RESUMO
Pulmonary contusion (PC), defined as damage to the lung parenchyma with edema and hemorrhage, has classically been associated with acceleration-deceleration injuries. It is a frequent pathology in clinical practice. However, its clinical presentation and imaging findings are nonspecific. Patients with this entity can present with findings that can range from mild dyspnea to life-threatening respiratory failure and hemodynamic instability. We present the case of a 61-year-old man, a former smoker, who presented to the emergency department after suffering blunt chest trauma. On admission, he complained of only mild shortness of breath, and his vital signs were typical. Initial imaging identified asymmetric pulmonary infiltrates and mediastinal lymphadenopathy; this was suspicious for additional pathology in addition to PC. After an exhaustive evaluation, a neoplastic or infectious disease process was ruled out. Even though the patient presented with a clinical deterioration of respiratory function compatible with secondary acute respiratory distress syndrome, there was a complete recovery after supportive measures and supplemental oxygen. In conclusion, the nonspecific clinical and imaging findings in patients with pulmonary contusion warrant a complete evaluation of these cases. An early diagnosis is essential to establish adequate support and monitoring to prevent possible complications that could worsen the patient's prognosis.
Assuntos
Contusões , Lesão Pulmonar , Ferimentos não Penetrantes , Humanos , Masculino , Pessoa de Meia-Idade , Contusões/diagnóstico por imagem , Lesão Pulmonar/diagnóstico por imagem , Lesão Pulmonar/etiologia , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/diagnóstico por imagem , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Pulmão/diagnóstico por imagem , Dispneia/etiologiaRESUMO
Introducción: La lesión traumática de la médula espinal es la principal causa mundial de discapacidad motora y una prioridad para la OMS. El objetivo de esta investigación fue estudiar el efecto de la hipotermia terapéutica tras una contusión medular. Materiales y Métodos: Se utilizaron ratas macho a las que se les generó una contusión medular. Se formaron cuatro grupos (6 animales por grupo): a) de control, b) con lesión en normotermia (24 °C, sacrificados 12 h después de la lesión, c) con lesión en normotermia (24 °C, sacrificados 24 h después de la lesión) y d) lesión en hipotermia (8 °C, durante 180 min, sacrificados 24 h después de la lesión). Se estudió la expresión de la CIRBP, la caspasa-3 y la Neu-N. Resultados: La lesión medular aumentó ligeramente la expresión de CIRBP a las 24 h y, de manera importante, la de caspasa-3, todo acompañado por imágenes de motoneuronas dañadas en el asta anterior. En los animales tratados con hipotermia, se observó una alta expresión de CIRBP y niveles muy bajos de caspasa-3, que no se distinguen de los controles. El número de motoneuronas viables se restauró parcialmente. Conclusiones: Este modelo experimental resultó eficaz para inducir una lesión medular, demostró la protección neuronal mediada por hipotermia. El aumento de la expresión de CIRBP en la médula espinal de ratas con lesión e hipotermia comparado con el del grupo normotérmico abre el camino para un posible uso de sustancias que incrementen la CIRBP como terapéutica para las lesiones medulares contusivas. Nivel de Evidencia: I
Introduction: Traumatic spinal cord injury is the leading cause of motor disability worldwide, and the WHO considers it a priority. This study sought to investigate the effects of therapeutic hypothermia following spinal cord contusion. Materials and Methods: Male rats that underwent experimental spinal cord contusion were used. For this purpose, four experimental groups were created (n=6 per group): a) control, b) lesion in normothermia (24°C, sacrificed 12h after the injury), c) lesion in normothermia (24°C, sacrificed 24h after the injury), and d) hypothermic injury (8°C for 180 min, sacrificed 24h after the injury). The expression of cold-inducible RNA-binding protein (CIRBP), Caspase-3, and NeuN was studied. Results: At 24 hours, spinal cord damage raised CIRBP expression slightly while also increasing Caspase-3 significantly. All of this was accompanied by images of damaged motor neurons in the anterior horn. In animals treated with hypothermia, high expression of CIRBP and very low levels of Caspase-3 were observed, which were indistinguishable from controls. Furthermore, the number of viable motor neurons was partially restored. Conclusions: The experimental model developed in this study was effective at inducing spinal cord injury, demonstrating neuronal protection through hypothermia. The increased expression of CIRBP in the spinal cord of rats with injury and hypothermic treatment when compared to the normothermic group suggests the possibility of using substances that increase CIRBP as therapies for the treatment of contusive spinal cord injuries. Level of Evidence: I
Assuntos
Animais , Ratos , Traumatismos da Medula Espinal , Proteínas de Ligação a RNA , Contusões , HipotermiaRESUMO
OBJECTIVE: to analyze the prevalence of types of trauma, resulting injuries and managements in children and adolescents between 0 and 17 years old, treated in an Emergency Room in 2019. METHODS: a retrospective cross-sectional descriptive study carried out by collecting data from medical records from January to December of 2019, encompassing pediatric trauma victims, divided according to age groups: infants (0-1 year), preschool children (2-4 years), school children (5-10 years) and adolescents (11-17 years). RESULTS: 3,741 patients records were included in the study. The search for assistance occurred spontaneously in about 70% of the cases and males were the most affected at all ages. In infants and preschoolers, the main mechanism of trauma was fall from heights, corresponding to 57.2% and 34.1%, respectively, whereas in school children and adolescents, the main mechanism was ground-level falls (38%) and sports trauma (22,3%), in this order. The main injuries presented, in general, were traumatic brain injury (28,2%), upper limb contusion (23,2%) and upper limb fractures (16,3%). CONCLUSIONS: the profile of the victims analyzed indicates the male sex as the most affected, with the trauma mechanism being the differential according to age. The most frequent mechanism is falls, more prevalent in infants and preschoolers, and the most common injury is extremity contusion, with the upper limbs being the most affected. In general, the cases were considered of low complexity, with a hospitalization rate of 6%.
Assuntos
Lesões Encefálicas Traumáticas , Contusões , Myrtaceae , Adolescente , Lactente , Pré-Escolar , Humanos , Masculino , Criança , Recém-Nascido , Estudos Transversais , Estudos Retrospectivos , HospitaisRESUMO
OBJECTIVE: The aim of this study was to evaluate the best timing and feasibility of intrathecal application of sodium monosialoganglioside (GM1) after spinal cord contusion in Wistar rats as an experimental model. METHODS: Forty Wistar rats were submitted to contusion spinal cord injury after laminectomy. The animals were randomized and divided into four groups: Group 1 - Intrathecal application of GM1 24 hours after contusion; Group 2 - Intrathecal application of GM1 48 hours after contusion; Group 3 - intrathecal application of GM1 72 hours after contusion; Group 4 - Sham, with laminectomy and intrathecal application of 0.5 mL of 0.9% saline solution, without contusion. The recovery of locomotor function was evaluated at seven different moments by the Basso, Beattie, and Bresnahan (BBB) test. They were also assessed by the horizontal ladder, with sensory-motor behavioral assessment criteria, pre-and postoperatively. RESULTS: This experimental study showed better functional scores in the group submitted to the application of GM1, with statistically significant results, showing a mean increase when evaluated on known motor tests like the horizontal ladder and BBB, at all times of evaluation (p < 0.05), especially in group 2 (48 hours after spinal cord injury). Also, fewer mistakes and slips over the horizontal ladder were observed, and many points were achieved at the BBB scale analysis. CONCLUSION: The study demonstrated that the intrathecal application of GM1 after spinal cord contusion in Wistar rats is feasible. The application 48 hours after the injury presented the best functional results.
Assuntos
Contusões , Traumatismos da Medula Espinal , Ratos , Animais , Ratos Wistar , Gangliosídeo G(M1) , Recuperação de Função Fisiológica , Medula Espinal , Modelos Animais de DoençasRESUMO
to examine the effect of the medium intensity coughing technique during subcutaneous low molecular weight heparin injection on pain severity and individual satisfaction in general surgery patients. the prospective, quasi-experimental study included 100 patients who had been prescribed a subcutaneous low molecular weight heparin injection once in 24 hours. Each patient received two injections by the same researcher, one using the standard injection technique with medium intensity coughing technique and the other only the standard injection technique. there was a statistically significant difference between patients' mean scores on pain severity and satisfaction levels after injections administered by the two techniques (p= 0.000). Also, it was found that gender affected pain severity relating to the injection but did not affect the level of individual satisfaction. the medium intensity coughing technique was found to reduce pain severity and increase patient satisfaction in general surgery patients receiving subcutaneous low molecular weight heparin injections. Trial registration: NCT05681338.
examinar el efecto de la técnica de tos de mediana intensidad durante la inyección subcutánea de heparina de bajo peso molecular sobre la severidad del dolor y la satisfacción individual en pacientes de cirugía general. estudio prospectivo, cuasi experimental, que incluyó a 100 pacientes a los que se les prescribió una inyección subcutánea de heparina de bajo peso molecular una vez cada 24 horas. Cada paciente recibió dos inyecciones por el mismo investigador utilizando técnica de inyección estándar con técnica de tos de intensidad media y solo técnica de inyección estándar. hubo una diferencia estadísticamente significativa entre las puntuaciones medias de los pacientes sobre la intensidad del dolor y los niveles de satisfacción después de las inyecciones administradas por las dos técnicas (p= 0,000). Además, se encontró que el género afectó la severidad del dolor relacionado con la inyección, pero no afectó el nivel de satisfacción individual. se encontró que la técnica de tos de intensidad media reduce la severidad del dolor y aumenta la satisfacción del paciente de cirugía general que reciben inyecciones subcutáneas de heparina de bajo peso molecular. Registro del ensayo: NCT05681338.
examinar o efeito da técnica de tosse de média intensidade durante injeção subcutânea de heparina de baixo peso molecular na intensidade da dor e satisfação individual em pacientes submetidos à cirurgia geral. estudo prospetivo, quasi experimental que incluiu 100 pacientes que haviam recebido uma injeção subcutânea de heparina de baixo peso molecular em 24 horas. Cada paciente recebeu duas injeções pelo mesmo pesquisador usando a técnica de injeção padrão com técnica de tosse de média intensidade e apenas técnica de injeção padrão. houve diferença estatisticamente significativa entre as pontuações médias dos pacientes quanto à gravidade da dor e níveis de satisfação após as injeções administradas pelas duas técnicas (p = 0,000). Além disso, verificou-se que o sexo do paciente afetou a intensidade da dor relacionada à injeção, mas não afetou o nível de satisfação individual. a técnica de tosse de média intensidade reduz a intensidade da dor e aumenta a satisfação de pacientes submetidos à cirurgia geral recebendo injeções subcutâneas de heparina de baixo peso molecular. Registro do ensaio clínico: NCT05681338.
Assuntos
Contusões , Heparina , Humanos , Anticoagulantes , Heparina de Baixo Peso Molecular , Medição da Dor , Estudos Prospectivos , Fatores de TempoRESUMO
The aim of this study was to evaluate pre-slaughter risk factors on the probability of bruising and the number of bruises in different regions of the bovine carcass. The study evaluated the data from 4061 batches of slaughtered cattle, totalling 199,026 carcasses, from Hereford and Aberdeen Angus animals in crosses with continental European breeds and Zebu cattle. The factors that caused injury were sex, handling conditions (score), vehicle type, vehicle load density (kg/m2), travel time (minutes), travel distance (kilometres), physiological maturity (dentition), animal reactivity (score), and carcass fat (score). The type of vehicle had the greatest influence on the probability of carcass bruising and affected all carcass cuts. More bruising occurred in vehicles with a greater load capacity. A higher chance of bruising was seen in groups of older animals, those with an excitable temperament and, especially, in groups of females. Higher load densities during transport resulted in a greater chance of bruising occurring in all cuts except the hindquarters. Distance and travel time are unstable in the models, but also detrimental, increasing the probability of bruising and the number of bruises in the various cuts. The results of this study suggest that good practices in the welfare, handling and transport of the animals, as well as training the personnel responsible for their handling, should be adopted to minimise the risk of injury at different locations on the carcass.
Assuntos
Doenças dos Bovinos , Contusões , Feminino , Bovinos , Animais , Meios de Transporte/métodos , Carne , Matadouros , Bem-Estar do Animal , Contusões/veterinária , Contusões/etiologia , Fatores de Risco , CadáverRESUMO
Este estudo teve como objetivo identificar o risco de desenvolvimento de transtorno de estresse pós-traumático (TEPT), bem como sua associação com pensamentos ou tentativas suicidas e a saúde mental de policiais militares feridos por arma de fogo, na Região Metropolitana de Belém (RMB), nos anos de 2017 a 2019. A pesquisa contou com a participação de 30 entrevistados, que responderam o Inventário Demográfico e a Lista de verificação de TEPT para o DSM-5 (PCL-5). Para análise dos dados, utilizou-se a técnica estatística Análise Exploratória de Dados e a técnica multivariada Análise de Correspondência. Os resultados revelaram a existência de risco de desenvolvimento do transtorno de forma parcial ou total em uma expressiva parcela da população entrevistada, tendo homens como maioria dos sintomáticos, com média de 38 anos, exercendo atividades operacionais e vitimados em via pública quando estavam de folga do serviço. O ferimento deixou a maioria com sequelas, com destaque para dores crônicas, limitações de locomoção e/ou mobilidade e perda parcial de um membro. E, ainda, policiais sintomáticos apresentaram comportamentos suicidas, relatando já terem pensado ou tentado tirar a própria vida. Desta forma, conclui-se que policiais militares são expostos constantemente a traumas inerentes a sua profissão. Quando há ameaça de vida, como nos casos de ferimentos por arma de fogo, são suscetíveis a sequelas físicas decorrente do ferimento, somadas a sequelas mentais tardias, como o surgimento de sintomatologias de TEPT e ideação suicida.(AU)
This study aimed to identify the risk of developing post-traumatic stress disorder (PTSD) and its associations around suicidal thoughts or attempts and mental health in military police officers injured by firearms, in the Metropolitan Region of Belem (RMB), from 2017 to 2019. The research had the participation of 30 respondents who answered the Demographic Inventory and the PTSD checklist for DSM-5 (PCL-5). For data analysis, we used the statistical technique Exploratory Data Analysis and the multivariate technique Correspondence Analysis. The results revealed the existence of risk of developing partial or total disorder in a significant portion of the interviewed population, with men as most of the symptomatic individuals, with mean age of 38 years, developing operational activities and victimized on public roads when they were off duty. The injuries left most of them with sequelae, especially chronic pain, limited locomotion and/or mobility, and partial loss of a limb. In addition, symptomatic officers showed suicidal behavior, such as reporting they had thought about or tried to take their own lives. Thus, we conclude that military policemen are constantly exposed to traumas inherent to their profession. When their lives are threatened, as in the case of firearm wounds, they are susceptible to physical sequelae resulting from the injury, in addition to late mental sequelae, such as the appearance of PTSD symptoms and suicidal ideation.(AU)
Este estudio tuvo como objetivo identificar el riesgo de desarrollo de trastorno de estrés postraumático (TEPT) y sus asociaciones con pensamientos o tentativas suicidas y la salud mental en policías militares heridos por armamiento de fuego, en la Región Metropolitana de Belém (Brasil), en el período entre 2017 y 2019. En el estudio participaron 30 entrevistados que respondieron el Inventario Demográfico y la Lista de verificación de TEPT para el DSM-5 (PCL-5). Para el análisis de datos se utilizaron la técnica estadística Análisis Exploratoria de Datos y la técnica multivariada Análisis de Correspondencia. Los resultados revelaron que existen riesgos de desarrollo de trastorno de estrés postraumático de forma parcial o total en una expresiva parcela de la población de policías entrevistados, cuya mayoría de sintomáticos eran hombres, de 38 años en media, que ejercen actividades operacionales y fueron victimados en vía pública cuándo estaban de día libre del servicio. La lesión dejó la mayoría con secuelas, especialmente con dolores crónicos, limitaciones de locomoción y/o movilidad y la pierda parcial de un miembro. Aún los policías sintomáticos presentaran comportamiento suicida, tales como relataran qué ya pensaron o tentaron quitar la propia vida. Se concluye que los policías militaran se exponen constantemente a los traumas inherentes a su profesión. Cuando existe amenaza de vida, como en los casos de heridas por armamiento de fuego, son expuestos a secuelas físicas transcurridas de la herida, sumado a secuelas mentales tardías, como el surgimiento de sintomatologías de TEPT y la ideación suicida.(AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Dor , Ferimentos e Lesões , Ferimentos por Arma de Fogo , Sintomas Psíquicos , Risco , Angústia Psicológica , Ansiedade , Transtornos de Ansiedade , Transtornos Fóbicos , Prisões , Psicologia , Comportamento de Esquiva , Segurança , Atenção , Transtornos do Sono-Vigília , Transtornos de Estresse Pós-Traumáticos , Suicídio , Tentativa de Suicídio , Terapêutica , Violência , Sintomas Comportamentais , Jornada de Trabalho , Esgotamento Profissional , Adaptação Psicológica , Catatonia , Terapia Cognitivo-Comportamental , Saúde Ocupacional , Comportamento Autodestrutivo , Defesa Civil , Direitos Civis , Transtorno de Pânico , Setor Público , Cognição , Eficiência Organizacional , Contusões , Vítimas de Crime , Transtornos Relacionados ao Uso de Substâncias , Senso de Humor e Humor , Crime , Estado de Alerta em Emergências , Programa de Defesa Civil , Proteção Civil , Processo Legal , Morte , Manual Diagnóstico e Estatístico de Transtornos Mentais , Agressão , Depressão , Tontura , Sonhos , Alcoolismo , Reação de Fuga , Prevenção de Doenças , Vigilância em Saúde do Trabalhador , Vigilância do Ambiente de Trabalho , Fadiga Mental , Medo , Catastrofização , Medicalização , Esperança , Atenção Plena , Comportamento Criminoso , Transtornos Relacionados a Trauma e Fatores de Estresse , Trauma Psicológico , Abuso Físico , Excitabilidade Cortical , Equilíbrio Trabalho-Vida , Estresse Ocupacional , Violência com Arma de Fogo , Redução de Riscos de Desastres , Cinesiofobia , Bem-Estar Psicológico , Prevenção do Suicídio , Prevenção de Acidentes , Culpa , Cefaleia , Promoção da Saúde , Homicídio , Distúrbios do Início e da Manutenção do Sono , Satisfação no Emprego , Transtornos MentaisRESUMO
A Homeopatia é uma ciência fundamentada na observação dos fenômenos naturais. Segundo Hahnemann, a cura homeopática é aquela que acontece de acordo com as leis naturais, sendo uma delas a lei dos semelhantes, já descrita por muitos médicos desde a antiguidade, inclusive Hipócrates. Quando são seguidos os princípios estipulados por Hahnemann, considerando a totalidade sintomática, incluindo a escolha do medicamento, sua potência, dose e frequência de administração, o tratamento homeopático torna-se eficaz tanto em casos crônicos quanto nos agudos, "sendo capaz de aniquilar a doença sem produzir novos e sérios distúrbios". Este estudo tem como objetivo exemplificar como, seguindo os princípios estipulados, a Homeopatia pode ser eficaz no tratamento de um quadro agudo que não obteve sucesso com a terapêutica alopática convencional. Trata-se de um relato de caso de paciente de 64 anos, sem doença prévia instalada, com ferimento corto- -contuso em mão esquerda após queda da própria altura, mantendo sinais flogísticos e ausência de cicatrização 13 dias após a realização da sutura e de fazer uso regular de antibiótico e anti-inflamatório prescritos. Após a avaliação da totalidade sintomática, foi prescrito Belladonna 6cH, administrada pelo método plus, resultando em alívio imediato dos sintomas e cura total em 5 dias. Realizando com cautela o diagnóstico homeopático e a partir disso elegendo o medicamento mais similar ao caso, com potência, dose e frequência de administração adequadas, é possível obter resultados eficazes com o tratamento homeopático, sempre considerando a constituição do indivíduo.
Homeopathy is a science based on the observation of phenomena natural. According to Hahnemann, homeopathic cure is one that happens according to natural laws, one of which is the law of similars, already described by many doctors since ancient times, including Hippocrates. When the principles stipulated by Hahnemann, considering the symptomatic totality, including the choice of the medicine, its potency, dose and frequency of administration, the Homeopathic treatment becomes effective in both chronic and in acute cases, "being capable of annihilating the disease without producing new and serious disturbances." This study aims to exemplify how, following the stipulated principles, Homeopathy can be effective in treatment of an acute condition that has not been successful with therapy conventional allopathic. This is a patient case report 64 years old, with no previous illness, with a cut wound-bruise in the left hand after falling from a height, maintaining phlogistic signs and lack of healing 13 days after the procedure suture and regular use of prescribed antibiotics and anti-inflammatory drugs. After evaluating the totality of symptoms, Belladonna was prescribed 6cH, administered by the plus method, resulting in immediate relief of symptoms and complete cure in 5 days. Carrying out the diagnosis with caution homeopathic and from there choosing the medicine most similar to the case, with adequate potency, dose and frequency of administration, it is possible to obtain effective results with homeopathic treatment, always considering the constitution of the individual.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Medicamento Homeopático , Terapêutica Homeopática , Contusões/terapia , Atropa belladonnaRESUMO
To describe imaging findings of pulmonary contusions (PC) in adults and children using multidetector computed tomography (CT) scanners. We conducted a retrospective single center study. All chest multidetector computed tomography (MDCT) scans of victims of blunt trauma admitted to the emergency unit of a reference trauma center of Brazil between January 2015 and December 2016 were reviewed in search of opacities compatible with PC. The CT images were analyzed in conjunction with medical records, that provided demographic and clinical data. The obtained data were analyzed in the overall population and comparing children and adults. Significant P value was defined as <.05. 52.7% of patients presented bilateral opacities. Middle third, posterior and peripheral portions of the lungs were more frequently affected, in the craniocaudal, anteroposterior and axial axes, respectively. A vast majority of patients (80.6%) presented multiple opacities, whereas a minority showed subpleural sparing (26.9%) and fissure crossing (22.6%), with similar frequencies in children and adults. Children, although, more frequently presented consolidation and more diffuse lesions in the anteroposterior axis compared to adults, with statistically significant differences. PC usually are multiple and predominate in middle, posterior and peripheral portions of the lungs. Subpleural sparing and fissure crossing seems to be infrequent and have similar frequencies between children and adults. Although, there are differences between these age groups, as younger people tend to have more consolidation and diffuse opacities in the anteroposterior axis than older ones.
Assuntos
Contusões , Pneumopatias , Lesão Pulmonar , Ferimentos não Penetrantes , Adulto , Criança , Contusões/diagnóstico por imagem , Humanos , Pneumopatias/diagnóstico por imagem , Lesão Pulmonar/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Estudos Retrospectivos , Ferimentos não Penetrantes/diagnóstico por imagemRESUMO
It is well known that transporting livestock is stressful for the animals and a primary cause of skin lesions. The effects of transport on the water buffalo (Bubalus bubalis) have not been studied extensively despite reports of high incidences of trauma during and after these mobilizations. The present review article analyzes the frequency of skin injuries suffered by water buffaloes during transport and several key contributing factors. It also discusses the consequences of injuries on the quality of carcasses. Important aspects identified include inappropriate vehicle design that does not comply with the dimensions recommended by international institutions (e.g., height, type of flooring, characteristics of the ramp), handling methods, and the ability of stock people to manage water buffaloes, all of which impact the incidence of injuries. Our analysis of these elements will contribute to identifying critical control points and areas of opportunity while also suggesting strategies to ensure the welfare of these animals during transport and the quality of water buffalo products and by-products.