Curbing Inflammation in hemorrhagic trauma: a review

Trauma is one of the world's leading causes of death within the first 40 years of life and thus a significant health problem. Trauma accounts for nearly a third of the lost years of productive life before 65 years of age and is associated with infection, hemorrhagic shock, reperfusion syndrome, and inflammation. The control of hemorrhage, coagulopathy, optimal use of blood products, balancing hypo and hyperperfusion, and hemostatic resuscitation improve survival in cases of trauma with massive hemorrhage. This review discusses inflammation in the context of trauma-associated hemorrhagic shock. When one considers the known immunomodulatory effects of traumatic injury, allogeneic blood transfusion, and the overlap between patient populations, it is surprising that so few studies have assessed their combined effects on immune function. We also discuss the relative benefits of curbing inflammation rather than attempting to prevent it.

Gunshot wound to the pregnant uterus: case report

Crime and violence have become a public health problem. Pregnant women have not been the exception and gunshot injuries occupy an important place as a cause of trauma. An important fact is that pregnant women, who suffer trauma, are special patients because pregnancy causes physiological and anatomical changes. Management of these patients should be multidisciplinary, by the general surgeon, the obstetrician and the neonatologist. However, even trauma referral centers could neither have the staff nor the ideal training for these specific cases. In this context we present the following case.

Non-invasive measurement of trigeminal nerve somatosensory evoked potentials

Whiplash injuries are common yet enigmatic to substantiate clinically. Trigeminal somatosensory evoked potentials (TSEPs) were posited as an indicator of trigeminal nerve conduction damage resulting from whiplash. Alternating polarity square-wave current stimuli were applied transcutaneously in the facial region. 379 recorded pilot trials from 27 participants (8 male and 19 female) were utilized to develop a non-invasive recording capability for TSEPs. Stimulus intensity and artifact, cortical recording sites, stimulation electrode design and placement were explored. Statistically significant differences in amplitude of TSEP waveform components at 13, 19 and 27 ms between uninjured and whiplashed participants were noted. Increased stimulus intensity in whiplashed participants was observed to increase TSEP amplitude. The present methodology and hardware are discussed and directions for future advancement of the current process are outlined.

The effects of upper extremity functional electrically stimulated (FES) exercise training on upper limb function in individuals with tetraplegia

Functional Electrically Stimulated (FES) ami cycle ergometry is a relatively new technique for exercise in individuals with impairments of the upper limbs. The purpose of this study was to determine the effects of 12 weeks of FES arm cycle ergometry on upper limb function and cardiovascular fitness in individuals with tetraplegia. F!ve subjects (4M/1F; mean age 43.8 ± 15.4 years) with a spinal cord injury of the cervical spine (C3- C7; ASIA B-D) participated in 12 weeks of3 times per week FES arm cycle ergometry training. Exercise performance measures (time to fatigue, distance to fatigue, work rate) were taken at baseline, 6 weeks, and following 12 weeks of training. Cardiovascular measures (MAP, resting HR, average and peak HR during exercise, cardiovascular efficiency) and self reported upper limb function (as determined by the CUE, sf-QIF, SCI-SET questionnaires) were taken at baseline and following 12 weeks of training. Increases were found in time to fatigue (84.4%), distance to fatigue (111.7%), and work rate (51.3%). These changes were non-significant. There was a significant decrease in MAP (91.1 ± 13.9 vs. 87.7 ± 14.7 mmHg) following 12 weeks ofFES arm cycle ergometry. There was no significant change in resting HR or average and peak HR during exercise. Cardiovascular efficiency showed an increase following the 12 weeks ofFES training (142.9%), which was non-significant. There were no significant changes in the measures of upper limb function and spasticity. Overall, FES arm cycle ergometry is an effective method of cardiovascular exercise for individuals with tetraplegia, as evidenced by a significant decrease in MAP, however it is unclear whether 12 weeks of thrice weekly FES arm cycle ergometry may effectively improve upper limb function in all individuals with a cervical SCI.

The effects of an acute bout of whole-body vibration on pulse wave velocity in individuals with SCI

Cardiovascular disease is a leading cause of mortality in the spinal cord injured (SCI) population. Reduced arterial compliance is a cardiovascular risk factor and whole body vibration (WBV) has be en shown to improve arterial compliance in able-bodied individuals. The study investigated the effect of an acute session ofWBV on arterial compliance as measured by pulse wave velocity (PWV). On separate days, arm, leg and aortic PWV were measured pre- and post- a 45 minute session of passive stance (PS) and WBV. The WBV was intermittent with a set frequency of 45Hz and amplitude of O.6mm. There was no condition by time effect when comparing PWV after WBV and PS. Following WBV, aortic (928.6±127.7 vs. 901.1±96.6cm/sec), leg (1035.2±113.8 vs.l099.8±114.2cm/sec) and arm PWV (1118.9±119.8 vs. 1181.1±124.4cm/s) did not change. As such, WBV did not reduce arterial compliance, however future research with protocol modifications is recommended.

La mejora de la calidad de vida de las personas con lesión medular: la transición del centro rehabilitador a la vida cotidiana desde la perspectiva de los usuarios

El retorno a la vida cotidiana para una persona con lesión medular después del periodo de rehabilitación en régimen hospitalario, es un proceso difícil no exento de dificultades y nuevos retos personales. En este trabajo nos planteamos identificar aquellos factores más relevantes que contribuyen a mejorar su calidad de vida, desde la perspectiva de las propias personas afectadas. Hemos realizado dos grupos de discusión: uno formado por 12 personas con paraplejia y otro formado por 6 personas con tetraplejia. El análisis de contenido realizado indica que, para los participantes existen dos dimensiones relacionadas con su percepción de calidad de vida una vez salen del centro de rehabilitación: a) necesidad de atención al entorno más próximo y b) preparación para el mundo real. Concluimos señalando la importancia de realizar programas de rehabilitación integral, que incluyan, rehabilitación física, aprendizaje de habilidades que posibiliten el máximo de independencia y autonomía personal y trabajo de apoyo a la familia

Os acidentes humanos e suas implicações fonoaudiológicas: opiniões de docentes e discentes sobre a formação superior

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Infecções cutâneas e acidentes por animais traumatizantes e venenosos ocorridos em aquários comerciais e domésticos no Brasil: descrição de 18 casos e revisão do tema

FUNDAMENTOS: O aquarismo a cada dia ganha novos adeptos no Brasil. Impulsionado por belos peixes e objetos de decoração, o hábito pode trazer problemas como infecções e envenenamentos por diversos animais. OBJETIVOS: Demonstração dos animais causadores e dos quadros clínicos envolvidos com estes acidentes, das infecções cutâneas encontradas após traumas e das medidas terapêuticas e preventivas para controle do problema, pouco conhecido pela população em geral. MÉTODOS: Utilizou-se um estudo prospectivo para a detecção de acidentes por animais e infecções ocorridas após traumas em aquários. Estes dados serviram de base para um estudo epidemiológico, clínico e terapêutico sobre o problema. RESULTADOS: em cerca de 300 acidentes por animais aquáticos, 12 ou 4% do total foram causados por animais venenosos em aquários. Cinco infecções bacterianas e uma fúngica foram identificadas após traumas em aquários. CONCLUSÕES: Os acidentes em aquários domésticos e comerciais são relativamente comuns e podem acarretar infecções cutâneas e ferimentos por animais venenosos ou traumatizantes. Os proprietários de aquários na maioria das vezes não têm informações sobre estes acidentes. Os autores fornecem as espécies de microorganismos e animais mais freqüentemente envolvidas com ferimentos e as medidas terapêuticas e preventivas adequadas ao manejo do problema.

HIPERTERMIA EM RATOS INDUZIDA PELA LESAO ELETROLITICA DO MESENCEFALO: PARTICIPACAO DAS PROSTAGLANDINAS

The present studies were conducted to determine the role of prostaglandins in the etiology of a rise of body temperature observed in rats after electrolytic lesion made on the dorsal mesencephalic areas. This hyperthermia was abolished by intraperitoneal administration of indomethacin, an inhibitor of prostaglandins synthesis. These results strengthen the suggestion of a similar mechanism for both neurogenic hyperthermia and the fevers produced by pyrogens. However, until further experiments are carried out, the possibility of lesion in producing hyperthermia by different mechanisms cannot be ruled out.

Attack upon a bather by a swordfish: A case report

We report a case of a bather injured by a swordfish in shallow water off the coast of southern Brazil. The victim suffered multiple injuries from the fish's bill, including a puncture wound of his left knee and the tip of the bill remaining as a foreign body. The victim made a full recovery after field management and conservative care. The potential factors leading to this most unusual attack are discussed. © 2009 Wilderness Medical Society.

Occurrence of traumatic dental injury in cases of domestic violence

The purpose of this study was to investigate the prevalence and types of traumatic dental injuries in situations of domestic violence. A coross-sectional study was conducted and data were collected from the police occurrence records to domestic physical aggression between 2001 and 2005. Of the 1,844 subjects who underwent medical evaluation, 15 had information pertaining to traumatic dental injuries. From the medical records, the forensic medical reports completed by the forensic medical experts who examined the victims after the aggression were reviewed and data of individuals with dental injuries (e.g., fractures, luxation and avulsion) were collected. In the selected sample, there was a predominance of individuals with injuries to the head and neck region (38.7%), and the frequency of traumatic dental injuries among all injuries to the head and neck region was 2.0%. The most frequently injured teeth were the maxillary incisors (31.8%), followed by the mandibular incisors (27.3%) and the maxillary canines (9.1%). In 31.8% of the injured teeth, the forensic experts did not specify the nomenclature. Of the dental trauma cases, 59.1% were fractures, 27.2% were luxations and 13.7% were avulsions. In conclusion, domestic violence was an important etiologic factor of traumatic dental injury. The aggression in all cases occurred in the form of punches and slaps. Fracture was the most common type of traumatic dental injury, and the most frequently injured teeth were the incisors.

Eletroforetograma das proteínas do soro de equinos submetidos a diferentes protocolos de exercícios

Pós-graduação em Medicina Veterinária - FMVZ

Avaliação dos parâmetros gasométricos dos traumatizados durante o atendimento pré-hospitalar móvel

OBJECTIVE: To evaluate gasometric differences of severe trauma patients requiring intubation in prehospital care. METHODS: Patients requiring airway management were submitted to collection of arterial blood samples at the beginning of pre-hospital care and at arrival at the Emergency Room. We analyzed: Glasgow Coma Scale, respiratory rate, arterial pH, arterial partial pressure of CO2 (PaCO2), arterial partial pressure of O2 (PaO2), base excess (BE), hemoglobin O2 saturation (SpO2) and the relation of PaO2 and inspired O2 (PaO2/FiO2). RESULTS: There was statistical significance of the mean differences between the data collected at the site of the accident and at the entrance of the ER as for respiratory rate (p = 0.0181), Glasgow Coma Scale (p = 0.0084), PaO2 (p <0.0001) and SpO2 (p = 0.0018). CONCLUSION: tracheal intubation changes the parameters PaO2 and SpO2. There was no difference in metabolic parameters (pH, bicarbonate and base excess). In the analysis of blood gas parameters between survivors and non-survivors there was statistical difference between PaO2, hemoglobin oxygen saturation and base excess.

Orientações de alta: cartões padronizados ajudam na compreensão dos pacientes do pronto socorro?

OBJECTIVE: To determine whether the addition of discharge standard illustrated cards improves understanding of patients in the emergency room. METHODS: We conducted a prospective, randomized, interventional study with 228 patients discharged from the emergency department. All patients were interviewed and tested for the level of understanding of discharge instructions. Some of them received the intervention, with the standard cards, and another did not, constituting the control group. RESULTS: The average of followed discharge guidelines of the group that received the cards was higher than the control group, with statistical significance (p=0.009). When segregated by age, the group between 16 and 35 years of both sexes had the best average of followed guidelines, statistically, than the average of the control group (p=0.01). The difference between the mean orientations between the control group and the card for patients undergoing procedures was statistically significant (p=0.02); as for the stratification according to the number of procedures, the significance increases when that is equal to 1 (p=0.001) and decreased the more procedures were carried out. CONCLUSION: The introduction of discharge standard orientation cards was associated with improvement in the understanding of patients. Without replacing the verbal directions, which establishes dialogue and doctor-patient bonding, cards appear as auxiliary elements, facilitating understanding and care guidelines.

A lei seca cumpriu sua meta em reduzir acidentes relacionados à ingestão excessiva de álcool?

OBJECTIVE: To assess whether the Brazilian Driving Dry Law reached its goal after the three years following its enactment. METHODS: We onnducted a retrospective study of patients with craniofacial fractures who underwent surgery at a university hospital in two periods: before the Law (2005 to 2008) and after the Law (2008 to 2011). RESULTS: 265 patients (220 men and 45 women) were operated on during this period, 149 (56%) before and 116 (44%) after the Law, which indicates a reduction in the number of traumatisms (p=0.04). The age range between 19 and 40 years predominated in both periods. The main causes of traumas were car accidents, physical aggression and falls. Alcohol abuse was identified in 15.4% patients before and 19% patients after the enactment. The jaw and the maxillo-zygomatic complex were the most affected bones. CONCLUSION: The drop in the number of polytraumatized patients operated on at this institution in the three years following the Driving Dry Law was 22%, which is below the expected and desired percentage. These results must be compared to those of different services offering the same attendance type in order to compile data and enlarge statistics. The low index of reduction in the number of traumatisms and the report of alcohol abuse by several patients at the moment of trauma, even after the law, evidence the need of adopting stricter measures to control and punish violators.