RESUMO
Introducción: Las lesiones vertebrales por arma de fuego representan el 13-17% de las lesiones vertebrales traumáticas con presentación clínica variable. El objetivo de este estudio fue comparar las características demográficas y clínico-terapéuticas de pacientes que sufrieron lesiones vertebrales por arma de fuego en el contexto de accidentes laborales, según la posibilidad de retorno laboral. materiales y métodos: Estudio analítico, observacional y retrospectivo de pacientes con lesión vertebral por arma de fuego en accidentes de trabajo, entre enero de 2012 y marzo de 2022. Se registraron variables sociodemográficas y relacionadas con el siniestro, la atención inicial, la lesión vertebral, el tratamiento, la evolución y el retorno laboral. Resultados: Se evaluó a 22 pacientes (15 hombres y 7 mujeres; media de la edad 32.5 años). El 54% eran trabajadores de fuerzas de seguridad; no obstante, el 82% de los accidentes se había producido in itinere. El 90% tenía lesiones asociadas. Doce (55%) requirieron cirugía y 10 (45%), tratamiento conservador. El 81% sufrió complicaciones. Doce (54%) regresaron al trabajo, un tercio fue recalificado y 9 requirieron la baja laboral. Se halló una asociación estadística entre pacientes con baja laboral permanente y topografía torácica (p = 0,005), daño neurológico severo (p = 0,004), incidencia transfixiante o penetrante (p = 0,005), requerimiento de tratamiento psiquiátrico crónico (p = 0,012) y más días de incapacidad laboral temporaria (p = 0,001). Conclusión: La baja laboral permanente se asoció con lesiones torácicas, transfixiantes o penetrantes, compromiso neurológico severo y requerimiento de tratamiento psiquiátrico clínico-farmacológico crónico. Nivel de Evidencia: IV
Introduction: Firearm spinal injuries account for 13-17% of all traumatic spinal injuries, with varying clinical manifestations. The goal of this study was to examine the demographic and clinical-therapeutic characteristics of patients who suffered spinal injuries as a consequence of gunshots in the context of workplace incidents, based on how soon they could return to work. materials and methods: An analytic, observational, and retrospective study of patients with spinal injuries caused by firearms in workplace incidents between January 2012 and March 2022 was conducted. Variables associated with the incident, initial assessment, spinal injury, treatment, progression, and return to work were recorded. Results: Twenty-two individuals were evaluated (15 men and 7 women; mean age 32.5 years). 54% were law enforcement officers, yet 82% of the accidents happened on the job. 90% had associated injuries. Twelve (55%) required surgery, while ten (45%) required conservative treatment. 81% had complications. Twelve patients (54%) returned to work, one-third were requalified, and nine needed sick leave. Patients on permanent sick leave had a statistically significant relationship with chest topography (p = 0.005), severe neurological damage (p = 0.004), transfixing or penetrating injuries (p = 0.005), the need for chronic psychiatric treatment (p = 0.012), and more days of temporary incapacity for work (p = 0.001). Conclusion: In our series, permanent sick leave was associated with thoracic, transfixing, or penetrating injuries, severe neurological compromise, and the need for chronic clinical-pharmacological psychiatric treatment. Level of Evidence: IV
Assuntos
Traumatismos da Coluna Vertebral , Ferimentos por Arma de Fogo , Retorno ao TrabalhoRESUMO
Como parte del ciclo biogeoquímico, el fluoruro del suelo puede disolverse e ingresar al agua. La Organización Mundial de la Salud y la Norma Paraguaya NP 24 001 80 establecen una concentración máxima de 1,5 mg.L-1 de fluoruro en agua de consumo, pudiendo producir fluorosis cuando es elevada, tal como se encontró en niños residentes de Loreto. Estudios indican que la exposición al fluoruro concomitante al déficit de calcio puede agravar la pérdida de masa ósea, causando fragilidad y fluorosis esquelética. Además, se demostró mediante bioensayos en ratones que el exceso de fluoruro reduce la concentración de calcio sérico, por lo que el objetivo del estudio descriptivo con componente analítico fue elaborar un mapa de distribución espacial de fluoruro del agua subterránea de Loreto y relacionar con la calcemia en niños. Se determinó la concentración de fluoruro en muestras de veintitrés pozos de agua subterránea y el calcio sérico de dieciocho niños en edad escolar, ambos por método normalizado. Se identificaron dos pozos con concentraciones superiores al máximo permitido y en 61% de los niños el calcio sérico fue inferior al valor de referencia. Se encontró una correlación débil entre las variables (r = 0,212). El estudio proporciona información relevante sobre sitios con elevadas concentraciones de fluoruro lo que representa un riesgo para la salud pues aun con ingesta adecuada de calcio, los niños presentaron hipocalcemia. Sería importante incluir en estudios posteriores factores no abordados en esta investigación para una evaluación más completa del riesgo de la población expuesta(AU)
As part of the biogeochemical cycle, soil fluoride can dissolve and accumulate in groundwater. World Health Organization and the Paraguayan Standard NP 24 001 80 establishes of 1.5 mg.L-1 of fluoride in drinking water, which can produce fluorosis when it is higher, as it has been found in children of Loreto. Studies indicate that exposure to fluoride concomitant with calcium deficit may aggravate bone loss, causing frailty and skeletal fluorosis. In addition, it was demonstrated through bioassays in mice that excess fluoride reduces serum calcium concentration, the objective of the descriptive study with the analytical component has become a spatial distribution map of Loreto groundwater and related to calcemia in children. The fluoride concentration was determined in samples from twenty-three groundwater wells and serum calcium from eighteen school-age children, both by standard method. Two points were identified with levels above the maximum allowed and in 61% of the children the serum calcium was lower than the reference value. We found a weak correlation between the variables (r = 0.212). It would be important to include in later studies factors not addressed in this research for a more complete risk assessment of the exposed population(AU)
Assuntos
Humanos , Criança , Água Subterrânea/química , Cálcio/sangue , Fluoretos/análise , Características de Residência , Poços de ÁguaRESUMO
La presente obra es fruto de la itneracción generada a partir de la experiencia académica que ha anidado desde el año 2012, en el afán de abrir nuevos escenarios de estudio del tema fundamental que inspira esta obra. Así, se pretende examinar el valor que la salud ha desempeñado en nuestro país desde la instalación y despliegue de la idea de República como eje organizador de nuestra vida política, hasta las últimas décadas del siglo XX. En definitiva, a la luz de los estudios que la presente obra ha recopilado, es menester extender una invitación de nuesrta parte, la que apunta a reflexionar en torno a cómo el modelo de modernidad que comenzó a instalarse en diversos planos de la vida de la naciente República, transitó en ocasiones al ritmo de la imposición realizada por una élite social y en otros instantes al son de la legitimidad que brindó la cuidadanía. La serie de exámenes que hemos congregado han pretendido esbozar que, de uno u otro modo, concebir un modelo de modernidad basado exclusivamente en la razón instrumental, la ciencia y la técnica, y que,además, sea estrictamente tributario de dimensiones economicistas o políticas, puede desvirtuar la naturaleza social que encierra la noción de salud en tanto ella, desde el siglo XVIII, ha sido un factor determinante en la concepción de aquellos poryectos sociales que hacen del bien común uno de sus pilares constitutivos. (AU)
Assuntos
História da Medicina , Direito à Saúde , Chile , Medicina TradicionalRESUMO
Hablamos de la esfera de la salud dental y del nacimiento de la profesión odontológica en Chile, ambas meterias sobre las cuales no se han desplegado estudios históricos en las últimas décadas, y que, desde nuestra perspectiva, pueden ofrecer nuevas lecturas sobre algunos fenómenos relevantes, tales como la evolución de la profesionalización de la salud de nuestro país, la modernización de la sauld pública dental en Chile y su integración a los planes de desarrollo social que se instalaron en el siglo XIX, y las relaciones que se establecieron entre la odontología y la medicina en nuestro país, las cuales se fueron cimentando a partir de avenencias y discordancias. El curso histórico de cada una de estas cuestiones, sus características y qué interpretación podemos asignarle, es un afán que comenzamos a desmenuzar a continuación. (AU)
Assuntos
Odontologia , Educação em Odontologia/história , História do Século XIX , Prática Profissional , Assistência OdontológicaRESUMO
BACKGROUND: Multidetector computed tomography (MDCT) of the abdomen, with use of contrast medium, is able to detect and differentiate most focal liver lesions. AIM: To determine the prevalence and features of benign focal liver lesions (BFLL) detected by abdominal MDCT. PATIENTS AND METHODS: We reviewed the reports of contrast abdominal MDCT performed to outpatients between August 2011 and July 2012. Clinical data of examined patients and imaging findings in terms of description of the hepatic parenchyma and the presence of BFLL, were recorded. RESULTS: Data from 1,184 studies were analyzed. Of these, 461 studies (38.4%) reported BFLL. The most prevalent lesions were simple cysts in 290 studies (24%) and hemangiomas in 61 studies (5.1%), granuloma-calcification in 39 (3.2%), focal nodular hyperplasia in 19 (1.6%) and one adenoma. If patients with known causes of liver disease were excluded, the prevalence of BFLL did not change substantially (lesions were found in 396 (37.5%) patients). Compared with livers with signs of damage, normal livers had more cystic lesions (27 and 16.2% respectively, p = 0.014) and hemangiomas (5.3 and 1.1% respectively, p = 0.043). CONCLUSIONS: BFLL are very common findings in MDCT studies. Most of these lesions are simple cysts and hemangiomas.
Assuntos
Cistos/diagnóstico por imagem , Granuloma/diagnóstico por imagem , Hemangioma/diagnóstico por imagem , Hepatopatias/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Chile/epidemiologia , Meios de Contraste , Feminino , Humanos , Hepatopatias/epidemiologia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Distribuição por Sexo , Adulto JovemRESUMO
Background: Multidetector computed tomography (MDCT) of the abdomen, with use of contrast medium, is able to detect and differentiate most focal liver lesions. Aim: To determine the prevalence and features of benign focal liver lesions (BFLL) detected by abdominal MDCT. Patients and Methods: We reviewed the reports of contrast abdominal MDCT performed to outpatients between August 2011 and July 2012. Clinical data of examined patients and imaging findings in terms of description of the hepatic parenchyma and the presence of BFLL, were recorded. Results: Data from 1,184 studies were analyzed. Of these, 461 studies (38.4%) reported BFLL. The most prevalent lesions were simple cysts in 290 studies (24%) and hemangiomas in 61 studies (5.1%), granuloma-calcification in 39 (3.2%), focal nodular hyperplasia in 19 (1.6%) and one adenoma. If patients with known causes of liver disease were excluded, the prevalence of BFLL did not change substantially (lesions were found in 396 (37.5%) patients). Compared with livers with signs of damage, normal livers had more cystic lesions (27 and 16.2% respectively, p = 0.014) and hemangiomas (5.3 and 1.1% respectively, p = 0.043). Conclusions: BFLL are very common findings in MDCT studies. Most of these lesions are simple cysts and hemangiomas.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Comparação Transcultural , Disparidades nos Níveis de Saúde , Saúde Mental/estatística & dados numéricos , Saúde Ocupacional/estatística & dados numéricos , Carga de Trabalho/psicologia , Finlândia , Reino Unido , Japão , Aptidão Física , Sistemas Políticos , Fatores Sexuais , Estresse Psicológico , Carga de Trabalho/estatística & dados numéricosAssuntos
Humanos , Gravidez , Recém-Nascido , Lactente , Pré-Escolar , Criança , Neonatologia , Pediatria , Perinatologia , Internato e ResidênciaRESUMO
In 1918 Chile met the deadly presence of the Spanish influenza pandemic twentieth century's most important. For many historians, this event is an important milestone in the historical process of the unification of the world through sickness and in which our country has been involved. In this context, this paper aims to examine how the flu broke into Chilean society and how that situation helped give new impetus to the modernization of the Chilean public health and the establishment in the 1920s to model new medicine or preventive medicine.
Assuntos
Influenza Humana/história , Internacionalidade , Pandemias/história , Chile/epidemiologia , História do Século XX , Humanos , Influenza Humana/epidemiologiaRESUMO
BACKGROUND: Increasing evidence shows that excessive alcohol consumption during adolescence increases vulnerability to alcohol use disorders in adulthood. The aim of this study was to examine differences between adolescent and adult C57BL/6J mice in drinking behavior and blood ethanol (EtOH) concentrations (BECs) after chronic EtOH exposure and withdrawal. METHODS: Male adolescent (PND = 28 to 30) and adult (PND = 70) C57BL/6J mice were allowed to consume EtOH in a 2-bottle choice paradigm (15% EtOH vs. water) for 3 weeks (Baseline drinking, Test 1, and Test 2), which were interspersed with 2 cycles (Cycles I and II) of chronic EtOH vapor or air inhalation (16 hours) and withdrawal (8 hours). BECs were determined during both cycles. RESULTS: Chronic EtOH exposure led to increased EtOH intake during Test 1 and Test 2 in both adolescent and adult mice compared with air-exposed controls, and no differences between age groups were observed. During Cycle I adult mice showed higher BECs compared with adolescents. During Cycle II, BECs were lower in adult mice as compared to Cycle I, and BECs in adolescent mice did not change between the 2 cycles. CONCLUSIONS: Chronic EtOH exposure followed by withdrawal periods increases EtOH consumption similarly in both adolescent and adult mice, despite differences in BECs.
Assuntos
Consumo de Bebidas Alcoólicas , Comportamento Animal/efeitos dos fármacos , Depressores do Sistema Nervoso Central/farmacologia , Etanol/farmacologia , Fatores Etários , Animais , Masculino , Camundongos , Camundongos Endogâmicos C57BLRESUMO
BACKGROUND: The historical bases of occidental medicine precede the Hippocratic corpus. Between the third and first millennium B.C. Egyptian medicine developed a model of medical practice that was a reference horizon for other Mediterranean cultures. There are a great number of papyri of that time, which gathered the medical and surgical skills and that are matter of study. The Edwin Smith papyrus (PES) is one of them. We analyzed the PES in its historical context, its history, its structure and its medical and dental significance. Finally, we analyzed the relevance of PES as a sign of a change in the medicine study method in the ancient Egypt. PES is an insight into how medicine was practiced in ancient Egypt. Historically, it is also the first medical document based on objective observations, excluding all magical and religious perceptions, as well as the underlying cultural framework. The similarity between the current clinical method and that described in the Smith papyrus, strongly suggests the idea that part of the origin of medicine, can be found in ancient Egypt.
Assuntos
Cirurgia Geral/história , História da Odontologia , Manuscritos Médicos como Assunto/história , Arqueologia , Antigo Egito , História Antiga , Estados Unidos , Ferimentos e Lesões/históriaRESUMO
A pneumonia é a infecção nosocomial mais comum em unidades de terapia intensiva, sendo a ventilação mecânica um fator fortemente associado ao seu desenvolvimento. O objetivo deste estudo foi descrever o impacto do sistema de aspiração traqueal aberto e fechado na incidência de pneumonia associada à ventilação mecânica. Realizou-se uma pesquisa na base de dados Pubmed para identificar tentativas controladas aleatórias, publicadas no período de 1990 a novembro de 2008. Nove estudos foram incluídos. Dos estudos revisados, sete não observaram redução significante da incidência de pneumonia associada à ventilação mecânica com o uso do sistema fechado comparado ao aberto, sendo que dois destes verificaram que o uso do sistema fechado resulta em incremento nas taxas de colonização sem incrementar sua incidência e um observou que o uso do sistema fechado não incrementa a colonização do trato respiratório e reduz a expansão de infecção resultando em redução nas taxas de sepse. Apenas dois estudos verificaram redução na incidência de pneumonia associada à ventilação mecânica com o uso do sistema fechado, e um destes revelou um risco 3.5 vezes maior de desenvolvimento desta infecção com o sistema aberto. Os resultados sugerem que o impacto do sistema de aspiração traqueal aberto e fechado é semelhante para o desenvolvimento da pneumonia associada à ventilação mecânica, assim a escolha do tipo de sistema de aspiração traqueal deve ser baseada em outros parâmetros. Entretanto, o sistema fechado aumenta o risco de colonização do trato respiratório, mas apresenta como vantagens a manutenção da ventilação mecânica e o menor prejuízo hemodinâmico.
Pneumonia is the most common nosocominal infection in intensive care units and mechanical ventilation is a significant factor associated to its development. The objective of this study was to describe the impact of the open and closed tracheal suction systems on the incidence of ventilation-associated pneumonia. A search in the Pubmed database was performed to identify randomized controlled trials, published from 1990 to November 2008. Nine studies were included. Of the studies reviewed, seven did not disclose any significant advantages of using the closed system when compared to th e open, whereas two reported that use of the closed system increased colonization rates but not incidence of ventilation-associated pneumonia and one observed that use of the closed system did not increase colonization of the respiratory tract but reduced the spread of infection resulting in decreased sepsis rates. Only two studies found a reduction in the incidence of ventilation-associated pneumonia with use of the closed system, and one revealed a 3.5 times greater risk of developing this infection with the open system. Results suggest that the impact of the open and closed tracheal suction system is similar on development of ventilation-associated pneumonia, choice of the suction system should therefore be based on other parameters. While the closed system increases risk of colonization of the respiratory tract, but has the advantages of continuing mechanical ventilation and lessening hemodynamic impairment.
RESUMO
Pneumonia is the most common nosocominal infection in intensive care units and mechanical ventilation is a significant factor associated to its development. The objective of this study was to describe the impact of the open and closed tracheal suction systems on the incidence of ventilation-associated pneumonia. A search in the Pubmed database was performed to identify randomized controlled trials, published from 1990 to November 2008. Nine studies were included. Of the studies reviewed, seven did not disclose any significant advantages of using the closed system when compared to th e open, whereas two reported that use of the closed system increased colonization rates but not incidence of ventilation-associated pneumonia and one observed that use of the closed system did not increase colonization of the respiratory tract but reduced the spread of infection resulting in decreased sepsis rates. Only two studies found a reduction in the incidence of ventilation-associated pneumonia with use of the closed system, and one revealed a 3.5 times greater risk of developing this infection with the open system. Results suggest that the impact of the open and closed tracheal suction system is similar on development of ventilation-associated pneumonia, choice of the suction system should therefore be based on other parameters. While the closed system increases risk of colonization of the respiratory tract, but has the advantages of continuing mechanical ventilation and lessening hemodynamic impairment.
RESUMO
Introducción: El presente trabajo muestra las virtudes dela fijación vertebral pedicular para el tratamiento de lainestabilidad espinal de causa oncológica. Materiales y métodos: Desde septiembre de 2002 hasta junio de 2006 se trataron 20 pacientes con patología oncológicadel raquis utilizando estabilización posterior pedicular.Se incluyeron 14 mujeres y 6 varones; 4 presentabanpatología primaria y 16, secundaria. La lesión primariamás frecuente fue el mieloma y la secundaria, elcarcinoma de mama. La mayoría de los pacientes fuerontratados sólo por vía posterior. Resultados: Diecinueve pacientes tuvieron pronto alivio del dolor; 19 pudieron caminar enseguida, dos con ayuda de ortesis y muletas, y uno presentó paraplejía un mes más tarde. Hubo cuatro infecciones, que se resolvieron, y una seudoartrosis. No se registraron óbitos intraoperatorios. Conclusiones: La estabilización vertebral pedicular es una herramienta muy útil para el tratamiento de la patología oncológica de la columna vertebral, ya sea como tratamiento único o como complemento de una descompresión y estabilización anterior.
Assuntos
Neoplasias da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Metástase Neoplásica , Neoplasias da Mama , Vértebras Lombares/cirurgiaRESUMO
Se realizó una evaluación retrospectiva de 28 pacientes (29 hombros) intervenidos por artroscopía al presentar patología del espacio subacromial y del manguito rotador. Se compararon los hallazgos quirúrgicos con resonancia magnetica nuclear preoperatorias. Dichos hallazgos fueron clasificados siguiendo criterio radiológico de acuerdo a la presencia o no de ruptura, y si esta era parcial (articular o bursal) o completa. Se observaron resultados coincidentes o verdaderos en el 62 por ciento de los casos, correspondiendo estos a los manguitos sanos y a aquellos con lesiones completas. Los diagnósticos erróneos (falsos positivos o negativos) fueron en mayor proporción en las lesiones parciales.
Assuntos
Adulto , Pessoa de Meia-Idade , Artroscopia , Articulação do Ombro/patologia , Dor de Ombro/diagnóstico , Imageamento por Ressonância Magnética , Manguito Rotador/cirurgia , Manguito Rotador/lesões , Manguito Rotador/patologia , Estudos Retrospectivos , Ruptura/diagnóstico , Sensibilidade e EspecificidadeRESUMO
Se realizó una evaluación retrospectiva de 28 pacientes (29 hombros) intervenidos por artroscopía al presentar patología del espacio subacromial y del manguito rotador. Se compararon los hallazgos quirúrgicos con resonancia magnetica nuclear preoperatorias. Dichos hallazgos fueron clasificados siguiendo criterio radiológico de acuerdo a la presencia o no de ruptura, y si esta era parcial (articular o bursal) o completa. Se observaron resultados coincidentes o verdaderos en el 62 por ciento de los casos, correspondiendo estos a los manguitos sanos y a aquellos con lesiones completas. Los diagnósticos erróneos (falsos positivos o negativos) fueron en mayor proporción en las lesiones parciales