Urethral injury in penile fracture: a narrative review.

OBJECTIVE: To present the evolution and the recent data on the etiology, diagnosis, management and outcomes of penile fracture (PF) with concomitant urethral injury. MATERIALS AND METHODS: We searched the Pubmed database between 1998 and 2019 using the following key words: "penile fracture", "fracture of penis", "trauma to penis", "rupture of corpora cavernosa", "urethral injury", "urethral rupture" and "urethral reconstruction". RESULTS: The incidence of urethral lesion in patients with PF varies by geographic region and etiology. Blood in the meatus, hematuria and voiding symptoms are highly indicative of urethral rupture. The diagnosis of PF is eminently clinical and complementary exams are not necessary. The treatment consists of urethral reconstruction and the most common complications found are urethral stenosis and urethrocutaneous fistula. CONCLUSION: PF is an uncommon urological emergency, particularly in cases with urethral involvement. Urethral injury should be suspected in the presence of suggestive clinical signs, and diagnosis is usually clinical. Urgent urethral reconstruction is man-datory and produces satisfactory results with low levels of complications.

Commercial green tea from Portugal: Comprehensive microbiologic analyses.

In recent times green tea (GT) consumption has increased, due to the numerous studies that indicate a wide variety of health benefits following its regular consumption. The aim of this study was to assess the bioburden (bacteria and fungi) of bulk and bags of GT marketed in Lisbon and to obtain a more refined fungal burden characterization, including azole resistance profile. The bacteriota in tea bags before boiling ranged from lower than the detection limit to 1770 CFU.g-1, whereas in brew samples ranged from lower than the detection limit to 54.55 CFU.mL-1. In bulk samples before boiling ranged from lower than the detection limit to 2636 CFU.g-1, while after boiling ranged from lower than the detection limit to 72.73 CFU.mL-1. Fungal contamination on tea bags before boiling ranged from lower than the detection limit to 66.67 CFU.g-1 and after boiling, all samples presented results lower than the detection limit. Concerning bulk samples before boiling ranged from lower than the detection limit to 96.97 CFU.g-1, whereas after boiling ranged from lower the detection limit to 30.3 CFU.mL-1. Before boiling, the most common fungal species in the bagged tea (90.91 CFU.g-1; 45.45%) and bulk samples (66.67 CFU.g-1; 91.67%) was Aspergillus section Nigri. Fungal diversity was higher on bulk samples than in tea bags. Aspergillus section Nigri and Rhizopus sp. growth was observed mostly on itraconazole-supplemented Sabouraud dextrose agar media, which require further investigation. Aspergillus sections Fumigati and Nidulantes were detected by using real time PCR, but not in the GT samples in which they were identified through culture-based methods. A significantly reduction of bacterial contamination after boiling was observed, however fungal contamination with toxigenic potential was observed before and after boiling. Future research work needs to characterize in detail the mycotoxins contamination to allow a risk-benefit assessment to estimate the human health benefits and risks following tea consumption and to support policy-actions, if and when needed. The results also suggest that the conditions how tea is packed can influence the fungal diversity and this variable should be further investigated.

Case Report: An extremely rare occurrence of recurrent inguinal low-grade fibromyxoid sarcoma involving the scrotum.

Low-grade fibromyxoid sarcoma (LGFMS) is a rare sarcoma subtype. The most common tumor locations are the deep soft tissue of extremities or trunks. We report a rare case of recurrent LGFMS in the inguinal region involving the scrotum and both testicles. A 38-year-old male patient reported a history of multiple nodular lesions in the left inguinal region accompanied by local inflammation. The patient was submitted for local resection of the lesion at our institution, with histopathological diagnosis of LGFMS. He missed his follow-up, returning with a large bulge in the left inguinal region involving the scrotum with signs of tissue necrosis and local purulent discharge. Surgical exploration was performed and the patient underwent tumor resection in the left inguinal region and the entire scrotum, with bilateral orchiectomy, with the margins enlarged to the right inguinal region and proximal surface of the penis. Local reconstruction was performed with a left fascia lata tensor muscle flap and ipsilateral thigh coverage using partial skin graft. On microscopic examination, the tumor showed spindle cells arranged in bundles, with abundant collagen and myxoid stroma with interspersed prominent vessels. The immunohistochemical study carried out showed immunoreactivity with Ki67 (<5%), immunonegativity with desmin and S100, confirming the diagnosis of LGFMS. Postoperative recovery was good and no recurrence was seen after two years. The patient is in good health, realizing multidisciplinary outpatient follow-up and performing continuous testosterone replacement. Surgical resection with negative margins for localized disease remains the standard treatment for LGFMS.

Time- and fluid-sensitive resuscitation for hemodynamic support of children in septic shock: barriers to the implementation of the American College of Critical Care Medicine/Pediatric Advanced Life Support Guidelines in a pediatric intensive care unit in a developing world.

OBJECTIVES: To analyze mortality rates of children with severe sepsis and septic shock in relation to time-sensitive fluid resuscitation and treatments received and to define barriers to the implementation of the American College of Critical Care Medicine/Pediatric Advanced Life Support guidelines in a pediatric intensive care unit in a developing country. METHODS: Retrospective chart review and prospective analysis of septic shock treatment in a pediatric intensive care unit of a tertiary care teaching hospital. Ninety patients with severe sepsis or septic shock admitted between July 2002 and June 2003 were included in this study. RESULTS: Of the 90 patients, 83% had septic shock and 17% had severe sepsis; 80 patients had preexisting severe chronic diseases. Patients with septic shock who received less than a 20-mL/kg dose of resuscitation fluid in the first hour of treatment had a mortality rate of 73%, whereas patients who received more than a 40-mL/kg dose in the first hour of treatment had a mortality rate of 33% (P < 0.05). Patients treated less than 30 minutes after diagnosis of severe sepsis and septic shock had a significantly lower mortality rate (40%) than patients treated more than 60 minutes after diagnosis (P < 0.05). Controlling for the risk of mortality, early fluid resuscitation was associated with a 3-fold reduction in the odds of death (odds ratio, 0.33; 95% confidence interval, 0.13-0.85). The most important barriers to achieve adequate severe sepsis and septic shock treatment were lack of adequate vascular access, lack of recognition of early shock, shortage of health care providers, and nonuse of goals and treatment protocols. CONCLUSIONS: The mortality rate was higher for children older than 2 years, for those who received less than 40 mL/kg in the first hour, and for those whose treatment was not initiated in the first 30 minutes after the diagnosis of septic shock. The acknowledgment of existing barriers to a timely fluid administration and the establishment of objectives to overcome these barriers may lead to a more successful implementation of the American College of Critical Care Medicine guidelines and reduced mortality rates for children with septic shock in the developing world.

Urethral injury in penile fracture: a narrative review

ABSTRACT Objective To present the evolution and the recent data on the etiology, diagnosis, management and outcomes of penile fracture (PF) with concomitant urethral injury. Materials and Methods We searched the Pubmed database between 1998 and 2019 using the following key words: "penile fracture", "fracture of penis", "trauma to penis", "rupture of corpora cavernosa", "urethral injury", "urethral rupture" and "urethral reconstruction". Results The incidence of urethral lesion in patients with PF varies by geographic region and etiology. Blood in the meatus, hematuria and voiding symptoms are highly indicative of urethral rupture. The diagnosis of PF is eminently clinical and complementary exams are not necessary. The treatment consists of urethral reconstruction and the most common complications found are urethral stenosis and urethrocutaneous fistula. Conclusion PF is an uncommon urological emergency, particularly in cases with urethral involvement. Urethral injury should be suspected in the presence of suggestive clinical signs, and diagnosis is usually clinical. Urgent urethral reconstruction is mandatory and produces satisfactory results with low levels of complications.

Profissionais de saúde: um ponto de vista sobre a morte e a distanásia / Health professionals: a view on death and dysthanasia

RESUMO Para o profissional da saúde, a morte é um tema que se apresenta corriqueiramente, ao depararem-se com a certeza da morte de seus pacientes. O cuidado com o paciente terminal é uma questão de grande relevância, uma vez que o aprimoramento das técnicas e da qualidade da assistência permitem o prolongamento de muitas vidas. A partir desse fato, buscamos conhecer se existe preparo prévio do ponto de vista técnico e emocional do profissional de saúde para evitar a distanásia. Nosso estudo busca analisar qual a percepção dos profissionais diante desse processo de morte e também qual o seu preparo para a promoção de cuidados no fim da vida. Para este fim, foram entrevistados profissionais de saúde que cuidaram de pacientes em estado grave ou terminal, selecionados dentre os trabalhadores de um hospital-escola na cidade de Campinas, buscando contemplar as diferentes categorias profissionais do serviço. Trata-se de um estudo qualitativo que empregou como técnica a entrevista semi-estruturada, abordando a percepção do profissional diante da iminência da morte de seu paciente ou da sua sobrevivência com sequelas e limitações. O material coletado foi analisado pela técnica de análise de conteúdo e a amostra foi limitada por saturação. Foram entrevistados profissionais de diversas categorias da equipe multiprofissional, sendo observados algumas questões em comum em seus discursos, sistematizadas em três eixos temáticos baseados nas percepções do profissional: quanto a própria formação profissional, quanto à dinâmica equipe multiprofissional e quanto ao contato com os familiares, sinalizando para as respectivas conclusões: (1) o desconforto em conversar sobre a morte com o paciente e seus familiares e a sensação de despreparo para abordar o tema, (2) a falta de integração dentro da equipe multiprofissional e (3) a dificuldade de lidar com famílias que muitas vezes não aceitam o processo de morte de seu familiar, além do (4) desconhecimento por parte do profissional dos conceitos envolvidos em cuidados paliativos como "distanásia", "ortotanásia" e "eutanásia". Diante dos resultados obtidos, ficou clara a necessidade de uma formação profissional voltada para a discussão do tema da morte, de forma que terminalidade seja um assunto discutido com maior frequência e menos desconforto com pacientes e familiares. Além disso, faz-se necessário o direcionamento da formação das diversas categorias de profissionais de saúde para a integração da equipe multiprofissional, com relações horizontais e discussões dos casos entre todos os profissionais envolvidos no cuidado, a fim de melhorar a sua qualidade.

ABSTRACT Death is a subject that frequently presents itself to the health professional when facing the certainty of their patients' death. Caring for the terminally ill patient is a matter of great relevance, since quality care and it's techniques make it possible to prolong many lives. Therefore, we seek to evaluate if any previous preparation for the caregiver exists, from a technical and emotional point of view, in order to avoid dysthanasia. Our study seeks to analyze the professionals' perception of this death process and also their preparation to promote end-of-life care. For that, we interviewed health professionals who took care of patients in severe or terminal conditions. The participants were selected among all employees of a university hospital in the city of Campinas - SP (Brazil), seeking to include different professional categories from the institution. This qualitative study was based on semi-structured interviews, in order to better approach each professional's perception when facing the verge of the patient's death or even their survival with severe complications or limitations. The content of each answer was analyzed with content analysis and the sample was limited by saturation. Professionals from different categories of the multiprofessional team were interviewed, and there were some commom topics among their speeches, We interviewed professionals from several categories of the multiprofessional team, and observed some common issues in their speeches, systematized in three thematic axes based on the professionals' perceptions: regarding the professional formation itself, the multiprofessional team dynamic and the contact with family members, signaling to the respective conclusions: (1) the discomfort of talking about death with the patient and with his/her relatives and the feeling of lacking preparation to address the issue (2) the little engagement within the multiprofessional team and (3) the difficulty of dealing with families that often do not accept the relative's death process, , in addition to (4) the professional's lack of knowledge of the concepts involved in palliative care such as "dysthanasia", "orthanasia" and "euthanasia".. After analysing the results, it is clear that there is an important need to discuss the subject of death throughout the professional's education, in order to make terminality a subject that is more familiar and more comfortable, and to improve communication with patients and their relatives. In addition, it is necessary to guide the education of all different health professionals towards greater engagement within the multiprofessional team, while mantaining horizontal relationships, in order to allow discussing each patient's case among all professionals involved in their care, and thus improve it's quality.

O cuidado na prática médica / El cuidado en la práctica médica / Care in medical practice

Todos têm consciência que passamos por uma crise na relação médico-paciente. Uma profunda reflexão se faz necessária para que possamos compreender as causas principais dessa crise. Ao rever as bases históricas das origens da medicina, entendida comoarte e ciência, e a evolução dos conhecimentos científicos, culminando na modernidade e mudança da perspectiva da atividade médica nessa época, os autores chegam ao entendimento do fundamental papel desempenhado pelo Relatório Flexner na formação de uma mentalidade cientificista na formação médica, que tanto tem deteriorado os alicerces da relação médico-paciente. Somente conhecendo esse histórico poderemos compreender a realidade da situação e trazer novamente à cena os verdadeiros objetivos da prática médica. Certamente esses caminhos passam pelo resgate e fortalecimento de uma atitude que promova o humanismo, a ética e o cuidado no dia a dia da medicina.

We all know that we are currently a crisis in the doctor-patient relationship. A deep reflection is necessary so that we understand the root causes of this crisis. When reviewing the historical bases of the origins of medicine, understood as an art and a science,and the evolution of scientific knowledge, culminating in modernity and the change of the perspective of medical activity at our time, we understand the instrumental role the Flexner Report had in creating a scientificist mentality in medical training, that has so deeply affected the foundations of the doctor-patient relationship. Only knowing this history will we be able to understand the reality of the situation and to bring again to central stage the true objectives of medical practice. This no doubt requires the rescue and reinforcement of an attitude that promotes a humane attitude, ethics and care in daily medical practice.

Todos sabemos que hoy se vive una crisis en la relación doctor-paciente. Una reflexión profunda es necesaria de modo que entendamos las causas originales de esta crisis. Al repasar las bases históricas de los orígenes de la medicina, entendida como un arte yciencia, y la evolución del conocimiento científico, culminando en la modernidad y el cambio de la perspectiva de la actividad médica en nuestro tiempo, entendemos que el papel vital que el informe Flexner tubo en la creación de una mentalidad cientificista en el entrenamiento médico, que ha afectado tan profundamente a las fundaciones de la relación doctor-paciente. Solamente conociendo esta historia podremos entender la realidad de la situación y traer otra vez a la posición central los objetivos verdaderos de la práctica médica. Esto sin duda requiere el rescate y el refuerzo de una actitud que promueva una actitud humana, la ética y el cuidar en la práctica médica.

Busca ativa de casos de tuberculose pulmonar em uma Unidade de Atendimento em Farmacodependência no Município de Säo Paulo (agosto de 1999 a agosto de 2000) / Case-finding of pulmonary tuberculosis in a drug treatment Unit in the City of Säo Paulo (August 1999/ August 2000)

Objetivo: avaliar a ocorrência de casos de tuberculose pulmonar em uma unidade de atendimento a farmacodependência no Município de Säo Paulo. Métodos: foi realizada uma busca ativa de casos de tuberculose pulmonar em uma amostra intencional de 160 pacientes alcoolistas e usuários de drogas do serviço. Para tanto, foi aplicado um questionário estruturado com dados de história clínico- epidemiológica e para registro dos exames bacteriológicos de escarro e radiologia do tórax realizados. Resultados: de um total de 57 sintomáticos respiratórios, 67 por cento realizaram exame bacteriológico de escarro e, entre eles, näo encontramos nenhum caso de tuberculose pulmonar bacilífera. Em nove pacientes alcoolistas com antecedente de tuberculose pulmonar, a radiografia de tórax mostrou infiltrados pulmonares apicais. Para complementar a pesquisa, foi feita uma abordagem buscando traçar o perfil desse serviço e de sua demanda. Conlusäo: diante das características desse serviço e da sua clientela, concluímos Ter havido um viés externo de seleçäo de pacientes, com os casos de tuberculose pulmonar bacilífera sendo diagnosticados e tratados em outros serviços de saúde, principalmente hospitais

Influência palpebral na pressäo intra-ocular (PIO)

Objetivo: Avaliar a influência de determinados tipos de pálpebras sobre a pressäo intra-ocular (PIO). Local: Serviço de Oftalmologia da Sociedade de Assistência aos Cegos, em Fortaleza, CE. Métodos: A amostra foi constituída de 16 pacientes, perfazendo um total de 32 olhos, com PIO igual ou acima de 16mmHg em pelo menos uma das medidas e conformaçöes palpebrais semelhantes. Foram realizadas medidas da PIO antes e após elevaçäo da pálpebra superior, com fita adesiva, medidas da largura da fenda palpebral e medidas da funçäo do músculo elevador da pálpebra superior. Utilizou-se o teste t de Student comparando-se as medidas antes e após elevaçäo palpebral, separadamente em olho direito, olho esquerdo e ambos os olhos. Resultados: Do total de 32 olhos estudados, 28 olhos (87.5 por cento) apresentaram diminuiçäo da PIO após elevaçäo da pálpebra superior, enquanto 4 olhos (12.5 por cento) apresentaram aumento da PIO. Em todas as avaliaçöes houve significância estatística (p<0.05). As medidas da largura da fenda palpebral e funçäo do músculo elevador da pálpebra superior foram compatíveis com a normalidade. Conclusäo: Embora baseado em uma amostra limitada (32 olhos), nosso trabalho mostra que determinados tipos de pálpebras parecem ter influência significativa sobre a PIO. Estudos posteriores säo necessários para se avaliar a importância destes achados. Näo encontramos relatos na literatura médica.

Conjuntivite granulomatosa eosinofífica: relato de caso apresentando fenômeno de Splendore-Hoeppli / Eosinophilic granulomatosis of the conjunctiva with Splendore-Hoeppli phenomenon: report of a case

Objetivo: Estudo de um caso pouco comum de processo inflamatório da conjuntiva e tecido epibulbar com formação de nódulos, recidivantes, de ambos os olhos. Local: Trabalho realizado no Laboratório de Anatomia Patológica do HGF/SUS e na Sociedade de Assistência aos Cegos, em Fortaleza -CE. Material e métodos: Relato de caso. Paciente sexo feminino, 36 anos, que desenvolveu quadro ocular irritativo intenso, com 3 anos de acompanhamento, tendo sido feita biópsia nas manifestações iniciais. Resultados: Estudo histopatológico revelou granulomas necrosantes cercados por eosinófilos com intensa hiperemia. Os achados caracterizam o fenômeno de Splendore-Hoeppli. Conclusão: O caso mostra a evolução do processo inflamatório ocular, manifestado supostamente após infecção pelo vírus da Dengue, em paciente asmática e agravado por síndrome depressiva.

Sarcoma de Kaposi Ocular como manifestação inicial de AIDS - Relato de caso / Ocular Kaposi's Sarcoma as first manifestation of AIDS - Case Report

Objetivo: Chamar a atenção para a possibilidade do diagnóstico precoce da AIDS em pacientes cujo sítio inicial de surgimento de doença seja o olho, ressaltando também o fato do Sarcoma de Kaposi poder simular um hemangioma da pálpebra ou conjuntiva. Local: Trabalho realizado no Serviço de Oftalmologia da Sociedade de Assistência aos Cegos, Fortaleza, Ceará. Método: Relato de caso de um paciente jovem masculino no qual a primeira manifestação de AIDS foi o surgimento de um Sarcoma de Kaposi localizado na pálpebra inferior, e outro, na conjuntiva bulbar do olho direito. O estudo histopatológico das lesões revelou tratarem-se de Sarcoma de Kaposi. Os exames laboratoriais do paciente indicaram a presença de infecções pelo vírus da AIDS. Conclusão: Ainda que infreqüente, as manifestações do Sarcoma de Kaposi podem ser o primeiro sinal de AIDS em pacientes sem qualquer manifestação sistêmica da doença e a valorização dessas lesões permitirá, ao médico, fazer o diagnóstico precoce de AIDS nesses casos.