Atuação da cirurgia plástica no tratamento de feridas complexas

OBJETIVO: Relatar a atuação da Cirurgia Plástica no tratamento das feridas complexas em hospital terciário, analisando suas características, tipos de lesões e condutas adotadas, com ênfase no tratamento cirúrgico. MÉTODOS: Análise retrospectiva dos pacientes com feridas complexas atendidos pela Cirurgia Plástica em hospital terciário, através dos pedidos de consulta, em um período de cinco anos (2006 a 2010). A coleta dos dados foi obtida a partir de atendimentos realizados, avaliações seriadas e registros do prontuário médico. RESULTADOS: Foram atendidos 1927 pacientes (32 consultas/mês), com média de idade de 46,3 anos, predominando o sexo masculino (62%). As especialidades cirúrgicas solicitaram 1076 consultas (56%) e as clínicas, 851 (44%). A distribuição por tipo de ferida demonstrou predomínio das úlceras por pressão (635/33%), das feridas traumáticas (570/30%), cirúrgicas complicadas (305/16%) e necrotizantes (196/10%), sendo o restante representado por vasculite (83/4%), úlceras venosas (79/4%), diabéticas (41/2%) e pós-radiação (18/1%). O tratamento foi operatório em 1382 pacientes (72%) e não-operatório em 545 casos (28%). Nos pacientes operados, realizaram-se 3029 operações, predominando os desbridamentos (1988/65%) e enxertias de pele (619/21%) associadas ou não com a terapia por pressão negativa (vácuo), seguido pelos retalhos pediculados (237/8%), reimplantes digitais (81/3%), retalhos microcirúrgicos (66/2%) e outros procedimentos (38/1%). CONCLUSÃO: O cirurgião plástico demonstrou ter importante atuação no tratamento das feridas complexas por adotar o tratamento cirúrgico mais precocemente, colaborando para a efetiva resolução dos casos.

Molecular epidemiology of type 1 and 2 dengue viruses in Brazil from 1988 to 2001

Dengue is a mosquito-borne viral infection that in recent decades has become a major international public health concern. Epidemic dengue fever reemerged in Brazil in 1981. Since 1990 more than one dengue virus serotype has been circulating in this tropical country and increasing rates of dengue hemorrhagic fever and dengue shock syndrome have been detected every year. Some evidence supports the association between the introduction of a new serotype and/or genotype in a region and the appearance of dengue hemorrhagic fever. In order to study the evolutionary relationships and possible detection of the introduction of new dengue virus genotypes in Brazil in the last years, we analyzed partial nucleotide sequences of 52 Brazilian samples of both dengue type 1 and dengue type 2 isolated from 1988 to 2001 from highly endemic regions. A 240-nucleotide-long sequence from the envelope/nonstructural protein 1 gene junction was used for phylogenetic analysis. After comparing the nucleotide sequences originally obtained in this study to those previously studied by others, and analyzing the phylogenetic trees, we conclude that, after the initial introduction of the currently circulating dengue-1 and dengue-2 genotypes in Brazil, there has been no evidence of introduction of new genotypes since 1988. The increasing number of dengue hemorrhagic fever cases seen in Brazil in the last years is probably associated with secondary infections or with the introduction of new serotypes but not with the introduction of new genotypes.

Health in early adulthood: the contribution of the 1978/79 Ribeirão Preto birth cohort

The increase in non-communicable chronic diseases of adults is due to demographic changes and changes in the risk factors related to physical activity, smoking habits and nutrition. We describe the methodology for the evaluation of persons at 23/25 years of age of a cohort of individuals born in Ribeirão Preto in 1978/79. We present their socioeconomic characteristics and the profile of some risk factors for chronic diseases. A total of 2063 participants were evaluated by means of blood collection, standardized questionnaires, anthropometric and blood pressure measurements, and methacholine bronchoprovocation tests. The sexes were compared by the chi-square test, with alpha = 0.05. Obesity was similar among men and women (12.8 and 11.1%); overweight was almost double in men (30.3 vs 17.7%). Weight deficit was higher among women than among men (8.6 and 2.6%). Women were more sedentary and consumed less alcohol and tobacco. Dietary fat consumption was similar between sexes, with 63% consuming large amounts (30 to 39.9 g/day). Metabolic syndrome was twice more frequent among men than women (10.7 vs 4.8%), hypertension was six times more frequent (40.9 vs 6.4%); altered triglyceride (16.1 vs 9.8%) and LDL proportions (5.4 vs 2.7%) were also higher in men, while women had a higher percentage of low HDL (44.7 vs 39.5%). Asthma and bronchial hyper-responsiveness were 1.7 and 1.5 times more frequent, respectively, among women. The high prevalence of some risk factors for chronic diseases among young adults supports the need for investments in their prevention.