BackgroundAcute subdural hematoma (ASDH) is a traumatic lesion commonly found secondary to traumatic brain injury. Radiological findings on CT, such as hematoma thickness (HT) and structures midline shift (MLS), have an important prognostic role in this disease. The relationship between HT and MLS has been rarely studied in the literature. Thus, this study aimed to assess the prognostic accuracy of the difference between MLS and HT for acute outcomes in patients with ASDH in a low-income to middle-income country.MethodsThis was a post-hoc analysis of a prospective cohort study conducted in a university-associated tertiary-level hospital in Brazil. The TRIPOD (Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis) statement guidelines were followed. The difference values between MLS and HT (Zumkeller index, ZI) were divided into three categories (<0.00, 0.01–3, and >3). Logistic regression analyses were performed to reveal the OR of categorized ZI in predicting primary outcome measures. A Cox regression was also performed and the results were presented through HR. The discriminative ability of three multivariate models including clinical and radiological variables (ZI, Rotterdam score, and Helsinki score) was demonstrated.ResultsA total of 114 patients were included. Logistic regression demonstrated an OR value equal to 8.12 for the ZI >3 category (OR 8.12, 95% CI 1.16 to 40.01; p=0.01), which proved to be an independent predictor of mortality in the adjusted model for surgical intervention, age, and Glasgow Coma Scale (GCS) score. Cox regression analysis demonstrated that this category was associated with 14-day survival (HR 2.92, 95% CI 1.38 to 6.16; p=0.005). A multivariate analysis performed for three models including age and GCS with categorized ZI or Helsinki or Rotterdam score demonstrated area under the receiver operating characteristic curve values of 0.745, 0.767, and 0.808, respectively.ConclusionsThe present study highlights the potential usefulness of the difference between MLS and HT as a prognostic variable in patients with ASDH.Level of evidenceLevel III, epidemiological study.
Úlceras por pressão (UP) são importantes causas de morbidade, além de possuir alto custo ao sistema de saúde, agrega um risco adicional para os portadores pois impõe a perda da barreira constitucional da pele. A fotobiomodulação com laser de baixa potência (FBM) mostra efetivas ações analgésica, antinflamatória e reparação dos tecidos. O objetivo do presente estudo foi avaliar a eficácia da FBM no tratamento de UP a partir de uma revisão integrativa norteada pela pergunta “Qual a eficácia da fotobiomodulação no tratamento de úlceras por pressão?”. O estudo incluiu sete artigos selecionados nas bases de dados Scielo, PubMed e LILACS entre o período de 2015 e 2020. Após a leitura, análise e interpretação dos dados, pôde-se verificar que, apesar de haver poucos estudos recentes sobre a terapia a laser na temática da lesão por pressão, os artigos elucidam que a terapia com laser de baixa potência é uma modalidade promissora de tratamento, que proporciona redução do tempo de cicatrização e melhora no aspecto das feridas. Contudo, apesar de diversos estudos demonstrarem os efeitos benéficos desta, ainda não há consenso e protocolos específicos definidos que determinem parâmetros de irradiação, como comprimento de onda, energia, fluência, potência, irradiância, duração do pulso e intervalos entre as sessões de tratamento.
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