Comparative study of trauma in the elderly and non-elderly patients in a University Hospital in Curitiba.

OBJECTIVE: To compare and identify differences in the profile of elderly and non-elderly patients with trauma. METHODS: We conducted a comparative, cross-sectional, retrospective, quantitative study with 3112 patients between November, 25th 2010 and February, 25th 2011; patients were classified into GI: elderly (60 years or older) and GA: non-elderly (13-59 years). We collected information on the mechanism of trauma, injuries and factors associated with the event, which were compared between groups by using chi-square, Student t and proportions tests. RESULTS: Falls were more frequent in GI, mostly from the standing height, while violence and traffic accidents (especially with motorcycles) were the most important in GA. Both groups possessed mild trauma (bruises, sprains) as the most frequent, followed by traumatic brain injury (TBI) and fractures. Femur fractures were more common in the elderly, and hand and wrist fractures in the nonelderly. The elderly were hospitalized fewer days and there was no difference as for complications, need for intensive care unit (ICU), or mortality between groups. CONCLUSION: Falls from the standing height are more frequent in the elderly, and motorcycle accidents and interpersonal violence in the non-elderly. Both groups had superficial injuries, head trauma and fractures as major injuries. The elderly were hospitalized for less time. There was no difference in the need for ICU, complications and mortality.

Estudo comparativo entre o trauma em idosos e não idosos atendidos em um Hospital Universitário de Curitiba / Comparative study of trauma in the elderly and non-elderly patients in a University Hospital in Curitiba

OBJETIVO: comparar e identificar diferenças no perfil de pacientes idosos e não idosos atendidos por trauma. MÉTODOS: estudo transversal comparativo quantitativo retrospectivo realizado com 3112 pacientes entre 25/11/2010 e 25/02/2011 que foram classificados em GI idosos (60 anos ou mais) e GA não idosos (13 a 59 anos). Foram coletadas informações sobre mecanismo, lesões e fatores associados ao acidente que foram comparados entre os grupos através da utilização dos testes χ2, t de Student e proporções. RESULTADOS: as quedas foram mais frequentes em GI em destaque as de própria altura enquanto que violência, quedas e acidentes de trânsito (em especial os com moto) foram os mais importantes em GA. Ambos os grupos possuíram traumas leves (contusões, entorses) como os mais frequentes, seguido por traumatismo crânio-encefálico (TCE) e fraturas. Nos membros inferiores as fraturas de fêmur foram mais comuns em idosos enquanto que fraturas de mão e punho nos não idosos. Os idosos ficaram menos dias internados e não houve diferença quanto a presença de complicações, necessidade de UTI ou mortalidade entre os grupos. CONCLUSÃO: Quedas de mesmo nível são mais frequentes em idosos e acidentes de moto, violência interpessoal em não idosos. Ambos os grupos apresentaram traumas superficiais, TCE e fraturas como principais lesões decorrentes do trauma. Os idosos ficaram menos dias internados. Não houve diferença quanto a necessidade de UTI, presença de complicações e mortalidade.

OBJECTIVE: To compare and identify differences in the profile of elderly and non-elderly patients with trauma. METHODS: We conducted a comparative, cross-sectional, retrospective, quantitative study with 3112 patients between November, 25th 2010 and February, 25th 2011; patients were classified into GI: elderly (60 years or older) and GA: non-elderly (13-59 years). We collected information on the mechanism of trauma, injuries and factors associated with the event, which were compared between groups by using chi-square, Student t and proportions tests. RESULTS: Falls were more frequent in GI, mostly from the standing height, while violence and traffic accidents (especially with motorcycles) were the most important in GA. Both groups possessed mild trauma (bruises, sprains) as the most frequent, followed by traumatic brain injury (TBI) and fractures. Femur fractures were more common in the elderly, and hand and wrist fractures in the nonelderly. The elderly were hospitalized fewer days and there was no difference as for complications, need for intensive care unit (ICU), or mortality between groups. CONCLUSION: Falls from the standing height are more frequent in the elderly, and motorcycle accidents and interpersonal violence in the non-elderly. Both groups had superficial injuries, head trauma and fractures as major injuries. The elderly were hospitalized for less time. There was no difference in the need for ICU, complications and mortality.

Sustainability assessment for agriculture scenarios in Europe's mountain areas: lessons from six study areas.

Sustainability assessment (SA) is a holistic and long-range strategic instrument capable of assisting policy-making in electing, and deciding upon, future development priorities. The outcomes of an SA process become more relevant and strengthened when conducted with multi-stakeholder engagement, which provides for multiple dialogues and perspectives. This was the object of research of the SA team in the context of BioScene (Scenarios for Reconciling Biodiversity Conservation with Declining Agriculture Use in Mountain Areas in Europe), a three-year project (2002-2005) funded by the European Union 5th Framework Program, which aimed to investigate the implications of agricultural restructuring and decline for biodiversity conservation in the mountain areas of Europe, using three distinct methodological streams: the ecological, the socio-economic, and the SA approaches. The SA approach drew on the previous two to assess the importance for biodiversity management of different scenarios of agri-environmental change and rural policy in six countries (France, Greece, Norway, Slovakia, Switzerland, and the United Kingdom), develop causal chains, include stakeholder views, and identify potential contributions for, or conflicts with, sustainability. This article tells how SA was used, what sustainability meant in each study area through different objectives of sustainability considered, discusses the methods used in SA, and the benefits arising. The SA was conducted by a team independent of any study area, who developed and oversaw the application of the SA methodology, assisting national teams, and developing a cross-country understanding of the sustainability of proposed scenarios in the different geographical and social contexts, and their implications for policy-making. Finally, it reflects on the persistent challenges of interdisciplinary research, compounded by multi-cultural teams, and concludes on the BioScene's lessons for the further development and application of SA.

[Hyper IgE syndrome. Opportune diagnosis and management]. / Sindrome de hiper IgE. Diagnóstico y manejo oportunos.

The hyperimmunoglobulin E syndrome was discribed for Buckley, and it also called the Job syndrome. There are two types: dominant autosomal and recessive autosomal. It is a primary, rare and complex immunodeficiency, characterized clinically by recurrent skin abscesses for Staphylococcus aureus, recurrent pneumonia, and pneumatoceles, hypereosinophylia, high serum levels of immunoglobulin E (> 2,000 Ul/mL), early eczema and late loss of primary dentition. Recently a STAT3 mutation has been described as origin of dominant autosomal hyperimmunoglobulin E syndrome. Since 1972, 250 cases have been reported around the world. The diagnosis is done with the Grimbacher criteria and the prognosis depends on the opportune diagnosis and treatment. The incidence is same in women and men. The differential diagnosis is with allergic bronchopulmonary aspergillosis, chronic granullomatose disease, T cell lymphoma, and atopic dermatitis. The treatment is with prophylactic antibiotic, intravenous immunoglobulin or recombinant INF gamma.

[Asthma or laryngeal amyloidosis? A report of a case and literature review]. / Asma o amiloidosis laríngea? Comunicación de un caso y revisión de la literatura.

The laryngeal amyloidosis is an uncommon disease accounting for 1% of all benign lesions of larynx. The commonest symptom is the dysphonia, sometimes accompanied by stridor, laryngeal globus sensation, dysphagia and, in rare occasions, cough, dyspnea and hemoptysis, specially when the tracheobronchial tree is also affected. This paper describes the case of a 30-year-old female patient, whose main symptoms were progressive dysphonia and dyspnea, admitted at allergy service to rule out asthma. The respiratory function tests showed obstruction in the medium and small caliber ways without reversibility with salbutamol. Biopsies of ventricular band, vocal cord and arytenoid stained with positive Congo red for amyloid tissue, established the laryngeal amyloidosis diagnosis. The complementary studies to rule out amyloid tissue in the remaining tracheobronchial tree were negative. Dyspnea had characteristics of laryngeal origin, caused by a pulmonary ventilation disorder provoked by the difficult arrival of air to alveoli, which caused the decreased partial pressure of oxygen and CO2.

[Anxiety and depression in asthmatic adults in comparison to healthy individuals]. / Ansiedad y depresión en asmáticos adultos en comparación con sujetos sanos.

BACKGROUND: Asthmatic patients present different degrees of anxiety and depression, being psychiatric pathologies the most frequent alterations related to this illness. In this country there is available information of asthma in children but just a few about adult patients. OBJECTIVES: To know the frequency of anxiety and depression in adult asthmatic patients, compare them with healthy individuals and determine their relationship with the severity of illness. PATIENTS AND METHODS: There were included asthmatic adults (GINA 2002) and as control group healthy individuals, using the HAD scale (Hospital Anxiety and Depression Scale) to determine the presence of anxiety and depression RESULTS: 120 patients participated, 60 in each group with a mean age of 34 years old in the group 1 (asthmatic) and 31 years old in group 2 (healthy individuals). The HAD scale results in group 1 showed that 30% of patients presented anxiety, and 8% showed depression; in group 2 18% had anxiety and 3% depression. There are more anxiety and depression in asthmatic patients than in healthy individuals, p < 0.05, correlation between depression and severity of asthma is r = 0.288. CONCLUSIONS: Anxiety is frequent in asthmatic patients, being less common the presence of depression but related with asthma severity. These results contrast with available information where up to 54% of asthmatic patient present anxiety and 30% depression, using the same scale HAD. It is necessary to identify these problems, with the object to give an integral an accurate treatment to the patient.

[Coexistent diseases in allergic asthmatic patients. A study of 100 cases]. / Enfermedades coexistentes en pacientes asmáticos alérgicos. Estudio de 100 casos.

BACKGROUND: The prevalence of asthma in Mexico is of 12% in the general population. Allergic illnesses diminish the quality of life and increase the costs of health services. In our country there is a lack of information about asthma and the concomitant presence of other allergic diseases in adults. OBJECTIVE: To identify the association of asthma with other allergic illnesses in adults. MATERIAL AND METHODS: Patients of the Allergy and Clinical Immunology Service diagnosed with allergic asthma, according to GINA, were included. The studied variables were: age, sex, and the presence of concomitant illnesses, doing a descriptive statistic analysis. RESULTS: 100 allergic asthmatic patients were included, 69% corresponded to female and 31% to male. The association with allergic illnesses was as follows: rhinitis 92%, conjunctivitis 33% and atopic dermatitis 5%. In 13% it was associated to sinusitis, which is considered an infectious illness. CONCLUSIONS: Asthma has an important association with allergic diseases, especially rhinitis. The female group, as well as the age group between the third and fourth decades of the life, were the most affected. It is important to identify the relationship between asthma and other allergenic entities in order to establish a specific treatment, to diminish medical attention costs and to improve the quality of life of the patients.