RESUMO
BACKGROUND: Sickle cell disease (SCD) is an autosomal recessive genetic disease in which a mutation occurs in the ß-globin chain gene, resulting in abnormal hemoglobin levels. In an environment with reduced oxygen concentration, red blood cells change their conformation, resulting in chronic hemolysis and consequent anemia and vaso-occlusive crises with injuries to several organs, with a significant impairment of the osteoarticular system. This study aimed to verify the chronic osteoarticular alterations and their association with clinical and laboratory characteristics of patients with SCD with a more severe phenotype (SS and Sß0), on a steady-state fasis. METHODS: Fifty-five patients were referred to a medical consultation with a specialized assessment of the locomotor system, followed by laboratory tests and radiographic examinations. RESULTS: In total, 74.5% patients had hemoglobinopathy SS; 67.3% were female; and 78.2% were non-whites. The mean patient age was 30.5 years. Most patients (61.8%) reported up to three crises per year, with a predominance of high-intensity pain (65.5%). Radiographic alterations were present in 80% patients. A total of 140 lesions were identified, most which were located in the spine, femur, and shoulders. Most lesions were osteonecrosis and osteoarthritis and were statistically associated with the non-use of hydroxyurea. CONCLUSIONS: There was a high prevalence of chronic osteoarticular alterations, which was statistically associated only with the non-regular use of hydroxyurea.
Assuntos
Anemia Falciforme/complicações , Osteoartrite/diagnóstico por imagem , Osteonecrose/diagnóstico por imagem , Adolescente , Adulto , Anemia Falciforme/sangue , Anemia Falciforme/tratamento farmacológico , Antidrepanocíticos/uso terapêutico , Estudos Transversais , Feminino , Hemoglobina Falciforme/genética , Humanos , Hidroxiureia/uso terapêutico , Masculino , Osteoartrite/epidemiologia , Osteonecrose/epidemiologia , Pigmentação da Pele , Adulto JovemRESUMO
Objetivo: analisar a incidência e os fatores relacionados à obstrução de cateter intravenoso periférico em adultos hospitalizados. Método: uma coorte prospectiva, realizada a partir da observação de 203 cateteres, entre fevereiro de 2019 e maio de 2020, em hospital público e de ensino brasileiro. Foram consideradas variáveis clínicas e do cateter. Os dados foram analisados descritivamente e por estatística inferencial. Resultados: o tempo de permanência variou entre um a 15 dias e a obstrução ocorreu em 7,5% das observações. Houve aumento do risco de obstrução em relação ao sexo (RR=0,49 / p=0,186), à idade (RR=1,20/ p=0,732), aos cateteres de maior calibre (RR=0,53/ p=0,250), à inserção no dorso da mão até antebraço (RR=2,33/ p=0,114) e ao tempo do cateter in situ (RR=033/ p=0,433). Conclusão: O cuidado diário e observação do cateter intravenoso periférico são importantes para minimizar o surgimento de complicações locais e sistêmicas e manter a patência do dispositivo.
Objective: to analyze the incidence and factors related to peripheral intravenous catheter obstruction in hospitalized adults. Method: a prospective cohort, based on the observation of 203 catheters, between February 2019 and May 2020, in a Brazilian public teaching hospital. Clinical and catheter variables were taken into account. The data was analyzed descriptively and using inferential statistics. Results: the length of stay ranged from one to 15 days and obstruction occurred in 7.5% of the observations. There was an increased obstruction risk in relation to gender (RR=0.49 / p=0.186), age (RR=1.20/ p=0.732), larger catheters (RR=0.53/ p=0.250), insertion in the back of the hand up to the forearm (RR=2.33/ p=0.114) and the time length the catheter was in situ (RR=033/ p=0.433). Conclusion: Daily care and observation of the peripheral intravenous catheter is important to minimize the appearance of local and systemic complications and maintain the patency of the device.
Objetivo: analizar la incidencia y los factores relacionados con la obstrucción del catéter intravenoso periférico en adultos hospitalizados. Método: cohorte prospectiva, realizada mediante la observación de 203 catéteres, entre febrero de 2019 y mayo de 2020, en un hospital escuela público brasileño. Se consideraron variables clínicas y del catéter. Los datos se analizaron de forma descriptiva y mediante estadística inferencial. Resultados: el tiempo de permanencia varió entre uno y 15 días y la obstrucción ocurrió en el 7,5% de las observaciones. Hubo mayor riesgo de obstrucción en relación con el sexo (RR=0,49 / p=0,186), la edad (RR=1,20 / p=0,732), los catéteres de mayor calibre (RR=0,53 / p= 0,250), la inserción en el dorso de la mano hasta el antebrazo (RR=2,33/ p=0,114) y el tiempo del catéter in situ (RR=033/ p=0,433). Conclusión: el cuidado diario y la observación del catéter intravenoso periférico son importantes para minimizar la aparición de complicaciones locales y sistémicas y mantener la permeabilidad del dispositivo.
RESUMO
In this article, we present the case of a patient with heart failure with biological aortic valve prosthesis and multiple vascular changes consistent with Takayasu arteritis (TA) who was seen in our department receiving corticosteroids and secondary prevention of rheumatic fever (RF); it was not possible to exclude the association between both diseases.
Assuntos
Implante de Prótese de Valva Cardíaca , Febre Reumática/diagnóstico , Arterite de Takayasu/diagnóstico , Diagnóstico Diferencial , Próteses Valvulares Cardíacas , HumanosRESUMO
Abstract Background: Sickle cell disease (SCD) is an autosomal recessive genetic disease in which a mutation occurs in the β-globin chain gene, resulting in abnormal hemoglobin levels. In an environment with reduced oxygen concentration, red blood cells change their conformation, resulting in chronic hemolysis and consequent anemia and vaso-occlusive crises with injuries to several organs, with a significant impairment of the osteoarticular system. This study aimed to verify the chronic osteoarticular alterations and their association with clinical and laboratory characteristics of patients with SCD with a more severe phenotype (SS and Sβ0), on a steady-state fasis. Methods: Fifty-five patients were referred to a medical consultation with a specialized assessment of the locomotor system, followed by laboratory tests and radiographic examinations. Results: In total, 74.5% patients had hemoglobinopathy SS; 67.3% were female; and 78.2% were non-whites. The mean patient age was 30.5 years. Most patients (61.8%) reported up to three crises per year, with a predominance of high-intensity pain (65.5%). Radiographic alterations were present in 80% patients. A total of 140 lesions were identified, most which were located in the spine, femur, and shoulders. Most lesions were osteonecrosis and osteoarthritis and were statistically associated with the non-use of hydroxyurea. Conclusions: There was a high prevalence of chronic osteoarticular alterations, which was statistically associated only with the non-regular use of hydroxyurea.(AU)
Assuntos
Humanos , Osteoartrite/etiologia , Osteonecrose/etiologia , Doenças Ósseas Metabólicas/etiologia , Hidroxiureia/administração & dosagem , Anemia Falciforme/fisiopatologia , Prognóstico , Estudos Transversais/instrumentação , Fatores de Risco , Hidroxiureia/efeitos adversosRESUMO
Resumo Apresentamos o caso de uma paciente portadora de insuficiência cardíaca com prótese valvar aórtica biológica e alterações vasculares compatíveis com arterite de Takayasu (AT) que chegou ao serviço em uso de corticoides e em profilaxia para febre reumática (FR). Não foi possível afastar a associação entre ambas as enfermidades.
Abstract In this article, we present the case of a patient with heart failure with biological aortic valve prosthesis and multiple vascular changes consistent with Takayasu arteritis (TA) who was seen in our department receiving corticosteroids and secondary prevention of rheumatic fever (RF); it was not possible to exclude the association between both diseases.
Assuntos
Humanos , Febre Reumática/diagnóstico , Arterite de Takayasu/diagnóstico , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Diagnóstico DiferencialRESUMO
OBJECTIVE: To evaluate the use of ethyl-2-cyanoacrylate in the treatment of an injury caused in a partially excluded segment of the mouse gut: the cecum. METHODS: We used 45 male Wistar rats, divided into three equal groups; in all there was performed a partial resection of the cecum. The groups were designated as Group 1: the lesion was treated with application of ethyl-2-cyanoacrylate, Group 2: suture and application of ethyl-2-cyanoacrylate, Group 3: purse-string suture. The animals were monitored postoperatively and half of each group was necropsied 14 days after the procedure, the remaining on the 28th. They were subjected to macroscopic evaluation, had cecal samples collected for histological examination and the findings were submitted to statistical analysis. RESULTS: Weight gain after the experiment was different among groups (p=0.028). The presence of microabscesses was higher at 28 days postoperatively in group 2 when compared to group 3 (p=0.003). The collagen deposition on the 28th postoperative day was greater in group 1 (p=0.036) and intensity of inflammation at the 14th postoperative day was greater in group 1 (p=0.045). In the other parameters there was no statistical difference. CONCLUSION: The use of ethyl-2-cyanoacrylate was effective in the treatment of cecal stump exclusion of rats as for macroscopic and microscopic findings and postoperative outcome.
Assuntos
Adesivos , Ceco/cirurgia , Cianoacrilatos , Animais , Ratos , Ratos WistarRESUMO
OBJETIVO: Avaliar a utilização do etil-2-cianoacrilato no tratamento de uma lesão provocada em um segmento parcialmente excluso do intestino do rato: o ceco. MÉTODOS: Utilizaram-se 45 ratos machos da linhagem Wistar, distribuidos em três grupos iguais, sendo que foi realizada a ressecção parcial do ceco. Os grupos foram denominados como: Grupo 1: a lesão foi tratada com aplicação de etil-2-cianoacrilato; Grupo 2: sutura e aplicação de etil-2-cianoacrilato; Grupo 3: sutura em bolsa. Os animais foram acompanhados no pós-operatório e metade de cada grupo foi necropsiada no 14º e restante no 28º pós-operatório. Dessa forma, foram submetidos à avaliação macroscópica, sendo coletadas amostras do ceco para avaliação histológica e, por fim, realizou-se a análise estatística RESULTADOS: O ganho de peso pós-experimento foi diferente nos grupos (p=0,028). A presença de microabcessos foi maior no 28º dia de pós-operatório no grupo 2, em comparação com o grupo 3 (p=0,003). A deposição de colágeno no 28º dia de pós-operatório foi maior no grupo 1 (p=0,036) e a intensidade da inflamação no 14º dia de pós-operatório foi maior no grupo 1 (p=0,045). Nos demais parâmetros avaliados, não ocorreu diferença estatística. CONCLUSÃO: A utilização do etil-2-cianoacrilato foi efetiva no tratamento do coto cecal excluso de ratos frente à avaliação macroscópica, microscópica e evolução pós-operatória.
OBJECTIVE: To evaluate the use of ethyl-2-cyanoacrylate in the treatment of an injury caused in a partially excluded segment of the mouse gut: the cecum. METHODS: We used 45 male Wistar rats, divided into three equal groups; in all there was performed a partial resection of the cecum. The groups were designated as Group 1: the lesion was treated with application of ethyl-2-cyanoacrylate, Group 2: suture and application of ethyl-2-cyanoacrylate, Group 3: purse-string suture. The animals were monitored postoperatively and half of each group was necropsied 14 days after the procedure, the remaining on the 28th. They were subjected to macroscopic evaluation, had cecal samples collected for histological examination and the findings were submitted to statistical analysis. RESULTS: Weight gain after the experiment was different among groups (p=0.028). The presence of microabscesses was higher at 28 days postoperatively in group 2 when compared to group 3 (p=0.003). The collagen deposition on the 28th postoperative day was greater in group 1 (p=0.036) and intensity of inflammation at the 14th postoperative day was greater in group 1 (p=0.045). In the other parameters there was no statistical difference. CONCLUSION: The use of ethyl-2-cyanoacrylate was effective in the treatment of cecal stump exclusion of rats as for macroscopic and microscopic findings and postoperative outcome.
Assuntos
Animais , Ratos , Adesivos , Cianoacrilatos , Ceco/cirurgia , Ratos WistarRESUMO
Analisaram-se dados referentes às vítimas de homicídios ocorridos no município e de agressões atendidas no Hospital de Clínicas de Uberlândia entre 2000 e 2004. Ambos apresentaram tendência de crescimento, com elevação de quase 100 por cento no número de homicídios no período analisado. A maioria das vítimas era do sexo masculino (324 homicídios; 90,0 por cento e 2.802 agressões; 80,0 por cento) e das faixas de 20 a 29 anos (143 homicídios; 39,7 por cento e 1325 agressões; 38,3 por cento) e 30 a 39 anos (87 homicídios; 24,2 por cento e 765 agressões; 21,3 por cento). Predominou o uso da arma de fogo (235 casos; 65,4 por cento), e de arma branca (92 casos; 25,5 por cento) nos homicídios e este padrão se inverteu ao se analisar as agressões, com 39 por cento dos atendimentos devido a lesões por arma branca (1359 casos) e 28,1 por cento por arma de fogo (978 casos). As agressões ocorreram principalmente aos sábados (608 casos; 17,5 por cento) e domingos (804 casos; 23,1 por cento) e em relação aos meses do ano distribuíram-se homogeneamente. As vítimas de homicídios residiam predominantemente nos bairros: Dona Zulmira (54,9 homicídios/ 100.000 habitantes), Morumbi (37,9), Luizote de Freitas (32,2), Jardim Canaã (27,7) e Umuarama (24,9) e nos Distritos Oeste (16,3) e Leste (15,9). As vítimas de agressão residiam nos bairros: Umuarama (499,1/100.000), Martins (206,2), Morumbi (194,9) e Custódio Pereira (170,2) e nos Distritos Central (173,5) e Leste (121,2). Faz-se necessário o desenvolvimento de políticas públicas de prevenção da violência em Uberlândia, que atuem principalmente nos bairros onde é maior a sua incidência.
There have been analyzed data about homicides occurred in that city and the aggression victims attended in Hospital de Clínicas de Uberlandia between 2000 e 2004. There was tendency in raising the violence, with an increase of almost 100 percent in the number of homicides. Most of the victims were male, (323 homicides; 90,0 percent and 2.802 aggressions; 80,0 percent) from 20 to 29 (143 ; 39,7 percent e 1325 aggressions; 38,3 percent) and from 30 to 39 years old (87 homicides; 24,2 percent e 765 aggressions; 21,3 percent). Among the homicides, the fire weapon (235 cases; 65,4 percent) and the white weapon (95 cases; 25,5 percent) were the most used; this pattern was inverted when aggressions were analyzed, 39,0 percent (1359) of the cases were caused by white weapon e 28,1 percent (978) were caused by fire weapon. Hospitalization was necessary for 1522 victims (43,7 percent). The aggressions occurred especially on Saturdays (608 cases; 17,5 percent) and Sundays (804 cases; 23,1 percent) and had an homogeneous distribution between the months of the year. The homicide victims lived mainly in the following quarters: Dona Zulmira (54,9 homicides/100.000 inhabitants), Morumbi (37,9), Luizote de Freitas (32,2), Jardim Canaã (27,7) and Umuarama (24,9), and in West (16,3) and East (15,9) Districts. The aggression victims lived in the following quarters: Umuarama (499,1), Martins (206,2), Morumbi (194,9) and Custódio Pereira (170,2), and in Central (173,5) and East (121,2/100.000) Districts. The development of violence prevention public politics are necessary in Uberlandia, principally in the quarters where there is a bigger incidence.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Agressão , Homicídio , ViolênciaRESUMO
Calculamos os índices Injurity Severity Score (ISS), Revised Trauma Score (RTS) e Escala de Coma de Glasgow (ECG) dos pacientes vítimas de acidentes de trânsito atendidas no Hospital de Clínicas de Uberlândia (HCU) aos sábados dos meses de dezembro de 2005 a março de 2006, além de analisar os dados epidemiológicos referentes ao acidente, aos pacientes e ao atendimento pré e intra-hospitalar (primeiro atendimento). As informações foram obtidas nos prontuários das vítimas. A maioria dos pacientes apresentou lesões na superfície externa do corpo (58; 53,7 por cento), seguida por lesões em extremidades e ossos da pelve (30; 27,8 por cento) e por cabeça e face (15; 13,9 por cento). O sexo masculino foi o mais acometido (53; 58,2 por cento) e os acidentes motociclísticos foram os mais freqüentes (29; 31,9 por cento). Quanto ao ISS, os pacientes em geral apresentaram baixos escores, não excedendo a 16. Todas as vítimas tiveram escores altos na escala de coma de Glasgow, sendo que 60 (65,9 por cento) apresentaram escore igual a 15. Para 17 pacientes (18,7 por cento) foi possível o cálculo do índice RTS. Destes, 15 (88,2 por cento) obtiveram escore final 12. Concluímos que a maioria dos pacientes atendidos no HCU por acidentes de trânsito apresentou trauma leve, sendo que valores RTS e ECG altos correlacionaram-se com escores ISS baixos, indicadores de bom prognóstico e baixo risco de vida, o que em um hospital de atendimento de nível terciário congestiona o serviço e demanda ônus monetário e de pessoal, podendo interferir no bom atendimento de casos de maior complexidade.
The authors applied three different measurement tools to analyze patients, victims of traffic accidents, at the Emergency Room of the Hospital de Clínicas in Uberlândia, Minas Gerais (HCU). The measures used were: the Injury Severity Score (ISS), Revised Trauma Score (RTS) and the Glasgow Coma Scale (GCS). The data, including epidemiological factors, were collected from patients charts as they were treated, on Saturdays from December, 2005 through March of the following year. Most of the patients presented superficial lesions or abrasions to the body (58 patients; 53.7 percent), followed by lesions to the extremities and hips (30; 27.8 percent) and head and face injuries (15; 13.9 percent). Most of the injured were male (53; 58.2 percent) and accidents involving motorcycles were very frequent (29; 31.9 percent). Regarding the Injury Severity Score (ISS) patients demonstrated relatively low scores, not exceeding 16. All victims scored high on the Coma Glasgow Scale; of these, 60 (65.9 percent), presented a score of 15. Seventeen patients (18,7 percent) were assessed using the RTS scale. Of these, fifteen (88,2 percent), were given a final score of 12. It was concluded that the majority of the victims of traffic accidents admitted to the HCU Emergency Room during the period of the study demonstrated minimal trauma. High values for RTS and GCS correlated with lower ISS scores, indicating an adequate prognosis and a reduced risk to the patients lives. Unfortunately the services and costs involved with their treatment led to a congested situation prejudicial to adequate assistance for more serious cases.