Vascular trauma in the Amazon - the challenge of great distances

ABSTRACTObjective:to evaluate the incidence of unfavorable outcomes in vascular trauma patients and their possible correlation to the distance between the city where the injury was sustained and the hospital where the patient received definitive treatment.Methods:descriptive and retrospective study. Data were collected from medical records of patients submitted to surgical procedures for arterial or venous injuries from February 2011 to February 2013 at the only trauma center providing vascular surgery in a vast area of the Amazon region. Trauma date, patient gender and age, mechanism and anatomic topography of injury, surgical management, need for surgical re-intervention, hospitalization period, postoperative complications, mortality and limb amputation rates were analyzed. The incidence of unfavorable outcomes was assessed according to the distance between the city where the vascular injury was sustained and the trauma center.Results: One hundred seventy-three patients with 255 vascular injuries were analyzed; 95.95% were male (p<0.05), mean age of 28.92 years; 47.4% were caused by firearm projectiles (p<0.05); topographic distribution: 45.66% lower limbs (p<0.05), 37.57% upper limbs, 6.94% abdominal, 5.2% thoracic and 4.62% were cervical vascular injuries; 51.42% of patients required hospitalization for seven days or less (p<0.05); limb amputation was necessary in 15.6% and the overall mortality was 6.36%.Conclusion:distances greater than 200Km were associated to longer hospitalization period; distances greater than 300Km were associated to increased limb amputation probability; severe vascular trauma have an increased death probability when patients need to travel more than 200Km for surgical treatment.

Implementation of the trauma registry as a tool for quality improvement in trauma care in a brazilian hospital: the first 12 months

ABSTRACTObjective:to analyze the implementation of a trauma registry in a university teaching hospital delivering care under the unified health system (SUS), and its ability to identify points for improvement in the quality of care provided.Methods:the data collection group comprised students from medicine and nursing courses who were holders of FAPESP scholarships (technical training 1) or otherwise, overseen by the coordinators of the project. The itreg (ECO Sistemas-RJ/SBAIT) software was used as the database tool. Several quality "filters" were proposed to select those cases for review in the quality control process.Results:data for 1344 trauma patients were input to the itreg database between March and November 2014. Around 87.0% of cases were blunt trauma patients, 59.6% had RTS>7.0 and 67% ISS<9. Full records were available for 292 cases, which were selected for review in the quality program. The auditing filters most frequently registered were laparotomy four hours after admission and drainage of acute subdural hematomas four hours after admission. Several points for improvement were flagged, such as control of overtriage of patients, the need to reduce the number of negative imaging exams, the development of protocols for achieving central venous access, and management of major TBI.Conclusion: the trauma registry provides a clear picture of the points to be improved in trauma patient care, however, there are specific peculiarities for implementing this tool in the Brazilian milieu.

Epidemiological evaluation of hepatic trauma victims undergoing surgery

Objective : to evaluate the epidemiological variables and diagnostic and therapeutic modalities related to hepatic trauma patients undergoing laparotomy in a public referral hospital in the metropolitan region of Vitória-ES. Methods : we conducted a retrospective study, reviewing charts of trauma patients with liver injuries, whether isolated or in association with other organs, who underwent exploratory laparotomy, from January 2011 to December 2013. Results : We studied 392 patients, 107 of these with liver injury. The male: female ratio was 6.6 : 1 and the mean age was 30.12 years. Penetrating liver trauma occurred in 78.5% of patients, mostly with firearms. Associated injuries occurred in 86% of cases and intra-abdominal injuries were more common in penetrating trauma (p <0.01). The most commonly used operative technique was hepatorrhaphy and damage control surgery was applied in 6.5% of patients. The average amounts of blood products used were 6.07 units of packed red blood cells and 3.01 units of fresh frozen plasma. The incidence of postoperative complications was 29.9%, the most frequent being infectious, including pneumonia, peritonitis and intra-abdominal abscess. The survival rate of patients suffering from blunt trauma was 60%, and penetrating trauma, 87.5% (p <0.05). Conclusion : despite technological advances in diagnosis and treatment, mortality rates in liver trauma remain high, especially in patients suffering from blunt trauma in relation to penetrating one.

Morphology and histochemistry of glandular trichomes of Cordia verbenacea DC. (Boraginaceae) leaves

The objective of this work was to study, using light and fluorescence microscopy and scanning electron microscopy, the morphology and secretory products of glandular trichomes of Cordia verbenacea DC. (Boraginaceae), known as 'baleeira', a species used in folk medicine as anti-inflammatory, analgesic, anti-ulcerogenic and healing agent. Two classes of glandular trichomes were recognized, globular and reniform. A morphological study of the secretory head and the characterization of the secretory product are also presented. Secretory products of globular trichomes consisted of essential oils, whereas reniform trichomes consisted basically of phenolic compounds such as flavonoids. No pre-established regions for releasing secretory products were found.

Methods of discard ewes carcass suspension and the quality of meat

The objective of this study was to evaluate the carcass suspension method concerning quality of sheep meat. Ten discard ewes were used, with approximately 62 kg of body weight. After slaughtering, flaying, evisceration and removal of head and paws, carcasses were longitudinally divided into two parts. Alternated sides of half carcasses were hanged by the tendon of the gastrocnemius (Treatment 1 - T1) and by the pelvic bone (Treatment 2 - T2) in cold store for a 24-hour period. Subsequently, the Semimembranosus muscle was removed from all half carcasses for meat quality analyses. The Semimembranosus muscles from the carcasses hanged by the pelvis suspension method presented higher softness than the same muscles from the carcasses hanged by the tendon of the gastrocnemius, with values of 1.99 kgf.cm-2 and 3.15 kgf.cm-2, respectively. Treatment 2 presented lower meat cooking losses than Treatment 1, with average values of 32.14 and 33.44%, respectively. The remaining meat quality parameters evaluated were not influenced by the carcass suspension method. We concluded that the carcass suspension method influenced meat softness and losses by cooking, with better results for carcasses hanged by the pelvic bone.

Processing, physicochemical, and sensory analyses of ostrich meat hamburger

The objective of this study was to assess the potential utilization of ostrich meat trimming in hamburger preparation, as well as its physicochemical and sensory characterization. Using ostrich meat trimmings from the legs and neck, four different formulations were prepared with varied amounts of bacon and textured soybean protein. Physical analysis of yield, shrinkage percentage, and water retention capacity and chemical analysis of proximate composition, cholesterol levels, and calories were performed. The formulations underwent sensory analysis by 52 potential ostrich meat consumers, who evaluated tenderness, juiciness, flavor, and purchase intent. The formulations containing textured soybean protein showed the highest yield, lowest shrinkage percentage, and highest water retention capacity. Lipid content varied from 0.58 to 4.99%; protein from 17.08 to 21.37%; ash from 3.00 to 3.62%; moisture from 73.87 to 76.27%; cholesterol from 22.54 to 32.11 mg.100 g-1; and calorie from 87.22 to 163.42 kcal.100 g-1. All formulations showed low cholesterol and calorie levels, even that containing 10% bacon and 3.5% textured soybean protein, which achieved the best scores and acceptance by the panelists.