Fondaparinux em intervenção coronária percutânea no tratamento da síndrome coronária aguda

Background: Fondaparinux is considered an agent with a well-established safety and efficacy profile in the treatment of non-ST segment elevation acute coronary syndromes, but when used alone, is associated to a higher incidence of thrombotic complications during invasive coronary procedures, requiring the supplementation of an anti-IIa agent. This study aimed to evaluate the efficacy and safety of percutaneous coronary intervention (PCI) in patients with non-ST segment elevation acute coronary syndromes previously treated with fondaparinux. Methods: Prospective, controlled registry enrolling 127 consecutive patients submitted to an early invasive stratification during treatment with fondaparinux, with supplementation of intravenous unfractionated heparin at a dose of 85 U/kg at the time of PCI. Results: The rate of the composite primary endpoint including death, acute myocardial infarction, stroke, stent thrombosis or emergency myocardial revascularization was 3.2%. The cumulative incidence of major bleeding and vascular complications was 3.2%. There were no cases of guidecatheter thrombosis or abrupt vessel closure. Conclusions: PCI in patients with acute coronary syndromes receiving fondaparinux is associated with a low rate of major adverse cardiovascular ischemic events and severe hemorrhagic complications. Supplementation of unfractionated heparin during the invasive procedures eliminates the risk of catheter-related thrombosis.

Aspectos clínicos do enxerto conjuntival 360° e do implante da membrana amniótica criopreservada no tratamento de úlceras de córnea em cães

To evaluate the clinical application of implant of the canine cryopreserved amniotic membrane (DMEM plus DMSO 1:1) and 360° conjunctival flap in the treatment of progressive corneal ulceration. 10 dogs of the different breeds, males and females, aging four months to four years old with deep corneal ulceration and different clinical progression were divided in two groups: G1=360° conjunctival graft (n=5) and G2=implant of amniotic membrane, sutured at the edge of the ulcer with epithelial side facing up, associated with the third eyelid flap (n=5). The comparative analysis between groups was: complications, blepharospasm, ocular secretion, corneal vascularization, epithelial defect and corneal opacification in six moments (first emergency care, surgery and 3, 7, 15 and 30 days of postoperative). Without epithelial defect was evaluated quality of the scar. It was used score scale for subjective to qualify of the ocular signs. In G1, it was observed the non-adherence of the conjunctival graft to the ulcer (n=2), dehiscence of the suture (n=2), anterior synechia (n=2) and intense chemosis (n=1). In G2, it was not observed these complications. It was not significant difference between the groups to others ocular parameters, but it was different among the start and end moments of the same groups (ocular secretion, corneal vascularization, epithelial defect). The corneal opacity was more intense in G1. According to the clinical results, the cryopreserved amniotic membrane implant proved to be as effective in the corneal ulceration in comparison to the 360° conjunctival flap, because probably, the membrane promoted a trophic support for epithelialization, anti-inflamatory effect associated with important to the end result phenotype.

Implante da membrana amniótica criopreservada em associação ou não com transplante de limbo no tratamento de úlceras profundas de córnea em cães

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Análise dos atendimentos do SAMU 192: componente móvel da Rede de Atenção às Urgências e Emergências

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Violência interpessoal: estudo descritivo dos casos não fatais atendidos em uma unidade de urgência e emergência referência de sete municípios do estado de São Paulo, Brasil, 2008 a 2010

Objective: to describe the profile of non-fatal cases related to interpersonal violence treated in an emergency care unit of reference that serves seven municipalities of the state of São Paulo, Brazil, from 2008 to 2010. Methods: the study data came from the cases reported from the Epidemiological Vigilance in Penápolis-SP to the Brazilian Information System for Notifiable Diseases; variables were shown according to the Notification/Investigation Individual Formulary of Domestic, Sexual, and/or other Types of Violences. Results: 109 occurrences were studied; most of the victims were young and female (93.6%); and the aggressors, mostly were men (57.8%), partners or relatives/acquaintances of victims. Physical violence was the main form of aggression (93.6%), principally in the home (67.9%), on Sunday (16.5%), between 6:01pm and 12:00pm (57.8%). Conclusion: the cases reported had a consistent profile of domestic family violence against women, different from other studies about interpersonal violence in large cities and metropolitan regions

As interfaces da convivência da família em uma unidade de pronto socorro

The aim was to describe the positive and negative aspects in a family communication at an emergency care unit. This is a descriptive research with a qualitative approach. The sample consisted of 20 family members / caregivers of patients admitted to the emergency room of a university hospital. Data collection was carried out through semi-structured interviews applied during the period of May-June 2011. Data analysis was performed using the methodological framework of the Collective Subject Discourse which resulted in four themes: Lack of information compromising the family/health professional ties; The ideal model of information provided by the professional regarding the condition of the hospitalized relative; Assessment of information provided about hospital routines; and The role of the relative/companion. Therefore, for the patient and his family, communication is presented as a tool on the care given with the function of transmitting safety, respect and guidance. However when it is incomplete, it becomes a potential form of stress and dissatisfaction.

The viewpoint of health professionals on the role of basic units in the healthcare network of the Brazilian Unified Health System

In the process of creation of the Unified Health System (SUS) as a universal policy seeking to ensure comprehensive care, unscheduled assistance in primary healthcare units (UBS) is an unresolved challenge. The scope of this paper is to analyze the viewpoint of health professionals on the role of primary healthcare units in meeting this demand. It is a transversal study of qualitative data obtained through questionnaires and interviews with 106 medical practitioners from 6 emergency medical services and 190 professionals from 30 units. They explained why people seek emergency care for occurrences pertaining to primary care. The content analysis technique with thematic categories was used for data analysis. Lack of resources and problems with primary health unit work processes (50.8%) were the reasons most frequently cited by emergency care physicians to explain this inadequate demand. Only 33.3% of the health unit professionals agreed that these occurrences should be attended in the primary healthcare services. The limited viewpoint of the role of health services on the unscheduled care, particularly among primary care professionals, possibly leads to restrictive practices for access by the population.

Acidentes e violência na infância: evidências do inquérito sobre atendimentos de emergência por causas externas - Brasil, 2009

Compreender as características e a magnitude das causas externas (acidentes e violência) em crianças de 0 a 9 anos de idade torna-se cada vez mais importante em Saúde Pública. O objetivo do presente artigo foi analisar os atendimentos de emergência por causas externas em crianças. Utilizaram-se dados do Sistema de Vigilância de Violências e Acidentes em Serviços Sentinelas de Urgência e Emergência (Inquérito VIVA), realizado em 74 serviços de urgência do Distrito Federal e 23 capitais no ano 2009. Analisaram-se dados de 7.123 crianças: 6.897 (96,7%) vítimas de acidentes e 226 (3,3%) de violência. Em comparação às vítimas de violência, os atendimentos por acidentes foram mais frequentes entre crianças de 2 a 5 anos, de pele branca e ocorridos no domicílio (p < 0,05). Dentre os acidentes, as quedas e queimaduras predominaram no grupo de 0 a 1 ano, enquanto os acidentes de transporte foram mais frequentes no grupo de 6 a 9 anos (p < 0,001). Quanto às violências, atendimentos por negligência e agressão física predominaram, respectivamente, nos grupos extremos de faixa etária, sendo um familiar identificado como agressor (p < 0,001). Informações sobre ocorrência de causas externas em crianças podem apoiar políticas de promoção da saúde, além de orientar profissionais de saúde, educadores e famílias na prevenção destas causas.

Reações adversas a medicamentos levando crianças a atendimento na emergência hospitalar

Determinou-se incidência de reações adversas a medicamentos (RAM) que levaram crianças a atendimento de emergência em um hospital universitário de São Paulo, SP. Foram analisadas, retrospectivamente, 23.286 fichas de atendimento (FA) em emergência pediátrica, a partir de código CID que indicasse possível RAM. Observaram-se 83 (0,36%) RAMs. A maioria ocorreu na faixa etária entre 1 a 5 anos com leve predominância no sexo masculino (51,8%). Os medicamentos mais implicados foram antibacterianos para uso sistêmico (53,0%), vacinas (9,6%) e analgésicos (7,2%). A maior parte das RAMs foram manifestações dérmicas (54,2%) ou gastrointestinais (22,9%). Duas RAMs foram consideradas graves (2,4%) e levaram a internação; enquanto 61,4% foram leves e 36,1% foram moderadas. A incidência foi inferior à literatura, provavelmente por ser estudo retrospectivo, utilizando-se o CID para seleção das FA. Observou-se que, no Brasil, as RAMs levam crianças a atendimento de emergência, com características semelhantes às de outros países. Intervenções são necessárias para melhorar o diagnóstico e a utilização de antimicrobianos, uma vez que foram os medicamentos mais implicados nas RAMs observadas. A pesquisa no setor de emergência hospitalar é importante para se conhecer as RAMs que ocorrem fora do contexto hospitalar, podendo contribuir para identificar aquelas de maior gravidade. A metodologia utilizada, apesar das limitações, requer poucos recursos humanos e materiais, sendo uma boa alternativa para um diagnóstico inicial, que deve ser sucedido por estudos mais elaborados e de maior sensibilidade para detectar essas reações e propor medidas dirigidas à sua prevenção.

Chickenpox is not always benign: postvaricella purpura fulminans requires prompt and aggressive treatment

We present 2 patients, who were admitted owing to rapidly progressing purpuric lesions due to postvaricella purpura fulminans, a coagulopathy leading to life- or limb-threatening thrombosis caused by a severe transient autoimmune protein S deficiency. Laboratory results were being consistent with disseminated intravascular coagulation secondary to protein S deficiency; treatment with fresh frozen plasma, intravenous immunoglobulins, and prednisone was started. In our experience, a prompt therapy may limit the course and the extent of the disease. We present a review of the topic with supporting literature for the therapeutic options. Therefore, we should be reminded that purpura fulminans is a rare but severe complication of chickenpox, which demands quick action.

Frequency of and predictors for patient-reported medical and medication errors in Switzerland

OBJECTIVES: To analyse the frequency of and identify risk factors for patient-reported medical errors in Switzerland. The joint effect of risk factors on error-reporting probability was modelled for hypothetical patients. METHODS: A representative population sample of Swiss citizens (n = 1306) was surveyed as part of the Commonwealth Fund’s 2010 lnternational Survey of the General Public’s Views of their Health Care System’s Performance in Eleven Countries. Data on personal background, utilisation of health care, coordination of care problems and reported errors were assessed. Logistic regression analysis was conducted to identify risk factors for patients’ reports of medical mistakes and medication errors. RESULTS: 11.4% of participants reported at least one error in their care in the previous two years (8% medical errors, 5.3% medication errors). Poor coordination of care experiences was frequent. 7.8% experienced that test results or medical records were not available, 17.2% received conflicting information from care providers and 11.5% reported that tests were ordered although they had been done before. Age (OR = 0.98, p = 0.014), poor health (OR = 2.95, p = 0.007), utilisation of emergency care (OR = 2.45, p = 0.003), inpatient-stay (OR = 2.31, p = 0.010) and poor care coordination (OR = 5.43, p <0.001) are important predictors for reporting error. For high utilisers of care that unify multiple risk factors the probability that errors are reported rises up to p = 0.8. CONCLUSIONS: Patient safety remains a major challenge for the Swiss health care system. Despite the health related and economic burden associated with it, the widespread experience of medical error in some subpopulations also has the potential to erode trust in the health care system as a whole.

Handlebar injuries in children

Introduction: Handlebar injuries in children may lead to severe organ lesions despite minimal initial signs and without visible skin bruise. We present our experiences applying a diagnostic and therapeutic algorithm for blunt abdominal trauma, and present the history of two selected cases. Materials and methods: We retrospectively assessed the charts of children below 16 years of age, only who were observed for 24 h or more in our institution due to a handlebar injury between 2004 and 2011. All children were treated according to an institutional algorithm. Results: 40 patients with a median age of 9.5 years were included. Diagnosed lesions were: ruptures of the liver (n = 6), spleen (n = 5), kidney (n = 1), and pancreas (n = 2), small bowel perforation (n = 3), and hernias of the abdominal (n = 2) or thoracic wall (n = 1). Surgical interventions were performed in 8 patients. The outcome was favorable in all the cases. Overall median hospitalization duration was 4.5 days (range 1–19 days). The overall duration between the accident and arrival at our emergency unit was 2.75 h (median, range 1–19 h). 20 children presented directly at our emergency unit after a median of 1.7 h (range 1–19.5 h). 20 children were referred by a family physician or a primary hospital after a median of 4.0 h (range 1–46 h). Conclusion: Handlebar injuries in children resulted in serious trunk lesions in half of the present patient series. The spectrum of injuries in handlebar accidents varies widely, especially injuries to the abdomen can unmask often only in the course. We advocate close observation of patients with thoracic and abdominal handlebar injuries which may be regarded as blunt stab wounds. An institutional algorithm for blunt abdominal trauma management is supportive for emergency care in patients with handlebar injuries.

[Acute infectious emergencies in adults in medical practice]

Infectious diseases belong to the most frequent reasons to seek emergency care. Life-threatening infectious emergencies, which require rapid diagnosis and hospitalisation, are, however, rare. Leading signs and symptoms are high fever combined with rapidly deteriorating general conditions, hypotonia, tachycardia, tachypnea, dyspnea, confusion, headache, or petechia or information about asplenia, immunosuppression or recent travel to the tropics. Life threatening situations, such as suspicion of invasive meningococcal infection or bacterial infection in an asplenic patient, septic-toxic shock, and acute bacterial meningitis with delayed hospitalisation require rapid start of empiric antibiotic therapy in the outpatient practice. In addition, acute infectious emergencies comprise situation for which post exposure prophylaxis is indicated.