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M L Lebrão

Publications and source records attributed to M L Lebrão.

12 recordsLinked to original sources
PubMed2000

[Morbidity and mortality due to traumatic brain injury in São Paulo City, Brazil, 1997].

There are few epidemiological studies on traumatic brain injury (TBI), and those that allow broad comparative analyses of this problem are even more scarce, due to methodological obstacles. Usually, the studies address head injury (they include the cranial envelopments and content) but are reported as TBI, given the difficulty of mutual exclusion. It is also common for them to be centered at specific severity levels, only for hospitalized victims or according to the external cause, such as traffic accidents. With full respect to these limits, this study had as its objective the estimation of the TBI incidence in patients resident and in-hospital, in the hospital network in the city of São Paulo, Brazil, in 1997, as well as the estimation of TBI-caused mortality amongst external causes, at this same time and locale. Data for the study consisted of Ministério da Saúde data on hospital discharges, analyzed based on Autorizações de Internação Hospitalar (AIH) and obituary data on external causes, contained in the Programa de Aprimoramento das Informações de Mortalidade (PROAIM) data base. It was found that 29 717 patients were hospitalized due to lesions and poisoning; of these 3 635 (12%) had TBI; the hospitalization rate was 0.36/1000 pop.; and hospital mortality was 10%. The mortality coefficient due to external causes was 87.3/100 000 pop. Minimum TBI mortality rate is estimated at a minimum of 26.2 and a maximum of 39.3/100000 pop.

Adolescent↗
PubMed1999

[Hospital morbidity determinants in a region of São Paulo State (Brazil)].

INTRODUCTION: Many changes in the morbidity of patients attended to the Country's hospitals have occurred in recent years, wether resulting from demographic, epidemiological, financial and technological factors or from those related to the structure of the services themselves. METHODS: The change in diagnoses occurring over this period was analyzed using two data banks relating to hospital discharges during 1975 and 1988, in the Vale do Paraíba, Southeastern Brazil, taking into account the factors mentioned above. Both data banks covered the same variables: hospital, dwelling, patient's age and sex, health status at discharge, financing sources, duration of stay and main diagnosis. RESULTS: Among the results were to be found: an ageing of the population of the region, with an increase in life expectancy and a decrease in the general and infant mortality coefficients, with a proportional diminution of mortality from "infectious and parasitic diseases" and an increase in "neoplasms", "diseases of the circulatory system" and "injury and poisoning". There was a drop in the number of hospitalizations by some diagnostic groups such as "symptoms, signs and ill-defined conditions" and "infectious and parasitic diseases" and an increase in others, particularly the "neoplasms" and "diseases of the circulatory system". There was a shift from the poorly-defined to better defined diagnoses, further, there was a decrease in the duration of stay for all groups. It was possible to identify some factors which might have caused these changes, although there was no one behavioral pattern for all diagnoses.

Adolescent↗
PubMed1997

[Accidents and acts of violence in Brazil: II--Hospital morbidity from lesions and poisonings].

Today in Brazil the "Hospital Internment Authorizations" (AIH) represents about 80% of the total internments in the country and constitutes a data base of easy access available in CD-ROM. This high coverage allows one to draw a reasonable picture, close to reality, of the morbidity demanding hospitalization. Among the causes there is the diagnostic category lesions and poisonings noteworthy for severity and frequency. Hospital internments by this diagnostic category occurring in a month in 1994 have been focused on. Some epidemiological and hospital use characteristics, such as demographic aspects, specific diagnostic category, length of stay and mortality are described. It was observed that lesions and poisonings accounted for 5% to 6% of all hospital internments in the country, being predominantly among men under 65 of age. This diagnostic category was the first cause of hospital internments among men of from 15 to 29 years of age. Fractures were the most frequent specific diagnosis (about 37.5%), almost all of them involving members (legs or arms). The injuries were mainly located in hands, arms, head and neck and occurred predominantly among young men, leading to the believe that they were due to work or traffic accidents. Regarding burns, the fragment occurrence among children under 5 years of age is worthy of note. The authors lament the lack of information as to their causes such as would enable appropriate preventive actions to be taken.

Adolescent↗
PubMed1991

[Analysis of health and life status of a urban population of Botucatu, São Paulo (Brazil). IV. Morbidity reported in domiciliary interviews, 1983-1984].

The objective of the study was to analyse the referred morbidity of the urban population resident in the city of Botucatu, S. Paulo State, Brazil for the period 1983-1984 was analysed. Data was obtained from a sample population of 7,075 persons (12 per cent of the population) by means of household interviews using two pre-codified questionnaires applied by trained lay interviews under supervision. The recall period of the events was fixed at three weeks. The variables studied were: sex, age, schooling, "per capita" income, and referred morbidity (complaints, symptoms, common accidents, and diagnoses). The results showed that 56 percent reported episodes of illness to a total of 6,649. Women of 50 or more years old presented the highest frequency of complaints. There was no variation of occurrence of episodes in terms of "per capita" income. The prevalence of illness episodes was 939 per thousand persons. There was a predominance of complaints relating to the respiratory system (20 per cent of complaints), mainly acute respiratory infections; on a second level was signs, symptoms and ill-defined conditions (19 per cent), followed by diseases of the musculoskeletal system, of the nervous system and of the circulatory system (about 9%) and, finally, diseases of the digestive system and lesions and poisoning (8%). Specific rates of prevalence according to groups of diseases (ICD) and to the variables of study were estimated. The difficulties of comparing these results with those given by other works, because of the lack of homogeneity in the criteria adopted for obtaining information, are commented on.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Prognostic factors for local necrosis in Bothrops jararaca (Brazilian pit viper) bites.

The prognostic factors related to envenoming are not very well known. This study aims to identify prognostic factors for necrosis in envenoming by Bothrops jararaca. We analysed 779 medical records of patients bitten by B. jararaca and treated at the Hospital Vital Brazil, Butantan Institute, São Paulo, Brazil, between 1982 and 1990: 111 cases with necrosis were compared with the remaining cases. The length of the snake, the bite site, the month of the accident, pain, oedema, ecchymosis, blisters, systemic bleeding, shock, and the use of tourniquet were statistically associated with the presence of necrosis (P < 0.05) in the univariate analysis. The size of the snake, the bite site (leg and finger), the sex of the patient, the month of the accident, systemic bleeding, and the use of tourniquet were independent prognostic factors within the variables tested in the multivariate analysis. The size of the snake was the most important independent prognostic factor related to the presence of necrosis.

Adolescent↗
PubMedDate not supplied

[Deaths caused by venomous snakes in the State of São Paulo: evaluation of 43 cases from 1988 to 1993].

UNLABELLED: The prognostic factors and the causes for obit occurrence in ophidian envenoming are yet not completely clear. PURPOSE: To determine the prognostic factors and the most probable causes for obit occurrence in ophidian envenoming. METHODS: In the State of São Paulo were notified 12,639 cases of accidents by venomous snakes from 1988 to 1993. There were 43 deaths (0.34%). The variables from the accident notification reports were compared with the promptuary notes and/or with the death records (in lethal cases). RESULTS: The snake genus was classified in 11,297 accidents and in 41 from the lethal ones. Bothrops was responsible for 9,828 (87%) accidents and 28 (68.3%) deaths, Crotalus for 1,359 (12.0%) accidents and 13 deaths (31.7%) and Micrurus for 110 (1%) accidents and no death (p < 0.05). The information regarding to sex and age of the patients was available, respectively, in 12,620 and 12,527 accidents and in all lethal ones. There were 9,783 (77.5%) male patients in the accidents and 35 (81.4%) in the lethal cases (p > 0.05). Regarding to age, 15.9% of the patients and 41.8% of the ones who died were 50 years-old or more (p < 0.05). The most frequently bitten anatomic regions were: foot (42.2%), hand (20.6%), leg (17.6%), and ankle (13.1%) in the accidents, and foot (35.7%) and leg (35.7%) in the lethal cases (p < 0.05). Coagulation disorders occurred in 34 (91.9%) from 37 patients who died (those where this datum was available). The information above was not available in non lethal cases. The most common manifestations and complications implicated as possible death causes were: acute renal failure (34-79.1%), acute respiratory failure (28-65.1%), shock (18-41.9%), and sepsis (18-41.9%). Among all lethal cases but one without information, 29.4% of the patients died within the first two days after bite and 67.6% within the first 5 days. Acute respiratory failure was most common among the patients who died owing to crotalic envenoming, and sepsis was only seen in bothropic envenoming. CONCLUSION: Most of the accidents and obits are caused by Bothrops; Crotalus envenoming, leg bites, and accidents in 50 year-old patients (or more) are frequently lethal; the most common complication in lethal cases is acute renal failure.

Adult↗
PubMedDate not supplied

[Study of morbidity in patients hospitalized at the Clinic Hospital at the Medical School of the USP-1989].

The diagnostic categories of the patients discharged from the "Hospital das Clínicas" of the University of São Paulo in 1989 were arranged according the International Classification of Diseases (I.C.D.) and analysed. In each Group sex, age and the reason of discharge or death was indicated. The data concerning 39,601 cases were provided by the Medical Data Service of the "Instituto Central" of the "Hospital das Clínicas". Only the principal diagnosis was taken into account. In the "Instituto de Psiquiatria" most the patients (55.4%) were males between 20 and 49 years of age. The main diagnostic categories were affective psychoses (20.3%), schizophrenic disorders (15%), and disorders related to alcoholism (9.5%). The mortality rate was 0.27%. In the "Instituto da Criança" 56% of the patients that left the hospital were male children and 45.8% of them were less than one year old. Regarding to the diagnostic categories the most important one was that of the diseases of the respiratory system with 27.1% of cases, followed by that of infectious and parasitic diseases with 16.0% of cases. Within the respiratory diseases the most important were the pneumonias caused by not specified microorganisms, and within the infectious diseases the most important was the diarrhea of presumably infectious origin. The mortality rate in this Institute was 9.4%. The "Instituto de Ortopedia e Traumatologia" left 3,825 patients 61.7% males, and 46.9% of them were aged between 20 and 49 years. The greatest number of cases (57.1%) belonged to the Chapter "Injury and Poisoning" followed by that of "Diseases of the Muscoleskeletal System" and Connective Tissue Diseases (23.5%). In this Institute the mortality rate was 1.2%. From the "Instituto do Coração" 7,194 patients were discharged; 65% of them were males, varying their age between 50 and 69 years. The diseases of the circulatory system were mostly ischemic heart disease, miocardiopathies and rheumatic heart diseases. Mortality rate in this Institute was 10.8%. The "Instituto Central" was responsible for 65.6% of all the patients discharged from the "Hospital das Clínicas" (26,015 cases). As to the diagnostic categories the predominant chapter was that of "Injury and Poisoning" (12.8% of cases) followed by the "Diseases of the Digestive System" (10.9%) "Neoplasms" (10.8%) and the "Diseases of Circulatory System" (9.2%). The mortality rate in the "Instituto Central" was 7.2%.

Adolescent↗
PubMedDate not supplied

[Evaluation of deaths by accidents with venomous snakes in the State of São Paulo, 1988/1989].

UNLABELLED: In Brazil, the discussion about the quality of medical care evaluation is beginning. PURPOSE: Assessment of the cases of death by venomous snake bite in the State of São Paulo. METHODS: Twenty one deaths caused by venomous snakebite, that occurred in the State of S-ao Paulo, Brazil, during 1988 and 1989 were analysed. The method of three audits implicit criteria was used to evaluate the care given to these cases. Two of the authors did also a qualitative analysis of the care. RESULTS: The results showed a higher frequency of males and adults of 50 and more years of age. The answers to the question "if the death was predictable" were all negative, in 5 cases, and the majority agreed in 6 cases (52.4% of answers were "not predictable"). The question "if there was evidence that the complication was recognized" had answers as "yes" or "there was not sufficient information" in the majority. As to the question "all the appropriate measures were taken in view of the complications", in three cases the answer was "no". CONCLUSION: The main question mentioned was the bad quality of the information in the medical records. The qualitative analysis of the two authors, showed, some inadequate procedures.

Adult↗