Presentation

UNIFESP-EPMUNIFESP, EPMSciEL

Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy

BACKGROUND: Venous ulcers are a major public health problem worldwide and are responsible for considerable economic impact because of their high incidence. In addition to restricting daily living and leisure activities, they may result in changes in quality of life and self-esteem, and even lead to depression. The aim of this study is to evaluate the quality of life in patients with venous ulcers who are being treated with Unna's boot compression therapy. METHODS: Fifty patients with venous ulcers treated at the Conjunto Hospitalar de Sorocaba were enrolled. Data were collected using the Short Form-36 (SF-36) health survey upon inclusion in the study and after 4, 8, and 12 months of compression therapy. RESULTS: Initial mean SF-36 scores were low (15.10), indicating decreased quality of life. After 12 months of Unna's boot compression therapy, the mean SF-36 score was 95.38, indicating improved quality of life (P = 0.0001). CONCLUSIONS: Patients with venous ulcers at the beginning of data collection had lower quality of life but improved after 8 months of treatment with Unna's boot compression therapy.INTRODUÇÃO: As úlceras vasculares vêm se constituindo um grande problema de saúde pública em todo o mundo, sendo responsáveis por considerável impacto econômico pela elevada incidência dessas lesões crônicas. Além de restringir as atividades da vida diária e o lazer, pode ter como consequência alteração na qualidade de vida e na autoestima, levando o paciente, até mesmo, à depressão. O objetivo deste estudo é avaliar a qualidade de vida em pacientes com úlcera venosa que estão sendo tratados com terapia compressiva por bota de Unna. MÉTODO: Foram selecionados 50 pacientes com úlcera venosa em tratamento no Ambulatório de Feridas do Conjunto Hospitalar de Sorocaba (Sorocaba, SP, Brasil). A coleta de dados foi realizada no momento da inclusão no estudo, sendo repetida aos 4 meses, 8 meses e 12 meses após a primeira coleta de dados, utilizando o questionário Short Form-36 (SF-36). RESULTADOS: Durante a inclusão do paciente no estudo, os escores médios do SF-36 foram baixos (15,10), caracterizando queda da qualidade de vida. Após 12 meses de terapia compressiva por bota de Unna, o escore médio foi de 95,38, caracterizando melhora da qualidade de vida dos pacientes analisados (P = 0,0001). CONCLUSÕES: Os pacientes com úlcera venosa, no início da coleta de dados, apresentaram qualidade de vida baixa, e após 8 meses de tratamento com bota de Unna foi observada melhora da qualidade de vida.UNIFESPUNIFESPSciEL

Self-esteem and depression in patients presenting angle class III malocclusion submitted for orthognathic surgery

Objective: To assess self-esteem and depression in patients submitted for orthognathic surgery. Methods: Assessment was realized on 29 patients, male and female, aged 17 to 46, presenting Angle Class III malocclusion and referred for surgical treatment, during the preoperative (orthodontic preparation) and postoperative (six-month postoperative) periods. Either maxillomandibular or isolated procedures were performed. Two previously validated standardized measurement instruments for this area were used: the UNIFESP-EPM Rosenberg Self-Esteem Scale and the SelfReport Questionnaire-20 (SRQ-20). Descriptive and inferential statistical analysis (Repeated Measures Analysis of Variance and the Bonferroni test) verified possible interactions between the pre and postoperative periods, genders and types of surgery. Significance was determined at 5%. Results: Females showed improved self-esteem, presenting lower mean values after surgery (8.9 to 6.3). Regarding depression, a significant reduction in the number of depressive symptoms (p=0.002) occurred for female patients. Conclusions: Female patients presented improved self-esteem and diminished depressive symptoms due to surgical intervention; whereas male patients showed no alteration in self-esteem and depression with surgical intervention

Evaluation of depressive symptoms in patients with venous ulcers

BACKGROUND: Venous ulcers play an important role in patients' lives, as the incidence of deformities caused by this type of wound might produce adverse consequences, including psychosocial disorders. The objective of this study is to evaluate the occurrence of depressive symptoms presented by patients with venous ulcers. METHODS: An exploratory, descriptive, analytical, and cross-sectional study was conducted at the Outpatient Wound Clinic of the Hospital Set within the State of São Paulo. The data were collected by interviews between December 2008 and April 2009 after approval of the research project by the Research Ethics Committee of the Federal University of São Paulo (CEP-1611/08). The Beck Depression Inventory was the instrument of the study. RESULTS: Sixty patients participated in the survey. The majority (91.66%) showed some level of depression. There was a higher frequency of symptoms ranging from mild to moderate (n = 39; 65%). All levels of depression showed statistical differences. The five symptoms most commonly found were sadness, distorted body image, self-depreciation, decreased libido, and social withdrawal. Symptoms less represented were suicidal ideation and loss of appetite, each mentioned by only one patient. Forty-three patients were over 61 years old. Of these, 38 (88.4%) had depressive symptoms ranging from mild to severe. CONCLUSIONS: The data obtained and evaluated by the Beck Depression Inventory allow the conclusion that patients with venous ulcers present different levels of depressive symptoms.INTRODUÇÃO: A úlcera venosa assume grande importância na vida dos pacientes, pois a ocorrência de deformidades causadas por esse tipo de ferida pode gerar consequências adversas, as quais incluem distúrbios psicossociais. O objetivo deste estudo é avaliar o nível de ocorrência de sintomas depressivos apresentados pelos pacientes com úlcera venosa. MÉTODO: Estudo exploratório, descritivo, analítico e transversal, realizado no Ambulatório de Feridas de um Conjunto Hospitalar, localizado no interior do estado de São Paulo. Os dados foram coletados por meio de entrevistas, no período compreendido entre dezembro de 2008 e abril de 2009, após aprovação do projeto de investigação pelo Comitê de Ética em Pesquisa da Universidade Federal de São Paulo (UNIFESP) (CEP-1611/08). Foi utilizado o Inventário de Avaliação de Depressão de Beck. RESULTADOS: Participaram da pesquisa 60 pacientes. A maioria (91,66%) apresentou algum nível de depressão. Houve maior frequência de sintomas no nível leve a moderado (n = 39; 65%). Todos os níveis apresentaram diferença estatística. Os cinco sintomas mais encontrados foram: tristeza, distorção da imagem corporal, autodepreciação, diminuição da libido e retração social. Os sintomas menos representados foram ideia suicida e perda do apetite, sendo referidos por um paciente em cada aspecto. Quanto à idade, 43 pacientes tinham mais de 61 anos, dos quais 38 (88,4%) apresentavam sintomas depressivos no nível leve a grave. CONCLUSÕES: Os resultados obtidos por meio do Inventário de Avaliação de Depressão de Beck permitiram concluir que pacientes com úlcera venosa apresentam níveis diferentes de sintomas depressivos.Universidade do Vale de SapucaíUniversidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Assessment of depressive symptoms in people with diabetes mellitus and foot ulcers

OBJECTIVE: To evaluate the intensity of symptoms of depression in patients with diabetic foot ulcers. METHODS: a exploratory, descriptive, analytical and cross-sectional study was held at the wound clinic of a public hospital in Sorocaba, São Paulo State, Brazil. Fifty patients with diabetes mellitus and foot ulcers were enrolled. To assess the intensity of the symptoms of depression, a Beck Depression inventory was used. RESULTS: Of the 50 patients evaluated, 41 had some degree of depressive symptoms and 32 (64%) had moderate depression, with symptoms of self-loathing, grief, body image distortion and decreased libido. CONCLUSION: Patients with diabetic foot ulcers showed varying degrees of depressive symptoms.OBJETIVO: Avaliar a intensidade de sintomas de depressão nos pacientes diabéticos com úlceras no pé. MÉTODOS: Estudo exploratório, descritivo, analítico e transversal, realizado no ambulatório de feridas de um hospital público, de Sorocaba/SP. Participaram 50 pacientes com diabetes mellitus e pé ulcerado. Para mensurar a intensidade dos sintomas de depressão foi utilizado o inventário de Avaliação de Depressão de Beck. RESULTADOS: Dos 50 pacientes avaliados, 41 apresentavam algum grau de sintoma depressivo, sendo que 32 (64%) com depressão moderada, apresentando sintomas de autodepreciação, tristeza, distorção da imagem corporal e diminuição da libido. CONCLUSÃO: Pacientes diabéticos com pé ulcerado apresentaram graus variados de sintomas depressivos.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Quemaduras, el metabolismo y los requerimientos nutricionales

Objectives: To review the nutritional evaluation in burned patient, considering the literature descriptions of nutritional evaluation and energy requirements of these patients.Introduction: Thermal injury is the traumatic event with the highest metabolic response in critically ill patients. Various mathematical formulas have been developed to estimate nutritional requirements in burned patient. Indirect Calorimetry is the only method considered gold standard for measuring caloric expenditure.Methods: A survey of the literature and data was collected based on official data bases, LILACS, EMBASE and PubMed.Results: the metabolic changes involved in hypermetabolism are designed to supply energy to support immune function, brain activity, wound healing, and preservation of body tissues. Body weight is considered the easiest indicator and perhaps the best to assess the nutritional status. the most common formulas utilized in these patients are the Curreri, Pennisi, Schofield, Ireton-Jones, Harris-Benedict and the ASPEN recommendations. for children is the Mayes and World Health Organization formula. the majority of mathematical formulas overestimate the nutritional needs. the regular use of Indirect Calorimetry supplies adequate nutritional support to the burn patient.Discussion: the traditional nutritional evaluation considers anthropometry, biochemical markers and estimation of nutritional requirements. the weight provides a basis for decisions that are established in the clinical context. Classic parameters can be adapted to intensive care environment.Conclusions: the use of Indirect Calorimetry is crucial to ensure the safety of the nutritional support of burn patients and this should be widely encouraged. (Nutr Hosp. 2011;26:692-700) DOI:10.3305/nh.2011.26.4.5217Universidade Federal de São Paulo, Postgrad Course Surg, São Paulo, BrazilUniversidade Federal de São Paulo, Div Plast Surg, Dept Surg, São Paulo, BrazilUniversidade Federal de São Paulo, Postgrad Course Surg, São Paulo, BrazilUniversidade Federal de São Paulo, Div Plast Surg, Dept Surg, São Paulo, BrazilWeb of Scienc

Prevalência de úlcera por pressão em instituições de longa permanência para idosos em São Paulo

CONTEXT AND OBJECTIVE: The prevalence of pressure ulcers varies according to geographic region and population group, such as the institutionalized elderly. The aim of this study was to identify the prevalence of pressure ulcers among elderly people living in long-stay institutions. DESIGN AND SETTING: Cross-sectional study in six long-stay institutions for the elderly in São Paulo, Brazil. METHODS: Demographic and clinical data were collected in six long-stay institutions on two visits to each institution between May and August 2007, during which all elderly patients with pressure ulcers were evaluated. The Braden scale was used to identify the risk of developing pressure ulcers and the National Pressure Ulcer Advisory Panel (NPUAP) stages for classifying the pressure ulcers. Statistical analysis was performed using the chi-square test, Student's t-test and Fisher's exact test. RESULTS: There was no significant difference in the results between visits. The population was 181 elderly people in May and 184 in August: 23 had pressure ulcers in May (prevalence of 12.7%) and 17 in August (prevalence of 9.2%). The mean age at the two times was 84 years, and the average length of stay was 32 months. Pressure ulcers were found mainly in the sacral region (mean, 71.5%), and most commonly in stage II (mean, 41%). CONCLUSION: The prevalence of pressure ulcers was 10.95%. These data provide background information that may aid in developing protocols for applying best practices for prevention and treatment of pressure ulcers, consequently reducing the prevalence.CONTEXTO E OBJETIVO: A prevalência de úlcera por pressão (UP) varia de acordo com a região geográfica e grupo populacional, como idosos institucionalizados. O objetivo foi identificar a prevalência de UP em instituições de longa permanência para idosos (ILPI). TIPO DE ESTUDO E LOCAL: Estudo transversal em seis ILPI em São Paulo. MÉTODOS: A coleta de dados demográficos e clínicos foi realizada em seis ILPI durante duas visitas a cada instituição no período de maio a agosto de 2007, sendo avaliados todos os idosos com UP. Foi utilizada a Escala de Braden para identificar o risco de desenvolver UP e o National Pressure Ulcer Advisory Panel (NPUAP) para a classificação das UP. Foram realizados os testes: Exato de Fisher, Q-Quadrado e t-Student para análise estatística. RESULTADOS: Não houve significância estatística nos resultados encontrados. A população era de 181 idosos em maio e 184 em agosto, sendo 23 idosos com UP (prevalência de 12,7%) e 17 idosos com UP (prevalência de 9,2%) respectivamente. A média de idade nos dois períodos foi de 84 anos, e 32 meses de permanência nas Instituições. A região sacral foi a mais frequente com média de 71,5% e as úlceras no estágio II com média de 41%. CONCLUSÃO: A prevalência de UP foi de 10,95%. Estes dados fornecem informações de base que podem auxiliar no desenvolvimento de protocolos para a aplicação de melhores práticas na prevenção e tratamento de úlceras de pressão, consequentemente reduzindo a prevalência.Universidade Federal de São Paulo (UNIFESP) Division of Plastic SurgeryUniversidade Federal de São Paulo (UNIFESP) Division of Plastic Surgery Program on Plastic SurgeryUNIFESP, Division of Plastic SurgeryUNIFESP, Division of Plastic Surgery Program on Plastic SurgerySciEL

Número de objetivos e conclusões em dissertações e teses

PURPOSE: To analyze the number of objectives and conclusions presented in dissertations and thesis defended at Federal University of São Paulo - Paulista School of Medicine (UNIFESP - EPM). METHODS: It was realized a search in the master degree dissertations and doctor degree thesis defended at Federal University of São Paulo - Paulista School of Medicine in the years 2002 and 2003 that were found available in the central library of this university. RESULTS: From 723 master dissertations analyzed, 62 (8,57%) presented only one objective and one conclusion, 134 (18,53%) presented one objective and more than one conclusion and 527 (72,89%) had more than one objective and more than one conclusion. From 502 doctor thesis analyzed, 23 (4,58%) presented only one objective and one conclusion, 123 (24,50%) presented one objective and more than one conclusion and 376 (74,90%) had more than one objective and more than one conclusion.. CONCLUSIONS: It wasn't found in researched literature the number of objectives and conclusions a scientific work must have. A highest number of thesis and dissertations presented more than one objective and more than one conclusion.OBJETIVO: Analisar o número de objetivos e conclusões em teses e dissertações defendidas na Universidade Federal de São Paulo (UNIFESP) - Escola Paulista de Medicina (UNIFESP - EPM), em relação ao número de objetivos e conclusões que as mesmas apresentam.. MÉTODOS: Foi realizado um levantamento das dissertações de mestrado e teses de doutorado defendidas na Universidade Federal de São Paulo (UNIFESP) - Escola Paulista de Medicina (UNIFESP-EPM) nos anos de 2002 e 2003, que se encontravam disponíveis na biblioteca central desta universidade. RESULTADOS: Das 723 dissertações de mestrado defendidas na UNIFESP - EPM, 62 (8,57%) apresentaram apenas um objetivo e uma conclusão; 134 (18,53%) apresentaram um objetivo e mais de uma conclusão e 527 (72,89%) possuíam mais de um objetivo e mais de uma conclusão. Das 502 teses de doutorado analisadas, 23 (4,58%) apresentaram apenas um objetivo e uma conclusão, 123 (24,50%) apresentaram um objetivo e mais de uma conclusão e 376 (74,90%) possuíam mais de um objetivo e mais de uma conclusão. CONCLUSÕES: Não foi encontrado na literatura pesquisada a quantidade de objetivos e conclusões que um trabalho científico deve conter. A maioria das teses e dissertações defendidas na Universidade Federal de São Paulo (UNIFESP) - Escola Paulista de Medicina (UNIFESP-EPM) nos anos de 2002 e 2003 apresentou mais de um objetivo e mais de uma conclusão.Federal University of São Paulo Paulista School of MedicinePaulista UniversityUNIFESP-EPM Surgery DepartmentUNIFESP, Paulista School of MedicineUNIFESP, EPM Surgery DepartmentSciEL

Control of the skin scarring response

There comes a time when the understanding of the cutaneous healing process becomes essential due to the need for a precocious tissue repair to reduce the physical, social, and psychological morbidity. Advances in the knowledge on the control of interaction among cells, matrix and growth factors will provide more information on the Regenerative Medicine, an emerging area of research in medical bioengineering. However, considering the dynamism and complexity of the cutaneous healing response, it is fundamental to understand the control mechanism exerted by the interaction and synergism of both systems, cutaneous nervous and central nervous, via hypothalamus hypophysis-adrenal axis, a relevant subject, but hardly ever explored. The present study reviews the neuro-immune-endocrine physiology of the skin responsible for its multiple functions and the extreme disturbances of the healing process, like the excess and deficiency of the extracellular matrix deposition.Aproxima-se uma época na qual é fundamental a compreensão do processo cicatricial cutâneo frente à necessidade da restauração tecidual precoce, visando a diminuição das morbidades física, social e psicológica. O avanço no conhecimento acerca do controle das interações entre as células, a matriz e os fatores de crescimento dará maiores informações à Medicina Regenerativa, área de pesquisa emergente da bioengenharia médica. Entretanto, diante do dinamismo e complexidade da resposta cicatricial cutânea torna-se indispensável o entendimento do mecanismo de controle exercido pela interação e sinergismo do sistema nervoso cutâneo e o sistema nervoso central, via eixo hipotálamo-hipófise-adrenal, tema relevante, porém, pouco abordado. O presente estudo revisa a fisiologia neuro-imuno-endócrina da pele, responsável por suas múltiplas funções, e os distúrbios extremos do processocicatricial, como o excesso e deficiência de deposição da matriz extracelular.Universidade Federal de São Paulo (UNIFESP) Programa de Pós-Graduação em Cirurgia PlásticaUNIFESP, Programa de Pós-Graduação em Cirurgia PlásticaSciEL

UNIFESP Info Plastica – An informative application covering the most frequently performed plastic surgeries worldwide

OBJECTIVES: The objective of this study was to develop a free smartphone application with reliable and useful information for the lay public on the most frequently performed plastic surgeries worldwide. METHODS: The five most frequently performed surgeries worldwide according to ISAPS (International Society of Aesthetic Plastic Surgery) were selected. Information from the websites of the American Society of Plastic Surgeons (ASPS), American Society for Aesthetic Plastic Surgery (ASAPS) and Brazilian Society of Plastic Surgery (SBCP) and from the Outpatient and Hospital Medicine Guide of the Plastic Surgery Division at the Federal University of Sa˜o Paulo (UNIFESP) was used for content assembly. YouTube videos with patients’ postoperative testimonials were used for an improved understanding of their real concerns. Printed text was distributed to patients in Brazil’s Unified Health Service to improve comprehensibility. Content on each of the five surgeries was presented in the application with the following layout: What is the surgery?; Who are the candidates?; Preparations for surgery; Stages of surgery; Recovery after surgery; Complications; Choice of surgeon; Consultation; What is the cost? and Glossary. All material was delivered to an outsourced company to produce the application software. RESULTS: The result was the creation of an application with extensive content on the most frequently performed plastic surgeries. CONCLUSION: The UNIFESP Info Plastica application is an academically based, free and reliable source of information for the lay public interested in all aspects of the most frequently performed plastic surgeries worldwide