. et al. Acidentes de trânsito em área metropolitana da região sul do Brasil -Caracterização da vítima e das lesões. Rev. Saúde Pública, 27: 350-6,1993. Por meio de estudo retrospectivo, descreve-se a casuística referente aos atendimentos prestados a acidentados de trânsito, em 1988, em hospital de Pronto Socorro de Porto Alegre, RS -Brasil. Os dados utilizados foram fornecidos pelo Setor de Documentação e Estatística do hospital estudado (n=6.099). Os resultados encontrados, similares àqueles descritos na literatura, chama especial atenção pela predominância do sexo masculino (69,2% do total de atendimentos), pela concentração dos acidentados na faixa etária dos 20 aos 39 anos (52%) e pela freqüência com que a cabeça é acometida (49,6% dos pacientes). Lesões severas como contusões e fraturas foram encontradas, respectivamente, em 61,5% e 24,2% dos pacientes. Os dados revelam, ainda, o elevado número e a gravidade das lesões resultantes de atropelamentos, os quais foram responsáveis por 32,7% do total de atendimentos por acidentes de trânsito, 57,2% das internações hospitalares, 54,6% dos atendimentos de menores de 9 anos e 42,8% dos acima de 60 anos.Descritores: Acidentes de trânsito. Ferimentos e lesões, epidemiologia. IntroduçãoDesde o seu surgimento, chegando aos dias de hoje, a problemática urbana suscitada pelos veículos automotores não tem sido plenamente resolvida. Mais do que isto, os efeitos diretos e indiretos causados pelos elementos introduzidos por estes no cotidiano do cidadão normal contemplam abordagens, entre outras, do ponto de vista da ecologia (poluição ambiental), da engenharia de trânsito, do planejamento urbano, da qualidade de vida e dos acidentes de trânsito. Este último constitui-se grave problema de saúde pública, cuja relevância reside,ao menos, em três enfoques: a alta morbi-mortalidade conseqüente aos acidentes; sua predominância em populações jovens e/ou economicamente ativas; e o elevado custo ao sistema de saúde e previdência.Embora
Ninety-one Helicobacter pylori-positive patients with nonulcer dyspepsia were randomized to receive either lansoprazole, amoxicillin, and clarithromycin or lansoprazole and placebo. A validated questionnaire assessed dyspeptic symptoms at baseline and at 3, 6, and 12 months. Endoscopies and biopsies were performed at baseline and at 3 and 12 months. There was an overall trend, although not statistically significant, for a benefit of H. pylori eradication. Of the patients in the antibiotics group, 16 of 46 (35%) had symptomatic improvement, versus 9 of 43 (21%) in the control group (P = 0.164). In a secondary analysis, it was found that of the patients without endoscopic gastric erosions, 15 of 34 (44%) in the antibiotics group and 5 of 33 (15%) of controls had symptomatic improvement (P = 0.015). Helicobacter pylori eradication did not prove to be clinically beneficial, although a tendency to symptomatic benefit was detected. Further studies are necessary to confirm the implications of endoscopic gastric erosions in these patients.
SUMMARYBackground: The protective role of Helicobacter pylori in gastro-oesophageal reflux disease has been widely discussed. Aim: To assess the risk of reflux oesophagitis in patients with functional dyspepsia after treatment for H. pylori infection. Methods: A randomized, placebo-controlled, investigator-blinded trial was carried out on 157 functional dyspeptic patients. Patients were randomized to receive lansoprazole, amoxicillin and clarithromycin (antibiotic group) or lansoprazole and identical antibiotic placebos (control group). Upper gastrointestinal endoscopy was performed at baseline, 3 and 12 months after randomization. The primary aim was to detect the presence of reflux oesophagitis. Analyses were performed on an intention-to-treat basis. Results: A total of 147 patients (94%) and 133 (85%) completed 3 months and 12 months follow-up, respectively. The eradication rate of H. pylori was 90% in the antibiotic group (74 of 82) and 1% (one of 75) in the control group. At 3 months, reflux oesophagitis was diagnosed in 3.7% (three of 82) in the antibiotic group and 4% (three of 75) in the control group (P > 0.2). At 12 months, diagnosis was established in five new cases within the first group and in four within the second (P > 0.2). No difference was found in heartburn symptoms. Conclusions: H. pylori eradication does not cause reflux oesophagitis in this western population of functional dyspeptic patients.
Background Serological screening for celiac disease (CD) allows the identification of individuals genetically predisposed, as type 1 diabetes mellitus (T1DM). However, the diagnosis is confirmed by intestinal biopsy. The aim was to determine the prevalence of immunoglobulin‐A anti‐tissue transglutaminase antibodies (IgA‐tTG) and CD in a large cohort of young T1DM patients. Methods Screening for CD was randomly conducted in 881 T1DM by IgA‐tTG and total IgA. Individuals with positive antibodies were referred to endoscopy/duodenal biopsy. Results The age of the cohort at the screening was 14.3 ± 5.9 years and at T1DM onset was 7.9 ± 4.4 years. The prevalence of positive serology was 7.7%. Median IgA‐tTG levels were 117.7 U/mL (interquartile range [IQR] 35.7‐131.5 U/mL). Of the 62 duodenal biopsy, CD was diagnosed in 79.0%, yielding an overall prevalence of 5.6%. The mean age of CD patients was 15.6 ± 6.5 years and, at T1DM onset was 6.3 years (4.0‐9.9 years). The modified Marsh‐Oberhuber histological classification was 22.5% (3a), 36.7% (3b), and 40.8% (3c). In the biopsy‐proven patients, T1DM onset occurred at slightly younger ages (6.3 vs 9.7 years, P = 0.1947), gastrointestinal (GI) manifestations, predominantly abdominal pain and distension, were more prevalent (71.4% vs 38.5%, P = 0.027) and higher IgA‐tTG titers (128.0 vs 26.3 U/mL, P = 0.0003) were found than in those with negative‐biopsies. Conclusion Our results demonstrate the prevalence of 7.7% of IgA‐tTG and 5.6% of CD in T1DM patients in South Brazil and, emphasize the importance of the screening in high‐risk individuals. Furthermore, the presence of GI manifestations and higher IgA‐tTG titers strongly suggest the diagnosis of CD.
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