The burden of low back pain, rheumatoid arthritis, osteoarthritis, and gout and their respective attributable risk factors in Brazil: results of the GBD 2017 study.

INTRODUCTION: Musculoskeletal (MSK) disorders are a major cause of disability worldwide. Different modifiable risk factors are associated to these disorders. The objective of this study was to analyze the burden of low back pain (LBP), rheumatoid arthritis (RA), osteoarthritis (OA), and gout, attributable to risk factors, in 2017. METHODS: The burden of LBP, RA, OA, and gout, and attributable risk factors were analyzed using data extracted from the Global Burden of Disease (GBD) Brasil-2017 study. Descriptive analysis was conducted to compare disability-adjusted life years (DALY) rates between sexes and age groups (15-49 and 50-69 years), in 2017. RESULTS: The highest rates of DALY due to LBP were attributed to occupational ergonomic factors in the 15-49-year group, regardless of sex and males aged 50-69 years, whereas smoking was the major contributor in the 50-69-year female group. RA-related DALY rates were attributed to smoking and were higher among women aged 50-69 years. High body mass index (BMI) was the most relevant risk factor for the burden of OA, with higher rates detected in the 50-69-year group, and it was the most significant risk factor for DALY rate attributed to gout, regardless of sex or age group. CONCLUSIONS: Occupational surveillance measures are indicated to prevent LBP. Actions to decrease smoking and overweight, and the surveillance of weight gain are warranted to decrease the burden of LBP, RA and OA, and gout, respectively. These actions will be more effective if age and sex differentials are considered in planning.

The burden of low back pain, rheumatoid arthritis, osteoarthritis, and gout and their respective attributable risk factors in Brazil: results of the GBD 2017 study

Abstract INTRODUCTION: Musculoskeletal (MSK) disorders are a major cause of disability worldwide. Different modifiable risk factors are associated to these disorders. The objective of this study was to analyze the burden of low back pain (LBP), rheumatoid arthritis (RA), osteoarthritis (OA), and gout, attributable to risk factors, in 2017. METHODS: The burden of LBP, RA, OA, and gout, and attributable risk factors were analyzed using data extracted from the Global Burden of Disease (GBD) Brasil-2017 study. Descriptive analysis was conducted to compare disability-adjusted life years (DALY) rates between sexes and age groups (15-49 and 50-69 years), in 2017. RESULTS: The highest rates of DALY due to LBP were attributed to occupational ergonomic factors in the 15-49-year group, regardless of sex and males aged 50-69 years, whereas smoking was the major contributor in the 50-69-year female group. RA-related DALY rates were attributed to smoking and were higher among women aged 50-69 years. High body mass index (BMI) was the most relevant risk factor for the burden of OA, with higher rates detected in the 50-69-year group, and it was the most significant risk factor for DALY rate attributed to gout, regardless of sex or age group. CONCLUSIONS: Occupational surveillance measures are indicated to prevent LBP. Actions to decrease smoking and overweight, and the surveillance of weight gain are warranted to decrease the burden of LBP, RA and OA, and gout, respectively. These actions will be more effective if age and sex differentials are considered in planning.

Carga de distúrbios musculoesqueléticos e fatores de risco: estudo GBD Brasil / Burden of musculoskeletal disorders and risk factors: GBD Brazil study

Os distúrbios musculoesqueléticos (DME) são considerados um problema de saúde pública em razão dos anos vividos com incapacidade e da cronicidade. Essas doenças provocam morte prematura, incapacidade e sofrimento para os cidadãos com repercussões negativas sobre o desenvolvimento social e econômico dos países. DME estão entre as principais causas de anos de vida perdidos ajustados por incapacidade ou morte (DALY) em diversos países. O objetivo do estudo foi analisar os anos de vida perdidos por morte prematura e incapacidade por DME, atribuíveis a fatores de risco observados no Estudo Global Burden of Disease (GBD), e comparar a posição dos riscos ocupacionais no ranqueamento dos riscos, em 1990 e 2017 para o Brasil. Trata-se de um estudo descritivo que utilizou dados do GBD Brasil 2017 para análise da carga de DME e subgrupos e os fatores de risco atribuíveis. Realizou-se a análise descritiva, comparando-se as taxas de DALY por sexo e faixa etária (15 a 49 anos e 50 a 69 anos) para os anos de 1990 e 2017. Foi comparada a posição dos riscos ocupacionais no ranqueamento dos fatores de risco. Em 2017, a maior contribuição para a carga de DALY por DME no Brasil foi a lombalgia seguido por "outros" DME e cervicalgia, em ambos os sexos e faixas etárias. Em 1990 e 2017, em ambos os sexos. Na faixa etária de15 a 49 anos, a maior taxa de DALY por DME e lombalgia foi atribuída aos fatores ergonômicos; na faixa etária de 50 a 69 anos destacou-se o tabagismo, com exceção de 2017 para o grupo dos homens. A taxa de DALY por artrite reumatoide foi atribuída ao tabagismo, sendo maior entre mulheres da faixa etária de 50 a 69 anos. O Índice de Massa Corporal elevado (IMC) foi o fator de risco mais relevante na carga de osteoartrite, sendo as maiores taxas na faixa etária de 50 a 69 anos. Independentemente do sexo e faixa etária, IMC elevado foi o fator de risco que mais contribuiu para a taxa de DALY por gota. Os resultados indicam a necessidade de políticas entre os setores de saúde e trabalho para nortear modificações nos sistemas e processos laborais, além da inclusão de DME e fatores de risco ocupacionais nas agendas de enfrentamento de DCNT. Sugere-se avaliar a carga de DME por região do Brasil, além de continuar investigando a carga atribuível aos riscos ambientais/ocupacionais para cervicalgia, osteoartrite, artrite reumatoide e gota. Os resultados apresentados sugerem a abordagem dos diferenciais de gênero na elaboração das políticas setoriais de emprego e nas ações de prevenção de DME e seus subgrupos.

Musculoskeletal (MSK) disorders are considered a public health problem due to the years lived with disability and chronicity. These diseases cause premature death, disability and suffering for citizens with negative repercussions on countries' social and economic development. MSK disorders are among the main causes of Disability Adjusted Lost Life Years or Death (DALY) in several countries. The aim of the study was to analyze the years of life lost due to premature death and disability due to MSK disorders, attributable to risk factors observed in the Global Burden of Disease (GBD) study and compare the position of occupational risks in the ranking of risks, in 1990 and 2017 for Brazil. This is a descriptive study that used data from the GBD Brazil 2017 to analyze the burden of MSK disorders and subgroups and the attributable risk factors. A descriptive analysis was performed, comparing the DALY rates by sex and age group (15 to 49 years and 50 to 69 years) for the years 1990 and 2017. The position of occupational risks in the ranking of risk factors was compared. In 2017, the main contribution to the total burden of DALY due to MSK disorders in Brazil was low back pain followed by "others" MSK disorders and neck pain, in both sexes and age groups. In 1990 and 2017, the highest rates of DALY due to MSK disorders and low back pain were attributed to occupational ergonomic factors in the 15-49-year group, regardless of sex, whereas smoking was the major contributor in the 50-69-year group with the exception of 2017 for males. Rheumatoid arthritis-related DALY rates were attributed to smoking and were higher among women aged 50-69 years. High body mass index (BMI) was the most relevant risk factor for the burden of osteoarthritis, with higher rates detected in the 50-69-year group. High BMI was the most significant risk factor for DALY rate attributed to gout, regardless of sex or age group. Findings of this study emphasized the need for health and work sector policies to guide changes in labor systems and processes and suggest MSK disorders and occupational risk factors should be included in the agenda to address CNCD. Determination of the burden of MSK disorders per Brazilian region and continuing investigation of the burden attributable to environmental/occupational risks for neck pain, osteoarthritis, rheumatoid arthritis, and gout are warranted. Findings of this study suggested the need for different gender approaches regarding the formulation of professional policies and actions aimed to prevent MSK disorders and respective subgroups.

Análise documental da mídia escrita sobre eventos adversos ocorridos na prática da enfermagem / Documentary analysis of written media on adverse events occurring in practice nursing / Análisis documental de la media escrita sobre eventos adversos ocurridos en la práctica de enfermería

Objetivo: analisar os eventos adversos ocorridos na prática da enfermagem registradas na mídia escrita, no período de 2007 a 2012. Método: pesquisa documental, retrospectiva, de abordagem quantitativa. As fontes de dados foram os registros da imprensa escrita dos principais jornais brasileiros, de acordo com a Associação Brasileira de Jornais. Resultados: predominaram os erros relacionados à administração de medicamentos. Conclusão: os resultados deste estudo demonstraram a importância de uma discussão profunda acerca da segurança dos usuários dos serviços de saúde e as condições de formação e de trabalho dos sujeitos envolvidos.(AU)

Objective: to analyze the adverse events in nursing practice recorded in the written media, from 2007 to 2012. Method: documental retrospective research with quantitative approach. The data sources were records of the press of the main Brazilian newspapers, according to the Brazilian Association of Newspapers. Results: the mistakes related to administration of medicine were predominant. Conclusion: this study showed the importance of a deep discussion about the safety of users of health services and the conditions of training and work of those involved.(AU)

Objetivo: analizar los eventos adversos ocurridos en la práctica de enfermería registrados en la media escrita, en el período de 2007 a 2012. Método: investigación documental, retrospectiva, de enfoque cuantitativo. Las fuentes de datos fueron los registros de la empresa escrita de los principales periódicos brasileños, de acuerdo con la Asociación Brasileña de Periódicos. Resultados: predominaron los errores relacionados a la administración de medicamentos. Conclusión: los resultados de este estudio demostraron la importancia de una discusión profunda acerca de la seguridad de los usuarios de los servicios de salud y las condiciones de formación y de trabajo de los sujetos.(AU)

Intussuscepção de intestino delgado em paciente adulto por Gist: relato de caso e revisão da literatura / Small intestine intussusception in adult due to GIST: a case report

A intussuscepção do intestino delgado em adultos é rara e geralmente está associada à presença de neoplasias. Dentre estas, o GIST, a neoplasia mesenquimal em 30 por cento dos casos é considerada de alto grau de malignidade , são ainda menos comuns. A intussuscepção relacionada ao GIST tem sintomatologia inespecífica e pode manifestar-se com obstrução, massa palpável no abdômen, hemorragia ou perfuração intestinal. Relata-se caso de intussuscepção intestinal em paciente adulto por GIST, com ênfase em seu diagnóstico e tratamento.

Small intestinal intussusception in adults is rare and generally associated with neoplasms. Within them GIST, a mesenchymal neoplasm in which 30 percent of patients have high grade malignancy, are even less common. Intussusception and GIST may have unspecific symptoms and it almost always presents with obstruction, palpable abdominal mass, hemorrhage and bowel perforation. A case of intestinal intussusception in adult due to GIST is reported, emphasizing diagnose and treatment.

Ressecção alargada para o adenocarcinoma colorretal localmente invasivo: relato de caso e revisão da literatura / Enlarged resection for locally advanced colorectal adenocarcinoma: case report and literature review

O câncer colorretal localmente invasivo, que acomete por contiguidade estruturas adjacentes e sem metástases à distância, ocorre de 5 a 18% dos casos. São adequadamente tratados com ressecção do tumor e órgãos comprometidos em monobloco e margens livres. É relatado o caso de paciente de 27 anos, masculino, portador de adenocarcinoma de retossigmóide com extensa invasão para bexiga e ceco. Tratado com colectomia total, cistectomia radical em monobloco e ileostomia. O trânsito urinário foi reconstituído com reservatório ileal e anastomose com a uretra prostática. O estudo anátomo-patológico da peça cirúrgica revelou adenocarcinoma moderadamente diferenciado, invasão perineural e invasão da parede da bexiga (T4, N0). Realizou no pós-operatório quimioterapia adjuvante, 6 ciclos, com 5-Fluorouracil e ácido folínico. Após 36 meses de seguimento, o paciente encontra-se livre de doença neoplásica, função urinária preservada, porém com ejaculação retrógrada.

The locally advanced colorectal cancer compromises adjacent structures and do not disseminate distant metastasis, occur in 5 to 18% of patients. It is properly treated with tumour resection as well as other compromised organs in an "en bloc" resection with free margins. We report a 27 year old, male patient with colorectal adenocarcinoma invading the urinary bladder and cecum. He was treated with total colectomy associated with radical cistectomy and ileostomy. The urinary transit was established building an ileal reservatory anastomosed to the urethra. The tumour histopathologic study showed adenocarcinoma moderate differentiated, invading urinary bladder (T4N0). Postoperative treatment was 5-fluorouracil and folinic acid chemotherapy. After 36 months of outcome, patient is improving and preserves urinary function but has ejaculatory dysfunction.

Hérnia perineal primária: relato de caso / Primary perineal hernia: case report

As hérnias perineais primárias resultam de um defeito no assoalho pélvico que permite a passagem de conteúdo abdominal para a região pelve-perineal. É uma enfermidade rara, tendo sido descritos menos de cem casos até hoje. Apresentamos o caso de uma paciente jovem com queixa recente de tumoração glútea dolorosa que, mesmo após o exame físico e tomográfico, não teve sua etiologia esclarecida. Foi então submetida à ressecção cirúrgica da lesão via perineal, quando se confirmou tratar-se de saco herniário isquiorretal esquerdo transpondo defeito no músculo elevador do ânus. Evoluiu sem intercorrências no pósoperatório e sem indícios de recidiva.

Primary perineal hernias result from a defect in the pelvic floor. It is a rare disease, having been described less than one hundred cases until today. We present a case of a young patient with recent complaint of painful gluteal tumor that even after the physical examination and CT did not clarified its etiology. She was submitted to a perineal resection of the lesion that confirmed being a hernia. She is going well without recurrence.