AS BARREIRAS PERCEBIDAS PARA A PRÁTICA DE ATIVIDADE FÍSICA NO LAZER ENTRE POLICIAIS MILITARES

Essa pesquisa tem o objetivo de identificar barreiras relacionadas à prática de atividade física por policiais militares em uma Unidade de Polícia Pacificadora (UPP). Foi utilizado um questionário para analisar as barreiras para a prática de atividade física no lazer. A amostra foi composta por 41 policiais militares com idade média de 33,5 ± 3,1 anos, peso médio de 86,7 ± 9,7 quilos e estatura de 1,77 ± 0,05 metros. O Índice de Massa Corporal médio foi de 27,67 ± 3,0. Na amostra, 56,1% praticam atividade física no lazer e 43,9% não praticam atividade física no lazer, 85,4% estão classificados como excesso de peso e 14,6% classificados como peso normal. As barreiras foram significativamente associadas à prática de atividade física, sendo as barreiras mais frequentes excesso de trabalho, compromissos familiares e a falta de energia. O estado nutricional não apresentou associação significativa com as barreiras. Conclui-se que a prática de atividade física entre Policiais Militares é restrita por conta das barreiras que dificultam a prática

Comparação do impacto de anastomose torácica ou cervical no pós operatório de esofagogastrectomia - análise de 92 casos/ Comparison of the impact of thoracic or cervical anastomosis on postoperative esophagogastrectomy - analysis of 92 cases

A esofagectomia é o tratamento curativo do câncer de esôfago não metastático atualmente. Contudo ainda há falta de evidências fiéis que mostrem uma diferença significativa entre as técnicas cirúrgicas e permanece a controvérsia sobre a localização anatômica ideal da anastomose esofagogástrica, intratorácica ou cervical. O objetivo desse estudo foi avaliar a influência do local da anastomose, cervical ou torácica, nas complicações operatórias e mortalidade da esofagogastrectomia com linfadenectomia em dois campos

Management of Shock

Shock is a syndrome caused by a disorder in systemic perfusion leading to cellular hypoxia, inadequate tissue oxygenation, and organic dysfunction. To approach the shock, the following sequence must be followed: recognize its presence, preferably in the initial phase; establish measures of general support; establish the etiology of the shock; and establish early correction of the primary cause (stop the bleeding). During care in the emergency room, to evaluate these signs quickly and efficiently, one should observe the pulse, skin color, and level of consciousness. Other signs of shock are oliguria, hypotension, tachypnea, hypothermia, and reduction of pulse pressure. There are several types of shock: hemorrhagic, neurogenic, cardiogenic, septic, and obstructive

Great Vessels and Cardiac Trauma

The initial management of a patient with cardiac or great vessel trauma is to ensure airway and ventilation with adequate oxygenation, and treat shock according to ATLS protocol. FAST is a very useful adjunct tool in cardiac trauma because it allows diagnosis of injuries in the emergency room. Penetrating wounds to the anatomic area, known as the “cardiac box” (bordered superiorly by the clavicles, inferiorly by the xiphoid, and by the nipples laterally), should increase the suspicion of cardiac injury. Firearm injuries to the heart are more often associated with bleeding and exsanguination rather than tamponade. Definitive treatment involves surgical exposure through an anterior thoracotomy or median sternotomy with subsequent tamponade relief and/or hemorrhage control. The primary management of blunt cardiac injury (BCI) is supportive care. The role of surgery in BCI should be restricted to patients with structural abnormalities and/or a positive FAST. The clinical picture of great vessel trauma includes hypotension, unequal arterial pressures or pulses in the extremities, external evidence of major thoracic trauma, and palpable fracture of the sternum or thoracic spine. Indications for emergency thoracotomy include hemodynamic instability, significant bleeding in the thoracic drains, or radiographic evidence of a rapidly expanding mediastinal hematoma

Corrections to: The Trauma Golden Hour

The affiliation of co-editors Nicholas Namias and Antonio Marttos was incorrectly updated in the book front matter and this is corrected as follows

The Trauma Golden Hour A Practical Guide

The Golden Hour is a well-established concept in emergency medicine, related to the critical period of one hour after an injury, accident or trauma. This term implies that the mortality rates increase substantially if efficient care is not provided within 60 minutes after the trauma. This book is intended as a practical manual in Trauma Care within the context of the golden hour, addressing all trauma types and all body parts. Readers will find essential decision-making algorithms and protocols with commentary for traumas, along with easily accessible information on how to treat patients in a very practical and handy fashion. Furthermore, the content is presented in a didactic way suitable for a wide audience, from medical students who want to learn about the basics of trauma care to experienced surgeons seeking a comprehensive guide to trauma-related interventions. The book combines contributions from experts at two renowned Trauma Centers, the Hospital do Trabalhador at Curitiba, Brazil, and the Ryder Trauma Center in Miami, USA. Therefore, considering the different local environments and resources, the book provides distinct perspectives for several injuries, presenting the state of the art in Trauma Care. The diversity of perspectives in this book contributes to a global health care approach suitable for trauma-related events from developed countries to remote areas. The Trauma Golden Hour - A Practical Guide celebrates the Centennial Anniversary of the Federal University of Parana (Brazil), the 25th Anniversary of the Ryder Trauma Center (USA) and the 20th Anniversary of the Hospital do Trabalhador (Brazil)

Duodenopancreatectomy: influence of patient's intrinsic factors on results of pancreatic cancer surgical treatment

Introduction: Pancreatic cancer is the fourth leading cause of cancer death in Western countries, with a more prevalent incidence in the elderly (1). It presents itself as a neoplasm with high lethality and low survival, surgical resection being the only treatment with curative potential. However, pancreatoduodenectomy (Kausch-Whipple technique) is one of the most difficult surgeries in the gastrointestinal system, due to the great difficulty in accessing the pancreas and its proximity to various delicate and vital structures, requiring advanced knowledge by the surgeon (6). Objective: Evaluate the profile of patients with pancreatic cancer and factors that contribute to the surgical outcome and survival after curative pancreatoduodenectomy. Method: A descriptive retrospective cross-sectional study was carried out through the analysis of records of pancreatoduodenectomy in the period May 2005 – July 2015 at Hospital Erasto Gaertner (HEG) in Curitiba/PR. Variables were analyzed using Student's t-test, non-parametric Mann-Whitney U test, and chi-squared test with Fisher's correction. Survival and disease-free survival rates were evaluated using the Kaplan-Maier method with the log-rank test and survival predictors identified with Cox regression. The SPSS 23.0 and STATA 15 programs were used, with p value being lower than 0.05 considered statistically significant. Results: 98 pancreatoduodenectomy were evaluated and 46 were in male patients and 30 were in patients aged <60 years. Ca 19-9 levels were elevated in 29% of patients before surgery and elevated in 5% after surgery. Regarding the location of the tumor, 77% were pancreatic, 14% were duodenal papilla and 8% were biliary tract. Regarding tumor histology, 81 were adenocarcinoma, 6 were cholangiocarcinoma and 5 were other diagnoses; 29% were well differentiated, 53% moderately and 17% poorly differentiated. About staging, 21% T1, 23% T2, 36% T3 and 18% T4 were found. Factors such as local tumor extension, location of the lesion and surgery time do not show a significant influence on the surgical outcome of these patients. The main postoperative complications were fistula and evisceration. The mean overall survival after surgery at 5 years was 12.24% and this was seen to be significantly higher in the <60 years group (p < 0.01). Discussion and Conclusion: It was seen that pancreatic tumors present in more advanced stages at diagnosis and are more prevalent in the elderly. These characteristics negatively impact 5-year overall survival rates, as this is higher in patients older than 60 years. Early diagnosis remains a challenge for successful treatment with curative potential, and remains a key point for the survival of these patients, as it allows for better staging and better surgical results

Complex Vascular Reconstruction of an En Bloc Pediatric Kidney Damaged during Organ Procurement

En bloc pediatric kidney (EBPK) allografts are a potential solution to expand the organ donor pool; however, EBPK transplantation has been traditionally considered suboptimal due to concerns of perioperative vascular and urologic complications. Accidental organ or vasculature injury during harvest is not uncommon; however, this does not necessarily mean that the organ should be discarded. Careful vascular reconstruction can be performed using donor vascular grafts, salvaging the organ without stenosis or thrombosis of the vessels. We report an extensive vascular reconstruction of the right renal artery, aorta, and inferior vena cava of a damaged EBPK allograft using a donor pediatric aorta vascular patch with the goal of avoiding postoperative vascular complications