O Internato de Formação Especializada em Neurocirurgia: Qual o Atual Panorama Nacional?

Introduction: In Portugal, the number of neurosurgery residents has been rising steadily. However, there are no robust studies assessing the level of satisfaction and quality of the current training programs. The aim of this study was to describe and quantify the level of satisfaction about Neurosurgery residency in 2019, in Portugal.Material and Methods: Quantitative observational cross-sectional study based on an original questionnaire about the level of satisfaction of neurosurgical training in Portugal in 2019, sent electronically to residents and young consultants between October and December 2019.Results: A total of 37 responses were obtained from physicians aged around 29.0 (± 4.0) years old, of which 78.4% were men and 54.1% from centers in the center/south of the country/islands. Overall, 51.4% of the answers came from first three years’ residents. As for the theoretical training, there was dissatisfaction with the morbidity and mortality meetings (59.5%), existence of sessions/anatomical lab (89.2%), participation in medical education (64.9%) and in research (64.9%). As for practical training, there was dissatisfaction only towards outpatient clinics (56.8%). There is a tendency for the first surgery to occur in the first month of residency and, in ascending order, firstly a cranial trauma surgery (5.09 ± 4.59 months), then for cerebrospinal fluid diseases (5.95 ± 4.3 months), peripheral nerves (6.0 ± 7.0 months), craniotomy (6.59 ± 3.88 months) and lumbar spine diseases (11.41 ± 1.5 months). Pediatric surgery was the last type of surgery to begin (19.36 ± 20.0 months). There seems to be a generalized satisfaction with the annual (59.5%) but not with thefinal examination (37.8%).Conclusion: This study has succeed at being a better description of the Portuguese neurosurgical centers and of the level of satisfaction about neurosurgical training in Portugal.

Turbans vs. Helmets: A Systematic Narrative Review of the Literature on Head Injuries and Impact Loci of Cranial Trauma in Several Recreational Outdoor Sports

When in public, faith-based mandates require practising Sikh men to wear a turban which may not be covered by hats or caps. This makes it impossible for practising Sikhs to wear helmets and other protective headwear, mandatory in many countries and facilities for engagement in recreational pursuits (e.g., skiing) and on adventure outdoor recreation camps mandatorily run for school groups. The result is often social exclusion and ostracisation in the case of school children. Despite studies into the efficacy of protective helmets in some recreational outdoor activity settings, virtually nothing is known about the protective potential of turbans. This paper systematically reviews the extant literature on head injuries in several recreational outdoor activities and sports sectors (aerial, water, winter, wheeled and animal-based sports) and finds that the extant literature is of limited value when trying to understand the spatial distribution of trauma on the cranial surface. As the data do not permit to make inferences on the protective potential of turbans, future systematic, evidence-based epidemiological studies derived from hospital admissions and forensic examinations are required. Failure to do so perpetuates social exclusion and discrimination of religious grounds without an evidentiary basis for defensible public health measures.

Mitochondrial DNA and Exercise: Implications for Health and Injuries in Sports

Recently, several studies have highlighted the tight connection between mitochondria and physical activity. Mitochondrial functions are important in high-demanding metabolic activities, such as endurance sports. Moreover, regular training positively affects metabolic health by increasing mitochondrial oxidative capacity and regulating glucose metabolism. Exercise could have multiple effects, also on the mitochondrial DNA (mtDNA) and vice versa; some studies have investigated how mtDNA polymorphisms can affect the performance of general athletes and mtDNA haplogroups seem to be related to the performance of elite endurance athletes. Along with several stimuli, including pathogens, stress, trauma, and reactive oxygen species, acute and intense exercise also seem to be responsible for mtDNA release into the cytoplasm and extracellular space, leading to the activation of the innate immune response. In addition, several sports are characterized by a higher frequency of injuries, including cranial trauma, associated with neurological consequences. However, with regular exercise, circulating cell-free mtDNA levels are kept low, perhaps promoting cf-mtDNA removal, acting as a protective factor against inflammation.

Traumatic injury of dural venous sinus as cause of epidural hematoma: importance of recognition and adequate surgical planning

Background: Although most traumatic epidural hematomas are secondary to arterial injuries, particularly rupture of the middle meningeal artery, around 9.7% of cases are associated with dural venous sinus injury, leading to poorer prognosis and greater complications. We report a case of a patient presenting cranial trauma with bone fracture and laceration of the transverse sinus producing epidural hematoma, and discuss the main aspects of this condition. Case description: A 47-year-old man struck by a motorcycle was admitted to the Emergency Room with a score of 15 on the Glasgow Coma Scale, evolving over 5 hours with reduced level of consciousness. A cranial CT scan was performed disclosing right parieto- occipital hyperdensity, consistent with acute epidural hematoma, and a parieto-occipital fracture line crossing the path of the ipsilateral transverse sinus. Parietal craniotomy was performed to drain the hematoma, revealing a venous sinus injury requiring immediate repair. Conclusions: This case and discussion highlight the many details and technical specificities to be taken into account by neurosurgeons when encountering intracranial hematoma caused by traumatic injury of the dural venous sinus, and which are pivotal in determining the efficacy of the treatment approach and prognosis of the patient.

A humanização à vítima de traumatismo crânioencefálico: uma revisão narrativa

O estudo objetivou a compreender a influência da humanização durante a assistência de enfermagem ao paciente com Traumatismo Crânioencefálico. Trata-se de revisão narrativa, percorridas em seis etapas: (1) estabelecimento da hipótese e objetivos da revisão; (2) estabelecimento de critérios de inclusão e exclusão de artigos (seleção da amostra); (3) definição das informações a serem extraídas dos artigos selecionados (4) avaliação dos resultados (5) interpretação dos resultados (6) apresentação da revisão. Foram analisadas 7 artigos, os enfermeiros devem atuar demonstrando sempre o anseio pela busca de aperfeiçoamento em suas práticas assistenciais, e uma estratégia que beneficia a equipe, bem como também, promover a humanização, e a estruturação de um protocolo com base científica que auxilia nas atividades seguras e eficazes ao vínculo profissional-paciente. Conclui-se que a humanização tem influência direta na qualidade assistencial dos pacientes com TCE por meio de um ambiente confortável, com gestão de recursos, maior atividade de profissionais de várias especialidades capacitados para avaliar, diagnosticar e iniciar o tratamento de forma imediata, gerando a organização e integração dos serviços que atendam a demanda de usuários nos setores de urgência e emergência.Descritores: Humanização, Urgência e Emergência, Atendimento Pré-Hospitalar, Traumatismo Craniano. Humanization to the victim of traumatic brain injury: a narrative reviewAbstract: The study aimed to understand the influence of humanization during nursing care for patients with traumatic brain injury. It is a narrative review, carried out in six stages: (1) establishment of the hypothesis and objectives of the review; (2) establishment of inclusion and exclusion criteria for articles (sample selection); (3) definition of information to be extracted from selected articles (4) evaluation of results (5) interpretation of results (6) presentation of the review. Seven articles were analyzed, nurses should always demonstrate their desire to seek improvement in their care practices, and a strategy that benefits the team, as well as promoting humanization, and the structuring of a scientifically based protocol that helps in safe and effective activities to the professional-patient bond. It is concluded that humanization has a direct influence on the quality of care for patients with TBI through a comfortable environment, with resource management, greater activity of professionals from various specialties trained to evaluate, diagnose and start treatment immediately, generating the organization and integration of services that meet the demand of users in the urgency and emergency sectors.Descriptors: Humanization, Urgency and Emergency, Prehospital Care, Cranial Trauma. Humanización a la víctima de traumatismo craneoencefálico: una revisión narrativaResumen: El estudio tuvo como objetivo comprender la influencia de la humanización durante el cuidado de enfermería para pacientes con traumatismo craneoencefálico. Se trata de una revisión narrativa, realizada en seis etapas: (1) establecimiento de las hipótesis y objetivos de la revisión; (2) establecimiento de criterios de inclusión y exclusión de artículos (selección de muestra); (3) definición de la información que se extraerá de los artículos seleccionados (4) evaluación de los resultados (5) interpretación de los resultados (6) presentación de la revisión. Se analizaron siete artículos, los enfermeros siempre deben demostrar su deseo de buscar la mejora en sus prácticas de cuidado, y una estrategia que beneficie al equipo, además de promover la humanización, y la estructuración de un protocolo de base científica que ayude en actividades seguras y eficaces para el vínculo profesional-paciente. Se concluye que la humanización tiene una influencia directa en la calidad de la atención al paciente con TCE a través de un ambiente confortable, con manejo de recursos, mayor actividad de profesionales de diversas especialidades capacitados para evaluar, diagnosticar e iniciar tratamiento de manera inmediata, generando la organización e integración de servicios que satisfagan la demanda de los usuarios en los sectores de urgencia y emergencia.Descriptores: Humanización, Urgencia y Emergencia, Atención Prehospitalaria, Trauma Craneal.

Evidence of interpersonal violence at two sites of the Bijelo Brdo culture in eastern Croatia

Human skeletal remains from Bijelo Brdo-Venice Street and Vukovar-Lijeva Bara have previously been anthropologically analysed and published, but in this paper cranial traumas are studied for the first time. The sample consists of 84 adult skulls curated in the Natural History Museum and the Archaeological Museum in Zagreb. Results showed a high frequency of cranial trauma (19.0 %) recorded in 16 out of 84 well-preserved skulls. Although males exhibit twice as many traumas as females (24.4 % vs. 12.8 %) the difference is not statistically significant. Trauma is present most frequently on the left side of the skull, and there is perimortem trauma in both sites, as well as in both sexes; this indicates the existence of interpersonal violence in these populations.

Hyperbaric oxygen for intracranial abscess

The term “intracranial abscess” (ICA) includes cerebral abscess, subdural empyema, and epidural empyema, which share many diagnostic and therapeutic similarities and, frequently, very similar etiologies. Infection may occur and spread from a contiguous infection such as sinusitis, otitis, mastoiditis, or dental infection; hematogenous seeding; or cranial trauma. In view of the high morbidity and mortality of ICA and the fact that hyperbaric oxygen therapy (HBO2) is relatively non-invasive and carries a low complication rate, the risk-benefit ratio favors adjunct use of HBO2 therapy in selected patients with intracranial abscess.