Open Fracture of the Femoral Neck in an Adult: Case Report and Surgical Solution.

Intracapsular proximal femoral fracture is a frequent injury in elderly patients, often associated with low-energy trauma and reduced bone mass. In young patient, it is uncommon, usually caused by high-energy trauma and accompanied by damage to the adjacent soft tissues. However, reports of open intracapsular proximal femoral fracture due to indirect trauma are rare in the orthopedic literature. In the present article, we describe a case of this injury in a 35-year-old man involved in a car accident. The proximal femur was exposed at the gluteal region due to a mechanism similar to dislocation of the posterior hip. We describe the initial treatment and subsequent management until achieving a definitive solution using total hip arthroplasty and muscle transfer to reconstruct the abductor mechanism of the hip. At 10 months of follow-up, the patient presented good functional outcome, with gradual recovery of the abductive strength and a Harris Hip Score of 91 points. In addition, a radiographic study showed that the cemented total prosthesis was well-positioned. This therapeutic strategy (total hip arthroplasty with muscle transfer to reconstruct the abductor musculature) was successful to treat an intracapsular proximal femoral fracture with bone exposure.

Open Fracture of the Femoral Neck in an Adult: Case Report and Surgical Solution / Fratura exposta do colo do fêmur em adulto: Relato de caso e solução cirúrgica

Abstract Intracapsular proximal femoral fracture is a frequent injury in elderly patients, often associated with low-energy trauma and reduced bone mass. In young patient, it is uncommon, usually caused by high-energy trauma and accompanied by damage to the adjacent soft tissues. However, reports of open intracapsular proximal femoral fracture due to indirect trauma are rare in the orthopedic literature. In the present article, we describe a case of this injury in a 35-year-old man involved in a car accident. The proximal femur was exposed at the gluteal region due to a mechanism similar to dislocation of the posterior hip. We describe the initial treatment and subsequent management until achieving a definitive solution using total hip arthroplasty and muscle transfer to reconstruct the abductor mechanism of the hip. At 10 months of follow-up, the patient presented good functional outcome, with gradual recovery of the abductive strength and a Harris Hip Score of 91 points. In addition, a radiographic study showed that the cemented total prosthesis was well-positioned. This therapeutic strategy (total hip arthroplasty with muscle transfer to reconstruct the abductor musculature) was successful to treat an intracapsular proximal femoral fracture with bone exposure.

Resumo A fratura intracapsular do fêmur proximal é uma lesão frequente no paciente idoso, e em geral está associada a trauma de baixa energia e redução da massa óssea. No jovem, esta lesão é pouco frequente, decorre de trauma de alta energia, e resulta em dano das partes moles adjacentes. Contudo, o relato de fratura intracapsular do fêmur proximal com exposição óssea por trauma indireto é raro na literatura ortopédica. Neste relato, esta lesão foi diagnosticada em um homem de 35 anos, vítima de acidente automobilístico. Mediante um mecanismo semelhante ao da luxação posterior do quadril, o segmento proximal do fêmur determinou exposição óssea através da região glútea. Foram descritos o tratamento inicial e os tratamentos subsequentes até a solução definitiva por artroplastia total do quadril associada a transposição muscular para reconstrução do mecanismo abdutor do quadril. Após 10 meses de seguimento, o paciente apresentava boa recuperação funcional, com retorno gradual da força abdutora, Harris Hip Score de 91 pontos, com estudo radiográfico revelando prótese total cimentada bem posicionada. A estratégia terapêutica utilizada neste paciente (artroplastia total do quadril com transferência muscular para a reconstrução da musculatura abdutora) foi uma solução eficiente para tratar a fratura intracapsular do fêmur proximal com exposição óssea.

Parents' satisfaction with information received on psychotropic drugs used by adolescents in a Mental Health Unit.

OBJECTIVE: To analyze the satisfaction of those responsible for adolescents with information received for the use of psychotropic drugs. METHODS: Cross-sectional study carried out in a reference outpatient clinic in Brasília between 2017 and 2019. It involved 173 legal representatives of adolescents diagnosed with Mental and Behavioral Disorders using psychotropic drugs. In order to identify the level of satisfaction about the information received on psychotropic drugs, the Satisfaction with Information about Medicines Scale (SIMS) was used. RESULTS: Most guardians were dissatisfied with the information received on psychotropic drugs (n=112; 64.7%). The dissatisfaction with information about potential problems of medication was the one that stood out the most (n=127; 73.4%) when compared to information about action and usage (n=89; 51.5%). Participants considered information on the impact of medication on the adolescent's sexual life unsatisfactory or nonexistent. CONCLUSIONS: The parents' satisfaction with the information received about psychotropic drugs was low. Participants showed dissatisfaction with the information about potential problems, especially related to the impact on the sexual life of their tutored.

Parents' satisfaction with information received on psychotropic drugs used by adolescents in a Mental Health Unit / Satisfação dos responsáveis por adolescentes com as informações recebidas para o uso dos psicotrópicos em Unidade de Saúde Mental

Abstract Objective: To analyze the satisfaction of those responsible for adolescents with information received for the use of psychotropic drugs. Methods: Cross-sectional study carried out in a reference outpatient clinic in Brasília between 2017 and 2019. It involved 173 legal representatives of adolescents diagnosed with Mental and Behavioral Disorders using psychotropic drugs. In order to identify the level of satisfaction about the information received on psychotropic drugs, the Satisfaction with Information about Medicines Scale (SIMS) was used. Results: Most guardians were dissatisfied with the information received on psychotropic drugs (n=112; 64.7%). The dissatisfaction with information about potential problems of medication was the one that stood out the most (n=127; 73.4%) when compared to information about action and usage (n=89; 51.5%). Participants considered information on the impact of medication on the adolescent's sexual life unsatisfactory or nonexistent. Conclusions: The parents' satisfaction with the information received about psychotropic drugs was low. Participants showed dissatisfaction with the information about potential problems, especially related to the impact on the sexual life of their tutored.

Resumo Objetivo: Analisar a satisfação dos responsáveis por adolescentes com as informações recebidas para o uso dos medicamentos psicofármacos. Métodos: Estudo transversal realizado em ambulatório de referência entre 2017 e 2019, em Brasília, com 173 responsáveis por adolescentes diagnosticados com transtornos mentais e comportamentais em uso de psicofármacos. O questionário Satisfaction with Information about Medicines Scale (SIMS) foi utilizado para identificar o grau de satisfação em relação às informações recebidas sobre os medicamentos. Resultados: A maioria dos responsáveis estava insatisfeita quanto às informações recebidas sobre psicofármacos (n=112; 64,7%). Destacou-se a insatisfação com as informações sobre potenciais problemas do medicamento (n=127; 73,4%), quando comparada à ação e ao uso (n=89; 51,5%). As informações sobre o impacto do medicamento na vida sexual do adolescente foram consideradas insatisfatórias ou inexistentes. Conclusões: A satisfação dos responsáveis com as informações recebidas sobre psicofármacos foi baixa. Os participantes demonstraram insatisfação com as informações sobre potenciais problemas, especialmente às relacionadas ao impacto na vida sexual dos adolescentes.

Coronavírus no Brasil: a marcha da insensatez / Coronavirus in Brazil: the march of folly

Resumo A circulação do novo coronavírus é um acontecimento sanitário nas dimensões do fenômeno dantesco que se constituiu a Gripe Espanhola, porém, agravado pela globalização. A escolha deste objeto de estudo se impôs em função da preocupação mundial com a covid-19, e pela percepção de que há indagações persistentes e insuficiência de análises que explicitem a intrínseca relação entre o processo saúde-doença e as dimensões políticas, econômicas e sociais a ele associados. A tese defendida é de que o enfrentamento insensato e descoordenado da epidemia no Brasil traria reflexos no número de casos e óbitos. Trata-se de estudo exploratório, apoiado no referencial teórico da hermenêutica crítica, desenvolvido com base na análise de documentos e dados, que tem como objetivo analisar o perfil epidemiológico da covid-19 e, a partir desta análise, discutir as políticas econômicas, sociais e sanitárias adotadas no Brasil diante do quadro pandêmico. Conclui-se que a insensatez política, econômica, social e sanitária na aplicação de políticas públicas, bem como a descoordenação do governo federal do Brasil no enfrentamento da pandemia da covid-19 trouxe como reflexo o aumento exponencial do número de casos e de óbitos pela doença, principalmente em populações mais pobres e vulneráveis.

Abstract The circulation of the new coronavirus is a health event in the dimensions of the Dantesque phenomenon that constituted the Spanish Flu, but aggravated by the fact that we live in an interconnected world. The choice of this object of study was imposed due to the worldwide concern with the covid-19, and the perception that there are persistent questions and insufficient analyses that explain the intrinsic relationship between the health-disease process and the political, economic and social dimensions associated with it. We defend that the foolish and uncoordinated confrontation of the epidemic in Brazil would have affected the number of cases and deaths. This is an exploratory study, supported by the theoretical framework of critical hermeneutics, developed based on the analysis of documents and data, which aims at analyzing the epidemiological profile of Covid-19 and to discuss economic, social policies and sanitary measures adopted in Brazil in the face of the pandemic situation. We concluded that the political, economic, social and sanitary folly in the application of public policies combined with the lack of coordination of the federal government of Brazil in confronting the covid-19 pandemic reflected in the exponential increase in the number of cases and deaths, especially among the poorest and most vulnerable populations.

Lack of Corpses for Teaching and Research / A Falta de Cadáveres para Ensino e Pesquisa

ABSTRACT The aim of this study is to address the importance of providing unclaimed corpses and cadavers donated for use in studies, focusing on the training of health professionals, the improvement of professionals already trained in this area and the advance of research, mainly in surgical techniques, in the scope of educational and research institutions, both public and private. It seems unanimous, among the authors who deal with the matter, the view that the use of corpses is irreplaceable in technical training and professional development. There is, however, a lack of the material in question, which in turn is due to a series of difficulties raised here, such as the lack of regulation centers that manage the flow of capture and distribution of cadavers and the decrease in the number of unclaimed corpses. The following problem is thus defined: on the one hand, there is a clear need to obtain human remains for basic education in the health area - fundamentally in the disciplines of Anatomy - for the improvement of professionals in this area and for research - such as the disciplines of surgical techniques -; on the other hand, the lack of cadaveric material is evident, a fact that, by consequence, has been compromising the final quality of health services, especially those of surgical nature. A bibliographic survey was carried out aiming to know the state of the art on the current legislation and on the Bills currently submitted to the National Congress. It was found that, despite the existence of legislation concerning this matter, it is necessary to have legislative-normative improvement to encompass the several demands, including those of the emerging technologies. The legislative process is very slow, taking into account the need indicated here, considering the significant increase in the number of courses in the health area. It is necessary, therefore, that urgent measures be taken to supply the needs in the area, which must necessarily take place through legal and regulatory norms.

RESUMO O estudo tem como objetivo abordar a importância da disponibilização de cadáveres não reclamados e de cadáveres doados para utilização em estudos, com foco na formação de profissionais da área da saúde, no aperfeiçoamento de profissionais já formados nessa área e no avanço de pesquisas sobretudo em técnicas cirúrgicas, no âmbito de instituições de ensino e pesquisa, tanto públicas como privadas. Parece unânime, entre os autores que versam sobre a matéria, a opinião de que a utilização de cadáveres é insubstituível na formação técnica e no aperfeiçoamento do profissional. Verifica-se, entretanto, a falta do material em questão, o que, por sua vez, se deve a uma série de dificuldades aqui levantadas, como a falta de centrais de regulação que administrem o fluxo de captação e distribuição de cadáveres e a diminuição do número de cadáveres não reclamados. Configura-se, assim, o seguinte problema: por um lado, tem-se a clara necessidade de obtenção de restos mortais humanos para o ensino básico na área da saúde - em se tratando fundamentalmente das disciplinas de Anatomia -, para o aperfeiçoamento de profissionais dessa área e para pesquisa - a exemplo das disciplinas de técnicas cirúrgicas -; por outro lado, é flagrante a carência de material cadavérico, fato que, por via de consequência, vem comprometendo a qualidade final dos serviços de saúde, em especial os de caráter cirúrgico. Realizou-se aqui levantamento bibliográfico visando conhecer o estado da arte sobre a legislação vigente e os projetos de lei em tramitação no Congresso Nacional. Verificou-se que, apesar da existência de legislação concernente à matéria, é necessário haver aperfeiçoamento legislativo-normativo para contemplar as diversas demandas, incluídas as tecnologias que vêm surgindo. O processo legislativo é muito lento em face da necessidade aqui apontada, considerado o expressivo aumento do número de cursos na área da saúde. É mister, pois, que sejam tomadas medidas urgentes para suprir o passivo na área, o que deve realizar-se necessariamente por meio de regulamentação legal e normativa.

Perfil epidemiológico de pacientes com nódulos pulmonares em acompanhamento ambulatorial no período de 2013 a 2015 / Epidemiological profile of patients with pulmonary nodules in clinic follow-up in the period from 2013 to 2015

Este artigo teve como objetivo conhecer o perfil epidemiológico dos pacientes com nódulos pulmonares descobertos de forma acidental e seu desfecho durante o acompanhamento no ambulatório de pneumologia de Criciúma/SC entre os anos de 2013 a 2015. Realizou-se um estudo observacional, longitudinal, retrospectivo, de abordagem quantitativa, com coleta de dados de 250 prontuários de pacientes com diagnóstico de nódulo pulmonar ao acaso. As características clínicas estudadas foram: gênero, idade, tabagismo, carga tabágica e o exame de diagnóstico. As características radiográficas avaliadas em relação ao nódulo foram: presença de margens espiculadas, tamanho nodular, localização anatômica e, posteriormente, os nódulos foram classificados em: provavelmente benigno, maligno ou indeterminado. Como resultado, percebeu-se que 58,8%dos casos de nódulo pulmonar foram observados em mulheres, sendo a faixa etária mais comum, independente de gênero, entre 51-70 anos. Em 60,6% dos pacientes, o raio-X de tórax foi o exame que detectou esses nódulos. Observou-se, também, que 60,8% dos nódulos foram classificados como provavelmente benigno e 44,8% dos nódulos localizaram-se em lobos superiores. Houve associação significativa entre malignidade do nódulo e tamanho do mesmo (p = 0,001).Portanto, conclui-se que a prevalência dos nódulos incidentais foi maior na faixa etária de 51-70 anos, sendo que as mulheres alcançaram porcentagem 17,6% superior ao sexo masculino. Verificou-se predomínio da distribuição dos nódulos em lobos superiores e da categorização dos nódulos como provavelmente benignos. Além disso, significância estatística foi constatada em relação aos maiores tamanhos nodulares e provável desfecho maligno (p = 0,001).

This article had as objective to know the epidemiological profile of patients with accidentally discovered pulmonary nodules and their outcome during the follow-up in the Criciúma/SC pneumology clinic between 2013 and 2015. An observational, longitudinal, retrospective study, with quantitative approach was performed with data collection of 250 medical records of patients with diagnosis of incidental pulmonary nodules. The clinical characteristics studied were: gender, age, smoking, smoking load and diagnostic examination. The radiographic characteristics evaluated in relation to the nodule were: presence of spiculated margins, nodular size, anatomical location and, later, the nodules were classified in: probably benign, malignant or undetermined. As a result, it was observed that 58,8% of the cases of pulmonary nodule were observed in women, being the most common age group, independent of gender, between 51-70 years. In 60,6% of the patients, the chest xray was the test that detected theses nodules. It was also observed that 60,8% of the nodules were classified as probably benign and 44,8% of the nodules were located in upper lobes. There was a significant association between nodule malignancy and size of the nodule (p = 0.001). Therefore, it is concluded that the prevalence of incidental nodules was higher in the age group of 51-70 years, and women reached percentage 17.6% higher than male sex. There was a predominance of nodal distribution in upper lobes and the categorization of nodules as probably benign. Furthermore, statistical significance was observed in relation to the larger nodular sizes and probable malignant outcome (p = 0.001).

Impact of an ABCDE team triage process combined with public guidance on the division of work in an emergency department.

OBJECTIVE: To study the effects of applying an emergency department (ED) triage system, combined with extensive publicity in local media about the "right" use of emergency services, on the division of work between ED nurses and general practitioners (GPs). DESIGN: An observational and quasi-experimental study based on before-after comparisons. SETTING: Implementation of the ABCDE triage system in a Finnish combined ED where secondary care is adjacent, and in a traditional primary care ED where secondary care is located elsewhere. SUBJECTS: GPs and nurses from two different primary care EDs. MAIN OUTCOME MEASURES: Numbers of monthly visits to different professional groups before and after intervention in the studied primary care EDs and numbers of monthly visits to doctors in the local secondary care ED. RESULTS: The beginning of the triage process increased temporarily the number of independent consultations and patient record entries by ED nurses in both types of studied primary care EDs and reduced the number of patient visits to a doctor compared with previous years but had no effect on doctor visits in the adjacent secondary care ED. No further decrease in the number of nurse or GP visits was observed by inhibiting the entrance of non-urgent patients. CONCLUSION: The ABCDE triage system combined with public guidance may reduce non-urgent patient visits to doctors in different kinds of primary care EDs without increasing visits in the secondary care ED. However, the additional work to implement the ABCDE system is mainly directed to nurses, which may pose a challenge for staffing.

Impact of the ABCDE triage in primary care emergency department on the number of patient visits to different parts of the health care system in Espoo City.

BACKGROUND: Many Finnish emergency departments (ED) serve both primary and secondary health care patients and are therefore referred to as combined emergency departments. Primary care doctors are responsible for the initial assessment and treatment. They, thereby, also regulate referral and access to secondary care. Primary health care EDs are easy for the public to access, leading to non-acute patient visits to the emergency department. This has caused increased queues and unnecessary difficulties in providing immediate treatment for urgent patients. The primary aim of this study was to assess whether the flow of patients was changed by implementing the ABCDE-triage system in the EDs of Espoo City, Finland. METHODS: The numbers of monthly visits to doctors were recorded before and after intervention in Espoo primary care EDs. To study if the implementation of the triage system redirects patients to other health services, the numbers of monthly visits to doctors were also scored in the private health care, the public sector health services of Espoo primary care during office hours and local secondary health care ED (Jorvi hospital). A face-to-face triage system was applied in the primary care EDs as an attempt to provide immediate treatment for the most acute patients. It is based on the letters A (patient sent directly to secondary care), B (to be examined within 10 min), C (to be examined within 1 h), D (to be examined within 2 h) and E (no need for immediate treatment) for assessing the urgency of patients' treatment needs. The first step was an initial patient assessment by a health care professional (triage nurse). The introduction of this triage system was combined with information to the public on the "correct" use of emergency services. RESULTS: After implementation of the ABCDE-triage system the number of patient visits to a primary care doctor decreased by up to 24% (962 visits/month) as compared to the three previous years in the EDs. The Number of visits to public sector GPs during office hours did not alter. Implementation of ABCDE-triage combined with public guidance was associated with decreased total number of doctor visits in public health care. During same period, the number of patient visits in the private health care increased. Simultaneously, the number of doctor visits in secondary health care ED did not alter. CONCLUSIONS: The present ABCDE-triage system combined with public guidance may reduce patient visits to primary health care EDs but not to the secondary health care EDs. Limiting the access of less urgent patients to ED may redirect the demands of patients to private sector rather than office hours GP services.