Objective: to describe, analyze, and trace the epidemiological profile for cardiac trauma victims on a referral trauma hospital of a major urban center. Methods: a case series study to review, describe, compile and analyze medical records of all patients sustaining traumatic cardiac injuries, from January 2015 to January 2020 admitted to the referral trauma hospital of Curitiba, Brazil. Patients sustaining traumatic heart injuries were identified using the hospitals database. Patients who died prior to reaching hospital care were excluded. Results: all 22 cases were urban victims, mostly penetrating injuries (12 stab wounds, 9 gunshot wounds); 82% were male; mean age, 37.1 years. 17 cases (77%) occurred during night hours, 15 between Friday and Sunday, and 15 were admitted hemodynamically stable. Only 27% were diagnosed with FAST, the remainder requiring other imaging exams. About incisions, 14 had thoracotomies, 6 median sternotomies and in 2 cases both. Of injuries, 8 affected the right ventricle, 3 right atrium, 9 left ventricle, 1 right coronary sulcus and 1 anterior wall. All had cardiorrhaphy repair. 3 patients died, 17 were discharged and 2 were transferred. 17 received postoperative echocardiograms, revealing ejection fractions ranging 55.1% to 75%. Patients spent a mean of 9.6 days on ICU and a mean of 15.2 days of total hospital stay. The mortality rate was 14%. Conclusions: cardiac traumas predominantly occurred in adult males, due to violent causes, during night hours on weekends. The overall mortality rate found (14%), as well as total hospital stay, accords with the literature.
IntroductionTelomeres are nucleoproteic structures arranged in a double helix, located at the end of chromosomes protecting them from deterioration. Each time a cell divides, the enzymatic machinery is unable to replicate integrity of telomeres and by this way, they became smaller, leading to cell aging and death. This shortening can be accelerated by inflammation, oxidative stress, radiation and toxins.Several studies have shown that the adverse early-life experiences may also contribute to premature aging of the telomeres.ObjectivesThis work aims to make a review of the literature published about the impact of adverse life experiences in the shortening of telomeres and premature aging.MethodsBibliographic review.ResultsSeveral studies show that early childhood abuse contribute to accelerated shortening of telomeres, some suggest that there is a direct relationship between the severity and duration of abuse and the degree of shortening. Some studies also show that exposure to trauma in adulthood contributes to the accelerated aging, particularly in individuals who develop PTSD.DiscussionThe interaction of the environment in the biology of the organism seems very deep and precocious. These findings will possible allow the reconstruction the of the biopsychosocial model, opening up new avenues for holistic understanding of the human being.
IntroductionThe existence of a close relationship between the brain and the immune system has been demonstrated based on the results of several studies. Specific autonomic, neuroendocrine and neuropeptides mediators form the biological basis of this interrelationship, as has been demonstrated. The aim of this study is to review and systematize the current scientific knowledge related to the integration of these two systems, and it's clinical correlation.Material and MethodsReview of the literature that addresses the themeResultsStudies in humans have shown that stress and low immunity have a close connection. Works continuously prove this relationship.Discussion and ConclusionRecently, the view that the interaction between the brain and the immune system is bidirectional has been preferred to that in which the direction of communication is exclusively from the brain to the immune system.
IntroductionPisa Syndrome or pleurothotonus is a form of dystonia and often can arise as a side effect of antipsychotic treatment conditioning high morbidity and limiting management options. Despite the fact that the precise mechanism remains unclear, a neurochemical imbalance in dopaminergic and cholinergic transmission but also in serotoninergic and noradrenergic transmission can be a possible pathophysiologic mechanism, which can lead to changes in the axial axis with abnormal posture and marked lateral trunk flexion and abnormal gait.ObjectivesRegarding a clinical case, the authors intend to review the relevant and current literature on the relationship between psychotropic drugs and Pisa Syndrome.MethodsDescription of a clinical case by consulting databases of current and scientifically relevant articles.ResultsThe clinical case reports a 48-year-old woman with a history of HIV and Substance Use Disorder, hospitalized for unspecific behavioral changes, characterized by mood changes, self-referential, persecutory and somatic delusional ideas, and delusions of the control of thought. She was medicated with antipsychotics and mood stabilizers, with subsequent development of an acute-onset dystonic condition, characterizing the Pisa Syndrome. In this context, the dose of antipsychotics was lowered and anticholinergics were introduced, with progressive improvement of the clinical picture.ConclusionsPisa Syndrome, previously seen as a rare adverse effect, can occur as a dystonic reaction related to the use of psychotropic drugs, so its use should be judicious. Further studies are needed to understand the extent of this association and its pathophysiological mechanisms in order to guide more rigorous therapeutic lines.DisclosureNo significant relationships.
IntroductionThe emergence of new psychoactive substances (NPS) has had a substantial impact worldwide. NPS mimic the effect of “existing” drugs and are specifically manufactured so that the new substances fall out of regulatory frameworks. Although the structural changes might be minimal, NPS often have marked differences in potency and subsequent harm.The population of the Azores archipelago has been particularly affected by the rapid growing and changing nature of this phenomenon, mainly caused by the introduction and spread of the “newly” synthetic cathinones as a inexpensive and easily available street drug.Before any educational, public health and socioeconomic policy changes be proposed to accurately tackle the problem, the basic step of knowing how these substances have been affecting their users, specially their neuropsychiatric effects, must be taken.ObjectivesThis project aims to characterize the neuropsychiatric side effects caused by the acute intoxication of NPS with a psychostimulant profile, namely synthetic cathinones.MethodsDescription of the neuropsychiatric symptoms of intoxicated users of stimulant NPS that present to non-governmental organizations specialized in addictions and also to the psychiatry emergency department in Sao Miguel - Azores.Review of the forensic records of the deaths by suicide in 2021 in Sao Miguel, looking for evidence of recent abuse of NPS or previous history of “NPS use disorder”.Non-systematic review of the recent and relevant scientific literature on this topic.ResultsThe desired effects are increased energy, mood enhancement, euphoria, mental clarity, improved concentration, improved sociability, increased talkativeness, empathy inducing effects, amplification of sound and colour and prosexual effects. Nevertheless, in the case of intoxication, the frequent neuropsychiatric side effects tend to be agitation, agressiveness, irritability, altered consciousness, brief psychosis with paranoid delusion, visual and auditive hallucinations, transient mania, enhanced sensorial experiences, headaches, dizzyness, seizures, confusion and amnesia. Usually, the acjute intoxication period tend to be followed by a “crash” with depression, craving, anxiety, panic, suicidal ideation and behaviours. A third of the deaths by suicides in Sao Miguel Island in 2021, 7 out of 21, were in stimulant NPS active or recent users.ConclusionsReview of the neuropsychiatric effects of New Psychoactive Substances with a psychostimulant profile. Further studies of this population of synthetic cathinone users in the Azores are due, namely studying their socioeconomic background, looking for risk and protective factors, and also the long-term side effects.Disclosure of InterestNone Declared
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