Statistical Modeling of Deaths from COVID-19 Influenced by Social Isolation in Latin American Countries.

Social isolation is extremely important to minimize the effects of a pandemic. Latin American countries have similar socioeconomic characteristics and health system infrastructures. These countries face difficulties in dealing with the COVID-19 pandemic, and some of them have very high death rates. The government stringency index (GSI) of 12 Latin American countries was gathered from the Oxford COVID-19 Government Response Tracker project. The GSI is calculated by considering nine social distancing and isolation measures. Population data from the United Nations Population Fund and number-of-deaths data were collected from the dashboard of the WHO. We performed an analysis of the data collected from March through December 2020 using a mixed linear model. Peru, Brazil, Chile, Bolivia, Colombia, Argentina, and Ecuador had the highest death rates, with an increasing trend over time. Suriname, Venezuela, Uruguay, Paraguay, and Guyana had the lowest death rates, and these rates remained steady. The GSI in most countries followed the same pattern during the months analyzed. In other words, high indices at the beginning of the pandemic and lower indices in the latter months, whereas the number of deaths increased during the entire period. Almost no country kept its GSI high for a long time, especially from October to December. Time and GSI, as well as their interaction, were highly significant. As their interaction increases, the death rate decreases. In conclusion, a greater GSI at the start of the COVID-19 pandemic was associated with a decrease in the number of deaths over time in Latin American countries.

Burns and patients infected with COVID-19 at a burn treatment centre in Brazil: a series of case-reports.

BACKGROUND: In December 2019, in Wuhan, China, several cases of viral pneumonia, caused by a new type of coronavirus (SARS-CoV-2, a disease that became known as COVID-19) emerged. Being an alarming situation, many resources were directed to fight this pandemic. However, other diseases and conditions, such as burn injuries, continued to occur in this period, thus creating multiple challenges. METHOD: Four patients with COVID-19 treated in a reference burn treatment centre from the Northeast region of Brazil, in the city of Fortaleza were analysed between April to June 2020. RESULTS: All patients were admitted in the service without signs of COVID-19 infection; however the symptoms appeared a few days after hospitalisation. The most common symptom was fever, especially when it occurred in only one spike. Patients who evolved to an unfavourable outcome had comorbidities prior to the infection and burn injury. In addition to this, these two patients had a worsening of their renal function, in contrast to the other two patients that received hospital discharge. CONCLUSION: The burned patient is a complex one that requires the health professional's attention and special care. This became even more evident during the period of the COVID-19 pandemic. Thus, the patients' changes and symptoms must be cautiously analysed, their diagnosis should not be delayed and it must be made under standardised protocols accordingly with the socio-economic and cultural realities of each service.

Intraoperative blood salvage in proximal femur epiphysiolysis surgical treatment with hip controlled dislocation technique: a case series study.

OBJECTIVES: To report a case series of Intraoperative Blood Salvage (IOS) in surgeries during the treatment for Slipped Capital Femoral Epiphysis (SCFE) with controlled dislocation of the hip, identifying its efficacy, complications, and the profile of patients with SCFE. METHODS: Descriptive study reporting a case series, comprising patients seen between January 2016 and March 2018, diagnosed with SCFE, and treated with controlled surgical dislocation of the hip using IOS. RESULTS: Sample comprised of 15 patients, with a mean age of 13.1 years. The most affected side was the left with 8 cases. None of the patients required allogeneic blood in the postoperative period. Mean pre- and postoperative hemoglobin were 13.2 and 11.2 g.dL-1, respectively, and mean hemoglobin difference was 1.8 g.dL-1. Mean pre- and postoperative hematocrit were 39.13% and 33.20%, respectively, and mean hematocrit difference was 5.52%. No intraoperative complications were observed. One patient presented vomiting and another one, wound infection in the postoperative period. CONCLUSION: IOS was an alternative blood salvage approach and prevented allogeneic blood transfusion, enabling reduction of potential complications.

Fenômenos biomecânicos envolvidos nos traumas faciais: uma revisão integrativa / Biomechanical phenomena involved in facial trauma: an integrative review

Introdução: O trauma é definido como um agravo que leva a alterações na estrutura do indivíduo por causa da troca de energia entre os tecidos e o meio. Por causa da sua localização, o esqueleto maxilofacial é comumente acometido por traumas. Além disso, os estudos existentes que buscam abordar a temática comumente a abordam de maneira fragmentada, focada apenas em uma estrutura óssea. Portanto, o presente estudo foi proposto como tentativa de minorar essa lacuna existente na literatura hodierna. Métodos: A busca foi realizada nas plataformas PubMed, LILACS e Cochrane Library utilizando os descritores: "biomechanical phenomena", "facial injuries" e "fractures, bone", encontrando 321 artigos. Os critérios de inclusão foram: estudos publicados nos últimos 5 anos, disponíveis integralmente, nos idiomas inglês ou português. Após a utilização desses filtros foram encontrados 50 estudos, e após leitura analítica do título e do resumo disponível, foram excluídos 44 estudos. Discussão: A mandíbula é mais vulnerável aos impactos laterais do que frontais, evidenciou-se que nos impactos laterais a maior força de estresse era exercida em estruturas ipsilaterais ao impacto. Também se demonstrou que a ausência parcial ou total de dentição apresentavam maiores forças de estresse ao côndilo. Na órbita há principalmente fraturas de borda e fraturas de globo/assoalho. A primeira são fraturas que tendem a ser menores e dispostas anteriormente, já as de assoalho, seria o inverso. Conclusão: Em suma, existem vários fatores que podem influenciar na ocorrência do trauma de face, dentre elas estão os fenômenos biomecânicos envolvidos.

Introduction: Trauma is defined as an injury that leads to changes in an individual's structure due to the energy exchange between tissues and the environment. Because of its location, the maxillofacial skeleton is commonly affected by trauma. Besides, existing studies that seek to address the theme commonly do so in a fragmented way, focused only on a bone structure. Therefore, the present study was proposed as an attempt to bridge this gap in today's literature. Methods: The search was performed on the platforms PubMed, LILACS, and Cochrane Library using the descriptors: "biomechanical phenomena," "facial injuries" and "fractures, bone," finding 321 articles. The inclusion criteria were: studies published in the last five years, available in full, in English or Portuguese. After using these filters, 50 studies were found, and after analytical reading of the title and available summary, 44 studies were excluded. Discussion: The mandible is more vulnerable to lateral than frontal impacts; it was shown that in lateral impacts, the most significant stress force was exerted on structures ipsilateral to the impact. It was also demonstrated that dentition's partial or total absence presented greater stress forces on the condyle. In the orbit, there are mainly edge fractures and globe/floor fractures. The first are fractures that tend to be smaller and anteriorly arranged, whereas those on the floor would be the opposite. Conclusion: In short, several factors can influence the occurrence of facial trauma; among them are the biomechanical phenomena involved.

Modelo sintético e de baixo custo para treinamento de retalho cutâneo / Low-cost synthetic model for skin flap training

Introdução: A busca pela aprendizagem de técnicas cirúrgicas dentro da sala de operação está vinculada a dificuldades, como a redução do tempo de ensino pelos cirurgiões e problemas éticos. Já foram elaborados modelos para facilitar a prática de técnicas cirúrgicas, contudo de custo elevado, difícil acesso e com complicações éticas e morais. O presente trabalho tem como objetivo apresentar um modelo sintético, inédito e prático para o treinamento das técnicas de retalho cutâneo, formulado para ser de fácil reprodução e de baixo custo, permitindo sua exequibilidade. Métodos: No modelo foi utilizado malha, esponja para lavagem de carro, elástico de látex, pincel de ponta fina, bisturi e instrumentos cirúrgicos de sutura. A malha é fixada pelo elástico sobre a superfície da esponja, simulando pele e subcutâneo. Desenha-se, então, o retalho a ser feito na superfície do tecido. Resultados: O modelo criado mostrou-se satisfatório, visto que aprimora o manuseio de instrumentos cirúrgicos e o aprendizado da técnica de retalho proposta, além de ter demonstrado boa elasticidade e resistência a tração. Nas faculdades de medicina percebe-se uma carência na abordagem de temas importantes da cirurgia plástica. Ressalta-se a importância de modelos de baixo custo e de fácil execução, como o supracitado, para facilitar a aprendizagem de estudantes interessados no assunto, buscando cumprir a função educacional sem romper princípios éticos. Conclusão: O modelo proposto é uma excelente forma de treinamento por apresentar benefícios logísticos e instrutivos, facilitando a aprendizagem, sem causar prejuízo aos animais.

Introduction: The search for learning surgical techniques within the operating room is linked to difficulties, such as reducing teaching time by surgeons and ethical problems. Models have already been developed to facilitate the practice of surgical techniques, however, with high cost, difficult access, and ethical and moral complications. The present work aims to present a synthetic model, unpublished and practical for the training of skin flap techniques, formulated to be easy to reproduce and low cost, allowing its feasibility. Methods: In the model, fabric, sponge for car washing, latex elastic, fine-tipped brush, scalpel, and surgical suture instruments were used. The fabric is fixed by the elastic on the surface of the sponge, simulating skin and subcutaneous. The flap to be made on the surface of the fabric is then drawn. Results: The model created was satisfactory, since it improves the handling of surgical instruments and the learning of the proposed flap technique, besides having demonstrated good elasticity and tensile strength. In medical schools, there is a lack of approach to essential topics in plastic surgery. The importance of low-cost and easy-to-execute models, such as the above, is emphasized to facilitate the learning of students interested in the subject, seeking to fulfill the educational function without breaking ethical principles. Conclusion: The proposed model is an excellent form of training because it presents logistical and instructive benefits, facilitating learning, without causing harm to animals.

Description of Covid-19 Cases in Brazil and Italy.

The emergence of Covid-19 started in China and has rapidly spread across the globe, notably in Italy and more recently to Brazil. This is a very worrying situation for the affected countries. This Brief Communication aims to describe and correlate the number of confirmed cases and deaths of Covid-19 in Brazil and Italy. This is a descriptive and retrospective study that used data collated on the World Health Organization (WHO) online platform between 21 January and 19 April 2020. After analyzing the data, it was observed that the number of confirmed cases and deaths in Brazil is lower than that in Italy. There are certain factors in Brazil which see it in a lower risk position than Italy; however, despite the current slow spread of the virus, the situation in Brazil is difficult to predict.

Lesões por queimaduras com evolução para neoplasia: úlceras de Marjolin / Burn lesions with progression to neoplasia: Marjolin's ulcer

Introdução: A Úlcera de Marjolin é definida como a malignização de cicatrizes, geralmente, crônicas, decorrentes de diversos tipos de lesão, sendo mais comum lesões por queimaduras. Métodos: Foi realizado levantamento bibliográfico nas plataformas BVS, PubMed, SciELO e Cochrane, tendo como critério de inclusão estudos publicados nos últimos 5 anos, que envolvem a espécie humana, disponíveis na web nos idiomas inglês ou português. Resultados: Analisados um total de 31, dos quais apenas 6 compuseram a amostra final. Discussão: As úlceras de Marjolin são encontradas em cicatrizes antigas de queimaduras, podem ocorrer em qualquer local, sendo mais comuns em membros superiores e inferiores. O diagnóstico inicia-se com a suspeita clínica baseada em características das lesões: lesões ulcerativas crônicas que não cicatrizam, com bordas elevadas e endurecidas e odor desagradável, podendo apresentar descarga purulenta. Esse só pode ser efetivado, entretanto, por meio do histopatológico da lesão. O período de latência entre a injúria da lesão e a sua malignização é, em média, de 30 a 35 anos. O tratamento deve ser individualizado, uma vez que depende de diversos fatores. Contudo, considera-se o padrão ouro a excisão cirúrgica. Conclusão: O conhecimento dos profissionais de saúde acerca dessa condição faz-se imprescindível para o melhor prognóstico do paciente. De modo que possíveis casos de malignização não tenham o seu diagnóstico subestimado, permita a terapêutica adequada à minimização das recidivas, e medidas profiláticas sejam efetivadas, no que tange à prevenção da queimadura e à minoração de fatores de risco para a malignização.

Introduction: Marjolin's ulcer is defined as a malignancy within scars that is usually chronic and results from several lesion types, with burn injuries being the most common. Methods: A bibliographic survey was conducted of the Virtual Health Library, PubMed, Scientific Electronic Library Online, and Cochrane databases using the inclusion criteria of studies published in the last 5 years, human studies, and published in English or Portuguese. Results: A total of 31 studies were analyzed, of which only 6 were included in the final sample. Discussion: Marjolin's ulcer is found in old burn scars and can occur anywhere, but it is more common in the upper and lower limbs. The diagnosis begins with the clinical suspicion based on lesion characteristics: chronic unhealed ulcerative lesions with high and hardened edges, an unpleasant odor, and purulent discharge. However, the diagnosis can only be made histopathologically. The latency period between injury and malignancy is 30­35 years. Although treatment should be individualized since it depends on several factors, surgical excision is considered the gold standard. Conclusion: Knowledge about this condition is essential to better patient prognosis and prevent underestimation of possible cases of malignancy, allowing for appropriate therapy to minimize recurrence and enabling prophylactic measures to prevent burn injury and reduce risk factors for malignancy.

Importância de um atendimento pré-hospitalar efetivo a adultos vítimas de queimaduras: uma revisão integrativa / Importance of an effective pre-hospital care for victims of burns: an integrating review / Importancia de una atención pre-hospitalaria efectiva a adultos víctimas de quemaduras: una revisión integrativa

Introdução: As queimaduras são lesões traumáticas e podem ser causadas por vários agentes etiológicos, sendo classificados em 1°, 2° e 3° grau, atingindo a epiderme, a derme e a hipoderme, respectivamente. Objetivo: Identificar e analisar os artigos sobre as condutas no atendimento pré-hospitalar no paciente queimado. Método: Trata-se de uma revisão integrativa de literatura de artigos completos disponíveis nas bases de dados Medline, PubMed e Lilacs, utilizando os descritores "queimaduras", "atendimento pré-hospitalar", "primeiros socorros", serviços médicos de emergência", cuidados críticos" publicados no período de janeiro de 2013 a dezembro de 2017. Após a leitura analítica, apenas 6 atenderam aos critérios de inclusão e compuseram a amostra final deste estudo. Foi realizada análise descritiva, a qual permitiu resumir e avaliar os dados oriundos dos estudos selecionados. Resultados: O atendimento prestado ao paciente queimado tem como objetivo parar a progressão da queimadura, por meio do resfriamento do local com água a temperatura ambiente. O uso de gelo ou água excessivamente gelada é inadequado, uma vez pode causar vasoconstrição, ratificando a importância da retirada dos pertences das vítimas queimaduras e mensuração da superfície corporal queimada para um atendimento pré-hospitalar bem conduzido. Conclusão: O atendimento pré-hospitalar ao paciente acometido por injúrias térmicas exige uma avaliação clínica, habilidades e conhecimentos específicos sobre primeiros socorros para um bom prognóstico dessa enfermidade

Introduction: Burns are traumatic injuries, and can be caused by several etiological agents being classified in 1st, 2nd and 3rd degree, reaching the epidermis, dermis and hypodermis respectively. Objective: To identify and analyze the articles on the conduct of prehospital care in the burned patient. Methods: It is an integrative review of full-text literature available in the Medline, PubMed and Lilacs databases, using the descriptors "burns", "prehospital care", "first aid", "emergency medical services","critical care", published from January 2013 to December 2017. After the analytical reading, only 6 met the inclusion criteria and composed the final sample of this study. A descriptive analysis was carried out, which allowed summarizing and evaluating the data from the selected studies. Results: The care given to the burned patient aims to stop the burn progression, by cooling the room with water at room temperature. The use of ice or excessively cold water is inadequate, since it can cause vasoconstriction. This ratifies the importance of the removal of belongings of burn victims and measurement of the burned body surface, for well-conducted prehospital care. Conclusion: Prehospital care for the patient affected by thermal injuries requires a clinical evaluation, skills and specific knowledge on first aid for a good prognosis of this disease.

Introducción: Las quemaduras son lesiones traumáticas y pueden ser causadas por varios agentes etiológicos que se clasifican en 1 °, 2 ° y 3 ° grado, alcanzando la epidermis, la dermis y la hipodermis respectivamente. Objetivo: Identificar y analizar los artículos sobre la conducta de la atención prehospitalaria en el paciente quemado. Metodos: Es una revisión integradora de la literatura de texto completo disponible en las bases de datos Medline, PubMed y Lilacs, utilizando los descriptores "quemaduras", "atención prehospitalaria", "primeros auxilios", "servicios médicos de emergencia", cuidados críticos "Publicado desde Enero de 2013 a diciembre de 2017. Después de la lectura analítica, solo 6 cumplieron con los criterios de inclusión y compusieron la muestra final de este estudio. Se realizó un análisis descriptivo, que permitió resumir y evaluar los datos de los estudios seleccionados. Resultados: La atención al paciente quemado busca detener la progresión de la quemadura, al enfriar la habitación con agua a temperatura ambiente. El uso de hielo o agua excesivamente fría es inadecuada, ya que puede causar vasoconstricción. Esto ratifica la importancia de la eliminación de las pertenencias de la quemadura víctimas y la medición de la superficie corporal quemada, para la atención prehospitalaria bien conducida. Conclusión: La atención prehospitalaria para el paciente afectado por lesiones térmicas requiere una evaluación clínica, habilidades y conocimientos específicos sobre primeros auxilios para un buen pronóstico de esta enfermedad.