FERIDAS SUPERFICIAIS: FATORES TÉCNICOS ASSOCIADOS A COMPLICAÇÕES LOCAIS

Background: Trauma is a serious public health problem with relevant social and economic consequences. The open cutaneous wounds, despite less severe, are not different, because they have high prevalence, and the patients often need to be away from their functions. This study aims to evaluate these wounds, establishing relations between technique factors of the initial management with unwanted scar and local complications. Methods: A prospective, longitudinal, observational and analytical analysis was performed. Data were collected at Hospital do trabalhador (Curitiba/PR), through two questionnaires: the first was filled in the emergency care, and the second in the outpatient clinic return, within 05 to 11 days. Results: 232 patients were evaluated, and 87 returned to outpatient clinic. Considering the total, the epidemiological profile was male (81.5%) with mean age of 38.5 years. Related to the wound, 55% were cut-blunt, located at hands and frontispiece (62.7%), and 86.7% were less than 06 cm length. The initial treatment was cleaning with saline solution (94.7%), wound’s closure with simple interrupted suture (98.85%),  in a number of 06 or less (75.7%), with 3-0 or 4-0 (85.2%) nylon (98.25%). Antibiotic was prescribed to 42.7% of the patients. In outpatient clinic, it was found stitches dehiscence in 13.80%, infection signs in 14.95% and necrosis in 19.5%. Conclusions: Greater amount of stitches in suture, topical substances in home care and use of systemic antibiotics were related with high rates of necrosis, as well as application of hydrogen peroxide with hight rates of necrosis. Introdução: O trauma é um grave problema de saúde pública com relevantes consequências sociais e econômicas. As feridas cutâneas traumáticas, apesar de menor gravidade, não fogem esta regra, pois além da grande prevalência em atendimentos emergenciais, suas vítimas, não raro, necessitam de afastamento de suas funções. Este estudo objetiva avaliar o atendimento inicial dessas feridas, estabelecendo correlações entre fatores técnicos empregados e resultado cicatricial não desejado ou presença de complicações locais. Métodos: Foi realizada uma análise prospectiva, longitudinal, observacional e analítica. Os dados foram coletados no Hospital do Trabalhador (Curitiba/PR) através de dois questionários: o primeiro no atendimento inicial no pronto socorro, e o segundo no retorno ambulatorial em 05 a 11 dias. Resultados: Foram avaliados 232 pacientes, com seguimento ambulatorial de 87. Do total da amostra, a maioria foi de homens (81,5%) com idade média de 38,5 anos. Quanto aos ferimentos, 55% foram corto-contusos, localizados em mãos e face (62,7%), e 86,7% menores do que 6,0 cm. O manejo inicial realizado foi limpeza com soro fisiológico (94,7%), sutura com ponto simples (98,85%), em número menor ou igual a 06 (75,7%), utilizando fio de nylon (98,25%) de tamanho 3-0 e 4-0 (85,2%). Antibioticoterapia foi prescrita para 42,7% dos pacientes. No retorno, observou-se deiscência de pontos em 13,80%, sinais de infecção em 14,95% e necrose em 19,5%. Conclusão: Maior quantidade de pontos na sutura, uso de substâncias tópicas domiciliares e antibioticoterapia apresentaram possível correlação com altas taxas de necrose, assim como aplicação de peróxido de hidrogênio com altas taxas de infecção

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Evaluation of the environmental, economic, and social performance of soybean farming systems in southern Brazil

Soybean production has a crucial role in the development of Brazilian agriculture and recently became the most important commodity in Brazilian agribusiness. Various soybean farming systems exist, which are claimed to differ in terms of sustainability performance. In this regard, evaluation of environmental, economic, and social performance of different soybean farming systems in Brazil, by consideration of variability in input parameters, is critically needed. In this context, we evaluated a number of environmental, economic, and social issues for the two main soybean farming systems in southern Brazil, the conventional system, which produces genetically modified (GM) or non-genetically modified (non-GM) soybeans, and the organic system. Data were collected for 2012 from three sources: soybean farms in Paraná, Brazil (15 GM, 15 non-GM, and 15 organic farms), the Brazilian Enterprise for Agricultural Research (EMBRAPA), and expert elicitation. Monte Carlo simulation was used to account for the variation in input parameters. Five sustainability issues were evaluated in this study: global warming, land occupation, primary energy use, profitability, and employment. Results revealed that, compared with the GM and non-GM systems, organic systems had a higher probability (77%) to have a lower global warming potential. Land occupation was higher and energy use was lower for organic systems than for the GM and non-GM systems at every level of probability. Concerning profitability, organic systems had a higher probability (60%) to have higher profitability compared with GM and non-GM production, and employment was higher for organic systems at every level of probability. Overall, simulation results of this study illustrated the relatively high level of variation in the environmental, economic, and social performance of organic soybean farming systems. This study shows that accounting for variability in key system parameters provides not only insight in the most likely outcomes, but also in the robustness of system performance.</p

Plastia valvar aórtica por ampliação de válvula(s) com pericárdio bovino Reparative operation for aortic valve incompetence by leaflet advancement with bovine pericardium

É apresentada técnica para correção do refluxo valvar aórtico pela desinserção e ampliação de uma ou mais das válvulas com pericárdio bovino. Após estudo experimental em peças animais isoladas, a técnica foi empregada, com sucesso imediato, em seis pacientes. Em todos os casos, ampliou-se a válvula não coronariana e, em dois, ampliou-se, também, a válvula coronariana esquerda. O levantamento das comissuras valvares poderá constituir-se em uma técnica complementar, desde que foi uma constante em todos os pacientes operados. Uma paciente faleceu no sétimo mês de pós-operatório por endocardite bacteriana. Os demais pacientes encontram-se em períodos de observação de quatro a 12 meses. As observações iniciais permitem afirmar que a técnica é reproduzível com bons resultados imediatos. A evolução clínica a médio e a longo prazo é fundamental para uma apreciação mais definitiva, sendo motivo de constante preocupação a ocorrência de endocardite bacteriana e as conseqüências da evolução do processo reumático.A new technique for correction of aortic incompetence by the advancement of one more valve leaflets with bovine pericardium is presented. After experimental studies in isolated animal hearts, this technique was used with immediate success in six patients. In all cases non coronarian leaflet was advanced and in two cases the left coronarian leaflet was also advanced. The elevation of valve comissure may constitute a complimentary technique, as long as it has been constant in all cases operated. One patient died in the seventh month after surgery of bacterian endocarditis. All the others are now in postoperative follow-up of four to twelve months. Early observation allows the statement that the technique is reproducible with good immediate results. The early and late follow-up are fundamental to take a more definitive conclusion. The occurence of bacterian endocarditis and the consequences of evolution of rheumatic process are motives of constant preocupation

Desenvolvimento de um projeto para construção de bomba-balão para contrapulsação aórtica Development and construction of a balloon-pump for aortic counterpulsation

O presente trabalho tem por finalidade apresentar as etapas de um projeto para construção de uma bomba-balâo para contrapulsação aórtica. Desenvolveram-se três protótipos, sendo que os dois primeiros utilizavam ar comprimido e vácuo hospitalares para insuflação e deflação do cateter-balão. Esses dois protótipos apresentavam como diferenças fundamentais: o tipo de dispositivo que captava o sinal luminoso da onda R do ECG utilizado para a sincronização do bombeamento; o tipo de válvula solenóide e os componentes eletrônicos de maior resolução utilizados no segundo protótipo. O terceiro e atual protótipo passou a obter o sinal da onda R diretamente da saída de cardioversão do monitor de ECG e substituiu o ar comprimió e o vácuo hospitalares, além das válvulas solenóides, por uma bomba eletromagnética. Está em fase de resolução o problema de deflação tardia que ainda ocorre no sistema.The present paper presents the project and construction of a balloon-pump for aortic counterpulsation. Three experimental models were developed, the first two using hospital air and vacuum lines for inflation and deflation of the balloon catheter. These two inicial models diffères among themselves in the mechanism used to capture the light signal corresponding to the R wave of the ECG, which was used to sincronize the pumping. The solenoid valve and electronic components were of higher resolution in the second model. The third and present model recieves the R wave signal from the cardioversor adaptor of ECG monitor and the hospital vacuum and air lines along with the solenoid valve were substituted by an electromagnetic pump. The problems related to late deflation that have ocurred in the system are still in study. Emphasis is given on the importance of this research, which has incremented knowledge for the construction of other medical equipment, mainly in the area of respiratory care

Características químicas de solo e rendimento de fitomassa de adubos verdes e de grãos de milho, decorrente do cultivo consorciado Soil chemical characteristics and green manure yield in a corn intercropped system

A adubação verde é uma das formas de aporte de matéria orgânica ao solo. O sistema de cultivo consorciado de culturas pode ser uma alternativa para aumentar a reciclagem de nutrientes e melhorar a produtividade. Para avaliar o sistema consorciado de adubos verdes com o milho, foram estudadas as características químicas do solo, a produção de matéria seca, a composição mineral de adubos verdes e o rendimento de grãos de milho, num experimento realizado em campo, entre 1995 e 1997, em solo classificado como Nitossolo Vermelho eutrófico. O milho foi semeado no espaçamento de 90 cm nas entrelinhas, perfazendo, aproximadamente, 50.000 plantas por hectare. Os tratamentos constaram de quatro espécies de adubos verdes: mucuna anã [Mucuna deeringiana (Bort.) Merr], guandu anão (Cajanus cajan L.), crotalária (Crotalaria spectabilis Roth) e feijão-de-porco (Canavalia ensiformis L.) e um tratamento-testemunha, sem cultivo consorciado. Essas espécies foram semeadas sem adubação, no meio da entrelinha, em duas épocas: simultânea ao milho e 30 dias após. O delineamento experimental foi o de blocos ao acaso em parcelas subdivididas, com quatro repetições. O feijão-de-porco apresentou maior produção de fitomassa e acúmulo de N, P, K, Ca, Mg e S. No primeiro ano de cultivo, o rendimento de grãos de milho não foi influenciado pelo cultivo consorciado com adubos verdes; no entanto, no segundo, a produção foi beneficiada pelo consórcio com feijão-de-porco.<br>Green manure is one way of supplying organic matter to soil. The mixed cultivation of crops may be an alternative to increase nutrient cycling and to improve productivity. To evaluate intercrops of green manure and corn, soil chemical characteristics, green manure dry matter production and its mineral composition and corn yield were determined in a field experiment carried out between 1995 and 1997 on an Aleudalf Soil in Piracicaba, state of São Paulo, Brazil. Corn was sown in rows spaced 90 cm apart to obtain approximately 50,000 plants per hectare. The treatments consisted of four green manure species: dwarf mucuna [Mucuna deeringiana (Bort.) Merr], dwarf pigeon pea (Cajanus cajan L.), crotalaria (Crotalaria spectabilis Roth), jack bean (Canavalia ensiformis L.), plus a control without green manure. Green manure species were sown without fertilizer application in a single row in-between the rows simultaneously with corn or 30 days after corn sowing. The experimental design consisted of randomized blocks in split plots and four replicates. Jack bean produced most phytomass and accumulated the highest amounts of N, P, K, Ca, Mg, and S. In the first year of cultivation, the corn yields were not affected by the intercropped cultivation with green manure, but in the second year the yield was highest when corn was intercropped with jack bean