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PURPOSE: Our objective was to evaluate the syndesmotic and fracture instability using conventional ankle computed tomography (CT) with stress maneuvers. METHODS: A consecutive sample of 123 individuals with an ankle sprain was assessed for eligibility. In total, 33 patients met the inclusion criteria. All patients underwent a magnetic resonance imaging (MRI) and CT scan with stress maneuvers (CTSM). The patterns of ligament tears f were classified using West Point grades I, IIA, IIB, III. Mann-Whitney test was used to test the differences in the numerical variables between injured and uninjured syndesmoses. The Spearman correlation tested the strength of the association between the tibial joint surface involved in posterior malleolus fracture and syndesmotic instability. RESULTS: In MRI, two patterns of syndesmotic ligament injury predominated. A completely torn anterior inferior tibiofibular (AITFL) and interosseous tibiofibular ligaments (ITFL) and a completely torn AITFL were combined with a partially torn ITFL. In the neutral phase CTSM and during the stress phase the median difference of the narrowest tibiofibular distance between injured and uninjured syndesmoses was 0.2 mm (P = 0.057) and 2.3 mm (P < 0.0001), respectively. There was no association between the percentage of involvement of the posterior tibial joint surface in the posterior malleolar fracture and syndesmotic instability as measured with CTSM. CONCLUSION: The conventional computed tomography with external rotation and dorsiflexion represents a reproducible and accurate diagnostic option for detecting syndesmosis instability and fracture instability in acute isolated non-displaced posterior malleolar fractures Bartonícek and Rammelt type II. LEVEL OF EVIDENCE: Prospective study among consecutive patients (Diagnosis); Level of evidence, 2.
Assuntos
Fraturas do Tornozelo , Instabilidade Articular , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Humanos , Masculino , Feminino , Adulto , Estudos Prospectivos , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/etiologia , Instabilidade Articular/fisiopatologia , Pessoa de Meia-Idade , Imageamento por Ressonância Magnética/métodos , Rotação , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/fisiopatologia , Ligamentos Articulares/diagnóstico por imagem , Ligamentos Articulares/lesões , Adulto Jovem , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/fisiopatologia , Tomada de Decisão Clínica/métodosRESUMO
Background: Recognizing preoperative first-ray hypermobility is important to planning hallux valgus (HV) surgery. A recent study showed the minimally invasive chevron Akin (MICA) osteotomy increased varus displacement of the proximal fragment of the first metatarsal osteotomy. The present study aims to evaluate the ability of the radiographic first-ray squeeze test to predict the varus displacement of the proximal fragment of the first metatarsal osteotomy when performing the MICA procedure. Methods: A prospective case series of patients with moderate to severe HV who underwent MICA was performed. The HV deformity correction was analyzed by comparing the preoperative and 12-week postoperative hallux valgus angle (HVA) and the intermetatarsal angle between the first and second rays (1-2 IMA). The ability of the radiographic first-ray squeeze test to predict the varus displacement of the first metatarsal was done by comparing the preoperative 1-2 IMA measured in the AP radiographic first-ray squeeze test (IMA-ST) with the intermetatarsal angle between the second metatarsal and the axis of the first metatarsal osteotomy proximal fragment (IAPF) taken 12 weeks postoperatively. Results: Between July 2022 and May 2023, a total of 39 feet in 28 patients underwent MICA. The mean IMA improved from 13.8 (SD = 2.2) to 3.8 degrees (SD = 1.5) (P < .001), and the mean HVA improved from 27.8 (SD = 6.1) to 4.9 degrees (SD = 2.5) (P < .001). A linear regression analysis revealed that IMA-ST is highly associated with the 12 week assessed IAPF (P < .001). Conclusion: The preoperative radiographic first-ray squeeze test appears to predict with high fidelity the varus displacement of the proximal fragment of the first metatarsal that can occur after the MICA procedure.Level of Evidence: Level III, prospective cohort study.
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UNLABELLED: University students aged 17 to 24 years of age are prone to many risk factors. OBJECTIVES: Identify risk factors related to exploring sexuality and characteristics of consumption of psychoactive substances in students attending medical school. METHODS: 465 Medical students from Santa Casa of São Paulo Faculty of Medical Sciences (FCMSCSP) were prospectively and transversely evaluated during 2005. An anonymous, semi-structured, self-filling questionnaire was used. The average age of the students was 21.5 years, 43% females. 76.2% preferred alcohol, and 11.1% tobacco consumption; chloroethane (lança-perfume) consumption occurred in 22.6% and 15.3% consumption of other types of illicit drugs, with marijuana as the most used one (94%). 70.3%, of the parents drink alcohol and 30.5% smoke tobacco. As for the students' sexuality, 85.3% have already had sexual intercourses, starting at average age of 17. 88.8% used condom during the first sexual intercourse, however, 35.6% did not use it regularly; 5.4% had already had some type of DST. 79.8% of the females preferred having used contraceptive methods; however, 28.1% had a suspicion of pregnancy, which was confirmed in 7.9% of the cases. 9.9% of the students had ideas of abortion, 12.5% have effectively attempted it. 85% found medical school stressing and to relieve tension, 33.8% practiced sports; 6.9% preferred either licit or illicit drug consumption, and 5% used tranquilizers. The results showed risk behaviors: unsafe sex and the use of licit and illicit drugs indicated the need to establish guidance programs on reproductive health, improving self-esteem, and prevention during medical education.
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Comportamento Sexual/psicologia , Comportamento Sexual/estatística & dados numéricos , Estudantes de Medicina/psicologia , Estudantes de Medicina/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Brasil , Preservativos/estatística & dados numéricos , Cloreto de Etil/administração & dosagem , Características da Família , Feminino , Humanos , Masculino , Gravidez não Planejada , Estudos Prospectivos , Infecções Sexualmente Transmissíveis/epidemiologia , Fumar/epidemiologia , Adulto JovemRESUMO
PURPOSE: to assess knowledge of pediatric residents attending adolescents, including ethical issues on contraceptive advice. METHODS: A prospective study was conducted involving 75 residents in order to assess their knowledge, along with ethical issues involved, in clinical attendance of adolescents. The SPSS 13 software package was used for data analysis. RESULTS: 100% of interviewees stated that adolescents have the right to privacy during medical appointments. Yet, when asked from what age this privacy should be granted, 62% reported at any age. When questioned on whether an adolescent could be examined alone, without another person with them in the room, 50% of physicians answered yes and 50% no. 91.7% of interviewees felt that adolescents had the right to confidentiality and medical secrecy, but only 84.8% knew the contents of the Code of Medical Ethics regarding medical secrecy. A further 79.2% felt prepared to give advice on contraception to adolescents. CONCLUSIONS: The attitudes held by pediatric residents on privacy, confidentiality and medical secrecy are highly ambiguous. The doctors interviewed were ill-prepared to deal with the issues of contraception in adolescence on both practical and legal levels.
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Atitude do Pessoal de Saúde , Confidencialidade/ética , Anticoncepção , Ética Clínica , Relações Médico-Paciente/ética , Médicos/ética , Adolescente , Comportamento do Adolescente , Adulto , Análise de Variância , Brasil , Confidencialidade/legislação & jurisprudência , Anticoncepção/estatística & dados numéricos , Feminino , Hospitais Universitários , Humanos , Internato e Residência , Entrevistas como Assunto , Masculino , Médicos/psicologia , Privacidade , Estudos ProspectivosRESUMO
The purpose of this study was to evaluate the impact of the integral attention to the health of pregnant adolescents and adolescent mothers, having follow-up from the Integral Support Program for the Pregnant Teen (ISPPT), with the intention to determine quality of life and prevent repeat pregnancy. A prospective study comprised 85 adolescents attended by the ISPPT between January 2002 and June 2006 who participated in meetings during pregnancy with a multidisciplinary team that provided orientation concerning family planning, self-esteem, pregnancy prevention, motivation to continue education and/or work, and evaluate the postpartum mother-child relationship. The following were analyzed: education level, marital status, contraceptive use, thoughts and attempts at abortion, repeat pregnancy. This study was approved by the Human Research Ethics Committee. The Epi-Info v6.0b software was used for data and result evaluation using the means and the chi-squared test. The mean age of the adolescents was 15.7 years, 3.52% had repeat pregnancy within a mean follow-up of 23 months after childbirth, the mean education level was 8.1 years, 30.5% dropped out of school, with 79.4% occurring before pregnancy, 64.6% used no contraceptives, 68.3% were single, and 81.3% had a positive role model. One year after birth, 67.5% studied, 50% worked, 55.1% lived with the partner, 77% correctly used contraceptives, every child lived with their mothers and their vaccinations were up to date. The results demonstrate that the global attention given to the health of adolescent mothers and pregnant adolescents is a protective factor for pregnancy relapse and quality of life.
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Serviços de Saúde do Adolescente/estatística & dados numéricos , Aconselhamento/estatística & dados numéricos , Prestação Integrada de Cuidados de Saúde/métodos , Mães/estatística & dados numéricos , Gravidez na Adolescência/prevenção & controle , Gravidez na Adolescência/estatística & dados numéricos , Gravidez/estatística & dados numéricos , Adolescente , Feminino , Promoção da Saúde/estatística & dados numéricos , Humanos , Kentucky/epidemiologia , Avaliação de Programas e Projetos de SaúdeRESUMO
UNLABELLED: Pregnancy during adolescence represents a challenge to society as a whole. Its incidence is increasing and brings about social and medical consequences to both the teen mothers and their children. The purpose of this study was to evaluate pregnant teenager involvement in sexual activity and the social context. The group studied comprised 152 pregnant teenagers attending the Department of Pediatrics, Santa Casa de Sao Paulo (SCSP) General Hospital. All information was analyzed. The age at first intercourse was 14.2 years and the average period between first intercourse and pregnancy was 1.4 years. Most pregnancies (75%) were neither planned nor wanted, however, most teen mothers (64.3%) did not use any contraceptive method. Of the pregnant teenagers, 68.1% came from unstructured families where in 71% of the teen pregnancy cases, there was a role model (mother, sister, or cousin who already experienced teen pregnancy). The average number of school years attended by the analyzed pregnant teenagers was 8.1 years, however, there was a high dropout rate of 40.1%. The age at first intercourse was low and concurs with the high incidence of unstructured families. The average number of school years attended was high, which would theoretically reflect a greater knowledge with regard to human reproduction, pointing to the multicausality of teen pregnancy and the role played by the family. CONCLUSIONS: We confirmed that teen pregnancy presents multicausal etiology; sexual initiation of pregnant teenagers was quite early with high dropout rates, which indicated that prevention methodology should be based on early detection of risk factors for elaboration of appropriate prevention proposals.