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1.
Rev. Soc. Odontol. La Plata ; 30(58): 9-12, jul. 2020.
Article in Spanish | LILACS (Americas) | ID: biblio-1119102

ABSTRACT

El abuso del consumo de cocaína puede ocasionar problemas físicos y mentales graves. Dicha droga puede ser utilizada de varias formas y sus efectos sobre la cavidad oral varían según la vía de administración, causando desde erosiones en las piezas dentarias, abrasiones cervicales, caries, enfermedad periodontal, disfunción temporomandibular, xerostomía, ulceraciones hasta la perforación del paladar duro y/o blando. Se describirá el caso clínico de un paciente cocainómano que concurrió al servicio de odontología del Hospital San Martin de La Plata, presentando dos perforaciones en el paladar duro debido al consumo crónico, y el tratamiento de urgencia correspondiente mediante una placa obturatríz que favorece la deglución y el habla del paciente (AU)


Abuse of cocaine use can cause serious physical and mental problems. is drug can be used in several ways and its effects on the oral cavity vary according to the route of administration, causing from erosions in the teeth, cervical abrasions, caries, periodontal disease, temporomandibular dysfunction, xerostomia, ulcerations to the perforation of the hard palate and / or soft.The clinical case of a cocaine patient who attended the dentistry service of the San Martin de La Plata Hospital will be described, presenting two perforations in the hard palate due to chronic consumption, and the corresponding emergency treatment by means of an obturator plate that favors swallowing and He speaks of the patient (AU)


Subject(s)
Humans , Male , Adult , Cocaine/adverse effects , Cocaine-Related Disorders/complications , Palate, Hard/injuries , Patient Care Team , Argentina , Wounds, Penetrating , Dental Service, Hospital , Emergency Treatment
2.
Article in English, Portuguese | LILACS (Americas), BDENF | ID: biblio-1100404

ABSTRACT

Objetivo: Conhecer a percepção dos profissionais de saúde e a sua atuação frente a uma situação de urgência/ emergência dentro da atenção básica, bem como as facilidades e dificuldades nessa atuação. Método: Trata-se de um estudo exploratório, descritivo, qualitativo, desenvolvido com nove profissionais atuantes em duas unidades de atenção primária, da região central do Rio Grande do Sul. Os dados coletados nos meses de abril e maio de 2017, por meio de uma entrevista semiestruturada, foram submetidos a análise temática de conteúdo. Resultados: Emergiram quatro categorias: Situações de urgência/emergências atendidas nas unidades de atenção primária; Déficit no ensino de urgência e emergência durante formação profissional; Déficit de recursos materiais; Importância da educação permanente e protocolos para aperfeiçoar o atendimento de urgência e emergência na atenção primária. Conclusão: Torna-se necessário maiores investimentos acerca das questões relacionadas ao atendimento de urgência, emergência e trauma para profissionais da Atenção Primária


Objective: The object of this study it is to know the health professional's perception and their performance in the face of an urgent situation within basic care, as well the facilities and difficulties in this action. Methods: It is an exploratory study, descriptive and qualitative, developed with nine actuators in two primary attention units, in the central region of Rio Grande do Sul. The data were collected in the months of April and May 2017, through a semi-structured interview they were submitted to thematic content analysis. Results: Four categories emerged: Urgency/ emergencies situations attended in primary care units; Deficit in urgency and emergency education during vocational training; Deficit of material resources; Importance of continuing education and protocols to improve urgency and emergency assistance in primary care. Conclusion: It is necessary to invest more about the issues related to urgency, emergency and trauma care for primary care professionals


Objetivo: Conocer la percepción de los profesionales de la salud y su actuación frente a una situación de urgencia/emergencia dentro de la atención básica, así como las facilidades y dificultades en esa actuación. Método: Se trata de un estudio exploratorio, descriptivo, cualitativo, desarrollado con nueve profesionales actuantes en dos unidades de atención primaria, de la región central de Rio Grande do Sul. Los datos recogidos en los meses de abril y mayo de 2017, a través de una entrevista siniestradas, fueron sometidos a análisis temáticos de contenido. Resultados: emergieron cuatro categorías: Situaciones de urgencia/ emergencias atendidas en las unidades de atención primaria; Déficit en la enseñanza de urgencia y emergencia durante la formación profesional; Déficit de recursos materiales; Importancia de la educación permanente y protocolos para perfeccionar la atención de urgencia y emergencia en la atención primaria. Conclusión: Se hace necesario mayor inversión sobre las cuestiones relacionadas con la atención de urgencia, emergencia y trauma para profesionales de la Atención Primaria


Subject(s)
Humans , Male , Female , Primary Health Care , Education, Continuing , Emergency Treatment , Ambulatory Care , Qualitative Research , Professional Training , Nursing Care
3.
Rev. latinoam. enferm. (Online) ; 28: e3251, 2020. tab
Article in English | LILACS (Americas), BDENF | ID: biblio-1101733

ABSTRACT

Objective: to construct and validate a tool for the evaluation of responders in tactical casualty care simulations. Method: three rubrics for the application of a tourniquet, an emergency bandage and haemostatic agents recommended by the Hartford Consensus were developed and validated. Validity and reliability were studied. Validation was performed by 4 experts in the field and 36 nursing participants who were selected through convenience sampling. Three rubrics with 8 items were evaluated (except for the application of an emergency bandage, for which 7 items were evaluated). Each simulation was evaluated by 3 experts. Results: an excellent score was obtained for the correlation index for the 3 simulations and 2 levels that were evaluated (competent and expert). The mean score for the application of a tourniquet was 0.897, the mean score for the application of an emergency bandage was 0.982, and the mean score for the application of topical haemostats was 0.805. Conclusion: this instrument for the evaluation of nurses in tactical casualty care simulations is considered useful, valid and reliable for training in a prehospital setting for both professionals who lack experience in tactical casualty care and those who are considered to be experts.


Objetivo: construir e validar um instrumento de avaliação da prática, por meio da simulação, nos cuidados de saúde estratégicos. Método: três instrumentos para práticas de avaliação de aplicação do torniquete, bandagem de emergência e agente hemostático recomendados pelo Consenso de Hartford foram desenvolvidos e validados. A validade e a confiabilidade foram estudadas. A validação foi realizada por quatro especialistas da área e trinta e seis enfermeiros participantes selecionados por amostragem por conveniência. Três instrumentos de avaliação com 8 itens foram avaliados (com exceção da bandagem de emergência, que tinha 7 itens para avaliar). Cada prática foi avaliada por três especialistas. Resultados: uma pontuação excelente foi obtida no cálculo do índice de correlação para as três práticas e nos dois níveis avaliados (competente e especialista). A pontuação média para a aplicação do torniquete foi de 0,897, para o curativo de emergência foi de 0,982 e para a aplicação de agentes hemostáticos tópicos foi de 0,805. Conclusão: este instrumento de avaliação da prática por meio de simulação nos cuidados de saúde estratégicos é considerado útil, válido e confiável para o treinamento no contexto pré-hospitalar tanto dos profissionais que não possuem experiência nos cuidados estratégicos quanto nos considerados peritos.


Objetivo: construir y validar un instrumento de evaluación de la práctica, mediante simulación, en la atención sanitaria táctica. Método: se construyeron y validaron tres rúbricas de las prácticas de aplicación del torniquete, vendaje de emergencia y agente hemostático recomendadas por el Consenso Hartford. Se estudió la validez y fiabilidad. La validación se realizó por cuatro expertos en la materia y treinta y seis participantes enfermeros que fueron la muestra de conveniencia. Se evaluaron tres rúbricas con 8 ítems (excepto para el vendaje de emergencia que fueron 7 ítems a evaluar). Cada práctica fue evaluada por tres expertos. Resultados: se ha obtenido una excelente puntuación en el cálculo del índice de correlación para las tres prácticas y en los dos niveles evaluados (competente y experto). La puntuación media para la rúbrica de aplicación del torniquete fue de 0.897, la del vendaje de emergencia 0.982 y para la aplicación de hemostáticos tópicos 0.805. Conclusión: este instrumento de evaluación de la práctica mediante simulación en la atención sanitaria se considera útil, válido y fiable para la formación en el entorno prehospitalario tanto de profesionales que carecen de experiencia en atención táctica como de aquellos considerados como expertos.


Subject(s)
Humans , Male , Female , Adult , Tourniquets , Reproducibility of Results , Emergency Medical Services/standards , Emergency Treatment/standards , Mass Casualty Incidents , Hemorrhage
4.
Trends psychiatry psychother. (Impr.) ; 41(3): 237-246, July-Sept. 2019. tab
Article in English | LILACS (Americas) | ID: biblio-1043526

ABSTRACT

Abstract Objective To assess the association between brain-derived neurotrophic factor (BDNF) levels and acute stress disorder (ASD) in patients who have suffered physical trauma. Methods Data were collected at an emergency hospital in Porto Alegre, state of Rio Grande do Sul, southern Brazil. Participants were over 18 years of age, victims of physical trauma, and had been hospitalized for a minimum of 48 hours. A total of 117 hospitalized patients who agreed to participate in the research were grouped according to the shift in which blood was collected (38 subjects from the morning shift and 79 from the afternoon shift), had their BDNF levels measured and responded to other questionnaires. Respondents were further grouped by age into three ranges: 18-30, 31-50 and 51-70 years. Results We found a significant difference in the distribution of BDNF between the two shifts in which blood samples were collected, with the afternoon group having higher BDNF levels (U = 1906.5, p = 0.018). A difference was observed only between the 18-30 group and the 51-70 group in the afternoon shift (Umorning = 1107, pmorning = 0.575; Uafternoon = 7175, pafternoon = 0.028). Conclusions The population whose blood samples were collected in the afternoon showed significantly higher values of BDNF compared to those of the morning shift. This same population presented lower BDNF levels when associated with ASD subtypes A1, A2, and A. We hypothesize that the lower values of BDNF measured in the morning shift were due to a response to the circadian cycle of cortisol, whose action inhibits the expression of serum neurotrophins.


Resumo Objetivo Verificar a associação entre os níveis de fator neurotrófico derivado do cérebro (brain-derived neurotrophic factor [BDNF]) e transtorno de estresse agudo (TEA) em pacientes que sofreram trauma físico. Métodos Os dados foram coletados em um hospital de emergência de Porto Alegre, Rio Grande do Sul, Brasil. Os participantes eram maiores de 18 anos, vítimas de trauma físico e estavam hospitalizados por um período mínimo de 48 horas. Um total de 117 pacientes hospitalizados que concordaram em participar da pesquisa foram agrupados de acordo com o turno de realização da coleta de sangue (38 sujeitos no turno da manhã e 79 sujeitos no turno da tarde), tiveram seus níveis de BDNF medidos e responderam a outros questionários. Os entrevistados também foram agrupados por idade em três faixas etárias: 18-30, 31-50 e 51-70 anos. Resultados Encontramos uma diferença significativa na distribuição de BDNF entre os turnos, sendo que o grupo da tarde apresentou níveis maiores de BDNF (U = 1906,5, p = 0,018). Houve diferença entre o grupo de 18-30 anos e o de 51-70 anos no turno da tarde (Umanhã = 1107, pmanhã = 0,575; Utarde = 7175, ptarde = 0,028). Conclusões A população cuja coleta ocorreu à tarde apresentou valores significativamente maiores de BDNF em relação à coleta do turno da manhã. Esta mesma população apresentou menores níveis dessa neurotrofina quando associada com os subtipos A1, A2 e A de TEA. É possível hipotetizar que os menores valores de BDNF aferidos na coleta do turno da manhã se devam a uma resposta ao ciclo circadiano do cortisol, cuja ação inibe a expressão de neurotrofinas séricas.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Wounds and Injuries/psychology , Brain-Derived Neurotrophic Factor/metabolism , Brazil , Hydrocortisone/metabolism , Biomarkers/metabolism , Surveys and Questionnaires , Circadian Rhythm , Stress Disorders, Traumatic, Acute/blood , Emergency Service, Hospital , Emergency Treatment/methods , Hospitalization , Middle Aged
5.
Rev. bras. ter. intensiva ; 31(3): 282-288, jul.-set. 2019. tab, graf
Article in Portuguese | LILACS (Americas) | ID: biblio-1042586

ABSTRACT

RESUMO Objetivo: Descrever o perfil epidemiológico das vítimas assistidas pela Viatura Médica de Emergência e Reanimação em paragem cardiorrespiratória e refletir se tinham critérios para utilizar a oxigenação por membrana extracorpórea. Métodos: Estudo retrospectivo, de coorte, descritivo e exploratório. A colheita de dados foi efetuada durante o mês de janeiro de 2018, na região Norte de Portugal, por meio da consulta à base de registos da Viatura Médica de Emergência e Reanimação sobre assistências prestadas no período de 2012 a 2016. Foi elaborada uma grelha de observação suportada pelo instrumento utilizado para a colheita de dados do registo nacional de paragem cardiorrespiratória pré-hospitalar. Resultados: Após aplicar critérios de inclusão, a amostra foi composta por 36 vítimas. Verificou-se que a oxigenação por membrana extracorpórea poderia ter sido aplicada a 24 vítimas no período balizado da colheita de dados, o que resultaria em várias possibilidades de transplantação e/ou sobrevivência, quer da própria vítima quer de outras vidas. Conclusão: A Viatura Médica de Emergência e Reanimação tem potencial para ser incluída na rede oxigenação por membrana extracorpórea da área em estudo.


ABSTRACT Objective: To describe the epidemiological profile of victims of cardiac arrest assisted using a nontransporting emergency medical service vehicle and to determine whether these patients met the criteria for the use of extracorporeal membrane oxygenation. Methods: This study employed a retrospective, cohort, descriptive, and exploratory design. Data were collected in January 2018 in northern Portugal by consulting the records of nontransporting emergency medical service vehicles that provided assistance between 2012 and 2016. An observation grid was prepared that was supported by the instrument used for collecting data from the national registry of out-ofhospital cardiac arrests. Results: After applying the inclusion criteria, the sample consisted of 36 victims. Extracorporeal membrane oxygenation could have been applied to 24 victims during the period analyzed, which might have increased the odds for transplantation, survival, or both, for either the victim or other individuals. Conclusion: Nontransporting emergency medical service vehicles have the potential for inclusion in the extracorporeal membrane oxygenation network of the study area.


Subject(s)
Humans , Male , Female , Adult , Extracorporeal Membrane Oxygenation , Heart Arrest/therapy , Retrospective Studies , Cohort Studies , Emergency Treatment , Heart Arrest/epidemiology , Middle Aged
6.
Rev. Asoc. Argent. Ortop. Traumatol ; 84(3): 260-264, jun. 2019. ilus
Article in Spanish | LILACS (Americas) | ID: biblio-1020341

ABSTRACT

El hematoma epidural espontáneo es una entidad muy poco frecuente que supone una urgencia neurológica. Su presentación es muy variable, desde un dolor de espalda hasta una tetraplejia, según la gravedad y el nivel de compresión. Se comunica el caso de un paciente cardiópata de 71 años, tratado con acenocumarol, que presentó un hematoma epidural de modo espontáneo. Al inclinarse hacia el suelo, el paciente, que no tenía síntomas, sufrió un dolor brusco cervical seguido de debilidad en los miembros superiores e inferiores. Ante la sospecha clínica de una compresión medular, se decide realizar una resonancia magnética de urgencia, que mostró un hematoma de localización epidural con extensión desde C4 hasta T8. El diagnóstico urgente y el tratamiento de descompresión precoz son fundamentales para reducir al mínimo los daños neurológicos posteriores permanentes. Nivel de Evidencia: IV


Spontaneous spinal epidural hematoma is an uncommon condition and a neurological emergency. The clinical presentation of this type of hematoma is very variable, ranging from a backache up to a quadriplegia, according to the severity and the site of compression. Here, we discuss the clinical case of a 71-year-old patient with heart problems, under previous treatment with acenocumarol, that suffered a spontaneous epidural hematoma. The patient, previously asymptomatic, presented, sudden cervical pain when he bent over, followed by weakness in the lower and the upper limbs. Due to the clinical suspicion, an emergency MRI was performed, showing an epidural hematoma extending from C4 to T8. Early diagnosis and decompressive treatment are mandatory to minimize permanent neurological damage. Level of Evidence: IV


Subject(s)
Aged , Spinal Diseases , Decompression, Surgical/methods , Hematoma, Epidural, Spinal/surgery , Emergency Treatment , Acenocoumarol/adverse effects
7.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-739844

ABSTRACT

PURPOSE: The aim of this study was to identify the predictive validity of the Korean Triage and Acuity Scale (KTAS). METHODS: This methodological study used data from National Emergency Department Information System for 2016. The KTAS disposition and emergency treatment results for emergency patients aged 15 years and older were analyzed to evaluate its predictive validity through its sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS: In case of death in the emergency department, or where the intensive care unit admission was considered an emergency, the sensitivity, specificity, positive predictive value, and negative predictive value of the KTAS were 0.916, 0.581, 0.097, and 0.993, respectively. In case of death in the emergency department, or where the intensive or non-intensive care unit admission was considered an emergency, the sensitivity, specificity, and positive predictive value, and negative predictive value were 0.700, 0.642, 0.391, and 0.867, respectively. CONCLUSION: The results of this study showed that the KTAS had high sensitivity but low specificity. It is necessary to constantly review and revise the KTAS level classification because it still results in a few errors of under and over-triage. Nevertheless, this study is meaningful in that it was an evaluation of the KTAS for the total cases of adult patients who sought help at regional and local emergency medical centers in 2016.


Subject(s)
Adult , Classification , Emergencies , Emergency Service, Hospital , Emergency Treatment , Humans , Information Systems , Intensive Care Units , Methods , Sensitivity and Specificity , Triage
8.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-764191

ABSTRACT

PURPOSE: The author's trauma center implemented Mobile Trauma Units (MTU), which are ground transportation automobiles constructed with advanced medical equipment, in an attempt to improve the survival rate of severe trauma patients. The purpose of this study was to examine the efficacy of MTU as a means of inter-hospital transfer of patients in urban environments. METHODS: Patients with an injury severity score (ISS) of 16 or more were enrolled in this study. The participants must also be patients who were transferred with the MTU in the 18 months between January 2017 and June 2018. To assess the survival probability, the revised trauma score (RTS), trauma and injury severity score (TRISS), and w-score were used as the outcome indices. RESULTS: Forty-four (86.3%) of the severe trauma patients with an ISS of 16 or more were male and 7 (13.7%) were female. The number of patients from the territory were 32 (62.7%), and patients from the others were 19 (37.3%). All the patients received their injury from blunt force trauma. The average time of from the scene of the accident to the trauma center was 176 minutes. In 13 deaths, 10 (76.9%) of the RTS values were below 4 points. Among the 51 patients, TRISS was more than 0.5 in 32 patients (62.7%). The w-score was 13.25 and the actual survival rate of a patient was 74.50%. CONCLUSION: Ground transportation automobiles that use MTU for severe trauma patients in urban areas are more economically beneficial and more efficient. The survival rate while using MTU was also shown to be higher than that of medical helicopter transfers.


Subject(s)
Aircraft , Automobiles , Emergency Treatment , Female , Humans , Injury Severity Score , Male , Survival Rate , Transportation , Transportation of Patients , Trauma Centers , Wounds and Injuries
9.
Rev. Col. Bras. Cir ; 46(4): e2211, 2019. tab, graf
Article in Portuguese | LILACS (Americas) | ID: biblio-1020368

ABSTRACT

RESUMO Objetivo: avaliar a aplicabilidade do sistema de classificação de cores "Timing of Acute Care Surgery" (TACS) em um hospital público terciário de um país em desenvolvimento. Métodos: estudo longitudinal, retrospectivo, de um único centro, de março a agosto de 2016 e o mesmo período em 2017. Optou-se pela seleção de quatro especialidades cirúrgicas com alta demanda de urgências, as quais foram previamente treinadas sobre o sistema TACS. Para comparação com as classificações prévias de urgência e emergência, emergências foram consideradas como vermelhas e laranjas e urgências como amarelas, com intervalo de tempo ideal para cirurgia de uma hora e de seis horas, respectivamente. Resultados: os procedimentos não eletivos representaram 61% do número total de cirurgias. As classificações vermelha, laranja e amarela foram predominantes. Houve melhora significativa do tempo para a cirurgia na cor amarela após o sistema TACS. Períodos diurnos e noturnos influenciaram os resultados, com melhores resultados durante o período noturno. Conclusão: este é o primeiro estudo que usou o sistema TACS no dia a dia de um centro cirúrgico, e demonstrou que o sistema TACS melhorou o tempo de atendimento das cirurgias classificadas como amarelas.


ABSTRACT Objective: to evaluate the applicability of the "Timing of Acute Care Surgery" (TACS) color classification system in a tertiary public hospital of a developing country. Methods: we conducted a longitudinal, retrospective study in a single center, from March to August 2016 and the same period in 2017. We opted for the selection of four surgical specialties with high demand for emergencies, previously trained on the TACS system. For comparisons with the previous classifications, we considered emergencies as reds and oranges and urgencies, as yellow, with an ideal time interval for surgery of one hour and six hours, respectively. Results: non-elective procedures accounted for 61% of the total number of surgeries. The red, orange and yellow classifications were predominant. There was a significant improvement in the time before surgery in the yellow color after the TACS system. Day and night periods influenced the results, with better ones during the night. Conclusion: this is the first study to use the TACS system in the daily routine of an operating room. The TACS system improved the time of attendance of surgeries classified as yellow.


Subject(s)
Humans , Triage/methods , Emergency Treatment/classification , Operating Rooms , Specialties, Surgical/classification , Specialties, Surgical/statistics & numerical data , Surgical Procedures, Operative/classification , Surgical Procedures, Operative/statistics & numerical data , Time Factors , Brazil , Retrospective Studies , Longitudinal Studies , Operating Room Information Systems , Color , Emergencies , Emergency Treatment/statistics & numerical data , Tertiary Care Centers
10.
Rev. colomb. cir ; 34(2): 132-143, 20190000. fig, tab
Article in Spanish | LILACS (Americas), COLNAL | ID: biblio-999100

ABSTRACT

La lesión pulmonar es relativamente infrecuente en el paciente politraumatizado y, posiblemente, subdiagnosticada inicialmente debido a su habitual asociación con otras lesiones aparentemente más graves, en particular tras el traumatismo cerrado. Por ello, es de vital importancia su diagnóstico precoz ya que puede conllevar consecuencias fatales si no se diagnostica a tiempo. Dada su localización anatómica, es habitual que se acompañe de lesiones concomitantes de otros órganos y estructuras vasculares intratorácicas, lo cual, unido a la necesidad ocasional de maniobras quirúrgicas críticas, resulta en altas tasas de morbimortalidad. El objetivo del trabajo fue estudiar las características de estas lesiones, incluyendo su incidencia, su mecanismo, y las técnicas diagnósticas y opciones terapéuticas disponibles, tanto quirúrgicas como no quirúrgicas. Además, se analizaron la evolución y el pronóstico de estos pacientes, con base en una revisión bibliográfica de 1965 hasta 2018


In the trauma patient, lung injury is relatively uncommon, possibly underdiagnosed due to its frequent association with other apparently more serious injuries, especially in cases of blunt trauma. Therefore, early diagnosis is of vital importance, as lung injuries can lead to fatal consequences. Due to their anatomical location, it is common for them to be associated with other organ and intrathoracic vascular structures, which together with the occasional need for critical surgical maneuvers, result in high rates of morbidity and mortality. The aim of the study is to describe the characteristics of pulmonary injuries including their incidence, mechanisms of injury, diagnostic techniques and available therapeutic options, both surgical and conservative. An analysis of the prognostic factors of these patients based on a review of the literature from 1965 to 2018 is included


Subject(s)
Humans , Lung Injury , Wounds and Injuries , Epidemiology , Emergency Treatment
11.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-759911

ABSTRACT

The Emergency Medicine Recipes in Local Medicinals (鄕藥救急方, Hyang'yak Kugŭpbang) (c. 14th century) is known to be one of the oldest Korean medical textbooks that exists in its entirety. This study challenges conventional perceptions that have interpreted this text by using modern concepts, and it seeks to position the medical activities of the late Koryŏ Dynasty 高麗 (918–1392) to the early Chosŏn Dynasty 朝鮮 (1392–1910) in medical history with a focus on this text. According to existing studies, Emergency Medicine Recipes in Local Medicinals is a strategic compromise of the Korean elite in response to the influx of Chinese medical texts and thus a medical text from a “periphery” of the Sinitic world. Other studies have evaluated this text as a medieval publication demonstrating stages of transition to systematic and rational medicine and, as such, a formulary book 方書 that includes primitive elements. By examining past medicine practices through “modern” concepts based on a dichotomous framework of analysis — i.e., modernity vs. tradition, center vs. periphery, science vs. culture — such conventional perceptions have relegated Emergency Medicine Recipes in Local Medicinals to the position of a transitional medieval publication meaningful only for research on hyangchal 鄕札 (Chinese character-based writing system used to record Korean during the Silla Dynasty 新羅 [57 BC–935 AD] to the Koryŏ Dynasty). It is necessary to overcome this dichotomous framework in order to understand the characteristics of East Asian medicine. As such, this study first defines “medicine 醫”, an object of research on medical history, as a “special form of problem-solving activities” and seeks to highlight the problematics and independent medical activities of the relevant actors. Through this strategy (i.e., texts as solutions to problems), this study analyzes Emergency Medicine Recipes in Local Medicinals to determine its characteristics and significance. Ultimately, this study argues that Emergency Medicine Recipes in Local Medicinals was a problem-solving method for the scholar-gentry 士人層 from the late Koryŏ Dynasty to the early Chosŏn Dynasty, who had adopted a new cultural identity, to perform certain roles on the level of medical governance and constitute medical praxis that reflected views of both the body and materials and an orientation distinguished from those of the so-called medicine of Confucian physicians 儒醫, which was the mainstream medicine of the center. Intertwined at the cultural basis of the treatments and medical recipes included in Emergency Medicine Recipes in Local Medicinals were aspects such as correlative thinking, ecological circulation of life force, transformation of materiality through contact, appropriation of analogies, and reasoning of sympathy. Because “local medicinals 鄕藥” is understood in Emergency Medicine Recipes in Local Medicinals as referring to objects easily available from one's surroundings, it signifies locality referring to the ease of acquisition in local areas rather than to the identity of the state of Koryŏ or Chosŏn. As for characteristics revealed by this text's methods of implementing medicine, Korean medicine in terms of this text consisted largely of single-ingredient formulas using diverse medicinal ingredients easily obtainable from one's surroundings rather than making use of general drugs as represented by materia medica 本草 or of multiple-ingredient formulas. In addition, accessible tools, full awareness of the procedures and processes of the guidelines, procedural rituals, and acts of emergency treatment (first aid) were more important than the study of the medical classics, moral cultivation, and coherent explanations emphasized in categorical medical texts. Though Emergency Medicine Recipes in Local Medicinals can be seen as an origin of the tradition of emergency medicine in Korea, it differs from medical texts that followed which specializing in emergency medicine to the extent that it places toxicosis 中毒 before the six climatic factors 六氣 in its classification of diseases.


Subject(s)
Asian Continental Ancestry Group , Ceremonial Behavior , Classification , Emergencies , Emergency Medicine , Emergency Treatment , Far East , Humans , Korea , Materia Medica , Medicine, East Asian Traditional , Methods , Publications , Thinking , Writing
12.
Article in English | WPRIM (Western Pacific) | ID: wprim-786156

ABSTRACT

OBJECTIVES: The aims of this study were to determine the effectiveness of local compression in patients presenting to the emergency room with intraoral bleeding and to identify when complex haemostatic measures may be required.MATERIALS AND METHODS: Five hundred forty patients who had experienced intraoral haemorrhage were retrospectively reviewed. The outcome variable was the haemostasis method used, i.e., simple (local compression with gauze) or complex (an alternative method after local compression has failed). Predictor variables were sex, age, American Society of Anesthesiologists (ASA) class, hepatic cirrhosis, bleeding disorder, use of antithrombotic agents, and site/cause of haemorrhage.RESULTS: The mean patient age was 48.9±23.9 years, 53.5% were male, 42.8% were ASA class II or higher, and 23.7% were taking antithrombotic agents. Local compression was used most often (68.1%), followed by local haemostatic agents, sutures, systemic tranexamic acid or blood products, and electrocautery. The most common site of bleeding was the gingiva (91.7%), and the most common cause was tooth extraction (45.7%). Risk factors for needing a complex haemostasis method were use of antithrombotic agents (odds ratio 2.047, P=0.009) and minor oral surgery (excluding extraction and implant procedures; odds ratio 6.081, P=0.001).CONCLUSION: A haemostasis method other than local compression may be needed in patients taking antithrombotic agents or having undergone minor oral surgery.


Subject(s)
Anticoagulants , Electrocoagulation , Emergency Service, Hospital , Emergency Treatment , Fibrinolytic Agents , Gingiva , Hemorrhage , Humans , Liver Cirrhosis , Male , Methods , Odds Ratio , Retrospective Studies , Risk Factors , Surgery, Oral , Sutures , Tooth Extraction , Tranexamic Acid
13.
Article in English | WPRIM (Western Pacific) | ID: wprim-741368

ABSTRACT

Hyperammonemia can be caused by several genetic inborn errors of metabolism including urea cycle defects, organic acidemias, fatty acid oxidation defects, and certain disorders of amino acid metabolism. High levels of ammonia are extremely neurotoxic, leading to astrocyte swelling, brain edema, coma, severe disability, and even death. Thus, emergency treatment for hyperammonemia must be initiated before a precise diagnosis is established. In neonates with hyperammonemia caused by an inborn error of metabolism, a few studies have suggested that peritoneal dialysis, intermittent hemodialysis, and continuous renal replacement therapy (RRT) are effective modalities for decreasing the plasma level of ammonia. In this review, we discuss the current literature related to the use of RRT for treating neonates with hyperammonemia caused by an inborn error of metabolism, including optimal prescriptions, prognosis, and outcomes. We also review the literature on new technologies and instrumentation for RRT in neonates


Subject(s)
Ammonia , Astrocytes , Brain Edema , Coma , Diagnosis , Edema , Emergency Treatment , Humans , Hyperammonemia , Infant, Newborn , Metabolism , Metabolism, Inborn Errors , Peritoneal Dialysis , Plasma , Prescriptions , Prognosis , Renal Dialysis , Renal Replacement Therapy , Urea
14.
Rev. Fac. Odontol. (B.Aires) ; 33(75): 7-13, jul.-dic. 2018. ilus
Article in Spanish | LILACS (Americas) | ID: biblio-999353

ABSTRACT

Los traumatismos dentoalveolares que afectan a escolares pueden involucrar a los tejidos blandos y/o duros de las piezas primarias y permanentes jóvenes. Las causas por las que se producen son múltiples e incluyen caídas, accidentes en el hogar, actividad deportiva en el colegio o el club, accidentes de tránsito. El objetivo de este trabajo es presentar la resolución y el seguimiento a dos años de dos situaciones clínicas de traumatismos dentoalveolares en pacientes escolares que concurrieron a la Universidad de Buenos Aires, Facultad de Odontología, Odontología Integral Niños (AU)


Dentoalveolar trauma in schoolchildren can involve soft and/or hard tissues of deciduous and young permanent teeth. It has multiple causes, including falls, home accidents, sports accidents at school or at a club, and car accidents. The aim of the present work was to show treatmentand two-year clinical follow up of dentoalveolar trauma in schoolchildren seen at the Universidad de Buenos Aires, Facultad de Odontología, Odontología Integral Niños (AU)


Subject(s)
Humans , Male , Child , Tooth Fractures , Tooth Avulsion , Tooth Injuries , Argentina , Schools, Dental , Follow-Up Studies , Dental Care for Children , Dental Pulp Capping , Dental Restoration, Permanent , Emergency Treatment , Ferula , Glass Ionomer Cements
15.
Rev. Paul. Enferm. (Online) ; 29(1/3): 108-116, nov. 14, 2018.
Article in Portuguese | LILACS (Americas), BDENF | ID: biblio-970773

ABSTRACT

O abuso de álcool e outras drogas é um problema mundial de saúde pública. As consequências deste uso\r\nsão determinantes para a morbi-mortalidade no campo da saúde e ocupam um lugar de destaque no\r\natendimento de urgência/emergência dada a alta prevalência neste cenário. Entretanto, o atendimento\r\nnesses serviços se limita aos cuidados dos problemas físicos agudos e uma pequena parcela é diagnosticada e encaminhada, soma-se a este fato o predomínio do estigma e do estatuto de incapacidade e periculosidade dos usuários de álcool e drogas. Este estudo objetivou identificar na literatura nacional e\r\ninternacional a representação social dos trabalhadores dos serviços de urgência/emergência acerca dos\r\nusuários de álcool e drogas, publicados entre 1999 a 2009, analisando a influência dessa categoria na\r\nqualidade do serviço prestado. Foram selecionados três artigos que apresentavam similaridade com o\r\ntema. Conclui-se que uma mudança cultural se faz necessária nos paradigmas que têm orientado o trabalho\r\nde profissionais da saúde para que possam prestar uma assistência adequada, livre de preconceitos e\r\njulgamentos de modo a realizar intervenções que facilitem a recuperação do usuário de álcool e drogas


The abuse of alcohol and drugs is a worldwide problem of public health. The consequences of this abuse\r\nare determinants to the morbidity and mortality in the health fi eld and occupy a prominent place in the emergency care. However, the attendance at these services is limited to acute physical problems and a\r\nsmall proportion are diagnosed and referred appropriately. Also there is a prevalence of stigma, disability\r\nand dangerousness of the alcohol and other drugs user. This study objectives to identify through the\r\nnational and international literature, the social representation of workers from emergency department\r\nabout the users of alcohol and drugs published between 1999 to 2009, analyzing the influence of this\r\ncategory on the quality of the service. 03 articles were selected because showed similarity to the theme.\r\nWe conclude that a it is needed a cultural change on the paradigms that have traditionally guided the\r\nhealth professionals work, so they can provide appropriate assistance, free of prejudices and judgments\r\nto implement interventions that facilitate the alcohol and other drugs users recovery.


El abuso de alcohol y drogas es un problema mundial de salud pública. Las consecuencias de éste uso\r\nabusivo constituyen poderosos determinantes de la morbilidad y mortalidad en la salud y ocupan un lugar\r\ndestacado en la atención de urgencia/emergencia. Sin embargo, la atención en esos servicios se limita a\r\nlos problemas físicos agudos y sólo una pequeña proporción son diagnosticados y referidos apropiadamente, también existe estigmatización, discapacidad y peligrosidad de los usuarios de alcohol y drogas.\r\nEste estudio busca en la literatura nacional y internacional la representación social de los trabajadores de\r\nlos servicios de urgencia/emergencia sobre los usuarios de alcohol y otras drogas, publicados entre 1999 y\r\n2009, analizando la influencia de esta categoría en la calidad del servicio. Se seleccionaron 03 artículos que\r\npresentaron similaridad con el tema. Se concluye que es necesario un cambio en los paradigmas que tradicionalmente han guiado el trabajo de estos profesionales, para que puedan brindar la asistencia adecuada, libre de prejuicios y juicios de modo que sea más fácil la recuperación del usuario de alcohol y otras drogas


Subject(s)
Humans , Psychiatric Nursing , Review Literature as Topic , Health Personnel , Substance-Related Disorders , Alcoholism , Emergency Treatment , Mental Disorders
16.
J. vasc. bras ; 17(4): 348-352, out.-dez. 2018. ilus
Article in Portuguese | LILACS (Americas) | ID: biblio-969242

ABSTRACT

A fístula do tronco arterial braquiocefálico-traqueal é uma complicação pouco frequente da traqueostomia, com incidência entre 0,1 e 1%, porém com alta mortalidade nos casos não tratados. Sinais precoces incluem desde sangramento autolimitado a hemorragia maciça com choque hipovolêmico. A espessura da cânula de traqueostomia, seu posicionamento junto à parede traqueal e a pressão do balonete traqueal podem lesionar a mucosa e precipitar seu desenvolvimento. Descrevemos o caso de paciente do sexo feminino, 14 anos, traqueostomizada aos oito anos após traumatismo craniencefálico. Evoluiu após esse período com estenose subglótica e necessidade de sessões de dilatação por seis anos. No quinto ano das sessões, apresentou hemoptise de repetição, inicialmente tratada por cirurgia com prótese de politetraflouroetileno expandido. Um ano depois, apresentou novo sangramento com repercussão hemodinâmica, controlada pela técnica endovascular, e nova cirurgia foi programada em caráter eletivo. Após a segunda cirurgia, houve seis meses de acompanhamento clínico ambulatorial, sem novas complicações


Tracheo-innominate artery fistula (TIF) is a rare complication of tracheostomy, with incidence ranging from 0.1 to 1%, but mortality is high in untreated cases. Early signs range from self-limited bleeding to massive hemorrhage with hypovolemic shock. The caliber of the tracheostomy cannula, its position in contact with the tracheal wall, and tracheal cuff pressure can traumatize the mucosa and trigger development of a TIF. We describe the case of a 14-year-old female patient who had been tracheostomized at the age of eight because of head trauma. She later developed subglottic stenosis requiring dilation sessions for six years. During the fifth year of these sessions, she presented repetitive hemoptysis, initially treated by surgery to implant an expanded polytetrafluoroethylene graft. One year later, she had an intense hemorrhage, which was controlled using endovascular techniques followed by definitive surgery, performed electively. The patient was followed up for six months, without complications


Subject(s)
Humans , Female , Child , Truncus Arteriosus , Tracheostomy/methods , Endovascular Procedures/methods , Fistula , Hemorrhage/diagnosis , Angiography/methods , Stents , Treatment Outcome , Emergency Treatment/methods , Ambulatory Care , Brain Injuries, Traumatic/complications , Hemorrhage/therapy
17.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 28(3 (supl))jul.-set. 2018. tab
Article in Portuguese | LILACS (Americas) | ID: biblio-964476

ABSTRACT

As formas agudas de hipertensão arterial constituem-se nas crises hipertensivas (CH), as quais representam uma causa frequente de emergência e consultas de atenção primária. O presente estudo teve como objetivo analisar as evidências científicas sobre os cuidados de enfermagem em CH publicadas na literatura nos últimos 10 anos. Trata-se de uma revisão integrativa desenvolvida a partir das etapas propostas pela literatura. Foram utilizadas as bases de dados Public Medline ou Publisher Medline (PubMed), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Scientific Electronic Library Online (SCIELO) e selecionados os artigos publicados entre 2008 e 2018. Foram encontrados 10 artigos, sendo 40% deles nacionais, 50% dos Estados Unidos e 10% do México. Os achados apontam que os cuidados de enfermagem com o paciente em crise hipertensiva se referem à abordagem inicial do paciente em sala de emergência, avaliação inicial, intervenções da enfermagem relacionadas aos cuidados emergenciais, educação em saúde e medida de pressão arterial. É necessária a realização de estudos que abordem a atuação do enfermeiro frente aos cuidados prestados em CH, a fim de construir evidências para garantir a melhor forma de avaliar o cliente, identificar os diagnósticos de enfermagem para, então, propor intervenções eficazes


Acute forms of hypertension constitute hypertensive crises (HC), which represent a frequent cause of emergency and primary care consultations. This study aims to analyze scientific evidence relating to nursing care in HC published in the literature in the last ten years. This is an integrative review developed based on the stages proposed in the literature. The databases used were Public Medline or Publisher Medline (PubMed), Latin American and Caribbean Health Sciences Literature (LILACS) and Scientific Electronic Library Online (SCIELO), selecting articles published between 2008 and 2018. Ten articles were found; 40% from Brazil, 50% from the United States and 10% from Mexico. The findings indicate that the nursing care of patients in hypertensive crisis relate to the initial approach to the patient in the emergency room, initial evaluation, nursing interventions related to emergency care, health education and blood pressure measurement. Studies are needed that address nurses' actions in relation to HC care, in order to construct evidence to ensure the best form of evaluating the client, identify the nursing diagnoses, and then propose effective interventions


Subject(s)
Humans , Male , Female , Emergencies , Hypertension/complications , Nursing Care/methods , Patient Care Team , Therapeutics , Evidence-Based Medicine/methods , Emergency Medicine/methods , Emergency Treatment/methods
18.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 28(3)jul.-ago. 2018. tab, ilus, graf
Article in Portuguese | LILACS (Americas) | ID: biblio-916547

ABSTRACT

A incidência exata de parada cardiorrespiratória (PCR) mesmo em países com registros clínicos bem estruturados ainda é desconhecida, mas as estimativas variam de 180.000 a mais de 450.000 mortes anuais. A etiologia mais comum da PCR é a doença cardiovascular isquêmica que ocasiona no desenvolvimento de arritmias letais. A sobrevivência decorrente da PCR apresenta desfechos divergentes. No cenário extra-hospitalar, os estudos relataram taxas de sobrevida de 1% a 6%. Três revisões sistemáticas de alta hospitalar sobre a PCR extra-hospitalar mostraram 5% a 10% de sobrevida entre aqueles tratados através de serviços médicos de emergência e 15% quando o distúrbio do ritmo era a fibrilação ventricular (FV). O suporte básico de vida consiste em ressuscitação cardiopulmonar (RCP) e, quando disponível, desfibrilação com desfibrilador externo automático (DEA). As chaves para a sobrevivência após a PCR são reconhecimento e tratamento precoces, especificamente, início imediato de excelente RCP e desfibrilação precoce. O presente artigo discutirá os princípios do suporte básico de vida em adultos do pré-hospitalar à sala de emergência, conforme descritos nas Diretrizes de Ressuscitação Cardiopulmonar e Atendimento Cardiovascular de Emergência do ILCOR e AHA, atualizadas em novembro de 2017


The exact incidence of cardiorespiratory arrest (CRA) even in countries with well-structured clinical records is still unknown, but estimates range from 180,000 to over 450,000 annual deaths. The most common etiology of CRA is ischemic cardiovascular disease, resulting in the development of lethal arrhythmias. Survival of CRA shows divergent outcomes. In the out-of-hospital setting, studies have reported survival rates of 1% to 6%. Three systematic reviews of hospital discharge on extra-hospital CRA showed 5% to 10% survival between those treated by emergency medical services and 15% when the rhythm disorder was ventricular fibrillation (VF). Basic life support consists of cardiopulmonary resuscitation (CPR) and, when available, defibrillation with an automatic external defibrillator (AED). The keys to survival of CRA are early recognition and treatment, specifically, immediate onset of excellent CPR and early defibrillation. This article will discuss the basics of adult life support from prehospital to emergency room, as outlined in the ILCOR and AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, updated in November 2017


Subject(s)
Humans , Male , Female , Cardiopulmonary Resuscitation/methods , Emergency Treatment/methods , Guidelines as Topic/standards , Prehospital Care/methods , Amiodarone/therapeutic use , Arrhythmias, Cardiac , Cardiovascular Diseases/etiology , Coronary Artery Disease/complications , Coronary Artery Disease/etiology , Defibrillators , Defibrillators, Implantable , Electric Countershock/methods , Electrodes , Epinephrine/therapeutic use , Heart Arrest/etiology , Ventricular Fibrillation/therapy
19.
ABCS health sci ; 43(1): 36-40, maio 18, 2018. ilus, tab
Article in Portuguese | LILACS (Americas) | ID: biblio-883999

ABSTRACT

Introdução: Anafilaxia é uma reação sistêmica grave, aguda e potencialmente fatal. Apresenta vários desencadeantes e mecanismos diferentes, entretanto, o tratamento agudo é igual em todos os casos. Objetivo: Avaliar o conhecimento sobre tratamento da anafilaxia e choque anafilático (CA) de pediatras que atuam em setor de emergência pediátrica. Métodos: Estudo transversal através da aplicação de questionário de múltiplas escolhas com 10 perguntas sobre tratamento da anafilaxia e CA. Foram convidados todos os pediatras do Pronto Socorro de um Hospital Público Pediátrico. Resultados: Cinquenta entre 51 pediatras concordaram em participar do estudo. A média de acertos foi 6,32 com mediana de 7 (mínimo 2 e máximo 10). Houve reconhecimento adequado dos pediatras sobre a droga de escolha para iniciar o tratamento da anafilaxia e CA em 96% e 92%, respectivamente. Sobre a via de administração da adrenalina, a adequação das respostas foi de 64%. Em relação à dose de adrenalina, 70% identificaram corretamente, porém, o conhecimento sobre a dose máxima foi de 44%. Ao perguntar o intervalo para repetir a adrenalina, 38% responderam corretamente. Perguntou-se sobre terapias adjuvantes no tratamento do CA com 74% de acerto. Sobre a droga que previne a reação anafilática bifásica, 60% responderam corretamente. Quanto ao tempo de observação, 54% responderam o período adequado. O acerto sobre apresentações disponíveis de adrenalina autoinjetável foi de 40%. Conclusão: Houve dificuldade principalmente em reconhecer dose máxima, dose de adrenalina autoinjetável e tempo necessário para ser repetida, o que aumenta o risco de superdosagem e seus efeitos adversos. (AU)


Introduction: Anaphylaxis is a severe, acute and potentially fatal systemic reaction. It presents several triggers and different mechanisms, however, the acute treatment is the same in all the cases. Objective: To evaluate the knowledge about treatment of anaphylaxis and anaphylactic shock (AS) of pediatricians who works in the pediatric emergency sector. Methods: Cross-sectional study through the use of a multiplechoice questionnaire with 10 questions about the treatment of anaphylaxis and AS. All the emergency room pediatricians of a general pediatric hospital were invited. Results: Fifty of fifty-one pediatricians agreed to take part of the study. The mean of right answers was 6.32 and median of 7 (minimum 2 and maximum 10). There was an appropriate recognition about the drug of choice to initiate the treatment of anaphylaxis and AS in 96% and 92%, respectively. On the route of adrenaline administration, the adequacy of the answers was 64%. Regarding to adrenaline dose 70% were right, however the recognition of the maximum dose was 44%. When asked about the interval to repeat the adrenaline, 38% responded correctly. About adjuvant therapies to treat AS the score was 74% and 60% when questioned about the drug that prevents biphasic anaphylactic reaction. In relation to the observation time, 54% answered the appropriate period. The right answers about available self-injectable adrenaline presentations were 40%. Conclusion: There were difficulty to recognize the maximum dose, self-injectable adrenaline dose and the correct time to repeat the adrenaline/medication, which increase the risk of overdose and adverse effects. (AU)


Subject(s)
Humans , Anaphylaxis , Emergency Treatment , Epinephrine , Knowledge , Pediatrics
20.
J. bras. pneumol ; 44(2): 125-133, Mar.-Apr. 2018. tab, graf
Article in English | LILACS (Americas) | ID: biblio-893911

ABSTRACT

ABSTRACT Objective: Early tuberculosis diagnosis and treatment are determinants of better outcomes and effective disease control. Although tuberculosis should ideally be managed in a primary care setting, a proportion of patients are diagnosed in emergency facilities (EFs). We sought to describe patient characteristics by place of tuberculosis diagnosis and determine whether the place of diagnosis is associated with treatment outcomes. A secondary objective was to determine whether municipal indicators are associated with the probability of tuberculosis diagnosis in EFs. Methods: We analyzed data from the São Paulo State Tuberculosis Control Program database for the period between January of 2010 and December of 2013. Newly diagnosed patients over 15 years of age with pulmonary, extrapulmonary, or disseminated tuberculosis were included in the study. Multiple logistic regression models adjusted for potential confounders were used in order to evaluate the association between place of diagnosis and treatment outcomes. Results: Of a total of 50,295 patients, 12,696 (25%) were found to have been diagnosed in EFs. In comparison with the patients who had been diagnosed in an outpatient setting, those who had been diagnosed in EFs were younger and more socially vulnerable. Patients diagnosed in EFs were more likely to have unsuccessful treatment outcomes (adjusted OR: 1.54; 95% CI: 1.42-1.66), including loss to follow-up and death. At the municipal level, the probability of tuberculosis diagnosis in EFs was associated with low primary care coverage, inequality, and social vulnerability. In some municipalities, more than 50% of the tuberculosis cases were diagnosed in EFs. Conclusions: In the state of São Paulo, one in every four tuberculosis patients is diagnosed in EFs, a diagnosis of tuberculosis in EFs being associated with poor treatment outcomes. At the municipal level, an EF diagnosis of tuberculosis is associated with structural and socioeconomic indicators, indicating areas for improvement.


RESUMO Objetivo: O diagnóstico e tratamento precoce da tuberculose são determinantes de melhores desfechos e controle eficaz da doença. Embora a tuberculose deva ser diagnosticada e tratada idealmente na atenção primária à saúde, uma porcentagem dos pacientes recebe o diagnóstico no pronto-socorro. Nosso objetivo foi descrever as características dos pacientes de acordo com o local onde o diagnóstico de tuberculose foi feito e determinar se há relação entre o local do diagnóstico e os desfechos do tratamento. Um objetivo secundário foi determinar se há relação entre indicadores municipais e a probabilidade de diagnóstico de tuberculose no PS. Métodos: Analisamos dados provenientes do banco de dados do Programa de Controle da Tuberculose do Estado de São Paulo, referentes ao período de janeiro de 2010 a dezembro de 2013. Foram incluídos no estudo pacientes recém-diagnosticados com mais de 15 anos de idade e tuberculose pulmonar, extrapulmonar ou disseminada. Modelos de regressão logística múltipla ajustados para levar em conta possíveis fatores de confusão foram usados para avaliar a relação entre o local do diagnóstico e os desfechos do tratamento. Resultados: De um total de 50.295 pacientes, 12.696 (25%) foram diagnosticados no PS. Em comparação com os pacientes que foram diagnosticados no ambulatório, os pacientes diagnosticados no PS eram mais jovens e mais vulneráveis socialmente. A probabilidade de tratamento com desfechos ruins, incluindo perda de seguimento e óbito, foi maior nos pacientes diagnosticados no PS (OR ajustada: 1,54; IC95%: 1,42-1,66). Nos municípios, a probabilidade de diagnóstico de tuberculose no PS relacionou-se com baixa cobertura da atenção primária, desigualdade e vulnerabilidade social. Em alguns municípios, mais de 50% dos casos de tuberculose foram diagnosticados no PS. Conclusões: No Estado de São Paulo, um em cada quatro pacientes com tuberculose é diagnosticado no PS; o diagnóstico de tuberculose no PS está relacionado com tratamento com desfechos ruins. Nos municípios, o diagnóstico de tuberculose no PS está relacionado com indicadores estruturais e socioeconômicos e indica pontos que precisam melhorar.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Tuberculosis/diagnosis , Tuberculosis/epidemiology , Emergency Service, Hospital/statistics & numerical data , Socioeconomic Factors , Tuberculosis/therapy , Brazil/epidemiology , Logistic Models , Retrospective Studies , Risk Factors , Treatment Outcome , Sex Distribution , Age Distribution , Early Diagnosis , Emergency Treatment/statistics & numerical data , Hospitalization/statistics & numerical data
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