Trauma severity predictors / Preditores de gravidade no trauma

This review aimed to determine which are the indexes for early detection and evaluation of clinical and physiological deterioration of traumatized patients. A Scoping Review according to the methods proposed by Joanna Briggs Institute (JBI) was performed from February 2018 to December 2018 on LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde), National Library of Medicine (PubMed), and SCOPUS databases. Sixty-two studies were included, of which 43 evaluated patients with general trauma. A variety of physiological variables, such as Glasgow Coma Score, Glucose, Days in the Intensive Care Unit, Lactate, and predictor indexes - Injury Severity Score (ISS), Trauma Injury Severity Score (TRISS), Revisited Trauma Score (RTS), and APACHE II were identified. The values observed in the studies among patients were compared to the ones determined by the basic literature, being called Critical Values (CV). The group of gravity indexes, besides clinical and regulatory protocols, found in this review are the solidification of the healthcare process involving the traumatized patient's responses to the actions of the healthcare team. The analysis of these indexes must be emphasized to determine, with greater reliability, the prognosis of the patient. With these data, it may be possible to effectively predict mortality rates (AU).

O objetivo desta revisão é determinar os índices para detecção precoce e avaliação clínica e fisiológica para deterioração de pacientes do trauma. Conduziu-se uma revisão de escopo de acordo com os métodos propostos pelo Joanna Briggs Institute (JBI) entre fevereiro de 2018 a dezembro de 2018 nas bases de dados LILACS (Literatura Latina-Americana e do Caribe em Ciências da Saúde), National Library of Medicine (PubMed) e SCOPUS. Foram incluídos 62 estudos, dos quais 43 sobre trauma geral. Encontrou-se grande diversidade de variáveis fisiológicas, como Escala de Coma de Glasgow, Glicose, dias em Unidade de Terapia Intensiva, lactato e índices preditores­Injury Severity Score (ISS), Trauma Injury Severity Score (TRISS), Reviseted Trauma Score (RTS) e APACHE II. Os valores observados nos pacientes dos estudos encontrados foram comparados com os da literatura básica, sendo denominados Valores Críticos (CV). O grupo de índices de gravidade encontrados neste estudo, além de protocolos reguladores e clínicos, são a solidificação do processo de cuidado envolvendo a resposta das ações da equipe em saúde ao paciente de trauma. A análise desses índices deve ser enfatizada para determinar com maior confiabilidade o prognóstico do paciente. Com esses dados, pode ser possível predizer a taxa de mortalidade com maior acurácia (AU).

Detection of SARS-CoV-2 in semen samples: a scoping review / Detecção de SARS-CoV-2 em amostras de sêmen: revisão de escopo

Background: many doubts about the infection of SARS-CoV-2 were raised, such as sexual transmission, sterility, and changes in fertility procedures; however, information is not clearly stated and organized. Purpose: to review and summarize scientific evidence on detection of SARS-CoV-2 in semen samples of Covid-19 patients. Methods:literature search in PubMed, Web of Science, Scopus, Medline and Embase databases, and followed Scoping Review protocol defined by Joanna Briggs Institute (JBI) after the guiding question "Is it possible to detect SARS-CoV-2 in the semen of adult patients with a confirmed diagnosis of Covid-19?" Results: 287 studies were identified, and, after discerning analysis, 9 studies published in the English language were selected. Three researchers analyzed the studies for SARS-CoV-2 presence in the seminal fluid, patients' severity, days since the onset of disease, diagnosis confirmation, semen collection method, viral analysis method, and sample numbers. Conclusions: it was not possible to find strong evidence to confirm the presence or absence of Covid-19 in the semen of adult patients. New studies on the subject should be better designed, taking into account the possible anatomical and functional conditions and changes of the male reproductive system during and after the infection by SARS-CoV-2 (AU)

Objetivo: Revisar e resumir as evidências científicas em pesquisas realizadas para detectar a presença de SARS-CoV-2 em amostras de sêmen de pacientes com COVID-19. Métodos: A pesquisa de literatura foi conduzida nas bases de dados PubMed, Web of Science, Scopus, Medline e Embase. Seguiu o protocolo de revisão de escopo definido por Joanna Briggs Institute (JBI) e baseou-se na pergunta norteadora "É possível detectar SARS-CoV-2 no sêmen de pacientes adultos com diagnóstico confirmado de Covid-19?". Resultados: 287 estudos foram identificados, 9 estudos publicados em língua inglesa foram selecionados após análise minuciosa. Três pesquisadores analisaram os estudos em busca de presença de SARS-CoV-2 no fluído seminal, gravidade do paciente, dias desde o início da doença, confirmação diagnóstica, método de coleta de sêmen, método de análise viral e número de amostras. Conclusões: Não foi possível identificar fortes evidências para confirmar a presença ou ausência de COVID-19 no sêmen de pacientes adultos. Novos estudos sobre o tema devem ser melhor projetados, levando-se em conta as possíveis condições anatômicas e funcionais e mudanças no sistema reprodutor masculino durante e após a infecção por SARS-CoV-2 (AU)

Avaliação do volume urinário: comparação do desempenho do equipamento de ultrassonografia portátil de bexiga Mobissom® com o equipamento de mesa / Urinary volume assessment: comparison of the performance of Mobissom® portable bladder ultrasound equipment with tabletop equipment

Este estudo teve como objetivo comparar o desempenho do equipamento de ultrassonografia portátil de bexiga Mobissom® com o equipamento de ultrassonografia de mesa para avaliar o volume de urina da bexiga. Foram analisadas 192 imagens de 16 pacientes adultos que realizaram o exame. Os volumes vesicais obtidos pelo equipamento portátil foram arquivados na forma de imagem e, posteriormente, comparados com o laudo ultrassonográfico da avaliação realizada por um aparelho ultrassonográfico de mesa. Os resultados obtidos foram comparados por meio do Teste t pareado e as diferenças foram distribuídas graficamente pelo método de Bland & Altmann. No resultado geral, não houve diferenças significativas entre os dois equipamentos. Conclui-se que o equipamento, apesar da limitação na visibilização de outros órgãos, é de fácil utilização e relevante para avaliação beira leito.

This study aimed to compare the performance of Mobissom® portable bladder ultrasound equipment with tabletop ultrasound equipment to assess bladder urine volume. 192 images of 16 adult patients who underwent the exam were analyzed. The bladder volumes obtained by the portable equipment were archived in the form of an image and, later, compared with the ultrasound report of the evaluation performed by a tabletop ultrasound device. The results obtained were compared using the paired t test and the differences were graphically distributed using the Bland & Altmann method. In the overall result, there were no significant differences between the two devices. It is concluded that the equipment, despite the limitation in the visualization of other organs, is easy to use and relevant for bedside assessment.

Overcoming male factor infertility with intracytoplasmic sperm injection / Superando o fator masculino de infertilidade com injeção intracitoplasmática de espermatozoides

Summary Objective: To evaluate the effect of male factor infertility on intracytoplasmic sperm injection (ICSI) outcomes compared with a control group presenting isolated tubal factor. Method: This retrospective study included 743 couples undergoing ICSI as a result of isolated male factor and a control group consisting of 179 couples undergoing ICSI as a result of isolated tubal factor, performed in a private university- -affiliated in vitro fertilization center, between January/2010 and December/2016. Patients were divided into two groups according to maternal age: women ≤35 years old and >35 years old. The effects of infertility causes on laboratorial and clinical ICSI outcomes were evaluated using Student's t-test and (2 test. Results: No differences in controlled ovarian stimulation outcomes were observed between male factor cycles and tubal factor cycles in the two age groups. Implantation (male factor 35.5% vs. tubal factor 32.0%, p=0.340), pregnancy (male factor 46.9% vs. tubal factor 40.9%, p=0.184) and miscarriage (male factor 10.3% vs. tubal factor 10.6%, p=0.572) rates were similar between the infertility groups, irrespective of female age. Considering maternal age, the cancelation rate was higher in older women (>35 years old) undergoing ICSI as a result of male factor infertility (17.4% vs. 8.9%, p=0.013). Conclusion: Our results showed that there is no difference in the outcomes of pregnancy between couples with male or tubal factor infertility, which indicates that ICSI surpasses the worse specific outcomes associated with male factor.

Resumo Objetivo: Avaliar o efeito do fator masculino de infertilidade em resultados de injeção intracitoplasmática de espermatozoides (ICSI) em comparação com um grupo controle que apresenta o fator tubário isolado. Método: Este estudo retrospectivo incluiu 743 casais submetidos a ICSI por fator masculino e 179 casais por fator tubário, realizada em um centro privado de fertilização in vitro associado à universidade, entre janeiro de 2010 e dezembro de 2016. Os pacientes foram divididos em dois grupos de acordo com a idade materna: mulheres ≤ 35 e > 35 anos de idade. Os efeitos das causas de infertilidade nos resultados laboratoriais e clínicos da ICSI foram avaliados pelos testes T de Student e Qui-quadrado. Resultados: Não foram observadas diferenças nos parâmetros de estimulação ovariana entre os ciclos com fatores masculinos e com fatores tubários. A taxa de implantação (fator masculino 35,5% vs. fator tubário 32,0%, p=0,340), de gravidez (fator masculino 46,9% vs. fator tubário 40,9%, p=0,184) e de aborto (fator masculino 10,3% vs. fator tubário 10,6%, p=0.572) foram semelhantes entre os grupos de infertilidade, independentemente da idade feminina. Considerando a idade materna, a taxa de cancelamento foi maior em mulheres > 35 anos cuja causa de infertilidade era o fator masculino (17,4% vs. 8,9%, p=0,013). Conclusão: Não há diferenças nos resultados de gravidez entre casais com infertilidade dos fatores masculino ou tubário isolados, o que indica que ICSI supera os piores resultados associados ao fator masculino.

Comparison of the epidemiologic features and patterns of initial care for prostate cancer between public and private institutions: a survey by the Brazilian Society of Urology

OBJECTIVE: To describe the epidemiological features and patterns of initial care for prostate cancer at public and private institutions in the State of Sao Paulo, Brazil. MATERIALS AND METHODS: A total of 1,082 physicians affiliated to the Sao Paulo Section of the Brazilian Society of Urology were invited to participate in this cross-sectional, web-based survey. Between September 2004 and September 2005, participating urologists entered data on demographic, clinical and pathological characteristics of patients diagnosed with prostate cancer in their practice. Data on patients attended at public institutions were analyzed and compared with those patients attended at private practice. RESULTS: One hundred and ten society members contributed with data from 1915 patients, 1026 (53.6%) of whom from public institutions. When compared with patients attended at private institutions, those attended at public institutions were older and more likely to be black, had higher serum prostate specific antigen (PSA) levels, had a higher probability of being diagnosed with metastatic disease, but were less likely to undergo prostatectomy (all P < 0.001). In multivariate analysis, age, biopsy Gleason score, and being attended at a public institution were independently associated with metastatic disease upon diagnosis. The significant predictors of nonsurgical treatment were age, black race, and higher serum levels of PSA. CONCLUSIONS: A statewide registry provides valuable information regarding patient demographics, clinical features, and patterns of care. The results of this study suggest that significant disparities exist for patients with prostate cancer attended at different health-care systems. The relative contribution of biological versus socioeconomic features remains uncertain.

Age-related testosterone decline in a Brazilian cohort of healthy military men

INTRODUCTION: Androgen decline in the aging man has become a topic of increasing clinical relevance worldwide, as the reduction in testosterone levels has been reported to be accompanied by loss of muscle mass, accumulation of central adiposity, impaired mobility and increase risk of bone fractures. Although well-established in studies conducted in developed countries, progressive decline in serum testosterone levels with age has been poorly investigated in Brazil. AIM: To determine the pattern of blood testosterone concentrations decline with age in a cohort of Brazilian healthy military men. MATERIALS AND METHODS: We retrospectively reviewed data on serum testosterone measurements of healthy individuals that had undergone a routine check-up at the Military Biology Institute. Blood samples were obtained early in the morning, and total testosterone concentration was determined using a commercial chemoluminescent immunoassay. Mean values were analyzed in five age groups: < 40, 41 to 50, 51 to 60, 61 to 70, and > 70 years. MAIN OUTCOME MEASURE: Mean total testosterone levels. RESULTS: 1,623 subjects were included in the analysis; mean age was 57 years (24 to 87), and mean testosterone level was 575.5 ng/dL (25.0 to 1308.0 ng/dL). The evaluation of age-related changes in total testosterone levels revealed a progressive reduction in serum levels of this hormone with increasing age. Testosterone levels below 300 ng/dL were reported in 321 participants, a prevalence of nearly 20 percent in the study population. CONCLUSION: In agreement with other findings, a reduction of total testosterone levels with age was reported for healthy Brazilian men.

Epidemiologic characteristics of renal cell carcinoma in Brazil

PURPOSE: In Brazil, National data regarding the epidemiology of renal cell carcinoma (RCC) are scarce. The aim of this study was to describe the demographic, clinical, and pathologic characteristics of RCC diagnosed and treated by members of the SBU - Brazilian Society of Urology. MATERIALS AND METHODS: For this cross-sectional study, data were collected through an on line questionnaire available to the members of the Brazilian Society of Urology (SBU). Between May 2007 and May 2008, voluntary participant urologists collected data on demographic, clinical and pathological characteristics from patients diagnosed with RCC in their practice. RESULTS: Fifty SBU affiliated institutions contributed with patient information to the study. Of the 508 patients, 58.9 percent were male, 78.9 percent were white, and the mean age was 59.8 years. Smoking history, high blood pressure and a body mass index above 30 kg/m2 were present in 14.8 percent, 46.1 percent and 17.9 percent of the patients, respectively. Abdominal ultrasound and computed tomography were the main diagnostic methods. The majority of the cases were localized tumors and metastasis were presented in 9.5 percent of the patients; 98.4 percent underwent nephrectomy. Clear cell carcinoma was the most common histological type. In comparison with private institutions, stage IV disease was less frequent among patients treated at public health services (P = 0.033). CONCLUSIONS: RCC in Brazil is more common in white men in their sixth decade of life. Ultrasound is the main diagnostic tool for the diagnosis of clear cell carcinoma and we found that localized disease was predominant. A national registry of RCC is feasible and may provide valuable information.

Epidemiologic study on penile cancer in Brazil

OBJECTIVES: To assess epidemiologic characteristics of penile cancer in Brazil. MATERIALS AND METHODS: From May 2006 to June 2007, a questionnaire was distributed to all Brazilian urologists. Their patients' clinical and epidemiological data was analyzed (age, race, place of residence, history of sexually transmitted diseases, tobacco smoking, performance of circumcision, type of hospital service), as well as the time between the appearance of the symptoms and the diagnosis, the pathological characteristics of the tumor (histological type, degree, localization and size of lesion, stage of disease), the type of treatment performed and the present state of the patient. RESULTS: 283 new cases of penile cancer in Brazil were recorded. The majority of these cases occurred in the north and northeast (53.02 percent) and southeast (45.54 percent) regions. The majority of patients (224, or 78.96 percent) were more than 46 years of age while only 21 patients (7.41 percent) were less than 35 years of age. Of the 283 patients presenting penile cancer, 171 (60.42 percent) had phimosis with the consequent impossibility to expose the glans. A prior medical history positive for HPV infection was reported in 18 of the 283 cases (6.36 percent). In 101 patients (35.68 percent) tobacco smoking was reported. The vast majority of the cases (n = 207; 73.14 percent) presented with tumors localized in the glans and prepuce. In 48 cases (16.96 percent) the tumor affected the glans, the prepuce and the corpus penis; in 28 cases (9.89 percent) the tumor affected the entire penis. The majority of the patients (n = 123; 75.26 percent) presented with T1 or T2; only 9 patients (3.18 percent) presented with T4 disease. CONCLUSION: Penile cancer is a very frequent pathology in Brazil, predominantly affecting low income, white, uncircumcised patients, living in the north and northeast regions of the country.

Disfunção erétil na terceira idade / Erectile dysfunction in the elderly

A sexualidade do homem idoso tem sido estudada cientificamente desde o final dos anos 40, quando Alfred Kinsey demonstrou um declínio sexual - redução na freqüência de coito, diminuição da capacidade eretiva e orgásmica, diminuição da freqüência das ereções matinais, redução da libido - com o avançar da idade do homem.(au)

Effects of high-energy shock wave on organs adjacent to the kidney in the growing rat

OBJECTIVE: To assess the effects of high-energy shock waves (HESW) on organs adjacent to the kidney, in the growing rat. MATERIALS AND METHODS: We studied 60 Wistar male rats. Upon completing 30 days of age, a radiopaque marker was placed in the animals' left renal cavity. With 40 days of age, after radiologically confirming the markers' position, the rats were divided into 2 groups: control-group - 30 rats that did not receive shock waves; experimental group- 30 rats exposed to 1000 shock waves of 17.2 KV in intensity. The rats were sacrificed 7, 90 and 180 days after exposure to HESW. The bodily growth was assessed and the analysis of macro- and microscopic morphology of liver, spleen, pancreas, lungs and adrenals. RESULTS: There was no statistical difference in the animals' bodily growth. The microscopic morphologic analysis demonstrated significant alterations in spleen (proliferative changes in the red pulp) and liver (cloudy swelling) of the animals submitted to HESW and sacrificed on the seventh day. These changes completely disappeared in subsequent analyses. CONCLUSION: HESW applied to rat did not inhibit the animals' growth and caused transitory histological lesion in spleen (proliferative changes in the red pulp) and in liver (cloudy swelling of hepatocytes). Such changes were observed only in the group that was exposed to HESW and was sacrificed 7 days following the experiment, presenting spontaneous recovery.