ABSTRACT
La valoración médico legal en los casos de Síndrome de niño agredido debe ser minuciosa, y abarcar todos los aspectos que indican los artículos y guías nacionales e internacionales, para tener una certeza diagnóstica, debe incluir una historia médico legal completa, examen físico detallado y estudios complementarios, así como diagnóstico diferencial. El presente artículo abarca algunos de los aspectos principales a tomar en cuenta ante la sospecha de abuso infantil, mediante la presentación y abordaje de un caso clínico.
The medical legal assessment in the cases of Attacked Child Syndrome must be thorough and cover all the aspects indicated in the articles and national and international guides, to have a diagnostic certainty, it must include a complete legal medical history, detailed physical examination and complementary studies, as well as differential diagnosis. This article covers some of the main aspects to consider when suspected of child abuse, through the presentation and approach of a clinical case.
Subject(s)
Humans , Male , Child , Physical Examination , Battered Child Syndrome/diagnosis , Forensic Medicine , Costa RicaABSTRACT
Teaching clinical skills is core content of the medical and allied health curricula of the Faculty of Health Sciences (FoHS) at the University of the Free State (UFS) in South Africa. A major pedagogical tool used for this purpose across the faculty is peer physical examination (PPE). Objective. To investigate the lived experience and perceptions of students and educators on the use of PPE in undergraduate health professions education at a multicultural and multiracial institution. Suggestions on guidelines for a PPE policy for the FoHS at the UFS were also obtained from the participants.Methods. This research was designed as a qualitative study that used focus group interviews involving 26 participants (19 students and 7 educators) to obtain verbal statements that described their experience and perceptions of the use of PPE in undergraduate health professions education. Results. Participants reported that PPE was useful to create a safe learning environment and to prepare students for the clinical aspects of their training. Enhancing students' empathy, competency and clinical confidence were among the advantages attributed to using PPE; it also encouraged peer-assisted learning. Some of the disadvantages ascribed to PPE were that it made it difficult to maintain classroom discipline, and that it could promote memorisation over understanding. Finally, participants suggested that a guideline for PPE policy should address matters of consent, confidentiality, participation and gender, cultural, religious and racial considerations.Conclusions. The findings of this study reveal that PPE is an acceptable and useful learning strategy for the majority of students and educators. Issues relating to consent, confidentiality and cultural, religious and racial considerations are some of the potential problems associated with the use of PPE at the UFS. We believe that the suggestions given by the participants of this study will inform the establishment of a PPE policy for the FoHS of the UFS
Subject(s)
Physical Examination , Education, Medical, Undergraduate , Health Occupations , Students , Delivery of Health CareABSTRACT
Resumo: A pesquisa trata da criação de e-book para subsidiar a avaliação clínica realizada por enfermeiros a pacientes hospitalizados. A tecnologia desenvolvida contempla estrutura teórica, pautada em evidências científicas e no conteúdo, já validado, da série de aplicativos móveis, AVALIA TIS. Como método, seguiram-se os moldes da pesquisa metodológica, desenvolvida em duas fases: (I) exploratória que constituiu três etapas: revisão de literatura, desenvolvimento e aplicação de questionário a enfermeiros da prática assistencial; (II): criação do e-book, com seis etapas: definição do conteúdo; definição do editor de texto; seleção de imagens e produção vídeos; editoração do e-book; revisão do e-book; e edição final e-book. Como resultado, obteve-se e-book intitulado AVALIA TIS: avaliação clínica por enfermeiros, que aborda os principais conceitos da primeira etapa do processo de enfermagem e contém orientações para a prática destes profissionais. Esta tecnologia serve como ferramenta para educação em serviço de média complexidade, desenvolvida com apoio de outras áreas do conhecimento para o design, produção de vídeo e editoração de texto. A característica inovatória se pauta no conteúdo estruturado com informações e conhecimentos da avaliação clínica específica do enfermeiro centrada em subsídios para o cuidado e processo de enfermagem, com a inclusão de vídeos educativos, imagens referentes às manobras propedêuticas, instrumentos e escalas utilizados na avaliação. De abrangência nacional, tem impacto científico, social e na educação, com contribuição de novos conhecimentos para a área de enfermagem, assistência baseada em evidências, educação em serviço e formação de profissionais de enfermagem.
Abstract: The study focuses on the development of an e-book to assist nurses in their clinical assessments of hospitalized patients. The technologies developed includes a theoretical framework based on empirical data and the already verified content of the AVALIA TIS series of mobile applications. The methodological research was used as a method, and it was developed in two stages: (I) exploratory in three stages: literature review, development, and application of a questionnaire to nurses in care practice; II) development of the e-book, with six stages: content definition; text editor definition; images selection and video production; editing of the e-book; e-book review; and final e-book edition. As a result, an e-book entitled "AVALIA TIS: Avaliação clínica por enfermeiros" was obtained, which addresses the main concepts of the first stage of the nursing process and includes guidelines for these professionals' practice. This technology is a medium-complexity in-service education resource developed with the assistance of other areas of knowledge for design, video production, and text publishing. The innovative characteristic is that the content is organized with information and knowledge of the specific clinical evaluation of nurses centered on subsidies for nursing care and process, with the inclusion of educational videos, and images referring to propaedeutic maneuvers, instruments, and scales used in the evaluation. It has a national impact and affects science, society, and education through the inclusion of new knowledge to the nursing field, evidence-based care, in-service training, and nursing professional development.
Subject(s)
Humans , Male , Female , Adult , Physical Examination , Education, Nursing, Continuing , Digital Technology/education , Medical History Taking , Nurses , Nursing CareABSTRACT
Introducción: La fístula salival es la comunicaciónde la glándula salival o el conducto parotídeo hacia la piel,debido a una lesión traumática del parénquima o del conducto deexcreción; no suele ser una complicación frecuente en parotiditisaguda. El objetivo de este trabajo es destacar la presentaciónatípica de un caso de parotiditis bacteriana asociado a fistulasalival hacia el conducto auditivo externo y cavidad oral, y aparálisis facial periférica. Caso clínico: Paciente masculino de15 años de edad, quien consulta por otalgia y otorrea derechaasociado a aumento de volumen en región parotídea ipsilateralde 5 días de evolución. Al examen físico se evidencia, caraasimétrica con desviación de comisura labial hacia la izquierda ycierre palpebral completo sin esfuerzo, con aumento de volumende parótida derecha con signos de flogosis, otorrea purulentaderecha . solución de continuidad en tercio medio de pisode conducto auditivo externo. Ecosonograma de piel y partesblandas, reveló cambios inflamatorios en glándula parótida concolección de 112 cc., Los hallazgos tomográficos de oído medioy mastoides corroboraron hallazgos del ecosonograma. se realizódrenaje quirúrgico del absceso y se trató con Clindamicina600 mg vía endovenosa cada 6 horas y Penicilina Cristalina200 mg/kg/ peso cada 6 horas y su evolución fue satisfactoria.Conclusión:Los abscesos parotídeos pueden presentarse demanera atípica o en raras ocasiones con drenaje a través delconducto auditivo externo(AU)
Introduction: Salivary fistula is the communicationof the salivary glands or the parotid duct to the skin, due toa traumatic injury to the parenchyma or the excretion duct; Itis not usually a frequent complication in acute parotitis. the eobjective of this work is to highlight the atypical presentation of acase of bacterial parotitis associated with salivary fistula towardsthe external auditory canal and oral cavity, and peripheralfacial paralysis. Clinical case: A 15-year-old male patient, whoconsulted due to otalgia and right otorrhea associated with anincrease in volume in the ipsilateral parotid region of 5 days ofevolution. On physical examination, an asymmetrical face withdeviation of the lip corner to the leth and complete palpebralclosure without effort, with increased volume of the rightparotid gland with signs of phlogosis, right purulent otorrhea and continuity solution in the middle third of the external auditory canal are evident. Ultrasound of the skin and so the tissues revealed inflammatory changes in the parotid glands with a collection of 112 cc. yhe tomographic findings of the middle ear and mastoids corroborated the findings of the echosonogram; Surgical drainage of the abscess was performed and he was treated with clindamycin 600 mg intravenously every 6 hours and crystalline penicillin 200 mg/kg/weight every 6 hours, and his evolution was satisfactory. Conclusion: Parotid abscesses can present atypically or rarely with drainage through the external auditory canal(AU)
Subject(s)
Humans , Male , Adolescent , Parotitis , Salivary Gland Fistula , Ear Canal , Parotid Gland , Physical Examination , Clindamycin , Abscess , Ear , Parenchymal TissueABSTRACT
A semiologia é uma das técnicas mais utilizadas na prática médica há séculos. Ensinada por meio de roteiros sistematizados, estudantes de inúmeras escolas da área de saúde por todo o mundo aprendem as manobras semiológicas como fundamento na avaliação dos pacientes. No entanto, apesar de extremamente difundida, discute-se pouco sobre sua acurácia como manobra diagnóstica. Tendo este ponto em vista, este artigo aborda a precisão das diversas manobras semiológicas do exame físico do aparelho respiratório e a descrição comparativa do seu ensino em diferentes escolas médicas no mundo. Como resultados, tem-se valores de acurácia discordantes, o que pode ser justificado pela qualidade dos estudos ou pelas variáveis analisadas que diferem entre os estudos e propostas de padronização. Em conclusão, a semiologia é a base da avaliação médica, independentemente dos avanços e disponibilidade dos exames de imagens, e cada manobra deve ser ensinada com seu devido valor científico. Conhecer a aplicabilidade e individualizar a prática das etapas do exame respiratório pode ser um caminho possível de adequação aos tempos atuais, sem impor perdas de informações relevantes para o desenvolvimento do raciocínio clínico (AU)
Medical semiology has been one of the most common techniques used in medical practice for centuries. Health science students around the globe learn these techniques through a systematized model as a fundamental skill for patient evaluation. However, though being widespread, little is known about semiology's true accuracy as a diagnostic maneuver. Knowing that, through a literature review, this paper evaluated the precision of the preconized procedures that are used as part of the exam of the respiratory system and the comparative description of its teaching in different medical schools around the world. As a result, disagreement between several papers was found, which can be justified by the poor quality of the studies and the different variables that were studied in each one. However, one thing is still clear: respiratory physical examination continues to be essential in medical practice, independently of the recent advances and availability of imaging exams. Teaching each step should consider available scientific evidence. The knowledge of the applicability and practical individualization of the respiratory examination can be a possible way for the current times without missing relevant information for developing clinical reasoning (AU)
Subject(s)
Physical Examination , Respiratory System , Education, Medical , Medicine/standardsABSTRACT
Introdução: O objetivo deste estudo foi avaliar as características das práticas de telemedicina (TM) entre médicos alergistas/ imunologistas (A/I) brasileiros e avaliar seu conhecimento sobre as recomendações regulatórias. Métodos: Uma pesquisa eletrônica autorreferida foi enviada por e-mail uma vez por semana entre agosto e outubro/2021 a 2.600 médicos A/I brasileiros. Resultados: 205 (7,9%) participantes preencheram os formulários. 143 (70,2%) médicos usaram TM em sua prática clínica, e 184 (89,9%) nunca o usaram antes da pandemia de COVID-19. Dentre os médicos, 192 (93,8%) utilizaram a TM para consultas de acompanhamento, 186 (91%) para verificação de exames complementares e 136 (66,7%) nas primeiras consultas. Cento e quarenta e três médicos A/I (70,2%) sentiram-se seguros em seu diagnóstico por meio da TM, e 7 (3,5%) responderam que não conseguiram encontrar um diagnóstico correto usando a TM. Os principais benefícios da TM relatados foram: maior acessibilidade, principalmente em áreas mais distantes 159 (77,6%), redução dos custos de deslocamento 158 (77,1%) e segurança quanto à transmissão do COVID-19 145 (71,2%). Por outro lado, algumas desvantagens da TM foram listadas pelos participantes: ausência de exame físico 183 (89,7%), relação médico-paciente fragilizada 59 (28,8%) e problemas de Internet 45 (22%). Em relação ao campo jurídico/ético, 105 (51,4%) dos especialistas aplicaram o termo de consentimento e 34 (16,7%) registraram a teleconsulta, ambas as etapas exigidas em uma consulta de TM, conforme recomendações regulatórias locais. Além disso, plataformas online inadequadas para TM, como aplicativos de mídia social e programas de reuniões online não específicos, foram relatadas como sendo usadas por 131 (64,1%) dos participantes. Oitenta (40%) não leram as declarações e recomendações oficiais que regulamentam a prática da TM no Brasil. Conclusões: Observouse um uso crescente de TM no Brasil, influenciado principalmente pela pandemia de COVID-19. Apesar de ser ferramenta útil na pandemia, com vantagens e desvantagens, há necessidade de conhecer as recomendações regulatórias.
Introduction: The aim of this study was to evaluate the characteristics of telemedicine (TM) practices among Brazilian allergists/immunologists (A/I) and to assess their knowledge of regulatory recommendations. Methods: A self-report electronic survey was sent by email once a week between August and October 2021 to 2,600 Brazilian A/I physicians. Results: A total of 205 (7.9%) participants completed the survey. TM was used in clinical practice by 143 (70.2%) physicians, and 184 (89.9%) had never used it before the COVID-19 pandemic. Among participants, 192 (93.8%) used TM for follow-up consultations, 186 (91%) for checking complementary exams, and 136 (66.7%) for first consultations. The number of A/I physicians (70.2%) that felt confident in their diagnosis using TM was 143, and 7 (3.5%) reported that they could not reach the correct diagnosis using TM. Participants reported that the main benefits of TM were greater accessibility, especially in more distant areas (159, 77.6%), reduced travel costs (158, 77.1%), and safety regarding the transmission of COVID-19 (145, 71.2%). Conversely, the lack of physical examination (183, 89.7%), poor doctor-patient relationship (59, 28.8%), and internet connection problems (45, 22%) were mentioned as disadvantages. Regarding legal/ethical aspects, 105 (51.4%) physicians reported applying a consent form and 34 (16.7%) reported making a record of the teleconsultation, both of which are required for TM consultations, according to local regulatory recommendations. The use of inappropriate online platforms for TM, such as social media applications and nonspecific online meeting programs, was reported by 131 (64.1%) participants. Eighty (40%) participants did not read the official statements and recommendations that regulate the practice of TM in Brazil. Conclusions: An increasing use of TM was observed in Brazil, mainly influenced by the COVID-19 pandemic. Despite being a useful tool in the pandemic, with advantages and disadvantages, physicians should have knowledge of regulatory recommendations.
Subject(s)
Humans , Telemedicine , Remote Consultation , Allergists , COVID-19 , Patients , Physical Examination , Physician-Patient Relations , Physicians , Societies, Medical , Cross-Sectional Studies , Surveys and Questionnaires , Internet , Diagnosis , Allergy and Immunology , Social MediaABSTRACT
Abstract Objective To compare clinical data from the physical examination with arthroscopic findings in rotator cuff rupture. Methods A total of 177 patients submitted to arthroscopic treatment of rotator cuff rupture were selected, and arthroscopic findings were compared with physical examination. Results The impingement tests showed high sensitivity for rotator cuff rupture. Among the strength tests, the most sensitive was the Patte test (85.7%), and the one with the highest positive predictive value (PPV) was the Jobe test (95%). The Drop Sign test showed higher specificity and negative predictive value (NPV) (98.7 and 95.9%, respectively). Patients with a history of trauma were 3.5 times more likely to have a positive Lift Off test. Conclusion The impingement tests had high sensitivity for rotator cuff ruptures. The Jobe test showed similar sensitivity among patients who had partial or total supraspinal injury. For complete lesions of the subscapularis, The Lift Off and Belly Press tests showed high sensitivity and specificity.
Resumo Objetivo Comparar dados clínicos do exame físico com os achados artroscópicos na ruptura do manguito rotador. Métodos Foram selecionados 177 pacientes submetidos ao tratamento artroscópico de ruptura do manguito rotador e foram comparados os achados artroscópicos com o exame físico. Resultados Os testes irritativos de impacto apresentaram alta sensibilidade para ruptura do manguito rotador. Dentre os testes de força, o de maior sensibilidade foi o teste de Patte (85,7%) e o de maior valor preditivo positivo (VPP) foi o teste de Jobe (95%). O teste Drop Sign apresentou maior especificidade e valor preditivo negativo (VPN) (98,7 e 95,9%, respectivamente). Pacientes com história de trauma possuíam 3,5 vezes mais chances de apresentarem o teste Lift Off positivo. Conclusão Os testes irritativos tiveram alta sensibilidade para rupturas do manguito rotador. O teste de Jobe apresentou sensibilidade semelhante entre os pacientes que tinham lesão parcial ou total do supraespinhal. Para as lesões completas do subescapular, as testes Lift Off e Belly Press apresentaram alta sensibilidade e especificidade.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Physical Examination , Arthroscopy , Rupture , Rotator Cuff , Shoulder InjuriesABSTRACT
Se presentan, en un trabajo conjunto, las recomendaciones para la evaluación cardiovascular de personas menores de 35 años que realizan ejercicio y deportes. Se establecen pautas en cuanto a la valoración y la habilitación que tendrá dicha evaluación, quiénes estarán a cargo de su realización y cuáles son los componentes fundamentales de una correcta valoración cardiovascular. Se toman en cuenta los antecedentes familiares y personales, el examen físico exhaustivo y se considera conveniente la realización del ECG como parte integrante obligatorio. Se hacen referencia a otros estudios funcionales como opcionales, así como la posible derivación a los especialistas cuando se considere necesario.
We hereby present joint recommendations for cardiovascular assessment of people under 35 years of age who do exercise and sports. We set the guidelines regarding evaluation and score of such assessment, the agents in charge of implementing it and the main components of a correct cardiovascular assessment. We take into account the family and personal history and perform a comprehensive physical examination as well as an ECG as a mandatory part of this comprehensive approach. We mention other optional functional studies as well as reference to specialists whenever necessary.
Apresentamos através dum paper conjunto recomendações para a avaliação cardiovascular de pessoas de 35 anos de idade que praticam exercício e esportes. Estabelecem-se as diretrizes quanto à qualificação dessa avaliação, quem a realizará e quais são os componentes fundamentais de uma correta avaliação cardiovascular. Consideramos obrigatório incluir a história familiar e pessoal, o exame físico exaustivo e o ECG opcional. Referimo-nos a outros estudos funcionais opcionais, assim como ao possível encaminhamento para especialistas quando for necessário.
Subject(s)
Humans , Child , Adolescent , Adult , Young Adult , Sports , Cardiovascular Diseases/prevention & control , Exercise , Physical Examination , Cardiovascular Diseases/diagnosis , Death, Sudden, Cardiac/prevention & control , Electrocardiography , Medical History TakingABSTRACT
La celulitis orbitaria representa una causa frecuente de inflamación de la órbita, constituyendo una urgencia médica que requiere un manejo multidisciplinario. Se presenta caso de una recién nacida con clínica de aumento de volumen en región bipalpebral derecha y fiebre de 24 horas de evolución. Al examen físico se evidencia proptosis de ojo derecho, aumento de volumen bipalpebral que impide la apertura del globo ocular en su totalidad con signos de flogosis y secreción purulenta en borde palpebral. Los laboratorios reportan leucocitosis y trombocitosis reactiva; tomografía de orbita muestra tumefacción y edema periorbitario derecho, aumento difuso de densidad grasa post-septal extra e intraconal, hallazgos sugestivos de celulitis orbitaria derecha. Se indica antibioticoterapia con vancomicina y cefotaxime, ameritando además drenaje de absceso, obteniéndose secreción purulenta, en la que se aísla Estafilococo aureus meticilino resistente. Siendo una patología inusual en este grupo etario, se recomienda la publicación de este caso(AU)
Orbital cellulitis represents a frequent cause of inflammation of the orbit, constituting a medical emergency that requires multidisciplinary management. We present a case of a newborn with clinic of volume increase in right bipalpebral region and fever of 24 hours of evolution. Physical examination reveals proptosis of right eye, increase of bipalpebral volume that prevents the opening of the eyeball in its entirety with signs of flushing and purulent eyelid margin secretion. Laboratories report leukocytosis and reactive thrombosis; orbital tomography scan shows right periorbital swelling and edema, diffuse increase of extra and intraconal post-septal fat density, suggestive findings of right orbital cellulitis, covered with vancomycin and cefotaxime; subsequently requires abscess drainage where Staphylococcus aureus methycilin- resistant is isolated. Being an unusual pathology in this age group, the publication of this case is recommended(AU)
Subject(s)
Humans , Female , Infant, Newborn , Infant, Newborn , Emergencies , Orbital Cellulitis , Physical Examination , Signs and Symptoms , Tomography , Drainage , Abscess , LaboratoriesABSTRACT
Introducción: La evaluación anatómica músculo esquelética por imagen en la exploración clínica del pie diabético es la fotografía digital que evalúa la morfología superficial. Objetivos: Validar la obtención de las imágenes fotográficas del pie, calcular las mediciones longitudinales, angulares y el índice del arco plantar, de las imágenes fotográficas del pie por fotogrametría, y basados en estas, categorizar la normalidad de la forma en sujetos sanos. Métodos: Estudio exploratorio en 30 individuos sanos evaluados en la Unidad clínica de pie diabético en la ciudad de Trujillo, mediante un prototipo de cámaras alrededor de un podoscopio y un software de análisis de imágenes. La imagen fotográfica fue evaluada por mediciones longitudinales, angulares y el índice del arco plantar. Resultados: Los pacientes evaluados tenían una edad media de 25,06+/-11,95 años, y predominaron las mujeres. La longitud total del pie y anchura del metatarso en el lado derecho fue de 226,55 ± 36,49 mm y 98,99 ± 22,71 mm respectivamente; y en el lado izquierdo fue de 229,81 ± 42,25 mm y 104,49 ± 16,84 mm respectivamente. El ángulo intermetatarsal del 1-2 rayo, ángulo intermetatarsal del 4-5 rayo y ángulo del retropié para el lado derecho fueron 14 ± 4º, 11 ± 3º y 2 ± 2º respectivamente; para el lado izquierdo 14 ± 3º, 9 ± 3º y 2 ± 2º respectivamente, y el índice plantar del arco derecho e izquierdo fueron 0,23 ± 0,2 y 0,22 ± 0,1 respectivamente. La variabilidad solo se presentó en el antepie en el 20 percent de los casos. Conclusiones: La obtención de las imágenes fotográficas del pie fueron válidas, las mediciones fueron menores o similares a otros estudios. La variabilidad de la normalidad solo se presentó en el antepie(AU)
Introduction: The musculoskeletal anatomical evaluation by imaging in the clinical examination of the diabetic foot is digital photography that assesses the superficial morphology. Objectives: To validate the obtaining of photographic images of the foot, to calculate the longitudinal and angular measurements and the index of the plantar arch, from the photographic images of the foot by photogrammetry, and to categorize the normality of the shape in healthy subjects, based on these photographic images. Methods: This an exploratory study in 30 healthy individuals evaluated at the Diabetic Foot Clinical Unit in Trujillo city, using a prototype of cameras around a podoscope and image analysis software. The photographic image was evaluated by longitudinal and angular measurements and the plantar arch index. Results: The patients evaluated had a mean age of 25.06+/-11.95 years, and women predominated. Total foot length and metatarsal width on the right side were 226.55 ± 36.49 mm and 98.99 ± 22.71 mm, respectively; and on the left side it was 229.81 ± 42.25 mm and 104.49 ± 16.84 mm, respectively. The 1st-2nd ray intermetatarsal angle, 4th-5th ray intermetatarsal angle and hindfoot angle for the right side were 14 ± 4º, 11 ± 3º and 2 ± 2º respectively; for the left side 14 ± 3º, 9 ± 3º and 2 ± 2º respectively, and the plantar index of the right and left arch were 0.23 ± 0.2 and 0.22 ± 0.1 respectively. Variability only occurred in the forefoot in 20 percent of cases. Conclusions: Obtaining of the photographic images of the foot was valid, measurements were smaller or similar to other studies. The variability of normality only appeared in the forefoot(AU)
Subject(s)
Humans , Male , Female , Adolescent , Adult , Photogrammetry/methods , Diagnostic Techniques and Procedures , Foot/anatomy & histology , Physical Examination/methods , Foot Deformities/etiology , Epidemiology, Descriptive , Diabetic FootABSTRACT
Introduction: Intervertebral disc disorders (IDDs) are being commonly observed nowadays among the young and middle aged population. Objectives: This hospital record based study was done to study the risk factors, clinical presentation, imaging findings and management practices among patients with all types of IDDs. Methods: A validated proforma was used to obtain information of patients confirmed with IDDs over the past three years. Results: Mean age at onset of disc disorders among the 219 patients was 44.7±14.2 years. History of poor exercising habits were present among 72(32.9 percent) patients. The most common site of disc involvement was L4-L5 [151(68.9 percent)]. 143(65.3 percent) patients had single site disc involvement. The most common clinical symptom was lower back pain [180(82.2 percent)]. Nerve root compression was present among 154(70.3 percent) patients. Disc bulge, protrusion, extrusion and sequestration were present among 116(53 percent), 90(41.1 percent), 52(23.7 percent) and 4(1.8 percent) patients respectively. Age at onset >65 years (p=0.035), age at onset ≤55 years (p=0.004) and history of direct impact to the neck region (p=0.017) were associated with disc prolapse at L2-L3 level, L4-L5 level and C5-C6 level respectively, among patients with single site disc involvement. Risk of multiple level disc involvement was found to increase after 35 years (p<0.001). It was seen more involving cervical vertebrae (p=0.0068). Lumbar (p<0.0001) and lumbosacral vertebrae (p<0.0001) involvement were seenmore among patients with single site disc involvement. NSAIDs [155(70.8 percent)] were the most the commonly used medication. Microdiscectomy was done among 35(76.1 percent) out of the 46 patients who underwent surgical management. Conclusions: Exercising habits need to be encouraged among people for the prevention of IDDs. The various high risk groups identified in this study need to be periodically screened for IDDs(AU)
Introducción: Actualmente, los trastornos de los discos intervertebrales (TDI) son frecuentes en la población joven y de mediana edad. Objetivos: Este estudio hospitalario de las historias clínicas se realizó para examinar los factores de riesgo, la presentación clínica, los hallazgos imagenológicos y las prácticas de tratamiento entre los pacientes con todos los tipos de trastornos de los discos intervertebrales. Métodos: Se utilizó una proforma validada para obtener información de los pacientes confirmados con trastornos de los discos intervertebrales en los últimos tres años. Resultados: La edad media de aparición de los trastornos discales entre los 219 pacientes fue de 44,7 ± 14,2 años. El historial de malos hábitos de ejercicio estuvo presente en 72 (32,9 por ciento) pacientes. El sitio más común de afectación del disco fue L4-L5 [151 (68,9 por ciento)]. 143 (65,3 por ciento) pacientes tenían compromiso de disco en un solo sitio. El síntoma clínico más frecuente fue el dolor lumbar [180(82,2 por ciento)]. La compresión de la raíz nerviosa estuvo presente en 154 (70,3 por ciento) pacientes. Se mostró presencia de protuberancia, protrusión, extrusión y secuestro discal en 116 (53 por ciento), 90 (41,1 por ciento), 52 (23,7 por ciento) y 4 (1,8 por ciento) pacientes, respectivamente. La edad de inicio >65 años (p=0,035), la edad de inicio ≤55 años (p=0,004) y el antecedente de impacto directo en la región del cuello (p=0,017) se asociaron con prolapso discal a nivel L2-L3, L4- Nivel L5 y nivel C5-C6 respectivamente, entre pacientes con compromiso discal en un solo sitio. Se encontró que el riesgo de afectación del disco en múltiples niveles aumenta después de 35 años (p<0,001). Se vio más involucradas las vértebras cervicales (p=0,0068). La afectación de las vértebras lumbares (p<0,0001) y lumbosacras (p<0,0001) se observó más entre los pacientes con afectación del disco en un solo sitio. Los fármacos anti-inflamatorios no esteroideos (AINE) [155 (70,8 por ciento)] fueron los medicamentos más utilizados. La microdiscectomía se realizó en 35 (76,1 por ciento) de los 46 pacientes que se sometieron a manejo quirúrgico. Conclusiones: Es necesario fomentar hábitos de ejercicio entre las personas para la prevención de los TDI. Los diversos grupos de alto riesgo identificados en este estudio deben someterse a pruebas periódicas de IDD(AU)
Subject(s)
Humans , Male , Female , Adult , Aged , Physical Examination/methods , Spinal Diseases/therapy , Intervertebral Disc/diagnostic imaging , Exercise , Anti-Inflammatory Agents, Non-Steroidal/administration & dosageABSTRACT
ABSTRACT The number of surgical procedures in the world is large and in Brazil it has been expressing a growth trend higher than the population growth. In this context, perioperative risk assessment safeguards the optimization of the outcomes sought by the procedures. For this evaluation, anamnesis and physical examination constitute an irreplaceable initial stage which may or may not be followed by complementary exams, interventions for clinical stabilization and application of risk estimation tools. The use of these tools can be very useful in order to obtain objective data for decision making by weighing surgical risk and benefit. Global and cardiovascular risk assessments are of greatest interest in the preoperative period, however information about their methods is scattered in the literature. Some tools such as the American Society of Anesthesiologists Physical Status (ASA PS) and the Revised Cardiac Risk Index (RCRI) are more widely known, while others are less known but can provide valuable information. Here, the main indices, scores and calculators that address general and cardiovascular perioperative risk were detailed.
RESUMO O número de procedimentos cirúrgicos no mundo é amplo e no Brasil vem expressando tendência de crescimento superior ao crescimento populacional. Nesse contexto, a avaliação de risco perioperatório resguarda a otimização dos desfechos buscados pelos procedimentos. Para a realização dessa avaliação, a anamnese e exame físico constituem etapa inicial insubstituível, a qual pode ou não ser seguida de exames complementares, intervenções para estabilização clínica e aplicação de ferramentas de estimativa de risco. A utilização destas ferramentas pode ser bastante útil a fim de se obter um dado objetivo para a tomada de decisão pesando-se risco e benefício cirúrgico. As avaliações de risco global e cardiovascular são as de maior interesse no pré-operatório, entretanto informações sobre seus métodos encontram-se dispersas na literatura. Algumas ferramentas como o American Society of Anesthesiologists Physical Status (ASA PS) e Índice de Risco Cardíaco Revisado (RCRI) são mais amplamente conhecidos, enquanto outros são menos conhecidos em nosso meio mas podem fornecer informações valiosas. Aqui detalhou-se os principais índices, escores e calculadoras que abordam risco perioperatório geral e cardiovascular.
Subject(s)
Physical Examination , Heart Disease Risk Factors , Brazil , Risk Assessment/methodsABSTRACT
OBJECTIVE@#To investigate the diagnostic value of 6 conventional physical examination tests for the diagnosis of supraspinatus tendon tears, and how well they could tell the difference between partial-and full-thickness tears.@*METHODS@#A total of 91 patients with different shoulder symptoms who received shoulder arthroscopic procedure were enrolled in the study from June 2017 to September 2020. The intraoperative findings were compared with the results of the preoperative physical examination of 6 clinical tests, including the Hug-up test, the Jobe test, the 0°abduction test, the drop arm test, the Neer test, and the Hawkins test, to determine the sensitivity, specificity, positive and negative predictive value, accuracy, positive and negative likelihood ratio of each test.@*RESULTS@#By arthroscopy, a total of 44 full-thickness tears, 34 partial-thickness tears, and 13 intact supraspinatus tendons were found in all 91 cases. The Hug-up and the Jobe tests significantly correlated with the intraoperative findings. The sensitivity of the Hug-up test, the Jobe test, the 0° abduction test, the drop arm test, the Neer test, and the Hawkins test was 0.90, 0.79, 0.64, 0.42, 0.49, 0.24 respectively;the specificity was 0.61, 0.69, 0.54, 0.38, 0.31, 0.77;the positive predictive value was 0.93, 0.94, 0.89, 0.80, 0.81, 0.86;the negative predictive value was 0.50, 0.36, 0.20, 0.10, 0.09, 0.14;the accuracy was 0.86, 0.78, 0.63, 0.42, 0.46, 0.32;the positive likelihood ratio was 2.30, 2.58, 1.39, 0.69, 0.71, 1.06;and the negative likelihood ratio was 0.16, 0.30, 0.67, 1.50, 1.65, 0.98.@*CONCLUSION@#The Jobe test and the Hug-up test are both effective at accurately diagnosing supraspinatus tendon tears, the Hug-up test detects supraspinatus tears with a high sensitivity, and similar specificity. The tests assessed in this study are not capable of distinguish between partial-and full thickness supraspinatus tendon tears.
Subject(s)
Arthroscopy , Humans , Physical Examination/methods , Rotator Cuff , Rotator Cuff Injuries/surgery , TendonsSubject(s)
Humans , Male , Female , Adolescent , Office Visits , Physical Examination , Adolescent HealthSubject(s)
Humans , Male , Female , Adolescent , Physical Examination , Transsexualism , Health Records, Personal , Transgender PersonsABSTRACT
La prevalencia de artrosis de cadera en personas mayores de 45 años es de 9.2% y 27% de ellos evidencian signos radiológicos de la enfermedad, siendo el dolor uno de los motivos de consulta más comunes de quienes acuden al médico general y al ortopedista. La historia clínica precisa y el examen físico adecuado pueden llevar al clínico a determinar el origen del dolor. Sin embargo, nuestra experiencia en la consulta es que la mayoría de los médicos generales no conocen cuáles son los síntomas de la patología de la cadera. El objetivo de este artículo es presentar una guía práctica de su evaluación clínica y la patología más común, que sea útil para el estudiante de medicina, el médico general y el especialista. El artículo se desarrollará en el orden en que se realiza la evaluación de la cadera para al final poder tener un diagnóstico claro.
The prevalence of osteoarthritis of the hip among people over 45 years of age is 9.2% and 27% of them show radiological signs of this joint disorder, with pain being one of the most common reasons for consultation of patients seen by general practitioners and orthopedic surgeons. An accurate clinical history and a proper physical examination can lead the clinician to determine the origin of the pain. However, our experience in office visits shows that most general practitioners are unaware of the symptoms of hip disorders. The purpose of this article is to present a practice guideline for clinical examination of the hip and the most common disorders, which is useful for the medical student, general practitioner and specialist. The article will outline the steps in which hip evaluation is performed to obtain a clear diagnosis in the end
Subject(s)
Humans , Male , Female , Middle Aged , Physical Examination , Hip , Pain , Osteoarthritis, Hip , JointsABSTRACT
Resumo Objetivo identificar e analisar a acessibilidade e o acesso de mulheres brasileiras com lesão medular para a realização de exames preventivos do câncer de mama e colo de útero. Método estudo quantitativo e transversal desenvolvido em plataforma virtual. Realizadas análises estatísticas descritivas e de associação entre as variáveis qualitativas por meio do teste exato de Fisher. Quando identificada a associação (p<0,05), foi realizada a regressão logística. Resultados participaram 120 mulheres brasileiras com lesão medular com idades entre 25 e 67 anos; 85,83% foram ao ginecologista após a lesão medular, 79,17% realizaram a citologia e 52,50%, a mamografia. Observou-se que as mulheres que utilizavam a saúde suplementar apresentaram maior probabilidade de terem ido ao ginecologista do que as usuárias do serviço público. Aquelas com companheiro e as de maior idade apresentaram maior probabilidade de terem realizado o exame de citologia. Para a mamografia, aquelas de maior idade e que utilizavam a saúde suplementar apresentaram maiores chances de terem realizado o exame de mamografia após a lesão medular. Conclusão mulheres com lesão medular buscam a realização de exames de rastreamento. Entretanto, encontram dificuldades relacionadas à estrutura física, aos equipamentos, transporte, profissionais da saúde, assim como dificuldades sociodemográficas e quanto ao serviço de saúde utilizado.
Resumen Objetivo este estudio tuvo como objetivo identificar y analizar la accesibilidad y el acceso de mujeres brasileñas con lesión medular para la realización de exámenes preventivos de cáncer de mama y de cuello uterino. Método se desarrolló un estudio cuantitativo y transversal, realizado en un entorno virtual. Los análisis estadísticos descriptivos y la asociación entre variables cualitativas se realizaron mediante la prueba exacta de Fisher, cuando se identificó una asociación se realizó una regresión logística. Resultados participaron 120 mujeres brasileñas con lesión medular, la edad de las participantes varió de 25 a 67 años. Con relación al rastreo, el 85,83% de las mujeres acudió al ginecólogo tras la LM, el 79,17% se sometió a citología y el 52,50% a mamografía. Se observó que las mujeres que utilizaban un seguro médico privado tenían más probabilidades de haber visto a un ginecólogo que las usuarias del servicio público. Las que tenían pareja y mayores tenían más probabilidades de someterse a citología oncótica. Para la mamografía, las que eran mayores y que usaban un seguro médico privado tenían más probabilidades de someterse al examen después de la LM. Conclusión las mujeres con LM buscan pruebas de detección. Sin embargo, enfrentan dificultades relacionadas con la estructura física, equipamientos, transporte, profesionales de la salud, así como dificultades sociodemográficas relacionadas con el tipo de servicio de salud utilizado.
Abstract Objective to identify and analyze the accessibility and accessibility of Brazilian women with spinal cord injury to preventive examinations for breast and cervical cancer. Method quantitative and cross-sectional study developed in a virtual platform. Descriptive statistical analysis was performed, as well as association analysis between qualitative variables using Fisher's exact test. When identified the association (p<0.05), logistic regression was performed. Results a total of 120 Brazilian women with spinal cord injury, aged between 25 and 67 years participated in the study; 85.83% visited a gynecologist after the spinal cord injury, 79.17% underwent cytology and 52.50% underwent mammography. It was observed that women who used the supplementary health plan were more likely to have visited a gynecologist than those who used the public service. Those who had a partner and were older were more likely to have undergone the cytology exam. For mammography, those who were older and who used supplementary health care were more likely to have had mammography exams after the spinal cord injury. Conclusion women with spinal cord injury seek screening tests. However, they encounter difficulties related to the physical structure, equipment, transportation, health professionals, as well as socio-demographic difficulties and difficulties regarding the health service used.
Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Bone Marrow/injuries , Mass Screening , Women's Health/statistics & numerical data , Disabled Persons , Social Determinants of Health , Health Services Accessibility , Neoplasms/prevention & control , Physical Examination , Unified Health System , Breast/cytology , Breast Neoplasms/prevention & control , Mammography , Uterine Cervical Neoplasms/prevention & control , Cervix Uteri/cytology , Cross-Sectional StudiesABSTRACT
Objective: To understand the diagnosis of suspected occupational diseases reported in Guangzhou from 2014 to 2019, so as to provide theoretical basis and technical support for the supervision of suspected occupational disease reports. Methods: By cluster sampling, the suspected occupational disease report card, occupational disease report card and pneumoconiosis report card reported by Guangzhou from January 1, 2014 to December 31, 2019 in the occupational disease and occupational health information monitoring system were collected for matching analysis to understand the diagnosis of suspected occupational disease patients. Results: From 2014 to 2019, a total of 1426 suspected occupational cases in 7 categories and 32 species were reported in Guangzhou. The average number of reported cases per year was about 240. The main diseases of suspected occupational diseases were suspected occupational noise deafness (68.44%, 976/1426) , suspected occupational chronic benzene poisoning (16.48%, 235/1426) , suspected occupational other pneumoconiosis (4.84%, 69/1426) , suspected occupational silicosis (3.23%, 46/1426) and suspected occupational welder pneumoconiosis (1.82%, 26/1426) . The diagnostic rate required to enter the occupational disease diagnostic program is 36.61% (522/1426) , and the diagnostic rate is 59.20% (309/522) . In 2019, the diagnosis rate of suspected occupational diseases was the lowest (23.92%, 61/255) , Huadu District was the lowest (8.33%, 9/108) , suspected occupational pneumoconiosis was the lowest (28.03%, 44/157) , the diagnosis rate of suspected occupational diseases reported by the Centers for Disease control and prevention was the lowest (17.43%, 19/109) , and the diagnosis rate of suspected occupational diseases reported by outpatient treatment was the lowest (22.22%, 2/9) . The suspected occupational diseases reported by institutions outside Guangzhou did not enter the occupational disease diagnosis procedure. Suspected occupational skin diseases, suspected occupational diseases caused by physical factors and suspected occupational tumors were diagnosed, and the diagnosis rate of occupational disease prevention and control institutions was the highest (94.87%, 37/39) . Conclusion: The main types of suspected occupational diseases reported during these six years are noise deafness, chronic benzene poisoning and pneumoconiosis. The overall diagnosis rate and diagnosis rate of suspected occupational diseases are not high. It is suggested to improve the network direct reporting system of suspected occupational diseases and strengthen the follow-up management and supervision of suspected occupational diseases.