Outbreak report of polymyxin-carbapenem-resistant Klebsiella pneumoniae causing untreatable infections evidenced by synergy tests and bacterial genomes.

Polymyxin-carbapenem-resistant Klebsiella pneumoniae (PCR-Kp) with pan (PDR)- or extensively drug-resistant phenotypes has been increasingly described worldwide. Here, we report a PCR-Kp outbreak causing untreatable infections descriptively correlated with bacterial genomes. Hospital-wide surveillance of PCR-Kp was initiated in December-2014, after the first detection of a K. pneumoniae phenotype initially classified as PDR, recovered from close spatiotemporal cases of a sentinel hospital in Rio de Janeiro. Whole-genome sequencing of clinical PCR-Kp was performed to investigate similarities and dissimilarities in phylogeny, resistance and virulence genes, plasmid structures and genetic polymorphisms. A target phenotypic profile was detected in 10% (12/117) of the tested K. pneumoniae complex bacteria recovered from patients (8.5%, 8/94) who had epidemiological links and were involved in intractable infections and death, with combined therapeutic drugs failing to meet synergy. Two resistant bacterial clades belong to the same transmission cluster (ST437) or might have different sources (ST11). The severity of infection was likely related to patients' comorbidities, lack of antimicrobial therapy and predicted bacterial genes related to high resistance, survival, and proliferation. This report contributes to the actual knowledge about the natural history of PCR-Kp infection, while reporting from a time when there were no licensed drugs in the world to treat some of these infections. More studies comparing clinical findings with bacterial genetic markers during clonal spread are needed.

Effect of Organic Residues as Fertilizer on Postharvest Quality of Cherry Tomatoes

Abstract Composting of domestic residues to replace cattle manure was evaluated as a fertilization option for the cherry tomato crop. Two sources of organic compounds (CO) were used to prepare compost piles: Domestic residues (DR) and bovine manure (BM), used in 5 proportions (CO1 = 15% DR + 15% BM, CO2 = 10% DR + 20% BM, CO3 = 20% DR + 10% BM, CO4 = 30% BM (control) and CO5 = 30% DR). To compost the compost piles, the organic waste (carbon source) was mixed with remnants of tree pruning (filler) from the urban cleaning service in a ratio of 1: 3. After 90 days, the compost from each matured pile was mixed with 1: 1 coconut fiber substrate and filled into 15 L plastic bags where the cherry tomato plants were grown. The experiment was conducted in a greenhouse using the experimental design of randomized blocks with 5 treatments and 5 replicates (6 fruits per sample). The organic fertilization in the proportions of manure and food residue did not provide statistically significant differences in soluble solids, total sugars, lycopene, β-carotene and micronutrients Zn, Fe, N and P in cherry tomato fruits. Fertilization with CO1 and CO2 increased AT, Mn and decreased the SS / AT, K and Ca ratio. There was no nutritional deficiency of tomatoes in any of the proportions of the organic residues studied.

Assistência de enfermagem à pacientes portadores de hipertensão arterial sistêmica / Nursing assistance for patients with systemic arterial hypertension

Identificar e analisar os principais cuidados de enfermagem em relação aos pacientes hipertensos frente ao processo saúde-doença. Foi realizada uma revisão integrativa da literatura sobre os principais cuidados de enfermagem que podem ser disponibilizados aos pacientes com hipertensão arterial e obteve-se uma amostra de 23 artigos em língua portuguesa publicados no período de 2013 a 2017 disponíveis nas bases de dados LILACS, BDENFE e MEDLINE que foram selecionadas na Biblioteca Virtual em Saúde. No âmbito da atenção a saúde foi visto que é essencial um cuidado com a aplicação da Sistematização da Assistência de Enfermagem aos pacientes com Hipertensão Arterial Sistêmica, pois enriquece a consulta possibilitando a execução de etapas sistemáticas e, a participação do paciente e familiares é essencial na prática de um autocuidado. A educação em saúde é uma das principais estratégias de conscientização da erradicação de hábitos maléficos na saúde, garantindo uma vida mais saudável e confortável

To identify and analyze the main nursing care in relation to hypertensive patients facing the health-disease process. An integrative review of the literature on the main nursing care that can be made available to patients with arterial hypertension has been carried out and a sample of 23 Portuguese-language articles published in the period from 2013 to 2017 available in the LILACS databases, BDENFE and MEDLINE that were selected in the Virtual Health Library. In the health care area, it was observed that care with the application of Nursing Care Systematization to patients with Systemic Arterial Hypertension is essential, since it enriches the consultation allowing the systematic steps, and patient and family participation is essential in the practice of self-care. Health education is one of the main strategies to raise awareness of the eradication of harmful habits in health, ensuring a healthier and more comfortable life

Intervenção de saúde sobre hipertensão e diabetes / Health intervention on hypertension and diabetes

Objetivo: apresentar a experiência de uma intervenção realizada com pacientes hipertensos e diabéticos, seguindo os parâmetros da Metodologia do Arco de Charles Maguerez. Método: trata-se estudo qualitativo, descritivo, tipo relato de experiência, sobre uma intervenção em saúde realizada por acadêmicos de Enfermagem e profissionais da saúde em uma Unidade Básica de Saúde. Referiu-se a atividade sobre a não adesão dos usuários ao programa HiperDia e, como metodologia, foi seguida a Problematização com Arco, de Charles Maguerez. Resultados: identificou-se a não adesão dos pacientes hipertensos e diabéticos às consultas de HiperDia e, com o auxílio das etapas Arco de Charles Maguerez, realizou-se uma intervenção em saúde onde foram ofertadas, aos participantes, consultas de Enfermagem com: verificação da pressão arterial, teste de glicemia e peso. Distribui-se, após a consulta, um lanche nutritivo, ressaltando a importância de uma alimentação saudável, bem como estimulando a prática regular de atividade física de forma correta, tornando esse processo essencial para o controle e tratamento das doenças. Conclusão: obteve-se um resultado positivo e satisfatório e, dessa forma, compreende-se que a realização de ações em saúde como essa faz total diferença no processo saúde-doença.(AU)

Objective: to present the experience of an intervention performed with hypertensive and diabetic patients, following the parameters of the Methodology of the Arch of Charles Maguerez. Method: this is a qualitative, descriptive study, a type of experience report, about a health intervention performed by nursing students and health professionals in a Basic Health Unit. The activity on non-adherence of users to the HiperDia program and, as methodology, Charles Maguerez's Problematization with Arch was followed. Results: the non-adherence of hypertensive and diabetic patients to HiperDia's consultations was identified and, with the aid of the steps of Charles Maguerez Arch, a health intervention was carried out, where the participants were offered Nursing consultations with: blood pressure, blood glucose test and weight. After the consultation, a nutritious snack is distributed, emphasizing the importance of a healthy diet, as well as stimulating the regular practice of physical activity in a correct way, making this process essential for the control and treatment of diseases. Conclusion: a positive and satisfactory result was obtained and, therefore, it is understood that the accomplishment of health actions like this makes a total difference in the health-disease process.(AU)

Objetivo: presentar la experiencia de una intervención realizada con pacientes hipertensos y diabéticos, siguiendo los parámetros de la Metodología del Arco de Charles Maguerez. Método: se trata de un estudio cualitativo, descriptivo, tipo relato de experiencia, sobre una intervención en salud realizada por academicos de Enfermería y profesionales de salud de una Unidad Basica de Salud. Se referió a la actividad sobre la no adhesión de los usuarios al programa HiperDia y, como metodologia, fue seguida la Problematización con Arco de Charles Maguerez. Resultados: se identificó la no adhesión de los pacientes hipertensos y diabéticos a las consultas de HiperDia y, con el auxilio de las etapas Arco de Charles Maguerez, se realizó una intervención en salud donde se ofrecieron a los participantes consultas de Enfermería con: verificación de la presión arterial, prueba de glucemia y peso. Se distribuye, después de la consulta, una merienda nutritiva, resaltando la importancia de una alimentación sana, así como estimulando la práctica regular de actividad física de forma correcta, haciendo este proceso esencial para el control y tratamiento de las enfermedades. Conclusión: se obtuvo un resultado positivo y satisfactorio y, de esa forma, se comprende que la realización de acciones en salud como esa hace total diferencia en el proceso salud-enfermedad.(AU)

Aspectos crônicos de servidores públicos com foco nos problemas de varizes e colesterol elevado / Chronic aspects of public servants with a focus on the problems of varicose veins and high cholesterol

Objetivo: descrever aspectos de saúde crônico-degenerativos dos servidores públicos do IFRN, como, também, inferir as variáveis sociodemográficas com as variáveis mais expressivas: ter varizes e colesterol alto. Método: estudo quantitativo, descritivo, empregando, como instrumento, o questionário fechado. A amostra observada foi de 774 participantes. Foram realizadas análises estatísticas descritivas e inferenciais, considerando-se o quantitativo de respostas que afirmam ter varizes ou colesterol alto. Resultados: os problemas crônicos degenerativos mais expressivos, apontados pelos servidores, são varizes, colesterol e triglicérides elevados, hipertensão e diabetes. As mulheres acima de 35 anos, que têm pós-graduação e companheiro, são as com maiores problemas de varizes. Os servidores acima de 35 anos, que trabalham nos campi da Grande Natal e têm companheiro, apresentam colesterol elevado. Conclusão: sugere-se que os projetos de atenção à saúde dos servidores considerem esses parâmetros como referência para implementar suas ações.

Unilateral plantar flexors static-stretching effects on ipsilateral and contralateral jump measures.

The aim of this study was to evaluate the acute effects of unilateral ankle plantar flexors static-stretching (SS) on the passive range of movement (ROM) of the stretched limb, surface electromyography (sEMG) and single-leg bounce drop jump (SBDJ) performance measures of the ipsilateral stretched and contralateral non-stretched lower limbs. Seventeen young men (24 ± 5 years) performed SBDJ before and after (stretched limb: immediately post-stretch, 10 and 20 minutes and non-stretched limb: immediately post-stretch) unilateral ankle plantar flexor SS (6 sets of 45s/15s, 70-90% point of discomfort). SBDJ performance measures included jump height, impulse, time to reach peak force, contact time as well as the sEMG integral (IEMG) and pre-activation (IEMGpre-activation) of the gastrocnemius lateralis. Ankle dorsiflexion passive ROM increased in the stretched limb after the SS (pre-test: 21 ± 4° and post-test: 26.5 ± 5°, p < 0.001). Post-stretching decreases were observed with peak force (p = 0.029), IEMG (P<0.001), and IEMGpre-activation (p = 0.015) in the stretched limb; as well as impulse (p = 0.03), and jump height (p = 0.032) in the non-stretched limb. In conclusion, SS effectively increased passive ankle ROM of the stretched limb, and transiently (less than 10 minutes) decreased muscle peak force and pre-activation. The decrease of jump height and impulse for the non-stretched limb suggests a SS-induced central nervous system inhibitory effect. Key pointsWhen considering whether or not to SS prior to athletic activities, one must consider the potential positive effects of increased ankle dorsiflexion motion with the potential deleterious effects of power and muscle activity during a simple jumping task or as part of the rehabilitation process.Since decreased jump performance measures can persist for 10 minutes in the stretched leg, the timing of SS prior to performance must be taken into consideration.Athletes, fitness enthusiasts and therapists should also keep in mind that SS one limb has generalized effects upon contralateral limbs as well.

Chromosomal Variability Between Populations of Electrophorus electricus Gill, 1864 (Pisces: Gymnotiformes: Gymnotidae).

The electric eel, Electrophorus electricus, the only species of its genus, has a wide distribution in the Amazon and Orinoco drainages. There is little previous information regarding the population variation in E. electricus, with only basic karyotype data from two populations (Amazon and Araguaia Rivers). Karyotypic description and analysis of CO1 barcode sequences were performed for E. electricus from three localities (Caripetuba, Irituia, and Maicuru Rivers). All samples share the 2n=52 (42 m-sm [meta-submetacentric] +10 st-a [subtelo-acrocentric]) with previously studied material. However, the Maicuru River samples differ from the other populations, as they have B chromosomes. The distribution of noncentromeric constitutive heterochromatin between samples is relatively divergent. All samples analyzed present the Nucleolar Organizer Region (NOR) located in a single chromosome pair. In the samples from Caripetuba, NORs were colocalized with a heterochromatin block, whereas the NOR was flanked by heterochromatin in Maicuru River samples and pericentromeric heterochromatin adjacent NOR was found in Irituia River samples. Alignment of CO1 barcode sequences indicated no significant differentiation between the samples analyzed. Results suggest that karyotypic differences between samples from the Caripetuba, Irituia, and Amazon Rivers represent chromosome polymorphisms. However, differences between the samples from the Maicuru and Araguaia Rivers and the remaining populations could represent interpopulation differentiation, which has not had time to accrue divergence at the CO1 gene level.

Chromosomal diversity in three species of electric fish (Apteronotidae, Gymnotiformes) from the Amazon Basin.

Cytogenetic studies were carried out on samples of Parapteronotus hasemani, Sternarchogiton preto and Sternarchorhamphus muelleri (Apteronotidae, Gymnotiformes) from the Amazon basin. The first two species exhibited both a 2n = 52 karyotype, but differed in their karyotypic formulae, distribution of constitutive heterochromatin, and chromosomal location of the NOR. The third species, Sternarchorhamphus muelleri, was found to have a 2n = 32 karyotype. In all three species the DAPI and chromomycin A3 staining results were consistent with the C-banding results and nucleolar organizer region (NOR) localization. The 18S rDNA probe confirmed that there was only one pair of ribosomal DNA cistron bearers per species. The telomeric probe did not reveal interstitial telomeric sequences (ITS). The karyotypic differences among these species can be used for taxonomic identification. These data will be useful in future studies of these fishes and help understanding the phylogenetic relationships and chromosomal evolution of the Apteronotidae.

Efeito de diferentes durações do alongamento no desempenho de saltos unipodais / The effect of different stretching times on single-leg jump performance / Efecto de diferentes duraciones del alongamiento en el desempeño de saltos unipodales

INTRODUÇÃO: A prática de exercícios de alongamento é muito comum como parte do aquecimento em diversas modalidades esportivas, porém, esta prática pode ser negativa para aqueles que desejam o aprimoramento da força e potência muscular, consequentemente, o rendimento dos saltos pode ficar reduzido após exercícios de alongamento, que depende do tempo de duração e intensidade do mesmo. OBJETIVO: Avaliar a influência do tempo de permanência no exercício alongamento sobre o desempenho do drop jump unilateralmente (unipodal). MÉTODOS: A amostra foi composta por 16 adultos jovens hígidos, com larga experiência em saltos. O protocolo de teste consistiu em realizar três drop jumps unipodais máximos a partir de uma plataforma de 15 cm sobre um tapete de salto (Hidrofit(r)), antes e após duas durações (i.e. uma série 3 min. de um lado, e 6 min. para outro, a escolha foi de forma aleatória) de alongamento dos músculos tríceps sural, utilizando uma intensidade entre 70-90% da percepção subjetiva de desconforto. A análise de variância ANOVA (2x2) foi utilizada para verificar diferenças para a altura de salto, tempo de contato e flexibilidade, utilizando um nível de significância de 5%. RESULTADOS: Apresentaram diferenças significativas entre condições pré e pós-alongamento para as durações de 3 e 6 minutos (P=0,002 e P=0,001, respectivamente), com a diminuição na altura máxima do salto. O tempo de contato foi maior apenas para a duração de 6 minutos (P=0,039). CONCLUSÃO: A realização de exercícios de alongamento do músculo tríceps sural por 3 ou 6 minutos de duração resulta na queda do desempenho do drop jump unipodal, diminuição da altura do salto vertical ...

INTRODUCTION: Stretching is very common as part of the warm-up in several sports modalities. However this practice can be negative to strength improvement and muscular power. Consequently, jump performance can be reduced after stretching exercises, depending on its duration and intensity. OBJECTIVE: To evaluate the acute effects of different long-term stretching times on single-leg drop jump performance. METHODS: The sample was composed of 16 healthy jump experienced young adult athletes. The experimental protocol consisted of performing three maximum unipodal drop jumps from a 15 cm high platform, and landing on a contact mat (Hidrofit(r)), before and after two stretching times of the triceps surae muscles (i.e. a series of 3 minutes on one side and 6 minutes on the other, with the sides being randomly chosen), using an intensity of 70-90% of their subjective perception of discomfort. An ANOVA (2x2) analysis was used to verify differences for the jump height, contact time and flexibility, using a significance level of 5%. RESULTS: The results showed significant differences between pre and post-stretching times of 3 and 6 minutes (P=0.002 and P=0.001, respectively). Contact time was higher only for the stretching time of 6 minutes (P=0.039). CONCLUSION: We conclude that stretching exercises of the triceps surae muscle, for 3 or 6 minutes, resulted in a decreased performance in the single-leg drop jump, a decrease in the vertical jump height (for 3 and 6 minutes) and contact time (for 6 minutes only), reinforcing the need for more debates in this area regarding stretching before power activities. .

INTRODUCCIÓN: La práctica de ejercicios de alongamiento es muy común como parte del calentamiento en diversas modalidades deportivas. No obstante, esta práctica puede ser negativa para aquellos que desean la mejora de la fuerza y potencia muscular. Consiguientemente, el rendimiento de los saltos puede ser reducido después de ejercicios de alongamiento, que depende del tiempo de duración e intensidad del mismo. OBJETIVO: Evaluar la influencia del tiempo de permanencia en el ejercicio de alongamiento sobre el desempeño del drop jump unilateralmente (unipodal). MÉTODOS: La muestra fue composta por 16 adultos jóvenes sanos, con amplia experiencia en saltos. El protocolo de test consistió en realizar tres drop jumps unipodales máximos a partir de una plataforma de 15 cm sobre una alfombra de salto (Hidrofit(r)), antes y después de dos duraciones (i.e. una serie de 3 min. de un lado, y 6 min. para otro, la elección fue de forma aleatoria) de alongamiento de los músculos tríceps sural, utilizando una intensidad entre 70-90% de la percepción subjetiva de incomodidad. El análisis de variación ANOVA (2x2) fue utilizado para verificar diferencias para la altura de salto, tiempo de contacto y flexibilidad, utilizando un nivel de significancia de 5%. RESULTADOS: Presentaron diferencias significativas entre condiciones pre y post-alongamiento para las duraciones de 3 y 6 minutos (P=0,002 y P=0,001, respectivamente), con la disminución en la altura máxima del salto. El tiempo de contacto fue mayor sólo para la duración de 6 minutos (P=0,039). CONCLUSIÓN: La realización de ejercicios de alongamiento del músculo tríceps sural por 3 ó 6 minutos de duración resulta en la caída del desempeño del drop jump unipodal, disminución de la altura del salto vertical (para 3 y 6 min. de duración) ...

Internações por condições sensíveis à atenção primária no Espírito Santo: estudo ecológico descritivo no período 2005-2009 / Hospitalization for primary care sensitive conditions in Espirito Santo: an ecological decriptive study, 2005–2009

Objetivo: descrever as internações por condições sensíveis à atenção primária (CSAP) no estado do Espírito Santo, Brasil, no período 2005-2009. Métodos: estudo ecológico descritivo das internações do Sistema Único de Saúde, classificadas conforme a lista brasileira de internações por CSAP, estudadas por municípios de residência, distribuídas por microrregião, sexo, faixa etária e grupo de causas. Resultados: registro de 823.343 internações por CSAP no período, representando 28,9 por cento do total de internações por CSAP em 2005 e 23,2 por cento em 2009; coeficiente de internações por CSAP reduzido de 14,1 para 11,4/1000 habitantes, diferentemente segundo microrregiões; internações por CSAP mais frequentes em menores de cinco anos e idosos, 29,3 e 39,1/1000 habitantes respectivamente; gastroenterites, pneumonias, insuficiência cardíaca e infecção no rim e trato urinário somaram 50,3 por cento das causas. Conclusões: há indícios de melhoria no quadro das internações por CSAP apesar dos ganhos irregulares.

Objective: to describe hospitalization for ambulatory care sensitive conditions (ACSC) in the state of Espírito Santo, Brazil, in the period 2005-2009. Methods: an ecological descriptive study of hospitalizations in the National Health System, based on the Brazilian list of ACSC, by Municipalities of residence, distributed by Micro-region, gender, age group and causes. Results: were recorded 823,343 hospitalizations for ACSC in the period, representing 28,9 percent of these admissions in 2005 and 23,2 percent in 2009; ACSC rates per 1000 population decreased from 14,1 to 11,4 per 1000 inhabitants, differently among micro-regions; children underfive years and elderly were more likely to hospitalization, 29,3 and 39,1/1000 inhabitants respectively; gastroenteritis, bacterial pneumonia, heart failure and infection in urinary tract account for 50,3 percent of cases. Conclusion: there are indications of improvement on hospitalizations for ACSC in the State despite irregular gains.

Laparoscopic cholecystectomy in 960 elderly patients.

OBJECTIVE: To evaluate the operative time, hospital stay, conversion rate, morbidity and mortality in elderly patients undergoing laparoscopic cholecystectomy for gallbladder disease. METHODS: We conducted a descriptive, retrospective study with the chats of 960 patients, aged 60 and 97 years in the period from January 1993 to August 2009. RESULTS: Operative time ranged from nine to 180 minutes. The length of stay ranged from 24 to 120 hours. Conversion occurred in 28 patients (2.92%), of whom 67.9% were women and 28.6% men, a minilaparotomy having been performed in 11 cases (39.3%) and in 17 (60.7%) the conventional open route. The perioperative complications were two ruptures of the gallbladder, one failure in the pneumoperitoneum and one in clipping the cystic duct. Postoperative complications were five umbilical incisional hernias. Systemic complications were: nine arrhythmias, one postoperative jaundice, one acute myocardial infarction and one mesenteric infarction. Mortality occurred in three patients (0.3%), one due to perioperative myocardial infarction, one due to sepsis and one because of mesenteric infarction. CONCLUSION: Elderly patients undergoing laparoscopic cholecystectomy had low hospital stay and low morbimortality. The operative time and hospital stay were short, demonstrating that laparoscopic cholecystectomy is safe and effective in the elderly.

Colecistectomia videolaparoscópica em 960 pacientes idosos / Laparoscopic cholecystectomy in 960 elderly patients

OBJETIVO: Analisar o tempo operatório, a permanência hospitalar, a taxa de conversão, a morbidade e a mortalidade de pacientes idosos submetidos à colecistectomia videolaparoscópica por doença da vesícula biliar. MÉTODOS: Estudo descritivo, retrospectivo, realizado no prontuário de 960 pacientes, de ambos os sexos, com idade entre 60 e 97 anos no período de janeiro de 1993 a agosto de 2009. RESULTADOS: O tempo operatório variou de nove a 180 minutos. O tempo de internação variou de 24 a 120 horas. A conversão ocorreu em 28 pacientes (2,92 por cento), dos quais 67,9 por cento eram mulheres e 28,6 por cento homens tendo sido em 11 casos (39,3 por cento) realizada minilaparotomia e em 17 (60,7 por cento) a via aberta convencional. As intercorrências no transoperatório foram duas rupturas da vesícula biliar, uma falha no pneumoperitônio e uma na clipagem do ducto cístico. No pós-operatório observaram-se cinco hérnias umbilicais incisionais. As complicações sistêmicas foram: nove arritmias cardíacas, uma icterícia pós-operatória, um infarto agudo do miocárdio e um infarto enteromesentérico. Mortalidade ocorreu em três pacientes (0,3 por cento), um por infarto agudo do miocárdio no transoperatório, uma sepse e um infarto enteromesentérico. CONCLUSÃO: Os pacientes idosos submetidos à colecistectomia videolaparoscópica apresentaram baixo tempo de internação hospitalar e baixa morbimortalidade. O tempo operatório e o de internação hospitalar foram curtos, demonstrando que a colecistectomia videolaparoscópica é procedimento seguro e eficaz nos idosos.

OBJECTIVE: to evaluate the operative time, hospital stay, conversion rate, morbidity and mortality in elderly patients undergoing laparoscopic cholecystectomy for gallbladder disease. METHODS: we conducted a descriptive, retrospective study with the chats of 960 patients, aged 60 and 97 years in the period from January 1993 to August 2009. RESULTS: operative time ranged from nine to 180 minutes. The length of stay ranged from 24 to 120 hours. Conversion occurred in 28 patients (2.92 percent), of whom 67.9 percent were women and 28.6 percent men, a minilaparotomy having been performed in 11 cases (39.3 percent) and in 17 (60.7 percent) the conventional open route. The perioperative complications were two ruptures of the gallbladder, one failure in the pneumoperitoneum and one in clipping the cystic duct. Postoperative complications were five umbilical incisional hernias. Systemic complications were: nine arrhythmias, one postoperative jaundice, one acute myocardial infarction and one mesenteric infarction. Mortality occurred in three patients (0.3 percent), one due to perioperative myocardial infarction, one due to sepsis and one because of mesenteric infarction. CONCLUSION: elderly patients undergoing laparoscopic cholecystectomy had low hospital stay and low morbimortality. The operative time and hospital stay were short, demonstrating that laparoscopic cholecystectomy is safe and effective in the elderly.

Blunt abdominal trauma with small bowel injury: are isolated lesions riskier than associated lesions?

PURPOSE: The objective of this study was to compare patients with "isolated" blunt small bowel injury (SBI) to patients with multiple intra-abdominal injuries and analyze whether delayed laparotomy affected outcome. METHODS: Medical records of patients that suffered a blunt SBI between 1994 and 2005 were reviewed. The patients were divided into two groups: those with isolated SBI and those with other associated intra-abdominal injuries ("non-isolated"). The method of diagnosis, time to operation, small bowel Organ Injury Scale (OIS) assessment (grade >or= 2), injury severity score (ISS), morbidity, and mortality were analyzed. RESULTS: A total of 90 patients met the inclusion criteria, including 62 (68.9%) isolated cases and 28 (31.1%) non-isolated cases. Isolated cases required more supplementary diagnostic methods than the non-isolated cases. Non-isolated cases had a shorter diagnosis to treatment period (p < .01) and a higher ISS (mean 22.5 vs. 17.2 in "isolated" group). Morbidity (51.6% and 53.6%) and mortality (16.1% and 28.6%) did not differ significantly between the isolated and non-isolated groups. Delays in diagnosis were common in the isolated group, but this did not affect outcome. Patients with associated injuries, and higher ISS, had higher mortality. CONCLUSIONS: The presence of associated intra-abdominal injuries significantly affected the presentation and time to diagnosis of patients with SBI, but not morbidity or mortality. Delayed surgical treatment in the isolated cases was not associated with an increased incidence of complications. Patients inflicted with more severe associated injuries were less likely to survive the trauma.

Blunt abdominal trauma with small bowel injury: are isolated lesions riskier than associated lesions?

PURPOSE: The objective of this study was to compare patients with "isolated" blunt small bowel injury (SBI) to patients with multiple intra-abdominal injuries and analyze whether delayed laparotomy affected outcome. METHODS: Medical records of patients that suffered a blunt SBI between 1994 and 2005 were reviewed. The patients were divided into two groups: those with isolated SBI and those with other associated intra-abdominal injuries ("non-isolated"). The method of diagnosis, time to operation, small bowel Organ Injury Scale (OIS) assessment (grade > 2), injury severity score (ISS), morbidity, and mortality were analyzed. RESULTS: A total of 90 patients met the inclusion criteria, including 62 (68.9 percent) isolated cases and 28 (31.1 percent) non-isolated cases. Isolated cases required more supplementary diagnostic methods than the non-isolated cases. Non-isolated cases had a shorter diagnosis to treatment period (p < .01) and a higher ISS (mean 22.5 vs. 17.2 in "isolated" group). Morbidity (51.6 percent and 53.6 percent) and mortality (16.1 percent and 28.6 percent) did not differ significantly between the isolated and non-isolated groups. Delays in diagnosis were common in the isolated group, but this did not affect outcome. Patients with associated injuries, and higher ISS, had higher mortality. CONCLUSIONS: The presence of associated intra-abdominal injuries significantly affected the presentation and time to diagnosis of patients with SBI, but not morbidity or mortality. Delayed surgical treatment in the isolated cases was not associated with an increased incidence of complications. Patients inflicted with more severe associated injuries were less likely to survive the trauma.

OBJETIVO: Comparar pacientes com lesão "isolada" de intestino delgado com pacientes com lesões abdominais "associadas" e analisar o quanto o retardo para indicação de laparotomia influenciou na evolução dos pacientes. MÉTODOS: Foram revisados os prontuários de pacientes com trauma abdominal fechado e lesão de intestino delgado no período de 1994 a 2005, sendo os pacientes divididos em dois grupos: lesão "isolada" e lesões abdominais "associadas". Foram analisados os métodos diagnósticos, intervalo de tempo para a cirurgia, gravidade da lesão de delgado (grau > 2), ISS e morbimortalidade dos pacientes. RESULTADOS: Noventa pacientes preencheram os critérios de inclusão, 62 (68,9 por cento) no grupo "isolada" e 28 (31,1 por cento) no "associada". Pacientes do grupo "isolada" necessitaram mais de métodos diagnósticos complementares. O tempo de diagnóstico até o tratamento foi significantemente menor no grupo "associada", e estes pacientes apresentavam ISS mais elevado (média de 22,5 versus 17,2 no grupo "isolada"). A morbidade e mortalidade nos grupos foram, respectivamente, 51,6 por cento e 16,1 por cento no grupo "isolada", e 53,6 por cento e 28,6 por cento no "associada", sem diferença estatística. Demora para o diagnóstico foi comum no grupo "isolada", porém sem agravar a evolução dos pacientes. Pacientes com lesões "associadas", quantificadas pelo ISS, tiveram maior mortalidade. CONCLUSÃO: A presença de lesões abdominais "associadas" significativamente interferiu no quadro clínico e momento do diagnóstico em pacientes com lesão de delgado, porém não influenciou na morbimortalidade. No grupo "isolada" a demora para tratamento cirúrgico foi freqüente, porém sem interferir nas complicações. A elevada mortalidade foi reflexo da gravidade de lesões associadas.

Fatores preditivos de morbimortalidade no trauma de intestino delgado / Predictive factors of morbimortality in small bowel trauma

OBJETIVO: Os objetivos deste estudo foram avaliar o diagnóstico e o tratamento das lesões de intestino delgado e determinar os fatores que influenciaram a morbimortalidade. MÉTODO: Estudo retrospectivo incluindo 410 pacientes com lesão de intestino delgado operados entre janeiro de 1994 e dezembro de 2004. Os dados coletados incluíram: mecanismo de trauma, métodos diagnósticos, tempo transcorrido até a intervenção cirúrgica, grau das lesões, índices de trauma, conduta cirúrgica (sutura ou ressecção e anastomose), morbidade (especialmente fístula) e mortalidade. A comparação entre os grupos foi feita usando os testes de Fisher e Yates. RESULTADOS: O mecanismo de trauma foi penetrante em 321 pacientes (78,3 por cento) e fechado em 89 (21,7 por cento). Houve mais pacientes tratados cirurgicamente com intervalo maior que 6 horas após o trauma no grupo trauma contuso se comparados com trauma penetrante (p<0,05). Sutura da lesão foi feita em 52,2 por cento dos pacientes e ressecção e anastomose em 46,8 por cento, e ambos procedimentos apresentaram a mesma incidência de fístula (4,7 por cento). A morbidade foi de 35,1 por cento. A incidência de fistula foi maior nos pacientes submetidos à laparotomia com mais de 12 horas após o trauma quando comparados com aqueles operados com menos de 12 horas (8,3 por cento vs. 4,3 por cento; sem diferença estatística), mas isto não foi fator determinante para maior mortalidade. A mortalidade foi de 13,7 por cento e foi relacionada com escores de gravidade mais elevados. CONCLUSÃO: A lesão de intestino delgado é freqüente após o trauma abdominal, sendo mais comum nos traumas penetrantes. O diagnóstico desta lesão após trauma fechado pode ser difícil, com demora para o tratamento cirúrgico. A ocorrência de fistula não esteve relacionada aos seguintes fatores analisados: mecanismo de trauma, tempo transcorrido entre o trauma e a operação, conduta cirúrgica, lesões intra-abdominais associadas ou gravidade das...

BACKGROUND: The purposes of this study were to evaluate the diagnosis and management of small bowel injury (SBI) and to determine significant factors affecting morbidity and mortality. METHODS: A retrospective chart review was performed including 410 patients with SBI operated between January 1994 and December 2004. Data included mechanism of injury, methods of diagnosis, time to operation, organ injury scaling, trauma scores, type of repair (enterorrhaphy vs. resection and anastomosis), morbidity (specifically fistula) and mortality. Comparisons between groups were analyzed using the Fisher and Yates tests. RESULTS: The mechanism of injury was penetrating in 321 patients (78.3 percent) and blunt in 89 (21.7 percent). There were more patients with at least 6 hours of delay to operation in the blunt trauma group than in the penetrating one (p<0.05). Enterorrhaphy was performed in 52.2 percent of the patients and resection with anastomosis in 46.8 percent, both with the same incidence of fistula (approximately 4.7 percent). Morbidity rate was 35.1 percent and fistula was more frequent in patients with therapeutic laparotomy with more than 12 hours after injury compared with laparotomy performed less than 12 hours (8.3 percent vs. 4.3 percent; not statistically significant), and it was not a determinant factor of higher mortality. The mortality rate was 13.7 percent, and was related to higher injury severity scores. CONCLUSION: SBI is frequent after trauma and it was most common in penetrating injuries. Blunt SBI diagnosis may be difficult, therefore causing delay in operative treatment. Occurrence of fistula was not related to the different evaluated factors: mechanism of injury, time to treatment, surgical repair, associated intra-abdominal lesions, and/or injury severity score. Mortality was related to associated injuries.