RESUMO
ABSTRACT Subtalar dislocations were first described by Judey and Dufaurest in 1811. These dislocations represent only 1-2% of all joint dislocations, making them a rare injury. In this rare injury, there are four variations with differing clinical presentations. The clinical picture may vary from a dramatic deformity (as in medial and lateral dislocations) to a more subtle presentation (as in anterior and posterior dislocations). This case series highlights the variations in clinical presentations and the management difficulties associated with each subtype.
RESUMEN Las dislocaciones subtalares fueron por primera vez descritas por Judey y Dufaurest en 1811. Estas dislocaciones representan solamente el 1-2% de todas las dislocaciones de las articulaciones, por lo que constituye una lesión poco frecuente. Esta rara lesión se caracteriza por cuatro variaciones con presentaciones clínicas que difieren. El cuadro clínico puede variar desde una deformidad dramática (tal cual ocurre en las dislocaciones intermedias y laterales) hasta una presentación más sutil (como en el caso de las dislocaciones anteriores y posteriores). Esta serie de casos destaca las variaciones en las presentaciones clínicas y las dificultades en el tratamiento asociado con cada subtipo.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Articulação Talocalcânea/lesões , Fraturas Intra-Articulares/diagnóstico por imagem , Articulação Talocalcânea/diagnóstico por imagemRESUMO
Osteoporotic femoral neck fractures are increasing as the population ages. There is a significant cost to care for patients with such fractures. We prospectively analysed the in-hospital cost of managing 85 patients admitted to the University Hospital of the West Indies (UHWI) with such fractures. The majority of patients were females, 78.8%, and the mean age of the cohort was 83.7 years. There was a significant difference in the mean preoperative delay and length of stay between those patients treated publicly as compared to those treated privately, 9.6 vs 3.1 days and 18.9 vs 8.8 days, respectively. The mean acute cost of those treated publicly was 39% of the cost of those treated privately, J$110 878.80 vs J$284 287.61. The economic cost per year to the country for the acute management of femoral neck fractures was calculated at J$46 264 528.76 which is 0.30% of the 2005-2006 budgetary allocation for health. This cost was significantly associated with the length of hospital stay and the number of complications developed.
Assuntos
Artrite/imunologia , Gonorreia/imunologia , Lúpus Eritematoso Sistêmico/imunologia , Adulto , Artrite/complicações , Artrite/diagnóstico , Diagnóstico Diferencial , Feminino , Gonorreia/complicações , Gonorreia/diagnóstico , Gonorreia/tratamento farmacológico , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Neisseria gonorrhoeae/imunologia , SíndromeRESUMO
BACKGROUND: Studies of medical student outcome have been used to assist in medical manpower planning. There have been no published studies on medical graduates of The University of the West Indies (UWI). This study investigates the demographic characteristics, professional and social outcomes of the Class of 1982a, twenty-five years after qualification. METHOD: Data on demographic characteristics at entry and academic performance during medical school were obtained from UWI administrative records. Data on specialty training, migration and current social status were obtained by interview. Statistical analysis was conducted using simple frequencies, chi-square and t-tests. RESULTS: There was an intake of 110 students with 108 completing the course. The mean age at entry was 21.8 ± 3.0 years; 74.0% were male. Some 80.6% of students were from Jamaica, Trinidad and Tobago, and Barbados. Only 15.7% were admitted directly from high school. A quarter of students were scholarship awardees, with the majority being from Eastern Caribbean countries (p < 0.001). Female students outperformed male students (p < 0.05). Just over 70% of graduates pursued post-graduate training, the majority in North America. Approximately two-thirds of graduates were practising in the Caribbean region. Almost all graduates (95.0%) trained in the Caribbean were practising in the region but less than a third of those trained elsewhere were (p < 0.001). CONCLUSION: This study has provided important information on choice of specialty training, migration and the associated factors twenty-five years ago. The information provided can therefore be used as a base for examining the trends in medical education over time and the factors influencing these trends, allowing for better planning of the manpower needs of the region.
ANTECEDENTES: Se han usado estudios de los resultados en estudiantes de medicina para ayudar en la planificación de los recursos humanos en la medicina. No ha habido ningún estudio sobre los graduados de medicina de la Universidad de West Indies. Este estudio investiga las características demográficas, y los resultados profesionales y sociales de la Clase de 1982a, veinticinco años después de que adquirieran su calificación. MÉTODOS: A partir de datos que obran en los archivos administrativos de la Universidad UWI, se obtuvieron datos de las características demográficas al momento del ingreso, y del rendimiento académico. Los datos sobre el entrenamiento en relación con la especialidad, la migración y estado social actual, fueron obtenidos mediante entrevista. El análisis estadístico se llevó a cabo usando frecuencias simples, chi-cuadrado y pruebas t. RESULTADOS: Hubo un registro de 110 estudiantes, de los cuales 108 terminaron el curso. La edad promedio al momento del ingreso fue 21.8 ± 3.0 años; 74.0% eran varones. Alrededor del 80.6% de los estudiantes eran de Jamaica, Trinidad y Tobago, y Barbados. Sólo el 15.7% ingresaron directamente de la escuela secundaria. Un cuarto de los estudiantes había recibido becas, y procedía en su mayoría de países del Caribe Oriental (p < 0.001). El rendimiento de las estudiantes hembras estuvo por encima del de los estudiantes varones (p < 0.05). Más del 70% de los graduados pasaron entrenamientos de postgrado, la mayor parte de ellos en los Estados Unidos de Norteamérica. Aproximadamente dos tercios de los graduados estuvieron de práctica en la región del Caribe. Casi todos los graduados (95.0%) entrenados en el Caribe, estuvieron practicando en la región, pero menos de un tercio de los entrenados en otra parte fue (p < 0.001). CONCLUSIÓN: Este estudio ha proporcionado información importante sobre la opción de especialización, migración, y los factores asociados, hace veinte años. Por tanto, la información proporcionada puede usarse como base para examinar las tendencias en la educación médica en un período de tiempo. De igual modo pueden examinarse los factores que influyen sobre estas tendencias, haciendo posible de ese modo una mejor planificación de las necesidades de recursos humanos de la región..
Assuntos
Adulto , Feminino , Humanos , Masculino , Escolha da Profissão , Estudantes de Medicina/estatística & dados numéricos , Demografia , Índias OcidentaisRESUMO
BACKGROUND: Studies of medical student outcome have been used to assist in medical manpower planning. There have been no published studies on medical graduates of The University of the West Indies (UWI), This study Investigates the demographic characteristics, professional and social outcomes of the Class of 1982a, twenty-five years after qualification. METHOD: Data on demographic characteristics at entry and academic performance during medical school were obtained from UWI administrative records. Data on specialty training, migration and current social status were obtained by interview. Statistical analysis was conducted using simple frequencies, chi-square and t-tests. RESULTS: There was an intake of 110 students with 108 completing the course. The mean age at entry was 21.8 +/- 3.0 years; 74.0% were male, Some 80.6% of students were from Jamaica, Trinidad and Tobago, and Barbados. Only 15.7% were admitted directly from high school. A quarter of students were scholarship awardees, with the majority being from Eastern Caribbean countries (p < 0.001). Female students outperformed male students (p < 0.05), Just over 70% of graduates pursued postgraduate training, the majority in North America. Approximately two-thirds of graduates were practicing in the Caribbean region. Almost all graduates (95.0%) trained in the Caribbean were practicing in the region but less than a thitrd of those trained elsewhere were (p < 0.001). CONCLUSION: This study has provided important information on choice of specialty training, migration and the associated factors twenty-five years ago. The information provided can therefore be used as a base for examining the trends in medical education over time and the factors influencing these trends, allowing for better planning of the manpower needs of the region.
Assuntos
Escolha da Profissão , Estudantes de Medicina/estatística & dados numéricos , Adulto , Demografia , Feminino , Humanos , Masculino , Índias OcidentaisRESUMO
Tuberculosis affects a significant percentage of the world's population and is responsible for bone and joint infections particularly in the developing world. The problem has been compounded by the HIV/ AIDS epidemic. Whereas tuberculous involvement of the spine is readily included in a list of differentials for destructive lesions of the spine, infection in other skeletal areas is often not considered. In endemic areas, physicians are aware of the clinical and radiological presentations of musculoskeletal tuberculosis. In non-endemic areas, this knowledge is often lacking. Diagnostic delay often results in increased morbidity and mortality. There is a need therefore to highlight extra-spinal osteoarticular tuberculosis as a real entity.
Assuntos
Tuberculose Osteoarticular/diagnóstico , Acetábulo , Adulto , Idoso , Antituberculosos/uso terapêutico , Diagnóstico Diferencial , Evolução Fatal , Feminino , Fêmur , Pé , Humanos , Lactente , Masculino , Ombro , Tuberculose Osteoarticular/tratamento farmacológicoRESUMO
The authors present a case of disseminated granuloma inguinale with bilateral psoas abscesses. Infection with calymmatobacterium granulomatis is usually localized to the genital organs but rarely may be disseminated. A search of the literature revealed that only two cases of psoas abscesses due to calymmatobacterium granulomatis were previously reported.
Los autores presentan un caso de granuloma inguinal diseminado con abscesos bilaterales de psoas. La infección con calymmatobacterium granulomatis normalmente se localiza en los órganos genitales, y raramente se disemina. La literatura reveló sólo dos casos de abscesos de psoas debidos a calymmatobacterium granulomatis reportados con anterioridad.
Assuntos
Humanos , Feminino , Adulto , Abscesso do Psoas/complicações , Abscesso do Psoas/diagnóstico , Granuloma Inguinal/complicações , Granuloma Inguinal/diagnóstico , Imuno-Histoquímica , Abscesso do Psoas/tratamento farmacológico , Antibacterianos/uso terapêutico , Biópsia por Agulha , Doenças Raras , Granuloma Inguinal/tratamento farmacológico , Medição de Risco , Países em Desenvolvimento , Resultado do Tratamento , Seguimentos , Tomografia Computadorizada por Raios X , Índias Ocidentais , Índice de Gravidade de DoençaRESUMO
Tuberculosis affects a significant percentage of the world's population and is responsible for bone and joint infections particularly in the developing world. The problem has been compounded by the HIV/ AIDS epidemic. Whereas tuberculous involvement of the spine is readily included in a list of differentials for destructive lesions of the spine, infection in other skeletal areas is often not considered. In endemic areas, physicians are aware of the clinical and radiological presentations of musculoskeletal tuberculosis. In non-endemic areas, this knowledge is often lacking. Diagnostic delay often results in increased morbidity and mortality. There is a need therefore to highlight extra-spinal osteoarticular tuberculosis as a real entity
La tuberculosis afecta a un porcentaje significativo de la población mundial, y es causa de infecciones en los huesos y las articulaciones, particularmente en los países en vías de desarrollo. El problema ha sido agravado por la epidemia del HIV/AIDS. Mientras que la tuberculosis vertebral suele incluirse con prontitud en la lista de diagnósticos diferenciales de las lesiones destructivas de la columna vertebral, la infección en otras áreas de la estructura ósea a menudo se pasa por alto. En las regiones endémicas, los médicos conocen las manifestaciones clínicas y radiológicas de la tuberculosis músculoesqueletal. En las regiones no endémicas, este conocimiento está a menudo ausente. Con frecuencia, la demora en el diagnóstico trae como consecuencia una mayor morbosidad y mortalidad. Por lo tanto, se hace necesario prestar atención a la tuberculosis osteoarticular extraespinal como una entidad real