Compartment Syndrome Secondary to Bothrops spp. Envenomation in Triângulo Mineiro, Region, Minas Gerais, Brazil.

BACKGROUND: Snakebite is a neglected global health problem with high morbidity. We describe compartment syndrome (CS) cases related to snakebites by Bothrops spp. METHODS: The medical records of patients admitted with snakebites envenomation were reviewed. RESULTS: Of 47 patients with Bothrops spp. envenomation (4 male; mean age: 42 years), 7 (15%) developed CS. The mean time to antivenom administration was 9.5 hours. The time to fasciotomy was variable. Seven patients developed infection and four had acute kidney injury. CONCLUSIONS: The incidence of CS is higher than that reported previously. This may be due to the clinical severity and long delay before administering antivenom.

Compartment Syndrome Secondary to Bothrops spp. Envenomation in Triângulo Mineiro, Region, Minas Gerais, Brazil

ABSTRACT Background: Snakebite is a neglected global health problem with high morbidity. We describe compartment syndrome (CS) cases related to snakebites by Bothrops spp. Methods: The medical records of patients admitted with snakebites envenomation were reviewed. Results: Of 47 patients with Bothrops spp. envenomation (4 male; mean age: 42 years), 7 (15%) developed CS. The mean time to antivenom administration was 9.5 hours. The time to fasciotomy was variable. Seven patients developed infection and four had acute kidney injury. Conclusions: The incidence of CS is higher than that reported previously. This may be due to the clinical severity and long delay before administering antivenom.

Interface entre Oferta de Vagas de Residência Médica, Demanda por Médicos Especialistas e Mercado de Trabalho / Interface between the Medical Residency, Demand for Medical Specialists and the Labor Market

RESUMO A formação de médicos especialistas no Brasil vem sofrendo uma série de interferências ao longo do tempo, entre as quais a recomendação de pautar a oferta/ampliação de vagas de residência médica em necessidades regionais. Para direcionar a ampliação de vagas de residência de determinada região, foi realizado um diagnóstico da realidade local de atendimento especializado. Para isso, neste estudo, avaliou-se ao longo de cinco anos: a demanda de consultas por médicos especialistas na rede municipal de saúde, a quantidade de vagas de residência ofertadas nas universidades do município e sua ocupação conforme especialidade, e o número de médicos especialistas atuantes no setor público e privado. Constatou-se que existe grande demanda por consultas de médicos especialistas sem acolhimento pela rede pública de saúde. As especialidades com maior número de encaminhamentos não atendidos foram Oftalmologia, Neurologia, Endocrinologia, Cardiologia, Cirurgia Vascular e Gastroenterologia. Em paralelo, a oferta de vagas de residência foi relevante para o número de egressos locais. No entanto, constatou-se manutenção de vagas ociosas em todos os anos avaliados, especialmente para residência de Medicina de Família e Comunidade. Por fim, o número de médicos especialistas atuantes no setor privado foi muito superior ao dos atuantes no setor público, inclusive para as especialidades com maior carência de atendimento na rede pública. Mesmo com a mobilidade que caracteriza a formação médica complementar por meio da residência, as necessidades locais poderiam influenciar a fixação dos médicos especialistas. Cabe uma discussão sobre os parâmetros norteadores da oferta/ampliação de vagas de residência médica, ao se considerar inclusive que o reduzido número de especialistas em Medicina da Família e Comunidade atuante na rede pode interferir no aumento de encaminhamento a outras especialidades. Assim, a identificação das demandas em saúde é insuficiente para nortear a oferta de vagas de residência, em especial ao se considerar a formação do médico especialista frente ao mercado de trabalho.

ABSTRACT The training of medical specialists in Brazil has suffered a series of interferences over time, including the recommendation that the offer/expansion of medical residency be based on regional needs. With a view to directing the expansion of residency vacancies in a given region, a diagnosis of the local reality of specialized care was proposed. To that end, this study was evaluated over five years: the demand for consultations by specialists in the municipal health network, the number of vacancies offered in the universities of the municipality and their occupation according to specialty, and the number of practicing medical specialists in the public and private sector. It was verified that there is a great demand for specialist consultations not met by the public health network. Ophthalmology, Neurology and Endocrinology were the specialties with the highest number of unattended referrals. In parallel, the offer of residency places was relevant to the number of local graduates; however, it was observed that vacancies remained idle in all evaluated years, especially for Family and Community Medicine residency. Finally, the number of specialist physicians working in the private sector was much higher than the number of those working in the public sector, including those with the greatest deficiency in public health care. Even with the mobility that characterizes the complementary medical training through residency, local necessities could influence the placement of the specialist physician. The discussion about the parameters of the offer/expansion of medical residency vacancies is considered, bearing in mind that the reduced number of specialists in Family and Community Medicine working in the network can interfere in the increased referrals to other specialties. Thus, the identification of health demands is insufficient to guide the expansion of residency vacancies, especially considering the training of the specialist physician in relation to the labor market.