Paulo Afonso Nunes Nassif

Análise comparativa da cicatrização da pele com o uso intraperitoneal de extrato aquoso de Orbignya phalerata (babaçu). Estudo controlado em ratos

INTRODUCTION The wounds healing is a highly complex process with many phases. Countless substances have been used since the remote times with the purpose a simulating the process. Among them the Orbignya phalerata extract was considered as having a stimulating action. PURPOSE The aim of this study is to verify the healing action of the Orbignya phalerata in the healing of skin surgical wounds by a comparative analysis of the alterations obtained in histological and morphologic aspects. METHODS Sixty male adult Wistar rats were used. They were distributed in a randomly in two groups of 30 each and, in one group, Orbignya phalerata extract was used intraperitoneally in a dose of 50 mg/Kg in the first day of surgery. The experimental procedure consisted in a circular incision of two centimeters of diameter with metallic punch. In the control group the substance was not used. The rats were killed in the 7th, 14th, 21st days of the post-operative period and submitted to macro and microscopic analysis. The macroscopic one was made with magnifying glass and paquimeter. For the histological analysis, the sheets were processed with Hematoxilina-Eosina (HE) and trichromic of Masson and slides the vascular proliferation, mononuclear cells, polymorphonuclear cells, fibroblastic proliferation, collagen fibers and re-epithelization were assigned. RESULTS In the macroscopic view the experimental group of seven days had only one animal with small amount of secretion. In the animals of 14 days all of them had good aspect. The ones of 21 days, complete healing was observed in all animals. In the histological analysis, there was no significant difference among groups, except for the 7th day with significant difference in the fibroblastic proliferation and re-epithelization favoring the experimental group. CONCLUSION A favorable effect of the aqueous extract of babassu mesocarp was observed in a microscope analysis in the healing process of cutaneous surgical wounds in rats.

Procalcitonin as a prognostic biomarker of severe sepsis and septic shock

OBJETIVO: Avaliar a tendencia da concentracao plasmatica e do clearance de procalcitonina (PCT-c) como biomarcadores de prognostico de pacientes com sepse grave e choque septico, comparado a um outro marcador precoce de prognostico representado pelo numero de criterios de SIRS no momento do diagnostico da sepse. METODOS: Estudo de coorte prospectivo observacional onde foram incluidos pacientes com sepse grave e choque septico. A concentracao serica de procalcitonina foi determinada no momento do diagnostico da sepse e apos 24 e 48 horas. Foram coletados dados demograficos, escore APACHE IV, escore SOFA na chegada, numero de criterios de SIRS no momento do diagnostico, sitio da infeccao e resultados microbiologicos. RESULTADOS: Vinte e oito pacientes foram incluidos, 19 clinicos e nove cirurgicos. Em 13 (46,4%) a fonte da sepse foi pulmonar, em sete abdominal (25,0%), em cinco urinaria (17,9%) e de partes moles em tres casos (10,7%). Quinze pacientes tinham sepse grave e 13 choque septico. A mortalidade global foi cinco pacientes (17,9%), tres deles com choque septico. Vinte e oito determinacoes de PCT foram realizadas no momento do diagnostico da sepse, 27 apos 24 horas e 26 apos 48 horas. A concentracao inicial nao se mostrou expressivamente diferente entre os grupos sobreviventes e nao sobreviventes, mas as diferencas entre os dois grupos apos 24 e 48 horas alcancaram significância estatistica expressiva. Nao se observou diferenca em relacao ao numero de criterios de SIRS. O clearance de procalcitonina de 24 horas mostrou-se expressivamente mais elevado no grupo de sobreviventes (-3,0 versus -300,0, p=0,028). Embora o clearance de procalcitonina de 48 horas tenha mostrado resultado mais elevado no grupo de sobreviventes comparado aos nao sobreviventes, a diferenca nao alcancou significância estatistica. CONCLUSAO: Concentracoes persistentemente elevadas de procalcitonina no plasma, assim como, reducao do PCT-c 24 horas, associaram-se a elevacao expressiva da mortalidade de pacientes com sepse grave e choque septico.

Avaliação do uso do extrato bruto de Jatropha gossypiifolia L. na cicatrização de feridas cutâneas em ratos

INTRODUCTION: Phytotherapy is one of the research branches in the healing process of surgical wounds. PURPOSE: To analyze the morphological aspects of the healing process occurring in open skin lesions in rats under administration of raw extract from Jatropha Gossypiifolia L. METHOD: Sixty Wistar rats were utilized. A 2cm wound in diameter was done in each animal at the dorsal region. The animals were divided into two groups, each one consisting of 30 animals. Each group was subdivided into three subgroups of ten. They were analyzed in the 7th, 14th and 21st post-operative day. The two groups were compared through macroscopic analysis using digital planigraphy and histological examination. The microscopic parameters considered were the vascular proliferation, polymorph and mononuclear cells, fibroblastic proliferation, collagen and epithelium formation. RESULTS: Epitelization occurred in a same amount in all animals. There was no chronic inflamation on 21st day in the Jatropha group and also no difference in polimorphonuclear cells between the groups. The fibroblastic reaction was better on the 7th day in the Jatropha group and equal in the remaining ones. Colagenization was greater on 7th and 14th days in Jatropha and better re-epitelization occurred in the same group in the 7th day. CONCLUSION: Although with hystologic aspects favoring the Jatropha, no significant differences concerning to the macroscopic and microscopic aspects were observed among the skin wounds receiving raw extract Jatropha and those that received no treatment in the final evaluation.

Effects of a highly concentrated platelet-rich plasma on the bone repair using non-critical defects in the calvaria of rabbits

PURPOSE To verify the effect of highly concentrated platelet-rich plasma (hPRP) in the pathways of bone repair using non-critical defects in the calvaria of rabbits. METHODS The hPRP was produced from collected venous blood of 21 rabbits. Four non-critical defects of 8 mm in diameter were created on the calvaria of each animal. The defects were all treated differently: autogenous particled bone (APB, group 1), autogenous particled bone associated with hPRP (APB + hPRP, group 2), isolated hPRP (group 3), and blood clot (control, group 4). Animals were submitted to euthanasia on the 2nd, 4th and 6th week postoperatively. Histological and histomorphometric analysis were carried through. RESULTS After two weeks, groups 1 and 2 were in more advanced stage of repair than 3 and 4. At this period, comparing the groups 1 and 2, no significant differences were found between both, which also happened between the groups 3 and 4. However, after four and six weeks, the group 1 showed a more advanced stage of repair among all the other studied groups, while group 2 was in more advanced signs of bone repair than groups 3 and 4. Comparing groups 3 and 4, after four and six weeks, the least advanced stage of bone repair was found to be within group 3. CONCLUSION The use of a highly concentrated PRP was considered prejudicial to the repair of non-critical defects in the calvaria of rabbits, either in the association of autogenous particled bone, when compared to autogenous particled bone alone, or in its isolated form, when compared to blood clot (control).

Alterações nos parâmetros pré e pós-operatórios de pacientes com síndrome metabólica, submetidos a Bypass gastrointestinal em Y de Roux

BACKGROUND: Overweight and obesity affects approximately 1.7 billion people, with increase in morbid obesity of 80% for women and 400% for men, since 1970. Metabolic syndrome is a complex disorder associated with insulin resistance and abdominal obesity, causing changes in glucose metabolism in various tissues and hyperinsulinemia. AIM: To verify changes in the pre and post-operative parameters in morbidly obese patients with metabolic syndrome who underwent to Roux-en-Y gastrointestinal bypass. METHOD: Seventy four patients with obesity with metabolic syndrome submitted to gastrointestinal bypass Roux-en-Y were included. All of them had measured waist-hip ratio, blood pressure, total cholesterol, HDL, LDL, triglycerides and fasting glucose pre-operatively and at the first and fourth month post-operatively. RESULTS: In the first post-operative month, happened a weight reduction of 7.96%, BMI of 8%, waist-hip ratio of 1.35%, total cholesterol of 17.95%, HDL of 14.5%, LDL of 15.31%, TAGs of 30.29% and 9.75% of glucose; on the fourth month was observed a weight reduction of 14.94%, BMI of 20.08%, waist-hip ratio of 5.96%, total cholesterol of 21.27%, HDL of 3.53%, LDL of 23.72%, TAGs of 29.6% and 10.34% of glucose. CONCLUSION: All the parameters evaluated in this study had a statistic significant improvement, with the exception of HDL-cholesterol.

Prevalência de deficiência de vitamina D em pacientes com úlceras de perna de etiologia venosa

OBJECTIVE To study if the prevalence of vitamin D deficiency in patients with venous leg ulcer is higher than in the control population. METHODS Serum levels of 25 hidroxi (OH)-vitamin D3 was studied by chemiluminescence in 27 patients with chronic venous ulcer and 58 controls at the Evangelical Hospital of Curitiba. RESULTS The levels of 25 OH-vitamin D3 were below 8 ng/dl in 11.1% of ulcer patients and 3.4% of controls; between 8 and 20 ng/dl in 46.1% of ulcer patients and 25.8% of controls; between 21 and 30 ng/dl in 22.2% of ulcer patients and 27.5% of controls and above 30 ng/dl in 43.1% of controls and 18.5% of ulcer patients (p=0.04). CONCLUSION There is an increased prevalence of vitamin D deficiency in patients with chronic venous leg ulcers.

Tracheal suture in rats with hypothyroidism: wound healing study

PURPOSE To evaluate the influence of hypothyroidism in tracheal wound healing process. METHODS A controlled study was designed with 48 male Wistar rats, divided into two groups: study and control groups. In the first one hypothyroidism was surgically induced and 10 weeks after, a tracheal opening followed by suture was performed in both groups, subdivided into 7, 14, and 21 days in accordance with the date of animals death. A laboratorial evaluation was performed to prove the decreased in thyroid function in the study group. Also a macroscopic evaluation through a stablished protocol and a microscopic analysis with Hematoxylin-eosin and Sirius-Red staining methods were done. RESULTS The laboratorial evaluation certified suppressed thyroid function in the study group. The macroscopic evaluation showed the presence of suture blockade in the study group in all the evaluated days. Microscopic analysis showed a prolongated inflammatory process and less collagen with delay in organization in the study group comparing to control group. All these data were statistic significant. CONCLUSION Hypothyroidism had an influence in tracheal wound healing process, promoting delay in the inflammatory and organization processes and diminished tissue collagen quantity.

Indução de obesidade com sacarose em ratos

BACKGROUND Although is complex to identify the factors responsible for the important growth in obesity all over the world, the main causes are increased consumption of energy, highly saturated fats and sugars, and reduced physical activity. AIM To compare rats with normal and supplemented diet with sucrose in relationship to body mass, weight of gonadal and retroperitoneal fat and Lee index. METHODS Forty rats were divided into two groups: 20 in the control group that received normal chow diet and water for three months, and 20 animals in the experimental group who received the same diet but supplemented with sucrose 300 g/l of water. The animals were weighed once a week during 91 days. At scheduled death, they had measured the naso-anal length, body weight and Lee index. After laparotomy, retroperitoneal and gonadal fat were isolated, dried and the percentage of weight in relation to body weight at the date of death was evaluated. RESULTS There was a statistic significant difference between the 14th and 78th day favoring the experiment group indicating that sucrose interferes with weight gain in rats. The average weight was higher in the experimental group in all periods in comparison to initial weight. There was also significant difference in the weight of the gonadal and retroperitoneal fat. There was no significant difference comparing the Lee index. CONCLUSION The body mass index was higher in animals treated with diet supplemented with sucrose and had higher gonadal and retroperitoneal fat, but no difference in the Lee index.

Obesos diabéticos tipo 2 submetidos à derivação gástrica em Y-de-Roux: análise de resultados e influência nas complicações

BACKGROUND About 90% of type 2 diabetic patients are obese or overweight. The obvious clinical improvement observed with surgeries, such as Roux-en-Y gastric bypass, has opened space for research by different factors than only weight loss, as responsible for the return to euglycemia and reduction of medication use. AIM To evaluate the efficacy and safety of surgical treatment of diabetes in obese patients with BMI above 35 kg/m2 underwent to gastric bypass, for the control of diabetes, weight loss, improvement of laboratory findings and complications of diabetes. METHOD The protocol was implemented in three stages: initial, after losing 10% of weight, and after a year. RESULTS Seventeen patients who have lost weight in 10% were included in the surgical protocol. From the total, 11.8% continued needing medication (p <0.001). The time for weight loss was a month with significant reduction in fasting glucose, HOMA-IR index, insulin, HbA1c, hemoglobin, AST, urea and C-peptide and there was no variation in hematocrit, albumin, ALT and creatinine. With a year of monitoring, the surgical group showed a significant difference in weight, BMI, blood glucose, HbA1c, C-peptide, insulin and HOMA-IR. The percentage of patients with neuropathy (31.3%) was lower than the number of cases at baseline (52.9%) (p> 0.05). CONCLUSION Gastric bypass with Roux-en-Y derivation is a safe procedure, with good results in control of diabetes type 2 in obese patients with BMI above 35 kg/m2.

Alterações dos parâmetros clínicos e laboratoriais em pacientes obesos com diabetes melito tipo 2 submetidos à derivação gastrojejunal em y de Roux sem anel

OBJECTIVES 1) To assess the changes in body weight and body mass index in grade 2 and 3 obese patients with type 2 diabetes mellitus, pre and postoperatively; 2) to assess the changes in pre and postoperative fasting blood glucose, postprandial glucose, glycated hemoglobin and insulin. METHODS A prospective study was undertaken with 40 selected patients with grade 2 and 3 obesity and type 2 diabetes mellitus, all with indication for surgical treatment of obesity. All patients underwent Roux-en-Y gastric bypass without ring. The clinical parameters weight and body mass index were analyzed, as well as the laboratory parameters fasting blood glucose, postprandial glucose, glycated hemoglobin, and insulin. The analyses were carried out in the preoperative period and at 60 days postoperatively. Statistical analysis was conducted with Students t and the Kolmogorov-Smirnov tests. RESULTS Mean preoperative weight was 107.3 kg, declining to 89.5 kg postoperatively. Mean initial body mass index was 39.5 kg/m², and 32.9 kg/m² at 60 postoperative days. Preoperative fasting blood glucose was 132 mg/dL, which was reduced to 40.4 mg/dL, on average, postoperatively. Postprandial blood glucose was 172 mg/dL in the preoperative period and 111.6 mg/dL in the postoperative measurement. Initial glycated hemoglobin was 7%, declining to 5.7% postoperatively. Preoperative and postoperative insulin levels were 29.6 µIU/mL and 13.9 µIU/mL, respectively. The level of significance was p<0.001 for all variables. CONCLUSION There was a statistically significant reduction in body weight and body mass index between the pre and postoperative periods, as well as in fasting blood glucose, postprandial glucose, glycated hemoglobin.