RESUMEN
Introducción: La lesión traumática de la médula espinal es la principal causa mundial de discapacidad motora y una prioridad para la OMS. El objetivo de esta investigación fue estudiar el efecto de la hipotermia terapéutica tras una contusión medular. Materiales y Métodos: Se utilizaron ratas macho a las que se les generó una contusión medular. Se formaron cuatro grupos (6 animales por grupo): a) de control, b) con lesión en normotermia (24 °C, sacrificados 12 h después de la lesión, c) con lesión en normotermia (24 °C, sacrificados 24 h después de la lesión) y d) lesión en hipotermia (8 °C, durante 180 min, sacrificados 24 h después de la lesión). Se estudió la expresión de la CIRBP, la caspasa-3 y la Neu-N. Resultados: La lesión medular aumentó ligeramente la expresión de CIRBP a las 24 h y, de manera importante, la de caspasa-3, todo acompañado por imágenes de motoneuronas dañadas en el asta anterior. En los animales tratados con hipotermia, se observó una alta expresión de CIRBP y niveles muy bajos de caspasa-3, que no se distinguen de los controles. El número de motoneuronas viables se restauró parcialmente. Conclusiones: Este modelo experimental resultó eficaz para inducir una lesión medular, demostró la protección neuronal mediada por hipotermia. El aumento de la expresión de CIRBP en la médula espinal de ratas con lesión e hipotermia comparado con el del grupo normotérmico abre el camino para un posible uso de sustancias que incrementen la CIRBP como terapéutica para las lesiones medulares contusivas. Nivel de Evidencia: I
Introduction: Traumatic spinal cord injury is the leading cause of motor disability worldwide, and the WHO considers it a priority. This study sought to investigate the effects of therapeutic hypothermia following spinal cord contusion. Materials and Methods: Male rats that underwent experimental spinal cord contusion were used. For this purpose, four experimental groups were created (n=6 per group): a) control, b) lesion in normothermia (24°C, sacrificed 12h after the injury), c) lesion in normothermia (24°C, sacrificed 24h after the injury), and d) hypothermic injury (8°C for 180 min, sacrificed 24h after the injury). The expression of cold-inducible RNA-binding protein (CIRBP), Caspase-3, and NeuN was studied. Results: At 24 hours, spinal cord damage raised CIRBP expression slightly while also increasing Caspase-3 significantly. All of this was accompanied by images of damaged motor neurons in the anterior horn. In animals treated with hypothermia, high expression of CIRBP and very low levels of Caspase-3 were observed, which were indistinguishable from controls. Furthermore, the number of viable motor neurons was partially restored. Conclusions: The experimental model developed in this study was effective at inducing spinal cord injury, demonstrating neuronal protection through hypothermia. The increased expression of CIRBP in the spinal cord of rats with injury and hypothermic treatment when compared to the normothermic group suggests the possibility of using substances that increase CIRBP as therapies for the treatment of contusive spinal cord injuries. Level of Evidence: I
Asunto(s)
Animales , Ratas , Traumatismos de la Médula Espinal , Proteínas de Unión al ARN , Contusiones , HipotermiaRESUMEN
PURPOSE@#Patients with multiple traumas are at high risk of developing respiratory complications, including pneumonia and acute respiratory distress syndrome. Many pulmonary complications are associated with systemic inflammation and pulmonary neutrophilic infiltration. Leukotriene-receptor antagonists are anti-inflammatory and anti-oxidant drugs subsiding airway inflammation. The present study investigates the effectiveness of montelukast in reducing pulmonary complications among trauma patients.@*METHODS@#This randomized, double-blind, placebo-control trial was conducted in patients with multiple blunt traumas and evidence of lung contusion detected via CT scan. We excluded patients if they met at least one of the following conditions: < 16 years old, history of cardiopulmonary diseases or positive history of montelukast-induced hypersensitivity reactions. Patients were allocated to the treatment (10 mg of montelukast) or placebo group using permuted block randomization method. The primary measured outcome was the volume of pulmonary contusion at the end of the trial. The secondary outcomes were intensive care unit and hospital length of stay, ventilation days, multi-organ failure, and the in-hospital mortality rate.@*RESULTS@#In total, 65 eligible patients (treatment = 31, placebo = 34) were included for the final analysis. The treatment group had more pulmonary contusion volume (mean (SD), mm3) at the right (68726.97 (93656.54) vs. 59730.27 (76551.74)) and the left side (67501.71 (91514.04) vs. 46502.21 (80604.21)), higher initial C-reactive peptide level (12.16 (10.58) vs. 10.85 (17.87)) compared to the placebo group, but the differences were not statistically significant (p > 0.05). At the end of the study, the mean (SD) of pulmonary contusion volume (mm3) (right side = 116748.74 (361705.12), left side = 64522.03 (117266.17)) of the treatment group were comparable to that of the placebo group (right side = 40051.26 (64081.56), left side = 25929.12 (47417.13), p = 0.228 and 0.082, respectively). Moreover, both groups have statistically similar hospital (mean (SD), days) (10.87 (9.83) vs. 13.05 (10.12)) and intensive care unit length of stays (mean (SD), days) (7.16 (8.15) vs. 7.82 (7.48)). Of note, the frequency of the in-hospital complications (treatment vs. control group) including acute respiratory distress syndrome (12.9% vs. 8.8%, p = 0.71), pneumonia (19.4% vs. 17.6%, p = 0.85), multi-organ failure (12.9% vs. 17.6%, p = 0.58) and the mortality rate (22.6% vs. 14.7%, p = 0.41) were comparable between the groups.@*CONCLUSION@#Administrating montelukast has no preventive or therapeutic effects on lung contusion or its complications.
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Humanos , Adolescente , Pared Torácica , Neumonía , Heridas no Penetrantes , Traumatismos Torácicos/tratamiento farmacológico , Lesión Pulmonar , Contusiones , Síndrome de Dificultad Respiratoria del Recién Nacido/etiología , Inflamación , Comprimidos , Resultado del TratamientoRESUMEN
Este estudo teve como objetivo identificar o risco de desenvolvimento de transtorno de estresse pós-traumático (TEPT), bem como sua associação com pensamentos ou tentativas suicidas e a saúde mental de policiais militares feridos por arma de fogo, na Região Metropolitana de Belém (RMB), nos anos de 2017 a 2019. A pesquisa contou com a participação de 30 entrevistados, que responderam o Inventário Demográfico e a Lista de verificação de TEPT para o DSM-5 (PCL-5). Para análise dos dados, utilizou-se a técnica estatística Análise Exploratória de Dados e a técnica multivariada Análise de Correspondência. Os resultados revelaram a existência de risco de desenvolvimento do transtorno de forma parcial ou total em uma expressiva parcela da população entrevistada, tendo homens como maioria dos sintomáticos, com média de 38 anos, exercendo atividades operacionais e vitimados em via pública quando estavam de folga do serviço. O ferimento deixou a maioria com sequelas, com destaque para dores crônicas, limitações de locomoção e/ou mobilidade e perda parcial de um membro. E, ainda, policiais sintomáticos apresentaram comportamentos suicidas, relatando já terem pensado ou tentado tirar a própria vida. Desta forma, conclui-se que policiais militares são expostos constantemente a traumas inerentes a sua profissão. Quando há ameaça de vida, como nos casos de ferimentos por arma de fogo, são suscetíveis a sequelas físicas decorrente do ferimento, somadas a sequelas mentais tardias, como o surgimento de sintomatologias de TEPT e ideação suicida.(AU)
This study aimed to identify the risk of developing post-traumatic stress disorder (PTSD) and its associations around suicidal thoughts or attempts and mental health in military police officers injured by firearms, in the Metropolitan Region of Belem (RMB), from 2017 to 2019. The research had the participation of 30 respondents who answered the Demographic Inventory and the PTSD checklist for DSM-5 (PCL-5). For data analysis, we used the statistical technique Exploratory Data Analysis and the multivariate technique Correspondence Analysis. The results revealed the existence of risk of developing partial or total disorder in a significant portion of the interviewed population, with men as most of the symptomatic individuals, with mean age of 38 years, developing operational activities and victimized on public roads when they were off duty. The injuries left most of them with sequelae, especially chronic pain, limited locomotion and/or mobility, and partial loss of a limb. In addition, symptomatic officers showed suicidal behavior, such as reporting they had thought about or tried to take their own lives. Thus, we conclude that military policemen are constantly exposed to traumas inherent to their profession. When their lives are threatened, as in the case of firearm wounds, they are susceptible to physical sequelae resulting from the injury, in addition to late mental sequelae, such as the appearance of PTSD symptoms and suicidal ideation.(AU)
Este estudio tuvo como objetivo identificar el riesgo de desarrollo de trastorno de estrés postraumático (TEPT) y sus asociaciones con pensamientos o tentativas suicidas y la salud mental en policías militares heridos por armamiento de fuego, en la Región Metropolitana de Belém (Brasil), en el período entre 2017 y 2019. En el estudio participaron 30 entrevistados que respondieron el Inventario Demográfico y la Lista de verificación de TEPT para el DSM-5 (PCL-5). Para el análisis de datos se utilizaron la técnica estadística Análisis Exploratoria de Datos y la técnica multivariada Análisis de Correspondencia. Los resultados revelaron que existen riesgos de desarrollo de trastorno de estrés postraumático de forma parcial o total en una expresiva parcela de la población de policías entrevistados, cuya mayoría de sintomáticos eran hombres, de 38 años en media, que ejercen actividades operacionales y fueron victimados en vía pública cuándo estaban de día libre del servicio. La lesión dejó la mayoría con secuelas, especialmente con dolores crónicos, limitaciones de locomoción y/o movilidad y la pierda parcial de un miembro. Aún los policías sintomáticos presentaran comportamiento suicida, tales como relataran qué ya pensaron o tentaron quitar la propia vida. Se concluye que los policías militaran se exponen constantemente a los traumas inherentes a su profesión. Cuando existe amenaza de vida, como en los casos de heridas por armamiento de fuego, son expuestos a secuelas físicas transcurridas de la herida, sumado a secuelas mentales tardías, como el surgimiento de sintomatologías de TEPT y la ideación suicida.(AU)
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Adulto Joven , Dolor , Heridas y Lesiones , Heridas por Arma de Fuego , Síntomas Psíquicos , Riesgo , Distrés Psicológico , Ansiedad , Trastornos de Ansiedad , Trastornos Fóbicos , Prisiones , Psicología , Conducta Fugitiva , Seguridad , Atención , Trastornos del Sueño-Vigilia , Trastornos por Estrés Postraumático , Suicidio , Intento de Suicidio , Terapéutica , Violencia , Síntomas Conductuales , Horas de Trabajo , Agotamiento Profesional , Adaptación Psicológica , Catatonia , Terapia Cognitivo-Conductual , Salud Laboral , Conducta Autodestructiva , Defensa Civil , Derechos Civiles , Trastorno de Pánico , Sector Público , Cognición , Eficiencia Organizacional , Contusiones , Víctimas de Crimen , Trastornos Relacionados con Sustancias , Ingenio y Humor , Crimen , Alerta en Emergencia , Programa de Protección Civil , Protección Civil , Proceso Legal , Muerte , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Agresión , Depresión , Mareo , Sueños , Alcoholismo , Reacción de Fuga , Prevención de Enfermedades , Vigilancia de la Salud del Trabajador , Vigilancia del Ambiente de Trabajo , Fatiga Mental , Miedo , Catastrofización , Medicalización , Esperanza , Atención Plena , Conducta Criminal , Trastornos Relacionados con Traumatismos y Factores de Estrés , Trauma Psicológico , Abuso Físico , Excitabilidad Cortical , Equilibrio entre Vida Personal y Laboral , Estrés Laboral , Violencia con Armas , Reducción de Desastres , Kinesiofobia , Bienestar Psicológico , Prevención del Suicidio , Prevención de Accidentes , Culpa , Cefalea , Promoción de la Salud , Homicidio , Trastornos del Inicio y del Mantenimiento del Sueño , Satisfacción en el Trabajo , Trastornos MentalesRESUMEN
A Homeopatia é uma ciência fundamentada na observação dos fenômenos naturais. Segundo Hahnemann, a cura homeopática é aquela que acontece de acordo com as leis naturais, sendo uma delas a lei dos semelhantes, já descrita por muitos médicos desde a antiguidade, inclusive Hipócrates. Quando são seguidos os princípios estipulados por Hahnemann, considerando a totalidade sintomática, incluindo a escolha do medicamento, sua potência, dose e frequência de administração, o tratamento homeopático torna-se eficaz tanto em casos crônicos quanto nos agudos, "sendo capaz de aniquilar a doença sem produzir novos e sérios distúrbios". Este estudo tem como objetivo exemplificar como, seguindo os princípios estipulados, a Homeopatia pode ser eficaz no tratamento de um quadro agudo que não obteve sucesso com a terapêutica alopática convencional. Trata-se de um relato de caso de paciente de 64 anos, sem doença prévia instalada, com ferimento corto- -contuso em mão esquerda após queda da própria altura, mantendo sinais flogísticos e ausência de cicatrização 13 dias após a realização da sutura e de fazer uso regular de antibiótico e anti-inflamatório prescritos. Após a avaliação da totalidade sintomática, foi prescrito Belladonna 6cH, administrada pelo método plus, resultando em alívio imediato dos sintomas e cura total em 5 dias. Realizando com cautela o diagnóstico homeopático e a partir disso elegendo o medicamento mais similar ao caso, com potência, dose e frequência de administração adequadas, é possível obter resultados eficazes com o tratamento homeopático, sempre considerando a constituição do indivíduo.
Homeopathy is a science based on the observation of phenomena natural. According to Hahnemann, homeopathic cure is one that happens according to natural laws, one of which is the law of similars, already described by many doctors since ancient times, including Hippocrates. When the principles stipulated by Hahnemann, considering the symptomatic totality, including the choice of the medicine, its potency, dose and frequency of administration, the Homeopathic treatment becomes effective in both chronic and in acute cases, "being capable of annihilating the disease without producing new and serious disturbances." This study aims to exemplify how, following the stipulated principles, Homeopathy can be effective in treatment of an acute condition that has not been successful with therapy conventional allopathic. This is a patient case report 64 years old, with no previous illness, with a cut wound-bruise in the left hand after falling from a height, maintaining phlogistic signs and lack of healing 13 days after the procedure suture and regular use of prescribed antibiotics and anti-inflammatory drugs. After evaluating the totality of symptoms, Belladonna was prescribed 6cH, administered by the plus method, resulting in immediate relief of symptoms and complete cure in 5 days. Carrying out the diagnosis with caution homeopathic and from there choosing the medicine most similar to the case, with adequate potency, dose and frequency of administration, it is possible to obtain effective results with homeopathic treatment, always considering the constitution of the individual.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Medicamento Homeopático , Terapéutica Homeopática , Contusiones/terapia , Atropa belladonnaRESUMEN
PROPOSE@#In this study, we re-assessed the criteria defined by the radiological society of North America (RSNA) to determine novel radiological findings helping the physicians differentiating COVID-19 from pulmonary contusion.@*METHODS@#All trauma patients with blunt chest wall trauma and subsequent pulmonary contusion, COVID-19-related signs and symptoms before the trauma were enrolled in this retrospective study from February to May 2020. Included patients (Group P) were then classified into two groups based on polymerase chain reaction tests (Group Pa for positive patients and Pb for negative ones). Moreover, 44 patients from the pre-pandemic period (Group PP) were enrolled. They were matched to Group P regarding age, sex, and trauma-related scores. Two radiologists blindly reviewed the CT images of all enrolled patients according to criteria defined by the RSNA criteria. The radiological findings were compared between Group P and Group PP; statistically significant ones were re-evaluated between Group Pa and Group Pb thereafter. Finally, the sensitivity and specificity of each significant findings were calculated. The Chi-square test was used to compare the radiological findings between Group P and Group PP.@*RESULTS@#In the Group PP, 73.7% of all ground-glass opacities (GGOs) and 80% of all multiple bilateral GGOs were detected (p < 0.001 and p = 0.25, respectively). Single bilateral GGOs were only seen among the Group PP. The Chi-square tests showed that the prevalence of diffused GGOs, multiple unilateral GGOs, multiple consolidations, and multiple bilateral consolidations were significantly higher in the Group P (p = 0.001, 0.01, 0.003, and 0.003, respectively). However, GGOs with irregular borders and single consolidations were more significant among the Group PP (p = 0.01 and 0.003, respectively). Of note, reticular distortions and subpleural spares were exclusively detected in the Group PP.@*CONCLUSION@#We concluded that the criteria set by RSNA for the diagnosis of COVID-19 are not appropriate in trauma patients. The clinical signs and symptoms are not always useful either. The presence of multiple unilateral GGOs, diffused GGOs, and multiple bilateral consolidations favor COVID-19 with 88%, 97.62%, and 77.7% diagnostic accuracy.
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Humanos , COVID-19 , Contusiones/diagnóstico por imagen , Plomo , Pulmón/diagnóstico por imagen , Lesión Pulmonar/etiología , Estudios Retrospectivos , SARS-CoV-2 , Tomografía Computarizada por Rayos X/métodosRESUMEN
Abstract Objective To investigate the incidence, mechanisms, types of injury, most affected anatomical regions, and factors leading to injuries in trail bikers. Methods This was an observational, retrospective study analyzing 47 trail bikers. Data were collected through application of a referenced morbidity survey (RMS), which included information on injuries and their mechanisms. Results The lesions with the highest incidence were abrasion and bruise. The most affected anatomical regions were the shoulders and knees. The most common injury mechanism was skidding or loss of traction. Conclusion Trail bikers are exposed to risk factors and, consequently, to falls; it is important to develop more protective equipment, especially for the shoulders and knees.
Resumo Objetivo Investigar a incidência, os mecanismos, os tipos de lesão, as regiões anatômicas mais acometidas, e os fatores que podem levar a lesões nos motociclistas praticantes de trilhas. Métodos Trata-se de uma pesquisa observacional do tipo retrospectivo, na qual foi realizada análise com 47 motociclistas praticantes de trilhas. Os dados foram coletados através da aplicação de um inquérito de morbidade referida (IMR), que incluiu informações sobre lesões e seus mecanismos. Resultados Ao analisar a amostra, verificou-se que os tipos de lesões com maior incidência foram abrasão e contusão. As regiões anatômicas mais acometidas foram o ombro e o joelho, e o mecanismo de lesão mais comum foi a derrapagem ou perda da tração. Conclusão Os trilheiros estão expostos a fatores de risco e, consequentemente, às quedas, sendo importante desenvolver mais equipamentos de proteção, em especial para o ombro e para o joelho.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Equipos de Seguridad , Traumatismos en Atletas , Hombro , Deportes , Accidentes por Caídas , Motocicletas , Vehículos a Motor Todoterreno , Contusiones , RodillaRESUMEN
SUMMARY: The aim of this study was to evaluate the effects of stretching and therapeutic ultrasound (TUS) on desmin and laminin contents of rat muscle after contusion. Male Wistar rats (n = 35, 8-9 weeks of age, 271 ± 14g body weight) were divided into five groups: Control group (CG) (n= 03); Injured group (IG) (n= 8); Injured + ultrasound group (IUSG) (n= 8); Injured+stretching group (ISG) (n= 8); Injured +ultrasound + stretching group (IUSSG) (n= 8). The application of ultrasound started 72 hours after the contusion, using the 50 % pulsed mode, 0.5 W/cm2, 5 min, once a day, for five consecutive days. Passive manual stretching was started on the tenth day after injury, with four repetitions of 30 s each and 30 s rest between repetitions, once a day, five times per week, for a total of ten applications. After 22 days, the rats were euthanazied and the gastrocnemius of both limbs removed for desmin and laminin immunohistochemistry morphometric measurement. Analysis was conducted using ANOVA one way post-hoc Tukey to parametric data and Kruskall-Wallis for non-parametric data. The IUSSG animals showed a larger area of desmin than ISG (p<0.05). It was found a decrease in laminin comparing IUSG to IG. However, laminin area was higher in ISG than all groups (p<0.05). UST isolated or in combination with stretching influenced gastrocnemius regeneration in different manners. While stretching applied isolated enhanced gastrocnemius regeneration noticed by the increase in laminin area, in combination with TUS strengthened the muscle healing rising desmin area.
RESUMEN: El objetivo de este estudio fue evaluar los efectos del estiramiento y la ecografía en los contenidos de desmina y laminina del músculo de rata después de la lesión. Ratas Wistar macho (n = 35, 8-9 semanas de edad, 271 ± 14 g de peso corporal) se dividieron en cinco grupos: grupo de control (CG) (n = 03); Grupo lesionado (GL) (n = 8); Lesionado + grupo de ultrasonido (LGU) (n= 8); Lesionado + grupo de estiramiento (LGE) (n = 8); Lesionado + ultrasonido + grupo de estiramiento (LUGE) (n = 8). La aplicación de ultrasonido comenzó 72 horas después de la lesión, usando el modo pulsado al 50 %, 0,5W / cm2, 5 min, una vez al día, durante cinco días consecutivos. El estiramiento manual pasivo se inició el décimo día después de la lesión, con cuatro repeticiones de 30 seg cada una y 30 seg de descanso entre repeticiones, una vez al día, cinco veces por semana, para un total de diez aplicaciones. Las ratas fueron sacrificadas después de 22 días, y se extrajo el músculo gastrocnemio de ambos miembros para la medición morfométrica de desmina y laminina a través de inmunohistoquímica. El análisis se realizó utilizando ANOVA unidireccional Tukey post-hoc para datos paramétricos y Kruskall-Wallis para datos no paramétricos. Los animales LUGE mostraron un área mayor de desmina que LGE (p <0,05). Se encontró una disminución en la laminina comparando LGU con GL. Sin embargo, el área de laminina fue mayor en LGE que en todos los grupos (p <0,05). El tratamiento con ultrasonido aislado o en combinación con estiramiento influyó en la regeneración del músculo gastrocnemio de diferentes maneras. Si bien el estiramiento aplicado, en combinación con tratamiento de ultrasonido, fortaleció el área de desmina, la regeneración del músculo gastrocnemio mejoró por el aumento en el área de laminina aumentando la curación muscular.
Asunto(s)
Animales , Masculino , Ratas , Terapia por Ultrasonido/métodos , Músculo Esquelético/patología , Contusiones/terapia , Ejercicios de Estiramiento Muscular/métodos , Inmunohistoquímica , Análisis de Varianza , Laminina/análisis , Ratas Wistar , Músculo Esquelético/lesiones , Desmina/análisisRESUMEN
ABSTRACT Objective: Describe the clinical management of an atypical Le Fort I fracture case. Case presentation: A 33-year-old patient was brought to the Surgical and Maxillofacial Traumatology Service of Humberto Lucena Senatorial Emergency and Trauma Hospital in Joao Pessoa (PB), Brazil, after undergoing physical aggression. The patient was conscious and lucid. Clinical examination revealed sinking of the middle third of the face with edema and bilateral periorbital ecchymosis. Visual acuity and ocular motricity were preserved in both eyes. A cut-contusion injury on the upper lip, maxillary mobility when handled and discrete occlusal dystopia were also observed. Imaging examination identified a high bilateral Le Fort I fracture. The therapeutic approach chosen was fracture reduction and fixation with plates and screws. After a period of two months, the patient is healing well without any apparent functional or aesthetic alteration. Conclusions: Atypical Le Fort I fractures are not frequent; however, a number of etiologies besides the impact force may bring about them. Treatment should be based on the one for classical Le Fort I fractures with adjustments to the surgical access approach(AU)
RESUMEN Objetivo: Describir los manejos clínicos realizados en una víctima de fractura de Le Fort I atípica. Reporte de caso: Un hombre de 33 años fue llevado al Servicio de Traumatología Quirúrgica y Maxilofacial del Hospital de Trauma y Emergencias Senatorial Humberto Lucena - Joao Pessoa (PB), Brasil, víctima de agresión física. El paciente estaba consciente y lúcido. Clínicamente, se observó hundimiento del tercio medio de su cara con edema y equimosis periorbital bilateral. La agudeza visual y la motricidad ocular se conservaron en ambos ojos. También se observaron herida constuso-cortante en el labio superior, movilidad maxilar cuando se manipula y discreta distopia oclusal. El examen de imagen identificó una fractura bilateral alta de Le Fort I. El enfoque terapéutico elegido fue la reducción de la fractura y la fijación con placas y tornillos. Después de un período de 2 meses, el paciente está evolucionando bien sin aparentes alteraciones funcionales o estéticas. Conclusiones: las fracturas atípicas de Le Fort I no son frecuentes, sin embargo, diferentes etiologías añadidas a la fuerza de impacto pueden justificarlas. El tratamiento debe basarse en las fracturas clásicas de Le Fort I con ajustes en el abordaje de acceso quirúrgico(AU)
Asunto(s)
Humanos , Masculino , Adulto , Heridas y Lesiones/etiología , Fracturas Óseas/terapia , Fijación de Fractura/métodos , Contusiones/terapiaRESUMEN
Objective To screen serum biomarkers after skeletal muscle contusion in rats based on gas chromatography-mass spectrometry (GC-MS) metabolomics technology, and support vector machine (SVM) regression model was established to estimate skeletal muscle contusion time. Methods The 60 healthy SD rats were randomly divided into experimental group (n=50), control group (n=5) and validation group (n=5). The rats in the experimental group and the validation group were used to establish the model of skeletal muscle contusion through free fall method, the rats in experimental group were executed at 0 h, 2 h, 4 h, 8 h, 12 h, 24 h, 48 h, 96 h, 144 h and 240 h, respectively, and the rats in validation group were executed at 192 h, while the rats in the control group were executed after three days' regular feeding. The skeletal muscles were stained with hematoxylin-eosin (HE). The serum metabolite spectrum was detected by GC-MS, and orthogonal partial least square-discriminant analysis (OPLS-DA) pattern recognition method was used to discriminate the data and select biomarkers. The SVM regression model was established to estimate the contusion time. Results The 31 biomarkers were initially screened by metabolomics method and 6 biomarkers were further selected. There was no regularity in the changes of the relative content of the 6 biomarkers with the contusion time and the SVM regression model can be successfully established according to the data of 6 biomarkers and the 31 biomarkers. Compared with the injury time [(55.344±7.485) h] estimated from the SVM regression model based on the data of 6 biomarkers, the injury time [(195.781±1.629) h] estimated from the SVM regression model based on the data of 31 biomarkers was closer to the actual value. Conclusion The SVM regression model based on metabolites data can be used for the contusion time estimation of skeletal muscles.
Asunto(s)
Animales , Ratas , Biomarcadores , Contusiones , Análisis Discriminante , Metabolómica , Músculo Esquelético/lesiones , Ratas Sprague-DawleyRESUMEN
INTRODUCCIÓN: El traumatismo torácico (TT) es una causa importante de morbilidad y mortalidad, presente en el 25-50% de la mortalidad por traumatismo. El TT contuso (TTC) es el tipo más frecuente de TT según las diferentes publicaciones internacionales. OBJETIVO: Nuestros objetivos son describir las características, tratamientos, morbilidad y mortalidad en pacientes hospitalizados por TTC en nuestra institución. MATERIAL Y MÉTODOS: Estudio descriptivo transversal desde enero-1981 a diciembre-2017. Revisión de una base de datos prospectiva, protocolos quirúrgicos y fichas clínicas. Se describen y comparan las características de los TTC. Se calcularon índices de gravedad de traumatismo (IGT): Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). RESULTADOS: Total 4.163 pacientes hospitalizados por TT, 1.719 (41,3%) TTC. Hombres 1.327 (77,2%), edad promedio 46,7±18,8 años. Se consideró TT aislado 966 (56,2%), asociado a lesiones extratorácicas 753 (43,8%) y de estos 508 (29,6%) eran politraumatizados. Mecanismo: Accidente de tránsito 838 (48,7%), caída de altura 279 (16,2%). Lesiones y hallazgos torácicos: fractura costal 1.294 (75,3%), neumotórax 752 (43,1%). Tratamiento: médico 874 (50,8%), pleurotomía 704 (41%) y cirugía torácica 141 (8,2%). Período de hospitalización 9,2 ± 9,5 días. Según IGT: ISS promedio 14,1 ± 11,1, RTS-Tpromedio 11,5 ± 1,5, TRISS promedio 6,6. Morbilidad en 297 (17,3%), mortalidad en 68 (4%). DISCUSIÓN: La causa principal de los TTC fue el accidente de tránsito. La fractura costal correspondió a la lesión torácica más frecuente. La mayoría requirió solo tratamiento médico. La mortalidad fue menor a la esperada según IGT.
BACKGROUND: Thoracic trauma (TT) is a major cause of morbimortality, involved in 25-50% of trauma deaths. Internationally, blunt thoracic trauma (BTT) is the most frequent type of TT. OBJECTIVE: Our objectives are to describe the clinical characteristics, treatments, morbidity and mortality in patients hospitalized by blunt thoracic trauma (BTT) in our institution. MATERIAL AND METHODS: Cross-sectional descriptive study from january-1981 to december-2017. Prospective database review, surgical protocols and clinical files. The characteristics of the BTT are described and compared. The following trauma severity indices (TSI) were calculated: Injury Severity Score (ISS), Revised Trauma Score (RTS-T) and Trauma Injury Severity Score (TRISS). RESULTS: 4,163 patients were hospitalized because of TT, 1.719 (41.3%) of them with BTT. 1,327 (77.2%)patients were men, average age 46.7 ± 18.8 years-old. We considered isolated TT 966 (56.2%), associated with extrathoracic lesions 753 (43,8%) and 508 (29.6%)with polytraumatism. Mechanism: Traffic accident 838 (48.7%), fall down from a height 279 (16.2%). Lesions and intrathoracic findings: rib fracture 1.294 (75.3%), pneumothorax 752 (43.7%). Treatment: Medical 876 (50.8%), pleurotomy 704 (41%) and thoracic surgery 141 (8.2%). Average hospitalized period 9.2 ± 9.5 days. According to TSI: ISS average 14.1 ± 11.1, RTS-T average 11.5 ± 1.5, TRISS average 6.6. Morbidity in 297 (17.3%), mortality in 68 (4%). DISCUSSION: The TTC was mainly attributed to the traffic accident. Rib fracture was the most common chest injury. The majority of patients required only medical treatment. Mortality was lower than expected according to TSI.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Traumatismos Torácicos/terapia , Traumatismos Torácicos/epidemiología , Heridas no Penetrantes/terapia , Heridas no Penetrantes/epidemiología , Traumatismos Torácicos/etiología , Traumatismos Torácicos/mortalidad , Heridas no Penetrantes/etiología , Heridas no Penetrantes/mortalidad , Accidentes/estadística & datos numéricos , Índices de Gravedad del Trauma , Epidemiología Descriptiva , Estudios Transversales , Contusiones , HospitalizaciónRESUMEN
Atualmente os consumidores buscam cada vez mais alimentos seguros, de qualidade e produzidos de forma sustentável, dessa forma os produtores e empresas tentam ao máximo atender essas buscas, melhorando o manejo da propriedade ao frigorifico, trazendo cada vez mais o ideal de bem-estar animal. O bem-estar animal tem como objetivo evitar o sofrimento desnecessário dos animais nas etapas que antecedem o abate, ainda que com sua implementação, ainda há muitas perdas econômica e qualitativa das carcaças devido à presença de contusões. As contusões podem ocorrer pelas mais diversas causas, de manejo inadequado até rodovias precárias. Diante do exposto, considerando a importância das contusões para a qualidade das carcaças, o presente trabalho foi realizado em um abatedouro-frigorífico de bovinos sob Serviço de Inspeção Federal localizado em Mato Grosso, e teve como objetivo quantificar as carcaças com contusões, além de apontar o tipo de contusão e a região anatômica acometida. De um total de 4579 animais avaliados, 2829 (61,78%) apresentaram algum tipo de contusão, desde as pequenas e superficiais até as maiores e profundas. Em relação ao grau das contusões, a que teve maior ocorrência foi a de grau I (59,31%), seguida pelo grau II (37,39%) e grau III (3,28%). Quanto à localização anatômica, houve um predomínio de contusões na região do traseiro, seguido pelo gradil costal (PA), lombo e dianteiro. Portanto, observamos a necessidade da atualização dos conceitos de bem-estar dentro de toda a cadeia produtiva, além de treinamento de funcionários em relação ao manejo pré-abate, visando não comprometer o animal e a qualidade da carne.
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Animales , Bovinos , Sacrificio de Animales , Bienestar del Animal , Carne/análisis , Contusiones/veterinaria , Contaminación de Alimentos , MataderosRESUMEN
A cadeia produtiva de carne bovina ocupa um lugar de destaque no cenário da economia brasileira gerando empregos e renda à população. A inspeção post mortem, é realizada através do exame macroscópico de vísceras e carcaças, a partir do exame visual, obtém assim o destino final de carcaças e vísceras. O objetivo do trabalho foi levantar as principais causas de condenação total de carcaças bovinas em um abatedouro frigorífico de acordo com os critérios de inspeção, e avaliar os possíveis fatores que podem levar a ocorrência das mesmas. O estudo foi realizado em um abatedouro frigorífico de bovinos e suínos, localizado na cidade de Boa Esperança - MG. Para o levantamento dos dados de condenação foi consultado o mapa nosográfico mensal, no período de agosto de 2017 a agosto de 2018. Observou-se nas amostragens que o maior índice de condenações no abatedouro frigorífico foi tuberculose (25,2%), cisticercose (6,5%), caquexia (19,6%), contusão generalizada (32,2%) e neoplasias (4%). Com os resultados encontrados observamos que houve uma maior taxa de condenações de carcaças por contusão generalizada, dessa forma ressaltamos que é de extrema importância a implantação do programa de bem estar animal para que haja uma redução nos números de condenações. Uma vez que conhecido os fatores que levam a determinadas patologias, medidas profiláticas devem ser adotadas para a redução de perdas geradas pelas condenações, desde a fazenda até o abate.
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Animales , Bovinos , Sacrificio de Animales/estadística & datos numéricos , Contaminación de Alimentos , Contusiones/veterinaria , Inspección de Alimentos , Alimento Perdido y DesperdiciadoRESUMEN
Resumo Em países desenvolvidos, a violência é a principal causa de lesões bucomaxilofaciais (LBMF). No Brasil, há poucas evidências sobre tais lesões. Objetivou-se caracterizar as LBMF resultantes de agressão física em uma capital do nordeste brasileiro e analisar diferenças entre gêneros. Foram investigados 15.847 laudos do Instituto Médico Legal de São Luís/MA, ocorridos em 2012. Coletaram-se dados socioeconômicos, demográficos e características das LBMF. Utilizaram-se os testes Qui-quadrado e Exato de Fisher para avaliar diferenças entre gêneros. Dos casos periciados, 1977 eram LBMF. Vítimas do sexo feminino, com 20-59 anos de idade, cor parda, sem companheiro e empregadas foram mais afetadas. Lesões do tipo equimose, nas regiões bucinadora e labial, decorrentes do uso de instrumentos contundentes, ocasionando debilidade funcional permanente foram mais incidentes em mulheres (P < 0,05), ao passo que fratura dental, ferida contusa e perfurocontusa, decorrentes de instrumentos cortantes e perfurocontundentes, ocasionando deformidade permanente, incapacidade ocupacional e perigo de vida, em homens (P < 0,05). Conclui-se que a incidência de LBMF decorrente de agressão física é alta em São Luís, MA, e, embora as mulheres sejam mais acometidas, as LBMF em homens são mais severas.
Abstract In developed countries, violence is the main cause of oral maxillofacial (OMF) injuries. In Brazil, there are scant records of such lesions. The scope of this study was to detail the OMF injuries resulting from physical aggression in a capital of the Brazilian northeast and analyze gender differences. The Forensic Medicine Institute of São Luís, state of Maranhão, featured 15,847 reports, which occurred in 2012, and they were investigated. Socioeconomic, demographic data and OMF characteristics were analyzed. The Chi-square and Fisher's Exact tests were applied to assess gender differences. Of the cases examined, 1977 were OMF. Female victims, aged 20-59, dark-skinned, without a partner and maids were the most affected. Ecchymosis-type lesions, in the mouth and lip regions arising from the use of blunt instruments, causing permanent functional impairment, were the most prevalent in women (P < 0.05), whereas dental fracture and contusion arising from sharp instruments causing permanent deformity, occupational disability, and threat to life were detected in men (P < 0.05). The conclusion drawn is that the incidence of OMF due to physical aggression is high in São Luís, state of Maranhão, and although women are the most affected, the OMF in men are more severe.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Adulto Joven , Violencia/estadística & datos numéricos , Agresión , Fracturas Óseas/epidemiología , Traumatismos Maxilofaciales/epidemiología , Brasil/epidemiología , Índices de Gravedad del Trauma , Factores Sexuales , Incidencia , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Contusiones/etiología , Contusiones/epidemiología , Evaluación de la Discapacidad , Fracturas Óseas/etiología , Traumatismos Maxilofaciales/etiología , Persona de Mediana EdadRESUMEN
Post-traumatic hematoma formation is a common complication of contusion. If the hematoma is large enough to aspirate or drain, it can be treated quickly and appropriately. However, if the hematoma is small or concealed by local swelling, it may be overlooked and left untreated. In most cases, a hematoma will resolve following conservative treatment; however, associated infection or muscle fibrosis can occur. Herein, we present the case of a patient with a chin deformity caused by a post-traumatic hematoma. The deformity was treated using botulinum toxin and triamcinolone acetonide injections as minimally invasive treatments. The course of treatment was good.
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Humanos , Toxinas Botulínicas , Mentón , Anomalías Congénitas , Contusiones , Asimetría Facial , Fibrosis , Hematoma , Triamcinolona AcetonidaRESUMEN
Spinal cord contusion injury is one of the most serious nervous system disorders, characterized by high morbidity and disability. To mimic spinal cord contusion in humans, various animal models of spinal contusion injury have been developed. These models have been developed in rats, mice, and monkeys. However, most of these models are developed using rats. Two types of animal models, i.e. bilateral contusion injury and unilateral contusion injury models, are developed using either a weight drop method or impactor method. In the weight drop method, a specific weight or a rod, having a specific weight and diameter, is dropped from a specific height on to the exposed spinal cord. Low intensity injury is produced by dropping a 5 g weight from a height of 8 cm, moderate injury by dropping 10 g weight from a height of 12.5–25 mm, and high intensity injury by dropping a 25 g weight from a height of 50 mm. In the impactor method, injury is produced through an impactor by delivering a specific force to the exposed spinal cord area. Mild injury is produced by delivering 100 ± 5 kdyn of force, moderate injury by delivering 200 ± 10 kdyn of force, and severe injury by delivering 300 ± 10 kdyn of force. The contusion injury produces a significant development of locomotor dysfunction, which is generally evident from the 0–14(th) day of surgery and is at its peak after the 28–56th day. The present review discusses different animal models of spinal contusion injury.
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Animales , Femenino , Humanos , Ratones , Ratas , Peso Corporal , Vértebras Cervicales , Contusiones , Haplorrinos , Locomoción , Métodos , Modelos Animales , Enfermedades del Sistema Nervioso , Traumatismos de la Médula Espinal , Médula EspinalRESUMEN
Objective To study the expressions of transforming growth factor-β1 (TGF-β1) and EⅢA-fibronectin (EⅢA-FN) at different time points of antemortem injury, antemortem injury postmortem expression and postmortem injury and to explore their application value in wound age estimation. Methods A model of rat skeletal muscle contusion was established. The rats were randomly divided into normal control group (n=5), antemortem contusion group (n=40), antemortem contusion postmortem expression group (n=110) and postmortem injury group (n=25). The expressions of TGF-β1 and EⅢA-FN after rat skeletal muscles antemortem contusion were detected with immunohistochemical staining. Expression changes of TGF-β1 and EⅢA-FN mRNA in each group were analyzed with real-time fluorescence quantitative PCR. Results Immunohistochemical staining results showed that a large number of polymorphonuclear leukocyte, mononuclear cells and fibroblastic cells showed a strong expression of TGF-β1 in wounded zones 12 h-14 d after antemortem contusion. EⅢA-FN was mainly distributed in the extracellular matrix, 3 to 7 d post-traumatic. Real-time fluorescence quantitative PCR results showed that TGF-β1 and EⅢA-FN mRNA in antemortem injury group reached the peak at 3 and 5 d post-traumatic respectively. The expressions of TGF-β1 and EⅢA-FN mRNA in antemortem contusion postmortem expression group peaked at 6 h and 12 h postmortem. The expression of TGF-β1 and EⅢA-FN mRNA in postmortem injury group 0.5-12 h postmortem was significantly lower than those of the normal control group and the antemortem contusion group. Conclusion TGF-β1 and EⅢA-FN might become a reference index for skeletal muscle wound age estimation.
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Animales , Ratas , Biomarcadores/metabolismo , Contusiones/metabolismo , Fibroblastos , Fibronectinas/metabolismo , Músculo Esquelético/metabolismo , Cambios Post Mortem , Distribución Aleatoria , Factor de Crecimiento Transformador beta1/metabolismoRESUMEN
Objective To investigate the estimation of early and mid-term wound age by a combination of four mRNAs, the DNA polymerase delta-interacting protein 3 (POLDIP3) mRNA, regulator of chromosome condensation 1 like (RCC1L) mRNA, proline-rich 5 (PRR5) mRNA, and ribonucleic acid export 1 (RAE1) mRNA in rats skeletal muscles. Methods The model of rat skeletal muscle contusion was established, and then contusion area muscle tissue was extracted 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44 and 48 h after injury. Histomorphological changes during the repair process after rat skeletal muscle contusion were observed. The relative expressions of Poldip3, Rcc1l, Prr5 and Rae1 mRNAs were detected by reverse transcription real-time quantitative polymerase chain reaction (RT-qPCR). Different stages of wound age were classified by using the expression patterns of four genes at various time points after injury. The accuracy of the results was verified by Fisher discriminant analysis. Results Histomorphological results showed that the repair process after skeletal muscle contusion occurred with the prolonging of time. Through combination of the expression trends of the four kinds of mRNAs, the 48 h after injury could be divided into three periods, 4-12 h, 16-28 h and 32-48 h. The Fisher discrimination method showed that the classification accuracy rates of the three periods were 83.3%, 75.0% and 73.3%, respectively. Conclusion The classification discrimination based on the relative expression of every gene has a higher accuracy, and the accuracy of wound age estimation with combination of mRNA relative expressions is higher than that with a single indicator. By combining with Fisher discrimination method, this method can be used for early and mid-term wound age estimation.
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Animales , Ratas , Contusiones/metabolismo , Músculo Esquelético/metabolismo , ARN Mensajero/genética , Ratas Sprague-Dawley , Factores de TiempoRESUMEN
Objective To explore the application of neutrophil migration distance for wound age estimation of skeletal muscles in rats, and to provide methodological basis for follow-up study in future. Methods The skeletal muscle contusion model was established in rats, and the control group and the 2, 4, 6 h post-traumatic groups were set. The law of response of neutrophils that participated in the inflammation after injury was detected by immunohistochemical staining, and the relationship between neutrophil migration distance and injury time was detected by TissueFAXS PLUS software. Results The skeletal muscle was obviously infiltrated with neutrophils 2-6 h after injury. The positive rate of neutrophil was (28.75±0.94)% at 2 h post-traumatic, and reached the peak (45.50±3.63)% at 4 h post-traumatic, then decreased to (31.92±1.56)% at 6 h post-traumatic. The neutrophil migration distances increased with the progress of inflammation, and reached (124.80±12.32) μm, (229.03±21.45) μm and (335.04±16.75) μm at 2 h, 4 h and 6 h, respectively. Conclusion There is a relationship of neutrophil infiltrated number and migration distance and wound age within the 2-6 h after skeletal muscle injury, which could be used for the inference of skeletal muscle wound age.
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Animales , Ratas , Contusiones/metabolismo , Estudios de Seguimiento , Músculo Esquelético/patología , Infiltración Neutrófila , Neutrófilos , Ratas Sprague-Dawley , Factores de TiempoRESUMEN
Objective To observe the change pattern of pericyte number at different time periods after mice skeletal muscle contusion and discuss its role in wound age estimation. Methods A mice gastrocnemius muscle contusion model was established. The form and number changes of pericytes at 1, 3, 5, 7, 9, 14, and 28 d post-injury were detected by multiple immunofluorescence staining. Results Compared with the slender shape of pericytes in normal skeletal muscles, pericytes in the contusion area had increased volume, rounder form and a round nuclei. Part of pericytes were found to express satellite cell markers paired-box transcription factor (Pax7) or myoblast determination 1 (MyoD1). The changes of pericyte number in skeletal muscles after contusion were time-dependant, and showed unimodal distribution with the extension of wound age. In the central contusion area, the number of pericytes peaked at 5 d post-injury while in the peripheral contusion area, the number of pericytes peaked at 5 d and 7 d post-injury. Conclusion The number of pericytes in contusion area varies time-dependently after skeletal muscle contusion in mice and might be a reference index for muscle wound age estimation, and is involved in the repair and regeneration of skeletal muscle injury.
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Animales , Ratones , Contusiones , Modelos Animales de Enfermedad , Músculo Esquelético , Pericitos , Ratas Sprague-DawleyRESUMEN
Objective To investigate the morphological changes in the degeneration and regeneration of neuromuscular junctions (NMJ) during the repair of mouse skeletal muscle contusion and discuss the correlation between the degeneration and regeneration of NMJ and wound age. Methods A total of 50 healthy adult male mice were randomly divided into 10 groups, including 9 experimental groups and 1 control group. Immunofluorescent staining was applied, and neurofilament was marked with neurofilament protein-H (NF-H), presynaptic membrane was marked with synaptophysin (Syn), presynaptic membrane was marked with acetylcholine receptor (AChR). Morphological changes of NMJ regeneration at different time points after mouse skeletal muscle contusion were detected. Results The neurofilament and presynaptic membrane of NMJ at the junction of contusion zones began to degrade after contusion, and completed degradation at about 3 d post-injury. Then they gradually regenerated, roughly completing the regeneration at about 21 d and basically reaching the control group level. The ratio of presynaptic membrane quantity to presynaptic membrane quantity showed a trend of decreasing then rising and finally reaching the control level. Conclusion During the repair of mouse skeletal muscle contusion, the morphological changes and wound age of the NMJ at the junction of contusion zones have a close correlation, which is expected to be one of the biological indicators for forensic skeletal muscle wound age estimation.