Violência contra a criança: indicadores dermatológicos e diagnósticos diferenciais Child abuse: skin markers and differential diagnosis

As denúncias de abuso contra a criança têm sido frequentes e configuram grave problema de saúde pública. O tema é desconfortável para muitos médicos, seja pelo treinamento insuficiente, seja pelo desconhecimento das dimensões do problema. Uma das formas mais comuns de violência contra a criança é o abuso físico. Como órgão mais exposto e extenso, a pele é o alvo mais sujeito aos maustratos. Equimoses e queimaduras são os sinais mais visíveis. Médicos (pediatras, clínicos-gerais e dermatologistas) costumam ser os primeiros profissionais a observar e reconhecer sinais de lesões não acidentais ou intencionais. Os dermatologistas podem auxiliar na distinção entre lesões traumáticas intencionais, acidentais e doenças cutâneas que mimetizam maus-tratos<br>Reports of child abuse have increased significantly. The matter makes most physicians uncomfortable for two reasons: a) Little guidance or no training in recognizing the problem; b - Not understanding its true dimension. The most common form of child violence is physical abuse. The skin is the largest and frequently the most traumatized organ. Bruises and burns are the most visible signs. Physicians (pediatricians, general practitioners and dermatologists) are the first professionals to observe and recognize the signs of intentional injury. Dermatologists particularly, can help distinguish intentional injury from accidental, or from skin diseases that mimic maltreatmen

Surgical options for patients with shoulder pain.

Shoulder pain is a common musculoskeletal complaint in the community, which can arise from diverse causes. Regardless of the cause, mild cases can often be effectively treated conservatively, with options including rest, physiotherapy, pain relief and glucocorticoid injections. If conservative strategies fail after a 3-6 month period then surgery might be considered. Generally, the proportion of patients with shoulder pain who require surgery is small. When surgery is considered, a clear diagnosis and structural information from imaging are required. The indications for surgery, and success rate, depend on the specific diagnosis as well as on the individual clinical presentation. Evidence from case series suggest that surgical interventions for shoulder pain are effective when used appropriately. This article outlines the surgical management of the most common painful conditions that affect the shoulder, including impingement, rotator cuff tear, frozen shoulder, osteoarthritis, rheumatoid arthritis and calcific tendonitis