Mortalidade materna: perfil clínico e epidemiológico de uma maternidade pública do Amazonas / Maternal mortality: clinical and epidemiological profile of a public maternity hospital in Amazonas

Objetivo: Avaliar o perfil clínico e epidemiológico das mortes maternas ocorridas em uma maternidade pública de Manaus no período de janeiro de 2016 a dezembro de 2019. Métodos: Trata-se de um estudo do tipo descritivo e retrospectivo realizado a partir de dados contidos em prontuários médicos do Serviço de Arquivo Médico e Estatística (SAME) da Maternidade Ana Braga na cidade de Manaus-AM. A amostra foi constituída por pacientes admitidas na Maternidade Ana Braga e que evoluíram com óbito no ciclo gravídico puerperal, que consiste em grávidas, em trabalho de parto, que deram à luz ou que abortaram dentro de um período de até 42 dias. Resultados: Foram avaliados 29 prontuários de pacientes que foram a óbito no ciclo gravídico puerperal. Essas mulheres tinham entre 14 e 42 anos de idade. Quanto à escolaridade, 56,3% delas tinham ensino médio. Quanto à etnia, as mulheres negras e pardas representaram a maioria, as solteiras, o maior percentual. No óbito materno, observou-se que 10 mulheres realizaram menos de seis consultas pré-natal, a principal via de parto foi a cesariana e o choque séptico foi o mais prevalente como causa de morte. Conclusão: Esse resultado sugere a necessidade de avaliação do acesso oportuno das gestantes à assistência pré-natal, ao parto e ao puerpério adequada, além de melhorias na promoção de políticas públicas que busquem a redução da mortalidade materna.(AU)

Objective: To evaluate the clinical and epidemiological profile of maternal deaths that occurred in a public maternity hospital in Manaus from January 2016 to December 2019. Methods: This is a descriptive and retrospective study carried out based on data contained in medical records doctors from the Medical Archive and Statistics Service (SAME) of the Ana Braga Maternity Hospital in the city of Manaus-AM. The sample consisted of patients admitted to the Ana Braga Maternity Hospital and who died in the pregnancy-puerperal cycle, which consists of pregnant women, in labor, who gave birth or who aborted within a period of up to 42 days. Results: Were evaluated 29 records of patients who died in the pregnancy-puerperal cycle, these women were between 14 and 42 years old, and 56.3% had high school education. As for ethnicity, black and brown women represented the majority, single women the highest percentage. In maternal death, it was observed that 10 women had less than six prenatal consultations, the main mode of delivery was cesarean section and septic shock was the most prevalent cause of death. Conclusion: This result suggests the need to assess the timely access of pregnant women to adequate prenatal care, childbirth and postpartum care, in addition to improvements in the promotion of public policies that seek to reduce maternal mortality.(AU)

A fatal and metabolic experimental hemorrhagic shock in immature swine

Abstract Purpose: To use blood lactate (BL) as an end-point metabolic marker for the begin resuscitation of volume replacement in experimental hemorrhagic shock. Methods: Group I (n=7) was not bled (Control). Animals in Group II (n=7) were bled to a MAP of 30mmHg in thirty minutes. Hemodynamic and metabolic data were recorded at Baseline, at 30, 60 and 120 minutes after Baseline. The animals were intubated in spontaneous breathing (FIO2=0.21) with halothane. Results: Group I all survived. In Group II all died; no mortality occurred before a BL<10mM/L. Beyond the end-point all animals exhibited severe acidemia, hyperventilation and clinical signs of shock. Without treatment all animals died within 70.43±24.51 min of hypotension shortly after reaching an average level of BL 17.01±3.20mM/L. Conclusions: Swine's breathing room air spontaneously in hemorrhagic shock not treated a blood lactate over 10mM/L results fatal. The predictable outcome of this shock model is expected to produce consistent information based on possible different metabolic and hemodynamic patterns as far as the type of fluid and the timing of resuscitation in near fatal hemorrhagic shock.

Retrospective forensic analysis of 483 solved homicide cases in Suzhou city / 法医学杂志

OBJECTIVE@#To summarize the solved homicide cases taking place in Suzhou city and to find out the characteristics and commonness of them in order to analyze the key points of investigation at the scene.@*METHODS@#The data of 483 solved homicide cases occurring from January 2006 to March 2010 in the city were analyzed.@*RESULTS@#Most cases involved 1 victim and 1 suspect, with young male adults dominated. Most of them were non-local residents. The majority of suspects were intentional by passion due to quarrel and dispute. The most common weapons were sharp instruments generally carried by the suspects. Mechanical asphyxia and mechanical injury were the two most common causes of death in these cases.@*CONCLUSION@#The social characteristics of suspects, criminal motivation, injury instruments, distribution of injuries, cause of death, and manner of death in Suzhou showed similar general characteristics as the experience for detecting homicide cases in the future.

Extensive soft tissue injuries as a cause of death.

The blunt trauma injury is the most common type, a pathologist encounter when doing medico-legal autopsies. Sometimes, while searching the main cavities of the body for the fatal injuries like lacerations and damages to the vital organs, we, the Forensic Pathologist commonly ignores the superficial small abrasions, bruises over the other parts of the body. Cutaneous injuries i.e. abrasions, contusions in most cases, are not fatal and are seemingly unimportant. However, soft tissue injuries not always are simple as mostly described in the literature but sometimes these injuries may be so extensive internally that leads to irreversible shock. In fact, these injuries prove fatal when taken collectively into consideration. Sometimes trivial circumstances lead to serious quarrel, resulting into death of the victim which apparently looking uninjured externally while conducting autopsy. Under such circumstances sometimes at primary health care centres the inexperienced autopsy surgeons are not in a position to correlate the superficial looking soft tissue injuries attributing towards death.

Hyperkalemia accompanies hemorrhagic shock and correlates with mortality

OBJECTIVE: This study was designed to evaluate the effects of terlipressin versus fluid resuscitation with normal saline, hypertonic saline or hypertonic-hyperoncotic hydroxyethyl starch, on hemodynamics, metabolics, blood loss and short-term survival in hemorrhagic shock. METHOD: Twenty-nine pigs were subjected to severe liver injury and treated 30 min later with either: (1) 2 mg terlipressin in a bolus, (2) placebo-treated controls, (3) 4 mL/kg 7.5% hypertonic NaCl, (4) 4 mL/kg 7.2% hypertonic-hyperoncotic hydroxyethyl starch 200/0.5, or (5) normal saline at three times lost blood volume. RESULTS: The overall mortality rate was 69%. Blood loss was significantly higher in the hypertonic-hyperoncotic hydroxyethyl starch and normal saline groups than in the terlipressin, hypertonic NaCl and placebo-treated controls groups (p<0.005). Hyperkalemia (K>5 mmol/L) before any treatment occurred in 66% of the patients (80% among non-survivors vs. 22% among survivors, p=0.019). Post-resuscitation hyperkalemia occurred in 86.66% of non-survivors vs. 0% of survivors (p<0.001). Hyperkalemia was the first sign of an unsuccessful outcome for the usual resuscitative procedure and was not related to arterial acidemia. Successfully resuscitated animals showed a significant decrease in serum potassium levels relative to the baseline value. CONCLUSION: Hyperkalemia accompanies hemorrhagic shock and, in addition to providing an early sign of the acute ischemic insult severity, may be responsible for cardiac arrest related to hemorrhagic shock.

Responsiveness to different volume therapies following hemodilution and hemorrhagic shock: a comparative experimental study in rats

Guidelines for volume replacement for acutely hemorrhaged and hemodiluted trauma patients have not been well established. Purpose: To evaluate the effects of acute hemodilution on mean arterial pressure (MAP), and responsiveness of acutely hemodiluted and subsequently hemorrhaged rats to different volume therapies. Methods: 180 rats were hemodiluted to simulate hemorrhaged trauma patients with persistent bleeding after high volume replacement with isotonic solutions. Thirty hemodiluted [Anemia (ANE) group] animals received no further treatment. The remaining 150 animals were subjected to hypovolemic shock and randomized into five groups, according to the treatment option employed: Control (CTL) animals did not receive subsequent treatment after hemorrhagic hypovolemia, SAL4 animals received isotonic saline 4 mL/kg, SAL32 animals received isotonic saline 32 mL/kg, HS animals received hypertonic saline 4 mL/kg and BLD animals received re-infusion of drawn blood. Results: Highest mean arterial pressure (MAP) was achieved by BLD, followed by SAL32 and HS. MAP after treatment of BLD, HS, SAL32 and ANE were higher than CTL (p=0.036). At 85 and 95 minutes of experiment, SAL4, SAL32 and HS presented the lowest hematocrit levels (p<0.01). At day 3, ANE, CTL and HS had the highest hematocrit. SAL4 and CTL groups presented the highest mortality rates. Conclusion: Hypertonic saline is an effective and safe initial therapy for hemodiluted rats undergoing hemorrhagic shock, with an overall outcome comparable to blood replacement or high volume isotonic saline administration.

A conduta para reposição volêmica em pacientes traumatizados, hemodiluídos não está bem estabelecida. Objetivo: Avaliar o efeito da hemodiluição sobre a pressão arterial média (PAM), bem como a resposta de ratos agudamente hemodiluídos e submetidos a choque hemorrágico, à reanimação com diferentes soluções. Métodos: 180 ratos foram hemodiluídos, simulando pacientes traumatizados com sangramento persistente após reposição com soluções isotônicas. Trinta ratos hemodiluídos (grupo ANE) foram observados, sem tratamento. Os demais 150 foram submetidos a choque hipovolêmico e randomizados em 5 grupos segundo a opção terapêutica: CTL (controle), sem tratamento subseqüente após hipovolemia hemorrágica; SAL4 que recebeu 4 mL/kg de salina isotônica; SAL32 que recebeu 32 mL/kg de salina isotônica ; SH que recebeu 4mL/kg de salina hipertônica; e BLD que recebeu reinfusão do sangue removido. Resultados: A pressão arterial média (PAM) mais alta ocorreu no grupo BLD, seguida pelo SAL32, e SH. A PAM após tratamento nos grupos BLD, SH, SAL32 e ANE foram maiores que no CTL (-=0.036). Aos 85 e 95 minutos do experimento, SAL4, SAL32, e SH apresentaram os menores hematócritos (p<0.01). No 3° dia, ANE, CTL e SH apresentaram os maiores hematócritos. SAL4 e CTL apresentaram as maiores taxas de mortalidade. Em conclusão, nossos resultados indicam que a SH é uma terapia inicial efetiva e segura em ratos hemodiluídos, submetidos a hemorrágico choque, com prognóstico comparável à reposição com sangue ou administração de grande volume de solução isotônica.

Controvérsias no manejo do aneurisma de aorta abdominal roto / Controversies in the handling aortic aneurysm abdominal

Os autores fazem uma revisão bibliográfica sobre o manejo do aneurisma de aorta abdominal roto (AAAr). Seu diagnóstico e pontos referentes a atendimento em emergência, estabilização do paciente, técnicas e táticas cirúrgicas, alternativas de tratamento, pós-operatório e preditores de morbi-mortalidade são abordados

Effect of Induced and Spontaneous Hypothermia on Survival Time of Uncontrolled Hemorrhagic Shock Rat Model

We examined the hypothesis that mild hypothermia (rectal temperature 34 degrees C) results in the same survival time, whether induced spontaneously or intentionally, during untreated, lethal, uncontrolled hemorrhagic shock in rats. Sixty-four Sprague-Dawley male rats were randomly assigned to normothermia (Nth) (n=19), spontaneous mild hypothermia (Sp.Hth) (n=25) or controlled mild hypothermia (Con.Hth) (n=20) groups. After blood withdrawal of 3 mL/100 g over 15 minutes, followed by 75% tail amputation under spontaneous breathing and light anesthesia by i.p. injection of pentobarbital sodium, rats were observed without fluid resuscitation or hemostasis for 180 minutes or until death. The initial temperature of the Nth group was artificially maintained throughout the experiment. For the mild hypothermia groups, the Sp.Hth group was exposed to ambient temperature while the Con. Hth group was actively cooled to a target rectal temperature of 34 degrees C. In the Con.Hth group, all rats except one died before 180 minutes. All rats in the Nth group died within 38 minutes, and within 67 minutes in the Sp.Hth group. The average survival time was shortest in the Nth group at 20.3 +/- 5.3 minutes, followed by the Sp.Hth group at 30.1 +/- 13.5 minutes, and the Con.Hth group at 81.9 +/- 39.8 minutes (p 0.01). Tail bleed out volume was 0.51 +/- 0.19, 0.26 +/- 0.15 and 0.19 +/- 0.12 mL/100 g in the Nth, Sp.Hth and Con.Hth groups, respectively (p 0.05). In conclusion, spontaneous mild hypothermia did not prolong the survival time as much as controlled mild hypothermia in the rat model for untreated, lethal, uncontrolled hemorrhagic shock.

Lesäo péptica hemorrágica : avaliaçäo de resultados com aplicaçäo de um score / Peptic hemorrhage lesion: evaluation of results with application score

O presente trabalho consiste de estudo retrospectivo na avaliaçäo de resultados com aplicaçäo de um score, utilizado na clínica cirúrgica do HUSF, nas lesöes pépticas hemorrágicas. O score desenvolvido e publicado por Pimpl et al. Auxilia no prognóstico, índice de mortalidade e na comparaçäo dos pacientes e resultados, cotejando com doentes e resultados obtidos em outros serviços - facilitando estudos multicêntricos. A esclerose endoscópica deve ser enfatizada como método hemostático provisório nas lesöes pépticas hemorrágicas, para obtençäo de melhores resultados