Abstract Head injury is the leading cause of death and disability in trauma patients, and alcohol misuse is often associated with such injuries. Despite modern diagnostic facilities, the extent of traumatic brain injury (TBI) is difficult to assess and supplementary diagnostic tools are warranted. The contribution of alcohol misuse to traumas also needs to be elucidated, as the role of different patterns of alcohol drinking in particular has received less attention. We investigated the clinical utility of a novel serum marker of brain damage, protein S100B, as a tool for assessing TBI in patients with trauma. We also investigated the patterns of alcohol drinking among trauma patients and the trauma mechanisms in relation to blood alcohol concentration (BAC), with special emphasis on head traumas. Finally, we studied the early identification of hazardous drinkers among trauma patients. Serum protein S100B was found to be a feasible supplementary method for assessing TBI, as the latter was shown to elevate its levels significantly, the highest values being found in patients with severe injuries. S100B was also found to be elevated in patients with mild head injury, where it was associated with an increased risk of developing post-concussion symptoms (PCSs). Extracranial injuries also increased S100B values in patients with multitrauma. Accordingly, S100B was not specific to TBI. The more severe the extracranial injury, the higher the S100B value that was found. Binge drinking was found to be the predominant pattern in trauma patients. Alcohol intoxication on admission and hazardous drinking patterns were more often present in patients with head injury than in those with other types of trauma. The risk of sustaining a head trauma significantly increased with increasing BAC. The results also demonstrated that BAC on admission is the best marker of alcohol misuse in trauma patients. The BAC test depicts hazardous alcohol drinking better than conventional biochemical markers of alcohol misuse such as gamma-glutamyl transpeptidase (GGT), aspartate aminotransferase (AST), carbohydrate-deficient transferrin (CDT), or mean corpuscular volume (MCV) of erythrocytes. The findings support the use of S100B as a supplementary method for assessing TBI and the use of BAC as a marker of alcohol misuse in trauma patients.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-04-28T15:21:16Z No. of bitstreams: 1 karineandradeoliveirazanini.pdf: 564422 bytes, checksum: 95992f692adb8715af66d371f3987b2f (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-05-02T01:12:26Z (GMT) No. of bitstreams: 1 karineandradeoliveirazanini.pdf: 564422 bytes, checksum: 95992f692adb8715af66d371f3987b2f (MD5) / Made available in DSpace on 2016-05-02T01:12:26Z (GMT). No. of bitstreams: 1 karineandradeoliveirazanini.pdf: 564422 bytes, checksum: 95992f692adb8715af66d371f3987b2f (MD5) Previous issue date: 2016-03-04 / Introdução: Apesar dos avanços recentes no tratamento de pacientes com doença de Crohn (DC), os sintomas oclusivos e suboclusivos observados na presença de estenoses clinicamente significativas permanecem um problema clínico desafiador. Na DC, a identificação de fatores que se associam à redução do risco de cirurgia é importante. Materiais e Métodos: Neste estudo retrospectivo, avaliamos os possíveis fatores preditivos, incluindo os marcadores inflamatórios associados à redução da necessidade de intervenção cirúrgica em pacientes com DC que apresentaram o primeiro episódio de suboclusão intestinal clinicamente resolvido e tratados, subsequentemente, com azatioprina (AZA) durante três anos. Resultados: Trinta e seis pacientes com DC suboclusiva foram incluídos, dos quais, 24 não necessitaram de ressecção intestinal. Nenhum dado demográfico ou clínico associou-se com a resposta à AZA. Apenas a proteína C reativa (PCR) apresentou correlação com a eficácia da AZA. Para cada aumento de 1 mg na PCR, houve uma redução do risco de cirurgia em 8% (RR 0,92; IC 0,86-0,98; p=0,008). O grupo PCR>6 (elevada) apresentou 81% de redução de risco de cirurgia em relação ao grupo PCR<6 (OR 0,19 IC 0,05-0,64; p=0,008). Conclusões: Os pacientes que apresentaram PCR elevada tiveram uma menor taxa de cirurgia a médio e longo prazos durante a terapia com AZA. A PCR pode identificar pacientes com estenoses predominantemente inflamatórias e responsivas ao tratamento clínico. / Background: Despite recent advances in the treatment of patients with Crohn's disease (CD), occlusive and subocclusive symptoms observed in the presence of clinically significant stenosis remains a challenging clinical problem. In inflammatory bowel diseases (IBD), the identification of factors associated with reduced risk of surgery in this context is important. Materials and methods: In this retrospective study, we evaluated the possible predictive factors, including inflammatory markers associated with reduced need for surgical intervention in patients with CD who presented the first episode of clinically solved subocclusion and treated subsequently with azathioprine (AZA) for three years. Results: Thirty-six patients with subocclusive CD were included, of these, 24 has not required bowel resection. No demographic or clinical data associated with the response to AZA. Only C reactive protein (CRP) was correlated with the effectiveness of AZA. For each increase of 1 mg CRP, there was a reduction of surgery risk in 8% (RR 0.92, CI 0.86-0.98; P = 0.008). The CRP group> 6 (elevated) had 81% of surgery risk reduction compared to PCR group <6 (OR 0.19 CI 0.05-0.64; P = 0.008). Conclusions: Patients with elevated CRP has a lower rate of surgery in the medium and long term during therapy with AZA. CRP can identify patients with inflammatory stenosis and responsive to clinical treatment.