Enfrentamento e Adaptação de Pacientes na Amputação por Trauma ou Doença / Patients Coping and Adaptation in the Amputation by Trauma or Disease

A amputação é uma perda física e psíquica. A pessoa amputada precisa se adaptar a nova forma de vida. Objetivo: O presente estudo teve como objetivo avaliar o impacto da estratégia de enfrentamento no processo de adaptação de pacientes amputados devido a algum trauma (acidente) ou doença. Método: Foram aplicados entrevista semiestruturada, Escala Modo de Enfrentamento de Problemas - EMEP e questionário sociodemográfico no período de agosto a outubro de 2015, no Hospital de Base do Distrito Federal. Realizou-se um estudo quantitativo de corte transversal, com amostra não probabilística por conveniência. Os critérios de inclusão da pesquisa foram todos os pacientes que sofreram amputação por trauma ou doença, com condições cognitivas de participar da pesquisa e que aceitaram participar. Resultados: Dos 31 entrevistados, 9,7% sofreram amputação por trauma e 90,3% por doença. Foram considerados mal adaptados ao tratamento 12,9% dos entrevistados. A amostra encontrada foi dividida em dois grupos em relação ao seu modo de enfrentamento, a saber: a) enfrentamento focalizado no problema e b) práticas religiosas/pensamento fantasioso. Conclusão: A análise dos achados sugere uma não associação entre estratégias de enfrentamento e adaptação, dada a não variação nas estratégias de enfrentamento encontradas. Não foi possível concluir se não existe diferença quanto à estratégia de enfrentamento de pacientes amputados por trauma ou por doença. (AU)

Introduction: Amputation is a physical and psychological loss. The amputated person needs to adapt to a new way of life. Objective: The present study aimed to evaluate the coping strategy impact into the adaptation process of the amputated patient due to trauma (accident) or disease. Methods: Semi-structured interview, Ways of Coping Scale and sociodemographic questionnaire were applied during August, September and October of 2015 in the "Hospital de Base of Distrito Federal" and performing a quantitative cross-sectional study, with a non-probabilistic sample by convenience. The inclusion criteria of the research were all of the patients who suffered amputation due to trauma or disease, with cognitive conditions to participate in the research and who accepted to participate. Results: Among the 31 participants, 9,7% suffered amputation due to trauma and 90.3% due to a disease. Only 12.9% of the participants were considered ill-adapted to the treatment. The sample found was divided into two groups in relation to their mode of coping, namely: a) problem-focused and b) religious practices/fantasy thinking. Conclusion: The analysis of the findings suggests no association between coping strategies and adaptation, given the non-variation in coping strategies encountered. It was not possible to conclude that there is no difference in the coping strategy of patients amputated due to trauma or illness. (AU)

Causes of pediatric limb amputations at Tikur Anbessa specialized hospital and the role of traditional bone setters ("wogeshas")

Introduction: Limb amputation in pediatric age group is relatively infrequent compared to adults and is often associated with profound social, psychological and economic impacts on the growing child and family. There is few published literature specifying the cause of limb amputation in pediatrics in Ethiopia. The aim of this study is to determine the cause and patterns of paediatric limb amputation at 'Tikur Anbessa' specialized hospital and make recommendations towards reducing the incidence.Methods: This was a retrospective study conducted at 'Tikur Anbessa' Specialized teaching Hospital between May 2005 and April 2015. Data were retrieved from medical records and operation logbook of all pediatric patients aged 15 years and below who underwent limb amputations during the study period. Information regarding age, sex, indications and levels of amputation were studied.Results: A total number of 99 patients with 102 amputations were involved in the study. Their age ranged between 4 and 15 years with mean age of 10.5 ( SD ±3.2) years. There were 75 boys and 24 girls (male: female ratio=3.1:1). The most common indication for limb amputation was gangrene arising from treatment of limb injuries by traditional bone setters, locally called "Wogeshas" (55.5%), followed by malignancy (29.2%) and trauma (11.1%). An intractable bone and soft tissue infection accounted only for 2% of the amputations (2). Three limb amputations in one patient and two in another one were due to a condition with unclear vascular etiology resulting in multiple gangrenous limbs. Majority of the amputations were in the upper limbs.Conclusion: Traditional bone setters' practice related gangrene, late presenting musculoskeletal malignancy and trauma were the three most common causes for pediatric limb amputation in Ethiopia. Given that, all are non-communicable conditions, we can conclude that the majority of the amputations could have been prevented by provision of health education, early presentation and appropriate treatment in a modern health facility

Pirotecnia: lesiones graves de mano asociadas a explosión de un tipo de dispositivo (megapetardo/superbomba) / Pyrotechnics: severe hand lesions associated to the explosion of a certain device (megafirecrackers/superbombs)

Resumen Introducción: el uso de fuegos artificiales y dispositivos de pirotecnia forma parte de celebraciones y espectáculos públicos en todo el mundo. En Uruguay, su uso se encuentra concentrado en los meses estivales en eventos públicos y privados. Hay normativas para su uso, la importación y venta está regulada. En el verano de 2014-2015 hubo cuatro niños con lesiones graves de mano producidas por explosivos. Todas en circunstancias similares, compartieron el mismo mecanismo lesional y vinculados a un único dispositivo. En el año 2016 hubo más niños con iguales injurias. Objetivo: comunicar una serie de niños con injurias provocadas por un tipo de explosivo de pirotecnia con un patrón diferente al conocido previamente. Resultados: n=6. Todos varones, cinco adolescentes. Los seis presentaron lesiones severas en manos con amputación de uno o varios dedos, determinando secuelas estéticas y funcionales. Discusión: se identifica los dispositivos con alto contenido en pólvora y el mal uso de los mismos como factores asociados a las lesiones graves de mano. Se realizó una campaña desde la Sociedad Uruguaya de Pediatría, el Departamento de Emergencia Pediátrica, el Ministerio de Salud y otras autoridades para abordar este problema. Se prohíbe la venta de ese dispositivo. Conclusiones: la utilización de dispositivos de pirotecnia con alto contenido de pólvora como el megapetardo o superbomba puede determinar lesiones graves de mano, mutilantes y secuelas permanentes. No se recomienda la manipulación de fuegos artificiales por parte de los niños. El cumplimiento de las normativas vigentes y el correcto uso de los mismos podrían contribuir a disminuir estas injurias.

Summary Introduction: the use of fireworks and pyrotechnic devices are ways of public entertainment and celebration around the world. In Uruguay, they are more frequently used during summer-time in public and private events. Usage, import and sales are regulated by law. In summer 2014-2015 four children presented severe hand injuries caused by blasts, all of which occurred under similar conditions, shared the same injury mechanism and were linked to a specific device. In 2016 there were more children with similar lesions. Objective: to report a series of children with hand lesions caused by a certain type of pyrotechnic device with a pattern that was different from the one previously known. Results: n=6. All of them males 5 adolescents. The 6 children studied presented severe lesions in hands with amputation of 1 or several fingers, which resulted in aesthetic and functional sequelae. Discussion: devices with a high dose of gunpowder and their incorrect use are identified as factors associated to severe lesions. The Uruguayan Society of Pediatrics, the Pediatrics Emergency Department and the Ministry of Health, among other authorities, conducted a campaign to address this issue. The sale of this device is prohibited. Conclusions: the use of pyrotechnic devices with a high dose of gunpowder such as mega firecrackers or superbombs can result in severe hand lesions, mutilation and permanent sequelae. The handling of fireworks by children is not recommended. Fulfillment of updated regulations and the correct use of fireworks might contribute to diminishing these injuries.