Mônica Antar Gamba

Amputações de extremidades inferiores por diabetes mellitus: estudo caso-controle

OBJETIVO: As amputacoes de extremidades inferiores sao cada vez mais frequentes em pessoas com diabetes mellitus, tornando-se importante problema de saude publica, no Brasil e no mundo. O estudo objetivou detectar fatores associados a amputacoes de extremidades inferiores, em pessoas com diabetes mellitus. METODOS: Realizou-se estudo caso controle emparelhado. Foram identificados 117 pessoas com diabetes mellitus e submetidas a amputacoes de extremidades inferiores, na rede de servicos do Municipio de Sao Paulo. Os casos foram comparados com 234 controles, pessoas com diabetes mellitus, mas nao submetidas a amputacoes. As variaveis consideradas no emparelhamento foram sexo, idade e duracao da doenca. Caracteristicas sociodemograficas, de habitos de vida, clinicas e relativas a educacao em saude em diabetes mellitus foram incluidas. Inicialmente, foi realizada analise univariada, verificando a presenca de associacoes entre amputacoes e variaveis exploratorias. Foi utilizado modelo de regressao logistica condicional para a analise multivariada, com adocao do odds ratio como medida de associacao. RESULTADOS: Observou-se existencia de associacao entre amputacao e habito de fumar, ultima glicemia (superior a 200 mg/dl), presenca da polineuropatia simetrica distal e da vasculopatia periferica. O tratamento do diabetes mellitus e o comparecimento as consultas de enfermagem foram importantes fatores associados a prevencao dessas amputacoes. CONCLUSOES: O reconhecimento dos determinantes e dos fatores intervenientes para o acometimento desse agravo levarao a reducao dos custos na area e a melhoria da qualidade da assistencia prestada na rede de servicos de saude publica.

Nosocomial diarrhea in the intensive care unit

We made an epidemiological case-control study to examine risk factors for the development of diarrhea in the intensive care unit (ICU) of a public hospital in Santo André, SP, from January to October 2002. Forty-nine patients with diarrhea (cases) and 49 patients without diarrhea (controls), matched for age and gender, were included in the study. A stool culture and enzyme immunoassays for Clostridium difficile toxins A and B were performed on fecal specimens from diarrhea patients. Fourteen of them presented positive cultures for Pseudomonas aeruginosa and 22 patients presented positive ELISA for Clostridium diffícile. Nosocomial diarrhea was associated with several factors, including use of antibiotics (P=0.001), use of ceftriaxone (P=0.001), presence of infection (P=0.010) and length of hospital stay (P=0.0001).

Factors associated with nipple trauma in the maternity unit

OBJECTIVE To identify factors associated with nipple trauma in women breastfeeding exclusively in a maternity unit. METHODS This was a case-control study that recruited 146 recently-delivered mothers in rooming-in wards: 73 cases, defined as women with nipple trauma, and 73 controls, defined as women free from this pathology. Women breastfeeding exclusively were tested daily for a diagnosis of nipple injury, identified using a magnifying glass. Sociodemographic, obstetric and neonatal variables were studied. A logistic regression model was used for statistical analysis. RESULTS Cases and controls proved to be comparable in terms of their sociodemographic variables, although the women with nipple trauma were more likely not to be living with a partner. The following variables were found to be factors associated with nipple trauma: primiparity (OR 3.16; 95%CI 1.19-8.42), not living with a partner (OR 3.25; 95%CI 1.18-8.93), turgid and/or engorged breasts (OR 12.31; 95%CI 4.48-33.78), semi-protruding and/or malformed nipples (OR 4.69; 95%CI 1.50-14.62), and depigmentation of nipples (OR 13.98; 95%CI 4.43-44.06). CONCLUSION Primiparity, not living with a partner, turgid and/or engorged breasts, semi-protruding and/or malformed nipples, and depigmentated nipples are associated with nipple trauma.

Fatores associados à recidiva em hanseníase em Mato Grosso

OBJETIVO: Analizar factores asociados a la ocurrencia de recidiva en hanseniasis. METODOS: Estudio retrospectivo caso-control con 159 pacientes mayores de 15 anos diagnosticados con hanseniasis en cinco municipios del Estado de Mato Grosso, Centro-oeste de Brasil, cuyas unidades de salud eran consideradas de referencia para el atendimiento. El grupo de casos incluyo 53 individuos con recidiva de 2005 a 2007 y fue comparado con el grupo control (106 con alta por cura en 2005), pareados por sexo y clasificacion operacional. Se usaron datos del Sistema de Informacion de Agravios de Notificacion, Prontuarios y entrevistas. Se utilizo regresion logistica condicional y abordaje jerarquico. RESULTADOS: Posterior al analisis ajustado, se mostraron asociados a la ocurrencia de recidiva: individuos residentes en casas alquiladas (OR=4,1; IC95%:1,43;12,04), en domicilio de madera/tapia (OR=3,2; IC 95%:1,16;8,76), que moraban con mas de cinco personas (OR=2,1; IC95%:1,03;4,36), con trastorno por uso de alcohol (OR=2,8;IC95%:1,17;6,79), irregularidad del tratamiento (OR= 3,8; IC95%: 1,44;10,02), sin esclarecimiento sobre la enfermedad/tratamiento (OR= 2,6; IC95%:1,09,6,13), que usaban transporte colectivo para el acceso a la unidad de salud (OR=5,5; IC95%: 2,36;12,63), forma clinica de la enfermedad (OR= 7,1;IC95%: 2,48;20,52) y esquema terapeutico (OR= 3,7; IC95%:1,49;9,11). CONCLUSIONES: Los factores predictivos de recidiva se relacionan con condiciones de vivienda, habitos de vida, organizacion de los servicios de salud, formas clinicas y esquemas terapeuticos. Compete a los servicios de salud ofrecer orientaciones adecuadas a los pacientes, asi como garantizar la regularidad del tratamiento.OBJETIVO: Analisar fatores associados a ocorrencia de recidiva em hanseniase. METODOS: Estudo retrospectivo caso-controle com 159 pacientes maiores de 15 anos diagnosticados com hanseniase em cinco municipios do estado de Mato Grosso, cujas unidades de saude eram consideradas de referencia para o atendimento. O grupo de casos incluiu 53 individuos com recidiva de 2005 a 2007 e foi comparado ao grupo controle (106 com alta por cura em 2005), pareados por sexo e classificacao operacional. Foram usados dados do Sistema de Informacao de Agravos de Notificacao, prontuarios e entrevistas. Utilizou-se regressao logistica condicional e abordagem hierarquica. RESULTADOS: Apos analise ajustada, mostraram-se associados a ocorrencia de recidiva: individuos residentes em casas alugadas (OR = 4,1; IC95%:1,43;12,04), em domicilio de madeira/taipa (OR = 3,2; IC95%: 1,16;8,76), que moravam com mais de cinco pessoas (OR = 2,1; IC95% : 1,03;4,36), com transtorno de uso de alcool (OR = 2,8; IC95%: 1,17;6,79), irregularidade do tratamento (OR = 3,8;IC95%: 1,44;10,02), sem esclarecimento sobre a doenca/tratamento (OR = 2,6; IC95%: 1,09;6,13), que usavam transporte coletivo para o acesso a unidade de saude (OR = 5,5; IC95%: 2,36;12,63), forma clinica da doenca (OR = 7,1; IC95%: 2,48;20,52) e esquema terapeutico (OR = 3,7; IC95%: 1,49;9,11). CONCLUSOES: Os fatores preditivos de recidiva relacionam-se com condicoes de moradia, habitos de vida, organizacao dos servicos de saude, formas clinicas e esquemas terapeuticos. Cabe aos servicos de saude oferecer orientacoes adequadas aos pacientes, bem como garantir a regularidade do tratamento.

A posição de amamentar determina o aparecimento do trauma mamilar

The aim of the study was to identify the breast feeding position and holding variables related to nipple trauma. This case-control study assessed the onset of nipple trauma among women hospitalized at a University Hospital in the city of São Paulo, in 2004 and 2005. Subjects were puerperae diagnosed with unilateral or bilateral nipple trauma. Data analysis was performed using chi-square, Students t, and odds ratio tests (CI = 95%) and correspondence analysis. Participants were 146 puerperal women and their newborns, being 73 cases and 73 controls. Statistically significant position and holding variables for causing lesions were the following: newborns with their necks bent/contorted, chin away from the breast and lip-related defect (turned inward). Trauma prevention at the beginning of breast feeding is crucial for continuing this practice. Following adequate positioning is decisive for establishing effective and prolonged breast feeding.The aim of the study was to identify the breast feeding position and holding variables related to nipple trauma. This case-control study assessed the onset of nipple trauma among women hospitalized at a University Hospital in the city of Sao Paulo, in 2004 and 2005. Subjects were puerperae diagnosed with unilateral or bilateral nipple trauma. Data analysis was performed using chi-square, Students t, and odds ratio tests (CI= 95%) and correspondence analysis. Participants were 146 puerperal women and their newborns, being 73 cases and 73 controls. Statistically significant position and holding variables for causing lesions were the following: newborns with their necks bent/contorted, chin away from the breast and lip-related defect (turned inward). Trauma prevention at the beginning of breast feeding is crucial for continuing this practice. Following adequate positioning is decisive for establishing effective and prolonged breast feeding.

Recidivas de casos de hanseníase no estado de Mato Grosso

OBJECTIVE To compare new registrations of recurrences of leprosy cases in primary healthcare units (PHUs) and in specialized units in the State of Mato Grosso. METHODS This was a cross-sectional study based on all new registrations (N = 323) of recurrences of leprosy cases within the Notifiable Disease Information System (SINAN) between 2004 and 2006 that were made in the State of Mato Grosso, Central-West Brazil. The cases diagnosed were compared regarding sex, age, clinical-laboratory characteristics and geographical distribution among the municipalities. To compare and calculate the proportions of the variables, the chi-square test at the significance level of 5% was used. RESULTS Among the new registrations of recurrences, 20% were confirmed at specialized units and 80% at PHUs. However, most of the diagnoses at PHUs presented negative bacilloscopy findings (c2 = 12.34; p = 0.002). Seventy-one per cent of the cases were among males; the mean age was 43 years. No differences in the percentages of registrations were observed between the healthcare units with regard to clinical form, operational classification or degree of physical incapacity. Out of the total number of municipalities in the state, 64.7% presented recurrences and these accounted for 6 to 20% of all registrations. CONCLUSIONS The new registrations of cases of recurrence in Mato Grosso were influenced by the diagnoses made at PHUs, thus suggesting that there is a deficiency within the healthcare services in recognizing cases of recurrence.OBJECTIVE: To compare new registrations of recurrences of leprosy cases in primary healthcare units (PHUs) and in specialized units in the State of Mato Grosso. METHODS: This was a cross-sectional study based on all new registrations (N = 323) of recurrences of leprosy cases within the Notifiable Disease Information System (SINAN) between 2004 and 2006 that were made in the State of Mato Grosso, Central-West Brazil. The cases diagnosed were compared regarding sex, age, clinical-laboratory characteristics and geographical distribution among the municipalities. To compare and calculate the proportions of the variables, the chi-square test at the significance level of 5% was used. RESULTS: Among the new registrations of recurrences, 20% were confirmed at specialized units and 80% at PHUs. However, most of the diagnoses at PHUs presented negative bacilloscopy findings (c2 = 12.34; p = 0.002). Seventy-one per cent of the cases were among males; the mean age was 43 years. No differences in the percentages of registrations were observed between the healthcare units with regard to clinical form, operational classification or degree of physical incapacity. Out of the total number of municipalities in the state, 64.7% presented recurrences and these accounted for 6 to 20% of all registrations. CONCLUSIONS: The new registrations of cases of recurrence in Mato Grosso were influenced by the diagnoses made at PHUs, thus suggesting that there is a deficiency within the healthcare services in recognizing cases of recurrence.

Pressure ulcers in surgery patients: incidence and associated factors

Pressure ulcers are an important perioperatory care quality indicator This is a longitudinal case series study, performed with the following objectives: to estimate the incidence of pressure ulcers in patients submitted to medium and large surgeries; rate them according to the stage and location; verify the association with the variables: gender, age, body mass index (BMI), co-morbidities, surgical position, duration of surgery, anesthesia type and use of positioning devices, with presence or absence of pressure ulcers. Data collection took place in 2007 in São Paulo, with 199 patients, 20.6% of which presented pressure ulcers, and most (98.6%) in stages I and II, and the main location was the trunk (35.1%). The variables: position, surgery time, general anesthesia, and device use had a statistically significant association. In conclusion, there is a high incidence of pressure ulcers among surgical patients, requiring actions aimed at reducing this type of injury.As ulceras por pressao constituem um dos principais indicadores da qualidade do cuidado na assistencia perioperatoria. Este e um estudo longitudinal, do tipo serie de casos, com o objetivo de estimar a incidencia de ulceras por pressao em pacientes submetidos a cirurgias de medio e grande portes; classifica-las segundo estagio e localizacao, verificar a associacao das variaveis sexo, idade, indice de massa corporea, comorbidades, posicao cirurgica, tempo cirurgico, anestesia e uso de dispositivos de posicionamento com a presenca ou ausencia de ulceras por pressao. Os dados foram coletados em 2007, em Sao Paulo, com 199 pacientes, dos quais 20,6% apresentaram ulceras por pressao, 98,6% nos estagios I e II, com localizacao predominante no tronco frontal (35,1%). As variaveis: posicao, tempo cirurgico, anestesia geral e uso de dispositivos apresentaram associacao estatistica significativa. Concluiu-se que a incidencia de ulceras por pressao em pacientes cirurgicos e elevada, demandando acoes que visem a reducao desse tipo de lesao.

Factors associated to relapse of leprosy in Mato Grosso, Central-Western Brazil

OBJETIVO: Analizar factores asociados a la ocurrencia de recidiva en hanseniasis. METODOS: Estudio retrospectivo caso-control con 159 pacientes mayores de 15 anos diagnosticados con hanseniasis en cinco municipios del Estado de Mato Grosso, Centro-oeste de Brasil, cuyas unidades de salud eran consideradas de referencia para el atendimiento. El grupo de casos incluyo 53 individuos con recidiva de 2005 a 2007 y fue comparado con el grupo control (106 con alta por cura en 2005), pareados por sexo y clasificacion operacional. Se usaron datos del Sistema de Informacion de Agravios de Notificacion, Prontuarios y entrevistas. Se utilizo regresion logistica condicional y abordaje jerarquico. RESULTADOS: Posterior al analisis ajustado, se mostraron asociados a la ocurrencia de recidiva: individuos residentes en casas alquiladas (OR=4,1; IC95%:1,43;12,04), en domicilio de madera/tapia (OR=3,2; IC 95%:1,16;8,76), que moraban con mas de cinco personas (OR=2,1; IC95%:1,03;4,36), con trastorno por uso de alcohol (OR=2,8;IC95%:1,17;6,79), irregularidad del tratamiento (OR= 3,8; IC95%: 1,44;10,02), sin esclarecimiento sobre la enfermedad/tratamiento (OR= 2,6; IC95%:1,09,6,13), que usaban transporte colectivo para el acceso a la unidad de salud (OR=5,5; IC95%: 2,36;12,63), forma clinica de la enfermedad (OR= 7,1;IC95%: 2,48;20,52) y esquema terapeutico (OR= 3,7; IC95%:1,49;9,11). CONCLUSIONES: Los factores predictivos de recidiva se relacionan con condiciones de vivienda, habitos de vida, organizacion de los servicios de salud, formas clinicas y esquemas terapeuticos. Compete a los servicios de salud ofrecer orientaciones adecuadas a los pacientes, asi como garantizar la regularidad del tratamiento.OBJETIVO: Analisar fatores associados a ocorrencia de recidiva em hanseniase. METODOS: Estudo retrospectivo caso-controle com 159 pacientes maiores de 15 anos diagnosticados com hanseniase em cinco municipios do estado de Mato Grosso, cujas unidades de saude eram consideradas de referencia para o atendimento. O grupo de casos incluiu 53 individuos com recidiva de 2005 a 2007 e foi comparado ao grupo controle (106 com alta por cura em 2005), pareados por sexo e classificacao operacional. Foram usados dados do Sistema de Informacao de Agravos de Notificacao, prontuarios e entrevistas. Utilizou-se regressao logistica condicional e abordagem hierarquica. RESULTADOS: Apos analise ajustada, mostraram-se associados a ocorrencia de recidiva: individuos residentes em casas alugadas (OR = 4,1; IC95%:1,43;12,04), em domicilio de madeira/taipa (OR = 3,2; IC95%: 1,16;8,76), que moravam com mais de cinco pessoas (OR = 2,1; IC95% : 1,03;4,36), com transtorno de uso de alcool (OR = 2,8; IC95%: 1,17;6,79), irregularidade do tratamento (OR = 3,8;IC95%: 1,44;10,02), sem esclarecimento sobre a doenca/tratamento (OR = 2,6; IC95%: 1,09;6,13), que usavam transporte coletivo para o acesso a unidade de saude (OR = 5,5; IC95%: 2,36;12,63), forma clinica da doenca (OR = 7,1; IC95%: 2,48;20,52) e esquema terapeutico (OR = 3,7; IC95%: 1,49;9,11). CONCLUSOES: Os fatores preditivos de recidiva relacionam-se com condicoes de moradia, habitos de vida, organizacao dos servicos de saude, formas clinicas e esquemas terapeuticos. Cabe aos servicos de saude oferecer orientacoes adequadas aos pacientes, bem como garantir a regularidade do tratamento.

Ten years of a multidisciplinary diabetic foot team approach in Sao Paulo, Brazil.

Diabetes mellitus can cause devastating foot problems including loss of protective sensation with subsequent ulcerations and amputations. The natural history and pathophysiology of diabetic foot ulcers is best understood and managed by a multiprofessional team approach. The main factors for prevention and treatment of these devastating diabetic foot conditions are shown, with special attention to education of the patient. This approach decreases the morbidity of the disease, besides its economical and social feasibility.

Tratamento da mucosite em pacientes submetidos a transplante de medula óssea: uma revisão sistemática

OBJETIVO: Identificar as medidas terapeuticas para reducao da gravidade da mucosite oral em pacientes adultos submetidos ao Transplante de Medula Ossea (TMO). METODOS: Revisao sistematica nas bases de dados: LILACS, MEDLINE, CINAHL, EMBASE; CENTRAL (Cochrane Central) e DARE (Database of abstracts of reviews of effects), no periodo de 1972 a julho de 2010, utilizando os descritores mucositis, stomatitis e bone-marrow-transplantation. RESULTADOS: Identificaram-se 3.839 resumos, dos quais 22 foram incluidos na revisao sistematica que descreveram 14 intervencoes topicas e sistemicas, dentre as quais oito com significância estatistica para a reducao dessa complicacao. As terapias topicas foram a crioterapia, clorexidine, glutamina, laser e Traumeel® e as sistemicas, amifostine, Granulokine® e palifermin. CONCLUSAO: A heterogeneidade dos resultados dessas intervencoes e a falta de melhor elucidacao para a pratica assistencial indicam a necessidade de pesquisas mais precisas para identificar a efetividade de terapias topicas para a reparacao celular das mucosas.