Analysis of gunshot residues from nontoxic ammunition: a contribution to health and environmental analysis.

This study's aim was to determine the presence, as well as to evaluate the health and environmental impacts, of chemical elements from firearm shots during shooter practice at outdoor shooting ranges, both in the environment and on the shooters' hands. Two high-precision devices were used for measuring suspended particles that are released during discharge of Taurus PT 100 .40 caliber pistols. The analysis of collected data allowed the identification of specific distribution patterns of samples that were adsorbed. Moreover, samples were collected from the opisthenar area of the hand to investigate both the occurrence and deposition of particles and chemical elements through scanning electron microscopy coupled with energy dispersive spectroscopy (SEM-EDS). The results indicate that copper, lead, and zinc concentration profiles will be able to delimit and reveal more precise details regarding shots made with nontoxic ammunition (NTA). In particular, the residual graphic analysis indicated that the majority of metal deposited in the shooter's hand is zinc. Further, the metals barium and lead also were detected. Due to the exposure to these elements, it could be concluded that engineering controls and administrative management should be sought in order to avoid human overexposure and environmental release of these airborne toxic metals.

What can be expected to be seen in a Neurology ward? Eleven-year experience in a Brazilian university hospital.

BACKGROUND: Neurological disorders are significant causes of morbidity and mortality worldwide. However, data about general neurological inpatient admissions in Brazil is limited. Objective: To investigate the prevalence of neurological disorders according to disease group and lesion site among patients admitted to a general Neurology ward. METHODS: This was an observational and descriptive study. The hospital discharge database for the Neurology ward was surveyed in accordance with the International Classification of Diseases, 10th edition (ICD-10), from September 2008 to October 2019. The final diagnosis was classified into neurological disorder groups and site. RESULTS: Overall, 2,606 clinical neurological patient files were included, with mean length of hospitalization of 16.7 days and a total of 325 readmissions (12.5%). The overall mortality rate in the ward was 3.8% (100 patients). Among all the diagnoses, cerebrovascular disease was the most prevalent (45.8%), followed by inflammatory disorders (22.2%). The brain was the most common lesion site (66.0%), followed by peripheral nerves (10.0%) and meninges and cerebrospinal fluid (7.7%). CONCLUSIONS: The disease pattern upon admission showed that a majority of the cases consisted of cerebrovascular disorders and that the brain was the most frequently affected structure, although we observed that a wide variety of cases were admitted, encompassing all neurological disorders.

What can be expected to be seen in a Neurology ward? Eleven-year experience in a Brazilian university hospital / O que se espera encontrar em uma enfermaria de Neurologia? A experiência de 11 anos em um hospital universitário brasileiro

ABSTRACT Background: Neurological disorders are significant causes of morbidity and mortality worldwide. However, data about general neurological inpatient admissions in Brazil is limited. Objective: To investigate the prevalence of neurological disorders according to disease group and lesion site among patients admitted to a general Neurology ward. Methods: This was an observational and descriptive study. The hospital discharge database for the Neurology ward was surveyed in accordance with the International Classification of Diseases, 10th edition (ICD-10), from September 2008 to October 2019. The final diagnosis was classified into neurological disorder groups and site. Results: Overall, 2,606 clinical neurological patient files were included, with mean length of hospitalization of 16.7 days and a total of 325 readmissions (12.5%). The overall mortality rate in the ward was 3.8% (100 patients). Among all the diagnoses, cerebrovascular disease was the most prevalent (45.8%), followed by inflammatory disorders (22.2%). The brain was the most common lesion site (66.0%), followed by peripheral nerves (10.0%) and meninges and cerebrospinal fluid (7.7%). Conclusions: The disease pattern upon admission showed that a majority of the cases consisted of cerebrovascular disorders and that the brain was the most frequently affected structure, although we observed that a wide variety of cases were admitted, encompassing all neurological disorders.

RESUMO Introdução: As doenças neurológicas representam importante causa de morbidade e mortalidade globalmente, mas informações acerca de internações hospitalares em neurologia no Brasil são limitadas. Objetivo: Investigar a prevalência de admissões neurológicas por grupo de doenças e pela topografia atendidas em uma enfermaria de neurologia geral. Métodos: Estudo observacional e descritivo. Avaliados diagnósticos de saída de acordo com o Código Internacional de Doenças-10 (CID-10) no período de setembro de 2008 a outubro de 2019. Os diagnósticos foram classificados em grupos de doença e por topografia. Resultados: Foram incluídos 2,606 pacientes, com tempo médio de internação de 16,7 dias e um total de 325 (12,5%) readmissões. A mortalidade geral na enfermaria foi de 100 (3,8%) pacientes. A doença cerebrovascular foi mais prevalente (45,8%), seguida das doenças inflamatórias (22,2%). A topografia encefálica foi a mais comum (66,0%), seguida de nervos periféricos (10,0%), meninges e líquido cefalorraquidiano (7,7%). Conclusões: O perfil de doenças observado neste estudo demonstrou maior prevalência das doenças cerebrovasculares e da topografia encefálica, embora uma grande variedade de doenças tenha sido admitida dentro do espectro de doenças neurológicas.

Transesophageal echocardiography discloses unexpected cardiac sources of embolus in stroke patients aged more than 45 years

Embolia cerebral de fonte cardíaca é frequentemente relacionada a acidente vascular cerebral (AVC) em jovem.OBJETIVO: Descrever achados ecocardiográficos em jovens e não jovens com AVC isquêmico, sem suspeita de fonte cardíaca.MÉTODO: Estudo transversal; 523 pacientes (267 homens e 256 mulheres) com AVC isquêmico sem evidência de fonte cardíaca submeteram-se ao ecocardiograma transesofágico (ECOTE). RESULTADOS: 10% dos pacientes tinha 45 anos; ou menos. Hipertrofia do ventrículo esquerdo, aumento do átrio esquerdo, contraste espontâneo na aorta, aneurisma do septo interatrial, calcificação da válvula mitral e aórtica, insuficiência aórtica e placas de ateroma na aorta foram significantemente mais frequentes nos pacientes com mais que 45 anos; 2.8% dos não-jovens apresentaram trombo nas câmaras esquerdas.CONCLUSÃO: ECOTE é amplamente sugerido na investigação de embolia em pacientes jovens, porém parece ser tão importante também no grupo de pacientes mais velhos, nos quais o risco de embolia cerebral é subestimado; etiologia cardioembólica e aterosclerótica coexistem, e ambas devem ser identificadas e tratadas para melhor prognóstico.

Transesophageal echocardiography discloses unexpected cardiac sources of embolus in stroke patients aged more than 45 years.

UNLABELLED: Cerebral embolism from cardiac source is an important cause of stroke, specially in patients younger than 45 years old. OBJECTIVE: To describe the transesophageal echocardiography (TEE) findings in young and non-young stroke patients without any prior evidence of cardiac source for cerebral embolism. METHOD: Transversal study: 523 patients (267 men and 256 women) with ischemic stroke, without any evidence of cardiac abnormality, underwent to TEE. RESULTS: Ten percent were aged 45 years; or less. Left ventricle hypertrophy, left atrial enlargement, spontaneous contrast in aorta, interatrial septum aneurysm, mitral and aortic valve calcification, aortic valve regurgitation, and atherosclerotic plaques in aorta were significantly more frequent in patients aged more than 45 years; 2.8% of non-young patients had thrombus in left heart. CONCLUSION: TEE is widely used to diagnose cardiac source of cerebral embolism in young patients, but it seems to be as useful for older ones, in whom cerebral embolism risk is underestimated; atherogenic and cardioembolic causes may actually coexist, and both should be treated.

Quality of life of patients with obstructive sleep apnea syndrome treated with an intraoral mandibular repositioner.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is a very important and prevalent disease, which is associated with a poor quality of life in many patients. Treatments for OSAS include surgery, Continuous Positive Air way Pressure, and an intraoral mandibular repositioner (IOMR), but the tendency of sleep centers is to emphasize the apnea index, neglecting quality of life as treatment outcome. OBJECTIVE: To verify to what extent treatment with an IOMR improves the OSAS patient's quality of life. METHOD: Eleven male patients aged 34 to 63 years (mean=49) with mild to moderate OSAS were evaluated using the Calgary SAQLI questionnaire applied before and four weeks after treatment with an IOMR. The mandibular repositioners were manufactured individually for each patient with acrylic polymer and equipped with a retentive device to maintain the mandible in a forward position during sleep. RESULTS: Excellent improvement in the quality of life was observed in five patients (45.5%) and excellent improvement in symptoms in 10 (90.9%). CONCLUSION: The systematic use of the IOMR indicates a clear improvement in the global quality of life as well as in the symptoms of patients with OSAS.

Quality of life of patients with obstructive sleep apnea syndrome treated with an intraoral mandibular repositioner

CONTEXTO:A síndrome da apnéia obstrutiva do sono (SAOS) é importante e prevalente doença associada à má qualidade de vida em muitos pacientes. Os tratamentos disponíveis incluem cirurgias, CPAP e o aparelho reposicionador mandibular intra-oral (ARMIO). Muitos centros de distúrbios de sono valorizam apenas a redução do número de apnéias no tratamento da SAOS, dando pouca atenção à qualidade de vida como desfecho do tratamento. OBJETIVO: Graduar melhora da qualidade de vida dos pacientes com SAOS usando ARMIO. MÉTODO: O questionário Calgary SAQLI foi aplicado, antes e após, 4 semanas de tratamento com ARMIO, a 11 pacientes masculinos, entre 34 e 63 anos de idade (média de 49 anos), com SAOS leve a moderada. ARMIOs foram manufaturados com polímero acrílico e providos com retentivos para manter a mandíbula em posição anterior durante o sono. RESULTADOS: Observamos grande melhora na qualidade de vida em 5 pacientes (45,5%) e melhora dos sintomas em 10 (90,9%). CONCLUSÃO: O uso do ARMIO associa-se principalmente à melhora dos sintomas, como também à melhora da qualidade de vida global.

The diagnosis of delirium in 80 emergency unit patients

We evaluated the initial and final diagnosis of 80 patients with delirium arriving at the emergence unit of a university hospital in a large Brazilian city over a period of 30 months up to December 1991. The diagnosis was based on the DSM-IIIR criteria. Patients with a known history of head trauma or epileptic seizure and patients younger than 13 years were excluded. Only patients with a disease of up to 7 days were included. The patients were subdivided into four etiologic groups: vascular, associated with the use of alcohol; infectious-parasitic; miscellaneous. The results showed a rate of correct diagnosis ranging from 65 to 80 percent with the use of kappa test (standard good to excelent). Sensitivity, specificity, positive predictive and negative predictive values had results showing different conditions for intial diagnosis in each group. This study can help the initial diagnosis of delirium and the choice for diagnostic testing.

Hemorragia subaracnóidea com tomografia de crânio sem sinais de sangramento / Subarachnoidal hemorrhage with cranial tomography without bleeding signals

Foram observados 23 casos de pacientes com suspeita clínica de hemorragia subaracnoídea (HSA), com tomografia de crânio (CT) sem sinais de sangramento, com diagnóstico definitivo realizado por exame de líquido cefalorraquidiano (LCR). Desses, 20 casos foram submetidos a angiografia cerebral. Estabeleceu-se a classificaçäo clínica de Hunt & Hess. Os principais achados neste estudo foram: 1) um terço dos pacientes apresentou intervalo de tempo entre o ictus e a realizaçäo da CT e do LCR entre 24 e 48 horas, período de maior sensibilidade da CT; 2) dos pacientes estudados com angiografia cerebral, 55 por cento tiveram o diagnóstico de aneurisma com predomínio no território de carótida e cerebral anterior; 3) o grau clínico dominante foi Hunt & Hess I e II. Todos os achados encontrados demonstraram a necessidade da realizaçäo de LCR em suspeita de HSA sem sinais de sangramento na CT.