RESUMO
Introduction: Vascular ulcers constitute a serious global public health problem, responsible for causing a significant social and economic impact due to their recurrent, disabling nature and the need for prolonged therapies to cure them. Objective: To evaluate the use and efficacy of the rhEGF in the epithelialization of patients with a diagnosis of CEAP stage 6 venous insufficiency, in the two regimes of the health system in Colombia, the contributive (equivalent to a health system where citizens with payment capacity contribute a percentage of their salary) and the subsidized (equivalent to a health system where the state covers the vulnerable population and low socioeconomic level) versus the other treatments used. Methodology: Observational, descriptive, retrospective, multicenter study, in which 105 medical records with 139 ulcers were reviewed, in 2 centers, one belonging to the subsidized system and the other to the contributive system in Colombia. Results: The association with the epithelialization variable of the different treatment groups for ulcers according to the application of the mixed effect model test, for both regimes was for the Biologicals (EC 34.401/p = 0.000), Bioactive Agents (Hydrogels) (EC 24.735/p = 0.005) groups; for the rest of the treatment groups, the results were neither associated nor statistically significant. Conclusion: Intra- and perilesional therapy with rhEGF expands the therapeutic spectrum in patients with venous ulcers, regardless of the type of health system in which it will be applied, shortening the healing time and reaching a possible therapeutic goal, which according to this study there is an association with epithelialization regardless of the regime applied.
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Úlcera Varicosa , Humanos , Colômbia , Úlcera Varicosa/tratamento farmacológico , Úlcera Varicosa/economia , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Fator de Crescimento Epidérmico , Proteínas Recombinantes/economia , Proteínas Recombinantes/uso terapêutico , Proteínas Recombinantes/administração & dosagem , IdosoRESUMO
OBJECTIVE: The aim of the study was to phenotypically investigate the expression of the enzyme Klebsiella pneumoniae carbapenemase (KPC) in a Proteus mirabilis sample resistant to carbapenems, isolated from the wound of a patient with a venous leg ulcer (VLU) treated at an outpatient referral service. METHOD: This was a case study conducted with a patient who had a VLU on the lower left limb. Samples were taken for the examination of microbiological material from the patient's wound, using an aseptic technique. The colonies extracted were submitted to Gram staining and biochemical tests to identify the strain. In addition, an antimicrobial susceptibility test, E-test and a modified Hodge test were performed. RESULTS: The identified microorganism was Proteus mirabilis, which showed resistance to cefuroxime and the carbapenems imipenem and meropenem. As well as the minimum inhibitory concentration (MIC) of 3.0µg/ml for imipenem, demonstrating resistance, there was no KPC production by the tested isolate, which presented a negative modified Hodge test. CONCLUSION: The results highlight the importance of microbiological surveillance, aimed at reducing morbidity and mortality rates associated with infection by multiresistant bacteria.
Assuntos
Carbapenêmicos , Úlcera da Perna , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Carbapenêmicos/farmacologia , Carbapenêmicos/uso terapêutico , Humanos , Imipenem/farmacologia , Imipenem/uso terapêutico , Klebsiella pneumoniae , Testes de Sensibilidade Microbiana , Proteus mirabilis , beta-LactamasesRESUMO
Aim: Venous ulcers are the most serious complication of chronic venous insufficiency secondary to venous hypertension and represent between 80% and 90% of all ulcers vascular, having socioeconomic repercussions and on the patient's quality of life. Objective: To determine the factors associated and complications with the morbidity of patients with venous ulcers CEAP 6 in two health delivery systems in Colombia. Methodology: Observational study retrospective multicenter carried out in two health centers, one under the subsidized scheme and the other under the contributory scheme in patients captured adults over 18 years of age during the years 2018 and 2019 with a diagnosis of chronic venous insufficiency CEAP 6 performing a review to the clinical history up to 4 years before the consultation for vascular surgery of ulcerative pathology. Results: A total of 105 patients were evaluated 52% of the contributory regime and 48% patients of the subsidized regime. With 139 ulcers, 70% were women. The educational level of the population in 77% of the individuals had no schooling or only had primary education. The patients of the subsidized regime belonged to the low socioeconomic stratum vs the middle-class stratum in the contributory regime. 80.5% of the lesions are concentrated in groups less than 25 cm and 19.4% of the cases are located above 50 cm. Dressings and advanced technologies were used in 30.02% of the patients in the contributory scheme compared to 24.35% in the subsidized scheme. 37% of the subsidized scheme had contagion vs 28% of the contributory scheme. The epithelialization rates were 67.27% in the contributory regime compared to 26% in the subsidized regime. Conclusion: The prognostic factors that favor wound epithelialization are related to ulcers smaller than 25 cm, lesion evolution time under 36 months, having been managed with dressings and other advanced technologies, and belonging to the contributory regime.
Assuntos
Úlcera Varicosa , Insuficiência Venosa , Adolescente , Adulto , Colômbia/epidemiologia , Feminino , Humanos , Morbidade , Qualidade de Vida , Estudos Retrospectivos , Úlcera Varicosa/diagnóstico , Úlcera Varicosa/epidemiologia , Úlcera Varicosa/terapia , Insuficiência Venosa/terapiaRESUMO
Venous ulcers are the main causes of chronic lower-limb ulcers. The healing difficulties encourage the research and development of new products in order to achieve better therapeutic results. Fibrin sealant is one of these alternatives. Besides being a validated scaffold and drug delivery system, it possesses excellent healing properties. This review covered the last 25 years of the literature and showed that the fibrin sealant is used in various clinical situations to promote the healing of different types of ulcers, especially chronic ones. These are mostly venous in origin and usually does not respond to conventional treatment. Commercially, only the homologous fibrin sealants obtained from human blood are available, which are highly efficient but very expensive. The heterologous fibrin sealant is a non-commercial experimental low-cost product and easily produced due to the abundance of raw material. The phase I/II clinical trial is already completed and showed that the product is safe and promisingly efficacious for the treatment of chronic venous ulcers. In addition, clinical proteomic strategies to assess disease prognosis have been increasingly used. By analyzing liquid samples from the wounds through proteomic strategies, it is possible to predict before treatment which ulcers will evolve favorably and which ones will be difficult to heal. This prognosis is only possible by evaluating the expression of isolated proteins in exudates and analysis using label-free strategies for shotgun. Multicentric clinical trials will be required to evaluate the efficacy of fibrin sealant to treat chronic ulcers, as well as to validate the proteomic strategies to assess prognosis.
RESUMO
Introducción: Las úlceras flebostáticas son de difícil curación, no existe un tratamiento único y efectivo, por lo que hay que combinarlos en un mismo paciente. Objetivo: Identificar los tratamientos utilizados en los pacientes ingresados por úlceras flebostáticas y la relación entre el tiempo de estadía hospitalaria, el tratamiento recibido y el estado de las úlceras al egreso hospitalario. Métodos: Estudio descriptivo ambispectivo en 121 ingresos hospitalario con el diagnóstico de úlceras flebostáticas. Las variables de estudio fueron: tratamientos recibidos, estado de la lesión al egreso y estadía hospitalaria. Se asociaron las variables entre sí utilizando la prueba Ji-cuadrada no paramétrica para variables independientes. Resultados: En los 121 ingresos se realizó tratamiento convencional, el 93,4 por ciento recibió antibióticos; el 60,3 po ciento tratamiento compresivo; y quirúrgico en el 56,2 por ciento, con predominio del injerto libre de piel en 72,1 por ciento de estos tratamientos quirúrgicos. El 42,2 por ciento egresó con la lesión curada (tratamiento quirúrgico). Se encontraron asociaciones directas entre el tratamiento quirúrgico con la estadía hospitalaria (( 2 = 31,22; p= 0,0001), con la cura de la lesión (( 2 = 19,92; p= 0,0100) y con su estado al alta hospitalaria (( 2 = 36,07; p= 0,0001). Conclusiones: El tratamiento más empleado es el quirúrgico y dentro de estos, el autoinjerto dermo-epidérmico es el más utilizado, puesto que presenta los mejores resultados en cuanto a la curación de la lesión pero mayor estadía hospitalaria en los pacientes(AU)
Introduction: Phlebostatic ulcers are difficult to heal; there is no single and effective treatment, so several treatments must be combined in the same patient. Objective: To identify the treatments used in patients admitted for phlebostatic ulcers and the relationship between hospital stay, treatment received, condition of the ulcers at hospital discharge. Methods: Ambispective descriptive study of 121 hospital admissions with the diagnosis of phlebostatic ulcers. The study variables were treatments received, status of the injury at discharge, and hospital stay. The variables were associated with each other, using the non-parametric Chi-square test for independent variables. Results: The 121 admissions received conventional treatment. 93.4 percent received antibiotics; 60.3 percent, compression treatment; and 56.2 percent, surgical treatment, with predominance of free skin grafting in 72.1 percent of these surgical treatments. 42.2 percent was discharged with the lesion healed (by surgical treatment). Direct associations were found between surgical treatment with hospital stay (( 2 = 31.22; p = 0.0001), with the cure of the lesion (( 2 = 19.92; p=0.0100), and with the ulcer state at hospital discharge (( 2 =36.07; p= 0.0001). Conclusions: The most used treatment is the surgical one, specifically the dermo-epidermal autograft, which presented the best outcome regarding the healing of the injury, but a longer hospital stay for the patients(AU)
Assuntos
Humanos , Masculino , Feminino , Úlcera/diagnóstico , Úlcera/terapiaAssuntos
Monitorização Transcutânea dos Gases Sanguíneos , Microcirculação , Oxigênio/sangue , Síndrome Pós-Trombótica/diagnóstico , Úlcera Varicosa/diagnóstico , Adulto , Idoso , Biomarcadores/sangue , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Síndrome Pós-Trombótica/sangue , Síndrome Pós-Trombótica/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Úlcera Varicosa/sangue , Úlcera Varicosa/fisiopatologia , CicatrizaçãoRESUMO
Venous ulcers are the main causes of chronic lower-limb ulcers. The healing difficulties encourage the research and development of new products in order to achieve better therapeutic results. Fibrin sealant is one of these alternatives. Besides being a validated scaffold and drug delivery system, it possesses excellent healing properties. This review covered the last 25 years of the literature and showed that the fibrin sealant is used in various clinical situations to promote the healing of different types of ulcers, especially chronic ones. These are mostly venous in origin and usually does not respond to conventional treatment. Commercially, only the homologous fibrin sealants obtained from human blood are available, which are highly efficient but very expensive. The heterologous fibrin sealant is a non-commercial experimental low-cost product and easily produced due to the abundance of raw material. The phase I/II clinical trial is already completed and showed that the product is safe and promisingly efficacious for the treatment of chronic venous ulcers. In addition, clinical proteomic strategies to assess disease prognosis have been increasingly used. By analyzing liquid samples from the wounds through proteomic strategies, it is possible to predict before treatment which ulcers will evolve favorably and which ones will be difficult to heal. This prognosis is only possible by evaluating the expression of isolated proteins in exudates and analysis using label-free strategies for shotgun. Multicentric clinical trials will be required to evaluate the efficacy of fibrin sealant to treat chronic ulcers, as well as to validate the proteomic strategies to assess prognosis.(AU)
Assuntos
Úlcera Varicosa/classificação , Úlcera Varicosa/reabilitação , Úlcera Varicosa/terapia , Adesivo Tecidual de Fibrina/administração & dosagem , Adesivo Tecidual de Fibrina/análise , Proteômica , BiopolímerosRESUMO
Venous ulcers are the main causes of chronic lower-limb ulcers. The healing difficulties encourage the research and development of new products in order to achieve better therapeutic results. Fibrin sealant is one of these alternatives. Besides being a validated scaffold and drug delivery system, it possesses excellent healing properties. This review covered the last 25 years of the literature and showed that the fibrin sealant is used in various clinical situations to promote the healing of different types of ulcers, especially chronic ones. These are mostly venous in origin and usually does not respond to conventional treatment. Commercially, only the homologous fibrin sealants obtained from human blood are available, which are highly efficient but very expensive. The heterologous fibrin sealant is a non-commercial experimental low-cost product and easily produced due to the abundance of raw material. The phase I/II clinical trial is already completed and showed that the product is safe and promisingly efficacious for the treatment of chronic venous ulcers. In addition, clinical proteomic strategies to assess disease prognosis have been increasingly used. By analyzing liquid samples from the wounds through proteomic strategies, it is possible to predict before treatment which ulcers will evolve favorably and which ones will be difficult to heal. This prognosis is only possible by evaluating the expression of isolated proteins in exudates and analysis using label-free strategies for shotgun. Multicentric clinical trials will be required to evaluate the efficacy of fibrin sealant to treat chronic ulcers, as well as to validate the proteomic strategies to assess prognosis.(AU)
Assuntos
Animais , Úlcera , Úlcera Varicosa/diagnóstico , Fibrina , Proteômica , Biopolímeros/análiseRESUMO
Introducción: Las úlceras en los miembros inferiores se relacionan desde los tiempos antiguos con las venas varicosas; es aceptado que dichas úlceras son una enfermedad frecuente y un grave problema de salud pública en todo el mundo y que la gran mayoría es el resultado de una insuficiencia venosa crónica. Objetivo: Caracterizar a los a los pacientes hospitalizados por úlceras flebostáticas. Métodos: Se realizó un estudio ambispectivo en 81 pacientes ingresados con el diagnóstico de úlceras flebostáticas. Las variables de estudio fueron: edad, sexo, cantidad de ingresos y estadía hospitalaria. Resultados: Se encontró un predominio del sexo femenino y de los mayores de 60 años en los 121 ingresos realizados. El 72,8 por ciento ingresó una sola vez y el 18,2 por ciento en más de una ocasión. La estadía hospitalaria fue de más de 21 días en el 55,4 por ciento. Conclusiones: Los pacientes hospitalizados con úlceras flebostáticas son predominantemente adultos mayores del sexo femenino, presentan una baja frecuencia de reingresos y una estadía hospitalaria prolongada(AU)
Introduction: The ulcers in the lower limbs are related from the old times with the varicose veins; it is accepted that the same ones are a frequent illness and a serious problem of public health in the world, and the great majority is the result of chronic venous insufficiency. Objective: To characterize the patients hospitalized due to phlebostatic ulcers. Methods: It was carried out an ambispective study in 81 patients admitted with the diagnosis of phlebostatic ulcers. The study variables were: age, sex, quantity of hospital admissions and hospital stay. Results: It was predominant in the 121 of the hospital admission: the female sex and people older than 60 years. 72.8 percent of the patients were admitted one time and 18.2 percent in more than one occasion. The hospital demurrage was of more than 21 days in 55.4 percent of the cases. Conclusions: The patients hospitalized due to phlebostatic ulcers are predominantly female elder people. It was possible to characterize the patients hospitalized with a low frequency of hospital re-admission and hospital demurrage(AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Úlcera , Varizes , Insuficiência Venosa , Extremidade InferiorRESUMO
Chronic venous ulcers affect the quality of life of patients around the world. The aims of this study were to identify the proteins expressed in chronic venous ulcer exudates, to categorize them according to their roles and to correlate them with the clinical and epidemiological aspects of the disease. The study population consisted of 37 ulcers from 28 patients, and the inflammatory exudates of these thirty-seven ulcers were subjected to tryptic digestion and mass spectrometry analysis. Twenty-three patients were female (62.2%), and five (37.8%) were male. The patients had a mean age of 70 (±10.1) years. Of the patients, 73% adhered to compression and rest, 81.1% reported a history of primary varices, 54.1% reported a history of systemic arterial hypertension, 54.1% reported a history of devitalized tissue in the wound bed and 64.9% reported ulcers with more than ten years of evolution. Seventy-six proteins were identified, and they were grouped according to their primary role in the healing process. Eight correlations between clinical and epidemiological data and protein expression were noteworthy: diabetes mellitus vs. Ig gamma-2 and apolipoprotein-A1 and albumin; congestive heart failure vs. Ig lambda-2; colonization vs. actin; compressive therapy vs. Ig kappa; systemic arterial hypertension vs. alpha-2-macroglobulin and apolipoprotein-A1; area of ulcer vs. apolipoprotein-A1; race vs. heavy chain Ig and Ig γ-1 chain; age and race vs. Ig γ-1 chain. These associations may help to elucidate the prognosis and chronicity of chronic venous ulcers based on secreted proteins.
Assuntos
Proteínas Sanguíneas/metabolismo , Regulação da Expressão Gênica , Proteoma/metabolismo , Úlcera Varicosa/sangue , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: The goal of the study was to determine if there was an association between chronic venous disorders (CVDs), particularly venous leg ulcers, and ankle range of motion (ROM) in the Dominican Republic. METHODS: Chronic venous disorders were classified using the clinical manifestations portion (C) of the CEAP (clinical manifestations, etiology, anatomy, pathophysiology) method. The legs of participants attending mobile chiropractic clinics in rural, low-income areas in the Dominican Republic were assessed for clinical signs of CVD and venous ulcers. Ankle ROM was then measured, and photographs of the legs were taken. The 6 clinical stages of CVD were divided into 3 groups: normal legs (normal), no ulcer CVD, and ulcer CVD (healed and active). Multiple linear regression of ankle ROM against CVD grouping was used to test the association. RESULTS: Eight of the 837 patients for whom CVD classification was obtained had venous ulcers (healed or active) on at least 1 leg. About 30% relative reduction in ROM (ankle dorsiflexion plus plantar flexion) was observed between the ulcer group and the normal group. Regression analysis comparing legs with ulcers to healthy legs (normal), adjusted for age, gender, indicator for obesity, and previous leg trauma, revealed a significant decrease of approximately 14° (P = .0007) in ankle ROM. Age was also found to be strongly significant in the regression analysis, 1 year of aging was associated with a decrease of 0.16° (P < .0001) in ankle ROM (approximately 1.6° in 10 years). CONCLUSION: A significant decrease was observed in ankle ROM for participants with active and healed leg venous ulcers compared with those without ulcers. There appeared to be an association between venous leg ulcers and ankle ROM in this sample.
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Las úlceras flebostáticas son las más frecuentes en los miembros inferiores y constituyen una de las complicaciones más graves de la insuficiencia venosa crónica. Se caracterizan por ser invalidantes y tener alta repercusión socioeconómica. El objetivo de este trabajo es revisar los aspectos más relevantes de la epidemiología, la clínica y del tratamiento de las úlceras flebostáticas. Para la exploración bibliográfica se realizaron búsquedas de artículos en las bases de datos informatizadas on-line Medline, Cochrane Library, artículos publicados en páginas web, revistas líderes en la publicación de estudios sobre úlceras flebostáticas, el Consenso Latinoamericano sobre Úlceras Venosas, las Guías Prácticas de la Sociedad de Cirugía Vascular y el Fórum Americano de Flebología. Las úlceras flebostáticas son las más frecuentes de los miembros inferiores, más comunes en el sexo femenino y en mayores de 60 años. Repercuten en la calidad de vida del paciente y los gastos sanitarios. No existe tratamiento único para ellas, por lo que en un paciente se usan varios tratamientos o su combinación. Las evidencias científicas apuntan hacia las terapias compresivas como de primera línea. A pesar de los avances tecnológicos realizados en el tratamiento de estas úlceras, así como la gran variedad de los mismos, donde se complementan los más modernos con los ya existentes, las úlceras flebostáticas son de difícil curación y de alta recurrencia(AU)
The phlebostatic ulcers are the most common in the lower limbs and represent the most serious complications of the chronic venous insufficiency. These ulcers are disabling and have a significant social and economic impact. The objective of this paper was to review the most outstanding aspects of the epidemiology, the clinical manifestations and the treatment of the phlebostatic ulcers. The literature search was made in Medline, Cochrane Library, articles published in different web pages, leading journals in the publication of studies about phlebostatic ulcers, Latin American Consensus on Venous Ulcers, Practice Guidelines of the Society for Vascular Surgery and the American Venous Forum. The phlebostatic ulcers are the most frequent in the lower limbs, mainly in females and in patients older than 60 years. They have an impact on the quality of life of patients and on health expenditures. There is not a unique treatment for this type of ulcers, so several therapies or a combination of them is used. The scientific evidences point to the compressive therapies as the first-line method. Despite the technological advances in the treatment of these ulcers, and their great variety, in which the already existing ones and the latest ones complement each other, these ulcers are difficult to be cured and highly recurrent(AU)
Assuntos
Humanos , Úlcera Varicosa/complicações , Insuficiência Venosa/complicações , Insuficiência Venosa/tratamento farmacológico , Bases de Dados BibliográficasRESUMO
OBJECTIVE: Post-thrombotic syndrome (PTS) is the long-term sequelae of deep venous thrombosis (DVT). PTS clinical manifestations include chronic leg pain, oedema, lipodermatosclerosis and ulcers. The objective of this study is to determine in patients with documented history of thrombophilias and DVT whether the number of previous thrombotic events and optimal anticoagulation therapy are associated with the time to venous ulcer healing following the start of compression therapy. METHOD: Retrospective analysis performed in thrombophilic patients under the age of 50 years old with chronic venous ulcers secondary to DVT at the wound clinic in the National Institute of Medical Sciences and Nutrition 'Salvador Zubirán ' in Mexico City. Variables such as the number or episodes of thrombotic events, type of hypercoagulable disorder, optimal anticoagulation therapy with Warfarin monitored by therapeutic International Normalised Ratio (INR) (2-3) and compliance to compression therapy were examined. Patients that underwent superficial or perforator vein interruption or endovascular recanalisation of deep veins were excluded from the study. RESULTS: From a database of 29 patients with chronic venous ulcers followed in our clinic from January 1992 to September 2012, only 13 patients (61% female) met the inclusion criteria. Mean age±standard deviation (SD) was 32±12 years old. Of these, seven (54%) patients with suboptimal INR presented with an average of two previous thrombotic events and the remaining six (46%) patients with optimal INR only one event (p=0.28), the mean time to the clinical manifestation of a venous ulcer after the first episode of DVT was 39 months (range: 12-72) for patients with suboptimal INR and 82 months (range: 12-216) for those with optimal anticoagulation therapy (p=0.11). During the mean follow-up period of 52 months, all patients in optimal anticoagulation healed their ulcer; their mean time for wound healing was 44 months (range: 4-102). In the suboptimal INR group, only four healed the ulcers with an mean of 72 months (range: 2-204) (p=0.94). CONCLUSION: There seems to be an association between an optimal anticoagulation therapy with Warfarin monitored by INR and wound healing rates in thrombophilic patients with chronic venous ulcers. Further research is warranted. DECLARATION OF INTEREST: The authors have no conflict of interest.
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Anticoagulantes/administração & dosagem , Bandagens Compressivas , Síndrome Pós-Trombótica/complicações , Úlcera Varicosa/terapia , Varfarina/administração & dosagem , Adulto , Doença Crônica , Feminino , Humanos , Coeficiente Internacional Normatizado , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , CicatrizaçãoRESUMO
INTRODUCTION: Although venous ulcers have a great social and economic impact, there is a lack of evidence from randomised controlled trials (RCTs) to support appropriate management for this disease. Framing the research question using the Population; Intervention; Comparator; Outcome; Time frame (PICOT) format in RCTs can improve the quality of the research design. OBJECTIVES: To evaluate how the PICOT format is used to frame a research question in reports of RCTs of venous ulcer disease and to determine the factors associated with better adherence to the PICOT format in framing the research question. METHODS AND ANALYSES: We will conduct a systematic survey of RCTs on venous ulcers published in the National Institute of Health, PubMed database between January 2009 and May 2016. We will include all RCTs addressing therapeutic intervention for venous ulcer disease involving human subjects, and published in the English language. The selection process will be carried out in duplicate by two independent investigators. First, titles and abstracts will be screened, then full-text articles. We will examine whether the five elements of the PICOT format are used in formulating the research question and give a score between 0 and 5. The primary outcome will be the proportion of studies that have adequately reported all five PICOT elements. DISSEMINATION: This will be the first survey to assess how the PICOT format is used to frame research questions on the management of venous ulcers in reports of RCTs. On completion, this review will be submitted to a peer-reviewed biomedical journal for publication and the findings will also be presented at scientific conferences.
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Pesquisa Biomédica/métodos , Projetos de Pesquisa , Úlcera Varicosa/terapia , Cicatrização , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Pele , VeiasRESUMO
Objective: To describe the nursing care recommended in the literature to customers with venous ulcers. Method: Integrative literature bases VHL, LILACS, MEDLINE and SciELO. There were selected 10 articles, based on the inclusion criteria. Results: The analysis of the items resulted in thematic categories: the importance of nurses in the assessment of the client with venous ulcers and strategies used in the care of clients with venous ulcers. The first deals with the actions of the nurse go beyond the execution of dressing, requiring the evaluation of the client in its entirety in the second treatment strategies. Conclusion: The analysis of the articles showed the concern regarding the evaluation of the client in its entirety. Despite the diversity of technologies presented in the literature, highlights the need to conduct research with significant levels of evidence in order to optimize healing time, relapse prevention, encouragement of self-care and comfort of the client.
Objetivo: Descrever os cuidados de enfermagem recomendados na literatura aos clientes com úlcera venosa. Método: Revisão integrativa da literatura nas bases BVS, LILACS, MEDLINE e SCIELO. Selecionados10 artigos, baseando-se nos critérios de inclusão. Resultados: A análise dos artigos resultou nas categorias temáticas: importância do enfermeiro na avaliação do cliente com úlcera venosa e estratégias utilizadas no cuidado de clientes com úlceras venosas. A primeira aborda que as ações do enfermeiro vão além da realização de curativos, exigindo a avaliação do cliente em sua integralidade; na segunda, as estratégias de tratamento. Conclusão: A análise dos artigos evidenciou a preocupação em relação à avaliação do cliente em sua integralidade. Apesar da diversidade de tecnologias apresentadas na literatura, evidencia se a necessidade realizar pesquisas com níveis de evidência significativos, visando a otimização do tempo de cicatrização, prevenção de recidivas, estímulo ao autocuidado e conforto do cliente.
Objetivo: Describir los cuidados de enfermería se recomienda en la literatura a los clientes con úlceras venosas. Método: Literatura Integrativa, bases BVS, LILACS, MEDLINE y SciELO. Seleccionado 10 artículos, sobre la base de los criterios de inclusión. Resultados: El análisis de los elementos resultó en categorías temáticas: la importancia de las enfermeras en la evaluación del cliente con úlceras venosas y estrategias utilizadas en la atención de clientes con úlceras venosas. La primera trata de la actuación de la enfermera van más allá de la ejecución de vestir, lo que requiere la evaluación del cliente en su totalidad en el segundo estrategias de tratamiento. Conclusión: El análisis de los artículos mostró la preocupación con respecto a la evaluación del cliente en su totalidad. A pesar de la diversidad de las tecnologías presentadas en la literatura, se destaca la necesidad de llevar a cabo la investigación con importantes niveles de pruebas con el fin de optimizar el tiempo de curación, prevención de recaídas, el fomento del autocuidado y la comodidad del cliente.
Assuntos
Humanos , Masculino , Feminino , Cuidados de Enfermagem/métodos , Cuidados de Enfermagem/normas , Úlcera Varicosa/enfermagem , BrasilRESUMO
Introdução: Úlceras crônicas em membros inferiores podem apresentar diferentes etiologias, sendo as mais frequentes: venosa, arterial, traumática, infecciosa e diabética. O tratamento dessas feridas é dinâmico e depende da evolução da reparação tecidual. Esse tratamento inclui métodos clínicos e cirúrgicos, sendo o curativo o método não cirúrgico mais frequentemente utilizado. Curativos podem ser desde de coberturas inertes até veículos para atuação de princípios ativos no leito da ferida. A principal indicação de ativos está relacionada a efeitos de desbridamento e controle da população bacteriana, possibilitando o preparo desses leitos para resolução cirúrgica ou espontânea. Método: Esse estudo é observacional, longitudinal, retrospectivo, de amostra randomizada no qual pretendemos analisar o atendimento prestado aos portadores de úlceras crônicas em membros inferiores no Ambulatório de Feridas Crônicas da Divisão de Cirurgia Plástica do HCFMUSP entre 2011 e 2013. Resultados: Foram analisados prontuários de indivíduos de ambos os gêneros, idade média 60 anos, portadores de úlceras crônicas em diferentes estágios evolutivos. Foram pesquisadas comorbidades, doença de base, tamanho da lesão, tratamentos utilizados e evolução das feridas. Notouse predomínio das causas vasculares (69,2%) como doenças de base. Todos os pacientes foram primeiramente tratados com curativos contendo princípios ativos, para preparo do leito das feridas. Desses, 84% foram encaminhados para resolução cirúrgica das feridas. Houve fechamento espontâneo em 1,5% dos casos. Os demais pacientes (14,5%) apresentaram piora das lesões com tratamento tópico, necessitando outras formas de preparo desse leito. Conclusão: Agentes tópicos podem ser uma forma ambulatorial/domiciliar efetiva de preparo do leito de úlceras crônicas para resolução cirúrgica.
Introduction: Chronic ulcers of the lower limbs may have different etiologies, with the most frequent being venous, arterial, traumatic, infectious, and diabetic. The treatment of these wounds is dynamic and depends on the evolution of tissue repair. This treatment includes clinical and surgical methods, and dressings are the most frequently used. Dressings can range from inert covers to vehicles for actuation of active substances in the wound bed. The main indication for these substances is related to the effects of debridement and control of the bacterial population, enabling the preparation of wound beds for surgical or spontaneous resolution. Method: This study is an observational, cross-sectional, retrospective study, with random sampling, aimed at assessing the care provided to patients with chronic ulcers of the lower limbs in the Outpatient Clinic for chronic wounds of the Plastic Surgery Division, HCFMUSP, between 2011 and 2013. Results: The clinical charts of 481 patients of both sexes, with a mean age 60 years, were analyzed; all had chronic ulcers in different stages of evolution. Comorbidities, underlying disease, size of the lesion, treatments, and evolution of wounds were evaluated. A predominance of vascular disease (69.2%) was the underlying cause. All patients were initially treated with dressings containing active agents, for preparation of the wound bed. Of these, 84% were referred for surgical management of wounds. There was no spontaneous closure in 1.5% of cases. The remaining patients (14.5%) showed worsening of lesions with topical treatment, and required other forms of preparation of the wound bed. Conclusion: Topical agents may be an effective outpatient/home method to prepare the wound bed of chronic ulcers for surgical management.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , História do Século XXI , Cirurgia Plástica , Úlcera Varicosa , Cicatrização , Ferimentos e Lesões , Papaína , Prontuários Médicos , Estudos Retrospectivos , Estudos Longitudinais , Pé Diabético , Estudo de Avaliação , Extremidade Inferior , Estudos Observacionais como Assunto , Perna (Organismo) , Úlcera da Perna , Cirurgia Plástica/métodos , Úlcera Varicosa/cirurgia , Úlcera Varicosa/patologia , Ferimentos e Lesões/cirurgia , Ferimentos e Lesões/patologia , Ferimentos e Lesões/tratamento farmacológico , Ferimentos e Lesões/terapia , Papaína/uso terapêutico , Papaína/farmacologia , Prontuários Médicos/normas , Pé Diabético/cirurgia , Pé Diabético/patologia , Extremidade Inferior/patologia , Úlcera da Perna/cirurgia , Úlcera da Perna/patologiaRESUMO
Este trabalho teve como objetivo geral analisar a percepção de idosos sobre o viver com úlcera venosa e como objetivos específicos apreender a percepção do idoso sobre o viver com úlcera venosa e caracterizar o idoso que vive com úlcera venosa, através de um estudo exploratório, descritivo, com abordagem qualitativa, realizado na cidade de Jequié-BA, em uma Clínica Escola de Fisioterapia, com oito idosos, de ambos os sexos, acometidos por úlceras venosas. A coleta de informações aconteceu através de um roteiro de entrevista semiestruturado contendo uma parte com dados sócios demográficos para a caracterização dos sujeitos e uma específica relativa ao tema, que foram apreciados através da Análise de Conteúdo Temática proposto por Bardin. Os resultados mostraram que houve predominância de idosas, com idade entre 64 e 80 anos, brancas, casadas, católicas, com até o 5º ano de escolaridade e residentes na zona urbana de Jequié-Bahia. Das entrevistas emergiram três categorias: 1ª) Viver com a úlcera venosa é um sofrimento, apoiada em três subcategorias: A úlcera venosa provoca dor, A úlcera venosa provoca recidiva e A úlcera venosa provoca limitações; 2ª) Viver com a úlcera venosa é conviver com o estigma, sustentada por duas subcategorias: Enfrentar os preconceitos e Vivenciar constrangimentos e, por fim, a terceira categoria: 3ª) Viver com a úlcera venosa demanda fé/resignação/ aceitação, ancorada em três subcategorias: A fé no enfrentamento das adversidades provocadas pela úlcera venosa; A insatisfação com os serviços de saúde, e por fim, Aceitar e resignar-se. O estudo mostrou que os idosos com úlcera venosa a percebem como sofrimento marcado pela dor, pela recidiva da ferida e pelas limitações impostas por ela. Vivenciam o estigma causado pelo preconceito e constrangimento por terem no corpo uma marca que os excluem socialmente. Para enfrentarem o sofrimento, e o estigma apegam-se à fé e à religiosidade acreditando que os serviços de saúde possam melhorar o atendimento às pessoas acometidas por essa enfermidade, que resignados com sua vida procuram sobreviver da melhor forma possível. (AU)
Assuntos
Úlcera Varicosa , Saúde do Idoso , Enfermagem Geriátrica , Cuidados de EnfermagemRESUMO
Venous ulcers of the lower limbs complicated by infection or chronicity represent a serious public health problem. The elevated number of those afflicted burdens the health services, interferes in quality of life and causes absenteeism. Although there are 2,500 items on the market, ranging from the simplest dressing up to the most complex types of dressing, treatment remains a challenge. Among the substances used, fibrin sealant is the one that promotes diminution of bacterial colonization and of edema, controls hemorrhaging, alters the pain threshold by protecting the nerve endings, hydrates the wound bed and forms granulation tissue that favors healing. Its disadvantages include higher cost and utilization of human fibrinogen that can transmit infectious diseases. The Center for the Study of Venoms and Venomous Animals (CEVAP) at São Paulo State University (UNESP) developed a new sealant made up of fibrinogen extracted from large animals and from an enzyme obtained from snake venom. The present study, developed in the Health Education Clinic (CEPS) of Sacred Heart University (USC) aimed to evaluate the effect of the new sealant on the healing process of venous ulcers in 24 adult patients, seven of whom were male and 17 female. Two study groups were formed as follows: Group 1 (G1) - control group of 11 patients treated with essential fatty acid (EFA) and Unna's boot, and Group 2 (G2) - 13 patients treated with essential fatty acid (EFA), fibrin sealant and Unna's boot. The follow-up lasted eight weeks and the sealant was applied at only the first and fourth weeks. The results showed that Group 2 presented worse lesion conditions as to healing, but, when comparing the two groups, it was noteworthy that the the sealant was effective in healing venous ulcers.(AU)
Assuntos
Humanos , Venenos/toxicidade , Serpentes/classificação , Saúde Pública/classificação , Edema/complicações , Ferimentos e Lesões/complicaçõesRESUMO
Venous ulcers of the lower limbs complicated by infection or chronicity represent a serious public health problem. The elevated number of those afflicted burdens the health services, interferes in quality of life and causes absenteeism. Although there are 2,500 items on the market, ranging from the simplest dressing up to the most complex types of dressing, treatment remains a challenge. Among the substances used, fibrin sealant is the one that promotes diminution of bacterial colonization and of edema, controls hemorrhaging, alters the pain threshold by protecting the nerve endings, hydrates the wound bed and forms granulation tissue that favors healing. Its disadvantages include higher cost and utilization of human fibrinogen that can transmit infectious diseases. The Center for the Study of Venoms and Venomous Animals (CEVAP) at São Paulo State University (UNESP) developed a new sealant made up of fibrinogen extracted from large animals and from an enzyme obtained from snake venom. The present study, developed in the Health Education Clinic (CEPS) of Sacred Heart University (USC) aimed to evaluate the effect of the new sealant on the healing process of venous ulcers in 24 adult patients, seven of whom were male and 17 female. Two study groups were formed as follows: Group 1 (G1) - control group of 11 patients treated with essential fatty acid (EFA) and Unna's boot, and Group 2 (G2) - 13 patients treated with essential fatty acid (EFA), fibrin sealant and Unna's boot. The follow-up lasted eight weeks and the sealant was applied at only the first and fourth weeks. The results showed that Group 2 presented worse lesion conditions as to healing, but, when comparing the two groups, it was noteworthy that the the sealant was effective in healing venous ulcers...