Gestão Patrimonial. Os Ativos Fixos Corpóreos

A Marinha é detentora de um vasto património, no qual se inserem os ativos fixos corpóreos, e por força desta grandeza importa investigar a relevância que a informação patrimonial representa para a organização. A gestão dos ativos fixos corpóreos, pela heterogeneidade das suas caraterísticas, representa uma tarefa complexa, mas aliciante do ponto de vista da investigação, com o objetivo de preconizar políticas de gestão eficazes, elevando assim, a qualidade da informação patrimonial. A evolução do normativo afigura-se como um desafio, onde se inclui a transição para o Sistema de Normalização Contabilística para as Administrações Públicas e a necessária parametrização do sistema integrado de gestão, adequando-o a este novo normativo. Com o objetivo geral de compreender o processo da gestão patrimonial e a relevância que a informação patrimonial representa para a Marinha, definiram-se três objetivos específicos, com o propósito de efetuar uma descrição detalhada do problema a estudar. De forma a exprimir com exatidão o problema da investigação definiu-se a questão central, como ponto de partida e delimitação do rumo da investigação, indicando claramente a direção tomada, sustentada em três questões derivadas, alinhadas com três hipóteses a validar. Na primeira parte da investigação, procurou-se analisar de que forma a informação patrimonial é gerida no Sistema Integrado de Gestão da Defesa Nacional e aferir se estão reunidas as condições para auxiliar a gestão dos ativos fixos corpóreos. Na segunda parte, procurou-se estudar como é que a informação patrimonial se encontra vertida nas demonstrações financeiras e avaliar se as demonstrações financeiras apresentam, a todo o tempo, uma imagem verdadeira e apropriada da realidade patrimonial da Marinha. Na terceira parte, procurou-se verificar a que ponto a informação patrimonial contribui para o processo de tomada de decisão e confirmar se os decisores dispõem de informação útil e fiável no apoio à tomada de decisão. Da compreensão relativa ao processo da gestão patrimonial e sobre a relevância que a informação patrimonial representa, conclui-se que a informação patrimonial acrescenta valor e tem utilidade para a Marinha. Abstract: The Navy owns a vast patrimony, in which tangible fixed assets are inserted and by virtue of this greatness, it is important to investigate the relevance that the patrimonial information represents for the organization. The management of tangible fixed assets, due to the heterogeneity of their characteristics, represents a complex task, but it is attractive from the point of view of research, with the aim of advocating effective management policies, thus raising the quality of the information on equity. The evolution of regulations appears to be a challenge, which includes the transition to the Accounting Standardization System for Public Administrations and the necessary parameterization of the integrated management system, adapting it to this new regulation. With the general objective of understanding the patrimonial management process and the relevance that the patrimonial information represents for the Navy, three specific objectives were defined, with the purpose of making a detailed description of the problem to be studied. In order to express accurately the problem of research, the central question was defined as the starting point and delimitation of the course of research, clearly indicating the direction taken, based on three derived questions, aligned with three hypotheses to be validated. In the first part of the investigation, we sought to analyze the way in which the patrimonial information is managed, in the Integrated System of Management of National Defense and to verify if the conditions to assist the management of the tangible fixed assets are met. In the second part, we sought to study how the equity information is included in the financial statements and to evaluate whether the financial statements present, at all times, a true and proper image of the assets of the Navy. In the third part, the aim was to verify the extent to which the information on assets contributes to the decision-making process and to confirm that decision-makers have useful and reliable information in support of decisionmaking. From the understanding of the process of patrimonial management and the relevance that the patrimonial information represents, it is concluded, that the patrimonial information adds value and has utility for the Navy.N/

Aspectos clínicos de pacientes com lesão traumática do plexo braquial após tratamento cirúrgico

ResumoObjetivoAvaliar aspectos sociodemográficos e clínicos de pacientes operados de lesão traumática do plexo braquial (LTPB).MétodoEstudo retrospectivo, revisão de prontuários, amostra de conveniência, 48 pacientes operados entre 2000 e 2010. Avaliados: 1) ADM – em graus, do ombro, cotovelo e punho/mão; 2) grau de força do ombro, cotovelo e punho/mão; 3) sensibilidade; 4) EVA (0 a 10). Testes de t de Student, qui‐quadrado, Friedman, Wilcoxon e Kruskal‐Wallis (p<0,05).ResultadosIdade de 30,6 anos, 60,4% acidentes motociclísticos. Politraumatismo 52,1%. Tempo até a cirurgia de 8,7 meses (2 a 48). Trinta e um (64,6%) com lesão total do plexo. Cirurgias mais frequentes: neurais em 39 (81,3%). ADM≥30° do ombro 20 pacientes (41,6%) de 30° a 90°, média 73° (p=0,001); 13 (27,1%) já tinham força no ombro≥M3 (p=0,001). Cotovelo≥80° de flexão, 27 pacientes (56,2%) de 30° a 160°, com média de 80,6° (p<0,001); 22 com força≥M3 (p<0,001). Extensão do punho≥30° partindo de 45° de flexão em 22 pacientes (45,8%), de 30° a 90°, média 70° (p=0,003); 27 (56,3%) tinham força de extensão do punho/mão≥M3 (p=0,002); 45 (93,8%) hipoestesia e três (6,2%) anestesia (p=0,006). EVA inicial 4,5 (1 a 9) e EVA final 3 (1 a 7) (p<0,001).ConclusãoAs LTPB tem maior prevalência em jovens (21‐40 anos), homens, urbanos, trabalhadores braçais, acidentes motociclísticos, com politrauma, lesão total do plexo. Cirurgias neurais, seguidas em segundo tempo, pelas transferências miotendíneas. A cirurgia para LTPB mostrou melhoria significativa de ADM e força em ombro, cotovelo e punho/mão, da sensibilidade do membro afetado e diminuição da dor final.AbstractObjectiveTo evaluate sociodemographic and clinical aspects of patients undergoing operations due to traumatic lesions of the brachial plexus.MethodThis was a retrospective study in which the medical files of a convenience sample of 48 patients operated between 2000 and 2010 were reviewed. The following were evaluated: 1) range of motion (ROM) of the shoulder, elbow and wrist/hand, in degrees; 2) grade of strength of the shoulder, elbow and wrist/hand; 3) sensitivity; and 4) visual analogue scale (VAS) (from 0 to 10). The Student's t, chi‐square, Friedman, Wilcoxon and Kruskal‐Wallis tests were used (p<0.05).ResultsThe patients’ mean age was 30.6 years; 60.4% of them had suffered motorcycle accidents and 52.1%, multiple trauma. The mean length of time until surgery was 8.7 months (range: 2 to 48). Thirty‐one patients (64.6%) presented complete rupture of the plexus. The frequent operation was neurosurgery, in 39 cases (81.3%). The ROM achieved was ≥ 30° in 20 patients (41.6%), with a range from 30° to 90° and mean of 73° (p=0.001). Thirteen (27.1%) already had shoulder strength ≥ M3 (p=0.001). Twenty‐seven patients (56.2%) had elbow flexion ≥ 80°, with a range from 30° to 160° and mean of 80.6° (p<0.001). Twenty‐two had strength ≥ M3 (p<0.001). Twenty‐two patients (45.8%) had wrist extension ≥ 30° starting from flexion of 45°, with a range from 30° to 90° and mean of 70° (p=0.003). Twenty‐seven (56.3%) presented wrist/hand extension strength ≥ M3 (p=0.002). Forty‐five (93.8%) had hypoesthesia and three (6.2%) had anesthesia (p=0.006). The initial VAS was 4.5 (range: 1.0 to 9.0) and the final VAS was 3.0 (range: 1.0 to 7.0) (p<0.001).ConclusionTraumatic lesions of the brachial plexus were more prevalent among young adults (21‐40 years), men, people living in urban areas, manual workers and motorcycle accidents, with multiple trauma and total rupture of the plexus. Neurosurgery, with a second procedure consisting of muscle‐tendon transfer, was the commonest operation. Surgery for traumatic lesions of the brachial plexus resulted in significant improvement in the ROM and strength of the shoulder, elbow and wrist/hand, improvement of the sensitivity of the limb affected and reduction of the final pai

Risk of substantial intraocular bleeding with novel oral anticoagulants : systematic review and meta-analysis

Copyright © 2015, American Medical Association. All rights reserved.Importance: In noninferiority trials, novel oral anticoagulants (NOACs), also known as non–vitamin K oral anticoagulants, were at least noninferior to standard care in the prevention of most prothrombotic conditions. However, differences exist in the safety profile of antithrombotic drugs, and little is known about their intraocular bleeding risk. Objective: To evaluate the risk of substantial intraocular bleeding associated with NOACs. Data Sources: MEDLINE, Cochrane Library, SciELO collection, and Web of Science databases were searched from inception to November 2014, as well as other systematic reviews and regulatory agencies documentation. Study Selection: All phase 3 randomized clinical trials (RCTs) comparing NOACs with any other control that reported intraocular bleeding events. Data Extraction and Synthesis: Data were extracted independently by 2 of the authors and pooled using random-effects meta-analysis. Heterogeneity was assessed with the I2 test. Main Outcomes and Measures: Substantial intraocular bleeding was evaluated with pooled risk ratios (RRs) and 95% CIs. Results: Seventeen RCTs were included. In patients with atrial fibrillation, no difference was identified between NOACs and vitamin K antagonists (RR, 0.84; 95% CI, 0.59-1.19; I2 = 35%; 5 RCTs), and no increased risk was identified compared with acetylsalicylic acid (RR, 14.96; 95% CI, 0.85-262.00; 1 RCT). In patients with venous thromboembolism, no increased risk of substantial intraocular bleeding compared with sequential treatment with low-molecular-weight heparin and a vitamin K antagonist (RR, 0.67; 95% CI, 0.37-1.20; I2 = 0%; 5 RCTs) was identified. Regarding patients who underwent orthopedic surgery, the risk was not different between NOACs and low-molecular-weight heparin (RR, 2.13; 95% CI, 0.22-20.50; I2 = 0%; 5 RCTs). Conclusions and Relevance: Randomized data suggest that no differences exist in the risk of substantial intraocular bleeding between NOACs and other antithrombotic drugs. However, the number of events was scarce so that additional studies from larger databases that monitor patients under conditions of ophthalmologic routine clinical practice should be performed to better characterize the safety profile of NOACs.info:eu-repo/semantics/publishedVersio

Estudo anatômico do músculo gastrocnêmio medial visando transferência muscular livre funcional Anatomical study of the medial gastrocnemius muscle for functional free muscle transfer

Poucos são os trabalhos em que o músculo gastrocnêmio medial (MGM) foi estudado profundamente em sua anatomia ou foi utilizado a distância como músculo livre para transferência funcional. OBJETIVOS: Os autores apresentam os resultados da dissecção do MGM e seu feixe vasculonervoso, particularmente sua inervação, com o objetivo de contribuir anatomicamente com seu estudo. MÉTODOS: Foram dissecadas 40 peças englobando o joelho e perna (20 à direita e 20 à esquerda), de 40 cadáveres adultos (26 masculinos e 14 femininos), 20 fixados em formaldeído e 20 frescos. Foi realizado estudo anatômico detalhado avaliando o padrão de distribuição, trajeto, número e comprimento da inervação do MGM. RESULTADOS: Foi observado que em 95% dos casos o nervo sural medial é um ramo motor único, de comprimento médio de 3,29cm. Pode-se ganhar em média 1,66cm de extensão ao se dissecar o epineuro, separando-o do nervo poplíteo medial. CONCLUSÃO: O MGM dispõe de um feixe vasculonervoso com irrigação e inervação terminal, o que torna possível a sua transferência muscular livre funcional para membros superiores e não somente como retalho local em membros inferiores.There are not many papers in which the anatomy of the medial gastrocnemius muscle (MGM) was studied in depth or in which the medial gastrocnemius muscle was used remotely as free muscle for functional transfer. OBJECTIVES: The authors present the results of dissecting the MGM and its neurovascular bundle, the innervation in particular, with the purpose of making an anatomical contribution to the study. METHODS: 40 specimens were dissected, including knee joint and leg (20 right legs and 20 left legs) of 40 adult cadavers (26 male and 14 female), 20 fixated with formaldehyde and 20 fresh cadavers. A detailed anatomical study was performed to evaluate the standard distribution, the pathway, the number, and the length of MGM innervation. RESULTS:In 95% of the cases, the medial sural nerve was seen to be a single motor branch, with a mean length of 3.29 cm. An average 1.66 cm in length can be gained by dissecting the epineurium, separating it from the medial popliteal nerve. CONCLUSION: The MGM has a neurovascular bundle with irrigation and terminal innervation that permits its functional free muscle transfer to upper limbs and not only as a local flap of the lower limbs

Transtriquetral perihamate fracture-dislocation: case report

ABSTRACT The wrist is a region that is very vulnerable to injuries of the extremities. Among these injuries, fractures of the pyramidal bone (or triquetrum) in association with dislocation of the hamate and carpal instability are uncommon. They are generally correlated with high-energy trauma and may be associated with neurovascular deficits, muscle-tendon disorders, skin lesions or injuries to other carpal bones. Thus, in this report, one of these rare cases of transtriquetral perihamate fracture-dislocation with carpal instability is presented, diagnosed by means of radiography on the right wrist of the patient who presented pain, edema and limitation of flexion-extension of the carpus after trauma to the region. The stages of attending to the case are described, from the initial consultation to the surgical treatment and physiotherapy, which culminated in restoration of the strength and range of motion of the wrist

Resection osteotomy for calcaneus flattening after micro-surgical flap: technical note

ABSTRACT An open fracture of the calcaneus with loss of substance is a challenging injury and requires specialized care, involves high costs, and demands attention despite its lower incidence. The main complications are osteomyelitis, pressure ulcers, and fistulas, as well as pain conditions in the lateral, medial, and plantar regions. This is due to the wide loss of tissue and the change in anatomical conformation of the calcaneus in some cases. However, in cases of flattening of the calcaneus bone, these complications may be prevented or treated successfully. This technical note describes the resection osteotomy technique for calcaneus flattening to prevent and treat complications after micro-surgical flap in cases of open fracture or loss of substance

Evaluation of elbow flexion following free muscle transfer from the medial gastrocnemius or transfer from the latissimus dorsi, in cases of traumatic injury of the brachial plexus

ABSTRACT OBJECTIVE: To compare the gain in elbow flexion in patients with traumatic injury of the brachial plexus following muscle transfer from latissimus dorsi with the gain following free muscle transfer from the medial belly of the gastrocnemius. METHODS: This was a retrospective study in which the medical files of a convenience sample of 13 patients operated between 2000 and 2010 were reviewed. Group 1 comprised seven patients who underwent transfers from the gastrocnemius and group 2 (controls) comprised six patients who underwent transfers from the latissimus dorsi. The following functions were evaluated: (1) range of motion (ROM) of elbow flexion, in degrees, using manual goniometry and (2) grade of elbow flexion strength, using a muscle strength scale. Satisfactory results were defined as: (1) elbow flexion ROM ≥ 80° and (2) elbow flexion strength ≥ M3. The Fisher exact and Kruskal-Wallis tests were used (p < 0.05). RESULTS: The patients' mean age was 32 years (range: 17-56) and 72% had been involved in motorcycle accidents. Elbow flexion strength ≥ M3 was observed in seven patients (100%) in group 1 and in five patients (83.3%) in group 2 (p = 0.462). None of the patients presented M5, and one patient (16.7%) in group 2 had a poor result (M2). Elbow flexion ROM with a gain ≥ 80° (daily functions) was found in six patients (86%) in group 1 and in three patients (50%) in group 2 ( p = 0.1). CONCLUSION: The patients in group 1 had greater gains in strength and ROM than did those in group 2, but without statistical significance. Thus, transfers from the gastrocnemius become a new surgical option, if other techniques cannot be used

Osteomielite aguda do escafóide: relato de caso Osteomyelitis of the scaphoid: a case report

Relata-se um raro caso de osteomielite aguda do escafóide em punho esquerdo, por Staphylococcus aureus, em homem de 53 anos de idade, paraplégico, sem causa inicial aparente. O tratamento realizado foi baseado em antibioticoterapia venosa específica e drenagem cirúrgica, com bom resultado funcional após seis meses.The authors report a rare case of acute osteomyelitis of the scaphoid bone in the left wrist, due to Staphylococcus aureus, in a 53 year-old paraplegic man without an apparent initial cause. The treatment used was based in specific venous therapy with antibiotics and surgical draining, with good functional result after six months

Primary meningeal Burkitt-type lymphoma presenting as the first clinical manifestation of acquired immunodeficiency syndrome Linfoma de Burkitt primitivo da meninge como primeira manifestação clínica da síndrome da imunodeficiência adquirida

The purpose of this study is to report a rare case of primary meningeal high grade Burkitt-type lymphoma presenting as the first clinical manifestation of acquired immunodeficiency syndrome. A 38-year-old Caucasian man, with a negative past medical history, sought treatment after experiencing global headache for five days. CT-Scan revealed a right front-temporo-parietal hyperdense subdural expansive mass. A craniotomy was performed and a hard white subdural was microsurgically dissected. Some hours after the surgery, the patient developed hemispheric cerebral edema and intracranial hypertension syndrome. Decompressive craniotomy was performed and the patient had an excellent recovery. Screening blood tests diagnosed human immunodeficiency virus infection. Further investigation ruled out systemic diseases. Eleven days after the initial surgery, the patient developed an acute respiratory failure and sepsis, dieing on that day. Pathological studies diagnosed Burkitt-type lymphoma.O objetivo desse estudo é relatar um caso de linfoma de Burkitt de alto grau primitivo da meninge, que se apresentou como primeira manifestação clínica da síndrome de imunodeficiência adquirida. Um homem branco, de 38 anos, previamente hígido, referia cefaléia holocraniana há cinco dias. A TC de crânio evidenciou coleção hiperdensa subdural na região fronto-temporo-parietal direita. Após craniotomia fronto-temporal direita, um tumor branco e rígido de localização subdural foi microcirurgicamente ressecado. Algumas horas após, o paciente apresentou edema cerebral hemisférico e hipertensão intracraniana, tendo sido submetido à craniotomia descompressiva com excelente melhora clínica. Testes sorológicos evidenciaram infecção por vírus da imunodeficiência humana. Investigações complementares afastaram outras doenças sistêmicas. Onze dias após a primeira cirurgia, o paciente apresentou insuficiência respiratória aguda e sepse, evoluindo para o óbito. Análise histopatológica evidenciou linfoma de Burkitt