Diagnóstico diferencial e opções de tratamento da úlcera aftosa recorrente: revisão narrativa da literatura / Differential diagnosis and treatment options of recurrent aphrhous ulcer: narrative literature review

Resumo: A úlcera aftosa recorrente (UAR) é uma lesão frequente na mucosa oral de etiologia variada e subdividindo-se clinicamente úlceras menores, maiores e hepertiformes. Caracterizada por formato ovoide, recoberto por uma pseudomembrana e um halo eritematoso, seu diagnóstico é essencial para distinguir outras lesões e o tratamento se faz necessário para tratar a lesão e prevenir recorrências. Desta maneira, o presente estudo teve como objetivo descrever de forma analítica sobre o diagnóstico diferencial e o tratamento da UAR em cavidade oral. Tratou-se de um estudo descritivo, exploratório caracterizado como revisão narrativa da literatura. Os critérios de inclusão estabelecidos foram: estudos que abordassem essa temática, com idiomas inglês e português. O levantamento ocorreu em agosto/2023 a janeiro/2024, através das buscas eletrônicas PubMed, LILACS, SciELO, além da literatura cinzenta Google acadêmico e busca livre secundária. Os Descritores em Ciências da Saúde (DeCS/MeSH) foram cruzados com o operador booleano: "differential diagnosis" AND "aphthous ulcer". A UAR é caracterizada por úlceras arredondadas superficiais que pode persistir por dias ou meses. O seu diagnóstico é fundamentado no histórico do paciente e nas características da lesão. É crucial eliminar possíveis causas de úlceras orais, para evitar confusão com outras lesões, como úlceras traumáticas, imunomedia das ou até mesmo um carcinoma. Diversas terapias são empregadas no manejo da UAR, tais como corticosteroides, suplementos vitamínicos, ozonioterapia e o laser de baixa potência. Portanto, compreender o histórico das lesões é fundamental para diferenciação e diante da diversidade de terapias, é essencial ter estudos que dê esse enfoque.

Abstract: Recurrent Aphthous Ulcer (RAU) is a common lesion in the oral mucosa with varied etiology, clinically subdivided into minor, major, and herpetiform ulcers. Characterized by an ovoid shape, covered by a pseudomembrane and erythematous halo, its diagnosis is essential to distinguish it from other lesions, and treatment is necessary to address the injury and prevent recurrences. Thus, the present study aimed to analytically describe the differential diagnosis and treatment of RAU in the oral cavity. It was a descriptive, exploratory study characterized as a narrative literature review. Inclusion criteria were established as studies addressing this theme in English and Portuguese. The survey took place from August 2023 to January 2024, through electronic searches on PubMed, LILACS, SciELO, in addition to grey literature such as Google Scholar and secondary free searches. Health Sciences Descriptors (DeCS/MeSH) were crossed with the boolean operator: "differential diagnosis" AND "aphthous ulcer." RAU is characterized by round, superficial ulcers that may persist for days or months. Its diagnosis is based on the patient's history and the characteristics of the lesion. It is crucial to eliminate possible causes of oral ulcers to avoid confusion with other lesions, such as traumatic, immunomediated, or even carcinoma ulcers. Various therapies are employed in the management of RAU, such as corticosteroids, vitamin supplements, ozone therapy, and low-level laser. Therefore, understanding the history of lesions is fundamental for differentiation, and given the diversity of therapies, studies focusing on this aspect are essential.

Uso de fitoterápicos no controle das alterações bucais pós-tratamento oncológico: novas alternativas na odontologia / Use of herbal medicines to control oral changes post-oncological treatment: new alternatives in dentistry

O tratamento oncológico pode ocasionar diversas alterações orais durante e após o processo que podem acarretar déficit de mastigação, fonação, deglutição, além de dor e nutrição deficiente. Nesse contexto, ainda existe uma busca na comprovação do uso de fitoterápicos na oncologia com presença de lesões na cavidade oral ocasionadas pela oncoterapia, para tratamento destas. Assim, o trabalho em questão se trata de uma revisão de literatura, com objetivo de relatar, a partir da análise de periódicos, a observação de efeitos favoráveis para o tratamento das lesões orais por consequência da quimioterapia e radioterapia, através do uso dos fitoterápicos: Camomila (Matricaria chamomilla), Romã (Punica granatum) e extrato de Própolis (Apis mellifera L.). Realizou-se busca eletrônica de dados através do Scholar Google e PubMed, utilizando os Descritores em Ciências da Saúde (Medicamentos Fitoterápicos, Neoplasias, Protocolos Antineoplásicos). Os estudos apresentados neste trabalho evidenciam que o uso destes fitoterápicos pode auxiliar no tratamento das lesões decorrentes da quimioterapia e radioterapia, por possuírem diversas ações anti-inflamatórias, antimicrobianos, antitumorais, entre outras. Por fim, os fitoterápicos apresentados podem ser considerados como uma nova alternativa sendo assim uma escolha favorável de tratamento em relação aos medicamentos convencionais (alopatia), tanto pelo fato de serem naturais e não reduzirem mais ainda a imunidade do paciente, como também pelo seu baixo custo.

The cancer treatment can cause several oral changes during and after the process that can lead to deficits in chewing, phonation, swallowing, in addition to pain and poor nutrition. In this context, there is still a search to prove the use of herbal medicines in oncology with lesions in the oral cavity caused by oncotherapy. Thus, the work in question is a literature review, with the objective of reporting, from the analysis of journals, the observation of favorable effects for the treatment of oral lesions as a result of chemotherapy and radiotherapy, through the use of herbal medicines: Chamomile (Matricaria chamomilla), Pomegranate (Punica granatum) and Propolis extract (Apis mellifera L.). Electronic data search was carried out through Scholar Google and PubMed, using the Health Sciences Descriptors (Phytotherapic Drugs, Neoplasms, Antineoplastic Protocols). The studies presented in this work show that the use of these herbal medicines can help in the treatment of injuries resulting from chemotherapy and radiotherapy, as they have several anti-inflammatory, antimicrobial and anti-tumor actions, among others. Finally, the herbal medicines presented can be considered as a new alternative, thus being a favorable treatment choice in relation to conventional medicines (allopathy), both because they are natural and do not further reduce the patient's immunity, but also because of their low cost.

Characterizing Prehospital Wall Fall Injuries at the US-Mexico Border.

This cross-sectional study examines treatment received for falls from a section of the US-Mexico border wall with a focus on emergency medical services activation and type of treatment.

Versatility in the use of cadaveric skin grafts for wound management.

BACKGROUND: Cadaveric skin grafts were initially used for the management of acute burn wounds. The biological coverage of the wound improves the quality of the wound bed, which prepares it to receive an autologous skin graft. The benefits of cadaveric skin graft in burn wounds have led to its use in the management of acute and chronic wounds of diverse etiologies. OBJECTIVE: To evaluate the use of cadaveric skin graft and subsequent autologous split-thickness skin graft (STSG) in the management of wounds of diverse etiologies at a single institution. MATERIALS AND METHODS: A retrospective analysis was performed of patients with wounds of different etiologies managed with cadaveric skin grafts followed by a second procedure in which autologous STSG was performed from May 2017 through May 2022 in the Plastic and Reconstructive Surgery Department of German Hospital, Buenos Aires, Argentina. RESULTS: A total of 25 patients with wounds of different etiologies were included. The mean affected body surface area (BSA) was 1.87%. The mean engraftment percentage of the cadaveric skin graft was 96.6%. The mean engraftment percentage of the STSG was 90.6%. All patients demonstrated improvement in local edema and inflammation, reduced secretions, and reduced pain after treatment. Two patients (8%) had complications, with 1 case of delayed healing of the donor site and 1 case of hypertrophic scarring. CONCLUSIONS: Cadaveric skin graft with subsequent STSG is a simple, safe, and effective alternative for the management of complex wounds of diverse etiologies. This technique is particularly useful in patients with multiple comorbidities who are at risk of recurrence and of developing multiple wounds during their lifetime.

Analysis of reported cases of repeated violence in Espírito Santo.

OBJECTIVES: Identify the frequency of recurrent violence in cases reported in Espírito Santo and the associated factors. METHODS: Cross-sectional study. Which included data on violence in Espírito Santo from 2011 to 2018, from the Notifiable Diseases Information System, and, Statistical analyzes were performed using the chi-square test and Poisson regression. RESULTS: 54.2% (N:14.966) of reported cases of violence are repeated, and higher prevalences were associated with female sex (PR:1.54), child (PR: 1.29) or elderly victims (PR: 1.25), the presence of disabilities/disorders (PR:1.42) and occurrence in urban/peri-urban areas (PR: 1.10). Furthermore, there is a greater frequency of injuries caused by a single aggressor (PR: 1.20), man (PR: 1.28), aged 25 or over (PR: 1.09), known to the victim (PR: 2.81) and at home (PR: 1.69). CONCLUSION: The reported cases of violence showed a high frequency of recurrence, and were associated with the studied characteristics of the victim, the aggressor and the event.

Inferior vena cava collapsibility index and trauma severity in elderly fall injuries.

OBJECTIVE: Falls are a serious cause of morbidity and mortality among older people. One of the underlying causes of falls is dehydration. Therefore, ultrasonography has become an essential tool for evaluating volume status in the emergency department. However, the effect of volume status on falls in older people has not been evaluated before. The aim of this study was to determine the relationship between the inferior vena cava collapsibility index and the injury severity score in older patients who presented with fall-related injuries to the emergency department. METHODS: A total of 66 patients were included in the study. The injury severity score was used as the trauma severity score, and the Edmonton Frail Scale was used as the frailty scale. Volume status was evaluated with inferior vena cava collapsibility index. The primary outcome measure was defined as the correlation between inferior vena cava collapsibility index and injury severity score. Secondary outcome measures were defined as the effect of inferior vena cava collapsibility index and injury severity score on hospitalization and mortality. RESULTS: There was no significant correlation between injury severity score and inferior vena cava collapsibility index (p=0.342). Neither inferior vena cava collapsibility index nor injury severity score was an indicator of the mortality of these patients. However, injury severity score was an indicator of hospitalization. The mean Edmonton Frail Scale score was an indicator of mortality among older people who experienced falls (p=0.002). CONCLUSION: Inferior vena cava collapsibility index cannot be used to predict trauma severity in older patients who have experienced falls admitted to the emergency department.

Preparing the soil: Adjusting the metabolic health of patients with chronic wounds and musculoskeletal diseases.

In recent years, systemic inflammation has emerged as a pivotal player in the development and progression of various degenerative diseases. This complex, chronic inflammatory state, often undetected, can have far-reaching consequences for the body's physiology. At the molecular level, markers such as C-reactive protein, cytokines and other inflammatory mediators serve as indicators of systemic inflammation and often act as predictors of numerous musculoskeletal diseases and even certain forms of cancer. The concept of 'meta-inflammation', specifically referring to metabolically triggered inflammation, allows healthcare professionals to understand inflammatory responses in patients with metabolic syndrome. Driven by nutrient excess and the expansion of adipose tissue, meta-inflammation is closely associated with insulin resistance, further propagating the metabolic dysfunction observed in many Western societies. Wound persistence, on the other hand, exacerbates the detrimental effects of prolonged inflammation at the local level. Acute inflammation is a beneficial and essential process for wound healing and infection control. However, when inflammation fails to resolve, it can impede the healing process, leading to chronic wounds, excessive scarring and even the activation of fibrotic pathways. This approach significantly reduces the efficacy of regenerative biological therapies. Our review focuses on the vital role of proteins, vitamins and minerals in collagen synthesis and cell proliferation for tissue healing. We also examine hormonal influences on regeneration, noting the negative effects of imbalances, and emphasize glucose regulation's importance in creating a stable environment for chronic wound healing.

Can contrast injections cause or propagate coronary injuries? Insights from vessel and guiding catheter hemodynamics

BACKGROUND The association between hydraulic forces generated during contrast injection and the risk of coronary injury is poorly understood. We evaluated whether contrast injections increase intracoronary pressures beyond resting levels and estimated the risk of hydraulic propagation of coronary dissections. METHODS This prospective multicenter study included patients with non-flow-limiting coronaries. A continuous 60-second pressure recording was taken in 5 predetermined locations during contrast injections: distal, mid, and proximal vessel, catheter tip, and inside catheter. The primary endpoint was the change in intracoronary peak pressure between resting and injections in each location. RESULTS 269 pressure recordings (58 vessels, 52 patients) were analyzed. Injections led to small increase in peak pressure in the distal (mean difference [MD]: +4.5 mm Hg; 95% CI: 1.5-7.4), mid (MD: +4.1 mm Hg; 95% CI: 1.4-6.9), and proximal (MD: +5.1 mm Hg; 95% CI: 2.5-7.7) vessel locations, and much higher increases at the catheter tip (MD: +11.7 mm Hg; 95% CI: 5.8-17.7) and inside catheter (MD: +77.5 mm Hg; 95% CI: 64.5-90.4). Compared with the distal vessel, pressure changes were only significant at the catheter tip (+10 mm Hg; P < 0.01) and inside catheter (+79.1 mm Hg; P<0.01). CONCLUSIONS Contrast injections lead to negligible changes in intracoronary pressures beyond the catheter tip. Although injections should be avoided when dissections are close to the catheter, it is unlikely that they would cause injuries beyond the catheter tip.

WOUND-Q questionnaire: Translational and cross-cultural adaptation for Brazilian Portuguese.

Studies shows that 1%-2% of world population will develop chronic skin wound in their lifetime. Nowadays, the patient report outcome measure (PROM) questionnaires are used to evaluate the patient's quality of life. However, several PROM's questionnaires analyse specific chronic wounds. In this sense, WOUND-Q toll was designed to evaluate all types of wounds. Because of the WOUND-Q wide applicability, the use of WOUND-Q is helpful for other countries. This study aimed to translate and adapt WOUND-Q tool for Brazilian Portuguese language. Two independent translators translated the WOUND-Q questionnaire from English to Brazilian Portuguese. Then these translators build Version 1 (T1) and version 2 (T2). In a consensus meeting, a third senior author defined the final version. In the back translation process, an English proficient translator translated the Brazilian Portuguese version to the original version. After another consensus, a final version was defined. Then, our group performed a cognitive test to validate this version. After the first translation, the comparison of version T1 and T2 achieved an intraclass correlation coefficient of 77%. The back translation showed the need of few adjustments. For the cognitive test, the mean age was 44.1 ± 9.3 years. Only one question was changed to improve comprehensiveness. In the review phase, few adjustments were performed to the final Brazilian Portuguese version, mostly regarding verbal tense and prepositions. In conclusion, this study successfully translated and adapted the WOUND-Q questionnaire for a Brazilian Portuguese version.

Manejo cirúrgico de ferimento auto-infligido por arma de fogo em região maxilofacial / Surgical management of self-inflicted injury by gun in the maxillofacial region

INTRODUÇÃO: O manejo dos pacientes vítimas de PAF possui vertentes divergentes a respeito do tratamento cirúrgico, que pode ser realizado de forma imedata ou tardia. Em lesões auto-infligidas, a distância entre a arma e a região acometida é menor, causando consequências estéticas e funcionais mais devastadoras. Aliado ao fato desse tipo de trauma criar uma ferida suja devido à comunicação com a cavidade oral e seios paranasais, o manejo das lesões representam um desafio mesmo à cirurgiões experientes. OBJETIVO: Estre trabalho relata o manejo cirúrgico de uma ferida auto-infligida por arma de fogo que resultou em avulsão dos tecidos moles na região maxilofacial. DESCRIÇÃO DO CASO: Paciente do sexo masculino, 35 anos, vítima de projétil de arma de fogo auto-infligido em região maxilofacial, cursando com extenso ferimento em região de língua e mento. Clinicamente, o paciente não apresentava sinais de fratura em ossos da face. Ambos os ferimentos apresentavam secreção purulenta e o paciente manifestava disfonia devido a grande destruição tecidual. CONSIDERAÇÕES FINAIS: O tratamento de ferimentos por arma de fogo não só é um grande desafio para o cirurgião, como para toda a equipe multidisciplinar requerida para tais casos, visto que não há protocolos bem definidos para o tratamento dessas lesões(AU)

INTRODUCTION: The management of patients who are victims of FAP has divergent aspects regarding surgical treatment, which can be performed immediately or late. In self-inflicted injuries, the distance between the weapon and the affected region is smaller, causing more devastating aesthetic and functional consequences. Allied to the fact that this type of trauma creates a dirty wound due to the communication with the oral cavity and paranasal sinuses, the management of injuries represents a challenge even for experienced surgeons. OBJECTIVE: This paper reports the surgical management of a self-inflicted gunshot wound that resulted in soft tissue avulsion in the maxillofacial region. CASE DESCRIPTION: Male patient, 35 years old, victim of a self-inflicted firearm projectile in the maxillofacial region, coursing with extensive injury in the region of the tongue and chin. Clinically, the patient did not show signs of facial bone fractures. Both wounds had purulent secretion and the patient had dysphonia due to extensive tissue destruction. FINAL CONSIDERATIONS: The treatment of gunshot wounds is not only a great challenge for the surgeon, but also for the entire multidisciplinary team required for such cases, since there are no well-defined protocols for the treatment of these injuries(AU)

Budget impact analysis of implementing trauma registries in Argentina.

INTRODUCTION: In high-income countries, quality improvement interventions and research are usually guided by trauma registries. In low- and middle-income countries, the implementation of trauma registries has been limited mainly for cost reasons. OBJECTIVE: To analyze the budgetary impact of the implementation of trauma registries in Argentina. METHODS: We estimated direct costs of implementing trauma registries in public hospitals located in cities with a population over 50,000 inhabitants. In large urban areas, we selected hospitals by estimating a minimum volume of 240 severe trauma admissions/year and using the NBATS-2 instrument with geolocation techniques. We estimated costs based on a micro-costing approach of a trauma registry developed by Fundación Trauma. Scenario analysis was carried out restricting the population to hospitals from bigger cities and/or with higher concentration of trauma patients' care. For the high budget impact threshold, we used the total health spending estimation, and alternatively the health spending of the public sector. RESULTS: For the base case, 139 hospitals from 104 cities were included, comprising 175,605 injury-related discharges and 13,707 severely injured patients/year. The average cost for the initial three years was USD 3,753,085 (21.4 USD/per patient), falling below the high budget impact thresholds. The scenarios analysis showed a significantly costs reduction. CONCLUSIONS: The implementation of trauma registries in Argentina would be affordable, and in consequence, it would improve the coordination, management and quality of care for this great public health issue.

Amniotic membrane in wound healing: new perspectives.

There are several reasons for skin damage, including genetic factors, disorders, acute trauma, hard-to-heal wounds, or surgical interventions. Whatever the cause, wounds have a substantial impact on people who experience them, their caregivers and the healthcare system. Advanced wound care products have been researched and developed, providing an opportunity for faster and more complete healing. Tissue engineering (TE) is a promising strategy that can overcome limitations when choosing a graft for a wound. Amniotic membrane is a highly abundant, readily available, and inexpensive biological tissue that does not raise ethical concerns, with many applications in different fields of TE and regenerative medicine. It has attractive physical characteristics, such as elasticity, rigidity and mechanical strength, among others. The effects can also be potentiated by association with other substances, such as hyaluronic acid and growth factors. This paper describes new perspectives involving the use of amniotic membranes.

Epidemiology of high-energy trauma in Chile: An ecological analysis using public registries. / Epidemiología del trauma de alta energía en Chile: análisis ecológico con registros públicos.

High-energy trauma is defined as severe organic injuries resulting from events that generate a large amount of kinetic, electrical, or thermal energy. It represents a significant public health concern, accounting for 10% of global mortality. This article aims to describe the epidemiology of high-energy trauma in Chile. Specifically, it seeks to compare the mortality rate per 100 000 inhabitants among member countries of the World Health Organization (WHO), provide a descriptive analysis of notifications under the Explicit Health Guarantees (GES) for the health issue of polytraumatized patients, and analyze the trend in the mortality rate due to external causes in Chile. This study employs an ecological design using three open-access databases. First, the WHO database on deaths from traffic accidents in 2019 was used. Then, the GES database was consulted for the "Polytraumatized" issue between 2018 and 2022. Finally, the Chilean Department of Health Statistics database on causes of death between 1997 and 2020 was utilized. In 2019, Chile ranked in the middle regarding the mortality rate per 100 000 inhabitants due to traffic accidents. GES notifications for polytrauma predominantly involved men aged 20 to 40 years and those affiliated with the public health system, highlighting a primary focus for prevention efforts. Mortality from accidents showed a decreasing trend, with significant structural changes identified in 2000 and 2007.

El trauma de alta energía se define como lesiones orgánicas graves resultantes de eventos que generan una gran cantidad de energía cinética, eléctrica o térmica. Constituye una importante preocupación de salud pública, representando el 10% de la mortalidad mundial. El objetivo de este artículo es describir la epidemiología del trauma de alta energía en Chile. Específicamente, se busca comparar la tasa de mortalidad por 100 000 habitantes entre los países miembros de la Organización Mundial de la Salud (OMS), realizar un análisis descriptivo de las notificaciones por Garantías Explícitas en Salud (GES) del problema de salud "politraumatizado", y analizar la tendencia de la tasa de fallecidos por causa externa en Chile. El presente estudio tiene un diseño ecológico, utilizando tres bases de datos de acceso abierto. Primero, se utilizó la base de datos de la OMS sobre fallecidos por accidentes automovilísticos en 2019. Luego, se consultó la base de datos del programa Garantías Explícitas en Salud para el problema "politraumatizado" entre los años 2018 y 2022. Finalmente, se utilizó la base de datos del Departamento de Estadísticas de Salud de Chile sobre causas de muerte entre 1997 y 2020. En 2019, Chile ocupó una posición intermedia en cuanto a la tasa de mortalidad por 100 000 habitantes debido a accidentes de tráfico. Las notificaciones el programa Garantías Explícitas en Salud por politraumatismo fueron predominantemente en hombres de entre 20 y 40 años, afiliados al sistema de salud pública. Por este motivo, el foco principal de prevención debe centrarse en este grupo. La mortalidad por accidentes mostró una tendencia decreciente, identificándose cambios estructurales significativos en los años 2000 y 2007.

Tratamento de lesões de difícil cicatrização em membros superiores com bandagem de óxido de zinco / Treatment of difficult-to-heal injuries in the upper limbs with zinc oxide bandages

Este estudo avaliou um novo protocolo para tratar feridas de difícil cicatrização em membros superiores, utilizando produtos com polihexametileno biguanida 0,2% e associações com bandagem de óxido de zinco, em ambulatórios em Campos dos Goytacazes e no Hospital Santa Casa de Misericórdia de São João da Barra, RJ. Dez pacientes com feridas graves nos membros superiores foram selecionados com base em critérios específicos. Os pacientes apresentavam feridas graves, com comprometimento na cicatrização. Os curativos incluíram sabonete com polihexametileno biguanida 0,2% e associações com bandagem impregnada com óxido de zinco de Unna, trocados a cada 4-5 dias. O tratamento mostrou-se eficaz, reduzindo edema e promovendo a reabsorção do líquido intersticial pela rede linfática, o que melhorou a circulação sanguínea local e acelerou a cicatrização. Os resultados indicam que o protocolo com bandagem de óxido de zinco de Unna é viável para centros de tratamento de feridas de difícil cicatrização.(AU)

This study evaluated a new protocol for treating difficult-to-heal wound on upper limbs, using products with polyhexamethylene biguanide 0.2 % and combinations with zinc oxide bandages, in outpatient clinics in Campos dos Goytacazes and at the Santa Casa de Misericórdia Hospital in São João da Barra, RJ. Ten patients with severe wounds on the upper limbs were selected based on specific criteria. The patients had severe wounds with impaired healing. The dressings included soap with polyhexamethylene biguanide 0.2 % and combinations with bandages impregnated with Unna's zinc oxide, changed every 4-5 days. The treatment proved to be effective, reducing edema and promoting the reabsorption of interstitial fluid by the lymphatic network, which improved local blood circulation and accelerated healing. The results indicate that the protocol with Unna's zinc oxide bandage is viable for centers treating difficult-to-heal wounds.(AU)

Este estudio evaluó un nuevo protocolo para el tratamiento de heridas de difícil cicatrización en los miembros superiores, utilizando productos con polihexametileno biguanida al 0,2% y combinaciones con vendajes de óxido de zinc, en consultorios ambulatorios de Campos dos Goytacazes y del Hospital Santa Casa de Misericórdia de São João da Barra, RJ. Se seleccionaron diez pacientes con heridas graves en las extremidades superiores según criterios específicos. Los pacientes presentaban heridas graves con problemas de cicatrización. Los apósitos incluyeron jabón con polihexametileno biguanida al 0,2% y asociaciones con vendaje impregnado con óxido de zinc de Unna, cambiados cada 4-5 días. El tratamiento demostró ser eficaz, reduciendo el edema y favoreciendo la reabsorción del líquido intersticial por la red linfática, mejorando la circulación sanguínea local y acelerando la curación. Los resultados indican que el protocolo de vendaje con óxido de zinc de Unna es viable para centros que tratan heridas de difícil curación.(AU)

SMART Monitoring computer program for oral and skin lesions measurements: analysis through clinical photography

Lesion evaluation through photographs is a common clinical practice and its performance using computational tools is encouraged. Objective: To assess the reliability of the computer program SMART Monitoring (SM) in giving adequate lesion measurements through clinical photography. Materials and methods: A cross-sectional study was conducted with 28 patients diagnosed with oral or skin flat lesions. Each lesion was measured twice: clinically and by photographic image. Photographs were taken using a 3D-printed scale as a reference for SM measurements of the total lesional area (mm²) and the two longest axes (length and width) by two different operators. The agreement was evaluated between the axis's measurements of the two operators with the clinic measurements by the Bland-Altman plot. Results: Both operators revealed excellent agreement (ICC=0.98) regarding measurements of the lesion's axes and the total lesional area with no difference between operators. Comparison of the axes' values from SM to clinical measurements were also not different (p=0.82 and p=0.43). The Bland-Altman plot revealed that most mean differences were within the 95% confidence interval. Conclusion: SMART Monitoring proved to be a reliable tool for measuring oral or skin flat lesions on clinical photographs, regarding length, width, and total area measurements. The values obtained using SMART Monitoring presented an excellent agreement with the clinical measurements. (AU)

Surveillance for Violent Deaths - National Violent Death Reporting System, 48 States, the District of Columbia, and Puerto Rico, 2021.

Problem/Condition: In 2021, approximately 75,000 persons died of violence-related injuries in the United States. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) on violent deaths that occurred in 48 states, the District of Columbia, and Puerto Rico in 2021. Results are reported by sex, age group, race and ethnicity, method of injury, type of location where the injury occurred, circumstances of injury, and other selected characteristics. This report introduces additional incident and circumstance variables, which now include child victim-specific circumstance information. This report also incorporates new U.S. Census Bureau race and ethnicity categories, which now account for more than one race and Native Hawaiian or other Pacific Islander categories and include updated denominators to calculate rates for these populations. Period Covered: 2021. Description of System: NVDRS collects data regarding violent deaths from death certificates, coroner and medical examiner records, and law enforcement reports. This report includes data collected for violent deaths that occurred in 2021. Data were collected from 48 states (all states with exception of Florida and Hawaii), the District of Columbia, and Puerto Rico. Forty-six states had statewide data, two additional states had data from counties representing a subset of their population (31 California counties, representing 64% of its population, and 13 Texas counties, representing 63% of its population), and the District of Columbia and Puerto Rico had jurisdiction-wide data. NVDRS collates information for each violent death and links deaths that are related (e.g., multiple homicides, homicide followed by suicide, or multiple suicides) into a single incident. Results: For 2021, NVDRS collected information on 68,866 fatal incidents involving 70,688 deaths that occurred in 48 states (46 states collecting statewide data, 31 California counties, and 13 Texas counties), and the District of Columbia. The deaths captured in NVDRS accounted for 86.5% of all homicides, legal intervention deaths, suicides, unintentional firearm injury deaths, and deaths of undetermined intent in the United States in 2021. In addition, information was collected for 816 fatal incidents involving 880 deaths in Puerto Rico. Data for Puerto Rico were analyzed separately. Of the 70,688 deaths, the majority (58.2%) were suicides, followed by homicides (31.5%), deaths of undetermined intent that might be due to violence (8.2%), legal intervention deaths (1.3%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force acting in the line of duty, excluding legal executions), and unintentional firearm injury deaths (<1.0%). The term "legal intervention" is a classification incorporated into the International Classification of Diseases, Tenth Revision, and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement.Demographic patterns and circumstances varied by manner of death. The suicide rate was higher for males than for females. Across all age groups, the suicide rate was highest among adults aged ≥85 years. In addition, non-Hispanic American Indian or Alaska Native (AI/AN) persons had the highest suicide rates among all racial and ethnic groups. Among both males and females, the most common method of injury for suicide was a firearm. Among all suicide victims, when circumstances were known (84.4%), suicide was most often preceded by a mental health, intimate partner, or physical health problem or by a recent or impending crisis during the previous or upcoming 2 weeks. The homicide rate was higher for males than for females. Among all homicide victims, the homicide rate was highest among persons aged 20-24 years compared with other age groups. Non-Hispanic Black or African American (Black) males experienced the highest homicide rate of any racial or ethnic group. Among all homicide victims, the most common method of injury was a firearm. When the relationship between a homicide victim and a suspect was known, the suspect was most frequently an acquaintance or friend for male victims and a current or former intimate partner for female victims. Homicide most often was precipitated by an argument or conflict, occurred in conjunction with another crime, or, for female victims, was related to intimate partner violence. Nearly all victims of legal intervention deaths were male, and the legal intervention death rate was highest among men aged 30-34 years. The legal intervention death rate was highest among AI/AN males, followed by Black males. A firearm was used in the majority of legal intervention deaths. When circumstances were known, the most frequent circumstances reported for legal intervention deaths were as follows: the victim used a weapon in the incident and the victim had a substance use problem (other than alcohol use). Other causes of death included unintentional firearm injury deaths and deaths of undetermined intent. Unintentional firearm injury deaths were most frequently experienced by males, non-Hispanic White (White) persons, and persons aged 15-24 years. These deaths most frequently occurred while the shooter was playing with a firearm and were precipitated by a person unintentionally pulling the trigger. The rate of deaths of undetermined intent was highest among males, particularly among AI/AN and Black males, and among adults aged 30-54 years. Poisoning was the most common method of injury in deaths of undetermined intent, and opioids were detected in nearly 80% of decedents tested for those substances. Interpretation: This report provides a detailed summary of data from NVDRS on violent deaths that occurred in 2021. The suicide rate was highest among AI/AN and White males, whereas the homicide rate was highest among Black males. Intimate partner violence precipitated a large proportion of homicides for females. Mental health problems, intimate partner problems, interpersonal conflicts, and acute life stressors were primary precipitating circumstances for multiple types of deaths examined. Public Health Action: Violence is preventable, and data can guide public health action. NVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in developing, implementing, and evaluating programs, policies, and practices to reduce and prevent violent deaths. NVDRS data can be used to enhance prevention efforts into actionable strategies. States or jurisdictions have used their Violent Death Reporting System (VDRS) data to guide suicide prevention efforts and highlight where additional focus is needed. For example, North Carolina VDRS program data have played a significant role in expanding activities related to firearm safety and injury prevention. The program served as a primary data source for partners, which led to the creation of the Office of Violence Prevention in the state, focusing on combatting firearm-related deaths. In Maine, the VDRS provided data on law enforcement officer suicides that were used to help support a bill mandating mental health resiliency and awareness training in the state's law enforcement training academy, along with plans for similar training addressing mental health, substance use, and alcohol problems among corrections officers. In addition, states and jurisdictions have also used their VDRS data to examine factors related to homicide in their state or jurisdiction. For example, Georgia VDRS collaborated with the City of Atlanta Mayor's Office of Violence Reduction to develop two public dashboards that not only offer comprehensive data on violent deaths but also present data on the geographic distribution of populations disproportionately affected by violence to help inform violence prevention interventions.

Pediatric Early Warning Score (PEWS) in predicting prognosis of critical pediatric trauma patients: a retrospective study.

BACKGROUND: This study aimed to compare the predictive value of Pediatric Early Warning Score (PEWS) to Pediatric Risk of Mortality-3 (PRISM-3), Pediatric Trauma Score (PTS), and Pediatric Glasgow Coma Score (pGCS) in determining clinical severity and mortality among critical pediatric trauma patients. METHOD: A total of 122 patients monitored due to trauma in the pediatric intensive care unit between 2020 and 2023 were included in the study. Physical examination findings, vital parameters, laboratory values, and all scoring calculations for patients during emergency room admissions and on the first day of intensive care follow-up were recorded. Comparisons were made between two groups identified as survivors and non-survivors. RESULTS: The study included 85 (69.7%) male and 37 (30.3%) female patients, with an average age of 75 ± 59 months for all patients. Forty-one patients (33.6%) required Invasive Mechanical Ventilation (IMV) and 11 patients (9%) required inotropic therapy. Logistic regression analysis revealed a significant association between mortality and PEWS (p < 0.001), PRISM-3 (p < 0.001), PTS (p < 0.001), and pGCS (p < 0.001). Receiver operating characteristics curve analysis demonstrated that the PEWS score (cutoff > 6.5, AUC = 0.953, 95% CI 0.912-0.994) was highly predictive of mortality, showing similar performance to the PRISM-3 score (cutoff > 21, AUC = 0.999, 95% CI 0.995-1). Additionally, the PEWS score was found to be highly predictive in forecasting the need for IMV and inotropic therapy. CONCLUSION: The Pediatric Early Warning Score serves as a robust determinant of mortality in critical pediatric trauma patients. Simultaneously, it demonstrates strong predictability in anticipating the need for IMV and inotropic therapy.

Impactos da gestão da qualidade na prevenção de lesão de pele por adesivo / Impacts of quality management on the prevention of skin injuries caused by adhesives

INTRODUÇÃO: Adesivos médicos são materiais frequentemente utilizados nos serviços de saúde em todos os ambientes de cuidado. Lesão de pele relacionada a adesivo médico ocorre quando as camadas da pele são removidas juntamente com o adesivo, causando uma lesão cutânea, conhecida internacionalmente como Medical Adhesive-Related Skin Injuries (MARSI) (1). Esse tipo de lesão é comum, mas subnotificado, comprometendo a segurança do paciente (2-3). Alguns estudos apontam prevalência de MARSI em torno de 22,7 a 36% (2-5). Os adesivos médicos são necessários para fixarem curativos no local da cirurgia e a prevalência de MARSI Peri incisional gira em torno de 36% (5). A manutenção da integridade da pele é um indicador da qualidade da assistência prestada pela Enfermagem. A MARSI pode ser evitada por meio de intervenções. Desenvolver estratégias para prevenção é crucial para qualidade e segurança do paciente. OBJETIVO: Avaliar o impacto assistencial após a aplicação da ferramenta PDCA para prevenção de MARSI em ferida operatória de pacientes submetidos a cirurgia cardíaca. METODOLOGIA: Utilizou-se da ferramenta PDCA seguindo as etapas: Plan- identificação das MARSI que ocorreram no primeiro bimestre de 2024 por meio da análise individual das LP e estabelecido plano de ação fundamentado por evidências científicas o uso de adesivos adequados para a prevenção de MARSI e desenvolvido bundle para prevenção. Realizado treinamento dos membros da Comissão de Avaliação e Tratamento de feridas e, posterior, analise das ocorrências de MARSI à implantação do bundle. Do- implementado o bundle em amostra piloto composta por 13 casos em um período de 30 dias. Check- acompanharam-se os pacientes que receberam intervenções para prevenção de MARSI por sete dias e Action- monitoramento do indicador: lesão de pele por adesivo. O Estudo foi autorizado pela Divisão de Enfermagem da Instituição. RESULTADO: A Taxa de Efetividade na prevenção de MARSI por adesivo após a implantação do bundle nos pacientes avaliados foi de 100% no período de acompanhamento. Assim, a cobertura de espuma de silicone mostrou-se efetivo para prevenção de MARSI relacionado a adesivo. CONCLUSÃO: A ferramenta de gestão PDCA associada à implantação de programa educacional e assistencial impactou em assistência segura e preventiva de eventos adversos que contribui na melhoria da qualidade de vida dos pacientes em uso adesivo médico.

Caracterización de las lesiones ocasionadas en combate y su tratamiento / Characterization of injuries during combat and their treatment

Introducción. Colombia es un país que ha tenido el conflicto armado como parte de su historia. Durante más de 50 años, diferentes tipos de armas han sido empleados en la guerra interna. Desde el año 1999 hasta 2010, en el Hospital Militar Central, Bogotá, D.C., Colombia, se atendieron más de 15.000 personas heridas en combate. El objetivo de este estudio fue describir los abordajes quirúrgicos realizados para el tratamiento de lesiones generadas en combate militar, por el servicio de Cirugía general en el Hospital Militar Central, entre los años 2016 y 2021. Métodos. Se condujo un estudio observacional descriptivo de corte transversal, en donde se recolectó información de la base de datos del grupo de Trauma del Hospital Militar Central, sobre los pacientes con lesiones generadas en combate, atendidos por el servicio de cirugía general. Resultados. En total ingresaron 203 pacientes, 99 % de sexo masculino, 87 % pertenecientes al ejército. El departamento de donde más se recibieron heridos fue Arauca (20,7 %). Las armas de fuego de alta velocidad fueron los artefactos relacionados con las heridas en más de la mitad de los casos. Las intervenciones quirúrgicas más frecuentes fueron extracción de cuerpo extraño (28 %), exploración vascular (25,5 %) y toracostomía o toracoscopia (20,6 %). Conclusión. Los procedimientos quirúrgicos para el manejo del trauma militar siguen siendo variados con respecto a la ubicación y el abordaje, razón por la cual el conocimiento del cirujano general debe ser amplio, para estar capacitado para su manejo.

Introduction. Colombia is a country that has had armed conflict as part of its history. For more than 50 years, different types of weapons have been used in internal warfare. From 1999 to 2010, more than 15,000 people injured in combat were treated at the Central Military Hospital, Bogotá, D.C., Colombia. The objective of this study was to describe the surgical approaches carried out for the treatment of injuries generated in military combat, by the General Surgery service at the Central Military Hospital, between 2016 and 2021. Methods. A cross-sectional descriptive observational study was conducted, where information was collected from the database of the Trauma group of the Central Military Hospital on patients with injuries during combat treated by the General Surgery service. Results. A total of 203 patients were admitted, 99% were male, 87% belonged to the Army. The department from which the most wounded were received was Arauca (20.7%). High-velocity firearms were the injury-related weapons in more than half of the cases. The most common surgical interventions performed were foreign body extraction (28%), vascular exploration (25.5%), and thoracostomy or thoracoscopy (20.6%). Conclusion. Surgical procedures for the management of military trauma continue to be varied with respect to location and approach, which is why the general surgeon's knowledge must be extensive to be qualified for its management.