOVA and Pearson’s correlation. Multiple linear regression was used to assess the contribution of variables to the outcome quality of life using the stepwise method. Results: The domains that showed the best results in averages were Psychological (17.0), Social Relations (14.9) and Level of Independence (14.0). The domain that had the greatest determination was the Psychological (R² = 0.49), followed by Social Relations (R² = 0.434), the lowest determination was the Spirituality domain (R² = 0.270). No domain had a score considered high. Conclusion: The quality of life presented unsatisfactory results, especially in the Physical, Environment and Spirituality domains. The need to formulate strategies aimed at coping with HIV and increasing the quality of life of people living with HIV is evident.
Background The aim of this study was to analyze the extent and uniqueness of anatomical variations of the sternum bone, to assess its applicability for forensic analysis, especially for individual human identification. Methods and Findings Evaluations involved 501 computer tomography scans performed at the Medical Radiology Center, Manaus city, Amazonas, Brazil, and 427 skeletons belonging to the Collection of Identified Human Skeletons of the Center for Studies in Forensic Anthropology (CEAF), of the University of Pernambuco (UPE), Pernambuco, Brazil. Forms of morphological variations were evaluated, including the presence of foramina, fissures, and incomplete total or partial fusions, as well as forms of xiphoid process termination, and the presence of surgical sutures. Overall, summing computed tomographic images and skeletons, the sternal foramen was present in some 23% of samples, with a greater proportion in males (14%), while in females the frequency was 8.6%. Conclusions The qualitative analysis of the sternum bone is simple to apply and represents an important potential source of information in a human identification process.
Objectives: To assess an in situ simulation-based cardiopulmonary resuscitation training strategy, with emphasis on debriefing and follow-up assessment of knowledge after training. Method: This was an educational intervention study to measure intraparticipant variability. The simulation-based teaching techniques consisted of nine steps.This research followed STROBE recommendations for the methodological development of observational studies. Results: Significant differences (p < 0.05) were observed between the pre-test and post-theory assessments, and between the pre-practical phase and 60 days post-training. However, no differences were observed (p<0.05) between the post-theory and post-practical phases, showing that after participating in the training strategy, after the pre-test assessment, the participants seemed to have carried over the knowledge displayed in the post-theory to the post-practical time, with considerable reduction in performance 60 days after the training program. Conclusion: Theoretical emphasis coupled with simulation practice displayed the best results in performance when compared to theoretical training alone, even at 60 days post-training.
Background: Tissue remodeling requires protein degradation through a process directly dependent on metalloproteinases — enzymes capable of degrading the majority of proteins in this system. This process is regulated by some enzyme inhibitors, and balance between enzyme and inhibitor activity is fundamental to tissue integrity and health. Bone resorption and formation, and the molecules involved in these processes, raise questions on possible differences in tissue behavior in the system. Histological studies of tissues surrounding teeth that have been subjected to such forces show the presence of tension (associated with bone formation) and compression, which induce bone resorption. The duration of load application is an important parameterin osteoclastogenesis. The present study aimed to analyze the biological aspects associated with in vitro compression of the PL and alveolar bone. To this end, we reviewed articles describing the biological events that occur in the PL and alveolar bone during load application on this system and the possible influence of culture medium on the expression of molecules involved in response to such an event. Methods: This literature review included articles published between March 2008 and January 2018 describing in vitro laboratory tests and data on load application and its associated biological events in the human PL and alveolar bone, including studies on molecular-expression events and pathways involved in the process. Conclusions: Intermittent compressive forces stimulate bone resorption in orthodontic treatment, while cyclical forces induce cellular apoptosis at lighter loads than do compressive forces. Both 2D and 3D cell-culture systems seem to reproduce the physiology of evaluated tissues and are reliable analytical models for research purposes.
Background: Medical facilities in Vietnam both use Methylprednisolone acetate and Hydrocortisone acetate in treatment with different administrations. This study aimed to evaluate of effects and side-effects of epidural injection of Methylprednisolone acetate and Hydrocortisone acetate in the treatment of herniated lumbar disc sciatica. Methods and findings: Cross-sectional descriptive study on 80 herniated lumbar disc sciatica patients treated at Department of Orthopedic, 7A Military Hospital, Hochiminh City, VietNam. The patients were divided into two groups in coupling fashion based on the VAS score of pain. Study results showed that both corticosteroid drugs (Methylprednisolone acetate and Hydrocortisone acetate) yielded good outcomes on all investigated parameters and there was no significant difference between the two medications (p < 0.05); administration of Methylprednisolone acetate reduced VAS score of 1.98 ± 1.33 points and Hydrocortisone acetate reduced of 2.13 ± 1.17 points. Lasegue test score in Methylprednisolone acetate administered patients raised from 74.630 ± 18.820 to 80.750 ± 15.870 and in Hydrocortisone acetate patients from 71.250 ± 10.110 to 81.630 ± 8.350). Treatment methods were safe, and there was no difference in complication rates between the two groups. The direct and indirect cost of Hydrocortisone acetate administration was three times higher than Methylprednisolone acetate. Conclusion: It was safe and effective to administrate both Methylprednisolone acetate and Hydrocortisone acetate in the treatment of herniated lumbar disc sciatica. Methylprednisolone acetate administration was more economical than Hydrocortisone acetate. Keywords: Sciatica, epidural injection, Methylprednisolone acetate, Hydrocortisone acetate
Sexuality in adolescence is a major focus of interest and concern for parents and educators, thus family and school involvement is indispensable for adolescent sex education. This article analyzes educational scenarios, themes, and difficulties related to sex education, from the perspective of adolescent students, managers, and teachers from Brazilian public schools. This is a cross-sectional, exploratory, and descriptive survey, developed in 5 schools from the 2nd political-administrative region (PAR) of Recife, Pernambuco, Brazil. The sample consisted of 196 individuals (168 teenagers, 19 teachers, and 9 managers) and data was obtained through interviews, conducted in September and October 2017. The results indicate that the school infrastructure has deficiencies in relation to: living spaces, teaching scenarios, teacher education, dialogue with families, and integration with other teaching and health institutions. All this contributes to the persistence of sex education as a theme of biology-based classes. It is concluded that psychological, cultural, and relational aspects of healthy and safe sexuality persist as knowledge gaps according to the teenagers themselves, something which indicates the need to expand spaces for dialogue and embracement of human diversity within the school environment.
Background: Cutaneous leishmaniasis (CL) is an infectious disease caused by a protozoan of the genus Leishmania and is transmitted by the anopheline mosquito. This study focused on describe three cases of atypical clinical presentations on patients with American cutaneous leishmaniasis from Dermatology Department of the State University of the State of Pará. Methods and Findings: Three patients assisted at a referral service between 2017 and 2019 are reported, based on clinical interview, histopathological analysis and polymerase chain reaction. On the first patient, it was observed keratotic erythematous vegetative plaque measuring 10x8 cm, with satellite lesions, in the left lower limb; the second patient presented an erythematous infiltrated plaque with crusts, on left ear for 6 months, with progressive growth; the third patient showed erythematous infiltrated plaques, sometimes ulcerated, in the trunk and face, with a zosteriform aspect. All three patients had the diagnosis confirmed by polymerase chain reaction and histopathological analysis. Conclusions: The wide range of clinical manifestations may be related to factors such as: use of immunosuppressive drugs, concomitant infections with more than one variety of Leishmania spp. and association with other systemic diseases, with HIV co-infection and diabetes being the main associated diseases. Thus, it is always necessary to evaluate such comorbidities on patients with leishmaniasis suspection, in order to avoid misdiagnosis.
