Musculoskeletal injuries in motorcycle accidents

Study conducted in the city of São Paulo from January 2001 to July 2002 with the goal of analyzing the profiles of individuals involved in motorcycle accidents, evaluating the rider's profile, the circumstances of the accidents, injuries, and the use of protective gear. 387 patients needing only traumatic orthopedic treatment were found, between 16 and 44 years of age, of which 354 were males (91.0%). The most common mechanism of trauma involved a collision between the motorcycle and another vehicle (67.0%) at a speed between 12.5-37.5 mph (73.0%) involving less experienced riders (67.0%) between 21 and 24 years of age (45%), and in which 532 (53.9%) lower limb injuries occurred. Of the injuries, 393 (39.8%) were wounds, 314 (31.8%) were bruises and 212 (21.5%) were fractures [foot, 34 (16%); femur, 32 (15.1%); ankle, 27 (12.7%); tibia, 25 (11.8%)]. Recurring accidents were observed in 231 (60.0%) cases and only 6.0% of the riders were not using protective equipment. Increased speed showed a higher rate of fractures when the Mann-Whitney test was applied (p = 0.001). Research on mechanical and traffic engineering, in combination with supervision and awareness-raising of the population, should be considered the most effective methods of prevention.Estudo realizado no município de São Paulo entre janeiro de 2001 e julho de 2002 e tem como objetivo analisar o perfil do indivíduo envolvido em acidentes motociclísticos avaliando: o perfil do condutor, as circunstâncias dos acidentes, as lesões e o uso de equipamentos de segurança. Foram encontrados 387 pacientes sendo 354(91,0%) do sexo masculino, entre 16 e 44 anos e considerados os indivíduos que necessitaram somente do tratamento traumato-ortopédico. O mecanismo de trauma mais comum envolveu a colisão entre a moto com outro veículo (67,0%), numa velocidade entre 20-60km/h (73,0%), em pessoas com menor experiência (67,0%) na idade entre 21-24 anos (45,0%), nos quais 532 (53,9%) lesões ocorreram nos membros inferiores. Quanto ao tipo de lesão tivemos 393(39,8%) ferimentos, 314(31,8%) contusões e 212(21,5%) fraturas [ossos do pé 34(16%), fêmur 32(15,1%), tornozelo 27(12,7%), tíbia 25(11,8%)]. A reincidência foi observada em 231(60,0%) acidentes e somente 6,0% dos pacientes não usavam equipamentos de proteção.O aumento da velocidade relacionou-se à um índice maior de fraturas quando foi aplicado o teste de Mann-Whitney (p=0,001). Pesquisas de engenharia mecânica e de engenharia de tráfego, associadas à rigorosa fiscalização e conscientização da população, devem ser consideradas o método mais efetivo , que é o da prevenção.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Ortopedia e TraumatologiaUNIFESP, EPM, Depto. de Ortopedia e TraumatologiaSciEL

Teleophthalmology Support for Primary Care Diagnosis and Management

This study was performed to evaluate a healthcare strategy based on teleophthalmology for diagnosis and management of primary healthcare users. A descriptive cross-sectional study was conducted to review the medical records of patients from January 2013 to December 2014 from primary care units in the city of São Paulo. The units referred patients, who had diabetes or high blood pressure, and were users of chloroquine compounds, for a fundus examination. The images were sent to a reading center for review, diagnosis, and patient referrals. From 9173 analyzed patients, 570 (6.2%) were excluded because of poor image quality. Of the remaining patients, 4933 (57.3%) had diabetes, 7242 (84,2%) systemic hypertension, and 113 (1.3%) used chloroquine. Of these, 989 (11.5%) patients needed ophthalmologic treatment. The most frequently prescribed treatments were cataract extraction in 692 (70%) of 989 and photocoagulation in 245 (24.8%) of 989 cases. Overall, cataract extraction was indicated in 692 (8%) of 8603 cases and photocoagulation in 245 (2.8%) of 8603 cases. When only patients with diabetes were considered, the indication for photocoagulation increased to 4.5%.The results showed that non-medical professionals could produce good-quality ocular images for screening of ocular diseases in most cases; only 6.2% of ocular images did not meet quality requirements. Most patients referred for fundus examination did not need a specific treatment, indicating that this system could be an inexpensive and reliable tool for use in developing countries.

Large intestine obstruction complicated with perforation: a rare manifestation of Schistosoma mansoni infection

The authors report a case of a 25 year old Brazilian man with a history of crampy abdominal pain in the left iliac fossa for 2 weeks, abdominal distention, mucous diarrhea and anorexia. The patient presented signs of hemodynamic instability and a hard mass palpated in the left iliac fossa presented peritoneal irritation. At laparotomy, fecal peritonitis and a punched-out perforation of the midsigmoid colon were found. A left hemicolectomy was performed with terminal colostomy. Specimen examination revealed a thickened rectosigmoid wall, narrow lumen and multiple mucosal polyps. Microscopically, chronic granulomatous colitis with Schistosoma mansoni eggs confirmed the etiology. To the authors' knowledge, this is the first case of obstruction complicated with perforation due to mansoni schistosomiasis reported in the literature.Os autores relatam o caso de um paciente masculino, de 25 anos, admitido com história de dor em cólica na fossa ilíaca esquerda há duas semanas, distensão abdominal, diarréia mucóide e anorexia. Evoluiu com instabilidade hemodinâmica, uma massa endurecida era palpada na fossa ilíaca esquerda com sinais de irritação peritoneal. Na laparotomia, foram encontrados peritonite fecal e uma perfuração do cólon sigmóide. Realizada hemicolectomia esquerda com colostomia terminal. O exame anátomo-patológico revelou espessamento da parede do cólon com estreitamento de sua luz e múltiplos pólipos na mucosa. O exame histopatológico confirmou a causa da obstrução como colite granulomatosa crônica com ovos viáveis de Schistosoma mansoni. Este é o primeiro caso de obstrução colônica complicada com perfuração causada por esquistossomose mansônica relatado na literatura consultada.Universidade Federal de São Paulo (UNIFESP)Escola Paulista de MedicinaUNIFESP, EPMSciEL

Changes in the methodology of medical teaching due to the COVID-19 pandemic

ABSTRACT Objective To evaluate the perceptions of students and teachers regarding remote teaching modality in comparison with the traditional face-to-face method. Methods In this observational, retrospective, comparative, single-center study, questionnaires containing three major assessment domains were sent to two groups: university professors and undergraduate and graduate students. The first domain collected demographic and general data on the platforms used. The second and third domains contained questions that compared the perception of the quality of information offered by the two systems. Results Between May and September 2020, 162 students and 71 teachers participated in the study. A greater proportion of students demonstrated previous contact with the online method, while professors had presented a greater number of courses. Most participants reported that their expectations regarding the remote teaching method were met (students, 80.3%; teachers, 94.4%). A significant number of students (83.3%) and teachers (88.7%) rated the classes as easier to attend and manage. Despite difficulties, such as concentration retention, most of the participants agree (at least partially) that the format should be maintained. Conclusion The remote teaching methodology, although still incipient in Brazil, has become a reality in light of current health restrictions. Our study demonstrated a high level of overall satisfaction and a high sense of learning from both students and faculty. However, new challenges associated with this system have been identified, such as retention of attention and interference from the external environment. Longitudinal comparative studies that incorporate various aspects of medical education in all cycles are necessary to corroborate the findings of this study. Design Retrospective comparative study, level III evidence

Shock wave therapy associated with eccentric strengthening versus isolated eccentric strengthening for Achilles insertional tendinopathy treatment: a double-blinded randomised clinical trial protocol

Background There is no consensus regarding the treatment of Achilles insertional tendinopathies. Eccentric training remains the main choice in the conservative treatment of this illnesshowever, the good results in the management of non-insertional Achilles tendinopathy were not replicated in the insertional condition. Low energy shock wave therapy has been described as an alternative to these patients, but has yet to be empirically tested. Hypothesis Shock wave therapy, adjunctive to the eccentric strengthening protocol, will improve measures of pain and function. Design Double blind, placebo-controlled, parallel groups, randomised clinical trial. Materials and methods 93 patients with a diagnosis of chronic insertional tendinopathy, referred from primary or secondary healthcare services, will be assessed and enrolled in this study. They will be divided into two groups (randomised by sequentially numbered identical envelopes, which will be administered serially to participants), one containing the combination of low energy shock wave and eccentric exercises, as treatment and the other comprehending the exercises and the placebo treatment (an apparatus placed in the therapeutic head). The assessments will occur in 2, 4, 6, 12 and 24weeks. Patients will be evaluated primarily by the Victorian Institute of Sport Assessment-Achilles questionnaire and secondarily by the visual analogue scale, Algometry, the American Orthopedic Foot and Ankle Society scale, the Foot and Ankle Outcome Score and the 12-item Short Form Health Survey. We will use comparison of two proportions via relative frequency analysis, the Pearson Correlation the (2) test and the analysis of variance for statistical analyses. Discussion This study intends to demonstrate if the association of the eccentric exercise programme with the shock wave therapy can produce good results regarding the treatment of the Achilles insertional tendinopathy. In an attempt to prevent the high costs and complications associated with the surgical intervention, we will try to prove this combination as a viable therapeutic option in the conservative management of this prevalent condition. The strengths of the study are the design and the novelty of the combination of methods. The main limitation is the short follow-up course. Ethics and dissemination The study is registered in the Clinical Trials database (protocol number: 8094833648737701) and was approved by the University Ethics Committee (number: 1373481). Trial registration number 8094833648737701 (NCT02757664)Pre-results.Univ Fed Sao Paulo, Dept Orthopaed, Sao Paulo, SP, BrazilFed Univ Sao Paulo UNIFESP EPM, Orthoped & Traumatol Div Hand Surg & Upper Limb, Sao Paulo, SP, BrazilDepartment of Orthopaedics, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, SP, BrazilOrthopedics and Traumatology—Division of Hand Surgery and Upper Limb, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, BrazilWeb of Scienc

Large intestine obstruction complicated with perforation: a rare manifestation of Schistosoma mansoni infection

The authors report a case of a 25 year old Brazilian man with a history of crampy abdominal pain in the left iliac fossa for 2 weeks, abdominal distention, mucous diarrhea and anorexia. The patient presented signs of hemodynamic instability and a hard mass palpated in the left iliac fossa presented peritoneal irritation. At laparotomy, fecal peritonitis and a punched-out perforation of the midsigmoid colon were found. A left hemicolectomy was performed with terminal colostomy. Specimen examination revealed a thickened rectosigmoid wall, narrow lumen and multiple mucosal polyps. Microscopically, chronic granulomatous colitis with Schistosoma mansoni eggs confirmed the etiology. To the authors' knowledge, this is the first case of obstruction complicated with perforation due to mansoni schistosomiasis reported in the literature