Objective: The presence of focal lesion (FL) after a severe traumatic brain injury is an important factor in determining morbidity and mortality. Despite this relevance, few studies show the pattern of recovery of patients with severe traumatic brain injury (TBI) with FL within one year. The objective of this study was to identify the pattern of recovery, independence to perform activities of daily living (ADL), and factors associated with mortality and unfavorable outcome at six and twelve months after severe TBI with FL. Methodology: This is a prospective cohort, with data collected at admission, hospital discharge, three, six, and twelve months after TBI. RESULTS: The study included 131 adults with a mean age of 34.08 years. At twelve months, 39% of the participants died, 80% were functionally independent by the Glasgow Outcome Scale Extended, 79% by the Disability Rating Scale, 79% were independent for performing ADLs by the Katz Index, and 53.9% by the Lawton Scale. Report of alcohol intake, sedation time, length of stay in intensive care (ICU LOS), Glasgow Coma Scale, trauma severity indices, hyperglycemia, blood glucose, and infection were associated with death. At six and twelve months, tachypnea, age, ICU LOS, trauma severity indices, respiratory rate, multiple radiographic injuries, and cardiac rate were associated with dependence. Conclusions: Patients have satisfactory functional recovery up to twelve months after trauma, with an accentuated improvement in the first three months. Clinical and sociodemographic variables were associated with post-trauma outcomes. Almost all victims of severe TBI with focal lesions evolved to death or independence.

Background Patients with moderate and severe traumatic brain injury (TBI) admitted to the intensive care unit (ICU) may develop pressure injury (PI) due to haemodynamic instability caused by the disease, lack of mobility in bed, as well as intense and prolonged compression in prominent bone areas. Objective The objective of this review is to assess the incidence and identify risk factor for the development of PI in patients with moderate and severe TBI admitted to the ICU. Method Searches were conducted in the PubMed, CINAHL, Scopus, Embase, Web of Science, Google Scholar, Trove and Open Grey databases, including all records found up to May 2023. Patients with moderate and severe TBI admitted to the ICU were included in this review. Results A total of 368 studies on PI and TBI were identified in the databases. Two authors assessed study bias and extracted data, wit. h a third reviewer as arbitrator. Six studies met the inclusion and exclusion criteria in the review. The incidence of PI varied between 6.5% and 20% among the included studies. Only two studies applied the Braden Scale, which identified stage II lesions (52.6% and 51.5%), located in the sacral region (78.9% and 54.6%). The risk factors identified in the studies for the development of PI were mechanical ventilation, TBI severity, vasoactive drugs, age, fever, use of enteral nutrition, haemoglobin levels and time to perform tracheostomy. Conclusion The incidence of PI in moderate and severe patients was similar to that found in ICU patients. There were significant differences across the various studies in the ways in which data were collected and reported. Trial registration number The protocol has been deposited in the PROSPERO repository (CRD42023428817).

Background: The diagnosis and prognosis of diffuse axonal injury (DAI) remain challenging. This research aimed to analyze the impact on activities of daily living (ADL), functional outcomes, quality of life (QoL), and the association between lesion severity and DAI location identified through imaging exams. Methods: This prospective cohort study included 95 patients diagnosed with DAI. Data were collected at admission, three, six, and twelve months post-injury. The associations between variables were evaluated using a mixed-effects model. Results: Functional recovery and QoL improved between three and twelve months after DAI. An interaction was observed between independence in performing ADL and subarachnoid hemorrhage (p = 0.043) and intraventricular hemorrhage (p = 0.012). Additionally, an interaction over time was observed between the Glasgow Outcome Scale (GOS) and DAI severity (p < 0.001), brain lesions (p = 0.014), and the Disability Rating Scale (DRS) with injury in brain hemispheres (p = 0.026) and Adams classification (p = 0.013). Interaction effects over time were observed with the general health perceptions and energy/vitality domains with intraventricular hemorrhage, and the social functioning domain with the obliteration of basal cisterns and Gentry’s classification. Conclusion: The use of CT in the acute phase of DAI is important for predicting outcomes. The severity and location of DAI are associated with functional outcomes, ADL, and QoL.

Intestinal malrotation is a congenital anomaly of the midgut resulting from abnormal embryonic rotation. Although predominantly a neonatal diagnosis, it is an extremely rare, isolated finding in adolescents, often presenting with nonspecific symptoms that lead to diagnostic delays and increased morbidity. We report a 17‐year‐old male presenting with acute abdominal pain, distension, and vomiting. Diagnosis was established via contrast‐enhanced computed tomography (CT), which identified spiral rotation of mesenteric vessels and colonic displacement. The patient initially underwent a laparoscopic Ladd’s procedure; however, postoperative complications involving duodenal stenosis and recurrent obstruction required a conversion to a Billroth II gastrojejunostomy with a Braun anastomosis. This case highlights that while the Ladd’s procedure remains the surgical standard, the management of malrotation in older patients presents unique challenges compared to neonates. Unlike pediatric cases often associated with other malformations, adolescent presentation is typically isolated and insidious, making contrast‐enhanced CT essential for identifying the “whirlpool sign” and avoiding misdiagnosis. Furthermore, this report underscores that chronic inflammation or recurrence in adults may demand surgical strategies beyond the standard procedure. In complex scenarios with recurrent obstruction, reconstructive techniques such as the Billroth II gastrojejunostomy with Braun anastomosis or Roux‐en‐Y gastric bypass are effective alternatives to prevent alkaline gastritis and ensure long‐term symptom resolution.

Introduction: Severe obesity is most effectively treated with bariatric surgery. The resulting weight loss is expected to improve obesity-related conditions, including sexual dysfunction. Objective: To evaluate the sexual function of morbidly obese women undergoing bariatric surgery using a questionnaire validated at three time points: preoperatively, six months and twelve months later. Method: A quantitative, descriptive and analytical cross-sectional, quasi-experimental study was carried out with a convenience sample of women over 18 years of age, with class III obesity, submitted to Roux-en-Y gastric bypass. The questionnaire adopted was the Female Sexual Function Index (FSFI), which evaluates six domains: desire, arousal, lubrication, orgasm, satisfaction and pain. Scores above 26.55 translate satisfactory sexual function and lower scores define sexual dysfunction. Results: A total of 74 women were evaluated from 36.2 ± 8.3 years, BMI before surgery was 42.7 ± 4.0, after six months 31.8 ± 3.5 and after 12 months 30.0 ± 3.6. The mean total FSFI score obtained in the preoperative period was 20.7. After six months, 27.7 (p < 0.01), and after 12 months, 29.4 (increase of 42.0% compared to the preoperative period). Both in terms of the total score and the isolated domains of the FSFI, an association was observed between improved sexual function and reduced BMI. Conclusion: There was a significant improvement in sexual function as early as six months after surgery, as well as in the other domains alone.

Introduction: Severe obesity is most effectively treated with bariatric surgery. The resulting weight loss is expected to improve obesity-related conditions, including sexual dysfunction. Objective: To evaluate the sexual function of morbidly obese women undergoing bariatric surgery using a questionnaire validated at three time points: preoperatively, six months and twelve months later. Method: A quantitative, descriptive and analytical cross-sectional, quasi-experimental study was carried out with a convenience sample of women over 18 years of age, with class III obesity, submitted to Roux-en-Y gastric bypass. The questionnaire adopted was the Female Sexual Function Index (FSFI), which evaluates six domains: desire, arousal, lubrication, orgasm, satisfaction and pain. Scores above 26.55 translate satisfactory sexual function and lower scores define sexual dysfunction. Results: A total of 74 women were evaluated from 36.2 ± 8.3 years, BMI before surgery was 42.7 ± 4.0, after six months 31.8 ± 3.5 and after 12 months 30.0 ± 3.6. The mean total FSFI score obtained in the preoperative period was 20.7. After six months, 27.7 (p < 0.01), and after 12 months, 29.4 (increase of 42.0% compared to the preoperative period). Both in terms of the total score and the isolated domains of the FSFI, an association was observed between improved sexual function and reduced BMI. Conclusion: There was a significant improvement in sexual function as early as six months after surgery, as well as in the other domains alone