ABSTRACT Objective To evaluate the time interval and possible delay in transportation to referral units for the treatment of testicular torsion. Methods We retrospectively analyzed all cases of spermatic cord torsion surgically treated at a university hospital between January 2018 to December 2021. We evaluated the time intervals, including pain onset until the first presentation (D1), interhospital transference time (D2), pain onset until urological evaluation in a tertiary service (D3), urological evaluation until surgery (D4), and time from pain onset to surgical treatment (D5). We analyzed demographic and surgical data, orchiectomy rates, and time intervals (D1–D5). Torsions presented to the first medical presentation within 6h were considered early for testicular preservation. Results Of the 116 medical records evaluated, 87 had complete data for the time interval analysis (D1 to D5) and were considered the total sample. Thirty-three had D1 ≤6h, 53 had D1 ≤24h (includes patients in the D1 ≤6h subgroup), and 34 had D1 >24h. The median time intervals of the total samples and subgroups D1 ≤6h, D1 ≤24h, and D1 >24h were D1 = 16h 42min, 2h 43min, 4h 14min and 72h, D2 = 4h 41min, 3h 39min, 3h 44min and 9h 59min; D3 = 24h, 6h 40min, 7h and 96h; D4 = 2h 20min, 1h 43min, 1h 52min and 3h 44min; D5 = 24h 42min, 8h 03min, 9h 26min and 99h 10min, respectively. Orchiectomy rates of the total sample, subgroups D1 ≤6h, D1 ≤24h, and D1 >24h were 56.32%, 24.24% (p<0.01), 32.08% (p<0.01), and 91.18% (p<0.01), respectively. Conclusion Late arrival at the emergency department or a long interhospital transference time determined a large number of patients who underwent orchiectomy. Thus, public health measures and preventive strategies can be developed based on the data from this study aiming to reduce this avoidable outcome.

ABSTRACT Objective To report the effects of a tunica vagina flap on testicular compartment syndrome. Methods This single-arm clinical trial was conducted from September 2020 to October 2021. Consecutive patients with suspected testicular torsion within 24 hours of pain onset were included. Patients with past testicular torsion, bilateral torsion, or previous atrophy were excluded. The tunica vaginalis was opened, and the intratesticular pressure was measured before testicular retrieval from the scrotum and detorsion (P1), after detorsion (P2), and after transverse incision (P3). A tunica vaginalis flap was performed and a new intratesticular pressure was recorded (P4). The contralateral testicular pressure was recorded before fixation (Pc). The minimum follow-up period was 6 months. Results Fifteen patients were recruited from September 2020 to October 2021. Nine patients completed the follow-up. The median age (range) was 15 years (9-19). The mean P1, P2, P3, P4, and Pc (range) were 43, 60, 23, 20, and 14mmHg, respectively. The atrophy rate was 66.3% and the viability was 88.9%. No major complications were observed. Conclusion The modified tunica vaginalis flap in acute testicular torsion decreased intratesticular pressure. Furthermore, normal testicular pressure can improve testicular preservation. It can also decrease testicular pressure to normal levels and preserve the testicular parenchyma.

ABSTRACT Introduction: It has been more than a year since the first case of Covid-19 was diagnosed in Brazil, and its most problematic feature is the oversaturation of the healthcare system capacity. Urolithiasis is a disease that requires timely and appropriate management. The present study aimed to evaluate the impact of the pandemic in hospital admissions for urolithiasis in the Brazilian public healthcare system. Materials and Methods: In this cross-sectional study, hospital admissions were obtained from the Brazilian Public Health Information system. All hospital admissions associated with urolithiasis diagnosis (ICD-10 N20) between March 2017 and February 2021 were analyzed. Results: During the COVID-19 outbreak, there was a significant decrease in hospital admissions (p<0.0001). More than 20.000 patients probably did not have the opportunity to undergo their surgeries. The impact of the COVID-19 outbreak on women's admissions was significantly more intense than for men, reducing from 48.91% to 48.36% of the total (p=0.0281). The extremes of age seemed to be more affected, with patients younger than 20 years and older than 60 years having a significant reduction in access to hospital services (p=0.033). Conclusions: In conclusion, we have noticed a considerable reduction in overall admissions for the treatment of urolithiasis in the Brazilian public healthcare system during the first year of the Covid-19 pandemic. Women and individuals older than 60 years were especially affected. In contrast, we noted a rise in urgent procedures, comparing with the average of the corresponding period of the three previous years. Recovery plans will be needed while returning to activities to handle the impounded surgical volume.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor é uma das principais queixas dos indivíduos que procuram atendimento nos serviços de saúde. A alta prevalência de dor tanto aguda quanto crônica na população torna este um problema de saúde pública, devido aos elevados custos impostos à sociedade e aos serviços de saúde, além do impacto negativo nas atividades cotidianas daqueles que convivem com tal experiência. Este estudo teve como objetivo identificar a prevalência de dor crônica em estudantes de medicina de uma Universidade do Interior Paulista. MÉTODOS: Estudo transversal, realizado com 395 estudantes de todas as séries do curso de medicina da Universidade de Taubaté. As variáveis investigadas foram: ocorrência e tempo da dor sentida, presença ou não de fator (es) desencadeante (s), uso ou não de fármacos para alívio da dor, localização e dimensão da dor segundo o questionário de McGill. RESULTADOS: Houve predomínio do sexo feminino com 253 participantes (64,05%), prevalecendo a faixa etária de 21 a 25 anos com 217 alunos (54,93%). Entre os participantes, 219 (55,44%) apontaram a presença de algum tipo de dor e destes, 141 (64,38%) relataram sentir dor de forma crônica, ou seja, há mais de seis meses, perfazendo 35,69% do total. CONCLUSÃO: Neste estudo, a prevalência de dor crônica foi de 35,69%, com maior ocorrência no sexo feminino. Em relação a localização da dor, houve maior prevalência na região lombar e sacrococcígea, seguida pelo joelho e em terceiro lugar a dor de cabeça, face e boca e por último dor generalizada.

ABSTRACT BACKGROUND AND OBJECTIVES: Pain is a major complaint of individuals looking for healthcare services. The high prevalence of both acute and chronic pain makes it a public health problem, due to high costs imposed to society and healthcare services, in addition to the negative impact on daily activities of those living with such experience. This study aimed at identifying the prevalence of chronic pain among medical students of a University in the countryside of São Paulo. METHODS: Cross-sectional study carried out with 395 students of all grades of the medicine course of the Universidade de Taubaté. Investigated variables were: pain incidence and duration, presence or not of triggering factor(s), use or not of painkillers, pain location and dimension according to McGill questionnaire. RESULTS: There has been predominance of females with 253 participants (64.05%), prevailing the age group between 21 to 25 years with 217 students (54.93%). Among participants, 219 (55.44%) reported some type of pain and among them, 141 (64.38%) have reported chronic pain, that is, for more than six months, in a total of 35.69%. CONCLUSION: In our study, chronic pain prevalence was 35.69%, especially among females. With regard to pain location, there has been more prevalence of lumbar and sacrococcygeal regions, followed by knees and headache, face and mouth and finally widespread pain.