Navegando por Palavras-chave "Ferimentos E Lesões"
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- ItemAcesso aberto (Open Access)Algoritmos para manejo de cicatrizes(Universidade Federal de São Paulo (UNIFESP), 2020-04-26) Oliveira, Francisco Felipe Gois De [UNIFESP]; Haddad, Alessandra [UNIFESP]; Universidade Federal de São PauloIntroduction: The distinct characteristics of pathological scar patterns must be considered in their approach, hypertrophic scars and keloids require different treatments, in the specialized literature there are several proposed approaches, often based on personal experiences of surgeons. Objective: To discuss the content of Algorithms for the Management of Scars, compiling the information of the instruments, aiming to deepen knowledge about the flowcharts for the prevention and treatment of pathological scars. Methods: Descriptive study of an integrative literature review on algorithms for directing conducts with regard to the prevention and treatment of pathological scars. The was approved by the Research Ethics Committee of UNIFESP. Four Scar Treatment and Prevention algorithms were used: International clinical recommendations on scar management, The Most Current Algorithms for the Treatment and Prevention of Hypertrophic Scars and Keloids, Update on Scar Management: Guidelines for Treating Asian Patients, Updated International Clinical Recommendations on Scar Management: Part 2 - Algorithms for Scar Prevention and Treatment. Results: All algorithms meet the objective of guiding behavior in pathological scars, and were considered good or excellent by the authors. Conclusion: The content of Algorithms for the Management of Scars was analyzed and the authors considered that the information was relevant to guide the prevention and treatment of pathological scars.
- ItemSomente MetadadadosFatores prognósticos no tratamento das lesões traumáticas arteriais fêmoro-poplíteas em um centro de trauma brasileiro(Universidade Federal de São Paulo (UNIFESP), 2020-11-26) Kleinsorge, Gustavo Henrique Dumont [UNIFESP]; Abib, Simone de Campos Vieira [UNIFESP] ; Universidade Federal de São PauloIntroduction: Despite significant outcome improvements seen after traumatic arterial limb injuries, they still remain a significant cause of limb loss and mortality. This study sought to identify predictors of mortality and major amputation for patients undergoing revascularization after femoropopliteal arterial trauma. Methods: This is a retrospective review of an institutional Vascular Trauma Registry from an urban trauma center in Brazil. All patients with an arterial femoropopliteal injury admitted to our hospital from November 2012 to December 2017 who underwent a vascular reconstruction were included. Univariate analyses followed by logistic regression analyses were performed to identify factors independently associated with the primary outcomes of amputation and mortality. Results: Ninety-six patients with vascular reconstructions were included. They had on average, 27 years old. The RTS was, on average, 7.152. The ISS was, on average, 15. 11 patients (11.5%) had amputation and 14 (14.6%) died. In the logistic regression model for amputation, was observed that patients with ischemia time greater than 6 hours presented approximately 10 times more chance of amputation than those with ischemia time equal or less than 6 hours (CI95%: 1,2 to 79,9). With each increase of one unit in the RTS, the chance of the patient having an amputation reduces 43% (CI95%: 2 a 96%). Logistic regression model for mortality, revealed that patients with ischemia time greater than 6 hours had approximately 6 times more chance of mortality than those with ischemia time equal to or less than 6 hours (CI95%: 1,26 to 24,77). Patients presented with hemodynamic instability were approximately 9 times more likely to die than those with hemodynamic stability (CI95%: 2,36 a 36,67). Each increase of one unit in the ISS, the chance of death increases by 14% (CI95%: 3 to 26%). Conclusion: Ischemic time, physiological status on admission and trauma scores are important risk factors to be considered in limb revascularization of patients with femoropopliteal arterial trauma. Local protocols must be established to guide the best treatment for these patients.
- ItemSomente MetadadadosFração vascular estromal associada à matriz dérmica acelular na cicatrização de feridas cutâneas em coelhos(Universidade Federal de São Paulo (UNIFESP), 2020-03-31) Carvalho Junior, Jose Da Conceicao [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São PauloIntroduction: Several methods have been studied to optimize the use of the Acelular Dermal Matrix (ADM) in the healing of skin wounds, with a new option being the Stromal Vascular Fraction (SVF). Objective: To evaluate the effects of the Stromal Vascular Fraction associated with the Acellular Dermal Matrix on the healing of skin wounds in rabbits. Method: 24 rabbits were divided into four groups (n = 6). Three 20 x 20 mm skin wounds were performed on the animals' backs, the only procedure being performed in the Control Group. In the ADM group the wounds were covered with ADM. In the SVF group 2 x 106 autologous SVF cells were injected into the wound margins and in the ADM/SVF group, SVF cells were injected and the wounds covered with ADM. The wounds were photographed for 21 days and biopsies were performed on 3, 14 and 21 days to assess skin thickness, quantify collagen, to evaluate the formation and diameter of new vessels. Results: There was no difference in healing time between groups. The ADM/SVF group showed greater thickness of the dermis and epidermis, a greater amount of type I and III collagen and a greater number and diameter of blood vessels when compared to the control group, ADM and SVF alone. Conclusion: Stromal Vascular Fraction associated with the Acellular Dermal Matrix, increased vascularization, the amount of collagen and the thickness of the skin, during the healing of cutaneous wounds in rabbits, without changing the time of wound closure.
- ItemAcesso aberto (Open Access)Lesões mamilo-areolares decorrentes da prática da amamentação: construção e validação de uma classificação sob o enfoque dermatológico(Universidade Federal de São Paulo (UNIFESP), 2019-07-25) Cervellini, Marina Possato [UNIFESP]; Abrão, Ana Cristina Freitas de Vilhena [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objectives: to construct a new classification of nipple-areolar lesions resulting from the practice of breastfeeding with a dermatological focus and validate it, according to content and appearance. Methodology: the construction of the classification was based on the findings of two literature reviews, the knowledge acquired, and the clinical experience accumulated in breastfeeding assistance and injuries, and the qualitative analysis between the researchers and a specialist dermatology judge. The content and appearance validation process were developed using the Delphi technique and using a Likert scale with a score of one to four. The data collection took place electronically and the re-elaboration of the classification versions was performed after each round of responses. To verify the validity of the instrument was used the Content Validity Index with a minimum value of 80% and Kappa coefficient analysis with a significance level of 5%. Results: The proposed classification was sent to 10 judges and after the analysis of data from the first cycle of answers, 90 to 100% agreement was obtained for the items, definition, erythema, ecchymosis, edema, vesicle, fissure and erosion. Only the crust, did not obtain minimum value in the three variables judged: clarity, pertinence and comprehensiveness. With the second round of responses, a minimum agreement of 87.5% and maximum of 100% was reached. After statistical analysis, a Kappa Coefficient = 1 (perfect agreement) was obtained for the items definition, erythema, ecchymosis, edema, vesicle and erosion, Kappa = 0.46 (moderate agreement) for the fissure and Kappa = 0.58 (concordance moderate) to the crust. A new version of the classification was elaborated and sent to 16 specialists participating in the process of appearance validation. After the analysis of the data of the first cycle of answers, a minimum agreement of 94% and maximum of 100% was obtained. Subsequently, the final version of the classification was drawn up. This is the first classification of nipple-areolar lesions resulting from the practice of breastfeeding with morphological characterization and standardized dermatological language. The high percentage of agreement found, coupled with the great experience of the judges' committee in the content validation process, was able to confer even more quality for this classification, making it possible to use it in all health areas that work in breastfeeding care. Although appearance validation has demonstrated excellent agreement among breastfeeding experts, prior training may be required for its use. Conclusions: the study allowed the construction and validation of the proposed classification and presents several future perspectives for the teaching, research and assistance areas, which may help in the recognition of each type of nipple-areolar lesion, prescription of specific treatments and care.
- ItemSomente MetadadadosPacientes com lesões traumáticas decorrentes de acidentes de trânsito: análise do tempo de permanência na sala de emergência(Universidade Federal de São Paulo (UNIFESP), 2019-04-25) Aguiar, Katiuscia Larsen De Abreu [UNIFESP]; Whitaker, Iveth Yamaguchi [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objectives: To characterize patients with traumatic injuries due to traffic accidents admitted to emergency room (ER), analyze the length of ER stay up to the referral to operating room, intensive care unit (ICU), or hospital wards, and verify the association of length of ER stay with age, gender, type of traffic accident, day period of incident, type of prehospital care (PHC), amount of computed tomography (CT) scan undertaken, time up to cranial CT, number of specialists, injury and trauma severity, length of hospital and ICU stay, complications, type of hospital discharge, recovery after hospital discharge, and readmission. Method: Prospective cohort study for the follow-up of patients with traumatic injuries due to traffic accidents, since their admission into the ER up six months after hospital discharge. Data from patients admitted to ER due to traffic accidents aged more 14 years old in 2015 were included in the sample. Kruskal-Wallis, Chi-square, or likelihood-ratio tests were used to observe the association between length of ER stay and study variables, considering a 5% significance level and a 95% confidence interval. Results: The sample included 327 patients of which 82% were men, mean age was 34 years, primarily (58.7%) affected by motorcycle accidents, 97.2% suffered minor, moderate, and serious injuries. The length of ER stay mean was 4.8 hours. The longest length of ER stay was associated with the time for undertaking cranial CT scan (p=0.0039), trauma severity (anatomical p=0.0056 and physiological p=0.0141), and complications (p=0.0241). Among those who stayed in the ER for up to two hours, the highest percentage (37.1%) was referred to the green sector (p<0.0001), and was associated with motorcycle accidents (p=0.0147) and basic support (p=0.0478). Conclusion: The length of ER stay of patients with traffic accident injuries was 4,8 hours in average. It was associated with factors indicating trauma severity. Severe patients were observed in longer ER time intervals than those with lesser severity. Considering the high demand of patients in emergency department and for the therapeutic and monitoring needs of critically ill patients to be met at a time and place appropriate to their conditions, the organization of hospitalized patient flow should be part of health public service management agenda.
- ItemAcesso aberto (Open Access)Protocolo De Tratamento De Feridas Para O Sistema Penitenciário Do Estado De São Paulo(Universidade Federal de São Paulo (UNIFESP), 2018-02-16) Garcia, Silmara Jorge [UNIFESP]; Blanes, Leila [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Wounds are among the most frequent problems encountered in health services and may interfere with quality of life. Several health services need guidelines for wound management, including ambulatory care facilities in prison systems. Objective- To develop and implement a wound care protocol for the São Paulo State Penitentiary System. Methods- The study was approved by the Research Ethics Committee of Unifesp and by the State Department of Prison Administration (SAP). This protocol study was performed in stages. First, novelty search, analysis of epidemiological profile, literature review, and content development and validation using the Delphi technique were performed. The Content Validity Index (CVI) was used to measure agreement on the obtained responses. The overall CVI for the protocol version 2 was 1.0, above the required minimum of 0.90, reaching the highest level of agreement. Results- The wound care protocol was developed based on the literature and characteristics of the institution. Its validated final version contained 70 pages, 15 illustrations, and the following headings- Introduction, Objective, Assignments for the health care team, Instructions for use, Understanding wounds and wound healing, General assessment of the patient, Wound assessment, Treatment, Wound management, Topical therapy, and illustrations. Conclusion- A wound care protocol was developed for the São Paulo State Penitentiary System and implemented in the -Nestor Canoa- Prison in the city of Mirandópolis, Brazil.