Predictors of Hospital Mortality and the Related Burden of Disease in Severe Traumatic Brain Injury: A Prospective Multicentric Study in Brazil.

Traumatic brain injury (TBI) is a worldwide social, economic, and health problem related to premature death and long-term disabilities. There were no prospective and multicentric studies analyzing the predictors of TBI related mortality and estimating the burden of TBI in Brazil. To address this gap, we investigated prospectively: (1) the hospital mortality and its determinants in patients admitted with severe TBI we analyzed in three reference centers; (2) the burden of TBI estimated by the years of life lost (YLLs) due to premature death based on the hospital mortality considering the hospital mortality. Between April 2014 and January 2016 (22 months), all the 266 patients admitted with Glasgow coma scale (GCS), ≤ 8 admitted in three TBI reference centers were included in the study. These centers cover a population of 1,527,378 population of the Santa Catarina state, Southern Brazil. Most patients were male (n = 230, 86.5%), with a mean (SD) age of 38 (17) years. Hospital mortality was 31.1% (n = 83) and independently associated with older age, worse cranial CT injury by the Marshall classification, the presence of subarachnoid hemorrhage in the CT, lower GCS scores and abnormal pupils at admission. The final multiple logistic regression model including these variables showed an overall accuracy for hospital mortality of 77.9% (specificity 88.6%, sensitivity 53.8%, PPV 67.7%, and NPV 81.1%). The estimated annual incidence of hospitalizations and mortality due to severe TBI were 9.5 cases and 5.43 per 100,000 inhabitants, respectively. The estimated YLLs in 22 months, in the 2 metropolitan areas were 2,841, corresponding to 1,550 YLLs per year and 101.5 YLLs per 100,000 people every year. The hospital mortality did not change significantly since the end of the 1990s and was similar to other centers in Brazil and Latin America. Significant predictors of hospital mortality were the same as those of studies worldwide, but their strength of association seemed to differ according to countries income. Present study results question the extrapolation of TBI hospital mortality models for high income to lower- and middle-income countries and therefore have implications for TBI multicentric trials including countries with different income levels.

Effects of Ghrelin on the Oxidative Stress and Healing of the Colonic Anastomosis in Rats.

BACKGROUND: Anastomotic leakage is the deadliest complication of colonic procedures. Ghrelin is an orexigenic hormone with potent actions on growth hormone release and functions in the processes of growth, tissue inflammation, repair, and oxidative stress. We evaluated the hypothesis that the exogenous administration of ghrelin causes beneficial effects on the healing of colonic anastomosis. MATERIALS AND METHODS: Sixty-four male Wistar rats were randomly assigned to eight subgroups receiving postoperative intraperitoneal administration of ghrelin (23 µg/kg/d) or saline after a colonic anastomosis. The anastomotic tissue was evaluated on the third, seventh, and 14th postoperative days. Anastomotic bursting pressure, histological parameters, hydroxyproline content, and tissue oxidative stress markers were compared. RESULTS: There was a significant increase in the mean anastomotic bursting pressure in the ghrelin subgroup on the seventh postoperative day (P = 0.035). Histological evaluation demonstrated a significant difference in the neutrophilic infiltrate (P = 0.035) on the third and 14th d and in apoptosis (P = 0.004), granulation tissue (P = 0.011) and peritoneal inflammation (P = 0.014) on the 14th postoperative day. There was a statistically significant increase in the hydroxyproline content in the ghrelin subgroup on the 14th postoperative day (P = 0.043). There were significant differences in the nitrite tissue levels (P = 0.021) on day 3 and in reactive oxygen species (P = 0.012) on day 14. CONCLUSIONS: The administration of ghrelin had beneficial anti-inflammatory and antioxidant effects, increasing the resistance of the anastomosis and the hydroxyproline tissue content in the postoperative period.

An investigation into the relationship between anti-Helicobacter pylori and anti-Saccharomyces cerevisiae antibodies in patients with axial spondyloarthritis and Crohn disease.

Spondyloarthritis (SpA) is a musculoskeletal inflammatory disease linked with immune responses to intestinal microbiota, and subclinical intestinal ulcerations that are closely related to inflammatory bowel diseases. Helicobacter pylori is a common cause of gastroduodenal ulceration, and anti-Saccharomyces cerevisiae antibodies (ASCA) are associated with intestinal inflammation in both Crohn disease (CD) and SpA. We investigated the relationship between H. pylori and ASCA. Ninety-one patients with axial SpA and forty with CD were included. ASCA IgG/IgA and anti-H. pylori IgG titers were assessed by ELISA. The proportion of ASCA+ patients in the positive and negative anti-H. pylori IgG groups with SpA and CD were compared using Chi-square tests, and correlations were evaluated using the Spearman's coefficient. Anti-H. pylori IgG titers were significantly negatively correlated with the ASCA IgG (r = -0.563, p < 0.001) and IgA (r = -0.342, p = 0.019) titers in the axial SpA patients. The same pattern of negative correlation was also observed in the CD patients. Anti-H. pylori+ serology was significantly more frequent in axial SpA patients than in those with CD (52.4 vs. 18.4 %, p < 0.001), while ASCA+ serology was significantly more frequent in CD patients than in SpA patients. A negative correlation between the anti-H. pylori titers and ASCA was found for axial SpA and CD. Anti-H. pylori+ serology was more frequent in SpA than in CD, while ASCA positivity was more frequent in CD patients than in those with SpA. A possible influence of H. pylori on the development of ASCA needs further investigation.

Cultural adaptation of the National Institutes of Health--chronic prostatitis symptom index (NIH-CPSI)--to Brazilian spoken Portuguese: NIH-CPSI (Braz).

OBJECTIVES: To create a Brazilian version of the National Institutes of Health - Chronic Prostatitis Symptom Index (NIH-CPSI) using a cross-cultural adaptation process. MATERIALS AND METHODS: The nine items of the NIH-CPSI were translated to Portuguese, by two independent translators, of native Portuguese language origin, and it was obtained a single version, that was retranslated to English by two English native spoken translators, in order to correct any discrepancies. Those versions were compared to the original text, the modifications were applied and it was created a final version in Portuguese. That was pre-tested and applied to 30 patients with pain or perineal or ejaculatory disorder. To each item of the pre-final version it was assigned a score according to the grade of understanding and clarity in order to implement the adequate corrections. The final version in Portuguese was submitted to evaluations including face validation and psychometric proprieties of reproducibility and internal consistency, respectively evaluated by the (p) Pearson correlation coefficient and α Cronbach coefficient. RESULTS: All items applied to 30 patients during pre-test phase had a grade higher than 8 of understanding and clarity, and were considered clearly understandable by the patients. However, at face validation evaluation, there was an inconsistency of item three that was redone. The final produced version, called NIH-CPSI (Braz) showed good reproducibility (p = 0.89-0.99) and internal consistency (α Cronbach coefficient = 0.85-0.93). CONCLUSIONS: NIH-CPSI was adapted to Brazilian spoken Portuguese and its original proprieties were maintained, being a valid instrument for evaluations of symptoms of chronic prostatitis in Brazilian patients.

Cultural Adaptation of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) - to Brazilian Spoken Portuguese: NIH-CPSI (Braz)

Objectives To create a Brazilian version of the National Institutes of Health – Chronic Prostatitis Symptom Index (NIH-CPSI) using a cross-cultural adaptation process. Materials and Methods The nine items of the NIH-CPSI were translated to Portuguese, by two independent translators, of native Portuguese language origin, and it was obtained a single version, that was retranslated to English by two English native spoken translators, in order to correct any discrepancies. Those versions were compared to the original text, the modifications were applied and it was created a final version in Portuguese. That was pre-tested and applied to 30 patients with pain or perineal or ejaculatory disorder. To each item of the pre-final version it was assigned a score according to the grade of understanding and clarity in order to implement the adequate corrections. The final version in Portuguese was submitted to evaluations including face validation and psychometric proprieties of reproducibility and internal consistency, respectively evaluated by the (p) Pearson correlation coefficient and α Cronbach coefficient. Results All items applied to 30 patients during pre-test phase had a grade higher than 8 of understanding and clarity, and were considered clearly understandable by the patients. However, at face validation evaluation, there was an inconsistency of item three that was redone. The final produced version, called NIH-CPSI (Braz) showed good reproducibility (p = 0.89-0.99) and internal consistency (α Cronbach coefficient = 0.85-0.93). Conclusions NIH-CPSI was adapted to Brazilian spoken Portuguese and its original proprieties were maintained, being a valid instrument for evaluations of symptoms of chronic prostatitis in Brazilian patients. .

Prevalência de discromatopsia em estudantes de medicina da Universidade Federal de Santa Catarina / Dyschromatopsia`s prevalence among medicine students of the Federal University Santa Catarina

Objetivo: Avaliar a prevalência de discromatopsia em estudantes de medicina da Universidade Federal de Santa Catarina. Método: Foi realizado um estudo transversal, de cunho epidemiológico, no período de outubro de 2003 a junho de 2004. A amostragem utilizada foi de 604 estudantes, de ambos os sexos, com idades variando entre 17 e 35 anos.Os estudantes foram avaliados através da leitura da edição simplificada e modificada do livro de Ishihara, constituída de oito lâminas pseudo-isocromáticas. Os indivíduos com alteração ao exame eram questionados sobre o conhecimento prévio da deficiência, história familiar, uso de medicamentos e dificuldades nas atividades diárias. Resultados: Encontrou-se uma prevalência de discromatopsia de 2,6% (n = 16) na amostra total e 4,95% entre os estudantes do sexo masculino. No grupo que foi detectada a deficiência, 31,3% (n = 5) referiam alguma dificuldade e 81,2% (n = 13) já tinham o conhecimento prévio da deficiência visual.Conclusão: A prevalência de discromatopsia nos estudantes de medicina foi de 2,6%, sendo encontrada exclusivamente no sexo masculino (4,95%)...

Estudo de 434 casos de corpos estranhos corneais no Hospital Universitário da Universidade Federal de Santa Catarina / Study of 434 cases of corneal foreign body in the University Hospital of the Federal University of Santa Catarina

Introdução: A localização da córnea faz dela um sítio freqüente de traumatismos. Os acidentes oculares apresentam importâncias sociais, psicológicas e econômicas devido à sua grande freqüência. Objetivo: Identificar o perfil dos pacientes, vítimas de corpos estranhos corneais (CEC), atendidos no Serviço de Oftalmologia do Hospital Universitário da Universidade Federal de Santa Catarina (HU/UFSC).Métodos: Estudo retrospectivo dos prontuários de 434 pacientes do HU/ UFSC, que sofreram trauma por corpos estranhos corneais no período de janeiro de 2003 a dezembro de 2004. Foram analisados dados referentes a sexo, idade, faixa etária, olho afetado (OD: olho direito; OE: olho esquerdo; AO: ambos os olhos), quantidade de corpos estranhos (único ou múltiplo), localização do corpo estranho na córnea, dia da semana e mês dos atendimentos, profissão, atividade profissional e procedência desses pacientes. Resultados: Ocorreu predomínio do sexo masculino (93,1%), da faixa etária entre 19 a 35 anos (62%), com idade média de 29,9 anos. A maioria dos casos foi unilateral (95,2%), não havendo predomínio de olho quanto à lateralidade (OD ou OE). Grande parte dos acidentes se deveu a corpo estranho único (90,8%), sendo a localização mais comum a corneal intermediária (32,7%). Não houve uma época do ano em que o risco de trauma tenha sido maior, mas a prevalência foi maior nos dias úteis da semana, revelando associação com o trabalho. Toda a população pode ser acometida, entretanto, algumas profissões como: mecânico, chapeador, serralheiro, pedreiro, comerciante/comerciário apresentam risco maior de trauma por CEC. Quase a metade dos pacientes era oriunda da cidade de Florianópolis (42,6%). Conclusão: Indivíduos jovens do sexo masculino oriundos de Florianópolis são os mais acometidos, sendo a localização mais comum a corneal intermediária. A maioria dos casos se deve a corpo estranho único unilateral, não havendo predomínio de olho quanto à lateralidade. Não há uma...

Acidentes oculares nas atividades esportivas / Ocular accidents in the esportive activities

Objetivo: Analisar 20 casos de pacientes vítimas de acidentes oftalmológicos na atividade esportiva, atendidos no ambulatório do Serviço de Oftalmologia do Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC). Métodos: Avaliou-se, retrospectivamente, o prontuário de 20 pacientes admitidos no Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC), no período de março de 2003 a março de 2004. Resultados: A maioria dos pacientes foi procedente de Florianópolis (65%), seguida da região metropolitana de Florianópolis (25%) e outras localidades (10%). As vítimas do sexo masculino representaram 85% da amostra. A distribuição quanto ao olho atingido foi de 60% para o olho esquerdo e 40% para o olho direito, não havendo nenhum caso de lesão ocular bilateral. O futebol foi a modalidade predominantemente praticada (50%), seguido do voleibol (10%). A bola foi o objeto causadordo trauma em 60% dos casos, o dedo em 15% e o pé em 15%. A faixa etária mais acometida foi a de maiores de 18 anos, representando 65% da amostra. A profissão prevalente foi a de estudante (40%) seguida pela de advogado (10%). A principal complicação encontrada foi o hifema (23,3%), seguida pela irite traumática (16,6%) e hematoma/edema palpebral (13,3%).Conclusão: Apesar de o trauma ocular na atividade esportiva ser prevenível, ainda acontece com freqüência e gera conseqüências importantes...

Estudo de 162 casos de queimaduras oculares atendidos no Hospital Universitário da Universidade Federal de Santa Catarina / Research of 162 cases of taken care ocular burnings at the University Hospital of Federal University of Santa Catarina

Objetivos: Este estudo tem por objetivo descrever os principais tipos de queimaduras oculares, assim como relacioná-los com o sexo, a idade, o agente causador, a lateralidade, a profissão e as complicações oculares associadas, atendidos no ambulatório do Serviço de Oftalmologia do Hospital Universitário da Universidade Federal de Santa Catarina (HU/UFSC).Métodos: Foram estudados 162 pacientes, no período de março de 2003 a setembro de 2004. Foram analisadas as queimaduras oculares nas seguintes categorias: sexo, idade, tipo de queimadura ocular, agente causador, lateralidade, profissão e complicações oculares.Trata-se de um estudo transversal, de caráter descritivo, retrospectivo, não intervencionista. Os critérios de inclusão consistiram somente na análise dos prontuários nos quais continham todas as informações necessárias para o preenchimento dos dados da pesquisa, excluindo-se aqueles prontuários com informações incompletas. Resultados: Houve predominância do sexo masculino (79,6%) sobre o feminino (20,4%). A faixa etária mais acometida foi a de 15 a 35 anos, com 57,4% dos casos. O tipo de queimadura mais freqüente foi a química, com 58% dos casos. Os principais agentes causadores foram aqueles relacionados ao ambiente de trabalho: energia radiante (29,6%) e cal associada a cimento (21%). Quanto à lateralidade, em cerca de 50,6% dos casos, os dois olhos foram afetados. Em relação à ocupação profissional, os pacientes mais comprometidos foram aqueles que trabalhavam na construção civil (33,3%). Entre as complicações oculares encontradas, a erosão corneal foi observada em 72,2% dos casos, seguida pelas conjuntivites traumáticas (41,4%). Conclusão: Indivíduos jovens do sexo masculino foram os mais acometidos, sendo que o principal tipo de queimadura encontrada foi a queimadura química. Na maioria dos casos, os acidentes ocorreram no ambiente de trabalho, relacionados com a construção civil. Os principais agentes causadores foram o cimento...