ABSTRACT
Resumo Introdução: o atendimento isolado de pacientes com lesões por esforços repetitivos/distúrbios osteomusculares relacionados ao trabalho (LER/DORT) por profissionais de diferentes áreas é insuficiente para contemplar todos os aspectos sociais e de saúde afetados por esses agravos. Objetivo: relatar o trabalho conjunto interdisciplinar entre Fisioterapia e Psicologia, desenvolvido por meio de grupos de qualidade de vida (GQV) para pacientes com LER/DORT atendidos no Centro de Referência de Saúde do Trabalhador de Guarulhos-SP. Métodos: foram analisados os relatórios dos GQV desenvolvidos de 2009 a 2014 e as gravações das reuniões dos dois grupos mais recentes. Discussão: as identidades pessoais e profissionais dos pacientes afetados pelas LER/DORT estavam abaladas com o adoecimento, a invisibilidade da doença, os longos períodos de tratamento e de afastamento do trabalho e com a exclusão social decorrente desse quadro. O GQV propiciou um espaço de reflexão e socialização para os trabalhadores adoecidos, auxiliando-os no resgate da sua identidade e cidadania. A atuação conjunta interdisciplinar da Fisioterapia e da Psicologia nos grupos se mostrou fundamental para enfrentar a complexidade e a multifatorialidade desses agravos, ampliando a visão e a experiência dos profissionais e instrumentalizando-os para um olhar mais integrado e humanizado voltado ao trabalhador adoecido.
Abstract Introduction: the isolated care of patients with repetitive strain injury/work-related musculoskeletal disorders (RSI/WMSD) by different professionals is insufficient to cover all health and social aspects affected by these injuries. Objective: to report the interdisciplinary joint work between Physiotherapy and Psychology, developed through quality of life (QOL) groups for RSI/WMSD patients, at the Centro de Referência de Saúde do Trabalhador (Worker's Health Reference Center) in Guarulhos, São Paulo, Brazil. Methods: we analyzed the QOLs groups reports from 2009 to 2014, and the recordings of the two most recent groups meetings. Discussion: the RSI/WMSD patients' personal and professional identities were affected by their falling ill, the disease invisibility, the long periods of treatment and consequent absences from work, as well as by the social exclusion resulting from all these situations. The QOL group provided the sick workers with a space for reflection and socialization, and helped them recover their identity and citizenship. Physiotherapy and Psychology interdisciplinary joint work carried out in the groups was essential to face the RSI/WMSD complexity and its multiple factors. It also contributed to broaden the physioterapists' and psychologists' visions and experiences, supplying them with the needed tools to pursue a more integrated and humanized approach towards sick workers.
ABSTRACT
Introducción: el trauma se ha convertido en una pandemia que tiene un severo impacto socioeconómico, alta tasa de morbilidad y mortalidad y sobre todo las secuelas muchas veces permanentes. Todo esto obliga al sistema de salud a enfrentar esta entidad en forma multisectorial, buscando la disminución de los daños a través de múltiples estrategias. Objetivo: caracterizar a los pacientes fallecidos que fueron ingresados por lesiones traumáticas. Métodos: se realizó un estudio observacional, descriptivo y transversal en los 40 fallecidos por lesiones traumáticas admitidos en el Hospital Provincial Saturnino Lora Torres durante el periodo comprendido entre enero del 2010 a diciembre de 2012. Fue calculada la prueba chi al cuadrado de independencia para identificar asociación estadísticamente significativa entre variables seleccionadas con un nivel de significación p < 0,05. Resultados: se observó que la letalidad hospitalaria de esta muestra estuvo dada predominantemente en el politraumatizado joven. Existió un predominio del trauma torácico por arma blanca en el sexo masculino. La mayoría de los pacientes fueron intervenidos de extrema urgencia, predominaron las lesiones en dos órganos. En cuanto al tipo de intervención la cirugía definitiva se impuso sobre la de control de daños. La principal complicación y causa de muerte fue el shock hipovolémico. Conclusiones: la mortalidad de la serie estuvo determinada fundamentalmente por la gravedad de las lesiones, se registraron eventos adversos en muchos casos como causa de muerte(AU)
Introduction: trauma has become a pandemic that has a severe socio-economic impact, high morbidity and mortality rates and in many occasions, permanent sequelae. All this requires that the health care system faces this type of pathology with a multisectoral approach in order to reduce damages through multiple strategies. Objective: to characterize dead patients who had been admitted to hospital for traumatic injuries. Methods: observational, descriptive and cross-sectional study of 40 dead patients who had been admitted to Saturnino Lora Torres provincial hospital for trauma injuries during the period from January 2010 to December 2012. The Chi square test for independence was estimated to identify any significant statistical association among selected variables with a significance level of p < 0.05. Results: it was found that in-hospital fatality rate of this sample was mainly in young multi-trauma patients. Thoracic trauma from stabbing prevailed in males. Most patients were operated on at the emergency service and two organ damages predominated. As for the type of intervention, definitive surgery prevailed over the damage control type. The main complication and cause of death was hypovolemic shock. Conclusions: the mortality rate of the series was primarily estimated by the severity of injuries; adverse events were frequently the cause of death(AU)
Subject(s)
Humans , Male , Female , Wounds and Injuries/epidemiology , Wounds and Injuries/mortality , Cross-Sectional Studies , Epidemiology, Descriptive , Observational StudyABSTRACT
Trauma is an ever increasing problem and it is the leading cause of morbidity and mortality in the under 40s age group. The main purpose of this study is to determine the pattern of death related to trauma cases presenting to the emergency department (ED) of a university hospital. This was a retrospective analysis of 75 consecutive trauma case records at a university hospital for a one year period. The most common cause of deaths is motor vehicle crashes. The mean score for the injury severity score (ISS) and revised trauma score (RTS) on arrival to the ED among the succumbed patients were 27.8 (s.d 8.6) and 5.7 (s.d 1.1) respectively. 58.7% of deaths occurred within 48 hours after the admission. Less than 50% of studied patients were still alive beyond 45 hours post admission and less than 10% still alive beyond 11 days. Our analysis also showed that 28% (n=21) and 56% (n=41) of the studied sample had a probability of survival between 50% to 75% and more than 75% respectively upon arrival based on the initial vital signs in the ED and the trauma and injury severity score (TRISS) methodology. Overall, we observed similar injury mechanisms, demographics and causes of death compare to other studies. The figures from this study, mandate further exploration of preventive issues and management improvements that should be applied not only to the current trauma system, but also to the health care system in general.
ABSTRACT
Multislice computed tomography (MSCT) is the imaging modality of choice in assessing clinically stable patients with blunt abdominal trauma. This study assessed the role of MSCT in the detection of intra abdominal injury caused by blunt trauma in our centre within a two-year-period (2008-2009). A total of 151 patients had MSCT abdomen for blunt abdominal trauma within this study period. Positive scan were seen in 126 patients (83.4%). Out of these positive scans, liver, spleen and renal injuries were seen in 42.1% (n=53), 34.9% (n=44) and 30.0% (n=34) of cases respectively. Laparotomies were performed in 45 patients. Out of these 45 laparotomies, 10 patients had surgically significant injuries that were missed on CT scan findings. The injuries were bowel perforation (n=4), serosal tear of bowel (n=1), mesenteric injuries with active haemorrhage (n=3), spleen injury (n=1) and liver injury (n=1).
ABSTRACT
Objective: To investigate the expression of nuclear factor-κB (NF-κB), matrix metalloproteinase-2 (MMP-2), tissue inhibitor of metalloproteinase-2(TIMP-2) in the kidneys of rats with acute renal trauma, and to discuss the influence of ulinastatin on their expression and its protective mechanism on the kidney. Methods: The animal model was established by striking the rachi-costaz zone with falling object from the height of 45 cm. Sixty-six rats were randomly divided into three groups:normal control group (C,n = 6),trauma group (TRA,n = 30),and ulinastatin+trauma (UTI,n = 30); the last 2 groups were further divided into 1 h, 6 h, 12 h, 18 h and 24 h subgroups, with 6 animals at each time point. Tissue microarray and immunohistochemistry were used to examine the expression of NF-κB and MMP2/TIMP-2 in different groups. Results: MMP-2 and NF-κB began to express 1 h after trauma in TRA group and their expression was significantly stronger than that in the control group (P < 0.05, P < 0.01); their expression reached the peaks at 12 h and 6 h after trauma and then gradually decreased. The expression of MMP-2 and NF-κB in UTI group reached their peaks 18 h and 12 h after trauma,respectively,and was significantly higher than that in the control group(P<0.01),but was lower than that in the TRA group at corresponding time points(P<0.01,P<0.05). The expression of TIMP-2 was significantly stronger than that in the control group and TRA group at 6 h, 12 h and 18 h after trauma(P<0.01,P<0.05). Conclusion: The expression of NF-κB,MMP-2 is increased in acute traumatic tissue of the kidney; the increase of TIMP-2 is not evident. Ulinastatin can protect the kidney by inhibiting the expression of MMP-2 and NF-κB and maintaining the balance of MMP-2/TIMP-2.