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Objective The present study compares the analgesic efficacy of two techniques to perform non-surgical reduction: fracture hematoma block and radial nerve supracondylar block. Methods Forty patients with fractures of the distal third of the radius, who required reduction, were selected in a quasi-randomized clinical trial to receive one of the anesthetic techniques. All patients signed the informed consent form, except for those who did not wish to participate in the study, had neurological injury, had contraindication to the procedure in the emergency room, or with contraindication to the use of lidocaine. To measure analgesia, the numerical pain rate scale was used at four different moments: preblock, postblock, during reduction, and after reduction; then three differences were calculated: the first between before and after blocking; the second between during reduction and after blockade; and the third between before blocking and after reduction. Results The fracture hematoma and supracondylar block groups showed the following mean values, respectively: 3.90 (1-10) and 3.50 (-6-10) in difference 1; 4.35 (-5-10) and 5.00 (-3-10) in difference 2; and 4.65 (1-10) and 3.80 (-3-10) in difference 3. Conclusion Both techniques proved to be efficient for analgesia, with mild superiority of hematoma block, but without statistical significance.
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Abstract Objective The present study compares the analgesic efficacy of two techniques to perform non-surgical reduction: fracture hematoma block and radial nerve supracondylar block. Methods Forty patients with fractures of the distal third of the radius, who required reduction, were selected in a quasi-randomized clinical trial to receive one of the anesthetic techniques. All patients signed the informed consent form, except for those who did not wish to participate in the study, had neurological injury, had contraindication to the procedure in the emergency room, or with contraindication to the use of lidocaine. To measure analgesia, the numerical pain rate scale was used at four different moments: preblock, postblock, during reduction, and after reduction; then three differences were calculated: the first between before and after blocking; the second between during reduction and after blockade; and the third between before blocking and after reduction. Results The fracture hematoma and supracondylar block groups showed the following mean values, respectively: 3.90 (1-10) and 3.50 (-6-10) in difference 1; 4.35 (-5-10) and 5.00 (-3-10) in difference 2; and 4.65 (1-10) and 3.80 (-3-10) in difference 3. Conclusion Both techniques proved to be efficient for analgesia, with mild superiority of hematoma block, but without statistical significance.
Resumo Objetivo O estudo compara a eficácia analgésica de duas técnicas para realizar redução incruenta: o bloqueio de hematoma da fratura e o bloqueio supracondilar de nervo radial. Métodos Quarenta pacientes com fraturas do terço distal do rádio, que necessitassem redução, foram selecionados em um ensaio clínico quasi-randomizado, para receber uma das técnicas anestésicas. Todos os pacientes assinaram o termo de consentimento ou assentimento, com exceção daqueles que não desejassem participar do estudo, tivessem lesão neurológica, com contraindicação ao procedimento na sala de emergências, ou com contraindicação ao uso da lidocaína. Para aferir a analgesia foi utilizada a escala numérica da dor em quatro momentos distintos: pré-bloqueio, pós-bloqueio, durante a redução e após a redução; em seguida, foram calculadas três diferenças: a primeira entre antes e após o bloqueio; a segunda entre durante a redução e após o bloqueio; e a terceira entre antes do bloqueio e após a redução. Resultados Os grupos do bloqueio de hematoma de fratura e bloqueio supracondilar apresentaram respectivamente os seguintes valores médios: 3.90 (1-10) e 3.50 (-6-10) na diferença 1; 4.35 (-5-10) e 5.00 (-3-10) na diferença 2; e 4.65 (1-10) e 3.80 (-3-10) na diferença 3. Conclusão As duas técnicas se provaram eficientes para analgesia, com discreta superioridade do bloqueio de hematoma, mas sem significância estatística.
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Humanos , Fraturas do Rádio , Medição da Dor , Redução Fechada , Anestesia Local , Bloqueio NervosoRESUMO
Díaz-Díaz et al. (2018) described a new species of oweniid polychaete, Owenia vieitezi, from the north-western coast of the Gulf of Venezuela, Caribbean Sea. Although the description and figures presented by Díaz-Díaz et al. (2018) fully characterize the new species, the journal issue in which the description appeared was published online only and the article in which the new name appeared did not include a ZooBank registration number (LSID), required for validation of new species names in electronic-only publications (ICZN 2012). As a result, the name Owenia vieitezi Díaz-Díaz, Parapar Moreira, 2018, as published in Cahiers de Biologie Marine 59: 589-597, is not available according the International Code of Zoological Nomenclature (ICZN 1999, 2012). Therefore, the present note serves to validate the name Owenia vieitezi by fulfilling the ICZN conditions for nomenclatural availability.
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Anelídeos , Meliaceae , Poliquetos , Animais , VenezuelaRESUMO
BACKGROUND: Knowledge of the anatomy of the foramen transversarium (FT) is essential for performing surgical procedures on the cervical spine. The aim of the present study was to analyze the characteristics of the FT anatomy of the lower cervical spine and its anatomic variations using computed tomography (CT) in a Brazilian population. METHODS: Two independent observers performed linear measurements of the anteroposterior diameter (APD), lateral diameter (LD), and FT area (FTA) of 600 FTs of the lower cervical spine of 60 individuals (30 women and 30 men). The CT images were obtained from a database. The data were compared between genders and different age cohorts. RESULTS: The lowest average APD, LD, and FTA were found at the C7 level. The highest mean APD was found at the C6 level, and the highest mean LD was found at the C3 level. The highest mean FTA was at the C3 for the women and C6 for the men. The mean APD, LD, and FTA on the left side were greater than those on the right side at all levels. We found a tendency for the mean FTA to increase with increasing age. Finally, 95% of the whole sample had presented with ≥1 and 42% with >3 anatomical variations of the FT. CONCLUSIONS: We determined the morphometric features of the FT using CT images. Anatomic variations were observed that justify their study before performing cervical surgical procedures.
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Vértebras Cervicais/anatomia & histologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
BACKGROUND: In contrast with the abundance of global epidemiological descriptive data on cardiovascular diseases and their risk factors, information on the outcomes of real populations prospectively followed up in their life and care settings is much rarer, especially in low-income countries. OBJECTIVES: This study sought to evaluate the feasibility and the overall results of a hypertension control program, based mainly on a network of community nonprofessional health promoters, in the poor rural region of Borbon (Ecuador). METHODS: This is a prospective cohort study describing the results of a program of hypertension diagnosis, treatment and follow-up from 2004 to 2015 in the area, carried out mainly by the health promoters. RESULTS: The number of hypertensive patients identified and followed over the years increased from 1,024 in 2004 to 1,733 in 2015. The percentage of patients with no visits during a year was reduced to <10%, whereas the proportion of hypertensive subjects attending all 4 scheduled annual checks approached and, in some years, exceeded 50%. From 2004 to 2015, the proportion of patients at high or very high cardiovascular risk progressively decreased from 26.6% in 2004 to 17.5% in 2015 (p for trend <0.01), whereas the proportion of hypertensive patients at low or very low risk increased from 30.4% in 2004 to 45.0% in 2015 (p for trend <0.01). CONCLUSIONS: In a poor, disadvantaged area, a strategy of control mainly based on the involvement and responsibility of community health promoters (with health professionals as supporters more than direct actors) can achieve adequate follow-up of the population of hypertensive patients and improve their global cardiovascular risk level.
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Serviços de Saúde Comunitária/organização & administração , Hipertensão/prevenção & controle , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Equador/epidemiologia , Estudos de Viabilidade , Feminino , Promoção da Saúde/métodos , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Fatores de Risco , Saúde da População Rural/estatística & dados numéricos , Resultado do TratamentoRESUMO
Es ampliamente conocido que la principal causa de morbi mortalidad en pacientes con Diabetes Mellitus (DM) tipo 2 es la enfermedad cardiovascular en sus diferentes formas. Desde hace mucho tiempo se han diseñado herramientas de cálculo de dicho riesgo, basadas en información estadística obtenida de estudios poblacionales que correlacionan los factores de riesgo cardiovascular con la probabilidad de que los pacientes con diabetes Mellitus presenten complicaciones cardiovasculares. Sin embargo, todas y cada una de dichas herramientas presentan pros y contras para su aplicación en diferentes poblaciones y diferentes contextos clínicos. En el presente trabajo se discute la importancia de la evaluación del riesgo cardiovascular en los pacientes con diabetes Mellitus tipo 2 así como las diferentes opciones disponibles para el cálculo de dicho riesgo...(AU)
It is widely known that the main cause of morbidity and mortality in patients with type 2 Diabetes Mellitus (DM) is a cardiovascular disease in various forms. Since some time ago, tools have been designed for calculating this risk, based on statistical data obtained from population studies that correlate cardiovascular risk factors with the likelihood that patients with diabetes mellitus present cardiovascular complications. However, each and every one of these tools have pros and cons for application in different populations and different clinical settings. In this paper the importance of cardiovascular risk assessment in patients with type 2 diabetes mellitus and the various options available to calculate this risk are discussed...(AU)
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Humanos , Pessoa de Meia-Idade , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/tratamento farmacológico , Complicações do Diabetes/congênito , Diabetes Mellitus Tipo 2/diagnóstico , Medição de Risco/métodos , GuatemalaRESUMO
OBJECTIVES: To evaluate the effect of ivermectin mass drug administration on strongyloidiasis and other soil transmitted helminthiases. METHODS: We conducted a retrospective analysis of data collected in Esmeraldas (Ecuador) during surveys conducted in areas where ivermectin was annually administered to the entire population for the control of onchocerciasis. Data from 5 surveys, conducted between 1990 (before the start of the distribution of ivermectin) and 2013 (six years after the interruption of the intervention) were analyzed. The surveys also comprised areas where ivermectin was not distributed because onchocerciasis was not endemic. Different laboratory techniques were used in the different surveys (direct fecal smear, formol-ether concentration, IFAT and IVD ELISA for Strongyloides stercoralis). RESULTS: In the areas where ivermectin was distributed the strongyloidiasis prevalence fell from 6.8% in 1990 to zero in 1996 and 1999. In 2013 prevalence in children was zero with stool examination and 1.3% with serology, in adult 0.7% and 2.7%. In areas not covered by ivermectin distribution the prevalence was 23.5% and 16.1% in 1996 and 1999, respectively. In 2013 the prevalence was 0.6% with fecal exam and 9.3% with serology in children and 2.3% and 17.9% in adults. Regarding other soil transmitted helminthiases: in areas where ivermectin was distributed the prevalence of T. trichiura was significantly reduced, while A. lumbricoides and hookworms were seemingly unaffected. CONCLUSIONS: Periodic mass distribution of ivermectin had a significant impact on the prevalence of strongyloidiasis, less on trichuriasis and apparently no effect on ascariasis and hookworm infections.
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Anti-Helmínticos/uso terapêutico , Ivermectina/uso terapêutico , Oncocercose/tratamento farmacológico , Strongyloides stercoralis/efeitos dos fármacos , Estrongiloidíase/epidemiologia , Adolescente , Adulto , Idoso , Animais , Ascaríase/epidemiologia , Criança , Pré-Escolar , Tratamento Farmacológico/métodos , Equador/epidemiologia , Feminino , Infecções por Uncinaria/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Tricuríase/epidemiologia , Adulto JovemRESUMO
Chagas disease was described in Ecuador in 1930 in the province of Guayas and thereafter in various provinces. Triatomine were reported in the province of Esmeraldas but no human infection has been described. Here we report the first evidence that the disease does exist in the province of Esmeraldas. In indigenous Awá communities located in the northwest jungle of the Esmeraldas province, 144 individuals were tested using ELISA and PCR for T.cruzi of which 5 (3.47%) were positive. Twenty eight triatomine were collected, 27 were Triatoma dispar and 1 Pastrongylus rufotuberculatus, T.cruzi was detected in 11 (42.3%) of 26 insects.
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Doença de Chagas/epidemiologia , Trypanosoma cruzi/isolamento & purificação , Adulto , Animais , Doença de Chagas/parasitologia , Equador/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Populacionais , Triatominae/parasitologia , Adulto JovemRESUMO
BACKGROUND: The British Medical Research Council (BMRC) staging has been extensively used to evaluate the disease severity and establish the approximate prognosis of tuberculous meningitis. AIMS: This study aimed at analyzing the predictive accuracy for mortality and neurological sequelae of a set of clinical features, laboratory tests and imaging. METHODS: We compared the British Medical Research Council (BMRC) staging with a new scoring proposal to predict the prognosis of patients with Central Nervous System Tuberculosis. Data from Ecuador was collected. A score was built using a Spiegelhalter and Knill-Jones method and compared with BMRC staging with a ROC curve. RESULTS: A total of 213/310 patients (68.7%) were in BMRC stage II or III. Fifty-seven patients died (18.3%) and 101 (32.5%) survived with sequelae. The associated predictors were consciousness impairment (p = 0.010), motor deficit (p = 0.003), cisternal effacement (p = 0.006) and infarcts (p = 0.015). The new score based on these predictors yielded a larger area under the curve of 0.76 (95% CI: 0.70-0.82), but not significantly different from the BMRC (0.72: 95% CI: 0.65-0.77). CONCLUSIONS: This modern score is easy to apply and could be a sound predictor of poor prognosis. However, the availability of modern tests did not improve the ability to predict a bad outcome.
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Diagnóstico por Imagem/métodos , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Meníngea/diagnóstico , Adulto , Progressão da Doença , Equador/epidemiologia , Feminino , Humanos , Incidência , Masculino , Prognóstico , Curva ROC , Estudos Retrospectivos , Índice de Gravidade de Doença , Taxa de Sobrevida/tendências , Tuberculose Meníngea/epidemiologia , Tuberculose Meníngea/microbiologiaRESUMO
La Diabetes Mellitus representa un problema de salud mundial y nacional, y la hipoglicemia es unade sus más temidas complicaciones. Existe controversia en cuanto a los rangos glicémicos ideales,ya que se ha demostrado mayor mortalidad en pacientes que desarrollan hipoglicemia.Materiales y Métodos: El objetivo del presente estudio fue determinar la incidencia dehipoglicemia en pacientes en la Unidad de Cuidados Intensivos y Encamamiento de MedicinaInterna del Hospital Roosevelt y determinar su mortalidad, comparándola con un grupo control sinhipoglicemia. Es un estudio observacional de casos y controles. Se incluyó como grupo de estudioa 35 pacientes en quienes se documentó hipoglicemia, del 1 de enero al 30 de junio del 2011. Porcada sujeto de estudio se tomó un control que no desarrolló hipoglicemia. Se determinó lamortalidad intra-hospitalaria y a los seis meses de cada grupo.Resultados: Intrahospitalariamente fallecieron 10 pacientes (28.6%) del grupo de hipoglicemia y 3(8.6%) del grupo control (RR 3.33; 95% CI, 1.00 11.09; P=0.0496). A los seis meses habíanfallecido 15 pacientes (42.9%) del grupo de hipoglicemia, y 7 (20.0%) del grupo control (RR 2.14; CI0.997 4.605; P=0.0509). Tres pacientes (8.6%) del grupo de hipoglicemia desarrollaron infecciónnosocomial durante el estudio, y ninguno del grupo control (RR 7.00; CI 0.37 130.70; P=0.1926).Se documentaron 10 re-hospitalizaciones en el grupo de hipoglicemia y 9 en los controles.Conclusión: Este estudio demuestra que hay mayor riesgo de morir en pacientes que desarrollanhipoglicemia durante su estancia hospitalaria comparado con quienes no la realizan.
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Humanos , Glicemia , Diabetes Mellitus/economia , Diabetes Mellitus/mortalidade , Hipoglicemia/complicações , Hipoglicemia/epidemiologiaRESUMO
El Síndrome de POEMS (polineuropatía, organomegalia, endocrinopatía, pico gamma monoclonal ycambios en la piel) es una discrasia de células plasmáticas que se manifiesta con un característicoconjunto de trastornos para neoplásicos. Los cambios en la piel, como hiperpigmentación cutáneageneralizada, son debidos al aumento en la secreción del factor de crecimiento del endotelio vascular.Se reporta el caso de una mujer de 67 años de edad que se presentó con astenia, adinamia y uncuadro importante de anemia, asociados a diabetes mellitus, hipotiroidismo y polineuropatía motora ysensitiva de moderada intensidad. Sus cambios en la piel consistieron en hiperpigmentación, manchasvioláceas en los labios y acentuación de los pliegues de las manos. Los estudios subsecuentesevidenciaron el pico gamma monoclonal y la polineuropatía axonal sensitivo-motora en elelectromiograma. Se brindó el tratamiento quimioterapéutico correspondiente pero sufriócomplicaciones mielosupresoras por esta razón, desarrollo una neumonía intrahospitalaria y falleció aconsecuencia.
The POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M-protein and skin changes)is a rare atypical plasma cell dyscrasia with characteristic para neoplastic manifestations. The skinchanges, as generalized skin hyperpigmentation, are related with elevated levels of vascularendothelial growth factor. We report a clinical case of 67 years old woman who presented withasthenia, adynamia and important anemia, associated to diabetes mellitus, hypothyroidism and amoderated intensity motor-sensitive polyneuropathy. The skin changes presented by this patientwere hyperpigmentation, violet spots in the lips and accentuation of the lines in the palm of the hand.Subsequent analysis showed the Mprotein and the electromyography showed a motor-sensitivepolyneuropathy in both legs. Adequate chemotherapy was given but mielosuppressive effects wereshown, she acquired nosocomial pneumonia and died as consequence.
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Humanos , Feminino , Anemia/complicações , Astenia/diagnóstico , Cardiomegalia/diagnóstico , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Polineuropatias/complicações , Síndrome POEMS/complicaçõesRESUMO
UNLABELLED: Meningitis caused by Angiostrongylus cantonensis has recently been reported in patients resulting from the first outbreaks in subtropical regions of Ecuador. METHOD: Eight young adult patients from the two outbreaks were studied. IgA, IgM, IgG and albumin in cerebrospinal fluid and serum were quantified and plotted in cerebrospinal fluid/serum quotient diagrams (Reibergrams). The anamnesis on the patients included asking about any consumption of raw snails, symptoms and harm caused. RESULTS: Mean eosinophilia of 7.5% and 26% in serum and cerebrospinal fluid respectively was observed, as well as a moderate increase in total proteins. The most frequent pattern of intrathecal synthesis was observed in three classes of immunoglobulins. Intrathecal synthesis of IgM was observed in all cases two weeks after the first symptoms appeared. CONCLUSION: The intrathecal synthesis patterns of eosinophilic meningitis due to Angiostrongylus cantonensis, facilitated by cerebrospinal fluid analysis, were similar to those of previous cases from abroad.
Assuntos
Angiostrongylus cantonensis/imunologia , Eosinofilia/imunologia , Meningite/imunologia , Infecções por Strongylida/imunologia , Adolescente , Adulto , Albuminas/análise , Animais , Surtos de Doenças , Equador/epidemiologia , Eosinofilia/epidemiologia , Eosinofilia/parasitologia , Humanos , Imunoglobulinas/análise , Meningite/epidemiologia , Meningite/parasitologia , Infecções por Strongylida/epidemiologia , Infecções por Strongylida/parasitologia , Adulto JovemRESUMO
Meningitis caused by Angiostrongylus cantonensis has recently been reported in patients resulting from the first outbreaks in subtropical regions of Ecuador. METHOD: Eight young adult patients from the two outbreaks were studied. IgA, IgM, IgG and albumin in cerebrospinal fluid and serum were quantified and plotted in cerebrospinal fluid/serum quotient diagrams (Reibergrams). The anamnesis on the patients included asking about any consumption of raw snails, symptoms and harm caused. RESULTS: Mean eosinophilia of 7.5 percent and 26 percent in serum and cerebrospinal fluid respectively was observed, as well as a moderate increase in total proteins. The most frequent pattern of intrathecal synthesis was observed in three classes of immunoglobulins. Intrathecal synthesis of IgM was observed in all cases two weeks after the first symptoms appeared. CONCLUSION: The intrathecal synthesis patterns of eosinophilic meningitis due to Angiostrongylus cantonensis, facilitated by cerebrospinal fluid analysis, were similar to those of previous cases from abroad.
La meningitis provocada por Angiostrongylus cantonensis ha sido reportada recientemente en pacientes procedentes de los primeros brotes reportados en regiones subtropicales de Ecuador. MÉTODO: Ocho adultos jóvenes procedentes de dos brotes fueron estudiados. Se cuantificó IgA, IgM, IgG y albúmina en suero y líquido cefalorraquídeo y fueron colocados en los gráficos de las razones líquido cefalorraquídeo/suero (reibergramas). La anamnesia incluía ingestión de caracoles crudos, los síntomas y los daños provocados. RESULTADOS: Una eosinofílica promedio de 7,5 y 26 por ciento en suero y líquido cefalorraquídeo fue observada al igual que un moderado incremento en las proteínas totales. El patrón de síntesis intratecal predominante fue de tres clases de inmunoglobulinas. La síntesis intratecal de IgM se observó en todos los casos a las dos semanas después del inicio de los síntomas. CONCLUSIÓN: El patrón de síntesis intratecal de la meningitis eosinofílica por Angiostrongylus cantonensis facilitado por el análisis del líquido cefalorraquídeo fue similar a los casos previos reportados fuera del país.
Assuntos
Adolescente , Adulto , Animais , Humanos , Adulto Jovem , Angiostrongylus cantonensis/imunologia , Eosinofilia/imunologia , Meningite/imunologia , Infecções por Strongylida/imunologia , Albuminas/análise , Surtos de Doenças , Equador/epidemiologia , Eosinofilia/epidemiologia , Eosinofilia/parasitologia , Imunoglobulinas/análise , Meningite/epidemiologia , Meningite/parasitologia , Infecções por Strongylida/epidemiologia , Infecções por Strongylida/parasitologiaRESUMO
Angiostrongylus cantonensis meningitis was first reported in Cuba in 1981, and it was recently reported in South America. The aim of this paper is to evaluate the intrathecal immunoglobulin synthesis patterns from Cuba's and Ecuador's patients with angiostrongyliasis; 8 Ecuadorian patients from two different outbreaks and 28 Cuban patients were studied. Simultaneous blood and cerebrospinal fluid samples were taken. Immunoglobulin (Ig) A, IgM, IgG, and albumin were quantified by radial immunodiffusion. Corresponding Reibergrams were applied. A three-Ig pattern was the most frequent in the two groups, but IgM was presented in all Ecuadorian young mature patients; however, in the Cuban children, only 12 of 28 patients had intrathecal IgM, but about 90% had an IgA and IgG synthesis at time of later puncture. This indicates that, with a larger amount of parasites ingested, clinical symptoms are more severe, and a higher frequency of intrathecal IgM synthesis could be observed. This is discussed as a similarity with the intrathecal IgM synthesis in African trypanosomiasis.
Assuntos
Imunoglobulinas/líquido cefalorraquidiano , Meningite/líquido cefalorraquidiano , Meningite/parasitologia , Criança , Pré-Escolar , Cuba/epidemiologia , Equador/epidemiologia , Humanos , Imunoglobulinas/metabolismo , Meningite/epidemiologia , Meningite/imunologia , Infecções por Strongylida/líquido cefalorraquidiano , Infecções por Strongylida/epidemiologia , Infecções por Strongylida/imunologia , Infecções por Strongylida/metabolismo , Adulto JovemRESUMO
OBJETIVO: determinar a diferença dos valores angulares da cifose torácica utilizando como vértebra terminal cranial diferentes níveis (T2 a T5). MÉTODOS: foram avaliadas radiografias em perfil de cem adolescentes voluntários saudáveis da Escola Industrial do Serviço Social da Indústria (SESI) de Ribeirão Preto (SP), com prévia autorização dos pais ou responsáveis. Foram excluídas as radiografias de dez indivíduos por falhas na qualidade. Os parâmetros avaliados foram: mensuração da cifose torácica pelo método de Cobb, utilizando T2, T3, T4 ou T5 como vértebra terminal cranial e T12 como vértebra terminal caudal. RESULTADOS: foram avaliados 90 indivíduos (46 do sexo masculino e 44 do feminino), com idade variando de 13 a 15 anos (média 14±6). O valor angular da cifose torácica nos diferentes níveis variou entre 45º (T2-T12) e 35º (T5-T12) no sexo masculino, e valor angular entre 43º(T2-T12) e 30º (T5-T12) no sexo feminino. CONCLUSÃO: foi observada diferença constante de aproximadamente 5º quando comparados os valores angulares da cifose torácica utilizando diferentes níveis (T2 a T5) como vértebra terminal cranial.
OBJECTIVE: to determine the difference of the thoracic kyphosis angular values using different levels (T2 a T5) as a terminal cranial vertebra. METHODS: sagittal radiographies of one hundred healthy adolescent volunteers, who study at Escola Industrial do Serviço Social da Indústria (SESI) in Ribeirão Preto SP), were evaluated the sagittal radiographies of one hundred health volunteers adolescent, that studies at Escola Industrial do SESI in Ribeirão Preto (SP), with parents consent. Ten adolescents were excluded because of flaws in the quality. The studied parameters were: the measurement of thoracic kyphosis by the Cobb method, using T2, T3, T4, T5 as a terminal proximal vertebra and T12 as a distal final vertebra. RESULTS: Ninety individuals (46 men and 44 women), aged from 13 to 15 (average of 14±6), were evaluated. The angular value of thoracic kyphosis in the different levels varied from 46º (T2 - T12) to 35º (T5 - T12) in men, and from 44º (T2- T12) to 30º (T5 - T12) in women. CONCLUSION: A constant difference of approximately 5º was observed when comparing the angular values of thoracic kyphosis using different levels (T2 - T5) as a terminal cranial vertebra.
OBJETIVO: determinar la diferencia de los valores angulares de la cifosis torácica usando como vértebra terminal craneal, diferentes niveles (T2 a T5). MÉTODOS: fueron evaluadas radiografías en perfil de cien adolescentes voluntarios saludables de la Escola Industrial do Serviço Social da Indústria (SESI) de Ribeirão Preto (SP), con previa autorización de sus padres o responsables. Fueron excluidas radiografías de diez individuos por fallas de resolución. Los parámetros evaluados fueron: la medida de la cifosis torácica por el método de Cobb, usando T2,T3,T4 y T5 como vértebra terminal craneal y T12 como vértebra terminal caudal. RESULTADOS: fueron evaluados 90 individuos (46 hombres y 44 mujeres), con edades que varían de 13 a 15 años (media 14±6). El valor angular de la cifosis torácica en los diferentes niveles fue de 45º (T2-T12) y 35º (T5-T12) en el sexo masculino, y valor angular de 43º (T2-T12) y 30º (T5-T12) en el sexo femenino. CONCLUSIÓN: fue observada una diferencia constante de aproximadamente 5º cuando los valores angulares de la cifosis torácica fueron comparados, usando diferentes niveles (T2 a T5) como vértebra terminal craneal.
Assuntos
Humanos , Eficácia , Morbidade , Metilprednisolona/uso terapêutico , Traumatismos da Medula Espinal/tratamento farmacológicoRESUMO
PURPOSE: To relate the intuitive weight of harm by commission and harm by omission in therapeutic decisions for pulmonary tuberculosis, and to compare it with a weight based on probabilities. METHODS: Clinicians were asked for an estimation of probabilities related with the outcome of treated and nontreated pulmonary tuberculosis and for the toll of wrong decisions. Three ratios of the weight of forgoing a treatment in false-negative patients against the weight of treating false-positives were calculated. The first was based on intuitive estimations, whereas the second and third were based on calculated, either through intuitive estimations of probabilities or through literature data. The association between experience and the difference between the intuitive and the calculated ratios was assessed. RESULTS: Eighty-one participants from Ecuador, Laos, Nepal, and Rwanda responded. The ratio of intuitive weights was 2.0 (interquartile range [IQR], 1.0-4.0) and the ratio of calculated weights based on intuitive probabilities was 64 (IQR, 25.0-169.6; P < 0.001). The ratio of calculated weight based on literature probabilities was 30 (IQR, 17.9-59.2). No association (R(2) = 0.03) was found between experience and accuracy in estimating the weight of errors. CONCLUSION: The weight of a false negative is more important than the weight of a false positive for therapeutic decisions in pulmonary tuberculosis. The ratio of the intuitively estimated weights was much lower than the calculation based on intuitively estimated influencing factors. Clinicians were accurate in estimating probabilities but failed to incorporate them into therapeutic decisions.
Assuntos
Tomada de Decisões , Tuberculose Pulmonar/tratamento farmacológico , Reações Falso-Negativas , Humanos , ProbabilidadeRESUMO
RATIONALE: Bedside use of Bayes' theorem for estimating probabilities of diseases is cumbersome. An alternative approach based on five categories of powers of tests from 'useless' to 'very strong' has been proposed. The performance of clinicians using it was assessed. METHODS: Fifty clinicians attending a course of tropical medicine estimated powers of tests and post-test probabilities using the classical vs. the categorical Bayesian approach. The estimation of post-test probability was assessed for real and dummy diseases in order to avoid the bias of previous knowledge. Accuracy of answers was measured by the difference with reference values obtained from an expert system (Kabisa). RESULTS: Clinicians estimated positive likelihood ratios (LRs) a median of -1.07 log(10) lower than Kabisa [interquartile range (IQR): -1.47; -0.80] when derived classically and -0.17 (IQR: -0.42; +0.04) when estimated categorically (P < 0.001). For negative LRs the median was +0.39 log(10) higher (IQR: +0.71; +0.08) when derived classically and -0.18 log(10) lower (IQR: +0.03; -0.36) when estimated categorically (P < 0.001). Twenty (40%) disclosed not being able to calculate post-test probabilities using sensitivities and specificities. Regardless the approach post-test probabilities were overestimated both for real and dummy diseases [respectively +1.23 log(10) (IQR: +0,67; +2.08) and +2.03 log(10) (IQR: +0.49; +2.42)] (P = 0277), but the range was wider for the latter (P = 0.001). CONCLUSIONS: Participants were more accurate in estimating powers with a categorical approach than with sensitivities and specificities. Post-test probabilities were overestimated with both approaches. Knowledge of the disease did not influence the estimation of post-test probabilities. A categorical approach might be an interesting instructional tool, but the effect of training with this approach needs assessment.
Assuntos
Teorema de Bayes , Competência Clínica/normas , Técnicas e Procedimentos Diagnósticos/normas , Intuição , Funções Verossimilhança , Sensibilidade e Especificidade , Adulto , África/epidemiologia , Análise de Variância , Apendicite/diagnóstico , Apendicite/epidemiologia , Bélgica , Epidemiologia/educação , Sistemas Inteligentes , Feminino , Humanos , Masculino , Gravidez , Gravidez Ectópica/diagnóstico , Gravidez Ectópica/epidemiologia , Probabilidade , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/epidemiologia , Software , Estatísticas não Paramétricas , Inquéritos e Questionários , Medicina Tropical/educação , Medicina Tropical/métodos , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/epidemiologiaRESUMO
OBJECTIVES: To explore the predictive power of a risk stratification method for people with hypertension based on "essential" procedures (that is, available in economically less developed areas of the world), comparing it in the same population with the results given by the method suggested by the 1999 World Health Organization-International Society of Hypertension (WHO-ISH) guidelines. DESIGN: Prospective cohort study of outcomes according to cardiovascular risk profile at baseline. SETTING: Primary care in a poor rural area of the Ecuadorian forest. PARTICIPANTS: 504 people with hypertension prospectively monitored for a mean of 6.7 (SD 2.3) years. INTERVENTIONS: Essential data included blood pressure, medical history, smoking, age, sex, and diagnosis of diabetes; the WHO-ISH methods additionally included measurement of fasting blood glucose, total cholesterol, and creatinine, urinalysis, and electrocardiography. MAIN OUTCOME MEASURES: Cardiovascular events and total deaths. RESULTS: With both methods there was a highly significant association between the level of predicted risk and the incidence of cardiovascular events and of total deaths: up to three quarters of all cardiovascular events and two thirds of all deaths were reported among people classified as at high or very high risk with either method. The predictive discrimination of the essential method is comparable with the WHO-ISH with C statistics (95% confidence interval) of 0.788 (0.721 to 0.855) and 0.744 (0.673 to 0.815), respectively, for cardiovascular events and 0.747 (0.678 to 0.816) and 0.705 (0.632 to 0.778) for total mortality. CONCLUSIONS: The risk stratification of patients with hypertension with an essential package of variables (that is, available and practicable even in the economically less developed areas of the world) serves at least as well as the more comprehensive method proposed by WHO-ISH.
Assuntos
Países em Desenvolvimento , Hipertensão/diagnóstico , Adolescente , Adulto , Idoso , Transtornos Cerebrovasculares/epidemiologia , Equador/epidemiologia , Métodos Epidemiológicos , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Áreas de Pobreza , Saúde da População RuralRESUMO
OBJECTIVE: To determine how many more patients would be treated when lowering the treatment threshold for tuberculous meningitis. METHODS: From 1989 to 2004 findings of patients with symptoms lasting more than 1 week and inflammatory changes of cerebrospinal fluid (CSF) were collected. Several models of latent class analysis were tested. Cumulative numbers of cases were plotted against different cut-offs for post-test probability. RESULTS: In a cohort of 232 patients the prevalence of tuberculous meningitis (TBM) was estimated at 79.8% (95% CI. 67,0-88,1); probabilities above 80% were reached in 73% of patients. Lowering this threshold from 80% to 20% would add 14% more patients to be treated, for a total of 87%. A further lowering of the threshold to 5% would imply 5% more patients to be treated, bringing the cumulative number to 92%. The difference of lowering the threshold from 80% to 5% was 19%. CONCLUSION: In this setting, at least 75% of patients showing suggestive symptoms for more than a week and CSF changes very probably had TBM. The number of patients that should be treated does not increase linearly when lowering the threshold.
Assuntos
Modelos Estatísticos , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Meníngea/diagnóstico , Tuberculose Meníngea/tratamento farmacológico , Equador , Humanos , Prevalência , Probabilidade , Sensibilidade e Especificidade , Fatores de Tempo , Tuberculose Meníngea/líquido cefalorraquidiano , Tuberculose Meníngea/epidemiologia , Tuberculose Meníngea/fisiopatologiaRESUMO
Este trabalho analisa os esforços inovativos de empresas das indústrias têxtil-vestuário, de calçados, de móveis e de cerâmica que - mesmo tendo como principal fonte de tecnologia as indústrias fornecedoras, como a química e os bens de capital - são responsáveis pelo desenvolvimento de aplicações em produtos e processos capazes de proporcionar importantes vantagens diferenciais aos produtores.