Caracterização de lesões bucomaxilofaciais decorrentes de agressão física: diferenças entre gênero / Characterization of oral maxillofacial lesions resulting from physical aggression: differences between genders

Resumo Em países desenvolvidos, a violência é a principal causa de lesões bucomaxilofaciais (LBMF). No Brasil, há poucas evidências sobre tais lesões. Objetivou-se caracterizar as LBMF resultantes de agressão física em uma capital do nordeste brasileiro e analisar diferenças entre gêneros. Foram investigados 15.847 laudos do Instituto Médico Legal de São Luís/MA, ocorridos em 2012. Coletaram-se dados socioeconômicos, demográficos e características das LBMF. Utilizaram-se os testes Qui-quadrado e Exato de Fisher para avaliar diferenças entre gêneros. Dos casos periciados, 1977 eram LBMF. Vítimas do sexo feminino, com 20-59 anos de idade, cor parda, sem companheiro e empregadas foram mais afetadas. Lesões do tipo equimose, nas regiões bucinadora e labial, decorrentes do uso de instrumentos contundentes, ocasionando debilidade funcional permanente foram mais incidentes em mulheres (P < 0,05), ao passo que fratura dental, ferida contusa e perfurocontusa, decorrentes de instrumentos cortantes e perfurocontundentes, ocasionando deformidade permanente, incapacidade ocupacional e perigo de vida, em homens (P < 0,05). Conclui-se que a incidência de LBMF decorrente de agressão física é alta em São Luís, MA, e, embora as mulheres sejam mais acometidas, as LBMF em homens são mais severas.

Abstract In developed countries, violence is the main cause of oral maxillofacial (OMF) injuries. In Brazil, there are scant records of such lesions. The scope of this study was to detail the OMF injuries resulting from physical aggression in a capital of the Brazilian northeast and analyze gender differences. The Forensic Medicine Institute of São Luís, state of Maranhão, featured 15,847 reports, which occurred in 2012, and they were investigated. Socioeconomic, demographic data and OMF characteristics were analyzed. The Chi-square and Fisher's Exact tests were applied to assess gender differences. Of the cases examined, 1977 were OMF. Female victims, aged 20-59, dark-skinned, without a partner and maids were the most affected. Ecchymosis-type lesions, in the mouth and lip regions arising from the use of blunt instruments, causing permanent functional impairment, were the most prevalent in women (P < 0.05), whereas dental fracture and contusion arising from sharp instruments causing permanent deformity, occupational disability, and threat to life were detected in men (P < 0.05). The conclusion drawn is that the incidence of OMF due to physical aggression is high in São Luís, state of Maranhão, and although women are the most affected, the OMF in men are more severe.

Creation of a contusion injury method for skeletal muscle in rats with differing impacts

Abstract Purpose: To realize a morphological examination of the musculoskeletal tissue, assessing the effect of a contusion method for the production in rat gastrocnemius, comparing the inflammatory responses generated by different impacts. Methods: For the analysis of a contusion method, twelve female Wistar rats were distributed into four groups. The lesion was generated by 324 g of mass that was dropped from different predetermined heights for each group (30, 45, 60 and 70 cm). Results: In the analysis of musculoskeletal tissue, the response to injury varied according to the mass of the height drop onto the muscle. Only the group that was injured from 70 cm responded with uniform and severe inflammation, whereas the groups 30, 45 and 60 cm showed inflammation in some regions of the tissue with mild and moderate infiltrates. Conclusion: The method with the 324-gram mass dropped from a 70-cm height onto the gastrocnemius muscle of rats seems to be the most suitable for the production of muscle injury in these animals after 72 hours, showing an important inflammatory infiltrate.

A combination of methylprednisolone and quercetin is effective for the treatment of cardiac contusion following blunt chest trauma in rats

Cardiac contusion is a potentially fatal complication of blunt chest trauma. The effects of a combination of quercetin and methylprednisolone against trauma-induced cardiac contusion were studied. Thirty-five female Sprague-Dawley rats were divided into five groups (n=7) as follows: sham, cardiac contusion with no therapy, treated with methylprednisolone (30 mg/kg on the first day, and 3 mg/kg on the following days), treated with quercetin (50 mg·kg−1·day−1), and treated with a combination of methylprednisolone and quercetin. Serum troponin I (Tn-I) and tumor necrosis factor-alpha (TNF-α) levels and cardiac histopathological findings were evaluated. Tn-I and TNF-α levels were elevated after contusion (P=0.001 and P=0.001). Seven days later, Tn-I and TNF-α levels decreased in the rats treated with methylprednisolone, quercetin, and the combination of methylprednisolone and quercetin compared to the rats without therapy, but a statistical significance was found only with the combination therapy (P=0.001 and P=0.011, respectively). Histopathological degeneration and necrosis scores were statistically lower in the methylprednisolone and quercetin combination group compared to the group treated only with methylprednisolone (P=0.017 and P=0.007, respectively). However, only degeneration scores were lower in the combination therapy group compared to the group treated only with quercetin (P=0.017). Inducible nitric oxide synthase positivity scores were decreased in all treatment groups compared to the untreated groups (P=0.097, P=0.026, and P=0.004, respectively). We conclude that a combination of quercetin and methylprednisolone can be used for the specific treatment of cardiac contusion.

Extensive soft tissue injuries as a cause of death.

The blunt trauma injury is the most common type, a pathologist encounter when doing medico-legal autopsies. Sometimes, while searching the main cavities of the body for the fatal injuries like lacerations and damages to the vital organs, we, the Forensic Pathologist commonly ignores the superficial small abrasions, bruises over the other parts of the body. Cutaneous injuries i.e. abrasions, contusions in most cases, are not fatal and are seemingly unimportant. However, soft tissue injuries not always are simple as mostly described in the literature but sometimes these injuries may be so extensive internally that leads to irreversible shock. In fact, these injuries prove fatal when taken collectively into consideration. Sometimes trivial circumstances lead to serious quarrel, resulting into death of the victim which apparently looking uninjured externally while conducting autopsy. Under such circumstances sometimes at primary health care centres the inexperienced autopsy surgeons are not in a position to correlate the superficial looking soft tissue injuries attributing towards death.

Randomized clinical trial to assess pain and bruising in medicines administered by means of subcutaneous and intramuscular needle injection: Is it necessary to have needles changed? / Ensaio clínico randomizado para avaliação de dor e hematoma em administração de medicamentos por via subcutânea e intramuscular: há necessidade de troca de agulhas? / Ensayo clínico aleatorio para evaluación del dolor y hematoma durante la administración de medicamentos por vía subcutánea e intramuscular: ¿Es necesario cambiar las agujas?

This clinical trial aimed at comparing the intensity of pain and bruising by subcutaneous and intramuscular injections using and retractable fixed syringes and needles and syringes with no needles combined, at a public hospital in Sao Paulo, for six months. We evaluated the perception of pain in case of intramuscular (n=1000) and subcutaneous injections (n=240). In subcutaneous application, bruise formation was also verified. Pain and bruising scores were higher in the group with no needles combined (p<0.001) and (p<0.029), respectively. The test power in relation to the pain scale of was 0.98. The use of retractable fixed needles is recommended in the application of subcutaneous and intramuscular injections. Clinical trial registration number: NCT01271608.

Este ensaio clínico teve como objetivo comparar a intensidade da dor e hematoma consequentes a injeções por via subcutânea e intramuscular, utilizando seringas e agulhas fixas retráteis e seringas com agulhas não conjugadas, em hospital público na cidade de São Paulo, durante seis meses. Foi avaliada a percepção da dor na injeção intramuscular (n=1.000) e na subcutânea (n=240). Na aplicação por via subcutânea, verificou-se também a formação de hematoma. A pontuação de dor e hematoma foi maior no grupo com agulhas não conjugadas (p<0,001 e p<0,029, respectivamente). O poder do teste em relação à escala de dor foi de 0,98. Recomenda-se o uso de agulha fixa retrátil na aplicação de injeções intramusculares e subcutâneas. Registro de ensaio clínico nº NCT01271608.

Este ensayo clínico tuvo como objetivo comparar la intensidad del dolor y hematoma de inyecciones por vía subcutánea e intramuscular utilizando jeringas y agujas fijas retráctiles y jeringas con agujas no conjugadas, en un hospital público en la ciudad de Sao Paulo, durante seis meses. Fue evaluada la percepción del dolor de la inyección intramuscular (n=1000) y la subcutánea (n=240). En la aplicación por vía subcutánea se verificó también la formación de hematoma. La puntuación del dolor y hematoma fue mayor en el Grupo con agujas no conjugadas (p<0,001) y (p<0,029), respectivamente. El poder de la prueba en relación a la escala de dolor fue de 0,98. Se recomienda el uso de aguja fija retráctil en la aplicación de inyecciones intramusculares y subcutáneas. Registro de ensayo clínico nº NCT01271608.

Acute Promyelocytic Leukemia Presenting with Central Nervous System Involvement: A Report of 2 Cases / 대한진단검사의학회지

Central nervous system (CNS) involvement in acute promyelocytic leukemia (APL) is rare, and the presence of CNS symptoms at the time of diagnosis of APL is even rarer. We report 2 cases of APL presenting with CNS involvement. A 43-yr-old woman presented with easy bruising and stuporous mentality. Her complete blood count (CBC) revealed leukocytosis with increased blasts. Bone marrow (BM) analysis was carried out, and the diagnosis of APL was confirmed. This was done by cytogenetic analysis and demonstration of PML-RARalpha rearrangement by reverse transcriptase PCR in the BM cells. A lumbar puncture was performed to investigate the cause of her stuporous mentality, and her cerebrospinal fluid (CSF) analysis revealed 97% leukemic promyelocytes. Despite systemic and CNS therapy, she died due to septic shock by infection and rapid disease progression only 3 days after her admission. Another patient, a 3-yr-old girl, presented with easy bruising and epistaxis, and her CBC showed pancytopenia with increased blasts. BM studies confirmed APL. Quantitative PCR for PML-RARalpha in the BM cells revealed a PML-RARalpha/ABL ratio of 0.33 and CSF analysis revealed 9.5% leukemic promyelocytes (2 of 21 cells). She received induction chemotherapy and intrathecal therapy and achieved complete remission (CR) in the BM and CNS. She has been maintained in the CR status for the past 31 months. Thus, patients with APL must be evaluated for CNS involvement if any neurological symptoms are present at the time of diagnosis.

Battered child: A case report.

A four year old Muslim female child came with alleged h/o fall in school with bluish discoloration around the left eye, neck, back and limbs. The paediatrician suspected this to be a case of bleeding disorder because of family history as her elder sister was suffering from platelet disorder. Finally it turned out to be a physical assault case with no any ill or evil intention.

Oral manifestations and analysis of salivary and blood urea levels of patients under going haemo dialysis and kidney transplant.

AIM AND OBJECTIVES: To evaluate oral manifestations in patients with renal diseases and to correlate blood and salivary urea levels in patients undergoing haemodialysis and kidney transplant. MATERIAL AND METHODS: Study group subjects were selected from patients undergoing hemodialysis and patients who had underwent kidney transplant. Adequate history was recorded. All the groups were examined extra orally and intra orally and findings were recorded. SAMPLE COLLECTION: Venous blood was collected from the antecubital fossa in control group. In patients with renal disease undergoing dialysis, blood was collectedjust prior to the dialysis. Renal transplant patients' blood samples were collected during review visit. Unstimulated saliva was collected and submitted to the laboratory immediately for urea examination by an automated analyzer. RESULTS: Extra oral manifestations like swollen face, pale skin, pedal edema, and bruises on the skin, nausea and vomiting in nearly 50% of the patiens, and oral manifestations like uraemic odour, dry mouth, and altered taste sensation were noted. There was a correlation between blood urea and salivary urea concentration in patients under going hemodialysis and kidney transplant. CONCLUSION: Saliva can be used as a non-invasive diagnostic tool.

Prevalência de lesões na temporada 2002 da Seleção Brasileira Masculina de Basquete / Prevalence of injuries of Brazilian Basketball National Team during 2002 season

Este estudo objetiva apresentar a prevalência, provável etiologia e localizaçäo das lesöes da Seleçäo Brasileira de Basquete masculina adulta durante a fase de preparaçäo e o 14º Campeonato Mundial de Basquetebol, em 2002. No total, foram 102 queixas correspondendo ao período de 1/7/02 a 10/9/02, com média de 2,55 lesöes/mês/jogador. Encontrou-se maior índice de lesöes atraumáticas, incluindo as musculares, doenças sistêmicas e lesöes tendinosas (66/102 queixas), ou seja, 64,7 por cento do total. Dentre as lesöes traumáticas, as mais freqüentes foram as entorses de tornozelo (13/102 lesöes) com 12,8 por cento, seguidas dos traumas diretos (contusöes) na regiäo das mäos (9/102 lesöes), com 8,8 por cento. Em relaçäo ao local de acometimento, as maiores queixas foram nos membros inferiores (49 /102), com 48,0 por cento e membros superiores (14/102), com 13,7 por cento. Quanto à gravidade, lesöes leves representaram 57,8 por cento, seguidas das moderadas e graves, com 32,4 por cento e 9,8 por cento, respectivamente. Em relaçäo à posiçäo de jogo, os pivôs foram os atletas que apresentaram maior número de queixas, 45, representando 44,1 por cento do total, sendo estas devido, principalmente, ao contato físico na regiäo do garrafäo. Dessa forma, por ser um esporte de extremo contato, as lesöes traumáticas, principalmente em mäos e coxas, e as entorses de tornozelo säo altamente representativas, sendo os membros inferiores os mais acometidos

Accidentes: estudio en pacientes menores de 15 años / Accidents: a study with patients under 15

Se realizó un estudio descriptivo de los accidentes ocurridos en la población pediátrica atendida por 20 consultorios de médico de la familia pertenecientes al Policlínico Docente "19 de abril", durante el período de enero a diciembre del año 1991. Se encontró una tasa por 100 habitantes de 2,7, con un promedio en el sexo masculino. El mayor número de accidentados estuvo en la edad de 5 a 14 años. Las lesiones que más se presentaron fueron la contusión, las quemaduras y las heridas; la mayor parte de ellas ocurrio en el hogar y el resto en lugares públicos. La mayoría de los casos graves (65,5 por ciento ) estaban en lasedades de 5 a 14 años, igualmente que los 3 casos mortales. La repercusión psicológica predominante en las niñas fue la ansiedad y la fobia, mientras que en los varones predominó la fobia y la depresiónó los días de la semana en que predominaron los accidentes fueron el martes (22,2 por ciento ) y el sábado (18 por ciento )