Prevalence of people with sickle cell disease and leg ulcers in Brazil: Socioeconomic and clinical overview

Objective

To identify the prevalence of people with leg ulcers resulting from sickle cell disease, as well as to describe the clinical, social, economic, and demographic conditions of these people.

Method

Descriptive study, carried out at the Minas Gerais Hematology and Hemotherapy Center Foundation. The study population consisted of individuals over the age of 18 with a diagnosis of sickle cell disease in the State of Minas Gerais, Brazil. Data collection was performed from August 2019 to April 2020 through interviews. For the prevalence calculation, a census was taken of 5,379 people over the age of 18 with sickle cell disease, 77 of whom had active leg ulcers. Descriptive data analysis was performed using SPSS software (version 20.0, Chicago, IL, USA).

Results

The prevalence of people with leg ulcers in Minas Gerais, Brazil was 1.4%. Of the 72 respondents, the average age was 39 years (range 18–64 years), 41.7% were single, 48.6% said they were black, 84.7% lived in their own house, 38.9% were retired, 61.1% had an income of one minimum wage. The median years of education was 10.5, 50% cited the church as a place for leisure activities, 79.2% denied smoking. Regarding pain, the median score was 3, the median baseline hemoglobin was 7.7 g/dL, and 91.7% had the HbSS genotype. The median age of the first ulcer was 18 years, 77.8% of active ulcers were recurrent, and 59.7% had only one active ulcer. The median time of existence of the ulcer was 3 years. The ulcer prevented 80.6% of people from doing some activity. Prejudice was experienced by 48.6% of the participants.

Conclusion

The estimated prevalence of leg ulcers was lower than what it reported in the literature, however, the recurrence and the duration of ulcers were high. These findings bring reflection about the assistance to people with leg ulcer.

Biofilm model on mice skin wounds

PURPOSE

To evaluate a biofilm model of Pseudomonas aeruginosa in excisional cutaneous wound in mice.

METHODS

Preclinical, translational study conducted with 64 C57BL/6 mice randomly assigned to control and intervention groups. Evaluation was on days D0, D3, D5, D7 and D10 of wound making. The profile of biofilm formation and induction was evaluated using wound closure kinetics, quantitative culture, and evaluation of wounds using transmission electron microscopy (TEM). Clinical evaluation was performed by liver tissue culture, weight variation, and quantification of leukocytes in peripheral blood. Analyses were performed with GraphPad Prism software.

RESULTS

Bacterial load for induction of infection with P. aeruginosa and survival of animals was 104 UFC·mL-1. In D5 (p < 0.0001) and D7 (p < 0.01), animals in the intervention group showed a delay in the healing process and had their wounds covered by necrotic tissue until D10. Statistical differences were observed in wound cultures and weight at D5 and D7 (p < 0.01). Liver cultures and leukocyte quantification showed no statistical differences. No bacteria in planktonic or biofilm form were identified by TEM.

CONCLUSIONS

The findings raise questions about the understanding of the ease of formation and high occurrence of biofilm in chronic wounds.

Patients who experience systemic lupus erythematosus and leg ulcer: phenomenological approach

OBJECTIVE

To understand the experience of a woman with systemic lupus erythematosus and leg ulcers with cutaneous calcinosis.

METHODS

An experience report based on the social phenomenology of Alfred Schutz, conducted with a young woman undergoing treatment in an outpatient service.

RESULTS

The disease manifested itself in adolescence and brought emotional instability associated with body image concern and social isolation. The discontinuation of the studies triggered financial limitations with implications for treatment. The presence of ulcers aggravated by skin calcification makes the process of getting sick tiring and painful. Interpersonal relationships are resources for coping with situations experienced.

FINAL CONSIDERATIONS

Patients with lupus may have social, affective, and family life, even in the face of the limitations imposed by the disease. However, the emergence of leg ulcer with calcinosis changes this situation.

Microbiological profile of leg ulcer infections: review study

OBJECTIVES

to analyze the microbiological profile of leg ulcers of patients treated at outpatient clinics and hospitals regarding the type of microorganism, microbiological selection of antibiotics, and techniques for the collection of culture material.

METHODS

literature review performed on LILACS, IBECS, MEDLINE, and CINAHL databases, resulting in a descriptive analysis of 27 studies.

RESULTS

35.7% of the studies occurred in an outpatient care scenario; and 64.2% in hospitals. There was a predominance of swab (100%) in outpatient care and biopsy (55.5%) in the hospital. Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus were more common at both levels of assistance. Methicillin-resistant Staphylococcus aureus was isolated in both.

CONCLUSIONS

the microbiological profile of infections was similar, with the presence of resistant bacteria in both environments. This fact causes concern and raises the need for research to elucidate it. The studies did not compare the effectiveness between biopsy and swab.

PROFILE OF WOMEN WITH LEG ULCERS DUE TO SICKLE CELL DISEASE

Objective: to characterize the profile of women with leg ulcers resulting from sickle cell disease treated at a public health institution in Brazil. Method: historical cohort study conducted in the outpatient sector with a sample of women with sickle cell disease and leg ulcer, followed from 1998 to 2014. The data were extracted from the medical record and included sociodemographic, clinical and ulcer-related variables, and underwent descriptive statistical analysis. Results: of the 17 women, 64.7% were cured, 58.8% were aged between 30 and 39 years, 64.7% declared themselves brown, 70.6% were without partners, 41.2% had incomplete elementary education, 52, 9% had an income of 2 to 3 minimum wages, 70.6% were eutrophic and 82.4% used vitamin supplements. Women had a total of 29 ulcers, 52.9% had a single ulcer, 41.4% were located in the malleolar region, 55.17% were between 2 and 36 months, all classified as stage 3. The treatment was with coverings and Unna’s boot. Conclusion: the women received care from specialist nurses and most were cured with up to eight months of follow-up, which required a nursing consultation, including clinical evaluation, topical treatment and application of compression therapy.

PERFIL DE MULHERES COM ÚLCERAS DA PERNA DECORRENTES DE DOENÇA FALCIFORME

Objetivo:caracterizar o perfil de mulheres com úlceras da perna decorrentes da doença falciforme atendidas em uma instituição pública de saúde do Brasil. Método: estudo de coorte histórica realizado no setor ambulatorial com amostra de mulheres com doença falciforme e úlcera da perna, acompanhadas de 1998 a 2014. Os dados foram extraídos do prontuário e contemplaram variáveis sociodemográficas, clínicas e relacionadas à úlcera, e passaram por análise estatística descritiva. Resultados: das 17 mulheres, 64,7% obtiveram cura, 58,8% tinham idade entre 30 e 39 anos, 64,7% se autodeclaram pardas, 70,6% estavam sem parceiros, 41,2% possuíam ensino fundamental incompleto, 52,9% tinham renda de 2 a 3 salários mínimos, 70,6% eram eutróficas e 82,4% faziam uso de suplementos vitamínicos. As mulheres apresentaram o total de 29 úlceras, 52,9% tinham úlcera única, 41,4% localizadas na região maleolar, 55,17% com existência entre 2 e 36 meses, todas classificadas em estágio 3. O tratamento foi com coberturas e bota de Unna. Conclusão: as mulheres receberam cuidados de enfermeiros especialistas e a maioria obteve a cura com até oito meses de acompanhamento que demandou a consulta de enfermagem, contemplando a avaliação clínica, o tratamento tópico e aplicação da terapia de compressão.

INCIDENCE OF SKIN INJURIES, RISK AND CLINICAL CHARACTERISTICS OF CRITICAL PATIENTS

ABSTRACT Objective: to analyze the incidence of skin injuries, risk and clinical characteristics of critically ill patients. Method: a retrospective cohort study performed in the intensive care center with a sample of 125 patients whose outcome was skin injury. Results: the overall injury incidence was 28% (n=35), with 36.3% (n=8) being dermatitis associated with urinary and fecal incontinence, 19.2% (n=24) pressure injury, 7.2% (n=9) skin tears, and 0.8% (n=1) medical-adhesive-related skin injury. The appearance time of the injuries varied from 1 to 44 days. The average number of injuries per patient was 1.7. Factors such as enteral nutrition (p<0.001), mechanical ventilation (p=0.001), fecal incontinence (p=0.049), diaper use with a delayed urinary catheter or urinary diversion (p=0.004) were associated with injury onset. Conclusions: incontinence-associated dermatitis and pressure injury had a higher incidence in critically ill patients. Patients who developed pressure injuries were at higher risk.

Estimated costs in treating sickle cell disease leg ulcer

OBJECTIVE

To identify the costs of treating leg ulcers due to sickle cell disease from the perspective of the Unified Health System.

METHOD

An observational, descriptive, cost-effective economic assessment study conducted in a single center with ulcer patients. The data collected were extracted from the participant's medical records and recorded in a form prepared for this purpose. The cost of the products used in ulcer treatment was provided by the Solicitation/Purchasing Section and Pharmacy Sector of the study institution. The variables studied were ulcer area, number and interval between visits, patient's length of stay in the service, materials used in each visit, and the number of nurse appointments.

RESULTS

The sample consisted of 29 patients. The average initial area of ulcers was 14.47 cm2, 79% of the cases had complete epithelialization in an average time of 8.02 months, with an average cost of R$ 1,288.06. The average cost to reduce 1 cm2 of the lesion area was R$ 102.20. Silver activated carbon coating was the most cost-effective treatment.

CONCLUSION

The average cost for complete healing of a sickle cell ulcer with an average area of 14.95 cm2 was R$ 1,288.06.

Prevalence and Management of Urinary Incontinence in a Brazilian Hospital: A Prospective, Descriptive Study

Although urinary incontinence (UI) in hospitalized patients is a frequent health problem, research on the subject is limited.

PURPOSE

A prospective, descriptive study was conducted to evaluate the prevalence of UI, care implemented among hospitalized adult patients, and impact of UI on quality of life (QoL) in a large private institution in Brazil.

METHODS

All patients admitted during November 2018 who were at least 18 years of age, sufficiently conscious and oriented to answer questions, able to undergo skin inspection, and had the ability to urinate (ie, did not use an indwelling bladder catheter or have a nephrostomy, cystostomy, urostomy, or vesicostomy) were eligible to participate. Data were collected through interviews, physical examinations, chart review, and completion of the International Consultation on Incontinence Questionnaire-Short Form (ICQI-SF), a self-diagnostic, 6-item survey of UI frequency, amount of leakage, and overall impact of UI; answers for items 3 (6 answer options), 4 (4 answer options), and 5 (Likert scale ranging from 0 to 10) were considered individually and summed for a total score ranging from 0 to 21. Data were collected using paper forms and then double-entered and validated in a spreadsheet for statistical analysis. Continuous variables were described as mean/median and standard deviation. Categorical variables were described in absolute numbers and percentages. Pearson's chi-squared test and Fischer's exact test were used to investigate the variable statistical differences. The level of significance was 5%, and the intervals were obtained with 95% confidence. Prevalence was defined as the percentage of people with UI over the study period in all admitted patients.

RESULTS

Of the 858 eligible patients, 114 were incontinent (13.3%), but 61 were unable to answer the research questions, 2 used catheterization, and 9 refused to participate; therefore 42 patients (age 80 [range 77.6-82.3] years, 30 [71.4%] women) completed the study. All patients (100%) were managed using diapers. Twenty-one (21, 50%) were married, 24 (57.1%) were white, and 25 (59.5%) were retired. Sixteen (16, 38.1%) had urine loss several times a day, and 17 (40.5%) had urine loss in large amounts; 10 (23.8%) had incontinence-associated dermatitis. The ICQI-SF item regarding interference of urine loss in daily life had a reported mean of 4.1 ± 4.0, inferring urine loss interfered with life; mean ICQI-SF score was 12.1 ± 5.86, implying UI had a moderate impact on QoL.

CONCLUSION

The 13.3% prevalence of UI was similar to previous studies. The absence of a protocol for incontinence management was identified. The results suggest additional, larger sample UI prevalence studies need to be conducted.

Professional activity of stomatherapists graduated from the Federal University of Minas Gerais

Objectives: This study aimed to identify the area of professional activity, characterize the trajectory and clinical practice in the area of stomatherapy, and identify further training as a specialist. Method: A descriptive study with a quantitative approach was conducted by applying an online questionnaire to graduates of the specialization course in Stomatherapy of the Federal University of Minas Gerais, which began in 2007, totaling 97 by 2015. The convenience sample was composed of 84 specialists who agreed to answer the questionnaire considering the study variables. Results: Most of the graduates were female (86%), aged between 31 and 40 years (68%), residents (58%) and working (59.6%) in Belo Horizonte. They remain active in their specialty area (70%), with predominance of stoma and wound care (31%), in care activities (29.3%), in the hospital area (27.3%) and in the health public sector (38%). The pursuit of specialization was predominantly motivated by interest in technical-scientific development (48.5%) and (69%) of the graduates continues capacitating after specialization. Conclusion: Stomatherapy is expanding in the national market, requiring the continuation of national research for a broader view of the specialty.

Atuação profissional dos estomaterapeutas egressos da Universidade Federal de Minas Gerais

Objetivos: Este estudo teve como objetivos identificar a área de atuação profissional, caracterizar a trajetória e a prática clínica na área da estomaterapia e identificar posteriores capacitações como especialistas. Método: Estudo descritivo com abordagem quantitativa realizado por meio da aplicação de questionário online aos egressos do curso de especialização em Estomaterapia da Universidade Federal de Minas Gerais, iniciado no ano de 2007, totalizando 97 egressos até 2015. A amostra por conveniência foi composta pelos 84 especialistas que concordaram em responder o questionário contemplando as variáveis do estudo. Resultados: Os egressos eram em sua maioria do sexo feminino (86%), com idade entre 31 e 40 anos (68%), residentes (58%) e atuantes (59,6%) em Belo Horizonte. Mantêm-se atuantes em sua área de especialidade (70%), com predominância dos cuidados com estomias e feridas (31%), em atividades assistenciais (29,3%), na área hospitalar (27,3%) e no setor público de saúde (38%). A busca pela especialização foi motivada predominantemente pelo interesse no desenvolvimento técnico-científico (48,5%) e (69%) dos egressos continua se capacitando após a especialização. Conclusão: A estomaterapia encontra-se em expansão no mercado nacional, sendo necessária a continuidade de pesquisas de âmbito nacional para uma visão mais abrangente da especialidade.

Factors associated with complex surgical wounds in breast and abdomen: a case-control observational study

Objective:

to identify factors associated with complex surgical wounds in the breasts and abdomen in outpatients.

Method:

observational case-control study involving 327 patients, distributed into 160 cases (complex surgical wound) and 167 controls (simple surgical wound). Data were extracted from the medical records and a binary logistic regression model was used for analysis, considering a significance level of 5%.

Results:

the factors associated with greater chance of occurrence of complex surgical wound were 18 to 59 years of age (p = 0.003), schooling < 8 years (p = 0.049), radiotherapy (p < 0.001), hysterectomy (p = 0.003), glycemia (≤ 99 mg/dL) and arterial hypertension (p = 0.033), while quadrantectomy (p = 0.025) served as a protective factor.

Conclusion:

radiotherapy was the most significant factor for surgical wound complications. Glycemic alteration was an unexpected result and shows the need for further studies related to this topic.