As vivências da família e da pessoa portadora de esquizofrenia: contributos para o desempenho do enfermeiro de família

Mestrado em Enfermagem de Saúde FamiliarA esquizofrenia é uma doença mental caracterizada por uma perda do contacto com a realidade, alucinações, delírios, pensamentos anormais e alterações no funcionamento social e laboral. Com este trabalho pretendemos conhecer e compreender as vivências das famílias e da pessoa portadora de esquizofrenia, esperando que numa fase posterior possamos intervir de forma a capacitá-las para lidarem melhor com a doença. Enveredamos por um estudo fenomenológico, de abordagem qualitativa, cujos participantes foram elementos de famílias que têm um familiar portador de esquizofrenia e as pessoas portadoras da doença, do Concelho de Sever do Vouga. Para a colheita de dados foi utilizada uma entrevista semiestruturada, para que fosse possível recolher os dados que nos permitiram compreender a dinâmica familiar destas famílias e de que forma a mesma, foi ou não alterada com a emergência desta patologia em um dos seus membros. Os resultados apontam para a necessidade de maior atenção dos profissionais de saúde, da sociedade e da família enquanto unidade social em relação à pessoa portadora de esquizofrenia e ao familiar cuidador. Torna-se pertinente uma futura intervenção profissional, de forma a capacitar a família e a pessoa portadora de esquizofrenia para melhor controlar os sintomas e lidarem da forma menos traumática com as consequências inerentes à esquizofrenia. Deixamos como proposta de intervenção familiar na esquizofrenia, o Modelo de Falloon de forma a ajudar a família a adotar métodos que facilitem a expressão das emoções, onde seja facilitada a partilha das dificuldades sentidas no cuidar da pessoa com esquizofrenia. Salientamos a necessidade de uma intervenção multidisciplinar de forma a melhorar a assistência à pessoa doente e família, evitando o facto de muitas vezes a família adoecer como consequência da agressividade, da sobrecarga física, do preconceito e de sentimentos, que acabam por a desgastar, devido à convivência com a pessoa doente. Esperamos ainda que a concretização deste trabalho possa proporcionar mudanças de comportamento no sentido de aumentar a qualidade de vida da família e da pessoa portadora de esquizofrenia e contribuir para que outros estudos se efetuem neste domínio.Schizophrenia is a mental illness characterized by a loss of contact with reality, hallucinations, delusions, abnormal thinking and changes in social and occupational functioning. With this work we intend to know and understand the experiences of families and the person with schizophrenia, hoping that at a later stage can intervene in order to enable them to cope better with the disease. We set out phenomenological study of qualitative approach, whose participants were members of families who have a relative with schizophrenia and people with the disease, the Municipality of Sever do Vouga. For data collection we used a semistructured interview, to be able to collect the data that allowed us to understand the family dynamics of these families and how the same, or has not changed with the emergence of this disease in one of its members. The results point to the need for greater attention of health professionals, society and the family as a social unit in relation to the person with schizophrenia and the family caregiver. It is pertinent to a future professional intervention in order to empower the family and the person with schizophrenia to better control the symptoms and deal the least traumatic way with the inherent consequences to schizophrenia. We leave as family intervention proposal in schizophrenia, the model in order to help the family Falloon to adopt methods that facilitate the expression of emotions, where it facilitates the sharing of difficulties in caring for the person with schizophrenia. We highlight the need for a multidisciplinary approach to improve the assistance to the patient and family person, avoiding the fact that often the family become ill as a result of aggression, physical overload, prejudice and feelings that end up to wear due to living with the sick person. We also expect the completion of this work can provide behavioral changes to increase the quality of family life and carrier schizophrenia person and contribute to other studies are effected in this area

Effects of low-intensity pulsed ultrasound on injured skeletal muscle

BACKGROUND:Low-intensity pulsed ultrasound (LIPUS) has been shown to stimulate tissue metabolism and accelerate muscle healing. However, the optimal parameters in the use of LIPUS are still not clear.OBJECTIVE:The aim of this study was to analyze the effects of LIPUS on muscle healing in rats subjected to a cryolesion.METHOD:Twenty rats were divided into the following groups: an injured control group (CG) and an injured treated group (TG). Both groups were divided into 2 sub-groups (n=5 each) that were sacrificed 7 and 13 days post-surgery. Treatments were started 24 hours after the surgical procedure and consisted of 3 or 6 sessions. After euthanasia, the muscles were submitted to standard histological procedures.RESULTS:Qualitative analyses were based on morphological assessments of the muscle. The histopathological analysis on day 7 revealed that the muscles in the CG and the TG presented an intense inflammatory infiltrate, a large necrotic area and a disorganized tissue structure. After 13 days, both the CG and the TG had granulation tissue and newly formed fibers. The TG presented a more organized tissue structure. The quantitative analysis of collagen indicated similar findings among the groups, although the qualitative analysis revealed a better organization of collagen fibers in the TG at 13 days. The immunohistochemical analysis indicated that, at both time points, the expression of cyclooxygenase-2 was upregulated in the TG compared to the CG.CONCLUSIONS: LIPUS used as a treatment for muscle injury induced a more organized tissue structure at the site of the injury and stimulated the expression of COX-2 and the formation of new muscle fibers.Universidade Federal de São Paulo (UNIFESP) Department of BiosciencesUniversidade Federal de São Carlos Physical Therapy DepartmentUNIFESP, Department of BiosciencesSciEL

Restoration of Noncarious Cervical Lesions: When, Why, and How

At this time, restoration of noncarious cervical lesions (NCCLs) is a common occurrence in clinics nowadays. Some reasons for this are the growth of the elderly population, a smaller rate of tooth loss, and possibly the increase of some etiologic factors. These factors include inadequate brushing techniques in gingival recession cases, corrosive food and drink consumption, and occlusal stress concentrating factors (occlusal interferences, premature contacts, habits of bruxism, and clenching). Unfortunately, Class V restorations also represent one of the less durable types of restorations and have a high index of loss of retention, marginal excess, and secondary caries. Some causes for these problems include difficulties in isolation, insertion, contouring, and finishing and polishing procedures. This work aims to help dentists in choosing the best treatment strategy, which necessarily involves steps of problem identification, diagnosis, etiological factor removal or treatment, and, if necessary, restoration. Finally, appropriate restorative techniques are suggested for each situation

Insuficiência renal aguda nefrotóxica: prevalência, evolução clínica e desfecho

INTRODUCTION: Nephrotoxic acute renal failure (ARF) is a frequent and important cause of morbidity and mortality. OBJECTIVE: To assess the prevalence, clinical course, and outcome of nephrotoxic ARF. PATIENTS AND METHODS: Historical cohort carried out in a tertiary school hospital from February to November, 1997. Patients over 12 years of age, diagnosed with ARF, and followed up by a team of nephrologists were included. The exclusion criteria were as follows: renal transplantation, chronic renal failure, dialysis due to exogenous poisoning, and those transferred to hospital during treatment. RESULTS: Of the 234 patients followed up, 12% had nephrotoxic ARF and 24% multifactorial ARF associated with the use of nephrotoxic drugs. The most prevalent comorbidities were as follows: hypertension, hepatopathy, neoplasias, congestive heart failure, and diabetes mellitus. Fifteen percent of the patients required dialysis, and the most commonly used type was continuous venovenous hemodialysis; 42% of the patients were oliguric; 44.7% died; and 33% recovered renal function. The most prevalent nephrotoxic drugs were antibiotics, nonsteroidal anti-inflammatory drugs, and radiographical contrast media. In order of frequency, the nephrotoxic drugs were as follows: vancomycin, aminoglycosides, acyclovir, chemotherapy agents, and radiographical contrast media. In multivariate analysis, hepatopathy was the only statistically significant variable (p = 0.03, CI = 1.08 to 6.49). The comparison of non-nephrotoxic and nephrotoxic ARF showed an increase in mortality proportional to the length of hospitalization. CONCLUSION: Nephrotoxic ARF is common, serious, and must be continuously monitored both in hospital and on an outpatient basis.INTRODUÇÃO: A insuficiência renal aguda (IRA) nefrotóxica é frequente e importante causa de morbimortalidade. OBJETIVO: Avaliar a prevalência, o curso clínico e o desfecho da IRA nefrotóxica. PACIENTES e MÉTODOS: Coorte histórica realizada em um hospital de ensino terciário, no período de fevereiro a novembro de 1997. Foram incluídos pacientes acima de 12 anos, com diagnóstico de IRA, acompanhados pela equipe de Interconsulta de Nefrologia. Foram excluídos transplantados renais, portadores de insuficiência renal crônica, dialisados por intoxicação exógena e aqueles transferidos de hospital durante o tratamento. RESULTADOS: Dos 234 pacientes acompanhados, 12% apresentaram IRA nefrotóxica e 24%, IRA multifatorial associada ao uso de drogas nefrotóxica. Entre as comorbidades mais prevalentes, estão hipertensão arterial, hepatopatias, neoplasias, insuficiência cardíaca congestiva e diabetes mellitus. Quinze por cento necessitaram de diálise, e o tipo mais frequentemente usado foi hemodiálise venovenosa contínua; 42% eram oligúricos, 44,7% evoluíram para óbito e 33% recuperaram a função renal. Antibióticos, AINH e contraste radiológico foram as drogas nefrotóxicas mais prevalentes.Os medicamentos nefrotóxicos implicados foram, em ordem de frequência, vancomicina, aminoglicosídeos, aciclovir, quimioterápicos e contraste radiológico. Hepatopatia foi a única variável com significância estatística (p = 0,03, IC = 1,08 a 6,49) em análise multivariada. Na comparação entre IRA nefrotóxica e não nefrotóxica, houve aumento da mortalidade proporcionalmente aos dias de internação. CONCLUSÃO: IRA nefrotóxica é frequente, grave e deve ser continuamente monitorada, tanto ambulatorialmente quanto no ambiente intra-hospitalar

Interactions among medicines under special control in the District Pharmacy Centro in Porto Alegre, RS, Brazil

A politerapia é uma prática útil no tratamento de patologias coexistentes ou para potencializar o efeito farmacológico em condições pouco responsivas, porém apresenta um grande risco para interações medicamentosas. Sendo assim, o objetivo deste estudo foi identificar em prescrições atendidas pela Farmácia Distrital Centro em Porto Alegre, RS, as interações medicamentosas de medicamentos sujeitos a controle especial e classificá-las quanto a potenciais interações medicamentosas e grau de severidade com auxílio da base de dados MICROMEDEX®. Após análise de 2.839 receituários, os resultados mostraram que grande parte dos pacientes pertencia ao sexo feminino e que 75% do total das prescrições apresentavam algum tipo de interação. Das 291 associações analisadas, 44,4% apresentavam risco forte de interação, 23,9% risco moderado e 6,5% risco leve. A maioria das interações com risco forte apresentava como principal risco a cardiotoxicidade. A elevada frequência de interações e o risco de efeitos tóxicos, aponta para a necessidade de um sistema adequado de informações sobre o uso de medicamentos e de orientação farmacêutica nessas unidades de saúde.Polytherapy is a useful practice in the treatment of coexisting conditions or to enhance the pharmacological effect in less responsive conditions, but it presents a significant risk for drug interactions. Thus, the objective of this study was to identify in prescriptions issued by the Farmácia Distrital Centro in Porto Alegre, RS, possible drug interactions of medicines under special control and to classify them about potential drug interactions and degree of severity using the database MICROMEDEX®. After analyzing 2,839 prescriptions, the results showed that the majority of the patients were female and 75% of prescriptions presented some interaction. Out of 291 drug-drug associations analyzed. 44.4% gave a substantial risk of interaction, 23.9% moderate risk and 6.5% minor risk. Most of the strong-risk interactions showed cardiotoxicity as the main risk. The high frequency of interactions and the risk of toxic effects, also point to the need for an adequate information system on the use of medications as well as pharmaceutical guidance in these health facilities

Nanostructured system based on hydroxyapatite and curcumin: A promising candidate for osteosarcoma therapy:A promising candidate for osteosarcoma therapy

Osteosarcoma is the most common type of bone cancer. Despite therapeutic progress, survival rates for metastatic cases or that do not respond well to chemotherapy remain in the 30% range. In this sense, the use of nanotechnology to develop targeted and more effective therapies is a promising tool in the fight against cancer. Nanostructured hydroxyapatite, due to its biocompatibility and the wide possibility of functionalization, is an interesting material to design nanoplatforms for targeted drug delivery. These platforms have the potential to enable the use of natural substances in the fight against cancer, such as curcumin. Curcumin is a polyphenol with promising properties in treating various types of cancer, including osteosarcoma. In this work, hydroxyapatite (n-HA) nanorods synthesized by the hydrothermal method were investigated as a carrier for curcumin. For this, first-principle calculations based on the Density Functional Theory (DFT) were performed, in which the modification of curcumin (CM) with the coupling agent (3-aminopropyl) triethoxysilane (APTES) was theoretically evaluated. Curcumin was incorporated in n-HA and the drug loading stability was evaluated by leaching test. Samples were characterized by a multi-techniques approach, including Fourier transform infrared spectroscopy (FTIR), UV–visible spectroscopy (UV–Vis), X-ray diffraction (XRD), X-ray fluorescence spectrometry (FRX), thermogravimetric analysis (TGA), differential scanning calorimetry (DSC), zeta potential analysis (ζ), X-ray photoelectron spectroscopy (XPS) and transmission electron microscopy (TEM). The results show that n-HAs with a 90 nm average size were obtained and successful incorporation of curcumin in the nanostructure was achieved. Cell viability and the number of osteosarcoma cells were decreased by CMAP-HA treatment. Furthermore, the stability test suggests that hydroxyapatite nanoparticles present great potential for the transportation of curcumin in the bloodstream, crediting this system for biological performance evaluations aiming at the treatment of osteosarcomas. Keywords: nanostructures, curcumin, hydroxyapatite, osteosarcoma

ANÁLISE MICROBIOLÓGICA DA ÁGUA DE BEBEDOUROS DE UMA INSTITUIÇÃO DE ENSINO SUPERIOR DE RONDÔNIA, BRASIL

A água é um recurso essencial para manutenção da vida humana, sendo recomendado a ingestão de no mínimo dois litros diariamente. Vale destacar que água para consumo humano deve ser livre de qualquer contaminante de modo que não comprometa a saúde. O objetivo deste estudo foi realizar a análise microbiológica da água de bebedouros de uma Instituição de Ensino Superior do estado de Rondônia. Para tanto, 48 amostras de água provenientes de oito bebedouros foram submetidas a pesquisa de coliformes totais e coliformes termotolerantes empregando a técnica de Número Mais Provável (NMP). As análises microbiológicas evidenciaram a presença de coliformes totais em 19 (39,5%) das amostras. Dessas, 18 (37,5%) também demonstraram positividade para coliformes termotolerantes. Sendo assim, 39,5% das amostras foram classificadas como impróprias para consumo, já que a legislação vigente no Brasil recomenda ausência desses grupos de microrganismos em água para consumo. Os resultados obtidos evidenciaram um elevado percentual de amostras impróprias para consumo, demonstrando a necessidade de medidas de correção a fim de evitar que os estudantes façam a ingestão de água contaminada

Biomechanical evaluation in runners with Achilles tendinopathy

OBJECTIVES: To evaluate the clinical characteristics, ground reaction force (GRF), and function of the plantar muscles and dorsiflexors of the ankle in runners with and without Achilles tendinopathy (AT) and in nonrunners. METHODS: Seventy-two participants (42 men, 30 women; mean age: 37.3±9.9 years) were enrolled in this crosssectional study and divided into three groups: AT group (ATG, n=24), healthy runners’ group (HRG, n=24), and non-runners’ group (NRG, n=24). Both ankles were evaluated in each group. The American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale was used for clinical and functional evaluation. GRF was evaluated using force plates and muscle strength was evaluated using an isokinetic dynamometer. RESULTS: The AOFAS scores were lower in the ATG. The strike impulse was higher in the ATG than in the HRG and NRG. However, GRF was similar among the groups. The ATG exhibited lower total work at 120o /s speed than the HRG. The peak torque in concentric dorsiflexion was lower in the NRG than in the ATG and HRG. The peak torque and total work in concentric plantar flexion were lower in the NRG than in the ATG. The peak torque and total work in eccentric plantar flexion were lower in the NRG than in the ATG and HRG. CONCLUSION: Runners with AT showed higher strike impulse, lower muscle strength of the plantar flexors, and higher clinical and functional damage

Evaluation of static and dynamic balance in athletes with anterior cruciate ligament injury – A controlled study

OBJECTIVES: Anterior cruciate ligament injury leads to adaptive responses to maintain postural control. However, there is no consensus regarding whether leg dominance also affects postural control in athletes with anterior cruciate ligament injury. The purpose of this study was to evaluate dynamic and static postural control among athletes with and without anterior cruciate ligament injury to the dominant leg. METHODS: Twenty-eight athletes, twenty-one males and seven females aged 15-45 years, were allocated to one of two groups: the anterior cruciate ligament injury group (26±3 years) or the control group without anterior cruciate ligament injury (25±6.5 years). All subjects performed one legged stance tests under eyes open and eyes closed conditions and squat and kick movement tests using a postural control protocol (AccuSwayPlus force platform, Massachusetts). The center of pressure displacement and speed were measured by the force platform. In addition, the distance traveled on the single-leg hop test was assessed as an objective measure of function. RESULTS: Significantly greater mediolateral sway was found under the eyes closed condition (p=0.04) and during squat movement (p=0.01) in the anterior cruciate ligament injury group than in the control group. Analysis of the single-leg hop test results showed no difference between the groups (p=0.73). CONCLUSION: Athletes with anterior cruciate ligament injury had greater mediolateral displacement of the center of pressure toward the dominant leg under the eyes closed condition and during squat movement compared to control athletes