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Resumo: A úlcera aftosa recorrente (UAR) é uma lesão frequente na mucosa oral de etiologia variada e subdividindo-se clinicamente úlceras menores, maiores e hepertiformes. Caracterizada por formato ovoide, recoberto por uma pseudomembrana e um halo eritematoso, seu diagnóstico é essencial para distinguir outras lesões e o tratamento se faz necessário para tratar a lesão e prevenir recorrências. Desta maneira, o presente estudo teve como objetivo descrever de forma analítica sobre o diagnóstico diferencial e o tratamento da UAR em cavidade oral. Tratou-se de um estudo descritivo, exploratório caracterizado como revisão narrativa da literatura. Os critérios de inclusão estabelecidos foram: estudos que abordassem essa temática, com idiomas inglês e português. O levantamento ocorreu em agosto/2023 a janeiro/2024, através das buscas eletrônicas PubMed, LILACS, SciELO, além da literatura cinzenta Google acadêmico e busca livre secundária. Os Descritores em Ciências da Saúde (DeCS/MeSH) foram cruzados com o operador booleano: "differential diagnosis" AND "aphthous ulcer". A UAR é caracterizada por úlceras arredondadas superficiais que pode persistir por dias ou meses. O seu diagnóstico é fundamentado no histórico do paciente e nas características da lesão. É crucial eliminar possíveis causas de úlceras orais, para evitar confusão com outras lesões, como úlceras traumáticas, imunomedia das ou até mesmo um carcinoma. Diversas terapias são empregadas no manejo da UAR, tais como corticosteroides, suplementos vitamínicos, ozonioterapia e o laser de baixa potência. Portanto, compreender o histórico das lesões é fundamental para diferenciação e diante da diversidade de terapias, é essencial ter estudos que dê esse enfoque.
Abstract: Recurrent Aphthous Ulcer (RAU) is a common lesion in the oral mucosa with varied etiology, clinically subdivided into minor, major, and herpetiform ulcers. Characterized by an ovoid shape, covered by a pseudomembrane and erythematous halo, its diagnosis is essential to distinguish it from other lesions, and treatment is necessary to address the injury and prevent recurrences. Thus, the present study aimed to analytically describe the differential diagnosis and treatment of RAU in the oral cavity. It was a descriptive, exploratory study characterized as a narrative literature review. Inclusion criteria were established as studies addressing this theme in English and Portuguese. The survey took place from August 2023 to January 2024, through electronic searches on PubMed, LILACS, SciELO, in addition to grey literature such as Google Scholar and secondary free searches. Health Sciences Descriptors (DeCS/MeSH) were crossed with the boolean operator: "differential diagnosis" AND "aphthous ulcer." RAU is characterized by round, superficial ulcers that may persist for days or months. Its diagnosis is based on the patient's history and the characteristics of the lesion. It is crucial to eliminate possible causes of oral ulcers to avoid confusion with other lesions, such as traumatic, immunomediated, or even carcinoma ulcers. Various therapies are employed in the management of RAU, such as corticosteroids, vitamin supplements, ozone therapy, and low-level laser. Therefore, understanding the history of lesions is fundamental for differentiation, and given the diversity of therapies, studies focusing on this aspect are essential.
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Ferimentos e Lesões , Úlceras Orais , Úlceras Orais/tratamento farmacológico , Úlceras Orais/terapia , Diagnóstico Diferencial , BocaRESUMO
O tratamento oncológico pode ocasionar diversas alterações orais durante e após o processo que podem acarretar déficit de mastigação, fonação, deglutição, além de dor e nutrição deficiente. Nesse contexto, ainda existe uma busca na comprovação do uso de fitoterápicos na oncologia com presença de lesões na cavidade oral ocasionadas pela oncoterapia, para tratamento destas. Assim, o trabalho em questão se trata de uma revisão de literatura, com objetivo de relatar, a partir da análise de periódicos, a observação de efeitos favoráveis para o tratamento das lesões orais por consequência da quimioterapia e radioterapia, através do uso dos fitoterápicos: Camomila (Matricaria chamomilla), Romã (Punica granatum) e extrato de Própolis (Apis mellifera L.). Realizou-se busca eletrônica de dados através do Scholar Google e PubMed, utilizando os Descritores em Ciências da Saúde (Medicamentos Fitoterápicos, Neoplasias, Protocolos Antineoplásicos). Os estudos apresentados neste trabalho evidenciam que o uso destes fitoterápicos pode auxiliar no tratamento das lesões decorrentes da quimioterapia e radioterapia, por possuírem diversas ações anti-inflamatórias, antimicrobianos, antitumorais, entre outras. Por fim, os fitoterápicos apresentados podem ser considerados como uma nova alternativa sendo assim uma escolha favorável de tratamento em relação aos medicamentos convencionais (alopatia), tanto pelo fato de serem naturais e não reduzirem mais ainda a imunidade do paciente, como também pelo seu baixo custo.
The cancer treatment can cause several oral changes during and after the process that can lead to deficits in chewing, phonation, swallowing, in addition to pain and poor nutrition. In this context, there is still a search to prove the use of herbal medicines in oncology with lesions in the oral cavity caused by oncotherapy. Thus, the work in question is a literature review, with the objective of reporting, from the analysis of journals, the observation of favorable effects for the treatment of oral lesions as a result of chemotherapy and radiotherapy, through the use of herbal medicines: Chamomile (Matricaria chamomilla), Pomegranate (Punica granatum) and Propolis extract (Apis mellifera L.). Electronic data search was carried out through Scholar Google and PubMed, using the Health Sciences Descriptors (Phytotherapic Drugs, Neoplasms, Antineoplastic Protocols). The studies presented in this work show that the use of these herbal medicines can help in the treatment of injuries resulting from chemotherapy and radiotherapy, as they have several anti-inflammatory, antimicrobial and anti-tumor actions, among others. Finally, the herbal medicines presented can be considered as a new alternative, thus being a favorable treatment choice in relation to conventional medicines (allopathy), both because they are natural and do not further reduce the patient's immunity, but also because of their low cost.
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Ferimentos e Lesões , Práticas Alopáticas , Protocolos Antineoplásicos , Medicamento Fitoterápico , Boca , Neoplasias , Radioterapia , Tratamento FarmacológicoRESUMO
Los empiemas fúngicos representan una entidad potencialmente fatal, con tasas de mortalidad elevadas en la mayoría de las series. Se presenta el caso de un empiema por Candida albicans tratado exitosamente en un paciente diabético. Se demuestra la importancia del inicio precoz y agresivo del tratamiento.
Fungal empyemas represent a potentially fatal entity, with high mortality rates in most series. A case of empyema due to Candida albicans successfully treated in a diabetic patient is presented, demonstrating the importance of early and aggressive initiation of treatment.
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Humanos , Masculino , Adulto , Derrame Pleural , Candida albicans/isolamento & purificação , Doença Celíaca , Diabetes Mellitus , Empiema/tratamento farmacológico , Toracoscopia , Ferimentos e Lesões , Incidência , Mortalidade , Febre , Laparotomia , Leucocitose , Antifúngicos/uso terapêuticoRESUMO
OBJECTIVE: to analyze the preparation of nurses from the Brazilian Expeditionary Force to work in the air transport of wounded people during World War II. METHOD: historical-social study, of a qualitative nature, based on the work entitled "Nurses with the FAB on the Italian front: 1944-1945", written by nurse Izaura Barbosa Lima. The data results from a bibliographic survey, the use of documentary sources and database consultations, with the material being treated using Thematic Content Analysis. RESULTS: the following categories emerged: Professional trajectory of Nurse Izaura; Commuting between the United States and Italy; and the Nursing Air Evacuation Course. CONCLUSION: the study highlights the pioneering role of nurses in the Brazilian troops sent to Italy, the necessary preparation and completion of the course to join the air transport service for the wounded. Its achievement assumes relevance for contributing new elements to the History of Brazilian Nursing, particularly regarding the establishment of the foundations of Brazilian female military nursing.
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Resgate Aéreo , Enfermagem Militar , II Guerra Mundial , Brasil , História do Século XX , Enfermagem Militar/história , Resgate Aéreo/história , Humanos , Itália , Estados Unidos , Ferimentos e Lesões/história , Ferimentos e Lesões/enfermagemRESUMO
BACKGROUND: Falls are known to cause injuries ranging from minor to severe, resulting in local or systemic lesions. Addressing prognostic factors associated with falls is crucial for preventing this adverse event through the implementation of patient care protocols. This study aimed to explore the epidemiological, clinical, and pharmacological prognostic factors influencing falls in adult and elderly patients, assessing the timing and impact of these factors using survival curve analysis. METHODS: A retrospective observational cohort study included 176 hospitalized patients experiencing falls, categorized into adults (<60 years) and elderly (≥60 years). Binomial tests and logistic regression assessed variable associations, while Kaplan-Meier curves and Cox proportional hazards models analyzed survival. RESULTS: Overall, 25.9 % of adults and 33.3 % of the elderly experienced some form of injury (minor or moderate). Patients were alone during the fall in 77.6 % of cases for those under 60, compared to 50 % for those 60 and older (p < 0.001). Falls from own height were the most common, occurring in 46.6 % of patients under 60 years and 66.7 % of elderly patients (p = 0.011). Among adults under 60, factors such as past alcohol history (p = 0.0276), falling alone (p = 0.0002), benzodiazepine use (p = 0.0001), antiarrhythmic/antihypertensive medication (p = 0.0005), and antipsychotics (p = 0.0001) were significantly associated with falls. In the elderly, significant factors included falling from one's own height (p = 0.0112), muscle weakness (p = 0.0183), gait disorders (p = 0.0443), vasodilators (p = 0.0107), antihistamines (p = 0.0003), and hypoglycemic agents (p = 0.0041). Survival curve analysis indicated women under 60 had a worse prognosis for falls compared to elderly women (p = 0.038). For the elderly, opioid use (p = 0.045) and muscle weakness (p = 0.037) represented poor prognostic factors compared to adults under 60. In Cox regression, only female sex in patients under 60 showed a higher risk (HR=1.47) compared to women over 60 (p = 0.0014). Although not significant in multivariate analysis, muscle weakness (p = 0.066) and opioid use (p = 0.0545) had proportional hazards of 1.37 and 1.12, respectively. CONCLUSION: Female sex indicated poorer prognosis in <60 s, while opioids and muscle weakness were concerning for the elderly. These findings emphasize the need for tailored care protocols to stratify patient fall risk and prognosis during hospitalization and develop effective preventive strategies in healthcare.
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Acidentes por Quedas , Hospitalização , Humanos , Acidentes por Quedas/estatística & dados numéricos , Masculino , Feminino , Estudos Retrospectivos , Idoso , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Hospitalização/estatística & dados numéricos , Adulto , Idoso de 80 Anos ou mais , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/complicaçõesRESUMO
BACKGROUND: Initiated in 2021, a Brazilian project aims to establish a national injury registry, compiling comprehensive data on events and individuals across the country, irrespective of injury severity. The registry integrates information from prehospital and hospital care, diverse health systems lacking interoperability, and sectors such as firefighters and the police. Its primary goal is to enhance health surveillance by providing timely, high-quality information, guiding prevention strategies, and informing policy making. The project still aims to reduce long-term morbidity and mortality associated with injuries. OBJECTIVE: A knowledge gap remains regarding the effects of injury registries in relation to policies and injury outcomes. This protocol outlines a systematic review and meta-analysis to answer "What is the effect of implementation and use of injury registry data on policy making, hospitalization, and mortality?" METHODS: The systematic review follows PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, focusing on studies reporting results related to the implementation and use of injury registries, including trauma registries. Outcomes of interest include policy making, hospitalization rates or duration, and mortality. Registries within well-defined administrative boundaries will be included. Data will be collected from PubMed, Embase, Scopus, Web of Science, Lilacs, and references. Records will be independently screened by 2 reviewers, with any disagreements resolved through arbitration by a third reviewer. Homogeneous studies, with 3 or more evaluating the same outcome, may undergo meta-analysis. Subgroup analyses by registry type, injury groups, and other selected variables of interest will be conducted. Sensitivity analysis, risk of bias assessment, publication bias evaluation, and quality appraisal will also be performed. RESULTS: This systematic review will run from November 2023 to June 2024. No identical review was found. Search strategies were finalized, the bibliographic search started, duplicates were eliminated, and title and abstract screening began. Of 35 studies retrieved, 85 were excluded due to duplication, leaving 50 for selection. CONCLUSIONS: This study is timely, aligning with ongoing national efforts to implement an injury registry. By synthesizing available evidence, we will identify the potential of injury registries to guide the decisions of Brazilian policy makers. TRIAL REGISTRATION: PROSPERO CRD42023481528; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=481528. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/55029.
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Hospitalização , Metanálise como Assunto , Formulação de Políticas , Sistema de Registros , Revisões Sistemáticas como Assunto , Ferimentos e Lesões , Humanos , Brasil/epidemiologia , Hospitalização/estatística & dados numéricos , Revisões Sistemáticas como Assunto/métodos , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/epidemiologiaRESUMO
This cross-sectional study examines treatment received for falls from a section of the US-Mexico border wall with a focus on emergency medical services activation and type of treatment.
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Acidentes por Quedas , Humanos , Masculino , México/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Feminino , Adulto , Pessoa de Meia-Idade , Serviços Médicos de Emergência/estatística & dados numéricos , Estados Unidos/epidemiologia , Idoso , Adolescente , Adulto Jovem , Ferimentos e Lesões/epidemiologiaRESUMO
BACKGROUND The association between hydraulic forces generated during contrast injection and the risk of coronary injury is poorly understood. We evaluated whether contrast injections increase intracoronary pressures beyond resting levels and estimated the risk of hydraulic propagation of coronary dissections. METHODS This prospective multicenter study included patients with non-flow-limiting coronaries. A continuous 60-second pressure recording was taken in 5 predetermined locations during contrast injections: distal, mid, and proximal vessel, catheter tip, and inside catheter. The primary endpoint was the change in intracoronary peak pressure between resting and injections in each location. RESULTS 269 pressure recordings (58 vessels, 52 patients) were analyzed. Injections led to small increase in peak pressure in the distal (mean difference [MD]: +4.5 mm Hg; 95% CI: 1.5-7.4), mid (MD: +4.1 mm Hg; 95% CI: 1.4-6.9), and proximal (MD: +5.1 mm Hg; 95% CI: 2.5-7.7) vessel locations, and much higher increases at the catheter tip (MD: +11.7 mm Hg; 95% CI: 5.8-17.7) and inside catheter (MD: +77.5 mm Hg; 95% CI: 64.5-90.4). Compared with the distal vessel, pressure changes were only significant at the catheter tip (+10 mm Hg; P < 0.01) and inside catheter (+79.1 mm Hg; P<0.01). CONCLUSIONS Contrast injections lead to negligible changes in intracoronary pressures beyond the catheter tip. Although injections should be avoided when dissections are close to the catheter, it is unlikely that they would cause injuries beyond the catheter tip.
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Humanos , Ferimentos e Lesões , Cateterismo Cardíaco , Meios de Contraste , HemodinâmicaRESUMO
OBJECTIVES: Identify the frequency of recurrent violence in cases reported in Espírito Santo and the associated factors. METHODS: Cross-sectional study. Which included data on violence in Espírito Santo from 2011 to 2018, from the Notifiable Diseases Information System, and, Statistical analyzes were performed using the chi-square test and Poisson regression. RESULTS: 54.2% (N:14.966) of reported cases of violence are repeated, and higher prevalences were associated with female sex (PR:1.54), child (PR: 1.29) or elderly victims (PR: 1.25), the presence of disabilities/disorders (PR:1.42) and occurrence in urban/peri-urban areas (PR: 1.10). Furthermore, there is a greater frequency of injuries caused by a single aggressor (PR: 1.20), man (PR: 1.28), aged 25 or over (PR: 1.09), known to the victim (PR: 2.81) and at home (PR: 1.69). CONCLUSION: The reported cases of violence showed a high frequency of recurrence, and were associated with the studied characteristics of the victim, the aggressor and the event.
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Recidiva , Violência , Humanos , Masculino , Estudos Transversais , Feminino , Adulto , Violência/estatística & dados numéricos , Criança , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Adolescente , Brasil/epidemiologia , Pré-Escolar , Lactente , Prevalência , Ferimentos e Lesões/epidemiologiaRESUMO
OBJECTIVE: Falls are a serious cause of morbidity and mortality among older people. One of the underlying causes of falls is dehydration. Therefore, ultrasonography has become an essential tool for evaluating volume status in the emergency department. However, the effect of volume status on falls in older people has not been evaluated before. The aim of this study was to determine the relationship between the inferior vena cava collapsibility index and the injury severity score in older patients who presented with fall-related injuries to the emergency department. METHODS: A total of 66 patients were included in the study. The injury severity score was used as the trauma severity score, and the Edmonton Frail Scale was used as the frailty scale. Volume status was evaluated with inferior vena cava collapsibility index. The primary outcome measure was defined as the correlation between inferior vena cava collapsibility index and injury severity score. Secondary outcome measures were defined as the effect of inferior vena cava collapsibility index and injury severity score on hospitalization and mortality. RESULTS: There was no significant correlation between injury severity score and inferior vena cava collapsibility index (p=0.342). Neither inferior vena cava collapsibility index nor injury severity score was an indicator of the mortality of these patients. However, injury severity score was an indicator of hospitalization. The mean Edmonton Frail Scale score was an indicator of mortality among older people who experienced falls (p=0.002). CONCLUSION: Inferior vena cava collapsibility index cannot be used to predict trauma severity in older patients who have experienced falls admitted to the emergency department.
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Acidentes por Quedas , Escala de Gravidade do Ferimento , Veia Cava Inferior , Humanos , Acidentes por Quedas/estatística & dados numéricos , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/lesões , Feminino , Masculino , Idoso , Idoso de 80 Anos ou mais , Ultrassonografia , Serviço Hospitalar de Emergência , Ferimentos e Lesões/diagnóstico por imagem , Ferimentos e Lesões/fisiopatologia , Ferimentos e Lesões/complicações , Ferimentos e Lesões/mortalidade , Hospitalização/estatística & dados numéricos , Índices de Gravidade do Trauma , Avaliação Geriátrica , FragilidadeRESUMO
In recent years, systemic inflammation has emerged as a pivotal player in the development and progression of various degenerative diseases. This complex, chronic inflammatory state, often undetected, can have far-reaching consequences for the body's physiology. At the molecular level, markers such as C-reactive protein, cytokines and other inflammatory mediators serve as indicators of systemic inflammation and often act as predictors of numerous musculoskeletal diseases and even certain forms of cancer. The concept of 'meta-inflammation', specifically referring to metabolically triggered inflammation, allows healthcare professionals to understand inflammatory responses in patients with metabolic syndrome. Driven by nutrient excess and the expansion of adipose tissue, meta-inflammation is closely associated with insulin resistance, further propagating the metabolic dysfunction observed in many Western societies. Wound persistence, on the other hand, exacerbates the detrimental effects of prolonged inflammation at the local level. Acute inflammation is a beneficial and essential process for wound healing and infection control. However, when inflammation fails to resolve, it can impede the healing process, leading to chronic wounds, excessive scarring and even the activation of fibrotic pathways. This approach significantly reduces the efficacy of regenerative biological therapies. Our review focuses on the vital role of proteins, vitamins and minerals in collagen synthesis and cell proliferation for tissue healing. We also examine hormonal influences on regeneration, noting the negative effects of imbalances, and emphasize glucose regulation's importance in creating a stable environment for chronic wound healing.
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Inflamação , Doenças Musculoesqueléticas , Cicatrização , Humanos , Cicatrização/fisiologia , Doenças Musculoesqueléticas/metabolismo , Doenças Musculoesqueléticas/fisiopatologia , Doença Crônica , Inflamação/metabolismo , Ferimentos e Lesões/metabolismo , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Síndrome Metabólica/metabolismoRESUMO
BACKGROUND: Cadaveric skin grafts were initially used for the management of acute burn wounds. The biological coverage of the wound improves the quality of the wound bed, which prepares it to receive an autologous skin graft. The benefits of cadaveric skin graft in burn wounds have led to its use in the management of acute and chronic wounds of diverse etiologies. OBJECTIVE: To evaluate the use of cadaveric skin graft and subsequent autologous split-thickness skin graft (STSG) in the management of wounds of diverse etiologies at a single institution. MATERIALS AND METHODS: A retrospective analysis was performed of patients with wounds of different etiologies managed with cadaveric skin grafts followed by a second procedure in which autologous STSG was performed from May 2017 through May 2022 in the Plastic and Reconstructive Surgery Department of German Hospital, Buenos Aires, Argentina. RESULTS: A total of 25 patients with wounds of different etiologies were included. The mean affected body surface area (BSA) was 1.87%. The mean engraftment percentage of the cadaveric skin graft was 96.6%. The mean engraftment percentage of the STSG was 90.6%. All patients demonstrated improvement in local edema and inflammation, reduced secretions, and reduced pain after treatment. Two patients (8%) had complications, with 1 case of delayed healing of the donor site and 1 case of hypertrophic scarring. CONCLUSIONS: Cadaveric skin graft with subsequent STSG is a simple, safe, and effective alternative for the management of complex wounds of diverse etiologies. This technique is particularly useful in patients with multiple comorbidities who are at risk of recurrence and of developing multiple wounds during their lifetime.
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Cadáver , Transplante de Pele , Cicatrização , Humanos , Transplante de Pele/métodos , Estudos Retrospectivos , Masculino , Feminino , Cicatrização/fisiologia , Pessoa de Meia-Idade , Idoso , Adulto , Transplante Autólogo , Ferimentos e Lesões/cirurgia , Ferimentos e Lesões/terapia , Resultado do Tratamento , Queimaduras/terapia , Queimaduras/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Idoso de 80 Anos ou maisRESUMO
Studies shows that 1%-2% of world population will develop chronic skin wound in their lifetime. Nowadays, the patient report outcome measure (PROM) questionnaires are used to evaluate the patient's quality of life. However, several PROM's questionnaires analyse specific chronic wounds. In this sense, WOUND-Q toll was designed to evaluate all types of wounds. Because of the WOUND-Q wide applicability, the use of WOUND-Q is helpful for other countries. This study aimed to translate and adapt WOUND-Q tool for Brazilian Portuguese language. Two independent translators translated the WOUND-Q questionnaire from English to Brazilian Portuguese. Then these translators build Version 1 (T1) and version 2 (T2). In a consensus meeting, a third senior author defined the final version. In the back translation process, an English proficient translator translated the Brazilian Portuguese version to the original version. After another consensus, a final version was defined. Then, our group performed a cognitive test to validate this version. After the first translation, the comparison of version T1 and T2 achieved an intraclass correlation coefficient of 77%. The back translation showed the need of few adjustments. For the cognitive test, the mean age was 44.1 ± 9.3 years. Only one question was changed to improve comprehensiveness. In the review phase, few adjustments were performed to the final Brazilian Portuguese version, mostly regarding verbal tense and prepositions. In conclusion, this study successfully translated and adapted the WOUND-Q questionnaire for a Brazilian Portuguese version.
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Comparação Transcultural , Qualidade de Vida , Traduções , Humanos , Brasil , Inquéritos e Questionários , Masculino , Feminino , Adulto , Reprodutibilidade dos Testes , Medidas de Resultados Relatados pelo Paciente , Pessoa de Meia-Idade , Cicatrização , Ferimentos e Lesões , Doença Crônica , Idioma , Tradução , Psicometria/métodosRESUMO
There are several reasons for skin damage, including genetic factors, disorders, acute trauma, hard-to-heal wounds, or surgical interventions. Whatever the cause, wounds have a substantial impact on people who experience them, their caregivers and the healthcare system. Advanced wound care products have been researched and developed, providing an opportunity for faster and more complete healing. Tissue engineering (TE) is a promising strategy that can overcome limitations when choosing a graft for a wound. Amniotic membrane is a highly abundant, readily available, and inexpensive biological tissue that does not raise ethical concerns, with many applications in different fields of TE and regenerative medicine. It has attractive physical characteristics, such as elasticity, rigidity and mechanical strength, among others. The effects can also be potentiated by association with other substances, such as hyaluronic acid and growth factors. This paper describes new perspectives involving the use of amniotic membranes.
Assuntos
Âmnio , Engenharia Tecidual , Cicatrização , Humanos , Âmnio/transplante , Ferimentos e Lesões/terapia , Medicina Regenerativa/métodosRESUMO
High-energy trauma is defined as severe organic injuries resulting from events that generate a large amount of kinetic, electrical, or thermal energy. It represents a significant public health concern, accounting for 10% of global mortality. This article aims to describe the epidemiology of high-energy trauma in Chile. Specifically, it seeks to compare the mortality rate per 100 000 inhabitants among member countries of the World Health Organization (WHO), provide a descriptive analysis of notifications under the Explicit Health Guarantees (GES) for the health issue of polytraumatized patients, and analyze the trend in the mortality rate due to external causes in Chile. This study employs an ecological design using three open-access databases. First, the WHO database on deaths from traffic accidents in 2019 was used. Then, the GES database was consulted for the "Polytraumatized" issue between 2018 and 2022. Finally, the Chilean Department of Health Statistics database on causes of death between 1997 and 2020 was utilized. In 2019, Chile ranked in the middle regarding the mortality rate per 100 000 inhabitants due to traffic accidents. GES notifications for polytrauma predominantly involved men aged 20 to 40 years and those affiliated with the public health system, highlighting a primary focus for prevention efforts. Mortality from accidents showed a decreasing trend, with significant structural changes identified in 2000 and 2007.
El trauma de alta energía se define como lesiones orgánicas graves resultantes de eventos que generan una gran cantidad de energía cinética, eléctrica o térmica. Constituye una importante preocupación de salud pública, representando el 10% de la mortalidad mundial. El objetivo de este artículo es describir la epidemiología del trauma de alta energía en Chile. Específicamente, se busca comparar la tasa de mortalidad por 100 000 habitantes entre los países miembros de la Organización Mundial de la Salud (OMS), realizar un análisis descriptivo de las notificaciones por Garantías Explícitas en Salud (GES) del problema de salud "politraumatizado", y analizar la tendencia de la tasa de fallecidos por causa externa en Chile. El presente estudio tiene un diseño ecológico, utilizando tres bases de datos de acceso abierto. Primero, se utilizó la base de datos de la OMS sobre fallecidos por accidentes automovilísticos en 2019. Luego, se consultó la base de datos del programa Garantías Explícitas en Salud para el problema "politraumatizado" entre los años 2018 y 2022. Finalmente, se utilizó la base de datos del Departamento de Estadísticas de Salud de Chile sobre causas de muerte entre 1997 y 2020. En 2019, Chile ocupó una posición intermedia en cuanto a la tasa de mortalidad por 100 000 habitantes debido a accidentes de tráfico. Las notificaciones el programa Garantías Explícitas en Salud por politraumatismo fueron predominantemente en hombres de entre 20 y 40 años, afiliados al sistema de salud pública. Por este motivo, el foco principal de prevención debe centrarse en este grupo. La mortalidad por accidentes mostró una tendencia decreciente, identificándose cambios estructurales significativos en los años 2000 y 2007.
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Acidentes de Trânsito , Bases de Dados Factuais , Traumatismo Múltiplo , Sistema de Registros , Chile/epidemiologia , Humanos , Acidentes de Trânsito/estatística & dados numéricos , Acidentes de Trânsito/mortalidade , Masculino , Adulto , Feminino , Adulto Jovem , Pessoa de Meia-Idade , Traumatismo Múltiplo/epidemiologia , Traumatismo Múltiplo/mortalidade , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/mortalidade , Saúde Pública , Distribuição por Sexo , Adolescente , Distribuição por Idade , Organização Mundial da Saúde , IdosoRESUMO
INTRODUCTION: Hemorrhage is a leading cause of death in trauma. Prehospital hemorrhage control techniques include tourniquet application for extremity wounds and direct compression; however, tourniquets are not effective in anatomic junctions, and direct compression is highly operator dependent. Balloon catheter compression has been employed previously in trauma care, but its use has been confined to the operating room and restricted to specific anatomic injuries. METHODS: In a single-center retrospective review, we describe a technique for balloon catheter compression for hemorrhage control that can be employed across the continuum of trauma care, from the prehospital setting to the trauma bay, the operating room, and postoperative period. RESULTS: Of 18,303 trauma patients in Venezuela, 45% of the 1757 patients with vascular injuries received Foley catheter compression for hemorrhage control. Of these catheters, the majority (75%) were placed in the emergency department, 5% in the prehospital setting, and 20% in the operating room. Over half (53.2%) of the balloon catheters were placed for hemorrhage control in non-compressible anatomic junctions. CONCLUSIONS: Foley catheter balloon compression is a useful addition to a provider's arsenal of hemorrhage control techniques, as it is effective in anatomic junctions, preserves collateral circulation through focused compression, and requires minimal active physical attention to maintain hemostasis.
Assuntos
Hemorragia , Torniquetes , Humanos , Estudos Retrospectivos , Hemorragia/terapia , Hemorragia/etiologia , Hemorragia/prevenção & controle , Masculino , Feminino , Adulto , Oclusão com Balão/métodos , Técnicas Hemostáticas/instrumentação , Pessoa de Meia-Idade , Ferimentos e Lesões/terapia , Ferimentos e Lesões/complicações , Serviços Médicos de Emergência , Lesões do Sistema Vascular/terapiaRESUMO
INTRODUCTION: In high-income countries, quality improvement interventions and research are usually guided by trauma registries. In low- and middle-income countries, the implementation of trauma registries has been limited mainly for cost reasons. OBJECTIVE: To analyze the budgetary impact of the implementation of trauma registries in Argentina. METHODS: We estimated direct costs of implementing trauma registries in public hospitals located in cities with a population over 50,000 inhabitants. In large urban areas, we selected hospitals by estimating a minimum volume of 240 severe trauma admissions/year and using the NBATS-2 instrument with geolocation techniques. We estimated costs based on a micro-costing approach of a trauma registry developed by Fundación Trauma. Scenario analysis was carried out restricting the population to hospitals from bigger cities and/or with higher concentration of trauma patients' care. For the high budget impact threshold, we used the total health spending estimation, and alternatively the health spending of the public sector. RESULTS: For the base case, 139 hospitals from 104 cities were included, comprising 175,605 injury-related discharges and 13,707 severely injured patients/year. The average cost for the initial three years was USD 3,753,085 (21.4 USD/per patient), falling below the high budget impact thresholds. The scenarios analysis showed a significantly costs reduction. CONCLUSIONS: The implementation of trauma registries in Argentina would be affordable, and in consequence, it would improve the coordination, management and quality of care for this great public health issue.
Assuntos
Hospitais Públicos , Sistema de Registros , Ferimentos e Lesões , Humanos , Argentina/epidemiologia , Ferimentos e Lesões/economia , Ferimentos e Lesões/terapia , Ferimentos e Lesões/epidemiologia , Hospitais Públicos/economia , Orçamentos , Centros de Traumatologia/economia , Melhoria de Qualidade/economia , Análise Custo-Benefício , Custos de Cuidados de Saúde/estatística & dados numéricosRESUMO
INTRODUÇÃO: O manejo dos pacientes vítimas de PAF possui vertentes divergentes a respeito do tratamento cirúrgico, que pode ser realizado de forma imedata ou tardia. Em lesões auto-infligidas, a distância entre a arma e a região acometida é menor, causando consequências estéticas e funcionais mais devastadoras. Aliado ao fato desse tipo de trauma criar uma ferida suja devido à comunicação com a cavidade oral e seios paranasais, o manejo das lesões representam um desafio mesmo à cirurgiões experientes. OBJETIVO: Estre trabalho relata o manejo cirúrgico de uma ferida auto-infligida por arma de fogo que resultou em avulsão dos tecidos moles na região maxilofacial. DESCRIÇÃO DO CASO: Paciente do sexo masculino, 35 anos, vítima de projétil de arma de fogo auto-infligido em região maxilofacial, cursando com extenso ferimento em região de língua e mento. Clinicamente, o paciente não apresentava sinais de fratura em ossos da face. Ambos os ferimentos apresentavam secreção purulenta e o paciente manifestava disfonia devido a grande destruição tecidual. CONSIDERAÇÕES FINAIS: O tratamento de ferimentos por arma de fogo não só é um grande desafio para o cirurgião, como para toda a equipe multidisciplinar requerida para tais casos, visto que não há protocolos bem definidos para o tratamento dessas lesões(AU)
INTRODUCTION: The management of patients who are victims of FAP has divergent aspects regarding surgical treatment, which can be performed immediately or late. In self-inflicted injuries, the distance between the weapon and the affected region is smaller, causing more devastating aesthetic and functional consequences. Allied to the fact that this type of trauma creates a dirty wound due to the communication with the oral cavity and paranasal sinuses, the management of injuries represents a challenge even for experienced surgeons. OBJECTIVE: This paper reports the surgical management of a self-inflicted gunshot wound that resulted in soft tissue avulsion in the maxillofacial region. CASE DESCRIPTION: Male patient, 35 years old, victim of a self-inflicted firearm projectile in the maxillofacial region, coursing with extensive injury in the region of the tongue and chin. Clinically, the patient did not show signs of facial bone fractures. Both wounds had purulent secretion and the patient had dysphonia due to extensive tissue destruction. FINAL CONSIDERATIONS: The treatment of gunshot wounds is not only a great challenge for the surgeon, but also for the entire multidisciplinary team required for such cases, since there are no well-defined protocols for the treatment of these injuries(AU)
Assuntos
Humanos , Masculino , Adulto , Língua/lesões , Infecção dos Ferimentos , Ferimentos por Arma de Fogo , Palato Duro/lesões , Ferimentos e Lesões , Ferimentos Penetrantes , Palato Duro , Equimose , Edema , Traumatismos MaxilofaciaisRESUMO
Este estudo avaliou um novo protocolo para tratar feridas de difícil cicatrização em membros superiores, utilizando produtos com polihexametileno biguanida 0,2% e associações com bandagem de óxido de zinco, em ambulatórios em Campos dos Goytacazes e no Hospital Santa Casa de Misericórdia de São João da Barra, RJ. Dez pacientes com feridas graves nos membros superiores foram selecionados com base em critérios específicos. Os pacientes apresentavam feridas graves, com comprometimento na cicatrização. Os curativos incluíram sabonete com polihexametileno biguanida 0,2% e associações com bandagem impregnada com óxido de zinco de Unna, trocados a cada 4-5 dias. O tratamento mostrou-se eficaz, reduzindo edema e promovendo a reabsorção do líquido intersticial pela rede linfática, o que melhorou a circulação sanguínea local e acelerou a cicatrização. Os resultados indicam que o protocolo com bandagem de óxido de zinco de Unna é viável para centros de tratamento de feridas de difícil cicatrização.(AU)
This study evaluated a new protocol for treating difficult-to-heal wound on upper limbs, using products with polyhexamethylene biguanide 0.2 % and combinations with zinc oxide bandages, in outpatient clinics in Campos dos Goytacazes and at the Santa Casa de Misericórdia Hospital in São João da Barra, RJ. Ten patients with severe wounds on the upper limbs were selected based on specific criteria. The patients had severe wounds with impaired healing. The dressings included soap with polyhexamethylene biguanide 0.2 % and combinations with bandages impregnated with Unna's zinc oxide, changed every 4-5 days. The treatment proved to be effective, reducing edema and promoting the reabsorption of interstitial fluid by the lymphatic network, which improved local blood circulation and accelerated healing. The results indicate that the protocol with Unna's zinc oxide bandage is viable for centers treating difficult-to-heal wounds.(AU)
Este estudio evaluó un nuevo protocolo para el tratamiento de heridas de difícil cicatrización en los miembros superiores, utilizando productos con polihexametileno biguanida al 0,2% y combinaciones con vendajes de óxido de zinc, en consultorios ambulatorios de Campos dos Goytacazes y del Hospital Santa Casa de Misericórdia de São João da Barra, RJ. Se seleccionaron diez pacientes con heridas graves en las extremidades superiores según criterios específicos. Los pacientes presentaban heridas graves con problemas de cicatrización. Los apósitos incluyeron jabón con polihexametileno biguanida al 0,2% y asociaciones con vendaje impregnado con óxido de zinc de Unna, cambiados cada 4-5 días. El tratamiento demostró ser eficaz, reduciendo el edema y favoreciendo la reabsorción del líquido intersticial por la red linfática, mejorando la circulación sanguínea local y acelerando la curación. Los resultados indican que el protocolo de vendaje con óxido de zinc de Unna es viable para centros que tratan heridas de difícil curación.(AU)