Flávia Sampaio Latini Gomes

Fatores associados à úlcera por pressão em pacientes internados nos Centros de Terapia Intensiva de Adultos

Trata-se de um estudo seccional analitico com o objetivo de estimar a ocorrencia de ulceras por pressao e seus fatores associados em CTIs de adultos, em Belo Horizonte. A amostra foi constituida por 142 pacientes, com 18 anos ou mais, internados ate as 24h do dia anterior a coleta de dados, em 316 leitos, distribuidos em 22 CTIs. A presenca de pelo menos uma ulcera por pressao, e por paciente, foi de 35,2% (IC 95% = 27,4-47,7). Das 99 ulceras identificadas, constatou-se que foram mais frequentes nas regioes sacral (36,0%) e calcânea (22,0%). Observou-se que presenca de sepses (OR = 6,04; IC 95% = 1,09-33,53), tempo de internacao > 10 dias (OR = 7,61; IC 95% = 2,92-19,82) e risco alto e elevado na classificacao da escala de Braden (OR = 4,96; IC 95% = 1,50-16,50) foram fatores independentes e significativamente associados a presenca de ulcera por pressao. Conclui-se que sepses, tempo de internacao e risco alto e elevado na classificacao da escala de Braden sao fatores potencialmente associados a formacao de ulceras em pacientes acamados.

Wound-healing activity of a proteolytic fraction from Carica candamarcensis on experimentally induced burn.

Carica candamarcensis is a species from the Caricaceae family whose immature fruit contains latex with large amounts of cysteine proteinases. In prior studies, we isolated two of these enzymes displaying mitogenic activity when incubated with L929 fibroblastic cells. One of the fractions containing these enzymes (P1G10) was shown to enhance wound healing of skin and to accelerate healing of chemically induced gastric ulcer. In this study we evaluate the effect of P1G10 on heat-induced, third-degree burn using a rodent model. The results show that 0.1% P1G10 accelerates epithelisation while the effect of 1% or 0.01% P1G10 is not significantly different to 1% silver sulphadiazine, 2% papain or the hydrosoluble vehicle used as control. In a double-blind randomised experiment comparing the healing response of 0.1%, 1% and the vehicle alone, we confirmed the enhanced healing property of P1G10. Histological analysis of burn-tissue sections following treatment with P1G10 support these observations. These results extend the healing properties of these groups of enzymes to a different type of trauma and open the way to future clinical applications.

Factors associated to pressure ulcers in patients at Adult Intensive Care Units

Trata-se de um estudo seccional analitico com o objetivo de estimar a ocorrencia de ulceras por pressao e seus fatores associados em CTIs de adultos, em Belo Horizonte. A amostra foi constituida por 142 pacientes, com 18 anos ou mais, internados ate as 24h do dia anterior a coleta de dados, em 316 leitos, distribuidos em 22 CTIs. A presenca de pelo menos uma ulcera por pressao, e por paciente, foi de 35,2% (IC 95% = 27,4-47,7). Das 99 ulceras identificadas, constatou-se que foram mais frequentes nas regioes sacral (36,0%) e calcânea (22,0%). Observou-se que presenca de sepses (OR = 6,04; IC 95% = 1,09-33,53), tempo de internacao > 10 dias (OR = 7,61; IC 95% = 2,92-19,82) e risco alto e elevado na classificacao da escala de Braden (OR = 4,96; IC 95% = 1,50-16,50) foram fatores independentes e significativamente associados a presenca de ulcera por pressao. Conclui-se que sepses, tempo de internacao e risco alto e elevado na classificacao da escala de Braden sao fatores potencialmente associados a formacao de ulceras em pacientes acamados.

Avaliação de risco para úlcera por pressão em pacientes críticos

Pacientes acamados apresentam risco de desenvolver ulceras por pressao e representam um grupo prioritario para o estudo e identificacao deste agravo. Para tal, utilizam-se instrumentos de avaliacao especificos para o problema. O objetivo deste estudo foi analisar os fatores de risco para o desenvolvimento de ulcera por pressao em pacientes adultos internados em CTIs. Trata-se de um estudo seccional analitico no qual foram avaliados 140 pacientes, internados em 22 CTIs, utilizando-se a escala de Braden. Os resultados mostraram que pacientes internados por 15 dias ou mais apresentavam alguma categoria de risco. As maiores frequencias de ulcera por pressao foram encontradas em pacientes que estavam nas categorias: percepcao sensorial (completamente limitado), umidade (constantemente umida), mobilidade (completamente imobilizado), atividade (acamado), nutricao (adequado) e friccao e cisalhamento (problema). Conclui-se que a utilizacao dessa escala traduz-se em estrategia importante no cuidar de pacientes em terapia intensiva.Bedridden patients are in risk to developing pressure ulcers and represent a priority group to be studied to identify this condition. To reach this goal, specific instruments are used to assess this problem. The objective of this study was to analyze the risk factors to developing pressure ulcers in adult patients hospitalized in ICUs. This is a sectional analytical study, in which evaluations were performed on 140 patients, hospitalized in 22 ICUs, using the Braden scale. Results showed that patients hospitalized from 15 days or more showed some level of risk. The highest frequencies of pressure ulcers were found in patients in the following categories: sensorial perception (completely limited), moistness (constantly moist), mobility (completely immobilized), activity (bedridden), nutrition (adequate) and friction and shear (problem). In conclusion, the use of this scale is an important strategy when providing care to patients in intensive treatment.

Risk assessment for pressure ulcer in critical patients

Pacientes acamados apresentam risco de desenvolver ulceras por pressao e representam um grupo prioritario para o estudo e identificacao deste agravo. Para tal, utilizam-se instrumentos de avaliacao especificos para o problema. O objetivo deste estudo foi analisar os fatores de risco para o desenvolvimento de ulcera por pressao em pacientes adultos internados em CTIs. Trata-se de um estudo seccional analitico no qual foram avaliados 140 pacientes, internados em 22 CTIs, utilizando-se a escala de Braden. Os resultados mostraram que pacientes internados por 15 dias ou mais apresentavam alguma categoria de risco. As maiores frequencias de ulcera por pressao foram encontradas em pacientes que estavam nas categorias: percepcao sensorial (completamente limitado), umidade (constantemente umida), mobilidade (completamente imobilizado), atividade (acamado), nutricao (adequado) e friccao e cisalhamento (problema). Conclui-se que a utilizacao dessa escala traduz-se em estrategia importante no cuidar de pacientes em terapia intensiva.Bedridden patients are in risk to developing pressure ulcers and represent a priority group to be studied to identify this condition. To reach this goal, specific instruments are used to assess this problem. The objective of this study was to analyze the risk factors to developing pressure ulcers in adult patients hospitalized in ICUs. This is a sectional analytical study, in which evaluations were performed on 140 patients, hospitalized in 22 ICUs, using the Braden scale. Results showed that patients hospitalized from 15 days or more showed some level of risk. The highest frequencies of pressure ulcers were found in patients in the following categories: sensorial perception (completely limited), moistness (constantly moist), mobility (completely immobilized), activity (bedridden), nutrition (adequate) and friction and shear (problem). In conclusion, the use of this scale is an important strategy when providing care to patients in intensive treatment.

Custo comparativo do tratamento de feridas

Este estudio compara el coste del curativo tradicional y el del preconizado/propuesto por el protocolo del sector de Estomaterapia del HC/UFMG en el tratamiento de diversos tipos de heridas. Al final del trabajo se pudo concluir que el coste del ultimo es inferior al primero y que la frecuencia en el cambio del curativo tradicional constituye factor de mayor significancia para elevar su coste.This study compares the cost of traditional wound dressing and the one commended by HC/UFMG Stomotherapy sectors protocol for several kinds of wounds treatment. We finally concluded that the cost of the latter is inferior to the first, and the it is the frequency in changing the dressings that appoint a greater significance factor in the increasing of the price.

The Proteolytic Fraction from Latex of Vasconcellea cundinamarcensis (P1G10) Enhances Wound Healing of Diabetic Foot Ulcers: A Double-Blind Randomized Pilot Study

IntroductionThe aim of the study was to investigate the role of the proteolytic fraction from Vasconcellea cundinamarcensis, designated as P1G10, on the healing of chronic foot ulcers in neuropathic patients with diabetes 2.MethodsFifty patients were enrolled in a prospective, randomized, double-blind trial, to verify the efficacy and safety of a topical dressing formulated with 0.1% P1G10, intended for wound healing, versus a hydrogel (control) protocol. Upon completion of the intervention, the outcome evaluated the number of patients attaining full epithelization (100%), or at least 80% healing. Statistical analysis compared the data on each group for the significance of the differences.ResultsCollection of data was finished in week 16, and the results were analyzed by intention to treat. The results showed that, in the control group, 5 patients attained 100% ulcer healing, 3 patients ≥ 80% healing and 11 experienced ulcer changes ≤ 80%, and the remainder showed no changes or their wounds became worse. Meanwhile, in the P1G10 group, 11 patients experienced full healing, 4 had healing ≥ 80% and 5 had ulcer changes ≤ lower than 80%, and the remainder showed no changes or their wounds became worse. The healing incidence for the first endpoint (100% healing) showed that the P1G10 group was 2.95-fold more efficacious than the control group (CI 95%) and 2.52-fold (CI, 95%) higher than its control for the second endpoint (80% healing).ConclusionsThese data support the hypothesis that topical application of the proteolytic fraction identified as P1G10 significantly enhances foot ulcer healing compared to hydrogel treatment.

Prevalência e aglomeração de fatores de risco cardiometabólicos em população idosa residente em área rural

Com este artigo objetivou-se avaliar a prevalencia e aglomeracao dos fatores de risco para doencas cardiovasculares em populacao idosa da arearural. Foi realizado estudo transversal com 236 individuos, com idade entre 60 e 99 anos, residentes em area rural. Os fatores analisados foram:excesso de peso (IMC ≥ 27 kg/m²), obesidade abdominal (circunferencia da cintura ≥ 88 cm para as mulheres e ≥ 102 para os homens), colesteroltotal ≥ 200 mg/dL, triglicerideos ≥ 150 mg/dL, colesterol LDL ≥ 160 mg/dL, colesterol HDL ≤ 40 mg/dL para homens e ≤ 50 mg/dL para mulheres,glicemia ≥ 100 mg/dL, pressao arterial sistolica/diastolica > 140/90 mmHg, tabagismo, sindrome metabolica definida de acordo com criteriosdo National Cholesterol Education Program e escore de dieta ruim. Razoes de prevalencia (RP) e intervalos de confianca de 95% (IC95%) foramcalculados segundo sexo. Foi encontrada aglomeracao de quatro ou mais fatores de risco em 47,4% da populacao. As mulheres apresentaramalta prevalencia de excesso de peso (RP = 1,9; IC95% = 1,05-3,61), obesidade abdominal (RP = 3,1; IC95% = 1,80-5,50), colesterol LDL aumentado(RP = 2,4; IC95% = 1,31-4,21), sindrome metabolica (RP = 2,2; IC95% = 1,25-3,84), hipercolesterolemia (RP = 1,3; IC95% = 1,06-1,68) e dislipidemia(RP = 1,1; IC95% = 1,01-1,29) quando comparadas aos homens. Este estudo confirma a alta prevalencia de fatores de risco cardiovasculares napopulacao idosa e a necessidade de politicas publicas efetivas de prevencao de doencas, objetivando envelhecimento saudavel.(AU) This study assessed the prevalence and clustering of risk factors for cardiovascular diseases in the elderly population of rural areas. This crosssectionalstudy was performed with 236 individuals, aged between 60 and 99 years, residents in a rural area. The factors analyzed were:overweight (BMI ≥ 27 kg/m²), abdominal obesity (waist circumference ≥ 88 cm for women and ≥ 102 for men), total cholesterol ≥ 200 mg/dL, triglycerides ≥ 150 mg/dL, LDL cholesterol ≥ 160 mg/dL, HDL cholesterol ≤ 40 mg/dL for men and ≤ 50 mg/dL for women, blood glucose ≥100 mg/dL, systolic/diastolic blood pressure ≥ 140/90 mmHg, smoking, metabolic syndrome defined according to criteria from the NationalCholesterol Education Program, and bad diet score. Ratios of prevalence (PR) and 95% confidence intervals (IC95%) were calculated according tosex. Agglomeration of four or more risk factors was observed in 47.4% of the population. Women showed high prevalence of overweight (PR = 1.9;IC95% = 1.05-3.61), abdominal obesity (PR = 3.1; IC95% = 1.80-5.50), increased LDL cholesterol (PR = 2.4; IC95% = 1.31-4.21), metabolic syndrome(PR = 2.2; IC95% = 1.25 -3.84), hypercholesterolemia (PR = 1.3; IC95% = 1.06-1.68), and dyslipidemia (PR = 1.1; IC95% = 1.01-1.29) when comparedto men. This study confirms the high prevalence of cardiovascular risk factors in the elderly population and the need for effective public policiesfor prevention, aiming at healthy aging.(AU) Este articulo estima la prevalencia y aglomeracion de factores de riesgo cardiovascular entre la poblacion anciana de una zona rural. Estudiotransversal realizado con 236 individuos entre 60 y 99 anos. Los factores estudiados fueron (IMC≥27kg/m²), obesidad abdominal (circunferencia de...(AU)

Análise da concordância da avaliação de estadiamento de úlcera por pressão

This study aimed to evaluate the consistency of the diagnoses, among nurses, of the staging of pressure ulcers based upon bi-dimensional images. This was a cross-sectional study with a diagnostic approach for staging of pressure ulcers, as measured by the overall rate of agreement and the Kappa Index. Training was conducted with 12 nurses and evaluation of the level of agreement in comparison to the diagnostic standard of an experienced investigator in the reading of ten digital images. Three applications of the test were necessary to obtain more than 80% agreement in the classification of the ulcers. The level of agreement obtained based on the evaluations of the bi-dimensional images was lower than those obtained in clinical practice. This study showed that in order to achieve agreement of greater than 85%, a high level of professional training is necessary, in large part, of the professionals who perform the evaluation.This study aimed to evaluate the consistency of the diagnoses, among nurses, of the staging of pressure ulcers based upon bi-dimensional images. This was a cross-sectional study with a diagnostic approach for staging of pressure ulcers, as measured by the overall rate of agreement and the Kappa Index. Training was conducted with 12 nurses and evaluation of the level of agreement in comparison to the diagnostic standard of an experienced investigator in the reading of ten digital images. Three applications of the test were necessary to obtain more than 80% agreement in the classification of the ulcers. The level of agreement obtained based on the evaluations of the bi-dimensional images was lower than those obtained in clinical practice. This study showed that in order to achieve agreement of greater than 85%, a high level of professional training is necessary, in large part, of the professionals who perform the evaluation.

Evaluación de riesgo para úlcera por presión en pacientes críticos

Pacientes acamados apresentam risco de desenvolver ulceras por pressao e representam um grupo prioritario para o estudo e identificacao deste agravo. Para tal, utilizam-se instrumentos de avaliacao especificos para o problema. O objetivo deste estudo foi analisar os fatores de risco para o desenvolvimento de ulcera por pressao em pacientes adultos internados em CTIs. Trata-se de um estudo seccional analitico no qual foram avaliados 140 pacientes, internados em 22 CTIs, utilizando-se a escala de Braden. Os resultados mostraram que pacientes internados por 15 dias ou mais apresentavam alguma categoria de risco. As maiores frequencias de ulcera por pressao foram encontradas em pacientes que estavam nas categorias: percepcao sensorial (completamente limitado), umidade (constantemente umida), mobilidade (completamente imobilizado), atividade (acamado), nutricao (adequado) e friccao e cisalhamento (problema). Conclui-se que a utilizacao dessa escala traduz-se em estrategia importante no cuidar de pacientes em terapia intensiva.Bedridden patients are in risk to developing pressure ulcers and represent a priority group to be studied to identify this condition. To reach this goal, specific instruments are used to assess this problem. The objective of this study was to analyze the risk factors to developing pressure ulcers in adult patients hospitalized in ICUs. This is a sectional analytical study, in which evaluations were performed on 140 patients, hospitalized in 22 ICUs, using the Braden scale. Results showed that patients hospitalized from 15 days or more showed some level of risk. The highest frequencies of pressure ulcers were found in patients in the following categories: sensorial perception (completely limited), moistness (constantly moist), mobility (completely immobilized), activity (bedridden), nutrition (adequate) and friction and shear (problem). In conclusion, the use of this scale is an important strategy when providing care to patients in intensive treatment.