Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 198
Filter
1.
Rev. méd. Minas Gerais ; 31: 31116, 2022.
Article in English, Portuguese | LILACS | ID: biblio-1372327

ABSTRACT

Introdução: O trauma é uma das principais causas de morte no mundo e a hemorragia é responsável por 30% a 40% da mortalidade relacionada ao trauma. O estabelecimento de um protocolo de transfusão maciça (PTM) oferece oportunidade de medidas preventivas de controle de danos ao doente com choque hemorrágico grave. Objetivo: analisar dados epidemiológicos dos pacientes submetidos ao PTM em instituição de referência em trauma. Métodos: estudo quantitativo, envolvendo pacientes submetidos ao PTM no período de janeiro a dezembro de 2018. Dados sanguíneos, identificação do paciente, local do trauma, tipo de acidente, informações clínicas e desfecho foram obtidos por meio de revisão de prontuários e informações coletadas no núcleo transfusional do hospital. A análise estatística foi feita com o programa Statistical Package for the Social Sciences (SPSS) versão 23. Resultados: 306 pacientes foram avaliados, houve predominância do sexo masculino e idade de 18 a 30 anos. 55,9% dos pacientes eram procedentes de Fortaleza. O grupo sanguíneo predominante foi O, a maioria fator Rh positivo. O tórax foi o local mais comum de trauma. A maioria dos casos foi relacionada a trauma penetrante, sendo 53,6% por armas de fogo e 8,5% por armas brancas. As medianas do Escore ABC, de concentrado de hemácias e de plasma fresco usados foram de 2. 29,7% tiveram óbito em 24 horas e apenas o local do trauma - abdome - revelou-se como fator protetor para esse desfecho. Conclusão: observou-se a inexistência de associações significativas entre as variáveis do protocolo e o desfecho clínico de óbito.


Introduction: Trauma is one of the main causes of death in the world and hemorrhage is responsible for 30% to 40% of trauma-related mortality. The establishment of a massive transfusion protocol (TMP) offers the opportunity for preventive measures to control damage to the patient with severe hemorrhagic shock. Objective: to analyze epidemiological data of patients submitted to the MTP in a trauma reference institution. Methods: this is a study retrospective with a quantitative approach, involving patients undergoing MTM from January to December 2018. Blood data, patient identification, trauma site, accident type, clinical information and outcome were obtained through review of medical records and information collected at the hospital transfusion center. Statistical analysis was performed with the Statistical Package for the Social Sciences (SPSS) version 23. Results: 306 patients were evaluated, there was a predominance of males and ages from 18 to 30 years. 55.9% of the patients were from Fortaleza. The predominant blood group was O, being the majority with Rh positive factor. The thorax was the most common site of trauma. Most cases were related to penetrating trauma, being 53.6% for firearms and 8.5% for white weapons. Median ABC score, concentration of red blood cells and fresh plasma used were 2. 29.7% were dead in 24 hours and only the trauma site - abdomen - was revealed as a protective factor for this outcome. Conclusion: it was observed, after completing the study, the inexistence of significant associations between the protocol variables and the clinical death outcome.


Subject(s)
Humans , Male , Adult , Wounds and Injuries/diagnosis , Blood Component Transfusion , Shock, Hemorrhagic , Epidemiology , Hemorrhage
2.
J. coloproctol. (Rio J., Impr.) ; 41(4): 430-437, Out.-Dec. 2021. tab, ilus
Article in English | LILACS | ID: biblio-1356440

ABSTRACT

Abstract: Introduction Colorectal carcinoma (CRC) is the most common gastrointestinal neoplasm in the world, accounting for 15% of cancer-related deaths. This condition is related to different molecular pathways, among them the recently described serrated pathway, whose characteristic entities, serrated lesions, have undergone important changes in their names and diagnostic criteria in the past thirty years. The multiplicity of denominations and criteria over the last years may be responsible for the low interobserver concordance (IOC) described in the literature. Objectives: The present study aims to describe the evolution in classification of serrated lesions, based on the last three publications of theWorld Health Organization (WHO) and the reproducibility of these criteria by pathologists, based on the evaluation of the IOC. Methods: A search was conducted in the PubMed, ResearchGate and Portal Capes databases, with the following terms: sessile serrated lesion; serrated lesions; serrated adenoma; interobserver concordance; andreproducibility.Articlespublished since 1990were researched. Results and Discussion: The classification of serrated lesions in the past thirty years showed different denominations and diagnostic criteria. The reproducibility and IOC of these criteria in the literature, based on the kappa coefficient, varied in most studies, from very poor to moderate. Conclusions: Interobserver concordance and the reproducibility of microscopic criteria may represent a limitation for the diagnosis andappropriatemanagementof these lesions. It is necessary to investigate diagnostic tools to improve the performance of the pathologist's evaluation, for better concordance, and, consequently, adequate diagnosis and treatment. (AU)


Subject(s)
Humans , Wounds and Injuries/diagnosis , Intestine, Large/injuries , Polyps/classification , Colorectal Neoplasms/surgery , Adenoma/classification
3.
Pesqui. vet. bras ; 41: e06782, 2021. tab, graf
Article in English | LILACS, VETINDEX | ID: biblio-1340352

ABSTRACT

This research reports the use of different diagnostic tests in cattle, naturally infected by Rabies lyssavirus (RABV), and correlates the positivity of the tests with the clinical moment of euthanasia, the intensity of the inflammatory lesion and viral load. It also highlights the possibility of euthanasia in early stages of the disease as a way to improve animal welfare. For that, samples of 34 bovine brains were collected for analysis, preserved in 10% buffered formaline and refrigerated with subsequent freezing. The samples were subjected to direct immunofluorescence antibody technique (DFAT) tests, viral isolation in cell culture (VICC), histopathology with hematoxylin and eosin staining (HE), immunohistochemistry (IHC), Shorr stainied neural tissue smears (DSS), Reverse transcription polymerase chain reaction (RT-PCR) and polymerase chain reaction by quantitative reverse transcriptase (qRT-PCR). The areas used for analysis were the cerebellum, parietal telencephalon and thalamus. Samples with Negri bodies (NBs) or immunostaining in at least one of the analyzed areas were considered positive. For the study of the intensity of histological lesions, the lesions were classified into grades 0, 1, 2 and 3 and the positivity of the test in the presence or absence of NBs in one of the three areas analyzed. To verify the influence of the disease clinical evolution, 4-four groups of analysis were created according to the animal's clinical status at moment of the euthanasia, being: M1 = animal euthanized while standing, M2 = euthanized when in sternal recumbence, M3 = euthanized when in lateral recumbence, M4 = animal with natural death. Of the 34 brains evaluated, IHC was positive in 100% of cases, DFAT was positive in 97.05% of them, and in this negative sample the presence of RABV was confirmed by VICC. NBs ere seen in 88.23% of the cases, and the DSS test was positive in 82.35% of them. All diagnostic techniques showed positive cases in all groups analyzed. Each case was positive in at least two diagnostic methods. All cases that contained NBs were positive for rabies in the other tests. In this study, it was observed that the variables analyzed (intensity of injury and clinical evolution at the moment of euthanasia) had an influence only on HE and DSS techniques, which are based on NB research to form the diagnosis, but did not interfere with the effectiveness of the diagnosis performed by detecting the viral antigen performed by DFAT and IHC. All isolated RABV samples included in the present study have a genetic lineage characteristic of hematophagous bats Desmodus rotundus. The evaluation of qRT-PCR showed that the amount of virus did not interfere in the positivity of the tests. This work shows that IHC and DFAT are safe diagnostic techniques. They are capable of detecting RABV even in euthanized animals in the early stages of clinical evolution with mild intensities of histological lesions.(AU)


Esta pesquisa relata a utilização de diferentes testes de diagnóstico em bovinos, naturalmente infectados pelo Rabies lyssavirus (RABV), e correlaciona a positividade dos testes com o momento clínico da eutanásia, a intensidade da lesão inflamatória, e a carga viral. Salienta também a possibilidade da eutanásia em estágios precoces da doença como forma de melhorar o bem-estar animal. Para isso amostras de 34 encéfalos bovinos foram coletados para análise, conservadas em formol tamponado 10% e sob refrigeração com posterior congelamento. As amostras foram submetidas aos testes de imunofluorescência direta (IFD), isolamento viral em cultivo de células (IVCC), histopatologia com coloração de hematoxilina e eosina (HE), imuno-histoquímica (IHQ), esfregaço direto com coloração de Shorr (EDS), reação da polimerase em cadeia por transcriptase reversa (RT-PCR) e reação da polimerase em cadeia por transcriptase reversa quantitativo (qRT-PCR). As áreas utilizadas para análise foram o cerebelo, telencéfalo parietal e tálamo. Foram consideradas positivas as amostras que apresentaram Corpúsculo de Negri (CNs) ou imuno-marcação em ao menos uma das áreas analisadas. Para o estudo da intensidade das lesões histológicas, as lesões foram classificadas em graus 0, 1, 2 e 3 e a positividade do teste na presença ou ausência de CN em uma das três áreas analisadas. Para verificar a influência da evolução clínica da doença foram criados 4 grupos de análise conforme o estado clínico do animal no momento da eutanásia, sendo: M1 = animal eutanasiado em estação, M2 = eutanasiado em decúbito esternal, M3 = eutanasiado em decúbito lateral, M4 = animal com morte natural. Dos 34 encéfalos avaliados a IHQ foi positiva em 100% dos casos, a IFD foi positiva em 97,05%, sendo que na amostra negativa a presença de RABV foi confirmada por IVCC. A histologia com HE, através da visualização das CNs, foi positiva em 88,23 % dos casos, e o teste de EDS, foi positivo em 82,35%. Todas as técnicas de diagnóstico apresentaram casos positivos em todos os grupos analisados. Cada caso foi positivo em, pelo menos, dois métodos de diagnóstico. Todos os casos que continham CN foram positivos para raiva nos demais testes. Nesse estudo observou-se que as variáveis analisadas intensidade de lesão e evolução clínica no momento da eutanásia tiveram influência somente nas técnicas de HE e EDS, que se baseiam na pesquisa do CN para formação do diagnóstico, mas não interferiram na eficácia do diagnóstico realizado através da detecção do antígeno viral realizado por IFD e IHQ. Todas as amostras RABV isoladas incluídas no presente estudo apresentam linhagem genética característica de morcegos hematófagos Desmodus rotundus. A avaliação de qRT-PCR demostrou que a quantidade de vírus não interferiu na positividade dos testes. Esse trabalho mostra que a IHQ e a IFD são técnicas seguras de diagnóstico e que mesmo em animais eutanasiados em estágios iniciais de evolução clínica com intensidades leve de lesões histológicas, são capazes de detectar o RABV.(AU)


Subject(s)
Animals , Cattle , Cattle/injuries , Euthanasia , Viral Load/veterinary , Rabies virus , Wounds and Injuries/diagnosis , Encephalitis
4.
Acta ortop. mex ; 33(5): 285-288, sep.-oct. 2019. graf
Article in Spanish | LILACS | ID: biblio-1284957

ABSTRACT

Resumen: Introducción: Se creó el programa HAISS (Herramienta de Aprendizaje ISS) para mejorar la factibilidad y aprendizaje de las escalas de gravedad en trauma AIS (Abbreviated Injury Score) e ISS (Injury Severity Score). Objetivo: Obtener una herramienta de computación que promueva el aprendizaje y facilite el uso adecuado de las escalas AIS e ISS. Material y métodos: Se toma una muestra de 40 residentes de primero a cuarto grado de ortopedia de cuatro hospitales de la Secretaría de Salud. Se realizó un estudio longitudinal prospectivo con estadística analítica. Se entregaron 10 casos clínicos para obtención de ISS mediante la escala AIS, se utilizó el manual AIS 2005 actualización 2008, se plantearon dos preguntas para evaluar facilidad de uso y factibilidad, se midió el tiempo de realización. Se repitió el proceso al mes con el programa HAISS. Resultados: Con ayuda del programa HAISS se redujo el tiempo para resolver los 10 casos en más de 50%, la aceptación por parte del usuario de la escala AIS también mejoró. La fiabilidad de obtener la codificación de las lesiones con AIS no mejoró, pero no se ve afectada la obtención del ISS. Conclusiones: El programa HAISS mostró aceptación en un grupo de residentes de ortopedia, mejoró en forma subjetiva su uso y además ocupa poco tiempo.


Abstract: Introduction: The HAISS (Herramienta de Aprendizaje ISS) program was created to enhance the feasibility and learning of trauma severity scores AIS (Abbreviated Injury Score) and ISS (Injury Severity Score). Objective: Get a computer tool that promotes learning and facilitate proper use of AIS and ISS. Material and methods: A sample of 40 orthopedic residents from 1st to 4th grade from 4 hospitals of the Ministry of Health was taken. A prospective longitudinal study was conducted with analytical statistics. 10 clinical cases for obtaining ISS by AIS score were delivered, this was done with the AIS Manual 2005 update 2008, two questions were conducted to evaluate the feasibility and ease of use, the time to perform was measured. The process was repeated a month later with the HAISS program. Results: Using the HAISS program reduced the time to resolve the 10 cases by more than 50%, acceptance by the user of the AIS scale also improved. Reliability to obtain the codification of lesions with AIS did not improve, but it did not affected ISS. Conclusions: The HAISS computer program is useful for orthopedic residents to accept the AIS score and ISS score mainly because it improved the ease of use and makes it more user-friendly, it also takes less time to use it.


Subject(s)
Humans , Wounds and Injuries/diagnosis , Software , Emergency Service, Hospital , Abbreviated Injury Scale , Injury Severity Score , Prospective Studies , Reproducibility of Results , Longitudinal Studies , Mexico
5.
Rev. medica electron ; 40(5): 1585-1600, set.-oct. 2018. graf
Article in Spanish | LILACS, CUMED | ID: biblio-978689

ABSTRACT

RESUMEN La poliposis gigante localizada es una complicación rara de la colitis ulcerativa ideopática de corta evolución. Esta lesión representa un acumulo localizado de pólipos que forman una masa colónica intraluminal de aspecto neoplásico que puede simular un cáncer de colon. Suele presentarse en los adultos jóvenes y es más común en los países desarrollados con una incidencia cada vez mayor. Se presentó un caso de pólipos inflamatorios gigantes (PIG) de recto sigmoides que ingresa como un probable tumor de recto cuyas manifestaciones clínicas fueron semejantes a la de cualquier enfermedad inflamatoria. El paciente desarrolló esta masa inflamatoria sobre una enfermedad inflamatoria intestinal de poco tiempo de evolución clínica, con buena respuesta al tratamiento medicamentoso (AU).


ABSTRACT The located giant polyposis is rare complication of idiopathic ulcerative colitis of short evolution. This lesion is a localized accumulation of polyps forming an intra luminal colon mass of neoplastic aspect that might simulate a colon cancer. It is usually found in young adults, and it is more common in developed countries with a higher and higher incidence. We presented a case of giant inflammatory polyps (PIG as acronym in Spanish) of sigmoid rectum that entered the hospital as a probably rectum tumour, the clinical manifestations of which were similar to others of any inflammatory disease. The patient developed an inflammatory mass on a, intestinal inflammatory disease of short time clinical evolution, with a good answer to the medicinal treatment (AU).


Subject(s)
Humans , Male , Young Adult , Colitis/diagnosis , Adenomatous Polyposis Coli/epidemiology , Wounds and Injuries/diagnosis , Clinical Evolution , Colon/abnormalities , Adenomatous Polyposis Coli/complications , Adenomatous Polyposis Coli/diagnosis
6.
Rev. medica electron ; 40(4): 1172-1178, jul.-ago. 2018. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-961289

ABSTRACT

RESUMEN Se presenta el caso del paciente de 36 años de edad, con antecedentes de acondroplasia que desde hace 7 meses sufrió una lesión traumática no de gravedad en la rodilla derecha. La cual comienza a aumentar de volumen con contenido líquido fluctuante. Fue puncionado en dos ocasiones obteniéndose líquido serohemático; al no resolver y continuar aumentando de tamaño, se le plantea que es portador de un hematoma seroso de Morel Lavallée, que se produce por la fricción entre el tejido celular subcutáneo y la fascia. Su localización es infrecuente en la rodilla por lo que se decide presentar el caso ya que en la literatura revisada; no aparece ningún caso descrito. Por lo que constituye el objetivo principal de este trabajo, describir su proceder y la eficacia del tratamiento quirúrgico, con el que se obtuvo resultado satisfactorio (AU).


ABSTRACT We present the case of a patient aged 36 years, with antecedents of achondroplasia who 7 months ago suffered a non serious traumatic lesion in the right knee. The volume of the lesion began to increase with a fluctuant fluid contain. It was punctured twice draining serohematic fluid; it did not solve and the size increased more and more, so the patient was said that he had a serous Morel Lavallée hematoma, produced by the friction between the subcutaneous cell tissue and fascia. Its location in the knee is infrequent and it was not found any case like this in the reviewed literature; therefore we decided to present the case. The main objective of our work was describing it, showing the procedure and efficacy of the surgical that gave a satisfactory result (AU).


Subject(s)
Humans , Male , Adult , Hematoma/epidemiology , Knee/abnormalities , Achondroplasia/diagnosis , Achondroplasia/pathology , Wounds and Injuries/diagnosis , Friction/physiology , Fascia/abnormalities
7.
J. vasc. bras ; 17(3)jul.-set. 2018.
Article in Portuguese | LILACS | ID: biblio-915848

ABSTRACT

A fístula arteriovenosa (FAV) é uma comunicação anormal e permanente entre uma artéria e uma veia devido a traumas penetrantes e lesões iatrogênicas. O trauma penetrante na parede arterial pode levar à formação de pseudoaneurismas (PSA) e, se houver lesão venosa concomitante, à formação de uma FAV. Os autores apresentam o caso de um paciente portador de FAV complexa de vasos poplíteos associada a pseudoaneurisma de artéria poplítea, sugeridos a partir de exames clínicos e exames de imagem, e tratados por cirurgia convencional devido à indisponibilidade de um stent graft com diâmetro apropriado, além de a cirurgia endovascular não estar disponível no serviço em que o paciente foi operado


An arteriovenous fistula (AVF) is an abnormal and permanent communication between an artery and a vein caused by penetrating traumas or iatrogenic injuries. A penetrating trauma to the endothelial wall can lead to formation of pseudoaneurysms (PSA) and to formation of an AVF. Here, the authors present the case of a patient with a complex AVF of popliteal vessels, associated with popliteal artery pseudoaneurysm, suggested by clinical features and imaging exams, and treated with conventional surgery due to unavailability of a stent graft with appropriate diameter and because endovascular surgery isn't provided at the service where this patient was operated


Subject(s)
Humans , Male , Middle Aged , Aneurysm, False/surgery , Aneurysm, False/therapy , Arteriovenous Fistula/surgery , Arteriovenous Fistula/therapy , Popliteal Artery , Angiography/methods , Dissection/methods , Endovascular Procedures/methods , Lower Extremity , Popliteal Vein , Risk Factors , Surgical Procedures, Operative/methods , Tomography/methods , Wounds and Injuries/complications , Wounds and Injuries/diagnosis
8.
Rev. chil. cir ; 69(1): 16-21, feb. 2017. ilus, graf, tab
Article in Spanish | LILACS | ID: biblio-844319

ABSTRACT

Objetivos: Establecer la utilidad del índice de presión arterial tobillo-tobillo (ITT) en los pacientes con trauma de extremidades inferiores y signos blandos de lesión vascular en términos de sensibilidad, especificidad y valores predictivos según el mejor punto de corte detectado. Material y método: Se incluyeron 120 pacientes con trauma en extremidades inferiores y signos blandos de lesión vascular que ingresaron al Hospital Universitario de Santander (Bucaramanga, Colombia) durante los años 2012 a 2015, a los cuales se les calculó el índice tobillo-brazo (ITB) e ITT. Resultados: Un total de 21 (17,5%) pacientes tuvieron ITB menor a 0,9 al ingreso, los cuales fueron llevados a intervención quirúrgica inmediata, encontrando lesión vascular; 2 (1,6%) pacientes tuvieron ITB menor a 0,9 en el control realizado a las 6 h, los cuales también fueron llevados a intervención quirúrgica, encontrando lesión vascular. Por tanto, se encontraron 23 pacientes con lesión vascular. Las curvas ROC tanto de ITB como de ITT señalan que ambas tienen un muy buen desempeño para diagnosticar las lesiones vasculares en pacientes con signos blandos cuando se emplean una única vez. En ambos casos, el punto de corte propuesto tradicionalmente de 0,90 tiene una capacidad discriminatoria adecuada, con sensibilidad de 91% (IC 95%: 0,71-0,98), especificidad de 100% (IC 95%: 0,96-1,0), valor predictivo positivo de 100% (IC 95%: 0,83-1,0) y valor predictivo negativo de 97% (IC 95%: 0,92-0,99). Conclusión. El índice tobillo-tobillo (ITT) permite descartar lesión vascular en el paciente con trauma en extremidades inferiores y signos blandos.


Objectives: We pretend to establish the utility of the ankle-ankle systolic pressure index (AAI) in patients with trauma in the inferior limbs and soft signs of vascular injury describing its sensitivity, specificity and predictive values according to the best cut-off point. Material and method: The cohort included 120 patients with trauma in the inferior limbs and soft signs of vascular injury who attended the University Hospital of Santander (Bucaramanga, Colombia) over a period of 4 years (2012-2015). Results: 21 (17.5%) patients had an ankle brachial pressure index (ABI) < .9 at the admission and they received immediately surgical management, finding vascular injury in the operating room; 2 (1.6%) patients had an ABI < .9 in the 6 h monitoring control and they also received surgical management finding vascular injury. Therefore, we found 23 patients with vascular injury. The ROC curves for the ABI and AAI show that they both have a good achievement for the diagnosis of vascular injury in patients with soft signs when they were used one time. In both cases, the traditionally point of .90 has a good discriminatory capacity with a sensitivity of 91% (95% CI: .71-.98), specificity of 100% (95% CI: .96-1.0), positive predictive value of 100% (95% CI: .83-1.0) and negative predictive value of 97% (95% CI: .92-.99). Conclusion. The ankle-ankle systolic pressure index (AAI) allows to rule out vascular injury in the patient with trauma in the inferior limbs and soft signs.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Ankle Brachial Index , Blood Vessels/injuries , Lower Extremity/injuries , Wounds and Injuries/diagnosis , Predictive Value of Tests , ROC Curve , Sensitivity and Specificity
9.
Hosp. Aeronáut. Cent ; 12(2): 106-13, 2017. ilus, graf
Article in Spanish | LILACS, BINACIS | ID: biblio-910999

ABSTRACT

Introducción: La atención inicial de los pacientes traumatizados es una de las prácticas médicas más frecuentes en los servicios de urgencias. La adquisición de las habilidades necesarias para el manejo correcto de estos pacientes debe incorporarse desde la formación médica básica. La docencia es una tarea compleja y es necesario implementar múltiples estrategias que garanticen la adquisición de conocimiento, permitiéndole convertirse en una herramienta pedagógica para los médicos en formación y crear nuevas oportunidades para la incorporación de nuevas habilidades para los estudiantes de la escuela de medicina. La correcta identificación de las estructuras anatómicas y la atención inicial del paciente traumatizado permitirán disminuir los posibles eventos adversos y la morbimortalidad de los pacientes quirúrgicos. Objetivos: Demostrar el uso de la enseñanza en la atención inicial del trauma como una herramienta pedagógica para el correcto aprendizaje y entrenamiento del residente de cirugía general. Material y Método: Dos períodos de análisis (enero -diciembre de 2016). En el primer período: sesiones de entrenamiento para residentes de cirugía general en atención inicial en pacientes politraumatizados, aprendizaje de anatomía humana normal en cadáveres formolizados al 10% y el desarrollo de habilidades mediante la aplicación de simuladores básicos y avanzados. En el segundo período: talleres de habilidades iniciales y quirúrgicas destinadas a estudiantes de medicina; dictado por el residente bajo la supervisión de especialistas, evaluando a través de la observación directa y la supervisión de la adquisición de conocimiento. Aprendizaje de los contenidos establecidos y mediante la simulación cognitiva a través del desarrollo de casos clínicos, la retroalimentación y la evolución del médico en entrenamiento. Resultados: 10 residentes de cirugía general. Se evidenció un mejor desempeño de residentes al finalizar el primer periodo evaluando conocimientos teóricos sobre atención inicial de paciente politraumatizado (AIP), identificación de estructuras anatómicas (IEA) y procedimientos y técnicas quirúrgicas (PYTQ). En simulación y habilidades un 70% pudo realizar los ejercicios sin necesidad de participación de instructores. En el segundo periodo se evaluó a estudiantes de grado de la carrera de medicina, los cuales previa instrucción obtuvieron por encima del 60% de conocimientos y habilidades técnicas adquiridas. En este periodo también se pudo evaluar a los residentes en su rol de docentes, los cuales tuvieron un porcentaje promedio de 70% de respuestas positivas sobre el desempeño de estos por parte de los alumnos. Conclusión: El desarrollo de nuevos espacios de aprendizaje favorece la formación continua en trauma de residente. La estrategia pedagógica correctamente planificada y con la supervisión adecuada puede considerarse como una alternativa en los programas de capacitación, y es posible incorporar conocimientos y habilidades en los estudiantes de la carrera de medicina mejorando la calidad educativa de las instituciones


Introduction: The initial care of traumatized patients is one of the most frequent medical practices in the emergency services. The acquisition of the necessary skills for the correct management of these patients should be incorporated from the basic medical training. Teaching is a complex task and it is necessary to implement multiple strategies that guarantee the acquisition of knowledge, allowing it to become a pedagogical tool for doctors in training and create new opportunities for the incorporation of new skills for medical school students. The correct identification of the anatomical structures and the initial care of the traumatized patient will allow to reduce the possible adverse events and the morbidity and mortality of the surgical patients. Objectives: To demonstrate the use of teaching in the initial care of trauma as a pedagogical tool for the correct learning and training of the resident of general surgery. Material and method: : Two periods of analysis (January -December 2016). In the first period: training sessions for residents of general surgery in initial care in polytraumatized patients, learning of normal human anatomy in 10% formolized corpses and the development of skills through the application of basic and advanced simulators. In the second period: workshops of initial and surgical skills aimed at medical students; dictated by the resident under the supervision of specialists, evaluating through the direct observation and supervision of knowledge acquisition. Learning of the established contents by cognitive simulation hrough the development of clinical cases, the feedback and the evolution of the doctor in training. Results: 10 residents of general surgery. A better performance of residents at the end of the first period was evidenced evaluating theoretical knowledge about initial attention of polytraumatized patients (AIP), identification of anatomical structures (IEA) and surgical procedures and techniques (PYTQ). In simulation and skills, 70% could perform the exercises without the need for instructors to participate. In the second period, medical degree students were evaluated, which, after receiving instructions, obtained over 60% of the knowledge and technical skills acquired. In this period it was also possible to evaluate the residents in their role as teachers, who had an average percentage of 70% of positive responses on the performance of these by the students. Conclusions: The development of new learning spaces favors continuous training in resident trauma. The pedagogical strategy correctly planned and with adequate supervision can be considered as an alternative in the training programs, and it is possible to incorporate knowledge and skills in the medical career students improving the educational quality of the institutions


Subject(s)
Humans , General Surgery/education , Wounds and Injuries/diagnosis , Simulation Exercise , Internship and Residency/trends
10.
Pesqui. vet. bras ; 36(10): 971-978, out. 2016. tab, ilus
Article in Portuguese | LILACS, VETINDEX | ID: biblio-841995

ABSTRACT

Lesões podais em ovinos são causas importantes de perdas econômicas por quedas na produtividade, na reprodução, por gastos com tratamentos ineficientes e com o descarte de animais afetados. Dessa forma, os objetivos foram descrever as principais características das lesões podais observadas em ovinos da Mesorregião Sudoeste do Rio Grande do Sul, seus aspectos epidemiológicos e a importância da ocorrência desses distúrbios para a criação de ovinos nessa região. Foram coletados dados epidemiológicos e clinicopatológicos de rebanhos ovinos da região entre abril de 2014 e abril de 2015 através de visitas técnicas em propriedades rurais. Foram avaliados rebanhos ovinos em 27 propriedades rurais localizadas em diferentes municípios, dos quais 21 registraram a ocorrência de lesões podais com relato de perdas econômicas significativas. Aproximadamente 1.700 ovinos, em média 10% dos rebanhos, apresentavam diferentes graus de claudicação decorrente de lesões podais que variavam de brandas a severas. Verificou-se que diversos fatores como clima e manejo foram favoráveis para o desenvolvimento das lesões podais e essas podem estar associadas a diferentes distúrbios e agentes etiológicos. No entanto, embora essas condições sejam importantes, o controle e a prevenção tem se mostrado ineficientes. Observou-se ainda que a pododermatite infecciosa dos ovinos (Footrot), parece ser a principal doença podal na região e atualmente pode ser considerada uma doença negligenciada.(AU)


Foot lesions in sheep are important causes of economic loss due to fall in productivity, reproduction, by spending on ineffective treatment and elimination of affected animals. The purpose of this study was described the main features of foot lesions of sheep from southwestern Rio Grande do Sul, as well as epidemiological aspects and the importance of occurrence of these lesions for sheep farming in the region. Epidemiological and clinic-pathological information of sheep herds from the region between April 2014 and April 2015, by means of visits to farms. In the study were evaluated 27 sheep flocks on farms located in different municipalities. In 21 farms was reported occurrence of foot lesions in sheep having caused significant economic losses. About 1700 sheep, 10% of herds, showed different degree of lameness caused by foot lesions ranging from mild to severe. It was found that several factors, such as climate and breeding were favorable for the development of foot injuries which may be associated with different disorders and etiologic agents. Although these injuries are important, the control and prevention has proved ineffective. Also was observed that infectious pododermatitis (Footrot) may be the main foot disease of sheep in the region, and can be considered a neglected disease.(AU)


Subject(s)
Animals , Abscess/veterinary , Digital Dermatitis/diagnosis , Hoof and Claw/injuries , Lameness, Animal/diagnosis , Sheep/injuries , Wounds and Injuries/diagnosis , Wounds and Injuries/veterinary
11.
Rev. Col. Bras. Cir ; 43(5): 341-347, Sept.-Oct. 2016. tab, graf
Article in English | LILACS | ID: biblio-829603

ABSTRACT

ABSTRACT Objective: to study the profile of victims of kidney trauma who underwent surgical and medical treatment in a hospital in Curitiba. Methods: we conducted a retrospective, analytical, quantitative, cross-sectional study of patients with renal trauma admitted to the Evangelical Hospital of Curitiba between February 2011 and January 2014. Results: participated in the study 38 patients, four women and 34, men with a mean age of 28.4 years. Most injuries (60.5%) was due to closed mechanisms, especially motorcycle accidents. Injuries were treated conservatively in most cases. Patients who required surgical treatment had severe kidney damage or some other associated lesion, usually intra-abdominal. Hospital stay was lower in the conservative treatment group (10.8 days) compared with the surgical treatment one (18.8 days); mortality was also lower in the conservative treatment group (8.3%) compared with the surgical (14.3%). There were no deaths associated to kidney damage itself. Conclusion: patients with renal trauma in this study were young men, victims of motorcycle accidents, taking place during the night and early morning. Most injuries were treated conservatively.


RESUMO Objetivo: estudar o perfil das vítimas de traumas renais submetidos a tratamento cirúrgico e clínico em um hospital de Curitiba. Métodos: estudo transversal quantitativo analítico retrospectivo de pacientes com trauma renal admitidos no Hospital Universitário Evangélico de Curitiba entre fevereiro de 2011 e janeiro de 2014. Resultados: fizeram parte do estudo 38 pacientes, sendo quatro mulheres e 34 homens, com média de idade de 28,4 anos. A maior parte dos traumas (60,5%) foi decorrente de mecanismo fechado, em especial acidentes automobilísticos envolvendo motos, tratados de maneira conservadora na maior parte dos casos. Os pacientes que necessitaram de tratamento cirúrgico possuíam lesões renais graves ou alguma outra lesão associada, geralmente intra-abdominal. O tempo de internamento foi menor no grupo de tratamento conservador (10,8 dias) em relação ao grupo de tratamento cirúrgico (18,8 dias), assim como a mortalidade também foi menor no grupo de tratamento conservador (8,3%) comparada ao cirúrgico (14,3%). Nenhuma morte foi relacionada à lesão renal em si. Conclusão: os pacientes com traumatismo renal neste estudo foram homens jovens, vítimas de acidentes automobilísticos com motos, ocorrendo durante a noite e madrugada. A maioria das lesões foi tratada de modo conservador.


Subject(s)
Humans , Male , Female , Adult , Kidney/injuries , Wounds and Injuries/diagnosis , Wounds and Injuries/therapy , Brazil , Cross-Sectional Studies , Retrospective Studies , Hospitals, University
12.
Rev. Col. Bras. Cir ; 43(5): 334-340, Sept.-Oct. 2016. tab
Article in English | LILACS | ID: biblio-829600

ABSTRACT

ABSTRACT Objective: to analyze the epidemiological profile and mortality associated with the Revised Trauma Score (RTS) in trauma victims treated at a university hospital. Methods: we conducted a descriptive, cross-sectional study of trauma protocols (prospectively collected) from December 2013 to February 2014, including trauma victims admitted in the emergency room of the Cajuru University Hospital. We set up three groups: (G1) penetrating trauma to the abdomen and chest, (G2) blunt trauma to the abdomen and chest, and (G3) traumatic brain injury. The variables we analyzed were: gender, age, day of week, mechanism of injury, type of transportation, RTS, hospitalization time and mortality. Results: we analyzed 200 patients, with a mean age of 36.42 ± 17.63 years, and 73.5% were male. The mean age was significantly lower in G1 than in the other groups (p <0.001). Most (40%) of the visits occurred on weekends and the most common pre-hospital transport service (58%) was the SIATE (Emergency Trauma Care Integrated Service). The hospital stay was significantly higher in G1 compared with the other groups (p <0.01). Regarding mortality, there were 12%, 1.35% and 3.95% of deaths in G1, G2 and G3, respectively. The median RTS among the deaths was 5.49, 7.84 and 1.16, respectively, for the three groups. Conclusion: the majority of patients were young men. RTS was effective in predicting mortality in traumatic brain injury, however failing to predict it in patients suffering from blunt and penetrating trauma.


RESUMO Objetivo: analisar o perfil epidemiológico e a mortalidade associada ao escore de trauma revisado (RTS) em vítimas de trauma atendidas em um hospital universitário. Métodos: estudo transversal descritivo de protocolos de trauma (coletados prospectivamente) de dezembro de 2013 a fevereiro de 2014, incluindo vítimas de trauma admitidas na sala de emergência do Hospital Universitário Cajuru. Três grupos foram criados: (G1) trauma penetrante em abdome e tórax, (G2) trauma contuso em abdome e tórax, e (G3) trauma cranioencefálico. As variáveis analisadas foram: sexo, idade, dia da semana, mecanismo de trauma, tipo de transporte, RTS, tempo de internamento e mortalidade. Resultados: analisou-se 200 pacientes, com média de idade de 36,42 ± 17,63 anos, sendo 73,5% do sexo masculino. A média de idade no G1 foi significativamente menor do que nos demais grupos (p <0,001). A maioria (40%) dos atendimentos ocorreu nos finais de semana e o serviço de transporte pré-hospitalar mais frequente (58%) foi o SIATE (Serviço Integrado de Atendimento ao Trauma em Emergência). O tempo de internamento foi significativamente maior no G1, em comparação aos demais grupos (p <0,01). Quanto à mortalidade, houve 12%, 1,35% e 3,95% de óbitos nos grupos G1, G2 e G3, respectivamente. A mediana do RTS entre os óbitos foi 5,49, 7,84 e 1,16, respectivamente, para os três grupos. Conclusão: a maioria dos pacientes eram homens jovens. O RTS mostrou-se efetivo na predição de mortalidade no trauma cranioencefálico, entretanto falhou ao analisar pacientes vítimas de trauma contuso e penetrante.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Wounds and Injuries/epidemiology , Injury Severity Score , Wounds and Injuries/diagnosis , Cross-Sectional Studies , Hospitals, University , Middle Aged
13.
Buenos Aires; GCBA. Gerencia Operativa de Epidemiología; 16 sept. 2016. f: 21 l: 27 p. graf, tab.(Boletín Epidemiológico Semanal: Ciudad Autónoma de Buenos Aires, 1, 4).
Monography in Spanish | LILACS, InstitutionalDB, BINACIS, UNISALUD | ID: biblio-1116369

ABSTRACT

La morbi-mortalidad por Lesiones de Causas Externas (LCE) representa una problemática de Salud Pública creciente a nivel mundial ya que afecta a la población en su conjunto tanto en su desarrollo social, cultural y económico. Se observa que la llamada transición demográfica se ha acompañado de un complejo y heterogéneo proceso de transición epidemiológica. En términos generales, este proceso conlleva el aumento de enfermedades crónico-degenerativas que pueden ocasionar algún tipo de discapacidad. Existe una relación recíproca entre transición epidemiológica y transición demográfica que se refleja en el acceso a la protección en salud y nuevas demandas para la Salud Pública. En la Ciudad de Buenos Aires, el 20,4% de la población es mayor de 60 años, mientras que a nivel nacional esta proporción alcanza el 14,27%. Se analiza la mortalidad por LCE en Adultos Mayores residentes de la Ciudad de Buenos Aires a lo largo del periodo 2006-2015, según las siguientes variables: edad, sexo, intencionalidad de las lesiones, mecanismo de muerte.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Wounds and Injuries/classification , Wounds and Injuries/diagnosis , Wounds and Injuries/ethnology , Wounds and Injuries/mortality , Wounds and Injuries/epidemiology , Aged/statistics & numerical data , Health Statistics , Health of the Elderly , Mortality , External Causes
14.
Rev. cuba. estomatol ; 53(1): 111-118, ene.-mar. 2016. ilus
Article in Spanish | LILACS | ID: lil-778916

ABSTRACT

La posición expuesta de la oreja la hace vulnerable a muchos tipos de lesiones, entre las que se encuentran los traumas. Nuestro propósito es presentar un caso clínico en el que se realizó la reconstrucción de una pérdida parcial del pabellón auricular por trauma. Acude al cuerpo de guardia del Hospital Universitario General Calixto García; un paciente masculino de 42 años refiriendo haber perdido un fragmento de oreja en una riña. Se decide realizar hemostasia y fijación mediante puntos de sutura del pabellón auricular remanente a la región temporal, previa incisión en la zona. A los 3 meses del evento traumático se reevalúa con fines de realizar la planificación preoperatoria reconstructiva. Se decide la realizarla mediante injerto de cartílago costal colocado en forma de bolsillo; en la región temporal. Al mes de esta última intervención quirúrgica se realiza, bajo anestesia local, la liberación de la región auricular, el avance de un colgajo temporal y la colocación de un injerto libre de piel en la cara posterior del área reconstruida. Se observa una excelente evolución posoperatoria. El paciente refirió una gran satisfacción por los resultados estéticos obtenidos. En este caso se empleó una secuencia diagnóstica y terapéutica, según elección de los cirujanos involucrados, ante un defecto traumático parcial del pabellón auricular en sus tercios superior y medio. Este tipo de secuela traumática requirió el empleo de procederes quirúrgicos en varios tiempos operatorios que garantizaran un buen aporte sanguíneo de los tejidos y adecuados resultados estéticos finales(AU)


The exposed position of the ear makes it vulnerable to many types of injuries, including traumas. It is our purpose to present a clinical case in which reconstruction was performed of a partial traumatic auricular loss. A 42-year-old male patient presents at the emergency service of General Calixto García; University Hospital and reports having lost a piece of his ear in a fight. It was decided to perform hemostasis and fixation by stitching the remaining section of the auricle to the temporal region, after making an incision in the area. Three months after the traumatic event re-evaluation was conducted with a view to planning reconstructive surgery. It was decided to carry out the reconstruction placing a pocket-shaped rib cartilage graft in the temporal region. One month after the operation, auricular release, advancement of a temporary flap and placement of a free skin graft on the back of the reconstructed area were performed under local anesthesia. Excellent postoperative evolution was observed. The patient reported great satisfaction with the esthetic results obtained. The case herein presented was based on a diagnostic and therapeutic sequence of actions determined by the surgeons involved with a view to correcting a partial traumatic defect of the upper and middle thirds of the auricle. This type of traumatic sequel required the use of surgical procedures at several operative moments ensuring good blood supply to tissues and appropriate final esthetic results(AU)


Subject(s)
Humans , Male , Adult , Ear Auricle/injuries , Ear Auricle/surgery , Ear Cartilage/transplantation , Surgical Flaps/surgery , Wounds and Injuries/diagnosis
15.
Pesqui. vet. bras ; 36(3): 145-160, mar. 2016. tab, graf
Article in Portuguese | LILACS | ID: lil-782059

ABSTRACT

Numa pesquisa em abatedouros a procura de lesões em bovinos, realizada de janeiro de 2011 a julho de 2014, 544 foram encontradas, das quais 65 eram neoplasmas. Quarenta e dois porcento desses tumores eram de origem mesenquimal; 37% eram epiteliais; 14,5% eram derivados da crista neural; 5% eram tumores do cordão sexual; e 1,5 eram tumores originários do sistema nervoso periférico. O tumor mais frequentemente encontrado foi o linfoma (28% de todos os tumores), a maioria dos casos como parte do complexo leucose bovina enzoótica. O carcinoma de células escamosas foi o segundo tumor mais frequente (15% de todos os tumores). É chamada a atenção para a frequência desses tumores e para a sua importância no diagnóstico diferencial no abatedouro frigorífico entre eles e outras lesões importantes, incluindo as lesões granulomatosas da tuberculose. Houve uma ocorrência significativa do feocromocitoma adrenal (13% de todos os tumores). Papilomatose representou apenas 3% de todos os tumores. Como papilomas são comuns em bovinos, seu baixo número nesse estudo pode ser explicado pelo fato de que eles não são usualmente diagnosticados no exame post mortem (quando o couro já foi retirado da carcaça), mas sim no exame ante mortem, como ocorreu na maioria dos casos deste estudo. Tumores encontrados com menor frequência (cada um perfazendo entre 1.5 e 3% de todos os tumores) incluíram adenocarcinoma apócrino misto da cauda, adenocarcinoma mamário, adenocarcinoma uterino, carcinoma de células renais, fibroma interdigital, hemangiossarcoma, leiomioma uterino, lipoma, lipossarcoma, mesotelioma, neurofibroma, tumor de células da granulosa, tumor estromal gastrointestinal, tumores hepáticos, tumores melanocíticos, e tumores pulmonares primários. Pretende-se que os resultados dessa pesquisa possam ajudar na identificação das lesões na inspeção oficial em matadouros frigoríficos.


In a survey for lesions in cattle in abattoirs from January 2011 to July 2014, 544 lesions were found, of which 65 were neoplasms. Forty two percent of those were of mesenchymal origin; 37% were epithelial; 14,5% were neural crest derivatives; 5% were sex chord derived tumors and 1.5 was from the peripheral nervous system. The most common tumor found was lymphoma (28% of all tumors), most of them as part of the enzootic leukosis complex. Squamous cell carcinoma was the second most frequent tumor (15% of all tumors). Consideration is made on the frequency of these tumors and the importance of the differential diagnosis at gross examination at the slaughterhouse among them and other important lesions, including tuberculous granulomatous lesions. There was a significance occurrence (13% of all tumors) of the adrenal tumor, pheocromocytoma. Papillomatosis represented only 3% of all tumors; as those are common benign tumors in cattle; their low numbers in this review could be explained by the fact that these are not tumors usually detected in the postmortem examination (after the hide was stripped from the carcass) which was mostly the case of this study, but rather by antemortem inspection. Less common tumors found (each accounting for 1.5 to 3% of all tumors) included granulosa cell tumor, gastrointestinal stromal tumor, hemangiosarcoma, hepatic tumors, interdigital fibroma, lipoma, liposarcoma, mammary adenocarcinoma, melanocytic tumors, mesothelioma, mixed apocrine adenocarcinoma of the tail, neurofibroma, renal cell carcinoma, primary pulmonary tumors, uterine adenocarcinoma, and uterine leiomyoma. It is intended that the results of this survey would be helpful in the identification of lesions at in the official meat inspection at the slaughterhouses.


Subject(s)
Animals , Cattle , Wounds and Injuries/diagnosis , Wounds and Injuries/veterinary , Neoplasms/diagnosis , Neoplasms/veterinary , Abattoirs , Carcinoma/veterinary , Lymphoma/veterinary , Diagnostic Techniques and Procedures/veterinary
16.
São Paulo; s.n; 2016. 92 p. ilus, tab. (BR).
Thesis in Portuguese | LILACS, BBO | ID: biblio-868000

ABSTRACT

O presente estudo teve como objetivo avaliar o impacto de um modelo 3D, sobre a formação e progressão de lesões de cárie como objeto de aprendizagem, no desempenho teórico/prático e grau de satisfação de alunos de graduação em odontologia de diferentes contextos, na detecção de lesões de cárie utilizando o ICDAS. Foi conduzido um estudo multicêntrico controlado randomizado envolvendo uma amostra por conveniência de alunos de graduação em odontologia de cinco instituições (1 nacional e 4 internacionais). Inicialmente, os alunos receberam uma aula teórica tradicional e responderam uma primeira avaliação teórica. Posteriormente, foram aleatoriamente alocados em dois grupos: 1) grupo teste: que recebeu uma aula teórica tradicional expositiva mais acesso ao modelo 3D e 2) grupo controle: que recebeu unicamente a aula teórica tradicional expositiva. Depois, os alunos do grupo controle saíram da sala e um vídeo de 6 minutos (modelo 3D) foi projetado. Após o vídeo os alunos do grupo controle regressaram à sala e ambos os grupos foram submetidos a uma avaliação teórico/prática com o propósito de avaliar o desempenho após a intervenção e grau de satisfação da atividade. Análises de regressão


linear e de Poisson multinível foram realizadas para analisar o impacto do objeto de aprendizagem no desempenho teórico-prático do aluno. Análises descritivas foram realizadas para avaliar o grau de satisfação do aluno. Um total de 307 alunos participou do estudo. Alunos que tiveram melhor desempenho na avaliação teórica inicial obtiveram melhores notas na média teórica final (OR=1,11; 95%IC=1,02-1,21). Alunos do grupo teste tiveram um melhor desempenho teórico em comparação com os do grupo controle (p=0,04), principalmente para questões relacionadas à correlação histológica do ICDAS com características clínicas dos diferentes estágios de progressão. Não houve diferença estatisticamente significante na avaliação prática entre grupos e, um alto nível de satisfação da atividade foi observado na amostra. Conclui-se que, a atividade avaliada teve um impacto satisfatório no desenvolvimento de competências teóricas relacionadas à detecção de lesões de cárie utilizando o ICDAS.


This study aimed at evaluating the impact of a 3D model as a learning object in the training/teaching and satisfaction degree of undergraduate dental students from different contexts for the detection of caries lesions using the ICDAS. A multicenter controlled randomized trial was conducted, involving a convenience sample of undergraduate dental students from five institutions (1 national and 4 international). Firstly, students attended a traditional theoretical lecture and answered a first theoretical test. Then, they were randomly allocated into two groups as follows: 1) test group: receiving the theoretical lecture and accessing the 3D model, and 2) control group: receiving the theoretical lecture only. Afterwards, control group students left the room and a 6-minute video was projected (3D model). Once the video had finished, control group students returned to the room and both groups were submitted to a theoretical/practical test to evaluate their performance after intervention as well as their satisfaction degree. Multilevel linear and Poisson regression analyses were done, to analyze


the learning object impact in the students´ theoretical/practical performance. Descriptive analyses were conducted to assess the students´ satisfaction degree. Three hundred and seven students participated. Those having a better performance in the initial theoretical test also had better grades in the final theoretical assessment (OR=1,11; 95%IC=1,02-1,21). Test group students had a better theoretical performance in comparison to control group ones (p=0,04), mainly in relation to questions regarding the ICDAS histological correlation with clinical features on each severity caries stage. There were no statistically significant differences regarding practical assessment between groups, and a high level of activity satisfaction was observed. In conclusion, the assessed activity had a satisfactory impact in the developing of theoretical skills in relation to the detection of caries lesions using the ICDAS.


Subject(s)
Humans , Male , Female , Dental Caries/complications , Dental Caries/diagnosis , Education/methods , Education/organization & administration , Education , Wounds and Injuries/complications , Wounds and Injuries/diagnosis
17.
São Paulo; s.n; 2016. 123 p. ilus, tab. (BR).
Thesis in Portuguese | LILACS, BBO | ID: biblio-868004

ABSTRACT

O diabetes mellitus (DM) pode levar à disfunção das glândulas salivares. A ativação do receptor de produtos finais de glicosilação avançada e de seus ligantes tem sido reportado em várias doenças crônicas, entre estas, a diabetes e suas complicações. Este estudo analisou a expressão do RAGE, proteína do grupo de alta mobilidade B1 (HMGB1) e de produtos de glicosilação avançada (AGE), bem como os efeitos da irradiação com laser de baixa potência (ILBP) em glândulas salivares submandibulares (GSMs) de ratas diabéticas. Ratas Wistar com 12 semanas de vida foram divididas em 3 grupos: controle (C), diabético (D) e diabético com laser (DL). A indução de DM nos grupos D e DL foi realizada com injeção intraperitoneal de estreptozotocina 60 mg/kg de peso corporal, no 1° dia experimental. No 29°dia, os animais do grupo DL receberam a ILBP (660 nm, 70 mW, 20 J/cm² e 0,56 J por ponto), aplicado no total de quarenta pontos cobrindo a área correspondente as GSMs, e os seus efeitos foram avaliados 24 h após a irradiação (eutanásia). As análises de parâmetros metabólicos, histológicos e de marcadores de inflamação, apoptose e proliferação foram realizadas. Nossos achados mostram que a ILBP diminuiu a glicemia das ratas diabéticas irradiadas, melhorando a resistência à insulina (HOMA-IR), sensibilidade à insulina (HOMA-IS) e função de células beta (HOMA-?). Em GSM, o DM parece aumentar a expressão do eixo HMGB1/AGE/RAGE, possivelmente associado à ativação do fator de transcrição nuclear kappa B (NF?B). A ILBP reduziu os marcadores de inflamação, HMGB1 e TNF-? em GSM de ratas diabéticas, e parece regular a expressão de proteínas relacionadas à proliferação e à apoptose, pela via do AMP cíclico, parcialmente mediado por proteína kinase regulada por sinais extracelulares. No entanto, mais estudos são necessários para melhor entender os efeitos do laser neste tecido.


Diabetes (DM) can lead to dysfunction of the secretory capacity in salivary glands. Since the activation of the receptor for advanced glycation end-products (RAGE) and its ligands has been suggested to participate in chronic disorders, such as diabetes and its complications. This study analyzed the expression of RAGE, high mobility group box protein B1 (HMGB1) and advanced glycation end-products (AGEs) were evaluated, as well as the effects of low-power laser irradiation (ILBP), in diabetic submandibular glands (GSM). Wistar rats 12 weeks-old were divided in three groups: control (C), diabetic (D) and diabetic with laser (DL). The D and DL rats were intraperitoneally injected with streptozotocin 60 mg/kg, in the 1st experimental day. On the 29° day, the DL rats received the ILBP (660 nm, 70 mW, 20 J/cm² e 0,56J per point), with a total of forty points covering the GSMs area, its effects were evaluated 24h after irradiation (euthanasia). Metabolic parameters, histology and the inflammatory, apoptosis and proliferation markers were evaluated. Our findings show that ILBP reduced the blood glucose levels of the irradiated diabetic rats, improving their insulin resistance (HOMA-IR), insulin sensitivity (HOMA-IS) e beta cell function (HOMA-?). In GSM, DM seems to upregulate the expression of HMGB1/AGE/RAGE axis, possibly associated with the activation of the nuclear factor kappa-light-chain-enhancer of activated B cells (NF?B). The ILBP reduced the inflammatory markers HMGB1 and TNF-? in diabetic GSM, and seems to regulate the expression of proteins related to proliferation and apoptosis, by cyclic AMP pathway, partially mediated by extracellular signal-regulated kinase. However, more studies are necessary to better understand the laser effects on this tissue.


Subject(s)
Humans , Male , Female , Wounds and Injuries/classification , Wounds and Injuries/complications , Wounds and Injuries/diagnosis , Wounds and Injuries/prevention & control , Lasers/adverse effects , Lasers/supply & distribution , Lasers , Peroneal Nerve/abnormalities , Peroneal Nerve/injuries , Peripheral Nerves/growth & development
18.
Hosp. Aeronáut. Cent ; 10(2): 110-5, dic. 2015. ilus, tab
Article in Spanish | LILACS | ID: biblio-834628

ABSTRACT

Introducción: La ultrasonografía es considerada como unelemento indispensable para el personal médico que sedesempeña en la atención del trauma y la emergencia, por lotanto en el programa de formación de los residentes de cirugíageneral debe tomarse en consideración la capacitación para lautilización de la misma.Objetivos: Demostrar la importancia de la formación de los residentes en cirugía general en ultrasonografía para laevaluación del paciente politraumatizado. Material y Método: Se instruyeron y evaluaron 11 médicosresidentes de cirugía general para la valoración inicial delpaciente politraumatizado mediante ultrasonografía durante tresperiodos, Enero-Marzo, Abril-Junio y Julio-Octubre 2015. Resultados: 11 (100%) residentes de cirugía general en lavaloración inicial del paciente politraumatizado. “A”. Vía aérea: 9(81.81 %) residentes lograron identificar el 80 % de lasestructuras anatómicas. “B”. Ventilación: 10 (90.90 %) residentes identificaron el 80 % de las estructuras anatómicas. “C”.Circulatorio: 10 (90.90 %) residentes lograron identificar el 100%de las mismas; solo 1 (9.1 %) necesito intervención delsupervisor. “D”. Neurológico: 7 (63.63 %) residentes lograron identificar el 100% de las estructuras anatómicas, 2 (18.18 %)reconocieron el 75 % los componentes del ojo mientras que dos(18.18 %) cirujanos en formación solo pudieron identificar el 50 %de las estructuras. “E”. Exposición: 10 (90.90 %) lograron identificar las estructuras anatómicas.Conclusiones: La capacitación e instrucción de médicos cirujanos en formación en la utilización de la ultrasonografíaresulta de suma importancia para el desenvolvimiento adecuadoen la guardia de emergencias.


Introduction: Ultrasonography is considered an essentialelement for the medical staff that works on trauma and emergencycare, therefore in the formation program of the general surgeryresidents must be considered the training for its usage.Objectives: Demonstrate the importance of ultrasonographyformation of general surgery residents for the evaluation of atrauma patient.Material and Methods: 11 general surgery residents wereinstructed and evaluated for the trauma patient initial valuationwith ultrasonography for three periods, January-March, April-Juneand July-October 2015.Results: 11 (100%) residents of general surgery at the initialvaluation of the trauma patient. “A”. Air tract: 9 (81.81%) residentsmanaged to identify the 80% of the anatomical structures. “B”.Ventilation: 10 (90.90%) residents managed to identify the 80% ofanatomical structures. “C”. Circulatory: 10 (90.90%) residentsmanaged to identify the 100% of anatomical structures; only 1(9.1%) needed supervisor intervention. “D”. Neurological: 7(63.63%) resident managed to identify the 100% of anatomical structures, 2 (18.18%) recognized the 75% of the eye’scomponent while 2 (18.18%) surgeons in formation could only identify 50% of the structures. “E”. Exposition: 10 (90.90%)managed to identify the anatomical structures. Conclusions: The training and instruction of surgeons in trainingat the usage of ultrasonography turn out to be of extreme importance for the correct development at the emergency guard.


Subject(s)
Humans , Wounds and Injuries/diagnosis , Wounds and Injuries , Ultrasonography
19.
Rev. chil. cir ; 67(4): 427-429, ago. 2015.
Article in Spanish | LILACS | ID: lil-752865

ABSTRACT

Introduction: Ureteral trauma can result from various noxas the most frequent iatrogenic. Additional this, external causes: blunt trauma, sharp weapon and gunshot contributing to the overall incidence. Its early diagnosis although great importance to avoid complications is difficult so it is their suspect is essential when confronted with trauma patients. Case reports: We report five patients aged 15 to 46 years with ureteral trauma. Two patients had gross hematuria, one patient acute abdominal pain and two as hypovolemic shock. The lesions were found mainly to the left ureter and in smaller proportion in right ureter. Four patients the diagnosis was surgical exploration and one case was performed by scans. All were operated, had an uneventful postoperative period and are currently asymptomatic.


Introducción: El trauma de uréter puede ser resultado de diferentes noxas siendo la más frecuente la iatrogénica. Adicional a esto, las causas externas de trauma contuso, las causadas con arma cortopunzante y las realizadas por arma de fuego contribuyen a la incidencia global. Su diagnóstico temprano, aunque de gran importancia para evitar complicaciones, resulta difícil por lo que es primordial su sospecha cuando nos enfrentamos a pacientes politraumatizados. Casos clínicos: Se identificaron 5 casos de trauma ureteral en nuestro hospital desde septiembre de 2012 a agosto de 2013. La mediana de edad fue 24,5 años (15-46 años). Se manifestaron como hematuria macroscópica en dos casos, un caso como dolor abdominal agudo y dos como choque hipovolémico. Estas lesiones se encontraron principalmente localizadas hacia uréter izquierdo y en menor proporción en uréter derecho, todas de tipo penetrante, causadas por arma de fuego. En 4 pacientes el diagnóstico fue por exploración quirúrgica y un caso fue realizado a través de escanografía. Los pacientes fueron intervenidos quirúrgicamente, ninguno presentó complicaciones y se encuentran actualmente asintomáticos.


Subject(s)
Humans , Adolescent , Adult , Young Adult , Middle Aged , Wounds and Injuries/surgery , Wounds and Injuries/diagnosis , Ureter/surgery , Ureter/injuries
20.
Rev. bras. queimaduras ; 14(2): 113-118, abr.-Jun. 2015. ilus
Article in Portuguese | LILACS | ID: lil-777685

ABSTRACT

Objetivo: Analisar o perfil dos pacientes portadores de sequelas de queimaduras admitidos para reabilitação no Hospital Sarah Brasília, e descrever o número de atendimentos de acordo com a classificação de escala Graham e de McCauley. Método: Trata-se de estudo retrospectivo consecutivo de prontuários de pacientes atendidos no Hospital Sarah Brasília durante o período de cinco anos, devido à sequela de queimaduras nos membros superiores. Na admissão realizou-se a avaliação física e funcional, o exame radiológico, Classificação de Graham e de McCauley, nos casos de queimaduras elétricas, e eletroneuromiografia (EMG), para o planejamento cirúrgico. Os procedimentos cirúrgicos foram realizados em centro cirúrgico, sob anestesia geral e ou bloqueio de plexo braquial. Realizou-se análise das variáveis encontradas com auxílio do programa Epiinfo. O estudo foi avaliado e aprovado pelo Comitê de Ética em Pesquisa da Associação das Pioneiras Sociais (CEP/APS). Resultados: Foram atendidos 71 pacientes, 97 lesões de membros superiores, devido a queimaduras, entre 1 a 20 anos de idade (49%), predomínio do sexo masculino, provocadas por fogo (28%) e queimadura elétrica por alta tensão (25%), classificados Grau III e IV (60%), com 24% de pacientes amputados. Para 29% realizou-se mais de uma cirurgia, entre estes retalhos locais (13%), enxerto de pele (24%), fixação com fios de Kirschner (44%), retalho à distância (2%). Entre os procedimentos não cirúrgicos, foram utilizados órteses, fisioterapia e próteses. Conclusão: Constatou-se que no perfil do paciente portador de sequela de queimadura no Hospital de Reabilitação predominou o atendimento a adultos jovens, com deformidades antigas, graves de Grau III, IV e amputações. As limitações físicas causadas pela queimadura ocasionaram redução da função do membro superior, com sequelas variáveis e variedade de cirurgias, e programa de reabilitação multidisciplinar foi necessário.


Objective: To analyze the profile of patients with burn sequels at Hospital Sarah Brasília, and describe the number of medical staff appointments according to the rating scale Graham and McCauley. Method: Retrospective study of patients seen in Sarah Hospital for five years, due to sequels of burns on the upper limbs. On admission there was the physical and functional evaluation, radiological examination, Graham classification and McCauley in cases of electrical burns, and electromyography (EMG), for surgical planning. Surgical procedures were performed in the operating room under general anesthesia or brachial plexus block. We conducted analysis of the variables found with the aid of Epi-info program. The study was approved by the Ethics Committee. Results: We served 71 patients, 97 upper limb injuries due to burns, between 1-20 years of age (49%), male predominance, caused by fire (28%) and high-voltage electrical burn (25%) ranked Grade III and IV (60%), with 24% of amputees. For more than 29% undergone surgery, among these local flaps (13%), skin grafts (24%) with Kirschner wire attachment (44%), the distance retail (2%), among nonsurgical procedures were used orthotics, physical therapy and prosthetics. Conclusion: It was found that the profile of the burn sequel to a patient at the Rehabilitation Hospital predominant care for young adults with old deformities, severe Grade III, IV and amputations. The physical and psychological limitations caused by the burn caused reduction of upper limb function, with varying consequences and variety of surgeries, and multidisciplinary rehabilitation program was necessary.


Objetivo: Analizar el perfil de los pacientes con secuelas de quemaduras en el Hospital de Rehabilitación Sarah Brasília, y describir el número de evaluaciones de acuerdo a la escala de calificación Graham e de McCauley. Método: Se trata de un estudio retrospectivo consecutivo de las historias clínicas de pacientes tratados en el Hospital Sarah Brasília durante cinco años debido a secuelas de quemaduras en las extremidades superiores. A su ingreso se hizo la evaluación física y funcional, exámenes radiológicos, clasificación de Graham y McCauley en casos de quemaduras eléctricas, y electromiografía (EMG), para la planificación quirúrgica. Los procedimientos quirúrgicos se realizaron en el quirófano bajo anestesia general o bloqueo del plexo braquial. Hemos llevado a cabo análisis de las variables encontradas con la ayuda del programa Epiinfo. El estudio fue aprobado por el Comité de Ética. Resultados: Se atendieron 71 pacientes con 97 lesiones de los miembros superiores debido a quemaduras, entre 1-20 años de edad (49%), predominio masculino, causado por el fuego (28%) y quemadura eléctrica de alta tensión (25%) clasificados en grados III y IV (60%), 24% de amputados. Para el 29% se realizó más de una operación, entre colgajos locales (13%), injertos de piel (24%), fijación con agujas de Kirschner (44%), colgajos a distancia (2%). Entre los procedimientos no quirúrgicos, se usaron órtesis, terapia física y prótesis. Conclusión: Se encontró que en el perfil de pacientes con secuela de quemadura en Hospital de Rehabilitación predominaron adultos jóvenes con deformidades antiguas y severas, grado III y IV, y amputaciones. Las limitaciones físicas causadas por la quemadura causaron reducción de la función de los miembros superiores, con diferentes secuelas y variedad de cirugías, y programa de rehabilitación multidisciplinario era necesario.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Burns/rehabilitation , Surgical Flaps/transplantation , Upper Extremity , Wounds and Injuries/diagnosis , Retrospective Studies , Skin Transplantation/rehabilitation
SELECTION OF CITATIONS
SEARCH DETAIL