Galvanic vestibular stimulation and its applications: a systematic review,

Abstract Objective: Galvanic vestibular stimulation has been evaluated in the context of vestibular rehabilitation. The objective was to identify evidence in the scientific literature about the clinical applications of galvanic vestibular stimulation. Methods: In this systematic review, the articles describing the applications of galvanic vestibular stimulation were extracted from PubMed, Web of Science, MEDLINE, Scopus, LILACS and SciELO databases. The survey was limited to articles published in English, Portuguese and Spanish. All the articles about the clinical applications of galvanic vestibular stimulation were compiled. Repeated articles in the databases, literature review articles, case reports, letters and editorials were excluded. The descriptors included: galvanic vestibular stimulation, postural balance, central nervous system diseases, vestibular diseases, spinal cord diseases and cognition. Results: The search strategy resulted in the initial selection of 994 articles; the reading of titles and abstracts was accomplished in 470 articles and the complete reading in 23 articles. Clinical applications of galvanic vestibular stimulation included Ménière's disease, vestibular neuritis, bilateral vestibular disorders, vestibular schwannoma, Parkinson's disease, ischemic central lesions, motor myelopathies, anxiety disorders, cognition and memory. Conclusion: Galvanic vestibular stimulation has been considered a potentially useful strategy for balance rehabilitation, since it has the effect of stimulating the central connections related to the postural balance, favoring new neuronal synapses that allow the partial or total recovery of postural imbalance.

Galvanic vestibular stimulation and its applications: a systematic review.

OBJECTIVE: Galvanic vestibular stimulation has been evaluated in the context of vestibular rehabilitation. The objective was to identify evidence in the scientific literature about the clinical applications of galvanic vestibular stimulation. METHODS: In this systematic review, the articles describing the applications of galvanic vestibular stimulation were extracted from PubMed, Web of Science, MEDLINE, Scopus, LILACS and SciELO databases. The survey was limited to articles published in English, Portuguese and Spanish. All the articles about the clinical applications of galvanic vestibular stimulation were compiled. Repeated articles in the databases, literature review articles, case reports, letters and editorials were excluded. The descriptors included: galvanic vestibular stimulation, postural balance, central nervous system diseases, vestibular diseases, spinal cord diseases and cognition. RESULTS: The search strategy resulted in the initial selection of 994 articles; the reading of titles and abstracts was accomplished in 470 articles and the complete reading in 23 articles. Clinical applications of galvanic vestibular stimulation included Ménière's disease, vestibular neuritis, bilateral vestibular disorders, vestibular schwannoma, Parkinson's disease, ischemic central lesions, motor myelopathies, anxiety disorders, cognition and memory. CONCLUSION: Galvanic vestibular stimulation has been considered a potentially useful strategy for balance rehabilitation, since it has the effect of stimulating the central connections related to the postural balance, favoring new neuronal synapses that allow the partial or total recovery of postural imbalance.

Firearm-Related Fractures: Epidemiology and Infection Rate.

Objective To investigate the incidence of infection in patients with gunshot-related fractures, and to correlate this finding with the occurrence of surgical debridement in the emergency room. Methods A retrospective, observational, descriptive study that included all cases of fractures caused by firearms between January 2010 and December 2014; 245 fractures in 223 patients were included. Results There was surgical-site infection in 8.5% of the fractures, and the mean number of debridements required to control the infectious process was of 1.273 ± 0.608. A correlation was identified between the surgical treatment chosen and the affected body segment ( p < 0.001). The surgical treatment in the emergency room had a correlation with the occurrence of infection ( p < 0.001; Chi-squared test). Conclusion Patients with gunshot injuries treated non-operatively presented less severe and stable lesions; thus, the incidence of complications in this group was found to be lower. On the other hand, those patients with complex lesions underwent debridement and external fixation. Therefore, a greater number of infectious complications in patients submitted to external fixation was found, as expected.

Firearm-Related Fractures: Epidemiology and Infection Rate / Fraturas causadas por armas de fogo: Epidemiologia e taxa de infecção

Abstract Objective To investigate the incidence of infection in patients with gunshot-related fractures, and to correlate this finding with the occurrence of surgical debridement in the emergency room. Methods A retrospective, observational, descriptive study that included all cases of fractures caused by firearms between January 2010 and December 2014; 245 fractures in 223 patients were included. Results There was surgical-site infection in 8.5% of the fractures, and the mean number of debridements required to control the infectious process was of 1.273 ± 0.608. A correlation was identified between the surgical treatment chosen and the affected body segment (p< 0.001). The surgical treatment in the emergency room had a correlation with the occurrence of infection (p< 0.001; Chi-squared test). Conclusion Patients with gunshot injuries treated non-operatively presented less severe and stable lesions; thus, the incidence of complications in this group was found to be lower. On the other hand, those patients with complex lesions underwent debridement and external fixation. Therefore, a greater number of infectious complications in patients submitted to external fixation was found, as expected.

Resumo Objetivo Investigar a incidência de infecção em pacientes com fraturas por arma de fogo, e correlacionar esse achado com a ocorrência de desbridamento cirúrgico na sala de emergência. Métodos Estudo retrospectivo, observacional e descritivo, que incluiu todos os casos de fraturas causadas por armas de fogo entre janeiro de 2010 e dezembro de 2014; foram incluídas 245 fraturas em 223 pacientes. Resultados Houve infecção do local cirúrgico em 8,5% das fraturas, e a média de desbridamentos necessários para controlar o processo infeccioso foi de 1,273 ± 0,608. Foi identificada correlação entre o tratamento cirúrgico escolhido e o segmento corporal afetado (p< 0,001). O tratamento cirúrgico na sala de emergência teve correlação com a ocorrência de infecção (p< 0,001; teste do qui-quadrado). Conclusão Pacientes com ferimentos à bala tratados de forma não operatória apresentaram lesões menos graves e estáveis; portanto, a incidência de complicações nesse grupo foi menor. Por outro lado, os pacientes com lesões complexas foram aqueles submetidos a desbridamento e fixação externa. Portanto, como esperado, foi encontrado um maior número de complicações infecciosas em pacientes submetidos à fixação externa.

Risk of recurrent venous thromboembolism related to prior risk situations: re-evaluation of a cohort study with a longer follow-up.

: Venous thromboembolism (VTE) is a chronic disease. Strategies to assess groups at a high risk of recurrence are needed. We reported that patients without prior risk situation for VTE had an incidence rate ratio (IRR) three times higher when compared with those with this history. The aim of this study was to re-evaluate the cohort, with a longer follow-up and evaluated the association between the absence of a prior risk situation for VTE with an increased risk for recurrence. A total of 289 patients with a previous VTE were followed for 116 months. Patients were advised to attend the outpatients' clinic in case of suspected VTE recurrence. Incidence rates of recurrent thrombotic events were calculated as the number of events over the accumulated observation time. Recurrent VTE occurred in 52 (18%) patients. Patients with a provoked first event and positive prior risk situations for VTE had an incidence rate for recurrence of 1.2 [95% confidence interval (95% CI), 0.7-1.9] per 100 patient-years. The IRR of this subgroup compared with patients with a provoked event without prior risk situations for VTE was 0.9 (95% CI 0.4-2.4). IRR was 2.5 (95% CI, 1.3-4.9) in patients with an unprovoked event and positive prior risk situations and 5.9 (95% CI, 32.8-12.5) in patients with an unprovoked event and no prior risk situations compared with patients with a provoked event without other prior risk situations for VTE. Exposure to prior risk situations for VTE was a protective factor among those patients whose first VTE event was unprovoked.

Significado e considerações sobre a osteoporose por mulheres com e sem diagnóstico da doença / Meaning and considerations about osteoporosis by women with and without diagnosis of the disease

INTRODUÇÃO: Entre pacientes diagnosticados e em tratamento para osteoporose, acredita-se que há desconhecimento geral sobre a doença. Entre os pacientes em faixa etária de risco, não diagnosticados, crê-se que o desconhecimento é maior. OBJETIVO: Avaliar as considerações de mulheres sobre o conceito da osteoporose e sua prevenção. MÉTODOS: Estudo qualitativo, descritivo, realizado no Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, com 10 pacientes portadores de osteoporose, e 10 pacientes sem. A tabulação dos dados ocorreu por meio da utilização de três figuras metodológicas: ideia central, expressões chave e o discurso sujeito coletivo. O estudo foi aprovado pelo Comitê de Ética e Pesquisa com Seres Humanos. RESULTADOS: Dentre as pacientes com diagnóstico, destacou-se como ideias centrais a vulnerabilidade às fraturas e os conceitos de apresentação da doença como osteopenia e osteoporose. No grupo sem diagnóstico, 40% desconhecia a doença. Na prevenção, observou-se maior conhecimento no grupo portador da doença, sendo as ideias centrais destacadas: os exercícios físicos, alimentação rica em cálcio e vitamina D, além da exposição solar. CONCLUSÃO: Evidenciou-se um conhecimento limitado sobre a osteoporose e suas formas de prevenção, sobretudo no grupo sem diagnóstico, porém em faixa etária de risco. Assim, conclui-se que, tratando-se de uma doença de elevada prevalência, de altos custos orçamentários para a saúde pública, e com riscos significativos uma vez não diagnosticados e não tratada, medidas resolutivas de maior esclarecimento sobre a doença devem ser praticadas em todas as esferas da saúde pública.

INTRODUCTION: Among patients diagnosed and under treatment for osteoporosis, it is believed that there is general ignorance about the disease. Among undiagnosed patients at risk, it is believed that the lack of knowledge is larger. OBJECTIVE: To evaluate the considerations of women about the concept of osteoporosis and its prevention. METHODS: A qualitative, descriptive study was carried out at Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil, with 10 patients with osteoporosis and 10 patients without the disease. Data tabulation occurred using three methodological figures: central idea, key expressions and collective subject discourse. The study was approved by the Committee of Ethics and Research with Human Beings. RESULTS: Among the diagnosed patients, the central ideas were vulnerability to fractures and the concepts of disease presentation like osteopenia and osteoporosis. In the undiagnosed group, 40% were unaware of the disease. About prevention, greater knowledge was observed in the group with the disease, with the main ideas being highlighted: physical exercises, calcium and vitamin D rich food, as well as sun exposure. CONCLUSION: There was limited knowledge about osteoporosis and its prevention, especially in the group without diagnosis, but in the age group at risk. Thus, it is concluded that, in the case of a disease of high prevalence, of high budgetary costs for public health, and with significant risks once it is undiagnosed and untreated, resolute measures of greater clarity about the disease should be practiced in all spheres of public health.

Guia prático para o manejo da dor / Guia prático para o manejo da dor

O estudo da dor e suas particularidades é de grande importância para o tratamento de diversas patologias e para a melhora na qualidade de vida dos pacientes. A maioria das disfunções orgânicas tem a dor como um ponto importante da sua manifestação. Dessa maneira, é justificável a elaboração de conteúdo para auxiliar os profissionais da saúde no entendimento e tratamento das principais causas de dores agudas e crônicas. Este livro foi elaborado com o objetivo de servir como um guia prático para o manejo da dor por profissionais e acadêmicos de Medicina. Engloba temas como conceitos e aspectos biopsicossociais da dor, além de questões mais complexas como a fisiologia da dor e o tratamento medicamentoso com o arsenal terapêutico existente. Finalmente, também trata dos diversos tipos de dor mais prevalentes e o conhecimento básico que envolve seu manejo.

Autopercepção da qualidade de vida de pacientes submetidos à artroplastia total do joelho / Patient self-perception of the quality of life after total knee arthroplasty / Autopercepción de la calidad de vida de pacientes luego de una artroplastia total de rodilla

Introdução: A doença articular degenerativa, osteoartrose, é, no geral, a principal causa de deficiência física entre idosos. A dor e a limitação funcional provocadas por essa condição, especialmente nos membros inferiores, apresentam forte correlação com a redução na qualidade de vida dessas pessoas. A artroplastia total do joelho é um procedimento terapêutico de excelentes resultados na artrose do joelho, cada vez mais prevalente. Objetivo: Conhecer a qualidade de vida antes e depois desse procedimento sob a perspectiva do paciente. Material e método: Estudo qualitativo, descritivo, realizado no Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, com 50 pacientes submetidos a artroplastia total do joelho. A tabulação dos dados ocorreu por meio da utilização de três figuras metodológicas: ideia central, expressões chave e o discurso sujeito coletivo. Resultados: Melhora importante da dor, ganho funcional, maior sensação de segurança e menor dependência de medicamentos com função analgésica foram vantagens destacadas. Ainda que uma parcela mantenha queixas álgicas em outros segmentos após o procedimento, a satisfação com a prótese foi significativa entre os pacientes, com descrições originais sobre a qualidade de vida nos dois momentos exemplificando essa constatação. Conclusão: A satisfação com a artroplastia total do joelho é significativa entre os pacientes em vários domínios, claramente visível em uma exploração de caráter qualitativo(AU)

Introduction: Degenerative joint disease, osteoarthritis, is, in general, the main cause of physical disability among the elderly. The pain and functional limitation caused by this condition, especially in the lower limbs, present a strong correlation with a reduction in their quality of life. Total knee arthroplasty is a therapeutic procedure with excellent results in knee arthritis, which is increasingly prevalent. Objective: The objective was to assess the quality of life before and after this procedure from the patient's perspective. Methods: A qualitative, descriptive study was performed at Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil, with 50 patients who underwent total knee arthroplasty. The tabulation of data occurred through the use of three methodological figures: central idea, key expressions and collective subject discourse. Results: Significant improvement of pain, functional gain, greater sensation of safety and less dependence on drugs with analgesic function were the main benefits. Although a portion maintains painful complaints in other segments after the procedure, the satisfaction with the prosthesis was significant among the patients, with original descriptions about the quality of life in the two moments, exemplifying this finding. Conclusion: Satisfaction with total knee arthroplasty is significant among patients in several domains, clearly visible in a qualitative exploration(AU)

Introducción: La enfermedad articular degenerativa, la osteoartritis, es, en general, la principal causa de deficiencia física entre ancianos. El dolor y la limitación funcional provocada por esta condición, especialmente en los miembros inferiores, presentan una fuerte correlación con la reducción en la calidad de vida de esas personas. La artroplastia total de la rodilla es un procedimiento terapéutico de excelentes resultados en la artrosis de la rodilla, cada vez más prevalente. Objetivo: Se objetivó conocer la calidad de vida antes y después de ese procedimiento desde la perspectiva del paciente. Material y método: Estudio cualitativo, descriptivo, realizado en el Hospital de las Clínicas de la Universidad Federal de Minas Gerais, Belo Horizonte, con 50 pacientes sometidos a artroplastia total de la rodilla. La tabulación de los datos ocurrió por medio de la utilización de tres figuras metodológicas: idea central, expresiones clave y el discurso del sujeto colectivo. Resultados: Mejora importante del dolor, aumento funcional, mayor sensación de seguridad y menor dependencia de medicamentos con función analgésica fueron ventajas destacadas. Aunque una parcela mantiene quejas álgicas en otros segmentos después del procedimiento, la satisfacción con la prótesis fue significativa entre los pacientes, con descripciones originales sobre la calidad de vida en los dos momentos ejemplificando esa constatación. Conclusión: La satisfacción con la artroplastia total de la rodilla es significativa entre los pacientes en varios dominios, claramente visible en una exploración de carácter cualitativo(AU)