Development and clinical application of hydrogel formulations containing papain and urea for wound healing

Abstract Hydrogels are used for wound treatment, as they may contain one or more active components and protect the wound bed. Papain is one of the active substances that have been used with this purpose, alongside urea. In this paper, carboxypolymethylene hydrogels containing papain (2% and 10% concentrations) and urea (5% concentration) were produced. Physical-chemical stability was performed at 0, 7, 15 and 30 days at 2-8ºC, 25ºC and 40ºC, as well as the rheological aspects and proteolytic activity of papain by gel electrophoresis. Clinical efficacy of the formulations in patients with lower limb ulcers was also evaluated in a prospective, single-center, randomized, double-blind and comparative clinical trial. The results showed 7-day stability for the formulations under 25ºC, in addition to approximately 100% and 15% of protein activity for 10% and 2% papain hydrogel, respectively. The rheological profile was non-Newtonian for the 10% papain hydrogel tested. There were no significant differences regarding the mean time for healing of the lesions, although 10% papain presented a better approach to be used in all types of tissue present in the wound bed.

Role of Brain Angiotensin-II in Development of Experimental Diabetic Nephropathy in Wistar Rats

Abstract The renin-angiotensin-aldosterone system (RAAS) plays a key role in diabetic nephropathy (DN). Angiotensin-II secreted during the RAAS pathway increases nephropathy. It stimulates oxidative stress which can quench nitric oxide. Reduced nitric oxide level aggravates Ang-II-induced vasoconstriction. Ang-II has also emerged as a central mediator of the glomerular hemodynamic changes that are associated with renal injury. Deletion of ACE2 is also noted due to increased Ang-II level which leads to the development of DN. We hypothesize that nephropathy caused by Ang-II in the periphery may be controlled by brain RAAS. ACE inhibitors and ARBs may show the renoprotective effect when administered through ICV without crossing the blood-brain barrier. DN was observed after 8 weeks of diabetes induction through alloxan. Administration of captopril and valsartan once and in combined therapy for 2 weeks, significantly reduced urine output, blood urea nitrogen, total protein in the urine, serum cholesterol, serum creatinine, serum triglycerides, and kidney/body weight ratio as compared to diabetic control rats. Further, combination therapy significantly increased the body weight and serum nitrate level as compared to diabetic control animals. However, increased ACE2 levels in the brain may reduce the sympathetic outflow and might have decreased the peripheral activity of Ang-II which shows beneficial effects in DN.

Morfología de las lesiones iatrogénicas de la vía biliar: aspectos diagnósticos y terapéuticos / Morphology of iatrogenic lesions of the bile duct: diagnostic and therapeutic options

RESUMEN: Las lesiones iatrogénicas de las vías biliares (LIVB), en el curso de una colecistectomía laparoscópica (CL), son complicaciones que causan resultados inesperados para cirujanos un incremento en los riesgos de los pacientes (morbilidad y mortalidad), afectando su calidad de vida. Asimismo, causan situaciones difíciles desde el punto de vista técnico para el cirujano que debe repararlas desde un punto de vista técnico. El objetivo de este manuscrito fue resumir la información referente a las LIVB y describir su morfología y opciones diagnóstico-terapéuticas.

SUMMARY: Iatrogenic Bile duct injuries (IBDI), during laparoscopic cholecystectomy (CL), are complications that cause unexpected results for surgeons, an increment in patient risks (morbidity and mortality), and affect the patient´s quality of life. At the same time, they create difficult situations for the repairing surgeon from a technical point of view. The aim of this manuscript was to summarize the information regarding IBDI and to describe its morphology and diagnostic-therapeutic options.

Aloe vera and wound healing: a brief review

Abstract Aloe vera possesses a great therapeutic importance in traditional medicine. It has attracted the attention of modern medical fields due to its wide pharmacological applications. The bioactive substances in Aloe vera proved to have antioxidant, anti-inflammatory, antibacterial, and antiviral properties. Taken into our consideration the long history of clinical applications of Aloe vera in traditional medicine, especially for promoting the healing of cutaneous wounds with rare adverse effects, it provides a cheap alternative to many expensive synthetic drugs. Recent techniques in tissue engineering created novel scaffolds based on Aloe gel extracts for wound healing applications. Nonetheless, further guided researche is required to foster the development of Aloe vera based scaffolds for the benefit of worldwide populations. Here, I systemically summarize the main events following wounding and the mechanism of action of Aloe vera in promoting the healing process. I hope to provide a solid piece of information that might be helpful for designing new research studies into this topic.

Development and Characterization of a Hydrogel Containing Silver Sulfadiazine for Antimicrobial Topical Applications. Part II: Stability, Cytotoxicity and Silver Release Patterns

Abstract Hydrogels are interesting for use in the treatment of topical wounds due to their virtually zero toxicity, and capacity for extended release of pharmaceuticals. Silver sulfadiazine (SSDZ) is the drug of choice in the treatment of skin burns. The aim of the study was to determine cytotoxicity, antimicrobial activity and stability of a PVA hydrogel with integrated silver sulfadiazine. SSDZ-hydrogels were prepared using 10% (w/w) PVA (either 89% or 99% hydrolyzed) and 1% (w/w) silver sulfadiazine. Cellular viability was assessed via MTS assays, antimicrobial activity via disk-diffusion and accelerated stability tests were carried out with analysis at 0, 30, 60, 90 and 180 days of storage at 40 ± 2 °C and a relative humidity of 75 ± 5%. The parameters evaluated included organoleptic characteristics, moisture, swelling ability, mechanical strength, FTIR, XRD, TGA and DSC, and silver release patterns via XRD and potentiometry. Cell viability tests indicated some cytotoxicity, although within acceptable levels. After 90 days of storage, SSDZ hydrogel samples exhibited a brown coloration, probably due to the formation of Ag or Ag2O nanoparticles. The SSDZ-loaded hydrogels suffered visual and physical changes; however, these changes did not compromise its use as occlusive wound dressings or its antimicrobial properties.

The effects of methanol extract of Galium verum L on cardiac redox state in hypertensive rats

Abstract The aim of this study was to assess the effects of methanol extract of G. verum on redox status of isolated heart of spontaneously hypertensive rats after ischemia. Twenty-four Wistar albino rats were divided into three groups: untreated control rats and rats that received 125 and 250 mg/kg G. verum extract for 4 weeks per os. Index of lipid peroxidation (measured as TBARS) and parameters of antioxidative defence system such as level of reduced glutathione (GSH) and activities of catalase (CAT) and superoxide dismutase (SOD) were spectrophotometrically determined in heart homogenate. The index of lipid peroxidation in heart tissue was lower in both treated groups compared to the control group. On the other hand, the activity of SOD was significantly higher after consumption of both doses, while the activity of CAT was significantly higher only after treatment with a higher dose of extract. Based on our results we might conclude that 4-week treatment with methanol extracts of G. verum has the potential to modulate myocardial redox signaling after ischemia, thus significantly alleviating cardiac oxidative stress and exerting dose-dependent antioxidant properties. Future studies are certainly necessary to fully clarify the role of this plant species in myocardial I-R injury.

Synthesis and characterization of chitosan-PVA hydrogel containing PEGylated recombinant epidermal growth factor on cell culture for wound healing substitute

Abstract The aim of the current study was to assess the physicochemical characteristics and wound healing activity of chitosan-polyvinyl alcohol (PVA) crosslinked hydrogel containing recombinant human epidermal growth factor (rh-EGF) or recombinant mouse epidermal growth factor (rm-EGF). The hydrogels were prepared and analyses were made of the morphological properties, viscosity, water absorption capacity, mechanical and bio-adhesive properties. The viscosity of the formulations varied between 14.400 - 48.500 cPs, with the greatest viscosity values determined in K2 formulation. F2 formulation showed the highest water absorption capacity. According to the studies of the mechanical properties, H2 formulation (0.153±0.018 N.mm) showed the greatest adhesiveness and E2 (0.245±0.001 mj/cm2) formulation, the highest bio-adhesion values. Hydrogels were cytocompatible considering in vitro cell viability values of over 76% on human keratinocyte cells (HaCaT, CVCL-0038) and of over 84% on human fibroblast cells (NIH 3T3, CRL-1658) used as a model cell line. According to the BrdU cell proliferation results, B1 (197.82±2.48%) formulation showed the greatest NIH 3T3 and C1 (167.43±5.89%) formulation exhibited the highest HaCaT cell proliferation ability. In addition, the scratch closure assay was performed to assess the wound healing efficiency of formulation and the results obtained in the study showed that F2 formulation including PEGylated rh-EGF had a highly effective role.

Colgajo bigemelar para lesiones extensas de rodilla / Bigemelar flap for extensive knee injuries

El traumatismo de miembros inferiores representa un reto para el cirujano plástico en cuanto a su reconstrucción cuando no se dispone de técnicas microquirúrgicas. En el presente trabajo se presentan tres casos de reconstrucción de rodilla con doble colgajo muscular de gemelo en donde se demuestra que la utilización simultánea de los dos gemelos puede ser aplicada sin dejar ninguna secuela en la parte funcional y estética en la deambulación de los pacientes. No existe en la literatura nacional ni internacional un reporte de casos con esta aplicación, ya que siempre se ha limitado al uso de un solo músculo precisamente por el temor de alterar la función en cuanto a la flexoextensión del pie.

Lower limb trauma is a challenge for plastic surgeons in their reconstruction when microsurgical techniques are available. In this paper we present three cases of reconstruction of the knee with twin double-muscle flap where it is shown that the simultaneous use of the twins can be applied without leaving any sequel partly functional and aesthetics in ambulation of patients. For there is in the national or international literature a repost of cases with this application as it has always been limited to using just a single muscle for fear of disrupting the function in terms of flexion and extension of the foot.

Classificação WifI: o novo sistema de classificação da Society for Vascular Surgery para membros inferiores ameaçados, uma revisão de literatura / WIfI classification: the Society for Vascular Surgery lower extremity threatened limb classification system, a literature review

Resumo A Society for Vascular Surgery propôs nova classificação para o membro inferior ameaçado, baseada nos três principais fatores influenciadores do risco de amputação do membro: ferida (Wound, W), isquemia (Ischemia, I) e infecção do pé (foot Infection, fI): a classificação WIfI. Esta abrange também os diabéticos, anteriormente excluídos do conceito de isquemia crítica do membro devido a seu quadro clínico complexo. O objetivo da classificação era fornecer estratificação de risco precisa e precoce ao paciente com membro inferior ameaçado; auxiliar no manejo clínico, permitindo comparar terapias alternativas; e predizer o risco de amputação em 1 ano e a necessidade de revascularização. O objetivo deste estudo é reunir os principais pontos abordados sobre a classificação WIfI no meio científico. A maior parte dos estudos de validação da classificação demonstram sua associação à predição de salvamento do membro, eventos de reintervenção, amputação e estenose, taxas de amputação maior e menor, sobrevida livre de amputação, e cicatrização de feridas.

Abstract The Society for Vascular Surgery has proposed a new classification system for the threatened lower limb, based on the three main factors that have an impact on limb amputation risk: Wound (W), Ischemia (I) and foot Infection ("fI") - the WIfI classification. The system also covers diabetic patients, previously excluded from the concept of critical limb ischemia because of their complex clinical condition. The classification's purpose is to provide accurate and early risk stratification for patients with threatened lower limbs; assisting with clinical management, enabling comparison of alternative therapies; and predicting risk of amputation at 1 year and the need for limb revascularization. The objective of this study is to collect together the main points about the WIfI classification that have been discussed in the scientific literature. Most of the studies conducted for validation of this classification system prove its association with factors related to limb salvage, such as amputation rates, amputation-free survival, prediction of reintervention, amputation, and stenosis (RAS) events, and wound healing.

Nesiritide protects endothelial function after balloon-induced trauma in the iliac artery in rabbits

To assess the effect of nesiritide on the endothelial function of iliac arteries following endothelia trauma. Right iliac artery trauma was created with a balloon catheter. Ten rabbits were treated with a 4-week subcutaneous injection of nesiritide at a fixed daily dose of 0.1mg/kg. Ten rabbits received daily normal saline injection. Plasma endothelin 1 (ET-1), nitric oxide (NO), and Von Willebrand Factor (vWF) were measured before and after the therapies. Tissue proliferating cell nuclear antigen (PCNA) was measured after the treatment. After the treatment, in the therapeutic group, the area under internal elastic membrane and the residual lumen area were higher than in the normal saline group (P <0.05). The plasma levels of ET-1 (91.6±6.8 vs 114.9±6.3 ng/L, P =0.001), vWF (134.6±10.8% vs 188.8±10.4%, P =0.001) and the ratio of PCNA positive expression (11.7±4.2% vs 36.2±11.4%, P =0.005) in the therapeutic group was lower than in the normal saline group, while the plasma levels of NO was higher (89.7±9.3 vs 43.5±5.3 µmol/L, P =0.001). Nesiritide inhibited remodeling of rabbit iliac artery following endothelial trauma. The inhibition of vascular remodeling may be related to the alleviated endothelial dysfunction and reduced expression of tissue proliferating cell nuclear antigen

Renal protective effects of vicenin-2 and scolymoside in a mouse model of sepsis

This study was initiated to determine whether 2 structurally related flavonoids found in Cyclopia subternata-vicenin-2 (VCN) and scolymoside (SCL)-could modulate renal functional damage in a mouse model of sepsis, and to elucidate the relevant underlying mechanisms. The potential of VCN and SCL treatment to reduce renal damage induced by cecal ligation and puncture (CLP) surgery in mice was measured via assessment of serum creatinine, blood urea nitrogen (BUN), lipid peroxidation, total glutathione, glutathione peroxidase activity, catalase activity, and superoxide dismutase activity. Treatment with either VCN or SCL resulted in elevated plasma levels of BUN and creatinine, and of protein in the urine of mice with CLP-induced renal damage. Moreover, both VCN and SCL inhibited nuclear factor κB activation and reduced the induction of nitric oxide synthase and excessive production of nitric acid. VCN and SCL treatment also reduced the plasma levels of interleukin-6, and tumor necrosis factor-α, reduced lethality due to CLP-induced sepsis, increased lipid peroxidation, and markedly enhanced the antioxidant defense system by restoring the levels of superoxide dismutase, glutathione peroxidase, and catalase in kidney tissues. The present results suggest that VCN and SCL protect mice from sepsis-triggered renal injury

Risk factors for death of trauma patients admitted to an Intensive Care Unit / Fatores de risco para óbito de pacientes com trauma internados em Unidade de Terapia Intensiva / Factores de riesgo para muerte de pacientes con trauma internados en unidad de terapia intensiva

Objective: To analyze the risk factors for death of trauma patients admitted to the intensive care unit (ICU). Method: Retrospective cohort study with data from medical records of adults hospitalized for trauma in a general intensive care unit. We included patients 18 years of age and older and admitted for injuries. The variables were grouped into levels in a hierarchical manner. The distal level included sociodemographic variables, hospitalization, cause of trauma and comorbidities; the intermediate, the characteristics of trauma and prehospital care; the proximal, the variables of prognostic indices, intensive admission, procedures and complications. Multiple logistic regression analysis was performed. Results: The risk factors associated with death at the distal level were age 60 years or older and comorbidities; at intermediate level, severity of trauma and proximal level, severe circulatory complications, vasoactive drug use, mechanical ventilation, renal dysfunction, failure to perform blood culture on admission and Acute Physiology and Chronic Health Evaluation II. Conclusion: The identified factors are useful to compose a clinical profile and to plan intensive care to avoid complications and deaths of traumatized patients.

Objetivo: analisar os fatores de risco para óbito de pacientes com trauma internados em Unidade de Terapia Intensiva (UTI). Método: estudo de coorte retrospectivo, com dados de prontuários de adultos hospitalizados por trauma em Unidade de Terapia Intensiva geral. Foram incluídos pacientes de 18 anos ou mais de idade e admitidos por lesões. As variáveis foram agrupadas em níveis de maneira hierarquizada. O nível distal contemplou variáveis sociodemográficas, da internação, causa do trauma e comorbidades; o intermediário, as características do trauma e do atendimento pré-hospitalar; o proximal, as variáveis dos índices prognósticos, da admissão intensiva, procedimentos e complicações. Realizou-se análise de regressão logística múltipla. Resultados: os fatores de risco associados ao óbito no nível distal foram idade igual ou superior a 60 anos e comorbidades; no nível intermediário, a gravidade do trauma e no nível proximal, as complicações circulatórias graves, uso de drogas vasoativas, ventilação mecânica, disfunção renal, não realização de hemocultura na admissão e Acute Physiology and Chronic Health Evaluation II. Conclusão: os fatores identificados são úteis para compor um perfil clínico e para planejar a assistência intensiva a fim de evitar complicações e óbitos de pacientes traumatizados.

Objetivo: analizar los factores de riesgo para muerte de pacientes con trauma internados en unidad de terapia intensiva. Método: estudio de cohorte retrospectivo, con datos de fichas médicas de adultos hospitalizados por trauma en unidad de terapia intensiva general. Fueron incluidos pacientes de 18 años o más de edad y admitidos por lesiones. Las variables fueron agrupadas en niveles de manera jerarquizada. El nivel distal contempló variables sociodemográficas, internación, causa del trauma, y comorbilidades; el nivel intermedio las características del trauma y de la atención prehospitalaria; el nivel proximal las variables de índices pronósticos, de admisión intensiva, de procedimientos y complicaciones. Se realizó análisis de regresión logística múltiple. Resultados: los factores de riesgo asociados a la muerte en el nivel distal fueron: edad igual o superior a 60 años y comorbilidades; en el nivel intermedio la gravedad del trauma; y, en el nivel proximal las complicaciones circulatorias graves, uso de drogas vaso activas, ventilación mecánica, disfunción renal, no realización de hemocultivo en la admisión y Acute Physiology and Chronic Health Evaluation II. Conclusión: los factores identificados son útiles para componer un perfil clínico y para planificar la asistencia intensiva con la finalidad de evitar complicaciones y muertes de pacientes traumatizados.

Effects of treatment with sitagliptin on hepatotoxicity induced by acetaminophen in mice

Up to date, the management of hepatotoxicity induced by a suicidal or unintentional overdose of acetaminophen (APAP) remains a therapeutic challenge. The present study aimed to elucidate the potential effect of sitagliptin, a DPP-4 inhibitor, to ameliorate the acute injurious effects of acetaminophen on the liver. APAP toxicity was induced in mice by an intraperitoneal injection of APAP (400 mg/kg). The effect of treatment with sitagliptin, initiated 5 days prior to APAP injection, was evaluated. Serum indices of hepatotoxicity, oxidative stress markers in liver tissues, serum IL-1ß, and TNF-α in addition to hepatic- NF-E2-related factor-2 (Nrf2) were determined. Our results showed that APAP induced marked hepatic injury as evidenced by an increase in serum levels of ALT and AST, in addition to the deterioration of histological grading. Oxidative stress markers, serum TNF-α, and IL-1ß were also elevated. Sitagliptin successfully ameliorated the histological changes induced by APAP, improving liver function tests and liver oxidant status accompanied with a marked increase in Nrf2 level in hepatic tissues. Thus, the hepatoprotective effects of sitagliptin in this animal model seem to involve Nrf2 modulation, coincidental with its anti-inflammatory and antioxidant effects

Informe especial: Vigilancia de lesiones ocasionadas por siniestros viales en la CABA: Año 2017. Parte III: Caracterización de los lesionados graves y fallecidos / Special report: Surveillance of injuries caused by road accidents in CABA: Year 2017. Part III: Characterization of the serious injured and deceased

El presente informe corresponde a la tercera edición de una serie de cuatro publicaciones en conjunto entre el Observatorio de Seguridad Vial -OSV- (de la Secretaría de Transporte del GCBA) y la Gerencia Operativa de Epidemiología (del Ministerio de Salud del GCBA) sobre la vigilancia de las lesiones ocasionadas por siniestros viales durante el año 2017. El OSV recolecta los datos de este evento en los 13 Hospitales de Agudos de la Ciudad y se sistematiza dicha información para caracterizar la situación y proponer diferentes acciones en función de la misma. Esta edición tiene como objetivo analizar las características de los lesionados graves y fallecidos, esto es, la distribución según género, grupo etario y lugar de residencia, así como también la distribución por tipo de usuario de la vía. Por último, también se analiza la distribución según la región anatómica lesionada. (AU)

Cicatrización normal y patológica: una revisión actual de la fisiopatología y el manejo terapéutico / Current concepts of the approach and treatment of normal and pathological wound healing: a literature review

El conocimiento del proceso de cicatrización normal y patológica es fundamental para todas las especialidades médicas y quirúrgicas que tratan heridas agudas y crónicas, ya que del efecto de estos procesos dependerá el resultado final del tratamiento quirúrgico. En cada tejido y órgano dentro del organismo existen diferentes mecanismos que regulan la función y homeostasis celular, como sucede en el proceso de cicatrización, en donde participan y contribuyen una serie de fases y factores mediados por células y señales químicas. Una cicatrización aceptable es aquella que deja una adecuada cicatriz externa, devuelve la normalidad anatómica y funcional del tejido, con lo que se espera llegar a tener un resultado final con éxito; Sin embargo se debe entender que este proceso es complejo, y pueden también existir variantes anormales, determinadas por ciertos factores que intervienen para dar resultado a una cicatriz patológica, para lo cual existen diferentes tipos de tratamientos específicos y coadyuvantes para cada una de ellas. Objetivo: Conocer los conceptos actuales en el abordaje y tratamiento de la cicatrización normal y patológica, ofreciendo al cirujano una guía práctica basada en los fundamentos de las investigaciones científicas actuales. Material y métodos: Se realizó una revisión bibliográfica de artículos recientes acerca de cicatrización publicados entre 2010 a 2018, con alto nivel de evidencia

The knowledge of normal and pathological wound healing process is essential for all the medical and surgical specialties that treat acute and chronic wounds, because the final result will depend on the effect of these processes. In each tissue and organ within the organism there are different mechanisms that regulate cellular function and homeostasis, as in the wound healing process, where a series of phases and factors mediated by cells and chemical signals participate. Acceptable wound healing, although it leaves an external scar, restores the anatomical and functional homeostasis of the tissue,which is expected to have a successful result; However, it must be understood that this is a complex process, and therefore may also exist abnormal variants, determined by certain factors that lead to pathological wound healing, hence different types of treatments and coadjuvants therapies are available. Objective: Comprehend the current concepts in the approach and treatment of normal and pathological wound healing, offering the surgeon a practical guide based on state of the art evidence, Material and Methods: A literature review of recent articles published between 2010 and 2018 was carried out, with a high level of evidence

Análisis de las lesiones ocasionadas por mordeduras de animales de compañía en la Ciudad de Buenos Aires: Año 2017 / Analysis of the injuries caused by pets´s bites in the City of Buenos Aires: Year 2017

Las lesiones ocasionadas por mordeduras de animales de compañía constituyen un problema de importancia para la salud, por un lado se relaciona con los traumas directos y los derivados posteriormente tanto físicos como psicológicos, así como con aspectos relacionados con la transmisión potencial de una enfermedad mortal como es la rabia. Actualmente la rabia no se encuentra erradicada; aún se registran casos en animales de compañía de países limítrofes e incluso en provincias del norte de nuestro país. Asimismo en la Ciudad de Buenos Aires (CABA) se mantiene el ciclo aéreo de la rabia a través de los murciélagos. Éstos, al padecer la enfermedad, y por la afectación del sistema nervioso central, presentan: incoordinación, problemas de su sistema de radar, parálisis y muerte. Los perros y gatos domésticos, así como las personas, pueden tomar contacto con estos animales enfermos o muertos y contagiarse de rabia. Se analizan las denuncias efectuadas en la Ciudad de Buenos Aires durante 2017, así como los datos de los animales agresores

Medication-related inpatient falls: a critical review

Abstract Falls are the second leading cause of accidental and unintentional injury deaths worldwide. Inpatient falls in hospital settings are likely to prolong the length of stay of patients in nearly 6.3 days, leading to increased hospitalization costs. The causes of fall incidents in healthcare facilities are multifactorial in nature and certain medications use could be associated with these incidents. This review seeks to critically evaluate the available literature regarding the relationship between inpatient falls and medication use. A comprehensive search was performed on MEDLINE, EMBASE and Lilacs with no time restriction. The search was filtered using English, Spanish or Portuguese languages. Our study evaluated medication use and inpatients falls that effectively happen, considering all ages and populations. An assessment of bias and quality of the studies was carried out using an adapted tool from the literature. The drugs were classified according to the Anatomic Therapeutics Chemical Code. The search strategy retrieved 563 records, among which 23 met the eligibility criteria; ninety three different pharmacological subgroups were associated with fall incidents. Our critical review suggests that the use of central nervous system drugs (including anxiolytics; hypnotics and sedatives; antipsychotics; opioids; antiepileptics and antidepressants) has a greater likelihood of causing inpatient falls. A weak relationship was found between other pharmacological subgroups, such as diuretics, cardiovascular system-related medications, and inpatient fall. Remarkably, several problems of quality were encountered with regard to the eligible studies. Among such quality problems included retrospective design, the grouping of more than one medication in the same statistical analysis, limited external validity, problems related to medication classifications and description of potential confounders.

Vigilancia de lesiones ocasionadas por siniestros viales en la Ciudad de Buenos Aires / Surveillance of injuries caused by road accidents in Buenos Aires City

En la Ciudad de Buenos Aires y con el fin de dar respuesta a los Objetivos de Desarrollo Sostenible así como al compromiso de Gobierno de reducir un 30% las víctimas fatales por siniestros viales, se desarrolló el Primer Plan de Seguridad Vial de la Ciudad. El mismo, se basa en un enfoque ético por el cual, las muertes o lesiones graves son inaceptables y pueden ser prevenidas. Para este fin, el Observatorio de Seguridad Vial dependiente de la Subsecretaría de Movilidad Sustentable y Segura, junto con la Subsecretaría de Atención Hospitalaria de la Ciudad de Buenos Aires y con la Gerencia Operativa de Epidemiología dependiente de la Subsecretaria de Planificación Sanitaria, han comenzado a trabajar de manera conjunta para relevar los datos de lesiones por siniestros viales dentro del Sistema Hospitalario de la Ciudad de Buenos Aires. El presente informe busca caracterizar la ocurrencia de estos eventos a través de: la gravedad de la lesión, las características sociodemográficas y el tipo de usuario de la vía al que representan los traumatismos graves y fatales ocasionados por un siniestro vial, en los trece hospitales de agudos de la Ciudad de Buenos Aires. (AU)

Fatores associados às alterações fonoaudiológicas em vítimas de acidentes de motocicletas / Factors associated with speech-language disorders in motorcycle accident victims

RESUMO Objetivo Verificar fatores associados às alterações fonoaudiológicas em vítimas de acidentes motociclísticos. Método Trata-se de um estudo de corte transversal. Foram estudadas vítimas de acidentes motociclísticos assistidas no Hospital da Restauração entre junho e julho de 2014. Os dados foram coletados através da consulta dos prontuários e entrevistas direta com esses acidentados, no momento da internação e após a alta hospitalar. Para análise, foram estudadas as frequências simples, média e teste Quiquadrado de Pearson ou o teste Exato de Fisher. A margem de erro utilizada nas decisões dos testes estatísticos foi de 5% e os intervalos de confiança foram obtidos com confiabilidade de 95%. Resultados Foram estudados 99 indivíduos, sendo 90,9% do gênero masculino, com idade média de 32,7 anos. Constatou-se um alto percentual de condutores alcoolizados (42,3%) e não habilitados (51,5%). Os traumatismos cranianos estavam presentes em 30,3% dos casos. As áreas corporais mais afetadas foram os membros inferiores (71,7%), seguidos da região da cabeça e face (56,6%). Depois da alta hospitalar, 30,3% referiram queixa de alterações fonoaudiológicas e essas mostraram uma associação estatisticamente significativa com não habilitados (p=0,012) e colisões entre motos (p=0,004). Conclusão Verificou-se alto percentual de lesões em região de cabeça e face decorrentes dos acidentes, associadas principalmente à não habilitação para conduzir moto e colisões entre motocicletas, sugerindo que tais fatores podem agravar as lesões fonoaudiológicas.

ABSTRACT Purpose To investigate factors associated with speech-language disorders in victims of motorcycle accidents. Methods This is a cross-sectional study. Victims of motorcycle accidents studied were treated at Hospital da Restauração between June and July 2014. The data were collected by consulting the records and direct interviews with these, at admission and after discharge. For analysis were raised single frequencies, average and chi-square test or Fisher's exact test. The margin of error used in the statistical tests was 5%, and the intervals were obtained with 95% reliability. Results 99 individuals were studied, 90.9% male, the mean age of 32.7 years. It found a high percentage of 42.3% of drunk drivers and 51.5% were not enabled. The Head Injuries were present in 30.3% of cases. The most affected body area were the lower limbs (71.7%), followed by the head and face region (56.6%). It was also found that 30.3% had complaints of speech pathology after hospital discharge and a statistically significant association between speech therapy complaint and not enabled (p=0.012) and collisions between bikes (p=0.004). Conclusion There was a high percentage of lesions in the head and face resulting from accidents, associated mainly not eligible to drive bike and collisions between motorcycles, suggesting that these factors can aggravate injuries speech therapy