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Objective The present study compares the analgesic efficacy of two techniques to perform non-surgical reduction: fracture hematoma block and radial nerve supracondylar block. Methods Forty patients with fractures of the distal third of the radius, who required reduction, were selected in a quasi-randomized clinical trial to receive one of the anesthetic techniques. All patients signed the informed consent form, except for those who did not wish to participate in the study, had neurological injury, had contraindication to the procedure in the emergency room, or with contraindication to the use of lidocaine. To measure analgesia, the numerical pain rate scale was used at four different moments: preblock, postblock, during reduction, and after reduction; then three differences were calculated: the first between before and after blocking; the second between during reduction and after blockade; and the third between before blocking and after reduction. Results The fracture hematoma and supracondylar block groups showed the following mean values, respectively: 3.90 (1-10) and 3.50 (-6-10) in difference 1; 4.35 (-5-10) and 5.00 (-3-10) in difference 2; and 4.65 (1-10) and 3.80 (-3-10) in difference 3. Conclusion Both techniques proved to be efficient for analgesia, with mild superiority of hematoma block, but without statistical significance.
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Abstract Objective The present study compares the analgesic efficacy of two techniques to perform non-surgical reduction: fracture hematoma block and radial nerve supracondylar block. Methods Forty patients with fractures of the distal third of the radius, who required reduction, were selected in a quasi-randomized clinical trial to receive one of the anesthetic techniques. All patients signed the informed consent form, except for those who did not wish to participate in the study, had neurological injury, had contraindication to the procedure in the emergency room, or with contraindication to the use of lidocaine. To measure analgesia, the numerical pain rate scale was used at four different moments: preblock, postblock, during reduction, and after reduction; then three differences were calculated: the first between before and after blocking; the second between during reduction and after blockade; and the third between before blocking and after reduction. Results The fracture hematoma and supracondylar block groups showed the following mean values, respectively: 3.90 (1-10) and 3.50 (-6-10) in difference 1; 4.35 (-5-10) and 5.00 (-3-10) in difference 2; and 4.65 (1-10) and 3.80 (-3-10) in difference 3. Conclusion Both techniques proved to be efficient for analgesia, with mild superiority of hematoma block, but without statistical significance.
Resumo Objetivo O estudo compara a eficácia analgésica de duas técnicas para realizar redução incruenta: o bloqueio de hematoma da fratura e o bloqueio supracondilar de nervo radial. Métodos Quarenta pacientes com fraturas do terço distal do rádio, que necessitassem redução, foram selecionados em um ensaio clínico quasi-randomizado, para receber uma das técnicas anestésicas. Todos os pacientes assinaram o termo de consentimento ou assentimento, com exceção daqueles que não desejassem participar do estudo, tivessem lesão neurológica, com contraindicação ao procedimento na sala de emergências, ou com contraindicação ao uso da lidocaína. Para aferir a analgesia foi utilizada a escala numérica da dor em quatro momentos distintos: pré-bloqueio, pós-bloqueio, durante a redução e após a redução; em seguida, foram calculadas três diferenças: a primeira entre antes e após o bloqueio; a segunda entre durante a redução e após o bloqueio; e a terceira entre antes do bloqueio e após a redução. Resultados Os grupos do bloqueio de hematoma de fratura e bloqueio supracondilar apresentaram respectivamente os seguintes valores médios: 3.90 (1-10) e 3.50 (-6-10) na diferença 1; 4.35 (-5-10) e 5.00 (-3-10) na diferença 2; e 4.65 (1-10) e 3.80 (-3-10) na diferença 3. Conclusão As duas técnicas se provaram eficientes para analgesia, com discreta superioridade do bloqueio de hematoma, mas sem significância estatística.
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Humanos , Fraturas do Rádio , Medição da Dor , Redução Fechada , Anestesia Local , Bloqueio NervosoRESUMO
Díaz-Díaz et al. (2018) described a new species of oweniid polychaete, Owenia vieitezi, from the north-western coast of the Gulf of Venezuela, Caribbean Sea. Although the description and figures presented by Díaz-Díaz et al. (2018) fully characterize the new species, the journal issue in which the description appeared was published online only and the article in which the new name appeared did not include a ZooBank registration number (LSID), required for validation of new species names in electronic-only publications (ICZN 2012). As a result, the name Owenia vieitezi Díaz-Díaz, Parapar Moreira, 2018, as published in Cahiers de Biologie Marine 59: 589-597, is not available according the International Code of Zoological Nomenclature (ICZN 1999, 2012). Therefore, the present note serves to validate the name Owenia vieitezi by fulfilling the ICZN conditions for nomenclatural availability.
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Anelídeos , Meliaceae , Poliquetos , Animais , VenezuelaRESUMO
BACKGROUND: Knowledge of the anatomy of the foramen transversarium (FT) is essential for performing surgical procedures on the cervical spine. The aim of the present study was to analyze the characteristics of the FT anatomy of the lower cervical spine and its anatomic variations using computed tomography (CT) in a Brazilian population. METHODS: Two independent observers performed linear measurements of the anteroposterior diameter (APD), lateral diameter (LD), and FT area (FTA) of 600 FTs of the lower cervical spine of 60 individuals (30 women and 30 men). The CT images were obtained from a database. The data were compared between genders and different age cohorts. RESULTS: The lowest average APD, LD, and FTA were found at the C7 level. The highest mean APD was found at the C6 level, and the highest mean LD was found at the C3 level. The highest mean FTA was at the C3 for the women and C6 for the men. The mean APD, LD, and FTA on the left side were greater than those on the right side at all levels. We found a tendency for the mean FTA to increase with increasing age. Finally, 95% of the whole sample had presented with ≥1 and 42% with >3 anatomical variations of the FT. CONCLUSIONS: We determined the morphometric features of the FT using CT images. Anatomic variations were observed that justify their study before performing cervical surgical procedures.
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Vértebras Cervicais/anatomia & histologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
BACKGROUND: In contrast with the abundance of global epidemiological descriptive data on cardiovascular diseases and their risk factors, information on the outcomes of real populations prospectively followed up in their life and care settings is much rarer, especially in low-income countries. OBJECTIVES: This study sought to evaluate the feasibility and the overall results of a hypertension control program, based mainly on a network of community nonprofessional health promoters, in the poor rural region of Borbon (Ecuador). METHODS: This is a prospective cohort study describing the results of a program of hypertension diagnosis, treatment and follow-up from 2004 to 2015 in the area, carried out mainly by the health promoters. RESULTS: The number of hypertensive patients identified and followed over the years increased from 1,024 in 2004 to 1,733 in 2015. The percentage of patients with no visits during a year was reduced to <10%, whereas the proportion of hypertensive subjects attending all 4 scheduled annual checks approached and, in some years, exceeded 50%. From 2004 to 2015, the proportion of patients at high or very high cardiovascular risk progressively decreased from 26.6% in 2004 to 17.5% in 2015 (p for trend <0.01), whereas the proportion of hypertensive patients at low or very low risk increased from 30.4% in 2004 to 45.0% in 2015 (p for trend <0.01). CONCLUSIONS: In a poor, disadvantaged area, a strategy of control mainly based on the involvement and responsibility of community health promoters (with health professionals as supporters more than direct actors) can achieve adequate follow-up of the population of hypertensive patients and improve their global cardiovascular risk level.
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Serviços de Saúde Comunitária/organização & administração , Hipertensão/prevenção & controle , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Equador/epidemiologia , Estudos de Viabilidade , Feminino , Promoção da Saúde/métodos , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Fatores de Risco , Saúde da População Rural/estatística & dados numéricos , Resultado do TratamentoRESUMO
Es ampliamente conocido que la principal causa de morbi mortalidad en pacientes con Diabetes Mellitus (DM) tipo 2 es la enfermedad cardiovascular en sus diferentes formas. Desde hace mucho tiempo se han diseñado herramientas de cálculo de dicho riesgo, basadas en información estadística obtenida de estudios poblacionales que correlacionan los factores de riesgo cardiovascular con la probabilidad de que los pacientes con diabetes Mellitus presenten complicaciones cardiovasculares. Sin embargo, todas y cada una de dichas herramientas presentan pros y contras para su aplicación en diferentes poblaciones y diferentes contextos clínicos. En el presente trabajo se discute la importancia de la evaluación del riesgo cardiovascular en los pacientes con diabetes Mellitus tipo 2 así como las diferentes opciones disponibles para el cálculo de dicho riesgo...(AU)
It is widely known that the main cause of morbidity and mortality in patients with type 2 Diabetes Mellitus (DM) is a cardiovascular disease in various forms. Since some time ago, tools have been designed for calculating this risk, based on statistical data obtained from population studies that correlate cardiovascular risk factors with the likelihood that patients with diabetes mellitus present cardiovascular complications. However, each and every one of these tools have pros and cons for application in different populations and different clinical settings. In this paper the importance of cardiovascular risk assessment in patients with type 2 diabetes mellitus and the various options available to calculate this risk are discussed...(AU)
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Humanos , Pessoa de Meia-Idade , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/tratamento farmacológico , Complicações do Diabetes/congênito , Diabetes Mellitus Tipo 2/diagnóstico , Medição de Risco/métodos , GuatemalaRESUMO
OBJECTIVES: To evaluate the effect of ivermectin mass drug administration on strongyloidiasis and other soil transmitted helminthiases. METHODS: We conducted a retrospective analysis of data collected in Esmeraldas (Ecuador) during surveys conducted in areas where ivermectin was annually administered to the entire population for the control of onchocerciasis. Data from 5 surveys, conducted between 1990 (before the start of the distribution of ivermectin) and 2013 (six years after the interruption of the intervention) were analyzed. The surveys also comprised areas where ivermectin was not distributed because onchocerciasis was not endemic. Different laboratory techniques were used in the different surveys (direct fecal smear, formol-ether concentration, IFAT and IVD ELISA for Strongyloides stercoralis). RESULTS: In the areas where ivermectin was distributed the strongyloidiasis prevalence fell from 6.8% in 1990 to zero in 1996 and 1999. In 2013 prevalence in children was zero with stool examination and 1.3% with serology, in adult 0.7% and 2.7%. In areas not covered by ivermectin distribution the prevalence was 23.5% and 16.1% in 1996 and 1999, respectively. In 2013 the prevalence was 0.6% with fecal exam and 9.3% with serology in children and 2.3% and 17.9% in adults. Regarding other soil transmitted helminthiases: in areas where ivermectin was distributed the prevalence of T. trichiura was significantly reduced, while A. lumbricoides and hookworms were seemingly unaffected. CONCLUSIONS: Periodic mass distribution of ivermectin had a significant impact on the prevalence of strongyloidiasis, less on trichuriasis and apparently no effect on ascariasis and hookworm infections.
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Anti-Helmínticos/uso terapêutico , Ivermectina/uso terapêutico , Oncocercose/tratamento farmacológico , Strongyloides stercoralis/efeitos dos fármacos , Estrongiloidíase/epidemiologia , Adolescente , Adulto , Idoso , Animais , Ascaríase/epidemiologia , Criança , Pré-Escolar , Tratamento Farmacológico/métodos , Equador/epidemiologia , Feminino , Infecções por Uncinaria/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Tricuríase/epidemiologia , Adulto JovemRESUMO
Chagas disease was described in Ecuador in 1930 in the province of Guayas and thereafter in various provinces. Triatomine were reported in the province of Esmeraldas but no human infection has been described. Here we report the first evidence that the disease does exist in the province of Esmeraldas. In indigenous Awá communities located in the northwest jungle of the Esmeraldas province, 144 individuals were tested using ELISA and PCR for T.cruzi of which 5 (3.47%) were positive. Twenty eight triatomine were collected, 27 were Triatoma dispar and 1 Pastrongylus rufotuberculatus, T.cruzi was detected in 11 (42.3%) of 26 insects.
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Doença de Chagas/epidemiologia , Trypanosoma cruzi/isolamento & purificação , Adulto , Animais , Doença de Chagas/parasitologia , Equador/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Populacionais , Triatominae/parasitologia , Adulto JovemRESUMO
BACKGROUND: The British Medical Research Council (BMRC) staging has been extensively used to evaluate the disease severity and establish the approximate prognosis of tuberculous meningitis. AIMS: This study aimed at analyzing the predictive accuracy for mortality and neurological sequelae of a set of clinical features, laboratory tests and imaging. METHODS: We compared the British Medical Research Council (BMRC) staging with a new scoring proposal to predict the prognosis of patients with Central Nervous System Tuberculosis. Data from Ecuador was collected. A score was built using a Spiegelhalter and Knill-Jones method and compared with BMRC staging with a ROC curve. RESULTS: A total of 213/310 patients (68.7%) were in BMRC stage II or III. Fifty-seven patients died (18.3%) and 101 (32.5%) survived with sequelae. The associated predictors were consciousness impairment (p = 0.010), motor deficit (p = 0.003), cisternal effacement (p = 0.006) and infarcts (p = 0.015). The new score based on these predictors yielded a larger area under the curve of 0.76 (95% CI: 0.70-0.82), but not significantly different from the BMRC (0.72: 95% CI: 0.65-0.77). CONCLUSIONS: This modern score is easy to apply and could be a sound predictor of poor prognosis. However, the availability of modern tests did not improve the ability to predict a bad outcome.
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Diagnóstico por Imagem/métodos , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Meníngea/diagnóstico , Adulto , Progressão da Doença , Equador/epidemiologia , Feminino , Humanos , Incidência , Masculino , Prognóstico , Curva ROC , Estudos Retrospectivos , Índice de Gravidade de Doença , Taxa de Sobrevida/tendências , Tuberculose Meníngea/epidemiologia , Tuberculose Meníngea/microbiologiaRESUMO
La Diabetes Mellitus representa un problema de salud mundial y nacional, y la hipoglicemia es unade sus más temidas complicaciones. Existe controversia en cuanto a los rangos glicémicos ideales,ya que se ha demostrado mayor mortalidad en pacientes que desarrollan hipoglicemia.Materiales y Métodos: El objetivo del presente estudio fue determinar la incidencia dehipoglicemia en pacientes en la Unidad de Cuidados Intensivos y Encamamiento de MedicinaInterna del Hospital Roosevelt y determinar su mortalidad, comparándola con un grupo control sinhipoglicemia. Es un estudio observacional de casos y controles. Se incluyó como grupo de estudioa 35 pacientes en quienes se documentó hipoglicemia, del 1 de enero al 30 de junio del 2011. Porcada sujeto de estudio se tomó un control que no desarrolló hipoglicemia. Se determinó lamortalidad intra-hospitalaria y a los seis meses de cada grupo.Resultados: Intrahospitalariamente fallecieron 10 pacientes (28.6%) del grupo de hipoglicemia y 3(8.6%) del grupo control (RR 3.33; 95% CI, 1.00 11.09; P=0.0496). A los seis meses habíanfallecido 15 pacientes (42.9%) del grupo de hipoglicemia, y 7 (20.0%) del grupo control (RR 2.14; CI0.997 4.605; P=0.0509). Tres pacientes (8.6%) del grupo de hipoglicemia desarrollaron infecciónnosocomial durante el estudio, y ninguno del grupo control (RR 7.00; CI 0.37 130.70; P=0.1926).Se documentaron 10 re-hospitalizaciones en el grupo de hipoglicemia y 9 en los controles.Conclusión: Este estudio demuestra que hay mayor riesgo de morir en pacientes que desarrollanhipoglicemia durante su estancia hospitalaria comparado con quienes no la realizan.