Arlete Mazzini Miranda Giovani

Histological study of fresh versus frozen semitendinous muscle tendon allografts

OBJECTIVE: The purpose of this study was to histologically analyze allografts from cadaveric semitendinous muscle after cryopreservation at −80°C in comparison to a control group kept at only −4°C to test the hypothesis that the histological characteristics of the tissue are maintained when the tendons are kept at lower temperatures. METHODS: In a tissue bank, 10 semitendinous tendons from 10 cadavers were frozen at −80ºC as a storage method for tissue preservation. They were kept frozen for 40 days, and then a histological study was carried out. Another 10 tendon samples were analyzed while still “fresh”. RESULTS: There was no histological difference between the fresh and frozen samples in relation to seven variables. CONCLUSIONS: Semitendinous muscle tendon allografts can be submitted to cryopreservation at −80ºC without suffering histological modifications.

COMPARATIVE STUDY OF CRYOPRESERVED BONE TISSUE AND TISSUE PRESERVED IN A 98% GLYCEROL SOLUTION

OBJECTIVE To compare the bone graft cryopreservation method (at -80 degrees C) with a preservation method using a 98% glycerol solution at room temperature (10 degrees C-35 degrees C), by testing the antibacterial and fungal effects of 98% glycerol and comparatively analyzing the observed histological changes resulting from the use of both methods. METHOD This study was of 30 samples of trabecular bone tissue from 10 patients undergoing total hip arthroplasty. Each femoral head provided 3 samples that were randomized into 3 groups, namely, the control group, the cryopreserved group, and the group preserved in a 98% glycerol at room temperature for 1 year. The samples were submitted to histomorphologic, cell feasibility, and microbiologic analyses. The results were statistically analyzed using the McNemar test, with a statistical significance index of 0.05. RESULTS Values obtained using the McNemar test to compare probability distributions of histomorphologic variables (mature or lamellar bone, immature bone, and necrosis) and cell feasibility (osteoblasts and osteoclasts) indicated that there is no difference between the distributions of variables under the 3 experimental conditions. Microbiological analysis of the 98% glycerol solution and bone fragments from samples stored for 1 year at room temperature did not show bacterial or fungal growth. The histological and microbiological investigation were performed at 2 different time points: immediately after the sample processing and after 1 year. CONCLUSION The method used to preserve bone grafts kept in 98% glycerol at room temperature (10 degrees C-35 degrees C) was similar to cryopreservation in terms of bone matrix preservation; no bacteria or fungi were found in the samples.

Massage application for occupational low back pain in nursing staff

This is a clinical trial which aims to evaluate the efficiency of massage in the reduction of occupational low back pain, and its influence on the performance of work and life activities for the nursing team. The sample consisted of 18 employees who received seven to eight sessions after their work period. From the Numerical Pain Rating Scale, significant improvements were found between the 3rd and 1st evaluations (p=0.000) and between the 3rd and 2nd (p=0.004), using the Wilcoxon test. Regarding the Oswestry Disability Index, the paired t test showed a statistical difference (p=0.02) between the baseline, with a mean of 21.33% and the second evaluation (18.78%), which was also seen between the second and third evaluation (16.67%). The score for the Handling and Transfer Risk Evaluation Scale was 18 points (medium risk). It is concluded that massage was effective in reducing occupational low back pain, and provided improvement in activities of work and life. Clinical Trials Identifier: NCT01315197.Se trata de ensayo clinico con el objetivo de verificar la eficiencia del masaje para apocar la lumbalgia ocupacional y su influencia en el desempeno de las actividades laborales y de vida, en el equipo de Enfermeria. La muestra fue compuesta por 18 empleados, que recibieron de 7 a 8 sesiones despues del planton. Por la escala numerica de dolor, hubo mejora significante estadisticamente entre la 3a y 1a evaluacion (p=0,000) y entre la 3a y 2a (p=0,004), por la prueba de Wilcoxon. Sobre la evaluacion funcional de Owestry, en la prueba T pareado, se observo diferencia estadistica (p=0,02) entre el primer momento, con media del 21,33% y el segun (18,78%), y se mantuvo entre la segunda y tercera evaluacion (16,67%). Fueron encontrados 18 puntos (medio riesgo) para escala de evaluacion del riesgo en el movimiento y transferencia. Se concluye que el masaje fue eficiente en la disminucion de la lumbalgia ocupacional, asi como trajo mejoria en las actividades de trabajo y vida. Clinical Trials Identifier: NCT01315197.

Aplicação da massagem para lombalgia ocupacional em funcionários de Enfermagem

This is a clinical trial which aims to evaluate the efficiency of massage in the reduction of occupational low back pain, and its influence on the performance of work and life activities for the nursing team. The sample consisted of 18 employees who received seven to eight sessions after their work period. From the Numerical Pain Rating Scale, significant improvements were found between the 3rd and 1st evaluations (p=0.000) and between the 3rd and 2nd (p=0.004), using the Wilcoxon test. Regarding the Oswestry Disability Index, the paired t test showed a statistical difference (p=0.02) between the baseline, with a mean of 21.33% and the second evaluation (18.78%), which was also seen between the second and third evaluation (16.67%). The score for the Handling and Transfer Risk Evaluation Scale was 18 points (medium risk). It is concluded that massage was effective in reducing occupational low back pain, and provided improvement in activities of work and life. Clinical Trials Identifier: NCT01315197.Se trata de ensayo clinico con el objetivo de verificar la eficiencia del masaje para apocar la lumbalgia ocupacional y su influencia en el desempeno de las actividades laborales y de vida, en el equipo de Enfermeria. La muestra fue compuesta por 18 empleados, que recibieron de 7 a 8 sesiones despues del planton. Por la escala numerica de dolor, hubo mejora significante estadisticamente entre la 3a y 1a evaluacion (p=0,000) y entre la 3a y 2a (p=0,004), por la prueba de Wilcoxon. Sobre la evaluacion funcional de Owestry, en la prueba T pareado, se observo diferencia estadistica (p=0,02) entre el primer momento, con media del 21,33% y el segun (18,78%), y se mantuvo entre la segunda y tercera evaluacion (16,67%). Fueron encontrados 18 puntos (medio riesgo) para escala de evaluacion del riesgo en el movimiento y transferencia. Se concluye que el masaje fue eficiente en la disminucion de la lumbalgia ocupacional, asi como trajo mejoria en las actividades de trabajo y vida. Clinical Trials Identifier: NCT01315197.

The long-term impact of a program to prevent central line-associated bloodstream infections in a surgical intensive care unit.

Central line-associated bloodstream infections (CLABSIs) are an important type of healthcare-associated infection in intensive care units (ICUs) with high mortality rates and high healthcare costs (1). According to the World Health Organization (WHO), CLABSIs are also the most common cause of healthcare-associated infections of the bloodstream (2). In the United States, the median rate ranges from 1.8 to 5.2 per 1,000 catheter days, according to the Centers for Disease Control and Prevention (CDC) (3). Each year, 100,000 cases and 30,000 deaths occur among patients in ICUs (4). In limited-resource countries, CLABSI rates range from 1.6 to 44.6 cases per 1,000 central line days in adult and pediatric ICUs and from 2.6 to 60.0 cases per 1,000 central line days in neonatal ICUs. CLABSIs are associated with significant additional mortality, with an odds ratio ranging from 2.8 to 9.5 (5). The optimal intervention method for reducing the incidence of CLABSIs has not been definitively identified, but some studies have proven that many practical, low-cost, low-technology educational measures related to inserting and maintaining central lines not only may be successful and effective but can also be sustained (3,4,6)–(10). Within this scenario, the CDC has recommended that an education program be implemented for healthcare personnel (6). The objective of this study was to describe the long-term impact of a program for decreasing CLABSI rates in a surgical ICU in Sao Paulo, Brazil.

Outpatient parenteral antimicrobial therapy for orthopedic infections - a successful public healthcare experience in Brazil.

Treatment of orthopedic infections usually requires prolonged antimicrobial therapy, ranging from 14 days up to 6 months. Nowadays, rising levels of antimicrobial resistance demands parenteral therapy for many patients. Outpatient parenteral antimicrobial therapy (OPAT) is a modality that allows treatment out of hospital in these situations. In Brazil, where a public universal healthcare system allows full coverage for all citizens, implantation and dissemination of OPAT programs would be beneficial for patients and for the system, because it would allow a better allocation of health resources. The Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da USP (IOT) started, in July 2013, a partnership with municipal health authorities in Sao Paulo, Brazil, in order to initiate an OPAT program in which patients discharged from that hospital would be able to continue antimicrobial therapy at primary care facilities. When necessary, patients could also receive their therapy at the day-hospital located at IOT. Primary care nursing and physician staff were trained about antimicrobial infusion and peripherally inserted central catheter manipulation. An OPAT specific antimicrobial protocol was designed and a special reference and counter-reference organized. As a result, 450 primary healthcare professionals were trained. In the first year of this program, 116 patients were discharged for OPAT. Chronic and acute osteomyelitis were most frequent diagnosis. Teicoplanin, ertapenem and tigecycline were the most used drugs. Duration of treatment varied from 10 to 180 days (average 101, median 42). Total sum of days in OPAT regimen was 11,698. Only 3 patients presented adverse effects. Partnership between services of different levels of complexity allowed implantation of a safe and effective public healthcare OPAT program for treatment of orthopedic infections. This program can serve as a model for developing similar strategies in other regions of Brazil and Latin America.

CATETER CENTRAL DE INSERÇÃO PERIFÉRICA EM PACIENTES ORTOPÉDICOS. EXPERIÊNCIA EM 1023 PROCEDIMENTOS

ABSTRACT Objectives The advantages of using a peripherally inserted central catheter (PICC) in hospitalized patients make this device very important for intravenous therapy. This study describes the use of PICCs at the Institute of Orthopedics and Traumatology at the Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo over the last 10 years. Methods This retrospective study analyzed 1,057 medical records and included 1,023 medical files with complete information on the punctured vein, diagnosis, duration of catheterization, complications, and catheter tip positioning. Results Seven hundred and twenty PICCs (70.4%) were considered successfully positioned, and mean duration of catheterization was 34.3 days. The basilic vein was used in 528 (51.6%) patients, while 157 (15.4%) catheters were removed due to complications. No cases of catheter-related thrombosis or infection were found. Eight hundred and sixty-six (84.6%) patients completed their treatment with PICC in place. Conclusion PICC is a safe intravenous device that can be successfully utilized for medium- and long-course intravenous therapy in hospitalized and discharged orthopedic patients. Level of Evidence IV; Case series.

Aplicación del masaje para lumbalgia ocupacional en empleados de Enfermería

This is a clinical trial which aims to evaluate the efficiency of massage in the reduction of occupational low back pain, and its influence on the performance of work and life activities for the nursing team. The sample consisted of 18 employees who received seven to eight sessions after their work period. From the Numerical Pain Rating Scale, significant improvements were found between the 3rd and 1st evaluations (p=0.000) and between the 3rd and 2nd (p=0.004), using the Wilcoxon test. Regarding the Oswestry Disability Index, the paired t test showed a statistical difference (p=0.02) between the baseline, with a mean of 21.33% and the second evaluation (18.78%), which was also seen between the second and third evaluation (16.67%). The score for the Handling and Transfer Risk Evaluation Scale was 18 points (medium risk). It is concluded that massage was effective in reducing occupational low back pain, and provided improvement in activities of work and life. Clinical Trials Identifier: NCT01315197.Se trata de ensayo clinico con el objetivo de verificar la eficiencia del masaje para apocar la lumbalgia ocupacional y su influencia en el desempeno de las actividades laborales y de vida, en el equipo de Enfermeria. La muestra fue compuesta por 18 empleados, que recibieron de 7 a 8 sesiones despues del planton. Por la escala numerica de dolor, hubo mejora significante estadisticamente entre la 3a y 1a evaluacion (p=0,000) y entre la 3a y 2a (p=0,004), por la prueba de Wilcoxon. Sobre la evaluacion funcional de Owestry, en la prueba T pareado, se observo diferencia estadistica (p=0,02) entre el primer momento, con media del 21,33% y el segun (18,78%), y se mantuvo entre la segunda y tercera evaluacion (16,67%). Fueron encontrados 18 puntos (medio riesgo) para escala de evaluacion del riesgo en el movimiento y transferencia. Se concluye que el masaje fue eficiente en la disminucion de la lumbalgia ocupacional, asi como trajo mejoria en las actividades de trabajo y vida. Clinical Trials Identifier: NCT01315197.

Cryopreserved Musculoskeletal Tissue Bank in Dentistry: State of the Art and Perspectives

Maxillary and mandibular bone loss has long been a challenge to dental surgeons who seek to reconstruct these lost segments. These lesions lead to deformation of some maxillary and mandibular areas which interferes in the functional rehabilitation process of these structures. The most common cause of these lesions is prolonged use of total prostheses in a large part of the Brazilian population and the searches for surgical techniques and bone substitutes are today proposed and studied by the academic class. In this context, Brazil is starting to distribute allogeneic tissue obtained, processed and qualified by musculoskeletal tissue banks. Such banks already have experience in dispensing tissue to the orthopedic area, which has been using reconstructive techniques with allografts for many years. The first studies proposing the use of bone substitutes for replacement of these faulty parts commenced in the decades subsequent to 1860. (Carrel, 1912;Groves, 1917; Sharrard, Collins, 1961; Urist, 1965; Fischer, 1998; Tomford, 2000).

Validation of Primary Packaging for Cryopreserved Musculoskeletal Tissues

Bones and tendons are obtained from donors who have been pronounced brain dead after a rigid and extensive screening process. The tissues obtained are sent to a Tissue Bank and submitted to processing steps, packaging and cryopreservation at -80◦C. It is vital to maintain sterility and integrity, so that no tissue is discarded.These precautions also extend to the packaging, which should promote containment and protection. Although minimum technical criteria have already been defined for the food industry, this has still not been regularized in Brazil. We emphasize, therefore, the need to study this subject, focusing on maintaining the quality of the musculoskeletal tissues produced by tissue banks. All procedures developed byTissue Banks currently present in the country have rigid control over the quality and the traceability of tissues made available, based on international standards (EATB, 2004; AATB, 2007) on the legislation (BRASIL, 1997-2006) and in conformity with Good Manufacturing Practices GMP.