The influence of a doppler ultrasound in arteriovenous fistula for dialysis failure related to some risk factors / Influência da Ultrassonografia Doppler nas Falhas de Fístulas Arteriovenosas de Diálise Relacionada a Alguns Fatores de Risco

ABSTRACT Introduction: The increasing prevalence of chronic kidney disease has increased the demand for arteriovenous fistula (AVF) care. The objective of this study was to assess the relationship between some risk factors for AVF failure (advanced age, female sex, diabetes, obesity, central venous catheter, previous fistula, and hospitalization) and having a Doppler ultrasound performed preoperatively. Methods: A prospective study was performed with 228 dialysis patients from Imperatriz, Maranhão. Half of the sample was randomly selected to receive preoperative Doppler ultrasound and the other half did not, from the period of October 2016 to September 2018. Results: There were 53 total failures corresponding to 23.2% of our sample, which is almost double that of the patients in the clinical group. Considering the failures and risk factors associated with the overall sample, there was a statistically significant association between a central venous catheter on the same side of the AVF with P = 0.04 (Odds Ratio 1.24) and obesity with P = 0.05 (Odds Ratio 1.36), which was not repeated in the Doppler ultrasound group individually. There was no statistically significant difference between the Doppler group and clinical group with respect to the amount of days of previous AVF hospitalization and failure. Conclusions: We concluded that the reduction of failures with an introduction of the Doppler was statistically significant in the overall sample, but establishing a relationship between specific risk factors and failure was only possible with two of the risk factors in the study - obesity and central venous catheter on the same side of the AVF.

RESUMO Introdução: A crescente prevalência de doença renal crônica aumentou a demanda por confecção de fístula arteriovenosa (FAV). O objetivo do presente estudo foi avaliar a relação entre alguns fatores de risco para falha da FAV (idade avançada, sexo feminino, diabetes, obesidade, cateter venoso central, fístula prévia e hospitalização) e a realização de ultrassonografia Doppler no pré-operatório. Métodos: Estudo prospectivo com 228 pacientes em diálise em Imperatriz, MA. Metade da amostra foi randomizada para receber ultrassonografia Doppler no pré-operatório. A outra metade dos pacientes não foi submetido a exame ultrassonográfico. O estudo incluiu pacientes atendidos no período de outubro de 2016 a setembro de 2018. Resultados: Houve 53 falhas (23,2%) em nossa amostra, quase o dobro do número dos pacientes no grupo clínico. Considerando as falhas e os fatores de risco associados à amostra geral, houve associação estatisticamente significativa entre catéter venoso central do mesmo lado da FAV (P = 0,04; Razão de Chances: 1,24) e obesidade (P = 0,05; Razão de Chances: 1,36), o que não foi reproduzido no grupo de ultrassonografia Doppler individualmente. Não houve diferença estatisticamente significativa entre o grupo Doppler e o grupo clínico em relação à quantidade de dias de internação e falha da FAV. Conclusões: A redução de falhas com a introdução do Doppler foi estatisticamente significativa na amostra geral, mas só foi possível estabelecer uma relação entre fatores de risco específicos e falha em dois dos fatores estudados, obesidade e catéter venoso central no mesmo lado da FAV.

Circular saw misuse is related to upper limb injuries: a cross-sectional study

OBJECTIVES: Machinery injuries account for a substantial share of traumatic upper limb injuries (TULIs) affecting young active individuals. This study is based on the hypothesis that there is an important relationship between the improper use of power saws and TULIs. The aim of the study is to assess the prevalence and epidemiology of TULIs caused by power saws and determine the risks related to power saw use. METHODS: A cross-sectional evaluation of medical records from a two-year period was performed. Patients sustaining TULIs related to power saws were analyzed. Data on the epidemiology, site of injury, mechanism of trauma, technical specifications of the tool, cutting material, personal protective equipment, time lost and return to work were obtained. RESULTS: A database search retrieved 193 TULI records, of which 104 were related to power saws. The majority of patients were male (102/104; 98.1%), right-handed (97/104; 93.3%), and manual workers (46/104; 44.2%), with an average age of 46.8 years. The thumb was the most frequently injured site (32/93; 34.4%). Most of the injuries were caused by manual saws (85/104; 81.7%), and masonry saws accounted for 68.2% (58/85) of the cases. Masonry saws improperly used for woodwork resulted in 86.2% (50/58) of the injuries. TULI caused by masonry saws was 5 times higher in manual workers than in other patients. In addition, masonry saws had a risk of kickback 15 times higher than that of other saws, and the risk of injury increased by 5.25 times when the saws were used improperly for wood cutting. CONCLUSIONS: The profile of TULIs related to power saws was demonstrated and was mainly associated with manual saws operated by manual workers that inappropriately used masonry saws for woodworking.

Estudio prospectivo de un año sobre seguridad en el quirófano / A year prospective study on safety in the operating room

En un trabajo prospectivo se registraron todos los hechos no esperados ocurridos durante el acto quirúrgico en un año, en una clínica privada con condiciones edilicias y equipamiento adecuados, personal entrenado y médicos con título de especialistas. En 2.752 operaciones se detectaron 10 (0.36%) problemas que por su poca jerarquía hubieran pasado inadvertidos, pero sirvieron para hacer correcciones y aumentar las medidas de seguridad