A 44-year-old man underwent aortic valve replacement with a porcine bioprosthesis 21 years ago for infective endocarditis complicated by a cerebral mycotic aneurysm and intracranial bleeding. Nine years ago, he had a second aortic valve replacement with a mechanical bileaflet tilting-disk prosthesis because of porcine prosthesis degeneration. No pseudoaneurysm was noted on the operative report. Six months ago, he developed angina and had a positive stress test for ischemia. Angiography showed severe left main coronary artery (LM) stenosis, which was treated with intravascular ultrasound-guided percutaneous coronary intervention with a zotarolimus-eluting stent.Two months ago, he again developed angina. Follow-up angiography and intravascular ultrasound revealed severe
Suggested citation: Waksman RD, Pirito RM. The pediatrician and traffic safety. J Pediatr (Rio J). 2005;81(5 Suppl):S181-S188. AbstractObjective: To instruct children and teenagers about safe transportation and about their behavior as cyclists and pedestrians. Sources of data:The MEDLINE and LILACS databases were searched, using the following terms, from 1995 to 2005: traffic accidents, child, adolescent, morbidity, mortality, age, and gender. Scientific articles on morbidity and mortality from traffic accidents, children in a pedestrian situation, as cyclists or as motor vehicle passengers, were selected.Summary of the findings: More than 300 scientific articles were found, but only the studies that addressed those issues in a broad manner were selected.Conclusions: Traffic-related mortality rates are still very high and show the necessity to intensify educational campaigns for community awareness, in addition to encouraging investments in effective pedestrian safety. The pediatricians role is to decrease the number of children and adolescents who get involved in traffic accidents by providing them with traffic guidance and education.J Pediatr (Rio J). 2005;81(5 Suppl):S181-S188: Accident prevention, prevention and control, pedestrian, transportation, cyclist.
Purpose: To evaluate severity and built a pilot of a national databank about pediatric trauma and to determine its severity. Methods: Prospective study of unintentional pediatric trauma in five hospitals in the city of São Paulo, Brazil. Results: 916 patients in 4 months. 61.5% of traumatized children were male, average 6.5 years. 48. 4% were falls. Most families had an average monthly income less than three minimum wages. 42% of accidents occurred at home. 18.9% of children were alone. 59,8% of parents thought it could be prevented. 26.5% of children had previous accidents. GCS was severe: 5 patients, moderate: 8 patients. 21 patients were intubated (2.4%), RTS <7 in 10.2%, PTS<8 in 3.6%. 8.5% patients were considered severe, which was related to falls (p=0.001); sports (p=0.045); pedestrian (p=0.006); child education (p=0.015) and cared by male (p=0.007). Conclusions: Severity occurred in 8.5% and was associated to falls, sports, traffic, child education, and cared by male. Simple preventive measures could have prevented most of the accidents. The tested tool for details was successful and can be used throughout the country.
Suggested citation: Waksman RD. Reduction of injuries due to external causes. Can the pediatrician help? J Pediatr (Rio J). 2004;80:435-6. This issue of the Jornal de Pediatria presents an article that analyzes certain factors related to physical injuries to children and adolescents that resulted in hospital admission, written by Gaspar et al. 1 This is a prospective research study of a one-year period including children under 19 years old who were hospitalized as a result of unintentional injuries (accidents), and which raised a number of different considerations of interest to pediatricians.The incidence of intentional and unintentional physical injuries (external causes: accidents and violence) is visibly greater in urban areas, concentrating 75% of all deaths from these causes. 2 The impact of these deaths can be analyzed by means of the relative indicator, years of potential life lost (YPLL), which increased by 30% (from 1981 to 1991) with respect of external causes. It is calculated that deaths and incapacitations due to these causes will increase by 20% over the coming years. 2,3 These causes occupy on average 10 to 30% of hospital beds. In the study in question, injuries accounted for 9.9% of hospitalizations.The economic impact of accidents and violence in Brazil can be measured directly by means of hospital spending on internments and general hospital stays. In 1997, these accounted for approximately 8% of the total cost of hospital admissions for all causes. Although these values are underestimates as they only refer to admissions via SUS (the Brazilian National Health System), and do not could private or affiliated hospitals, the cost/day of Reduction of injuries due to external causes.Can the pediatrician help?Renata D. Waksman * hospitalizations due to injuries and poisoning is 60% greater than the average for other types of admission. 2
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