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Objective The present paper aims to describe multiligament knee injuries and to associate their features with the profile of the patients and trauma mechanisms. Methods This is a cross-sectional study evaluating 82 patients with multiligament knee injuries from September 2016 to September 2018. Evaluated parameters included age, gender, mechanical axis, affected side, range of motion, trauma mechanism, associated injuries, affected ligaments, and absence from work. Results The sample included patients aged between 16 and 58 years old, with an average age of 29.7 years old; most subjects were males, with 92.7% of cases. The most common trauma mechanism was motorcycle accident (45.1%). The most injured ligament was the anterior cruciate ligament (80.5%), followed by the posterior cruciate ligament (77.1%), the posterolateral corner (61.0%), and the tibial collateral ligament (26.8%). The most frequent type of dislocation was KD IIIL (30.4%). Only 1 patient had a vascular injury, and 13 (15.9%) presented with neurological injuries. Most subjects took medical leave from work (52.4%). Conclusion There is a big difference between patients with multiligament lesions in Brazil compared with international studies. Thus, it is advisable to carry out more specific studies on the topic with our population to improve the treatment of these patients.

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Abstract Objective The present paper aims to describe multiligament knee injuries and to associate their features with the profile of the patients and trauma mechanisms. Methods This is a cross-sectional study evaluating 82 patients with multiligament knee injuries from September 2016 to September 2018. Evaluated parameters included age, gender, mechanical axis, affected side, range of motion, trauma mechanism, associated injuries, affected ligaments, and absence from work. Results The sample included patients aged between 16 and 58 years old, with an average age of 29.7 years old; most subjects were males, with 92.7% of cases. The most common trauma mechanism was motorcycle accident (45.1%). The most injured ligament was the anterior cruciate ligament (80.5%), followed by the posterior cruciate ligament (77.1%), the posterolateral corner (61.0%), and the tibial collateral ligament (26.8%). The most frequent type of dislocation was KD IIIL (30.4%). Only 1 patient had a vascular injury, and 13 (15.9%) presented with neurological injuries. Most subjects took medical leave from work (52.4%). Conclusion There is a big difference between patients with multiligament lesions in Brazil compared with international studies. Thus, it is advisable to carry out more specific studies on the topic with our population to improve the treatment of these patients.

Resumo Objetivo Descrever e associar as características das lesões multiligamentares de joelho com o perfil do paciente e mecanismo de trauma. Métodos Trata-se de um estudo transversal que avaliou 82 pacientes com lesões multiligamentares do joelho de setembro de 2016 até setembro de 2018. As variáveis coletadas foram idade, gênero, eixo mecânico, lateralidade, arco de movimento, mecanismo do trauma, lesões associadas, ligamentos afetados e afastamento do trabalho. Resultados A amostra incluiu pacientes de 16 a 58 anos, com média de 29,7 anos, e os homens foram os mais afetados, correspondendo a 92,7% dos casos. O mecanismo de trauma mais comum foi acidente motociclístico (45,1%). O ligamento mais lesado foi o ligamento cruzado anterior (80,5%), seguido do ligamento cruzado posterior (77,1%), do canto posterolateral (61,0%) e do ligamento colateral tibial (26,8%). O tipo de luxação mais frequente era o KD IIIL (30,4%). Apenas 1 paciente apresentou lesão vascular, e 13 (15,9%) apresentaram lesões neurológicas. A maioria das vítimas foi afastada do trabalho (52,4%). Conclusão Há grande diferença entre os pacientes que apresentam lesão multiligamentar no Brasil em relação ao encontrado nos estudos internacionais. Desta forma, convém realizar mais estudos específicos sobre o tema com a nossa população, de modo a aperfeiçoar o tratamento destes pacientes.

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BACKGROUND: Gunshot wounds require surgeons to decide whether to remove or leave bullet fragments in the body. Surgeons also decide how to follow up with patients who have lead fragments retained in their body. Current literature recommends to remove only intra-articular fragments without the need for a follow-up for patients with the metal retained. Therefore, this study investigates chronic lead toxicity for gunshot wounds. METHODS: The study was performed in the metropolitan area of Rio de Janeiro/Brazil, between 2013 and 2015. It was a case-control study that included 45 victims of gunshot lesions with metallic fragments retained for more than 6 months. The 45 controls were matched for gender, age, and race. We compared the lead blood levels and frequency of symptoms. RESULTS: The control group had average blood lead levels of 2.17 µg/dL (95% Confidence Interval [CI]; 1.71-2.63) and median 2.1 µg/dL. The case group had average values of 9.01 µg/dL (CI; 6.07-11.96) and median values of 6.5 µg/dL with p-values < = 0.001. The case group reported the following more frequently: irritancy, bad mood, headache, memory losses, daylight drowsiness, myalgia, weakness, abdominal pain, joint pain, trembling, tingling limbs. There was statistical significance for the differences of symptoms frequencies and for odds ratio between groups. CONCLUSIONS: Although the mean lead levels found were lower than the current laboratory references, low levels have been associated with both rising morbidity and mortality. The WHO stated: "There is no known level of lead exposure that is considered safe". In conclusion, this work showed that bullets retained in the body are not innocuous. There are impacts in the blood lead levels and symptoms related to it, even with few fragments, extra-articular located or existing with low blood lead levels.

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Fundamentos: Estudos demonstraram que a disfunção autonômica cardiovascular, medida através da variabilidade da frequência cardíaca, está associada a aumento do risco cardiovascular. Objetivos: Comparar a presença de disautonomia em diabéticos e não diabéticos através do teste ergométrico e determinar as variáveis preditoras de disautonomia em diabéticos. Métodos: Estudo retrospectivo, com pacientes que realizaram o teste ergométrico em caráter eletivo sob protocolo individualizado de rampa. Os pacientes foram estratificados em dois grupos: diabéticos (G1) e não diabéticos (G2). Foram definidos como disautonômicos os pacientes que obtiveram uma redução da FC no primeiro minuto da recuperação <12bpm. Os grupos G1 e G2 foram comparados. As variáveis com valores de p≤0,10 foram submetidas à análise de regressão logística. Resultados: Foram avaliados 1433 pacientes submetidos ao TE. A idade média foi 52,65±13,06 anos e variou entre 18-92 anos. Observaram-se, no G1, indivíduos mais velhos, obesos e dislipidêmicos. No teste ergométrico houve diferenças na FCR no primeiro minuto, FC do picodo esforço, número de METs e déficit cronotrópico. Submetidas as variáveis da população amostral, diabéticos e não diabéticos, à regressão logística, encontrou-se um único preditor de disautonomia: o número de METs (IC95% 0,083/0,031; p<0,0001); nos diabéticos, o único preditor independente da presença de disautonomia foi o índice de massa corporal (IC95%0,002-0,025; p=0,02). Conclusão: Indivídos diabéticos apresentam recuperação mais lenta da FC no pós-esforço que não diabéticos, evidenciando maior disautonomia e menor capacidade física; os diabéticos com excesso de peso têm maior comprometimento do sistema autonômico.

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