Accidentalidad vial y mortalidad por accidentes de tránsito en Honduras período 2013 al 2020 / Road accidents and mortality from traffic accidents in Honduras from 2013 to 2020

Introducción. Después de los homicidios, los accidentes de tránsito constituyen la segunda causa de muerte violenta en el país, la Policía Nacional de Honduras, es el ente gubernamental responsable de registrar los detalles de estos eventos. Objetivo. Analizar la frecuencia de accidentes de tránsito y la mortalidad asociada a los mismos, en el período 2013-2020. Métodos. Investigación cuantitativa, retrospectiva. Se consideró toda la población de 63,908 participantes en accidentes para el período 2013-2020, encontrados en la base de datos de la Policía Nacional de Honduras y la Unidad Técnica de Coordinación Institucional (UTECI). Se aplicó estadística descriptiva con un análisis univariado. Resultados. La tasa de muertes disminuyó de 1 a 3 personas por cada 10 participantes del año 2013-2020. El sexo más frecuente fue masculino en el rango de 20 a 39 años. La mortalidad predominó en los hombres con 82.8% (8,929) de las muertes predominando el rango de 15 a 39 años. El fenómeno de accidentalidad y mortalidad vial, desde el año 2013, aporta una tasa de crecimiento de 23%, solo interrumpida por la pandemia mundial por COVID19. En cuanto a responsabilidad de los accidentes un 33.4% de los hechores (responsables) eran hombres mientras que un 1.1% mujeres. Discusión. Los homicidios ocupan un espacio prioritario en la agenda pública por su impacto en la sociedad, no obstante, los accidentes de tránsito reportan una tasa de crecimiento constante y a pesar de ello no se observan esfuerzos de la sociedad que apunten a corregir el problema...(AU)

Accidentes de moto en Asunción-Paraguay: una problemática médica y social / Motorcycle accidents in Asunción-Paraguay: a social and medical problem

A nivel mundial el número de accidentes de tránsito va en aumento significativo, siendo uno de los mayoritarios los que se dan con motocicletas en el Paraguay, llenando la sala de urgencias del Hospital del Trauma, la falta de conocimiento de las normas de tránsito y la imprudencia a la hora de salir a las rutas sin normas de seguridad; sin casco protector son factores relacionados al accidente de tránsito. La rápida atención pre hospitalaria es fundamental en el lugar de los hechos, en relación con el tipo de lesión, el traumatismo sufrido, la forma de transportar al accidentado entre otros factores para disminuir de esa forma las muertes.

Traumatismes dento-maxillo-faciaux dans la ville de Ouagadougo: étude épidémiologique et clinique de 1221 cas sur une période de 365 jours / Dento-maxillo-facial trauma in the city of Ouagadougou: epidemiological and clinical study of 1221 cases over a 365-day period

Introduction : Les traumatismes dento-maxillo- faciaux (TDMF) représentent l'ensemble des lésions intéressants la face et les maxillaires. De par leur gravité, ils constituent une urgence en odontostomatologie. L'objectif de cette étude était de déterminer les facteurs étiologiques et d'identifier leurs différentes formes anatomocliniques dans notre contexte d'exercice. Méthodes : Il s'est agi d'une étude multicentrique transversale descriptive, à collecte rétrospective allant du 1er janvier au 31 décembre 2018. Elle a été réalisé dans des trois services de chirurgie buccale et maxillo- faciale des Centres Hospitaliers Universitaires de la ville de Ouagadougou. Résultats : Au total 1221 cas ont été colligés dans ces 3 CHU. La tranche d'âge de ]15-30] ans a été la plus représentée. Les accidents de la circulation routière ont constitué les principales causes 1012 cas (82,9%). Au plan anatomoclinique les lésions des parties molles constituaient 1221 cas (100%) et les lésions osseuses 721 cas (59 %). Conclusion : Les lésions occasionnées par les TDMF peuvent constituer de véritables urgences vitale et fonctionnelle. La sensibilisation des populations sur la sécurité routière, le renforcement du plateau technique de ces services et la collaboration interdisciplinaire permettraient de renforcer l'efficacité de la prise en charge des TDMF.

Análise da tendência da mortalidade por causas externas em pessoas idosas no Brasil, 2000 a 2022 / Analysis of the trend of mortality from external causes in older adults in Brazil, 2000 to 2022

Resumo Objetivo analisar a tendência de mortalidade por causas externas em pessoas idosas no Brasil no intervalo temporal entre os anos 2000 e 2022 e identificar o perfil sociodemográfico de mortalidade. Método estudo ecológico de série temporal utilizando dados secundários, envolvendo a mortalidade em pessoas idosas por causas externas no Brasil, no período de 2000 a 2022. Os dados foram coletados a partir das bases de dados do Departamento de Informática do Sistema Único de Saúde, das estimativas da população residente e de dados populacionais censitários disponibilizados pelo Instituto Brasileiro de Geografia e Estatística. A frequência absoluta e relativa dos dados foi analisada a partir do software Excel 2010. As análises das tendências das taxas de mortalidade e regressão linear segmentada foram realizadas por meio do Joinpoint, com significância estatística avaliada por meio do teste de Monte Carl Resultados No período investigado, foram identificados 572.608 óbitos por causas externas em pessoas idosas com 60 anos ou mais. Em relação ao comportamento da mortalidade por causas externas em pessoas idosas, observou-se tendência de aumento nas taxas de mortalidade na maior parte do período estudado (2000 a 2013) com uma variação percentual anual (VPA: 1,86; IC95%: 1,5-2,2). Conclusão os resultados indicam uma tendência de crescimento da mortalidade de pessoas idosas por causas externas, refletindo a necessidade de priorização de políticas públicas que intervenham sobre esse evento.

Abstract Objective To analyze the trend of mortality due to external causes in older adults in Brazil within the temporal interval spanning from 2000 to 2022 and to identify the sociodemographic profile of mortality. Method Ecological time-series study utilizing secondary data, encompassing mortality in older adults due to external causes in Brazil, spanning the period from 2000 to 2022. The data were collected from the databases of the Department of Informatics of the Unified Health System, population estimates, and census population data provided by the Brazilian Institute of Geography and Statistics. The absolute and relative frequency of the data were analyzed using Microsoft Excel 2010 software. The analysis of trends in mortality rates and segmented linear regression was conducted using Joinpoint, with statistical significance assessed through the Monte Carlo test. Results During the investigated period, 572,608 deaths due to external causes were identified in individuals aged 60 years or older. Regarding the mortality pattern due to external causes in older adults, an increasing trend in mortality rates was observed for the majority of the studied period (2000 to 2013) with an annual percent change (APC) of 1.86 (95% CI: 1.5-2.2). Conclusion The results indicate a growing trend in mortality among older individuals due to external causes, highlighting the need for prioritizing public policies that address this issue.

Medidas poblacionales para la seguridad vial: más allá de la responsabilidad individual / Population measures to improve road safety: Beyond individual responsibility

Las lesiones causadas por el tránsito (LCT) se encuentran dentro de las principales causas de mortalidad y discapacidad a nivel mundial, hecho reflejado en el puesto que ocupan dentro de las primeras diez causas de vida ajustados por discapacidad, con importantes costos e impacto económico y social para las sociedades que las padecen. En 2004, la Organización Mundial de la Salud (OMS) lanzó el primer informe sobre prevención de LCT. Sin embargo, en años posteriores esa situación no mejoró, por lo cual las Naciones Unidas lanzó la Década de Acción para la Seguridad Vial (2011-2020), donde se invitaba a los gobiernos a diseñar e implementar acciones para reducir la carga asociada a este problema; entre estas se encuentra diseño y mejoramiento de vías, atención oportuna pos siniestro, control de la velocidad, medidas de control administrativo, diseño y mejoramiento de estándares vehiculares, entre otras. Las medidas basadas en enfoque poblacional han demostrado ser más poderosas que las medidas que inducen cambios de comportamiento individual.

Injuries caused by traffic (ICT) are among the main causes of mortality and disability worldwide, reflected in the fact that they occupy the first ten causes of disability adjusted life years with economic and social cost impacts for the societies that suffer from them. In 2004, the World Health Organization (WHO) released the first Prevention Report about ICT. Nevertheless, in subsequent years this situation has not improved, motivating the United Nations to launch the Decade of Action for Road Safety (2011-2020), where governments were invited to design and implement actions to reduce the burden associated with this problem: designing and improving of roads, increasing timely post-crash care, speed control, administrative control measures, designing and improving vehicle safety standards, among others. Population-based measures have been shown to be more powerful than measures that induce individual behavior changes.

Mortalidad en accidentes por moto en Venezuela, y su relación con Políticas Públicas de seguridad vial y preventiva,1996-2018 / Mortality in motorcycle accidents in Venezuela and relationship with public road safety and preventive policies, 1996 - 2018

Los accidentes de tránsito son un problema de salud pública de gran magnitud y gravedad, en las Américas; Venezuela ocupa un lugar destacado por su alta incidencia. El objetivo de la investigación es establecer la relación entre las políticas públicas para la prevención de los accidentes de motocicletas, y las tasas de mortalidad. Metodología: Estudio documental retrospectivo de las políticas viales y las tasas de mortalidad específicas de lesionados por accidentes de motocicletas en Venezuela durante el período 1996-2018. Resultados: como causa de muerte en Venezuela (2000-2018), representa casi 7% del total, entre 6 a 50% del total de las muertes por accidentes de tránsito terrestre y se mantiene muy alta al final del período, con fallecidos por motocicletas sobre 25%. La elevación de la curva endémica de mortalidad ocurrió simultáneamente al aumento en la producción e importación de motocicletas, y cayó durante la crisis económica, en el año 2014. La legislación actualizada mas no acatada en esta materia, es notoria Conclusiones: Los accidentes de motocicleta son un problema de salud pública de primer orden en Venezuela asociadas al clima económico y social, las tasas de mortalidad tuvieron su máxima meseta de elevación durante la bonanza petrolera 2005-2013. Las políticas asociadas a la prevención de accidentes viales en moto están fragmentadas, son ineficientes y reactivas a situaciones complejas, deficientemente aplicadas por los organismos de tránsito responsables a escala nacional, regional y municipal.

Introduction. Traffic accidents are a public health problem of great magnitude and gravity in the Americas; Venezuela occupies a prominent place for its high incidence. The objective of the research is to establish the relationship between public policies for the prevention of motorcycle accidents, and mortality rates. Methodology: Retrospective documentary study of road policies and specific mortality rates of those injured by motorcycle accidents in Venezuela during the period 1996-2018. Descriptive statistical analysis with trend lines, frequency distributions and annual average rates. Results: cause of death in Venezuela (2000-2018), represents almost 7% of the total. The burden of motorcycle injury deaths represents between 6 to 50% of total road traffic fatalities and remains very high at the end of the period, with motorcycle fatalities over 25%. The elevation of the endemic mortality curve occurred simultaneously with the increase in the production and import of motorcycles, and fell concomitantly with the economic crisis in 2014. Conclusions: Motorcycle accidents are a public health problem of the first order in Venezuela associated with the economic and social climate, mortality rates had their maximum plateau of elevation during the oil economic boom 2005-2013. The policies associated with the prevention of road accidents by motorcycle are fragmented, inefficient and reactive to complex situations and poorly applied by the responsible traffic agencies at national, regional and municipal level.

Prevalência de atendimentos às vítimas de acidentes de trânsito durante a pandemia de COVID-19 / Prevalence of care for road traffic accident victims during the COVID-19 pandemic

Objetivo: Analisar a prevalência de acidentes de trânsito atendidos em um hospital de referência de urgência e emergência, no contexto da pandemia de COVID-19. Métodos: Estudo transversal, com amostra de 364 adultos vítimas de acidentes de trânsito, com idade entre 18 a 60 anos, de ambos os sexos. Utilizou-se um formulário de caracterização sociodemográfica e as características do acidente para coletar os dados. As variáveis foram analisadas por meio da estatística descritiva, análise bivariada e pelo teste Exato de Fisher, com nível de significância de 5% (p<0,05). Resultados: Na amostra, observou-se predomínio de pacientes do sexo masculino (77,1%), motoristas (71,1%), envolvendo motocicleta (68,6%) e sem a utilização do equipamento de proteção (73,3%). As lesões predominantes nos acidentes foram as fraturas (70,8%). Conclusão: Apesar da prevalência de atendimentos de urgências às vítimas de acidentes de trânsito durante a pandemia de COVID-19 ter diminuído de 0,77% (2019) para 0,34% em 2020, percebeu-se que as variáveis ainda permaneceram predominantes. Logo, os achados compreendem uma ferramenta importante para as políticas de prevenção e promoção à saúde, visando a redução de mortes, lesões e incapacidades. Descritores: Acidentes de trânsito. Serviços médicos de emergência. Epidemiologia. COVID-19

Objective: To analyze the prevalence of traffic accidents attended at an urgent and emergency referral hospital, in the context of the COVID-19 pandemic. Methods: Cross-sectional study with a sample of 364 adult victims of traffic accidents, aged between 18 and 60 years, of both sexes. A sociodemographic characterization form and accident characteristics were used to collect data. The variables were analyzed using descriptive statistics, bivariate analysis, and Fisher's Exact test, with a significance level of 5% (p<0.05). Results: In the sample, there was a predominance of male patients (77.1%), drivers (71.1%), involving motorcycle (68.6%) and without the use of protective equipment (73.3%). The predominant injuries in accidents were fractures (70.8%). Conclusion:Although the prevalence of emergency care for traffic accident victims during the COVID-19 pandemic decreased from 0.77% (2019) to 0.34% in 2020, it was noticed that the variables still remained predominant. Therefore, the findings comprise an important tool for prevention and health promotion policies, aiming at reducing deaths, injuries and disabilities. Descriptors: Accidents, traffic. Emergency medical services. Epidemiology. COVID-19

A case of closed isolated medial subtalar dislocation / Un caso de luxación subastragalina medial aislada y cerrada

Introduction: Closed isolated subtalar dislocations are very rare and major cause of subtalar dislocation remains to be road traffic accidents. Objective: Identify isolated medial subtalar closed dislocations and their forms a management. Presentation of case: 22-year-old male sustained road traffic accident following which he had deformed foot with inability to bear weight. On evaluation he was found to have medial subtalar dislocation reduced with manual traction. One year follow up showed, no residual deformity or pain and had very good functional outcome. Conclusions: It is of great importance to identify the difference between medial subluxation or dislocation and medial swivel injury which have different mechanisms as well as different reduction maneuvers(AU)

Introducción: Las luxaciones subastragalinares aisladas cerradas son muy raras y la principal causa de luxación subastragalina resultan los accidentes de tráfico. Objetivo: Identificar las luxaciones cerradas subastragalina medial aisladas y su tratamiento. Presentación del caso: Un paciente hombre de 22 años sufrió un accidente de tránsito tras el cual quedó deformado el pie sin poder soportar peso. En la evaluación se encontró la luxación subastragalina medial que se redujo con tracción manual. El seguimiento al año no mostró deformidad residual ni dolor y tuvo muy buen resultado funcional. Conclusiones: Es de gran importancia identificar la diferencia entre subluxación o luxación medial y lesión por giro medial, las cuales tienen diferentes mecanismos, así como diferentes maniobras de reducción(AU)

Reparación quirúrgica de fracturas de fémur distal con biomodelos impresos 3D / Surgical repair of distal femur fractures with 3D printed biomodels

Introducción: Las fracturas complejas de fémur distal AO/AOT tipo 33C3.3 constituyen un reto para los ortopedistas debido a la dificultad de su tratamiento y las complicaciones asociadas. El planeamiento y procedimiento quirúrgicos emplean placas condilares, pero estas se asocian a la pérdida de la fijación y al colapso de la reducción. Objetivo: Describir la planificación preoperatoria de una fractura de fémur distal AO/AOT 33C3.3 con bioimpresión 3D y reconstrucción por computadora. Presentación del caso: Paciente masculino de 34 años con fractura izquierda conminuta del fémur distal, AO/AOT tipo 33C3.3, por un accidente de tránsito. El planeamiento y el tratamiento quirúrgicos se realizaron exitosamente con la impresión y reconstrucción de biomodelos 3D. Basados en las imágenes tomográficas del paciente, se identificaron los principales fragmentos, la secuencia de reducción, la cantidad y la posición de los implantes a utilizar. Conclusiones: La planificación preoperatoria resulta una etapa de vital importancia en el manejo de fracturas complejas. Las técnicas convencionales pueden optimizarse con la cirugía asistida por computadora y reconstrucción con biomodelos 3D impresos. Esta novedosa propuesta permitirá el adecuado uso de materiales, una óptima secuencia de reducción, mejor estabilidad de la fractura y menor riesgo de complicaciones quirúrgicas(AU)

Introduction: Complex distal femur fractures AO/AOT type 33C3.3 constitute a challenge for orthopedists due to the difficulty of their treatment and associated complications. The surgical planning and procedure use condylar plates; but these are associated with loss of fixation and collapse of the reduction. Objective: To describe preoperative planning for an AO/AOT 33C3.3 distal femur fracture with 3D bioprinting and computer reconstruction. Case report: The case of a 34-year-old male patient is reported. He has comminuted left fracture of the distal femur, AO/AOT type 33C3.3, due to a traffic accident. Surgical planning and treatment were successfully performed with 3D biomodel printing and reconstruction. Based on the patient's tomographic images, the main fragments, the reduction sequence, the number and position of the implants to be used were identified. Conclusions: Preoperative planning is a critically important stage in managing complex fractures. Conventional techniques can be optimized with computer-assisted surgery and reconstruction with 3D printed biomodels. This novel proposal will allow the appropriate use of materials, optimal reduction sequence, better stability of the fracture and lower risk of surgical complications(AU)

Clinical-epidemiological profile of traumatic brain injury associated with traffic accidents in southeastern Pará, in the Brazilian Amazon / Perfil clínico-epidemiológico de traumatismos cranioencefálicos associados a acidentes de trânsito no Sudeste do Pará, na Amazônia brasileira

Introduction: In Brazil, traumatic brain injury (TBI) represents about two thirds of all causes of death and are often associated with traffic accidents, causing overload of medium and high complexity services. Objectives:To describe the occurrence and clinical-epidemiological profile of TBIs associated with traffic accidents in a regional hospital in the southeast of the state of Pará. Materials and Methods: This is a cross-sectional analytical study. It was based on data from the medical and statistical archives service of a regional hospital, through the analysis of electronic medical records of patients treated with TBI resulting from traffic accidents in the period from 2016 to 2020. Results: Of the 20,077 overall hospitalizations recorded, 4.0% were associated with the occurrence of TBI, of which, 75.3% were directly caused by traffic accidents involving motorcycles. The cases were concentrated in individuals of mixed race, male, aged between 18 and 29 years, with percentages of 92.5%, 86% and 39%, respectively. Conclusions: The occurrence of TBIs associated with automobile accidents is a problem that requires attention in the region. Moreover, there were several gaps in the completion of the medical records, which made it difficult to determine the association of the outcome, alcohol consumption and the use of PPE. However, considering all the information presented, assertive local public policies aimed at prevention can be implemented. And this can be the starting point for promoting changes aimed at mitigating traffic accidents and bed occupations due to preventable causes, impacting the quality of health care and economic factors (AU).

Introdução: No Brasil, os traumatismos cranioencefálicos (TCEs) representam cerca dois terços de todas as causas de óbitos e são frequentemente associados a acidentes de trânsito, causando sobrecarga dos serviços de média e alta complexidade. Objetivos: Descrever a ocorrência e o perfil clínico-epidemiológico de TCEs associados a acidentes de trânsito em um hospital regional no Sudeste do Estado do Pará. Materiais e Métodos: Trata-se de um estudo analítico de corte transversal. Baseou-se em dados provenientes do serviço de arquivos médicos e estatísticos de um hospital regional, através da análise de prontuários eletrônicos de pacientes diagnosticados com TCE decorrentes de acidentes de trânsito no período de 2016 a 2020. Resultados: Das 20.077 internações gerais re-gistradas, 4,0% foram associadas à ocorrência de TCE, das quais 75,3% foram diretamente causados por acidentes de trânsito envolvendo motocicletas. Os casos se concentraram em indivíduos pardos, do sexo masculino, com faixa etária entre 18 e 29 anos, com percentuais de 92,5%, 86% e 39%, respectivamente. Conclusões: A ocorrência de TCEs associados a acidentes automobilísticos é um problema que requer atenção na região. Além disso, verificou-se várias lacunas no preenchimento dos prontuários, o que dificultou a determinação da associação do desfecho, o consumo de álcool e a utilização dos EPIs. No entanto, considerando todas as informações apresentadas, políticas públicas assertivas locais que visem a prevenção podem ser implementadas. E esse pode ser o ponto de partida para promover mudanças que visem mitigação dos acidentes de trânsito e ocupações de leitos por causas evitáveis, impactando na qualidade da assistência em saúde e fatores econômicos (AU).

Trauma e gestação / Trauma and pregnancy

A incidência de trauma durante a gestação é de 6% a 8% (formas graves de trauma: 3%-6%). Das gestantes que necessitam de internação por causa de um trauma, 60% evoluem para o parto. As gestantes têm 1,6 vez mais chances de morrer numa situação de trauma. As alterações anatômicas e fisiológicas da gestação interferem nas repercussões e na abordagem do trauma. A violência doméstica representa o mecanismo mais comum de trauma para a gestante e desencadeia várias complicações obstétricas, devendo ser, idealmente, identificada no pré-natal. No acidente automobilístico, atenção especial deve ser dada ao diagnóstico de descolamento prematuro de placenta (DPP). O ultrassom na sala de trauma possibilita ação na assistência ao trauma e também, como mecanismo rápido, informações necessárias sobre o feto e a gestação (FAST fetal). A maioria dos exames de imagem necessários para a boa assistência ao trauma não representa agravos à gestação. O pré-natal tem papel importante na prevenção dos traumas na gestação. A ação conjunta do cirurgião do trauma e do obstetra é recomendada no atendimento da gestante traumatizada, principalmente nos casos graves e em gestantes acima de 20-24 semanas

Disección de aorta secundario a trauma, manejo clínico en Hospital General / Aortic dissection secondary to trauma, clinical management in General Hospital

INTRODUCCIÓN. La disección de aorta es una patología poco frecuente, cuando se presenta, lo hace de una manera catastrófica manifestada por dolor torácico o lumbar intenso acompañado de compromiso hemodinámico agudo, un diagnóstico y tratamiento temprano suelen ser cruciales para evitar la muerte del paciente, así mismo, una disección de aorta puede ser secundario a un trauma torácico por desaceleración y se presenta en 1,5% a 2%, lo que induce sobre todo a un desgarro localizado en la región del istmo aórtico. CASO CLÍNICO. Paciente masculino de 35 años, con antecedente de accidente en vehículo motorizado que provocó un traumatismo cráneo encefálico moderado, hematoma epidural parietal derecho, con resolución quirúrgica hace 18 meses, se descartó lesiones a nivel de tórax con radiografía de tórax normal, además se realizó ecografía FAST en ventana perihepática, suprapúbica, periesplénica y subxi-foidea sin encontrar alteración. Acudió al servicio de emergencia por un cuadro de hemiparesia derecha más disartria de 4 horas de evolución, se realiza tomografía de cráneo sin encontrarse lesión, catalogándose como evento cerebrovascular isquémico con recuperación neurológica. Durante su estancia hospitalaria presenta un cuadro de disnea de grandes esfuerzos y tras realizar exámenes complementarios de control se llega a una conclusión de una cardiomegalia, por lo que es referido a consulta de cardiología donde se realiza ecocardiograma, en la cual se observa disección de aorta ascendente más aneurisma por lo que se decide su ingreso y se instaura tratamiento mediante medidas de soporte, con derivación a hospital de especialidades para cirugía cardiotorácica. CONCLUSIONES. La disección de aorta secundario a un traumatis-mo es poco frecuente, sin embargo, el diagnostico siempre debe estar presente en caso de trauma por desaceleración, ya que es vital para la supervivencia del paciente y su manejo oportuno.

INTRODUCTION. Aortic dissection is an infrequent pathology; when it occurs, it does so in a catastrophic manner manifested by intense thoracic or lumbar pain accompanied by acute he-modynamic compromise. Early diagnosis and treatment are usually crucial to avoid the patient's death; likewise, aortic dissection can be secondary to thoracic trauma due to deceleration and occurs in 1.5% to 2%, which mainly induces a localized tear in the region of the aortic isthmus. CLINICAL CASE. 35-year-old male patient, with a history of motor vehicle accident that caused a moderate head injury, right parietal epidural hematoma, with surgical resolution 18 months ago, chest injuries were ruled out with normal chest X-ray, and FAST ultrasound was performed in perihepatic, suprapubic, perisplenic and subxiphoid window without finding any alteration. She went to the emergency department for a picture of right hemiparesis and dysarthria of 4 hours of evolution, a cranial tomography was performed without finding any lesion, being clas-sified as an ischemic cerebrovascular event with neurological recovery. During his hospital stay he presented with dyspnea of great effort and after performing complementary control tests, a cardiomegaly was found, so he is referred to a cardiology clinic where an echocardiogram is per-formed, which showed dissection of the ascending aorta plus aneurysm, admission is decided and treatment is instituted through supportive measures, with referral to a specialty hospital for cardiothoracic surgery. CONCLUSIONS. Aortic dissection secondary to trauma is rare, however, the diagnosis should always be present in case of trauma due to deceleration, as it is vital for the survival of the patient and its timely treatment.

Emprego de dupla abordagem em fratura complexa de face: relato de caso / Use of dual approach in complex fracture of the face: case report / Uso de abordaje dual en fractura compleja de cara: reporte de caso

Objetivo: Relatar o tratamento de fratura de osso frontal e OPN. Relato de caso: Paciente G.S.M, 25 anos, foi encaminhado ao serviço de Cirurgia e Traumatologia Bucomaxilofacial (CTBMF) do Hospital Geral Clériston Andrade (HGCA). Em análise facial, notaram-se lesões em tecidos moles, hiposfagma em ambos os globos oculares, equimose periorbital bilateral e edema da região hemifacial esquerda, além de crepitação em região de OPN. Após a solicitação de Tomografia Computadorizada (TC) de face observou-se fratura complexa em região de terço superior esquerdo e região de glabela, acometendo osso frontal e margem supra orbital esquerda, além de fratura de OPN sem deslocamento considerável. Foi realizada uma abordagem cruenta por meio de um acesso coronal, e por meio deste foi realizada a redução e fixação dos arcos com placas e parafusos de titânio do sistema 2.0. Para o tratamento da fratura de OPN optou-se por uma abordagem incruenta devido ao mínimo deslocamento. Conclusão: O tratamento cruento com redução aberta e fixação interna rígida, mostrou-se uma abordagem eficaz para o alinhamento das fraturas do osso frontal, da mesma forma, a abordagem incruenta da fratura de OPN, embora conservadora, também apresentou bons resultados, demonstrando o sucesso da técnica empregada nesse caso... (AU)

Objective: To report the treatment of frontal bone fracture and OPN. Case report: Patient G.S.M, 25 years old, was referred to the Oral and Maxillofacial Surgery and Traumatology Service (CTBMF) of Hospital Geral Clériston Andrade (HGCA). In facial analysis, soft tissue lesions, hyposphagma in both eyeballs, bilateral periorbital ecchymosis and edema of the left hemifacial region were noted, in addition to crackling in the OPN region. After requesting a Computed Tomography (CT) scan of the face, a complex fracture was observed in the upper left third and glabella region, affecting the frontal bone and left supraorbital margin, in 5addition to an OPN fracture without considerable displacement. An open approach was performed through a coronal access, and through this the arches were reduced and fixed with titanium plates and screws of the 2.0 system. For the treatment of the OPN fracture, a closed approach was chosen due to the minimal displacement. Conclusion: Open reduction treatment with open reduction and rigid internal fixation proved to be an effective approach for the alignment of frontal bone fractures. success of the technique employed in this case... (AU)

Objetivo: Reportar el tratamiento de la fractura de hueso frontal y OPN. Caso clínico: Paciente G.S.M, de 25 años de edad, remitido al Servicio de Cirugía y Traumatología Oral y Maxilofacial (CTBMF) del Hospital Geral Clériston Andrade (HGCA). En el análisis facial se observaron lesiones de partes blandas, hiposfagma en ambos globos oculares, equimosis periorbitaria bilateral y edema de región hemifacial izquierda, además de crepitantes en región OPN. Tras solicitar una tomografía computarizada (TC) de rostro, se objetivó una fractura compleja en tercio superior izquierdo y región de glabela, afectando hueso frontal y margen supraorbitario izquierdo, además de una fractura OPN sin desplazamiento importante. Se realizó un abordaje abierto a través de un acceso coronal, mediante el cual se redujeron las arcadas y se fijaron con placas de titanio y tornillos del sistema 2.0. Para el tratamiento de la fractura OPN se optó por un abordaje cerrado debido al mínimo desplazamiento. Conclusión: El tratamiento de reducción abierta con reducción abierta y fijación interna rígida demostró ser un abordaje eficaz para la alineación de las fracturas del hueso frontal, éxito de la técnica empleada en este caso... (AU)

Boletín Epidemiológico Semana 30/2023 (Periodo de Vacaciones Agostinas del 01 al 06-agosto 2023) / Epidemiological Bulletin Week 30/2023 (Agostinas Holiday Period 01 to 06-August 2023)

Resumen de eventos de notificación hasta SE 30/2023. Informe Epidemiológico de vigilancia intensificada. 2022-2023. Eventos de notificación intensificada diaria y acumulado. Atenciones, consultas médicas, referencias y emergencias acumuladas 2022-2023. Informe de atenciones, consultas médicas, emergencias y referencias

Summary of notification events up to SE 30/2023. Epidemiological report of intensified surveillance. 2022-2023. Daily and cumulative intensified notification events. Attentions, medical consultations, referrals and cumulative emergencies 2022-2023. Report of care, medical consultations, emergencies and references

Heberprot-P® en el tratamiento de trauma vascular distal / Heberprot-P® in the treatment of distal vascular trauma

Introducción: Los traumatismos constituyen causa frecuente de consulta. Entre sus localizaciones más comunes se encuentran las extremidades inferiores. El Heberprot-P® resulta un factor de crecimiento epidérmico que se ha utilizado durante más de una década para la cicatrización de las úlceras del pie diabético con excelentes resultados. Ampliar su utilización a otras patologías, incluso de etiología traumática, permitiría expandir las posibilidades terapéuticas para la cicatrización de las heridas. Objetivo: Exponer el resultado de la aplicación del Heberprot-P® en una amputación transtarsiana en un paciente portador de un trauma vascular distal. Presentación del caso: Paciente masculino de 23 años con antecedentes de salud. Luego de traumatismo por accidente de tránsito presentó fractura de huesos del metatarso y la sección total de la arteria pedia del pie izquierdo, lo cual provocó una gangrena húmeda de la extremidad. Por este motivo se realizó una amputación transtarsiana del pie. Se usó el Heberprot-P® como terapia para acortar el tiempo de cicatrización. Conclusiones: El Heberprot-P® resultó útil para la evolución de la herida como consecuencia de un trauma vascular, al evitar una amputación mayor, acelerar el proceso de cicatrización y conservar una extremidad funcional, lo que demostró que puede constituir una terapia eficaz para las heridas de difícil cicatrización, independientemente de su etiología(AU)

Introduction: Trauma is a frequent cause of consultation. Among its most common locations are the lower extremities. Heberprot-P® is an epidermal growth factor that has been used for more than a decade for the healing of diabetic foot ulcers with excellent results. Extending its use to other pathologies, including traumatic etiology ones, would expand the therapeutic possibilities for wound healing. Objective: To present the result of the application of Heberprot-P® in a Chopart´s amputation in a patient with distal vascular trauma. Case presentation: A 23-year-old male patient with a health history. After trauma from a traffic accident, he presented a fracture of the bones of the metatarsus and the whole section of the left foot´s pedis artery, which caused a wet gangrene of the extremity. For this reason, a Chopart´s amputation of the foot was performed. Heberprot-P® was used as therapy to shorten healing time. Conclusions: Heberprot-P® was useful for wound evolution as a result of vascular trauma, avoiding major amputation, accelerating the healing process and preserving a functional limb, which showed that it can be an effective therapy for wounds that are difficult to heal, regardless of their etiology(AU)

Hérnia torácica traumática associada a laceração de lobo pulmonarcaudal em cão / Traumatic thoracic hernia associated with laceration of the caudal lung lobe in a dog

Traumas torácicos são comuns em pacientes traumatizados e incluem principalmente contusão pulmonar, laceração pulmonar, pneumotórax, hemotórax, fraturas de costela e esterno e hérnia diafragmática. As principais causas são acidentes automobilísticos, quedas e mordeduras. Taquipneia ou dispneia são possíveis sinais clínicos, associados a choque hipovolêmico e sinais gastrointestinais. Lesões torácicas podem ser negligenciadas quando lesões distrativas, como fratura de membros, estão presentes. Assim, o exame clínico minucioso é obrigatório e os animais com insuficiência respiratória podem necessitar de estabilização e cirurgia de emergência. Considerando a importância do trauma torácico na prática clínica, o objetivo deste manuscrito é relatar o caso de hérnia espúria torácica associada a laceração traumática de lobo pulmonar caudal em uma cadela apresentando dispneia intensa após trauma automobilístico. Após uma avaliação emergencial e exames radiográficos, foi diagnosticado tórax instável, fraturas de costelas, contusão pulmonar e pneumotórax grave. Após estabilização clínica, foi realizado tratamento cirúrgico para estabilização do tórax instável. Durante a cirurgia, observou-se herniação e laceração do lobo caudal esquerdo do pulmão, sendo realizadas suturas para correção da laceração pulmonar e estabilização do gradil costal, além da toracostomia para controle do pneumotórax. Nos casos de tórax instável e encarceramento lobar, o tratamento cirúrgico é fundamental, como realizado neste caso, com o objetivo de reparar e reposicionar o lobo pulmonar e estabilizar o tórax instável. A herniação pulmonar traumática é um possível diagnóstico diferencial no tórax instável pós-traumático, assim como a reparação do lobo e a estabilização das costelas por meio de suturas são técnicas eficazes de tratamento cirúrgico.

Thoracic traumas are common in trauma patients and mainly include pulmonary contusion, pulmonary laceration, pneumothorax, hemothorax, rib and sternum fractures and diaphragmatic hernia. The main causes are car accidents, falls and bites. Tachypnea or dyspnea are possible clinical signs, associated with hypovolemic shock and gastrointestinal signs. Thoracic injuries may be overlooked when distracting injuries, such as limb fractures, are present. Thus, thorough clinical examination is mandatory and animals with respiratory failure may require stabilization and emergency surgery. Considering the importance of thoracic trauma in clinical practice, the manuscript aimed to report the case of spurious thoracic hernia associated with traumatic laceration of the caudal lung lobe in a bitch with severe dyspnea after car trauma. After an emergency evaluation and radiographic examinations, a flail chest, rib fractures, pulmonary contusion and severe pneumothorax were diagnosed. After clinical stabilization, surgical treatment was performed to stabilize the flail chest. During surgery, herniation and laceration of the left caudal lobe of the lung were observed, and sutures were performed to correct the pulmonary laceration and stabilize the rib cage, in addition to thoracostomy to control the pneumothorax. In cases of flail chest and lobar entrapment, surgical treatment is essential, as in this case, with the aim of repairing and repositioning the pulmonary lobe and stabilizing the flail chest. Traumatic pulmonary herniation is a possible differential diagnosis in post-traumatic flail chest, as well as repairing the lobe and stabilizing the ribs using sutures are effective surgical treatment techniques.

Jovens diante da morte: experiências de sobreviventes de acidentes de trânsito e tentativas de homicídios / Young people facing death: experiences of survivors of traffic accidents and attempted homicides / Jóvenes frente a la muerte: experiencias de sobrevivientes de accidentes de tránsito y tentativas de homicidio

INTRODUÇÃO: Ainda hoje, a morte é um tema tabu, fortemente associado ao envelhecimento. Contudo, é preocupante o número de jovens que se envolvem em situações inesperadas, como os acidentes de trânsito e as tentativas de homicídio, levando-os a se depararem com sua finitude. OBJETIVO: compreender e analisar a experiência de jovens sobreviventes de acidentes de trânsito e tentativas de homicídios. MÉTODO: Foram realizadas entrevistas narrativas com oito jovens, com idade entre 19 e 29 anos, que residem no estado de Mato Grosso do Sul e que se sobreviveram a acidentes de trânsito ou tentativas de homicídio. As entrevistas foram orientadas por um roteiro semiestruturado e foram analisadas na perspectiva da Análise de Conteúdo. RESULTADOS: O discurso dos jovens entrevistados aponta para as implicações existenciais das mudanças impostas pelas intercorrências, sobretudo a partir dos impactos que elas causaram, alterando tanto suas rotinas como também a forma como pensavam e viviam. Além disso, essa experiência também trouxe implicações na percepção da imagem corporal, além de mudanças em outros âmbitos da vida dos entrevistados, como o trabalho, os estudos, bem como as relações familiares e de amizade, que também foram afetadas. CONCLUSÃO: Faz-se necessária uma maior compreensão dessas experiências, com o intuito de contribuir com elaboração de estratégias em saúde para ajudar esses jovens a lidarem com as consequências das ocorrências que, muitas vezes, são graves e permanentes.

INTRODUCTION: Even today, death is a taboo topic, strongly associated with aging. However, the number of young people who become involved in unexpected situations, such as traffic accidents and attempted murders, is worrying, leading them to face their finitude. OBJECTIVE: To understand and analyze the experience of young survivors of traffic accidents and attempted homicides. METHOD: Open interviews were carried out with eight young people, aged between 19 and 29 years old, who live in the state of Mato Grosso do Sul and who survived traffic accidents or attempted homicides. The interviews were guided by a semi-structured script and were analyzed from the perspective of Content Analysis. RESULTS: The speech of the young people interviewed points to the existential implications of the changes imposed by the intercurrences, especially from the impacts they caused, changing both their routines and the way they thought and lived. In addition, this experience also had implications for the perception of body image, in addition to changes in other areas of the interviewees' lives, such as work, studies, as well as family and friendship relationships that were also affected. CONCLUSION: A better understanding of these experiences is needed, in order to contribute to the development of health strategies that help these young people to deal with the consequences of events that are often serious and permanent.

INTRODUCCIÓN: Hoy en día, la muerte es un tema tabú, fuertemente asociado al envejecimiento. Sin embargo, es preocupante la cantidad de jóvenes que se ven involucrados en situaciones inesperadas, como accidentes de tránsito e intentos de homicidio, que los llevan a enfrentar su finitud. OBJETIVO: Comprender y analizar la experiencia de jóvenes sobrevivientes de accidentes de tránsito y tentativas de homicidio. MÉTODO: Se realizaron entrevistas abiertas con ocho jóvenes, con edades entre 19 y 29 años, que viven en el estado de Mato Grosso do Sul y que han sobrevivido a accidentes de tráfico o intentos de homicidio. Las entrevistas fueron guiadas por un guión semiestructurado y fueron analizadas desde la perspectiva del Análisis de Contenido. RESULTADOS: El discurso de los jóvenes entrevistados apunta a las implicaciones existenciales de los cambios impuestos por las intercurrencias, especialmente a partir de los impactos que provocaron, modificando tanto sus rutinas como su forma de pensar y vivir. Además, esta experiencia también tuvo implicaciones en la percepción de la imagen corporal, además de cambios en otras áreas de la vida de los entrevistados, como el trabajo, los estudios, así como las relaciones familiares y de amistad que también se vieron afectadas. CONCLUSION: Se necesita una mejor comprensión de estas experiencias, para contribuir al desarrollo de estrategias de salud que ayuden a estos jóvenes a enfrentar las consecuencias de eventos que muchas veces son graves y permanentes.

Incidence and pattern of traumatic spine injury in a single level I trauma center of southern Iran / 中华创伤杂志(英文版)

PURPOSE@#Spine injury is one of the leading causes of death and mortality worldwide. The objective of this study was to determine the incidence, pattern and outcome of trauma patients with spine injury referred to the largest trauma center in southern Iran during the last 3 years.@*METHODS@#This is a cross-sectional study conducted between March 2018 and June 2021 in the largest trauma center in the southern Iran. The data collection form included the age, sex, injury location (cervical, thoracic, and lumbar), cause of injury (traffic accidents, falls, and assaults), length of hospital stay, injured segment of spine injury, severity of injury, and outcome. Statistical analyzes were performed using SPSS software version 24.@*RESULTS@#Totally 776 cases of spine injury were identified. The spine injury rate was 17.0%, and the mortality rate was 15.5%. Cervical spine injury (20.4%) more often occulted in motorcycle accident, and thoracic spine injury (20.1%) occulted in falls. The highest and lowest rates of spine injurys were related to lumbar spine injury (30.2%) and cervical spine injury (21.5%), respectively. There was a statistically significant relationship between the mechanism of injury and the location of spine injury (p < 0.001). And patients with lumbar spine injury had the highest mortality rate (16.7%). Injury severity score (OR= 1.041, p < 0.001) and length of stay (OR = 1.018, p < 0.001) were strong predictors of mortality in trauma patients with spine injury.@*CONCLUSION@#The results of the study showed that the incidence of traumatic spine injury rate was approximately 17.0% in southern of Iran. Road traffic injury and falls are the common mechanism of injury to spine. It is important to improve the safety of roads, and passengers, as well as work environment, and improve the quality of cars. Also, paying attention to the pattern of spine injury may assist to prevent the missing diagnosis of spine injury in multiple trauma patients.

Risk of permanent medical impairment after road traffic crashes: A systematic review / 中华创伤杂志(英文版)

PURPOSE@#To systematically review the risk of permanent disability related to road traffic injuries (RTIs) and to determine the implications for future research regarding permanent impairment following road traffic crashes.@*METHODS@#We conducted this systematic review according to the preferred reporting items for systematic reviews and meta-analysis statement. An extended search of the literature was carried out in 4 major electronic databases for scientific research papers published from January 1980 to February 2020. Two teams include 2 reviewers each, screened independently the titles/abstracts, and after that, reviewed the full text of the included studies. The quality of the studies was assessed using the strengthening the reporting of observational studies in epidemiology (STROBE) checklist. A third reviewer was assessed any discrepancy and all data of included studies were extracted. Finally, the data were systematically analyzed, and the related data were interpreted.@*RESULTS@#Five out of 16 studies were evaluated as high-quality according to the STROBE checklist. Fifteen studies ranked the initial injuries according to the abbreviated injury scale 2005. Five studies reported the total risk of permanent medical impairment following RTIs which varied from 2% to 23% for car occupants and 2.8% to 46% for cyclists. Seven studies reported the risk of permanent medical impairment of the different body regions. Eleven studies stated the most common body region to develop permanent impairment, of which 6 studies demonstrated that injuries of the cervical spine and neck were at the highest risk of becoming permanent injured.@*CONCLUSION@#The finding of this review revealed the necessity of providing a globally validated method to evaluate permanent medical impairment following RTIs across the world. This would facilitate decision-making about traffic injuries and efficient management to reduce the financial and psychological burdens for individuals and communities.

Experiences and Interventions by Botswana police officers in providing emergency care in road traffic collisions in the greater Gaborone region

Background Close to 500 people die annually from Road Traffic Collisions in Botswana. The country's Emergency Medical Service is limited in capacity and coverage and greatest in the region of the capital city, Gaborone. Botswana Police Service officers are often first responders to the incidents and provide first aid, however the extent of their interventions and their experiences has not been studied. Methods A questionnaire based cross-sectional survey was conducted in January 2016 on a sample of 99 officers on past pre-hospital care training, attitudes towards providing pre-hospital care for accident victims, the number of road traffic collision related deaths and injuries encountered in the last 6 months, their interventions to the victims and limitations encountered in providing care. Results The officers self-reported attending to a median of 10 injured victims (IQR = 5 ­ 20) and a median of 2 deaths (IQR = 0 ­ 4) in the preceding 6 months. The officers generally acknowledged their role and responsibility to provide pre-hospital care to the victims. Officers frequently secured accident scenes and transported injured victims to health facilities. They rarely performed haemorrhage control on victims, performed any airway manoeuvres or splint injured limbs. The major limitations to providing care were lack of first aid supplies and personal protective equipment, lack of knowledge and skills to provide care and interference from onlookers at accident scenes. Conclusion Botswana Police officers in the greater Gaborone area attend to a considerable number of traffic related injuries and fatalities. These results support many opportunities for educational interventions to add value to pre-hospital care.