Recent Articles

Warfarin is a widely used anticoagulant agent with a large spectrum of indications for prevention and treatment of thromboembolic complications. Despite its low cost, warfarin and all other vitamin K antagonist (VKA) use has several limitations, including narrow therapeutic index requiring frequent laboratory monitoring to prevent complications related to under- and over-anticoagulation. The concomitant use of medications may alter the metabolism of warfarin by inducing or inhibiting the cytochrome P450-2C9, resulting in a decrease or increase in anticoagulant effect. In this setting, interactions between warfarin and antibiotics have been described. These interactions represent one of the problems with VKA use in the clinical setting. We aimed to report four cases where the prescription of antibiotics without proper control of anticoagulation levels led to major hemorrhagic complications.

Introduction: Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease characterized by selective degeneration of motoneurons in the cortex, brain stem and spinal cord. Diversity in the clinical condition is a well recognized feature of the disease. Functional Independence (FI) relates to functional activities, identified by the individual as essential for the preservation of their physical and psychological well-being. Patients diagnosed with ALS have direct effects on functionality and well-being. Objective: Analyze the FI index of patients with ALS, living in Aracaju/SE. Methods: This is an analytical, descriptive, cross-sectional study, with sampling for convenience. Data collection was performed in the patients’ homes and Functional Independence Measure (MIF) was used to measure functional independence levels. Results and Discussion: Patients of both sexes were evaluated, being 75% male and 25% female. The mean age was 63.2 years and the time of diagnosis was on average of 4.7 years. Of these, 50% breathed in ambient air and 50% used mechanical ventilation assistants, 75% were assisted with auxiliary devices and 25% were restricted to the bed. All patients receive medical care and 25% of them are assisted by a multidisciplinary team. MIF presented a mean of 65.25 points in total, indicating a dependence between modified and complete in the individuals studied. Chronic diseases such as ALS produce significant repercussions on IF, but with preservation of cognition and these are some of the main problems in the life of patients. Conclusion: Individuals affected by ALS have heterogeneous alterations, with a consequent decrease in their FI. The use of instruments such as MIF is important to assist in more personalized therapeutic action and contribute to the delay of functional dependence.

Introduction: Palliative term means “calm ‘’ or” temporarily slow down evil ‘’, according to the World Health Organization (WHO). In this process, palliative care to cancer patients is given from the time of diagnosis, generating preventive actions primarily for the relief of pain of each individual. Pediatric patients often require a different palliative care. Given this, the Law No. 11,104, of March 21, 2005, establishes toy libraries installation in health facilities that offer pediatric care in detention regime. Objective: analyze the benefits of toy in pediatric oncology. Methodology: This is a literature review study, using the following electronic journals in databases: BDENF, LILACS, SciELO and Brazilian law. The descriptors used were Therapeutic Toy, Cancer, Palliative Care, Child oncopediatrica. The search took place 10-20 July 2017. Under the inclusion criteria for articles published between 2012 and 2016, written in Portuguese and in full text. Excluding the items that did not meet the theme. Results and Discussion: identified 98 publications, 12 of these met the inclusion criteria. The discussion of the play as a palliative care to cancer child, demonstrates to be relevant, since it is considered an important element in fighting the disease and treatment. The use of therapeutic play is seen as an essential tool in the treatment because it facilitates the understanding of the procedures and acceptance in the treatment and minimize the anxiety, stress and fear, also contributing to the interaction, the welfare and development of child. Conclusion: Finally, it is noted that the therapy with toys provides a child’s positive response on the procedures and the team itself, making it more collaborative procedures during their treatment, thus making it less painful and traumatic.

Introduction: Leishmaniasis is a serious public health problem in Brazil and in the world. It is considered one of the six most important infectious diseases in the world and is endemic in 88 countries. The objective of this study is an account of the case of a patient attended by Dermatology Department from Clinical Hospital at the Federal University of Pernambuco, which was admitted with clinical suspicion for leishmaniasis in the year 2013 and had your lesion evaluated through histopathological, molecular and also with stress and cellular inflammation markers, Hypoxia-inducible factor, HIF-1α. The patient had a lesion located in the nose, which was initially submitted to biopsy after four months of evolution. Subsequently, the material was submitted to the paraffinization procedure and after to included in the dermatology collection and analysis. Slides with sections of the material were stained with Hematoxylin / Eosin for histopathological analysis performed at the Hospital, and others were not stained for the immunohistochemical study, performed with peroxidase system and HIF-1α detection occurred in the nucleus and / or cytoplasm of macrophages and it was performed by Laboratory of Tropical Disease from Department of Biology at University of Campinas and analysis by molecular biology was done by deparafinisation of fragments and subsequent DNA extraction with Promega® kit followed by PCR performed at the Aggeu Magalhães-Recife research center. Histopathological medical report classified the lesion as differentiated Spinocellular Carcinoma and did not report presence of parasite, while the PCR was positive for Leishmania braziliensis, and the evaluation for HIF-1α was observed by strong marking (3+). Histopathological analysis is the only diagnostic tool used in HC-PE, which may complicate the manipulation and treatment, and cases like this show us the need for methods that corroborate for a more concise and differential diagnosis, when necessary. Using specific and sensitive techniques…

Introduction: Parkinson’s disease is neurodegenerative, chronic and affects motor and non-motor domains. Its individualized spectrum of symptoms and its slow progression favor the abandonment of treatment. Teams composed of neurologists, physical educators, speech therapists, nutritionists, psychologists and other professionals are increasingly important in the care of this pathology. Objective: To evaluate the importance of a multidisciplinary treatment in Parkinson’s disease. Methodology: An integrative review was performed on the PubMed and BVS databases, using the descriptors “Parkinson’s Disease”, “Patient Care Team” and “Therapeutics” between the years of 2013 and 2017. Review articles and in animals were excluded. Results and discussion: From the 18 studies located, only three were in agreement with the inclusion criteria. Although multidisciplinary intervention is beneficial in the treatment of chronic patients, evidence of its effectiveness in Parkinson’s disease is still limited, due to the lack of standardization in interventions and heterogeneous results. But studies indicate that the insertion of a multidisciplinary team in the care of patients with Parkinson’s disease can bring benefits in the motricity, the emotional state and the quality of life itself. An integrative approach may also have substantial consequences when compared to invasive treatments. It is even recommended that there be prolonged multicenter follow-up to assess the emotional state and the psychic safety of these patients preceding invasive therapies. Conclusion: In multidisciplinary care, there is an interrelationship between different professionals gathering different knowledge, in a more humanized and holistic approach. Allowing more effective care of these patients. Although there is great importance in this subject are still scarce the works that deal with the subject, being necessary more studies in the area.

Introduction: According to the World Health Organization, cancer is a public health problem, especially among developing countries, where it is expected that in the coming decades, the impact of the disease on the population will correspond to 80% of the more than 20 million cases new estimates for 2025. Despite the advances in the technologies and drugs of antineoplastic therapy, several oral repercussions can be observed. Thus, dentistry plays a fundamental role in the restoration of general health and, consequently, the quality of life of these individuals. Objectives: To verify the dental assistance in the oncological practice. Methodology: Literature review where we searched for published articles available on the internet in the database systems: Medlars on line International Literature (Medline), Latin American and Caribbean Literature in Health Sciences (Lilacs) and Brazilian Bibliography of Dentistry (BBO) present on the website of the Virtual Health Library (BVS). Results and Discussion: The literature evidences the need for oral-dental care and the inclusion of the dental surgeon in the multi and inter-transdisciplinary medical team required for good oncological practice. The literature is unanimous in indicating the need for medical intervention with the support of a multidisciplinary health team, including dental surgeon, in order to ensure adequate performance of antineoplastic therapies and specific care in the control of oral side effects and consequent general repercussions. Dentistry, for example, the prevention, treatment and control of diseases such as mucositis, xerostomia, cavities, dental infections and opportunistic mouth. Precariousness or even lack of adequate dental care may compromise oncological practice. Conclusion: The dentist incorporated into the oncological practice contributes to the quality of the care, favoring the integral care with attention to the oral condition and systemic repercussions.

Introduction: Cancer is a public health problem, and among patients with neoplasias, 5 to 10% will develop disease-related wounds where they affect the quality of life of the patient. Odor is the most prevalent symptomatology and requires frequent assessment to identify appropriate conduct and necessary adjustments. Objective: To verify the existence of odor evaluation instruments in neoplastic wounds. Methodology: This is an integrative review of the literature. The bibliographical survey was performed from September to October 2016 in the databases Lilacs, SciELO, IBECS and MEDLINE, with no time limit. Original articles were included in Portuguese, Spanish and English, published in full and electronically available, totaling 15 articles. Results and Discussion: Among the symptoms of neoplastic wounds, bad odor is one of the most complex to address and should be explored carefully and scientifically, for decision-making and interventions. In this research were found only scales and no instrument. Nine assessment scales were found, most of them produced by nurses, who evaluated only the intensity of the odor, and only two evaluated the distance and intensity. The most used scale was the qualitative and quantitative odor evaluation guide, designed to evaluate products and / or coverings in neoplastic wound dressings, scoring the symptom in four levels. As for validation, only the Teler scale was validated, scoring on six levels. Therefore, even in the absence of validity, the scales have been used in clinical practice, both in verifying the efficacy of the treatment for odor control and in the measurement of the symptom itself. Conclusion: The results of this study have demonstrated to date a single validated scale, pointing to the need to develop new tools in order to incorporate validated and reliable instruments into clinical practice.

Introduction: Bruxism is a parafunctional oral activity that includes tightening, grinding and clapping teeth during sleep or wakefulness. Sleep bruxism (BS) is detected by electromyography (EMG) through the recording of masticatory muscle function during sleep. The EMG should be part of a more comprehensive examination, the polysomnography (PSG). Objectives: To analyze the polysomnographic aspects of bruxism and its relation to sleep disorders. Methodology: An integrative review was carried out in MEDLINE, LILACS, BDENF and SCIELO databases, with publications between 2012 and 2017, in Portuguese and English, using the descriptors: “Bruxism” and “Polissonography”. Result: 83 related articles were found, of which 3 served as theoretical basis. Discussion: PSG records the main nocturnal physiological events through electrodes and sensors arranged along the skull, which allows the identification of disorders, such as BS. In addition to the EMG there is the use of electrocardiogram, electroencephalogram, electro-oculogram and respiratory activity. PSG characterizes bruxism as abnormal continuous or intercalated peaks of temporo-massetric activity. During sleep, in normal individuals, physiologically, there are up to two mandibular movements per hour, but in the pathological state this happens four to twelve times an hour. Bruxism events occur mainly during light sleep (non-REM) and are usually associated with brief non-periodic body movements and micro-awakenings, which generate sleep fragmentation. It is believed that BS is one of the last events following brain and cardiac activations of micro arousers in response to respiratory obstruction. Conclusion: The aetiopathogenesis of BS is multifactorial, covering hereditary factors, disorders of the nervous system, micro-arousals, stress and anxiety. Thus the treatment is based on the signs and symptoms presented by the patients. Measures such as placement of stabilizing plaques, relaxation strategies and some drugs are proposed for therapy.

Introduction: The incidence of Alzheimer’s disease (AD) has increased worldwide as the population over 65 years old increases. According to Alzheimer’s disease this disease is a type of dementia that affects 35.6 million people worldwide. Although educating and assisting are really important, when it comes to a degenerative disease in which the patient has difficulty acting on his own behalf, it becomes arduous the educational and care procedures aimed at the care recipient and their families. Objectives: to verify the main challenges of the educator and care role of the patient without development of Alzheimer’s disease. Metrology: For an elaboration of the review was carried out for the literature in the SciELO (Online Electronic Scientific Library) database using nursing and Alzheimer’s disease. Applying the cut of the last 3 years (2015-2017), 11 were found which composes the bibliographic review. Results and Discussions: There was a shortage of medical care instruments in AD by nurses. Consequently, the lack of clarification for family members regarding continuity of care is evident, since it is essential or estimated cognitive by the family, in order to make patients independent. This in fact emphasizes the role of nurse educator in elucidating family members about the practice of care and the development of the disease. Conclusion: Associating cognitive stimulation with drug treatment and possible attenuation as sequelae of the disease. Activities such as manual practices, reading, dancing, identification of objects and temporal orientation, can awaken greater stability. Thus, the nursing professional favors the quality of life of the patients; therefore, it minimizes the difficulties of the caregivers.

Introduction: Spinal cord injury (MRT) is a traumatic external injury that compromises or not the function of the spinal cord or nerve roots. In Brazil it is estimated that about 40 new cases per year per million inhabitants occur. OBJECTIVES: To compare scientific publications through an integrative review, related to the prevalence of MRT in young adults in Brazil. Methodology: This is an integrative review based on articles from LILACS (Latin American and Caribbean Literature in Health Sciences) and SCIELO (Scientific Electronic Library Online), published from 2007 to 2017. It was built in the following phases: 1) problem formulation 2) data collection 3) data evaluation 4) analysis and interpretation 5) presentation of results. Results and Discussion: It was observed that the articles found that deal with spinal cord trauma, point to the prevalence of MRT in an age group that picks up from childhood the old age being more recurrent in young male adults. The results reveal that accidents involving cervical trauma are more frequent in the age group of 20- to 30-year-old males. It has also been observed in state hospitals that TRM injuries generate a longer time of hospitalization and, consequently, an increase in hospitalization costs. The main etiologies of TRM were falls and traffic accidents with cars and motorcycles. Conclusion: It is extremely important to educate the population about the risks of TRM through health education, as well as the creation of preventive campaigns both to reduce the occurrence of traffic accidents and to reduce the incidence of falls.