MAIN FINDINGS OF HIGH DIGESTIVE ENDOSCOPY IN PATIENTS WITHLARYNGOPHARYNGEAL REFLUX: RETROSPECTIVE STUDY OF 133 CASESEDUARDA RAQUEL PRZYGODA ALVES - FURB; BEATRIZ BRITTES KAMIENSKY - FURB; HADELLEHABITZREUTER HASSMANN - FURB; JAN ALESSANDRO SOCHER - FURBIntroduction: Laryngopharyngeal reflux (LPR) is considered an extraesophagealmanifestation which may or may not be associated with gastroesophageal refluxdisease (GERD) and there are two suggestions for theories to their causes andsymptoms: theory of direct damage and theory of vagal reflex.Objective: Raise the main findings of upper endoscopy (EGD) in patients with adiagnosis of laryngopharyngeal reflux.Methods: Retrospective analysis of results from EGD and urease test of 133 patientstreated between January 2011 and December 2011 selected with a previousdiagnosis of LPR through video faringolaringoscopia. In suspected cases alsounderwent biopsy when necessary. Results: The main findings were gastritis(77%), distal esophagitis (59%), hypofunction of the cardia (40%) and hiatal hernia(32%). In 9% of patients were identified Barretts esophagus and neoplasia in 2.2%of patients. In two cases was identified fungal esophagitis. Only 12% of patientshave normal EGD. In 30% of patients were identified H. pylori positive.Conclusion: EGD proved to be an important test in the diagnosis of additionalcomorbidities that can follow laryngopharyngeal reflux interfering in thetherapeutic setting.
EVALUATION OF THE EFFICACY AND TEMPORAL PATTERN OF DRY NEEDLING INTHE TREATMENT OF MYOFASCIAL PAIN SYNDROMEJULIANA TAKIGUTI TOMA - UNIFESP; MARCUS YU BIN PAI - FCMSCSP; IRINA RAICHER - HC-FMUSP;HELENA HIDEKO SEGUCHI KAZIYAMA - HC-FMUSP; RICARDO GALHARDONI - HC-FMUSP; MANOELJACOBSEN TEIXEIRA - HC-FMUSP; DANIEL CIAMPI DE ANDRADE - HC-FMUSPIntroduction: Myofascial Pain Syndrome (MPS) is a regional muscle pain disorderaccompanied by trigger points. Trigger point dry needling is one of the mosteffective treatments available. It relies on mechanical disruption of trigger points,also inhibiting nociception. In this study, we evaluated in a prospective, sham-controlled study the pattern of analgesic efficacy of trigger point dry needling inMyofascial Pain Syndrome (MPS) patients.Materials and Methods: We evaluated patients with shoulder pain due to excess ofnociception associated with chronic MPS in asymmetrical or unilateral trapeziusmuscle trigger points (VAS more painful side less painful side > 40mm). Patientswere randomly assigned to two treatment arms: Active (A) (n=20) and Sham (S)(n=21). Group A received actual treatment with trigger point dry needling. Group Sreceived a sham treatment, with the needle inserted superficially in the skin,without reaching the muscle underneath it. The duration (sec) and pain (VAS)elicited during active and sham dry needling were controlled for. Patients wereevaluated one week before needling (D-7), on the day of dry needling (D0) andseven days after the procedure (D+7). Patients filled out the Brazilian version of theDouleur Neuropathique 4, Beck Depression Inventory, Brief Pain Inventory (BPI),McGill Pain Questionnaire-SF (SFMPQ), Hospital Anxiety and Depression Scale andGlobal Impression of Change, and also filled out a 14-day pain diary with the firstpart of the BPI.Results: 41 patients were included in the trial. Mean VAS was 69.7±17.1 uponenrollment. The reduction in pain intensity after treatment was significant for theactive group (VAS before=54±19 vs VAS after= 29±20, p<0.05). Changes were notsignificant for the sham group (VAS before=57.1±21.4 vs. VAS after= 48.5±29.5,p=0.333). The total score of pain intensity in the SFMPQ was significantly improvedin Group A (before=51.5±28.7 vs. after= 30±31.6, p<0.05) but not in the shamgroup (before=57.1±32.8 vs. 44.3±26.9; p=0.104). The mean pain interference inlife activities did not differe between groups. The worst pain, and average 24h painscore of BPI decreased in the active group only. There were no correlationsbetween more intense pain during needling and immediate or long-term pain relief,which was maximal on the 7th day after needling.Conclusions: Dry needling MPS trigger points relieve pain when compared with asham procedure of the same duration and pain intensity. The analgesic effect builtup on the following days after stimulation and was higher on the 7th day after theprocedure, which argues for long-lasting local effects that go beyond the mechanicaleffect of the procedure. Needling may serve as a complementary therapeutic optionin these patients.
BRAZILIAN PORTUGUESE TRANSLATION, CROSS-CULTURAL ADAPTATION ANDVALIDATION OF THE HEART CONTINUITY OF CARE QUESTIONNAIREDÉBORA COSTA RACHID LACERDA - UNIVERSIDADE FEDERAL DE JUIZ DE FORA (UFJF); LUCAS MENDESNASCIMENTO - UNIVERSIDADE FEDERAL DE JUIZ DE FORA (UFJF); CARLA MALAGUTI - UNIVERSIDADEFEDERAL DE JUIZ DE FORA (UFJF)Introduction: To measure the continuity of care of such patients, a questionnairewas developed to reflect the patients perspective in several respects. For thispurpose, Hadjistavropoulos et al. developed the "Heart Continuity of CareQuestionnaire" (HCCQ), a specific questionnaire originally written in Englishcontaining 33 questions. It addresses information about the patients condition,medication, precautions related to diet and exercise, plans to release the patientfrom the hospital and follow-up care. There are also questions about the evaluationof communication and coordination of the health professionals. The translation andadaptation of this questionnaire into Portuguese, as well as its validation will allowit to be used in scientific and clinical fields in Brazil. As the Brazilian Ministry ofHealth emphasizes, cardiovascular diseases are the leading cause of death in thecountry, which increases the relevance of this study.Materials and Methods: The sample is composed of patients with clinical andlaboratory diagnosis of cardiovascular diseases, such as hypertension and chronicheart failure, aged over 20 years and of both sexes. The pilot test was performedwith 20 patients. Furthermore, it is important to note that patients with cognitivedisorders, suspicion of psychiatric disorders, lung disease and severeneuromuscular complications were excluded because this could affect the results.The methodological study involved the following steps: translation, synthesis, back-translation, review by an expert committee and pretest of the final version.Results: After application of the pilot test, an analysis was made considering thedifference of understanding between the synthesis version into Portuguese and theoriginal version. In this discussion, we noticed that in Brazil some terms are notcommonly known by the population as they are in other cultures. Thus, a culturaladaptation was crucial. The expression "health care providers" was the mostproblematic; therefore, there was a need to change it to "health team". The word"contact" also caused misunderstandings in item 22. Another problem was thetranslation of item 17, because this item had many repetitions of the expression"care providers" and of the word "care". Therefore, the structure of the sentencewas changed. Another important point was that most patients understand"pharmacist" as a person who works in drugstores and not the person graduated inPharmacy. It is important to mention that these data are preliminary and werecollected in the pilot test. The study of the total sample (100 patients) is still beingconducted.Conclusions: It is pertinent to note that in a questionnaire containing 33 questions,few problems were found and very little was changed, which means that the unifiedtranslated version into Portuguese is very consistent with the original version.
MYOCARDIAL REVASCULARIZATION IN END-STAGE RENAL DISEASE PATIENTSMATHEUS MIRANDA; NÉLSON AMÉRICO HOSSNE JR.; LUÍS ROBERTO GEROLA; JOSÉ OSMAR DE ABREUMEDINA PESTANA; JOSÉ HONÓRIO DE ALMEIDA PALMA DA FONSECA; ENIO BUFFOLOIntroduction : Cardiovascular diseases are the leading cause of mortality in end-stage renal disease (ESRD) patients. The impaired renal function has been a factoradverse in cardiac surgery, causing increased morbidity and mortality, being thegroup of dialysis patients the most affected.Objective: To analyze outcomes after coronary artery bypass grafting (CABG) inESRD, as well as complications in the immediate phase, trying to identify the causesand conduct during the perioperative period.Materials and methods: We analyzed the medical records of 43 consecutivepatients, not selected in a retrospective study underwent CABG at a tertiary publicuniversity hospital complex from January 2002 to December 2011. The mean agewas 56.5 ± 10.2 years and 77.4% were male.We studied the demographic and clinical characteristics, perioperative data andcomplications during the hospitalization of these patients.Result: The number of anastomosis per patient was 2.1 ± 0.8. The use ofcardiopulmonary bypass (CPB) was necessary in sixteen (37.2%) patients, themean CPB time 82.1 ± 31.2 minutes. The period of ICU stay was 6.8 ± 9.2 days andthe hospitalization was 12.0 ± 10.0 days. The hospital mortality was 11.6% andmorbidity of 35.1%, and the main complications was atrial fibrillation (23.2%) andinfection (16.3%).Conclusion (Conclusion): The IRC presents itself as a risk factor for increasedmorbidity and mortality. The exacerbated inflammatory response in this group ofpatients, with consequent increase in the overall atherosclerotic process, can beresponsible for this increase. CABG mortality in ESRD have high hospital mortalityand should be considered metabolic aspects of this special group of patients forintraoperative guidance of conduct.
THE TREATMENT OF VENOUS ULCERS IS EFFECTIVE RESOLUTION IN SUS?CYRO DE CAMPOS ARANHA PEREIRA NETO - UNICID; ANDRÉ FREITAS CAVALLINI DA SILVA - UNICID;TALITA MACHADO BOULHOSA - UNICID; ANA CAROLINA MATIELI - UNICIDIntroduction: venous stasis ulcer (UEV) represents about 70% to 90% of cases ofleg ulcers and features as the main cause chronic venous insufficiency. Thisunsuitability of the venous system is common in the elderly population, thefrequency being greater than 4% among the elderly over 65 years of age. The highnumber of recurrences of ulcers (66%) is one of the most important problems inthe care of patients with venous insufficiency. Patient education, in this situation, itis a priority in nursing care. It is estimated that the cost for the treatment of venousulcers is 1 billion U.S. dollars.Objective: To determine the characteristics of patients with UEV and identify thetypes of treatment used and the evolution with treatment.Methodology: This is a descriptive, exploratory cross-sectional. 25 records havebeen identified in Mairiporã Polyclinic. However, it was necessary to follow theroutine of dressing room and interview 16 patients due to lack of data. These weregrouped into categories: profile of patients with UEV, gender, form of expression,location, sensitivity, time of the wound, presence of associated diseases limitations;treatments; evolution with treatment category of the professional who performs it.Results: Evaluation UEV is not systematic, there is concern on the part of the teamto describe the evolution of the wound, but only reported by printing the patientsand the nursing assistant. Among the 16 respondents with UEV: 43.75% are malesand 56.25% were females, average age 62 female and 56 year old average male,40% and 60% spontaneous demonstration by trauma, 100% LL -1 / 3 distal leg,66.66% have some kind of pain, time interval UEV less than 12 months to 19 years,35.71% have UEV and do not take even one type of medication for chronic venousinsufficiency and 64.29% have other associated diseases - diabetes mellitus andhypertension, 100% reported limitation - 40% retired for invalides; healing in theclinic: Povidone-iodine (PVP), 0.9% saline solution, bandages, gauze, silversulfadiazine cream, Vaseline, xylocaine, 56.25% of the dressings at the Polycliniconly at home on weekends, while 43.75% home and twice / week only in the clinic,the first 77.77% reported improvement with the dressing, the second 85.71%reports stagnation; dressings performed by nursing assistants.Conclusion: Pointing to the need to do a better report in the medical records ofpatients (to develop a protocol): there is no specific description about the existenceof the injury, manifestation, progression, treatment and prognosis. The literatureindicates that the cleaning of the wound must be done with warm 0.9% salinesolution to facilitate cell division in the human body, with physiologicaltemperature of 37 ° C, however, this does not occur due to lack of local structure toadequately fulfill the criteria for treatment and all patients make the dressing athome, without supervision by the health professional.
THE SOCIAL IMPACT IN PATIENTS WHO HAD HEMORRHAGIC STROKES, AT THEUNIDADE BÁSICA DE SAÚDE JARDIM CUMBICA IANDRÉ FREITAS CAVALLINI DA SILVA - UNICID; CYRO DE CAMPOS ARANHA PEREIRA NETO - UNICID;TALITA MACHADO BOULHOSA - UNICID; ANA CAROLINA MATIELI - UNICIDIntroduction: The term Cerebrovascular Accident (CVA) is currently employed todescribe a group of diseases that present an abrupt start and provoke neurologicaldamages due to disturbance in the blood supply to the brain. They are the secondcause of death worldwide and the most devastating when it comes toatherosclerosis complications. Risk factors include: high blood pressure, age,ethnicity, gender, Mellitus diabetes, alcohol consumption, birth control pills usage,smoking, obesity and stress.Objective: Following a bedridden patient, due to a Hemorrhagic CerebrovascularAccident, at the Unidade Básica de Saúde Jardim Cumbica I in order to observe andstudy its neurological sequelae, as well as the impact on his social insertion.Methods: After the analysis of all the data concerning the neurological patients atthe UBS Jardim Cumbica I, from August to September 2010, a case was selected dueto the clinical picture it presented and the chronological proximity of theneurological accident that would enable a more accurate short term sequelae study.The patient was then visited at his residency where the group proceeded with aneurological anamnesis and throughout physical and neurological examinations toinsure all the necessary data for the case study. It was then presented atUniversidade Cidade de São Paulo, in November 2010, for a board of professors,including Neurologist PhD Ana Claudia Picollo. The patient is currently in awheelchair, with hemiparesis of the right limbs, using captropil 25 mg/day andDexalgem IM every five days. In the physical examination, the main alterationsfound were: slow and impaired speech, bitemporal hemianopsy, absence of thephotomotor and the consensual reflexes for the left eye, rightward deviation of theface and a diminishing in the trophism and muscular tone of the affected side.Considerations and Intervention Proposals: During the preparation of the casestudy presentation, several articles on the subjects were reviewed. Based on them,we can say that 15% of the patients that survive NCA present no sort of incapacity.However, that leaves us 85% of them that do. 37% of the patients that surve NCApresent discrete incapacity -they are unable to continue performing theirprofessional activities but do not require help with their daily activites; 16%,moderate incapacity requiring some kind of help with simple chores - and 32%,slightly intense or severe incapacity - being bedridden or in a wheelchair, usually inneed of constant care. Therefore, a considerate amount of these patients dependphysically, emotionally and financially on their care takers. Thus, we concluded thecase study pointing out the importance of regular visitations to these patients by ateam of different professionals (nutritionist, physiotherapist, psychologist, nursesand doctors among others) in order to prepare the care taker, minimize the impactof the
REGIONAL INFLUENCES PARTIALLY EXPLAIN THE HIGH BREAST CANCER RISK OFBRCA1/2 CARRIERS IN THE NORTHERN NETHERLANDSJANET R. VOS - DEPARTMENT OF EPIDEMIOLOGY, UNIVERSITY OF GRONINGEN, UNIVERSITY MEDICALCENTER GRONINGEN; DORINA M. VAN DER KOLK - DEPARTMENT OF GENETICS, UNIVERSITY OFGRONINGEN, UNIVERSITY MEDICAL CENTER GRONINGEN; MARIAN J.E. MOURITS - DEPARTMENT OFGYNAECOLOGY, UNIVERSITY OF GRONINGEN, UNIVERSITY MEDICAL CENTER GRONINGEN; NATALIATEIXEIRA - DEPARTMENT OF GYNAECOLOGY, UNIVERSITY OF GRONINGEN, UNIVERSITY MEDICALCENTER GRONINGEN; LIESBETH JANSEN - DEPARTMENT OF SURGICAL ONCOLOGY, UNIVERSITY OFGRONINGEN, UNIVERSITY MEDICAL CENTER GRONINGEN; JAN C. OOSTERWIJK - DEPARTMENT OFGENETICS, UNIVERSITY OF GRONINGEN, UNIVERSITY MEDICAL CENTER GRONINGEN; GEERTRUIDA H.DE BOCK - DEPARTMENT OF EPIDEMIOLOGY, UNIVERSITY OF GRONINGEN, UNIVERSITY MEDICALCENTER GRONINGENIntroduction: The breast cancer risk of female BRCA1 and BRCA2 mutation carriersby age 70 varies between 35-85% worldwide, and between 60-80% in theNetherlands. In the Northern Netherlands these risks are relatively high at 71.4%and 87.5% respectively. So far this higher risk cannot be explained. One of thehypotheses is that the high risk among female carriers in the Northern Netherlandsis due to their geographical location. Therefore we studied the regional influenceson breast cancer risk using updated breast cancer penetrance rates in this region.Methods: A consecutive prospective cohort study was conducted at our FamilyCancer Clinic, including all female BRCA1/2 carriers (N=1052) and first-degreerelatives (FDR) of carriers. Kaplan Meier analyses were used to estimate the breastcancer risks. Censoring was applied at the age of prophylactic mastectomy (N=188),the age at risk-reducing salphingo-oophorectomy (when performed before the ageof 50) (N=242), at the last follow-up or at death. Odds ratios were used to comparethe breast cancer incidences of mutation carriers ànd of women in the generalpopulation in the Northern Netherland with those from the rest of the Netherlands,using data from a previous study of a population of carriers including theNetherlands and data from the national Comprehensive Cancer Centre respectively.RResults: 670 women developed breast cancer: 481 (72%) in BRCA carriers and 172(26%) in not-tested FDRs. The cumulative incidence of breast cancer by age 70 forBRCA1 and BRCA2 carriers was 73.9% (95%CI 69.4-79.6%) and 77.7% (95%CI70.3-85.1%), respectively. BRCA carriers in the Northern Netherlands were morelikely to develop breast cancer than BRCA carriers in the rest of the Netherlands,OR=1.93 (95%CI 1.67-2.24). Females in the general population in this region had asmall increased risk to develop breast cancer, OR=1.07 (95%CI 1.01-1.13).Conclusion: BRCA1/2 mutation carriers in the Northern Netherlands are at a higherrisk to develop breast cancer and this cannot sufficiently be explained by regionaldifferences in background breast cancer incidence. Further research should aim toelicit other factors such as founder mutations, population specific modifiers orlifestyle factors.
COLORECTAL CANCER SCREENING BY HUMAN DNA STOOL QUANTIFICATIONYOLANDA MAROTO TEIXEIRA - UNIFESP; JACQUELINE MIRANDA DE LIMA - UNIFESP; NORAMANOUKIAN FORONES - UNIFESPBackground: The colorectal cancer (CRC) tends to increase with population agingreaching currently 1 million cases with 500.000 deaths around the world. In Brazil,the estimation for this year is 30.140 new cases with 12.471 deaths that make thisneoplasia the fourth cause of death in the country. Colonoscopy and fecal occultblood (FOBT) test are largely used for colorectal cancer screening. However, theFOBT had a low sensibility and the colonoscopy is expensive and brings greatinconvenience to the subjects. New methods involving the DNA of the stools arebeing studied to increase the diagnosis of cancer with a noninvasive method.Aim: Quantification of the human DNA of the stools of patients with colorectalcancer.Methods: We analyzed 97 stool samples of patients, divided in two groups: 51individuals without CRC that form the control group and 46 patients with colorectalcancer, which form the case group. All the patients from the control group had beensubmitted to colonoscopy. PCR Real Time was utilized, through the quantificationmethod by amplification of specific sequences of DNA (Quantifier Human Standard -Applied Systems) and by comparison between these groups. Also to compare thequantification by amplification, we used the fluorescent spectrophotometry. Thetotal DNA of the stools had also been quantified.Results: The mean total DNA from the stools of the CRC patients was 91.1ng/µL(SD=57.8) and of the control group was 109.7ng/µL (SD=95.3), (p>0.05). Themean human DNA quantification of the case group was 15.03ng/µL (SD=30.7) andfor the control group 0.47ng/µL (SD=1.02). This difference between both groupswas significant (p<0.0001). Patients with colorectal cancer localized on thedescendent, sigmoid and rectum had a higher mean concentration of human DNA(18.32ng/µL) when compared to the CRC localized in the ascendant or transverse(1.10ng/µL) (p=0.0027). In the analysis of tumor invasion, we did not finddifferences in the quantification of DNA of T1, T2 and T3 tumors compared to T4tumors (p=0.86). There were no correlation between the total quantification of DNAand the human DNA quantification in the stools in both groups case and control bythe Spearmans rank correlation test (p=0.16 and p=0.21, respectively).Conclusions: Patients with colorectal cancer had significant more quantities ofhuman DNA compared to patients without cancer. Higher quantities of human DNAwere found in patients with distal CRC.
OPERATIVE VERSUS NONOPERATIVE PROCEDURE IN THE TREATMENT OFPENETRATING ABDOMINAL TRAUMAANDRÉ FREITAS CAVALLINI DA SILVA - UNICID; CYRO DE CAMPOS ARANHA PEREIRA NETO - UNICID;TALITA MACHADO BOULHOSA - UNICIDIntroduction: Penetrating abdominal trauma is the main cause of trauma admissionin the US. Patients with stabbing injuries are thrice more common than by firearm,albeit a lower mortality rate4; 82% are male; 18%, female and they are, in average,32.8 years. By the mid 1960s, laparotomy was the standard procedure for theseinjuries but advances in diagnostic and image procedures have contributed to theadoption of new ones1. OBJECTIVE Compare operative and nonoperativemanagement treatment of penetrating abdominal trauma; establish a necessarymanagement algorithm.Methodology: This literature review was conducted between February and June 11,based on articles published between 06 and 11; selected at the PubMed and Biremedatabases using terminology registered in the Health Sciences Descriptors:laparoscopy, laparotomy, penetrating abdominal trauma. Studies related to thetherapeutic approach of laparotomy and (or) laparoscopy in penetrating abdominaltrauma and comparative ones were included; those that demonstrated its use inchildren were excluded.Results: There are three main procedures related to penetrating trauma of theabdomen (anterior and posterior): immediate surgical management, extendedsurgical procedure and nonoperative. The immediate surgical is recommended forpatients who shows signs of shock, hemodynamic instability, evisceration, andperitonitis. 50-75% of penetrating trauma in the anterior abdomen caused byweapons cross the peritoneal cavity, and of this 50-75% require surgical repair. Theliver (73%), the kidney (30.3%) and the spleen (30.3%) are the most affectedorgans. Velmahos et al (2011) showed that out of 1405 patients with gunshotwounds in the anterior abdomen, 484 had non-operative management (34%); 65were submitted to extended laparotomy (13.4%) after developing signs andsymptoms and 17 underwent non-therapeutic laparotomy. Penetrating trauma tothe posterior abdomen is less likely to present significant injury but they complicatethe evaluation of the retroperitoneal organs through physical examinations andFAST. In stable patients, CT is a safe choice4. Peritoneal integrity can be evaluatedclinically, through CT, FAST, diagnostic peritoneal lavage or laparoscopy. Suchmethods reduce the use of explorative laparotomy, immediate and extended,leading to an increase in non-surgical intervention3. Thus, when the rate ofexploratory laparotomy decreases, so does the immediate, the extended and thenegative laparatomies, as well as mortality, complications, length of stay andhospital costs. Conclusion: This review concluded that less invasive methods aresafe and effective in treating penetrating trauma to the abdomen. Although thereare few long-term studies, the literature indicates an association of the decrease inthe rate of surgical interventions and of negative laparotomy and of potentialsurgery related complications, hospital costs and length of stay of patients.
TEACHING AND LEARNING BIOPSY AND SUTURE SKILLS DURING MEDICALGRADUATION BY INSTRUCTOR-DIRECTED TRAINING ON BENCH MODEL: ARANDOMIZED CONTROLLED STUDY COMPARING LOW AND HIGH FIDELITY BENCHMODELSRafael Denadai¹, Lucas Denadai², Marie Oshiiwa³, Rogério Saad-Hossne⁴1 MD, Fellow of Surgery, Division of Coloproctology, Department of Surgery,Botucatu Medical School, UNESP, Botucatu-SP; Fellow of Research, Institute ofPlastic and Craniofacial Surgery, Hospital SOBRAPAR, Campinas-SP; and Resident,Department of Surgery, Hospital Municipal Dr. Mário Gatti, Campinas-SP, Brazil2 Graduate student, Faculty of Medical Sciences, UNIFESP –EPM. São Paulo, Brazil3 PhD, Associate Professor, Department of Statistics, FATEC, Marilia-SP, Brazil4 MD, PhD, Associate Professor, Division of Coloproctology, Department of Surgery,Botucatu Medical School, UNESP, Botucatu-SP, BrazilIntroduction: As the training of basic surgical skills training on live patients (traditionalapprenticeship model) may violate ethical and medico-legal aspects, learning technicalskills on inanimate bench models is becoming widely used during medical education. Theseinanimate simulators vary widely regarding their level of fidelity to living human patients.High-fidelity simulators (e.g., pig, rat, and chicken skins) are limited by high costs, lowavailability, potential for transmission of infectious disease, and ethical concerns andlower-fidelity synthetic simulators such as ethylene-vinyl acetate (EVA) plates andpolyurethane foam sacrifice "realism" for portability, lower costs, and potential forrepetitive use. Despite the intuitive belief that "the more realistic is the better" withinsurgical simulation this cannot be based only on subjectivity. Therefore, the purpose of thisstudy was to assess objectively if the fidelity of bench models interferes with theacquisition of cutaneous surgical skills (biopsy and suture) by novice medical students.Materials and Methods: The design was a randomized controlled study with blinding ofexpert examiners, including a session of verbal teaching based on instructional video, a pre-test, a 2-hour practice phase, and a post-test. The pre- and post tests were identical andconsisted of the manufacture of 5 simple interrupted sutures (bidimensional) and 1running subcuticular suture (tridimensional) for the closure of two elliptical incisionsmeasuring 8x2 cm each on ox tongue and an elliptical excision (marking of safety marginsforming an ellipse, incision and excision of the "tissue") for the "diagnosis and treatment" ofa "non-melanoma skin cancer" measuring 1cm in diameter simulated on ox tongue. Eachstudent was tested individually. No verbal feedback was provided during both pre- andpost-tests. Thirty six medical students with no surgical skills background (novices) wererandomized to 3 groups (n=12): didactic training alone (control); low-fidelity cutaneoussurgical training (plates of 4mm of EVA); or high-fidelity cutaneous surgical training (pigfeet skin). All students trained biopsy and sutures in a repetitive and deliberative mannerdirectly supervised by an experienced faculty surgeon (one instructor for each fourstudents). Objective evaluation based on Global Rating Scale with blinded assessment andself-perceived confidence based on Likert scale were used to assess all performances inpre- and post-training. Values were considered significant for a confidence interval of 95%(p<0.05). Effect sizes were also calculated in order to identify the magnitude of theintervention effect regardless of the sample size; effect sizes exceeding 0.80 wereconsidered large.
Results: The post-training analysis showed that the students that practiced on benchmodels (hands-on training) presented better (all p<0.0000) performance in the GlobalRating Scale evaluation, compared with the control, regardless of the model fidelity; therewas no significant difference (all p>0.05) between the groups that trained on bench models.The magnitude of the effect (training) was considered large (>0.80) in all measurements.Students felt more confident (all p<0.0000) to perform both procedures after training.Conclusion: The acquisition of biopsy and bi- and-tridimensional suture skills after theinstructor-directed training on low-fidelity bench models was similar to the training onhigh-fidelity bench models, and there was a more substantial increase in the performancesof students that received bench model training compared to the learning on didacticmaterials.
IS IT SAFE AND EFFECTIVE TO TREAT COMPLEX RENAL CYSTS BY THELAPAROSCOPIC APPROACH?REBECCA SUBIRA MEDINA - ESCOLA PAULISTA DE MEDICINA - UNIFESP; CASSIO ANDREONI - ESCOLAPAULISTA DE MEDICINA - UNIFESP; VALDEMAR ORTIZ - ESCOLA PAULISTA DE MEDICINA - UNIFESP;THOME PINHEIRO JR. - ESCOLA PAULISTA DE MEDICINA - UNIFESP; RICARDO NATALIN - ESCOLAPAULISTA DE MEDICINA - UNIFESP; FABIO SEPULVEDA - ESCOLA PAULISTA DE MEDICINA - UNIFESPBackground and Purpose: Bosniak III and IV renal cysts have low mortalitypotential, and little is reported regarding the feasibility and safety of managing suchtumors by laparoscopy and its comparison with open surgery. We report on theexperience with 37 complex renal cysts managed in the era of laparoscopy.Patients and Methods: A retrospective analysis of a prospective database from allpatients with renal tumors who were operated on at our institution was evaluatedafter Institutional Review Board approval. The database comprises information fordemographic, clinical, imaging, preoperative, intraoperative, histologic, and follow-up data. A comparison among all performed approaches was done for demographic,American Society of Anesthesiologists classification, operative time, estimatedblood loss, ischemia time, hospital stay, oncologic and survival rate. The cystsremoved by laparoscopic partial nephrectomy were compared with the solidtumors removed by the same approach at the same period.Results: The database included 407 patients with renal tumors who were operatedon from 2000 to 2009 at our institution. In 36 patients of the total cohort, therewere 37 complex renal cysts. No patients with preoperative Bosniak type I or IIunderwent surgery. Of the cysts, 60% were Bosniak IV, and 86% were confirmed asmalignant; 40% were Bosniak III, and 44% were confirmed as malignant.Laparoscopic partial nephrectomy was performed in 67.5%. The tumor size andhospital stay were significantly different in the laparoscopic group. No cyst spillageoccurred either by laparoscopy or by the open approach, and no tumor recurrencewas found in a mean follow-up of 43.7 months with overall survival of 100%.Conclusion: Laparoscopic surgery for complex cysts is safe, feasible, and effective.Nevertheless, regardless of surgical approach, patients with complex renal cystshave excellent overall survival with short-term follow-up.
END-STAGE CARDIOMYOPATHY AND SECONDARY MITRAL INSUFFICIENCYSURGICAL ALTERNATIVE WITH PROSTHESIS IMPLANT AND LEFT VENTRICULARRESTORATIONALINE COUTO CARNEIRO - ESCOLA PAULISTA DE MEDICINA, UNIVERSIDADE FEDERAL DE SÃO PAULO;JOÃO NELSON RODRIGUES BRANCO - ESCOLA PAULISTA DE MEDICINA, UNIVERSIDADE FEDERAL DESÃO PAULO; JOSE HONÓRIO DE ALMEIDA PALMA FONSECA - ESCOLA PAULISTA DE MEDICINA,UNIVERSIDADE FEDERAL DE SÃO PAULO; JOÃO ROBERTO BREDA - FACULDADE DE MEDICINA,UNIVERSIDADE FEDERAL DO ABC; ROBERTO CATANI - ESCOLA PAULISTA DE MEDICINA, UNIVERSIDADEFEDERAL DE SÃO PAULO; ENIO BUFFOLO - ESCOLA PAULISTA DE MEDICINA, UNIVERSIDADE FEDERAL DESÃO PAULOBackground: Secondary mitral insufficiency is a strong risk factor for death in end-stage cardiomyopathy. The possible correction of mitral regurgitation has now beenaccepted as an alternative to cardiac transplantation in a special subset of patients.We propose a new surgical approach that consists of implantation of a mitralprosthesis that is smaller than the annulus, and preservation and traction of thepapillary muscles to reduce sphericity of the left ventricle.Methods: Between December 1995 and October 2011, 155 patients with dilatedcardiomyopathy underwent this procedure, with the following etiologic factors:ischemic (98), idiopathic (54), Chagas disease (1), viral (1), and postpartum (1). Thepatients were analyzed according to clinical criteria, echocardiographic findings,and morphology of left ventricle.Results: All patients were in an end-stage phase, requiring hospital admissions overthe past 6 months, despite receiving full medication. Furthermore, seven were inintensive care unit receiving intravenous drugs or intra-aortic ballooncounterpulsation, and one was in cardiogenic shock. Hospital mortality was 16.1%(25/155), yet midterm follow-up showed a relatively flat late survival curve, withevidence of improved clinical status, better echocardiographic parameters, andreduction in ventricular sphericity.Conclusions: The high early mortality rate related to other clinical conditions at thetime of surgery. However, the resultant flat survival after this early interval offers apromising long-term therapeutic alternative for the treatment of patients inrefractory heart failure with cardiomyopathy that is associated with moderate orsevere secondary mitral regurgitation.
SEVERE EPISTAXIS: DIAGNOSIS PROTOCOL AND ENDOSCOPIC SURGERYTREATMENT IN 59 PATIENTSBEATRIZ BRITTES KAMIENSKY - FURB; EDUARDA RAQUEL PRZYGODA ALVES - FURB; HADELLEHABITZREUTER HASSMANN - FURB; JAN ALESSANDRO SOCHER - FURBIntroduction: The severe epistaxis is considered one of the most commonemergencies it the otorhinolaryngologist (ENT) practice and common cause ofhospital internment, including risk of life. The conventional treatment is nasalsplints, but it causes pain, nasal obstruction and significant morbidity. Therefore theendoscopic techniques become the diagnosis more accurate and the treatmentmore effective. Objective: To describe and discuss emergency care protocol fortopographic diagnosis and endoscopic surgical treatment performed on patientswith severe epistaxis.Material and methods: During the period between March 2004 and February 2012,59 patients who sought specialized service with severe epistaxis were treatedendoscopically. The patients had undergone an endoscopic exam for topographicdiagnosis and then set the point to cauterization of the bleeding or ligation of thesphenopalatine artery and/or anterior ethmoid. In suspected cases the diagnosticworkup was performed using computed tomography. All patients were operatedwith endoscopic optics 30 and 45 degrees and suitable material for dissection andligation.Results: A total of 36 cases of epistaxis were associated with nasosinusal post-operative complication, 20 spontaneous cases and 3 cases of posterior epistaxisrelated to nasosinusal tumors. In 49.1% of cases were identified posterior epistaxisand required ligation of the sphenopalatine artery and its branches in 29 patients.In 17% of cases were identified superior epistaxis and was required ligation of theanterior ethmoid artery in 10 patients. In 22% of cases did not identify precisely thefocus of epistaxis and thus it was necessary ligation of sphenopalatine and anteriorethmoidal arteries in 13 patients. In 8.4% of cases was founded bleeding point attail or body of the inferior turbinate requiring cauterization in 5 patients. In 3.3% ofcases identified in the posterior septum bleeding requiring cauterization of thesame in two patients. No patient had a new episode of epistaxis postoperatively andwas discharged generally between 8 to 48 hours.Conclusion: The use of the endoscope has proved to be a useful tool to aid in thetopographic diagnosis and endoscopic surgical techniques were safe and effective inthe treatment of severe epistaxis.
PAIN PROFILE IN TRAUMATIC BRACHIAL PLEXUS INJURY PATIENTS IN TWOBRAZILIAN PAIN CENTERSMATHEUS GOMES SILVA PAZ - FEDERAL UNIVERSITY OF BAHIA; MAURO TUPINIQUIM BINA - FEDERALUNIVERSITY OF BAHIA; SCHEILA NOGUEIRA SANTOS - FEDERAL UNIVERSITY OF BAHIA; ABRAH FONTESBAPTISTA - FEDERAL UNIVERSITY OF BAHIAIntroduction: Traumatic brachial plexus injuries (TBPI) may occur by compressionor traction (95% of cases), being more frequent in the supraclavicular region (70 to75% of cases). Pain is a common symptom in TBPI, which manifests itself ascomplaints of burning, shooting sensation, painful sensation or tightness. This studyintended to determine pain profile and characterization in patients with traumaticbrachial plexus injury in three brazilian pain centers.Materials and Methods: This was a cross-sectional study with consecutive patientswho suffered non-obstetric traumatic brachial plexus (TBPI) recruited from theUpper Limb Injuries Clinic of the University Hospital Prof. Edgard Santos, UFBA, andNerve Clinic of the Institute of Psychiatry, FMUSP, from August 2011 to January2013. Pain was the dependent variable and the independent variables were socio-demographic data and health information related to the TBPI, anxiety/depressionand quality of life. Muscle strength and range of motion were also assessed and painpressure threshold evaluations were done based on Quantitative Sensorial Testing.Possible confounding factors were excluded (neurological comorbidities andhistory of neurological diseases). The chronological and clinical-surgical aspectswere used as stratification parameters.Results: From August 2011 up to January 2012, 12 patients were recruited (81,71%were men). Patients aged 30,21±10,23, had 5,07±1,94 years of study and the meanBMI was 26,83±5,68. Half of the patients were from C1 social class and most weremarried/living together (57,14%); 78,57% were removed from their jobs and71,42% received some kind of social benefit. All were injured in a traffic accident,involving a car accident (1) or motorcycle accident (11). The mean time ofassessment was 51,17±27,89 weeks after injury, but the mean time of medicalassistance was 47,29±29,49 weeks. Just 3 patients were not undergoingphysiotherapy sessions and 9 patients had to use some auxiliary device fortreatment. Although pain was moderate (VAS: 51,67±33,85), disability was the mostimportant bothering factor for 66,66% of patients. Eight patients felt pain every dayand the most common pain location was the hand ipsilateral to the lesion, 50%., andthe mean time of pain was 46,58±31,70 weeks until the assessment. Five patientsused a combination of medicines for the treatment and three used none.Conclusion: Patients with traumatic brachial plexus injury are usually young men,with low educational and socioeconomic level and married. In most of thecases the lesion impeded their work activities. The most prevalent cause of lesionwas motorcycle accident. Although pain was moderate to intense, the mosttroublesome for the patients are the functional impairments. Pain is usually treatedby a combination of medications and physiotherapy.
VISUAL FUNCTION AMONG THE BRAZILIAN OLYMPIC JUDO TEAMPRISCILA RODRIGUES LEITE OYAMA - UNIFESP - ESCOLA PAULISTA DE MEDICINA; BERNARDO KAPLANMOSCOVICI - UNIFESP - ESCOLA PAULISTA DE MEDICINA; PAULO SCHOR - UNIFESP - ESCOLA PAULISTADE MEDICINAIntroduction: Medical evaluation of high performance athletes aim to identifygeneral and specific findings of each sport. Sportive ophthalmology analyzes thevisual function and the impact on the performance in the sports practice. The visualfunction is basically measured quantitatively by visual acuity(VA)and qualitativelyby aberrometry, measuring the high order aberrations in RMS(HOA).There areplenty of others exams to contribute to evaluate the visual function, like: Visualfield(VF-which indicates if the athlete has peripheral vision); Titmus (whichindicates if they have binocular vision and sense of depth)and SphericEquivalent(SEequal to the algebraic sum of the value of the sphere and half thecylindrical value of the ametropy of the patient).Judo is a sport with physicalcontact and depends on the speed, reflexes, strength and technique. The quality andquantity of vision could influence on this sport. We also believe that the peripheralvision and sense of depth could have influence on the success of the athletes,improving the ability of judo fighters. The high SE indicates that the athlete mighthave problems achieving a good vision without glasses.Materials and Methods: All exams made with the Brazilian Olympic judo team wereperformed by the residents and technologists of the depertment of ophthalmologyof UNIFESP sequentially,in the same day and location. It has been evaluated the VA,with and without correction,refraction,titmus,aberrometry and visual field ofthirteen judo athletes. All of them were man,except for one female judoka,with age26,2 years(ranged from 22 to 34 years). Ladarvision Wavefront was used tomeasure aberrometry and only the high order aberrations RMS wasconsidered.Values above 0.5 were considered abnormal. For the visual fiels it wasused the Humphrey perimeter under the 750I strategy and the Anderson criteria toclassify into normal and abnormal exams. The titmus exam was performed by thesame examiner on the same illumination conditions and normal values considereduntil 60.Results: All visual field exams were normal. The HOA ranged between 0,15 -1.32,being altered only in one patient with keratoconus diagnosis. Nine patients hadtitmus of 40(maximum),two 50 and one 60, only one patient had titmus of200(same patient with keratoconus).The keratoconus patient had poor distancevision(20/60 in the right eye,20/25 in the left eye),even with correction, and SEhigher than 4 diopters in the right eye. Beside this patient only one patient had SEhigher than 1 diopter(1.125),but had normal vision.Conclusions: Only one patient,with suspect keratoconus, showed altered values inthe exams and more prominent in only one eye, nevertheless he had altered titmusvalues, which means he might had problems in sense of depth. All other patientspresented normal exams and most of them with good HOA. The ophthalmologicexam in athletes is important to identify factors that could influence in theirperformance and help to solve them.
THROMBOEMBOLIC EVENTS AFTER KIDNEY TRANSPLANTATIONRENATO DEMARCHI FORESTO - FEDERAL UNIVERSITY OF SÃO PAULO; MAURÍCIO ISAAC PANICIO -FEDERAL UNIVERSITY OF SÃO PAULO; MILA SALENAVE - FEDERAL UNIVERSITY OF SÃO PAULO; TAINÁSANDES FREITAS - FEDERAL UNIVERSITY OF SÃO PAULO; HÉLIO TEDESCO JR - FEDERAL UNIVERSITY OFSÃO PAULO; JOSÉ MEDINA PESTANA - FEDERAL UNIVERSITY OF SÃO PAULOINTRODUTION: Venous Thrombosis (VT) and Pulmonary Embolism (PE) areimportant causes of morbidity and mortality in hospitalized patients. Studies showthat patients undergoing kidney transplantation have increased risk to developthromboembolic events, however, there are a few data in literature about incidence,risk factors and recurrence rate of VT/PE in these patients. The objectives were toassess the profile of patients with thromboembolic events and to identify possiblerisk factors and recurrence rate of VT/PE.MATERIALS AND METHODS: We conducted a retrospective records analysis ofrenal transplant patients who presented an episode of VT/PE until the sixth monthafter transplantation. We analyzed historical medical records of Hospital do Rim eHipertensão from January/1998 to December/2010. Data were analyzed bydescriptive statistics, with results expressed as proportions for categorical variablesand means for numerical variables.RESULTS: From January/1998 to December/2010, 7,147 renal transplants wereperformed in our hospital, of which 65 were related with VT/PE events until thesixth month of transplantation (deceased donor: 34 / living donor: 31). Weobserved a peak incidence in the second month of transplantation, and 7 patientspresented a second thromboembolic event on average 23 months after the firstevent (2-108 months). The mean age of patients was 49 years (28-68 years), withmale predominance (2:1), 55% hypertensive, 15% diabetic, 10% obese, 6%smokers, 6% had a previous thromboembolic event, 4% had previous diagnosis ofheart failure, and 4% had erythrocytosis at diagnosis. All patients were takingcalcineurin inhibitor in immunosuppressive regimen (17% Cyclosporine, 83%Tacrolimus), associated with antiproliferative (40% Azathioprine 40%Mycophenolate Mofetil) or m-TOR inhibitor (20%). The fatality rate for PE was47%.CONCLUSION: We observed that all of our patients presented at least one risk factorto thromboembolic event. Most thromboembolic events occurred in the first 2months after transplantation suggesting a risk assigned by the surgery itself. Therecurrence rate in this study was lower than that reported in literature, however,high rate of mortality due to PE points to a need for further studies to define thereal incidence of VT/PE in this population and to identify the patients most at riskto thromboembolic events.
ADRESSING CELL PROLIFERATION IN THE SUBEPENDYMAL ZONE IN THEEXPERIMENTAL AUTOIMMUNE ENCEPHALOMYELITIS MURINE MODEL OFMULTIPLE SCLEROSISAlberto Silva, Ana M. Falcao, Sandro Mesquita, Joana A. Palha, FernandaMarques, Life and Health Sciences Research Institute (ICVS), School of HealthSciences, University of MinhoAim: To address whether current treatment for multiple sclerosis, namely withnatalizumab, influences cell proliferation in the subependymal zone (SEZ), in theexperimental autoimmune encephalomyelitis murine model of multiple sclerosis(EAE).Background: The subependymal zone (SEZ) is one of the major sites ofneurogenesis in the adult brain. While these cells usually migrate through therostral migratory stream towards the olfactory bulb, they can also be mobilized toother brain regions and differentiate into various cell types. Such seems to be thecase in EAE where cells originating from the SEZ have been shown to originateoligodendrocytes that may regenerate damaged neurons.Methods: EAE was induced in female SJL mice All mice were weighed and scoreddaily for the appearance and severity of the symptoms. Treatment was at the onsetphase of the disease, with natalizumab (5mg/Kg), a humanized monoclonalantibody used as therapeutic approach to MS, that blocks the passage of T and Bcells from the immune system to the brain parenchyma because this antibody isagainst integrin α4. A group of mice received control rat IgG (control for thetreatment). Control animals were not treated with natalizumab because they do notshow any symptoms. Animals were sacrificed when symptoms were reverted in thetreatment group, brains frozen and cut in 20 ìm slices for immunohistochemistryagainst Ki‐67, a cellular proliferation marker. Sterological analysis is ongoing todetermine SEZ proliferation and ectopic migration.Results: Present data show that natalizumab successfully reverted the EAEphenotype. Preliminary data suggest that treatment control group, which was onlyinduced with EAE and not treated with natalizumab, decreased the number ofKi‐67+ cells in the SEZ but increased its number in SEZ vicinity. Treatment withnatalizumab leads to an increase in the proliferation rate of the SEZ and a decreasein the number of cells in proliferation in the vicinity of the SEZ.Discussion/Conclusions: CNS lesions, as MS, modulate cell proliferation in the SEZ.This modulation in relapse/remising model seems to be different from the EAEchronic models. In the EAE model of relapse and remission an increase in cellproliferation in the vicinity of SEZ is observed and a decrease of cells Ki‐67+ in SEZ,which may occur in order to repair the damaged foci. Natalizumab seems toincrease cell proliferation in SEZ but slightly decreases in the vicinity.
EFFECT OF DIETARY LIPIDS ON PROTEIN-ANATOMICAL AND HISTOPATHOLOGICALPARAMETERS OF THE ORGANS OF RATS AT BIRTH, END OF LACTATION ANDADULTS.ANA CRISTHINA RIBEIRO NOVAES - UNIVERSIDADE DE UBERABA; MORGANNA FERREIRA IDÁLIO SILVA -UNIVERSIDADE DE UBERABA; TIAGO CANEU ROSSI - UNIVERSIDADE DE UBERABA; RICARDO HENRIQUEALMEIDA BARBOSA - UNIVERSIDADE DE UBERABA; KAMILA BOTELHO FERNANDES DE SOUZA -UNIVERSIDADE DE UBERABA; GERALDO THEDEI JÚNIOR - UNIVERSIDADE DE UBERABAIntroduction: Excess weight is a global problem that affects about 50% of the adultBrazilian population. Diets high in protein and low in fats and carbohydrates areused for the purpose of weight reduction. However, these diets can cause damage tometabolism. Studies have shown that they may predispose the formation ofatherosclerosis, type 2 diabetes and hepatic steatosis. Recent experimental studieshave demonstrated effects caused by dietary lipids, protein consumed duringpregnancy and lactation and their effect on litter.Aim: to determine the effect of a diet low in protein, lipids carbohydrates consumedduring pregnancy and / or lactation on anatomical and histopathologicalparameters of the spleen, brain, heart, kidneys and testes of young Wistar rats,comparing with a balanced diet.Materials and Methods: For this purpose, 32 pregnant rats and their pups were feda diet balanced to control rats (C) or experimental diet (E, consisting of 5% CHO,45% and 45% TAG PTN) ad libitum during pregnancy and / or lactation formingthus, four groups: DC, EC, EC, EE. After weaning, the animals received only C dietuntil adulthood (12 weeks old). They were euthanized, and organs were removed,fixed in formaldehyde and a sample subjected to routine histopathological analysis,with staining by hematoxylin-eosin (HE). The statistical analysis of the results wasperformed in 14.4 software STSS by the Chi - square test with p <0.05.Results: Histopathological analysis of pups at the end of lactation showedhyperplasia of white pulp (p <0.05) in the spleens of animals from groups EE andCE. In the hearts showed the occurrence of inflammation with a significantpercentage in subgroups CE and EE (p <0.05). In both the comparison wascompared to the CC group. Anatomopathological analysis of the puppies at the endof the lactation period demonstrated a significant reduction of weight, in group EC(weight 1.29 g + / - 0.03) when compared with the CC group (weight 1.47 g + / -0.12) p <0.05. Weight reduction was also present in the EC group (weight 1.90 g +/ - 0.11), the young adults when compared to CC group (2.12 g + / - 0.08), with p<0.05 .The anatomo-histopathological analysis of kidneys and testes no showedsignificant changes.Conclusion: It is concluded that consumption of dietary lipids protein in differentlife cycle phases (gestation / lactation), can significantly affect the development andstructure of spleens, brains and hearts of puppies at the end of lactation and adultscan cause future consequences.
OXIDATIVE EFFECTS ON PULMONARY INFLAMMATORY RESPONSE IN MICEEXPOSED TO CIGARETTE SMOKEEVANDRO GUEDES GONÇALVES - UNIVERSIDADE FEDERAL DE OURO PRETO; VITOR ALVES DOURADO -UNIVERSIDADE FEDERAL DE OURO PRETO; FRANK SILVA BEZERRA - UNIVERSIDADE FEDERAL DE OUROPRETOIntrocuction: This study aimed to analyze and compare the influx of inflammatorycells into the lung parenchyma in animals exposed to cigarette smoke, as well asinvestigate the oxidative damage in the form of lipid peroxidation in lung extractsand the activity of antioxidant enzymes: Superoxide dismutase (SOD), glutathioneperoxidase (GPx) and catalase (CAT).Materials and Methods: We used 36 C57BL / 6 mice, 8 weeks, divided into groups ofsix animals exposed to cigarette smoke for 1 (GF1D), 2 (GF2D), 3 (GF3D), 4 (GF4D)and 5 (GF5D) days respectively, 3 times a day and the control group (CG) wasexposed to air. Each cigarette was attached to a plastic syringe of 60 ml, which isinflated after the smoke was expelled in the inhalation chamber 40 cm long, 30 cmwide and 25 cm high. Each cigarette produces about 1 liter of smoke diluted with 30liters of ambient air present in the chamber, the final concentration of 3%. Aftereuthanasia by cervical dislocation, were collected bronchoalveolar lavage fluid(BALF) through the tracheostomy, the peripheral blood by cardiac puncture andlung tissue removed through an incision in the anterior chest wall for analysis ofthiobarbituric acid reactive substances (TBARS ) and activity of SOD, GPx and CAT.Results: There was an increase in total leukocytes in GF2D groups (1.35 ± 0.53x105cels/ml) GF3D (2.33 ± 0.33x105 cels/ml) GF4D (3.05 ± 0.29x105 cels/ml) and GF5D(3.4 ± 0.39x105 cels/ml) compared to control (0.31 ± 0.09x105 cels/ml) (p<0.0001), and neutrophils in peripheral blood GF3D groups (3.8 ± 0.3x104cels/ml) GF4D (7.2 ± 0.23x104 cels/ml) and GF5D (9.3 ± 0.883x104 cels/ml)compared to the control group (2.6 ± 0.43x104cels/ml) (p <0.0001). Oxidativedamage in GF2D groups (1,017 ± 0.08545 U / mL / mg.prot) GF3D (1,037 ± 0.04204U / mL / mg.prot) GF4D (1,050 ± 0.07565 U / mL / mg.prot) GF5D (1,206 ± 0.02734U / mL / mg.prot) compared to the control group (0.8708 ± 0.05635 U / mL /mg.prot) (p <0.0001) were increased. The enzymatic activity of SOD in groupsGF3D (0.4767 ± 0.05207 U / mg. protein), GF5D (0.6000 ± 0.03606 U / mg.protein)compared with control group (1.197 ± 0.07688 U / mg. protein) (P <0.05) wasdecreased, however the enzymatic activity of GPx GF1D groups [163.7 ± 12.88 (mM/ min / mg ptn-1) x 10-5], GF2D [182.3 ± 14.25 (mM / min / mg ptn-1) x 10-5]compared to the control group [115.0 ± 4.509 (mM / min / mg ptn-1) x 10-5](p=0,0001) was increased. well as the increased activity of catalase in GF3D groups(24.71 ± 5.923 U / mg ptn) GF4D (23.96 ± 3.524 U / mg ptn) compared to GC (12.31± 3.125 U / mg ptn) (p = 0.0001). Conclusion:There was a growing influx of inflammatory cells in bronchoalveolarlavage, blood periferies as well as oxidative damage and an increased activity ofantioxidant enzymes in animals exposed to cigarette smoke. Further studies arenecessary to assess the cellular profile of this experimental model.
HISTIOCYTIC SARCOMA: HISTOLOGIC AND IMMUNOHISTOCHEMICAL ANALYSIS ANDSTUDY OF APOPTOSISRAFAEL BISPO PASCHOALINI - SÃO PAULO STATE UNIVERSITY; RODRIGO MATTOS DOS SANTOS - SÃOPAULO STATE UNIVERSITY; FABÍOLA ENCINAS ROSA - SÃO PAULO STATE UNIVERSITY; MARIAAPARECIDA CUSTÓDIO DOMINGUES - SÃO PAULO STATE UNIVERSITYIntroduction: Histiocytic Sarcoma (HS) is a malignant neoplasia characterized byproliferation of cells with morphological and immunophenotipical features similarto tissue mature histiocyte. Its a rare hematopoetic malignancy, comprising lessthan 1% non-Hodgkin lymphomas. The morphological heterogeneity, whichoverlaps with other malignancies, both lymphoid and non-lymphoid is accompaniedby various clinical and epidemiological aspects, giving this entity a difficultdiagnosis. We theorize that in the pathogenesis of HS apoptotic pathways may becompromised, what induces neoplasic histiocytes mortality, which despite welldifferentiated presents with wide morphological aspect. This theory wouldcomplement studies that determine morphological criteria andimmunophenotypical markers. The pathogenesis definition, associated to morefrequent morphological pattern and specific immunomarkers would assureappropriate anatomopathological diagnosis, efficient treatment and betterprognostic.Materials and Methods We conducted an analytical study involving morphologicaland immunohistochemical features that are described for the diagnosis of HS. Weevaluated three confirmed cases from our service, which entered between 1998 and2009. To configure the immunohistochemical panel of the test, 19 markers wereused, including those more relevant according to current literature. Themorphological study was performed with cell descriptors commonly used inliterature.Results: It was found the relevance of 12 morphological criteria presentsimultaneously in the three HS cases, which showed little variability when takentogether with others: medium to large cell size, vacuolized chromatin, irregular cellmembrane, intranuclear inclusion, vacuolar eosinofilic cytoplasm, bizarre cellspresence, cohesivity, epithelioid aspect, phagocytosis, stroma with inflammatoryinfiltrate, apoptosis and hemosiderin. Setting the 19 immunohistochemical markerspanel, 5 of them showed similar results in the three cases: CD163, CD68, vimentinand lysozime with diffuse distribution and focal S-100. The markers CD45 and CD30were positive strictly in the skin sample. With regards to markers for diseasepathogeny, two of them showed positive results for three cases: Fas-ligand andcaspase-3. The Bax marker was negative for the evaluated cases.Conclusion: Fas-ligand marker is an extrinsic factor in the apoptotic pathway andpresented positive for all cases. Studies show the extrinsic Fas pathway is sufficientto induce apoptosis in some cell types. Literature reports the ligant expression insome tumors may be an evidence of pro-inflammatory response. Microenvironmentalterations due to inflammatory processes may promote tumor growth and itsimmune response evasion. Thus, our results suggest the existence of an externalfactor that may lead to tumor induction, related to microenvironment, such as aninfection.
METALOPROTEINASES ROLE IN HEPARIN HEMORRHAGIC ACTIVITYCLARA CORREA FERNANDES - UNIFESP; CAMILA DE MELO ACCARDO - UNIFESP; ANA CAROLINA GOMESTRINDADE - UNIFESP; HELENA BONCIANI NADER - UNIFESP; IVARNE LUIS DOS SANTOS TERSARIOL -UNIFESPBackground: Heparin is a well-known anticoagulant drug widely used in Medicine.However, the major clinical complication of heparin anticoagulant therapy isbleeding. It has been suggested that heparin can produce intracranial hemorrhagedependent of MMP-9 activity.Methods: Bleeding time and bleeding flow - Briefly, a scarification is made with arazor blade in the terminal part of a rat tail which is then immersed in a small testtube containing 1 ml of a buffered isotonic solution to be tested held at 37ºC. Thebleeding from the vessels is observed with a dissecting microscope. The blood flowwas expressed as the ratio of mg of blood protein/minute oozed from the woundtreated with the compound and the amount of mg of blood protein/minute oozedfrom the controls.Results: Heparin (10-100 µM) was able to disrupt the normal vascular hemostaticmechanism promoting hemorrhage. In order to establish that the heparin wasproducing the bleeding by excessive activation of MMPs we have studied thereversal of the antihemostatic effect of heparin by minocycline a potent inhibitor ofMMPs activity. Minocycline (10-100 µM) significantly reduced heparin-inducedhemorrhage in the scarified rat tail.Conclusion: Our data strongly suggest that the hemorrhagic activity of heparin isrelated to the excessive activation of MMPs in vascular system. The finding thatminocycline can neutralize the antihemostatic activity of heparin, make it a goodcandidate as a therapeutic agent for the control of eventual hemorrhagic episodesof patients under heparin treatment.
IMPAIRED B-ADRENERGIC RESPONSE TO ISOPROTERENOL IN CIRRHOTIC WISTARRATSEDUARDO KAISER URURAHY NUNES FONSECA (ESCOLA PAULISTA DEMEDICINA - UNIFESP - BRASIL)/AUTOR PRINCIPAL /APRESENTADORELAINE DOS SANTOS DAMÁSIO (ESCOLA PAULISTA DE MEDICINA - UNIFESP –BRASIL); HEDER FRANK GIANOTTO ESTRELA (ESCOLA PAULISTA DEMEDICINA - UNIFESP – BRASIL); CÁSSIA DE TOLEDO BERGAMASCHI (ESCOLAPAULISTA DE MEDICINA - UNIFESP – BRASIL); RUY RIBEIRO DE CAMPOS JR(ESCOLA PAULISTA DE MEDICINA - UNIFESP - BRASIL)The development of the hepatic cirrhosis leads to many pathologic chances in themajority of the organic systems, including the cardiac system. These changes aregrouped together and named as Cirrhotic Cardiomiopathy, that includes a globalelevation in the basal cardiac output, which is not sustained in physical exercisesnor other activities that demand a physiological answer of increase in the cardiacoutput that would be expected in non-pathological conditions. We aimed tounderstand if the capacity of the cirrhotic cardiac muscle to respond, in vivo, to theadrenergic stimuli is impaired by the cirrhosis, what was evaluated by theadministration of Isoproterenol, a potent agonist to receptors. We used the cirrhoticmodel by common bile duct ligation (CBDL) in Wistar rats (200g) to theseexperiments. In the fourth week after the CBDL, with the cirrhosis well-established,the animals were submitted to a catheterism of the femoral artery and vein, todirect registration of blood pressure, heart rate and drugs infusion, respectively. Inthe vein, we administrated 3 doses of the Isoproterenol, in the following doses(0,001µg/kg; 0,01 µg/kg e 1µg/kg), with the animals waken. After statisticalanalysis of the data, we noticed that the cirrhotic animals, in basal conditions, hadan lower blood pressure (control (CO):108±2 and cirrhotic(CR):95±2mmHg, n=6)and a higher heart rate (CO:352±10 and CR:396±13bpm, n=9) as well as an increasein the hepatic enzymes TGO (CO: 197.5 ± 23.45 and CR: 566.3 ± 96.76 U/L, n=4) andTGP (CO: 59.48 ± 5.570 and CR: 209.6 ± 43.92 U/L n=4). After the drug infusion,there were also a statistically significant difference in the response between thecirrhotic and the control to all the three doses of Isoproterenol: the increase of theheart rate in CR was 2,4 times smaller that the CO in the smaller dose (0,001µg/kg) ;was 3,6 times smaller for the intermediated dose (0,01µg/kg) ; and was 3 timessmaller for the higher dose (0,1µg/kg). We concluded that there is an importantimpairment in the β-adrenergic sensibility in the heart of the cirrhotic rats inthe fourth week past the cirrhosis induction surgery. Such finding can be seen as apossible explanation to the heart failure that appear in cirrhotic man when theyundergo physical exercises or other conditions that require a bigger cardiacdemand to increase and sustain the cardiac output, explaining one of the mostimportant clinical impairments of the Cirrhotic Cardiomiopathy.
THE BEHAVIOR STUDY OF SERUM LEVELS OF SOLUBLE-FAS, ERYTHROPOIETIN,INFLAMMATORY CYTOKINES AND ANEMIA IN CRITICALLY ILL PATIENTS WITHACUTE KIDNEY INJURY.ILANA LEVY KORKES - ESCOLA PAULISTA DE MEDICINABackground: Anemia is a problem that usually complicates critically ill patients. Serumsoluble-Fas (sFas) levels are associated with anemia in chronic kidney disease (CKD)patients. Therefore, it is possible that sFas levels are also associated with anemia inacute kidney injury (AKI) patients under inflammatory effects during hemodiafiltration.Objectives: To compare hemoglobin (Hgb) concentration and serum levels of sFas,erythropoietin (Epo), IL-6, TNF- and IL-10 among critically ill patients withand without AKI, CKD- hemodialysis patients and healthy volunteers. Investigate therelationship between hemoglobin concentration, serum levels of sFas, Epo andinflammatory cytokines in AKI patients in hemodiaflitration during 24hours.Methodology: We studied critically ill patients with AKI in continuous venovenoushemodiafiltration (AKI group; n=39), critically ill patients without AKI (non-AKI group;n=17), CKD-hemodialysis patients (CKD group; n=20) and healthy volunteers (Healthygroup; n=18). Hematocrit and Hgb concentrations, iron status and serum levels of sFas,Epo, TNF-a, IL-6 and IL-10 were analyzed in all groups at baseline. We also investigatedthe correlation between these variables in AKI group after 24 hours ofhemodiafiltration.Results: We observed that Hgb concentrations were lower in AKI group (p<0,001).We also saw that AKI patients had serum levels of IL-6, TNF-a, creatinine and ferritinhigher than non-AKI and Healthy groups (p<0,001). Serum levels of sFas were higherin AKI and CKD groups than in the other groups at baseline (p<0,001).We found thatcritically ill patients (AKI and non-AKI groups) had higher IL-10 serum levels than theother groups and higher serum levels of Epo compared to Healthy group at baseline(p<0,001). After 24 hours of hemodiaflitration in AKI group, we observed that serumlevels of TNF-and Hgb concentration were lower and serum levelsof Epo, sFas and IL-6 were higher than before. Also, Hgb concentrations had negativecorrelation with serum levels of sFas(r=-0.34; p= 0.01), TNF-a(r= -0.28; p=0.04) and IL-6(r= -0.43; p=0.001). In multivariate analysis, after adjusting for markers ofinflammation, only serum sFas levels (p=0.02) correlated negatively with Hgbconcentration in the AKI group.Conclusions: Our study shows that serum levels of Epo are higher in critically illpatients and in CKD patients. At the same time, critically ill patients with AKI havelower Hgb concentrations than the other studied groups and serum sFas levels, as wellas in CKD group, higher. These information show a possible inadequate response ofEpo. The negative independent correlation between serum sFas levels and Hgbconcentrations suggests that there is an association between serum sFas levels andanemia in critically ill patients with AKI. In these cases, sFas could either be a causefactor or a secondary marker of anemia.
EFFECTS OF PAPAVERINE ON CONTEXTUAL FEAR CONDITIONING DEFICITPRESENTED BY AN ANIMAL MODEL OF SCHIZOPHRENIA: THE SPONTANEOUSLYHYPERTENSIVE RATSBIANCA AVANSI CAMERINI - UNIVERSIDADE FEDERAL DE SAO PAULO; NATALIA CRISTINA ZANTA -UNIVERSIDADE FEDERAL DE SAO PAULO; FILIPE M HUNGRIA - UNIVERSIDADE FEDERAL DE SAO PAULO;CLAUDIO FONTES SOUZA - UNIVERSIDADE FEDERAL DE SAO PAULO; RODRIGO A BRESSAN -UNIVERSIDADE FEDERAL DE SAO PAULO; VANESSA C ABILIO - UNIVERSIDADE FEDERAL DE SAO PAULO;MARIANA BENDLIN CALZAVARA - UNIVERSIDADE FEDERAL DE SAO PAULOIntroduction: Typical antipsychotics are widely used to treat schizophrenia. Thesedrugs act by blocking dopaminergic D2 receptors in the striatum, thereforeincreasing the cAMP level. Papaverine is known to inhibit phospodiesterase 10Aenzyme (PDE10A), which hydrolizes cAMP in the striatum. Hence, the inhibition ofPDE10A is involved with the increase of cAMP level, suggesting that papaverinemay produce antipsychotic effects. Recently, the Spontaneously Hypertensive Rats(SHR) strain has been suggested as an animal model of schizophrenia. This strainpresents several behavioral characteristics of schizophrenia, including deficit incontextual fear conditioning, deficit in social interaction and impaired prepulseinhibition of startle (PPI). All of these deficits could be reversed by theadministration of antipsychotics. Considering the behavioral characteristics of SHR,their adequate response to typical and atypical antipsychotics and the papaverinemolecular effects in the striatum, this pilot study aimed to investigate potentialantipsychotic effects of the papaverine on contextual fear conditioning deficitpresented by SHR strain.Materials and methods: On the training session, the rats were individually placed ina dark chamber with a grid floor. After 150 seconds, 0,4-mA foot shocks lasting 5seconds were applied every 30 seconds for the subsequent 150 seconds. The testsession was performed 24 hours after training. Each animal was placed in the samedark chamber, without receiving foot shocks. The freezing duration was quantifiedduring 5 minutes. The rats of different strains (i.e., Wistar and SHR, n=8 to 15 pergroup) were treated during training session with saline as vehicle controls,10mg/kg papaverine, 30mg/kg papaverine or 60mg/Kg papaverine. The sessionwas performed 30 minutes after the administration of the drug. Results: Two-wayANOVA revealed a significant strain effect and treatment effect on contextual fearconditioning. The SHR strain presented deficit on fear conditioning. Papaverineincreased the time of freezing on both strains.Conclusion: This preliminary study showed that papaverine did improve the deficitin emotional processing observed in SHR, suggesting its antipsychotical profile.
EFFECTS OF PAPAVERINE ON SOCIAL BEHAVIORS IN AN ANIMAL MODEL OFSCHIZOPHRENIA: THE SPONTANEOUSLY HYPERTENSIVE RATSNATÁLIA CRISTINA ZANTA - FEDERAL UNIVERSITY OF SAO PAULO; BIANCA AVANSI CAMERINI - FEDERALUNIVERSITY OF SAO PAULO; FILIPE M HUNGRIA - FEDERAL UNIVERSITY OF SAO PAULO; CLAUDIOFONTES SOUZA - FEDERAL UNIVERSITY OF SAO PAULO; VANESSA C ABILIO - FEDERAL UNIVERSITY OFSAO PAULO; RODRIGO A BRESSAN - FEDERAL UNIVERSITY OF SAO PAULO; MARIANA BENDLINCALZAVARA - FEDERAL UNIVERSITY OF SAO PAULOIntroduction: Typical antipsychotics are widely used to treat schizophrenia. Thesedrugs act by blocking dopaminergic D2 receptors in the striatum, thereforeincreasing the cAMP level. Papaverine is known to inhibit phospodiesterase 10Aenzyme (PDE10A), which hydrolizes cAMP in the striatum. Hence, the inhibition ofPDE10A is involved with the increase of cAMP level, suggesting that papaverinemay produce antipsychotic effects. Recently, the Spontaneously Hypertensive Rats(SHR) strain has been suggested as an animal model of schizophrenia. This strainpresents several behavioral characteristics of schizophrenia, including deficit incontextual fear conditioning, deficit in social interaction and impaired prepulseinhibition of startle (PPI). All of these deficits could be reversed by theadministration of antipsychotics. Considering the behavioral characteristics of SHR,their adequate response to typical and atypical antipsychotics and the papaverinemolecular effects in the striatum, this study aimed to investigate potentialantipsychotic effects of the papaverine on the social interaction deficit presented bySHR strain.Materials and methods: Rats of different strains (i.e., Wistar and SHR, n=6-8 pergroup) were treated with saline as vehicle controls, 10mg/kg papaverine or30mg/kg papaverine 30 min prior to experimentation. Unfamiliar rats of the samestrain were paired and placed in an open-field for 10 min. During this time, socialbehaviors, locomotion and rearing frequencies were scored. The social interaction(SI) test was performed in an open-field (97cm in diameter and 32.5cm high, withan open top and a floor divided into 19 similar parts) in a light room (25W).Duringthe test were scored parameters as locomotion, rearing frequency (the number oftimes each animal stood on its hind legs) and passive social behaviors. Thisexperiment quantified for each rat the time spent engaged in active and socialbehaviors.Results: The SHR treated with saline presented impaired social interaction,hyperlocomotion and increased rearing when compared to Wistar rats. The SHRtreated with 30mg/kg papaverine exhibited improvement on the social interaction,attenuated hyperlocomotion and diminished rearing.Conclusion: Our results demonstrated that papaverine is effective on the treatmentof positive (hyperlocomotion) and negative (social interaction deficit and increasedrearing) symptoms of schizophrenia observed in SHR. These results suggest thatpapaverine present an atypical antipsychotic profile.
CHALLENGES IN SCREENING AND DEALING WITH ATTENTION DEFICITHYPERACTIVITY DISORDER ON CHILDREN IN PUBLIC SCHOOLS AT DISTRITOFEDERAL RAFAELA FERNANDES DANTAS - ESCOLA SUPERIOR DE CIENCIAS DA SAUDE; JULIANA NOGUEIRAGARCIA - ESCOLA SUPERIOR DE CIENCIAS DA SAUDE; THATIANE DE SOUZA LEAO - ESCOLA SUPERIOR DECIENCIAS DA SAUDE; ANA LIDIA DE MELO ALCANTARA SILVA - ESCOLA SUPERIOR DE CIENCIAS DASAUDE; ATENA OLIVEIRA BENICIO - ESCOLA SUPERIOR DE CIENCIAS DA SAUDE; CLEIDIANE GOMESVASCONCELOS - ESCOLA SUPERIOR DE CIENCIAS DA SAUDE; DIEGO SOCRATES MROZINSKI - ESCOLASUPERIOR DE CIENCIAS DA SAUDE; ANDRE FERREIRA AGUIAR - ESCOLA SUPERIOR DE CIENCIAS DASAUDE; RICARDO LUIZ RAMOS FILHO - ESCOLA SUPERIOR DE CIENCIAS DA SAUDEIntroduction: The Attention Deficit Hyperactivity Disorder (ADHD) is the mostcommon childhood neurodevelopmental disorder. Its clinical presentation hasthree different categories: inattention, hyperactivity and impulsiveness that aremanifested in at least in two different environments and cause functionalcompromise. Considering that it is important to integrate health care services withschools, a group of ten second year medical students from Escola Superior deCiências da Saúde visited two public schools in order to identify how much teachersknow about learning difficulties and to verify whether or not teachers are preparedto deal and screen children with learning disorders.Materials and Methods: Its a qualitative study based on the methodology ofproblematizing using the Arch of Maguerez we developed this study making semi-structured interviews with teachers from two public schools in Sobradinho II atDistrito Federal in 2011. We used self made questionnaires that aimed to discoverhow much teachers, educators and educational psychologists knew about childlearning disorders. The project was approved by the Ethics Committee of theSecretaria de Saúde do Distrito Federal.Results: Although half of the teachers said they knew what ADHD is, less than half ofthem were formally trained to deal with children who suffer from ADHD. 85% ofthem have at least one student diagnosed with ADHD. And 56,75 % believe itsappropriate to change the curriculum for these kids.Conclusion: We noticed a low level of knowledge about learning disorders, mainlyADHD, among the teachers even though most of them have at least one student whosuffers from this disorder and some others who suffer from different learningdifficulties. These teachers didnt go through training to deal with learning disordersduring graduation nor after it. Considering teachers needs, we prepared ahandbook about the most common learning disorders describing what really isADHD, ways to deal with diagnosed children and presenting some differentialdiagnosis of ADHD.
SIMULATORS IN OBSTETRIC AND GINECOLOGIC PRACTICE: A COST-EFFECTIVE ANDREALISTIC MODEL FOR THE AMNIOCENTESIS TEACHINGKARL RICHARD BUSSE FILHO - UNIFESP; ANTÔNIO FERNANDES MORON - UNIFESPIntroduction: It is well know that maternal age is directly linked with fetalmalformations and with increase in chromosome abnormalities incidence. Theolder the mother, the higher are the chances of congenital disturbances. The mostcommon way to get a fetal cell sample is by amniocentesis. Amniocentesis is adiagnostic procedure that consists in the percutaneous trans abdominal puncture ofthe uterus during pregnancy to obtain amniotic fluid. It is commonly used for fetalkaryotype determination in order to diagnose abnormal fetal conditions. It is a veryefficient technique, but it is also invasive, and is also linked to a significative numberof complications. Depending on the case, amniocentesis can be very tricky toperform, especially in the oligohydramnios affected patients. The techniquerequires intense training and great ability, and these are neither easy to teach or tolearn. Some training models have been elaborated. They provide an environmentwithout risks, where errors are welcome, considered a part of the learn curve. Ourobjective was to develop a simple and low-cost simulator, but at same time realisticand capable of withstanding multiple procedures. As part of the task, we analysedexisting models proposed by other authors and developed our own model, whichincorporates their positive characters and brings creative solutions for theirproblems.Materials and Methods: The technique consists in three stages: (1) manufacturing ofthe plaster molds; (2) manufacturing of the latex belly; and (3) setting the belly onits support. We developed this technique by trial and error, and did many tests toget it to its current format.Results: In our tests the simulator worked perfectly as a amniocentesis trainingdevice and for other ultrasonography procedures, such as the tridimensional studyof the fetus. We used water filled condoms as targets. The image was clear andmuch better than expected. 4. Conclusion This device had a very low cost whencompared with other commercial simulators. The materials were chosen based ontheir cost, easiness to be found, handled and based on their durability. Oursimulator was designed to withstand multiple punctures while maintaining itsintegrity and realism. All this factors make maintenance extremely cheap and easy.Another positive point is the possibility of using various belly sizes.
HUMANIZED CHILDBIRTH: A DIFFERENT FOCUS ON OBSTETRIC MEDICAL AREALÍVIA AMORIM - UNESP; LAURA NUNES LOPES - UNESPIntroduction: The central idea of Humanized Birth is to respect the pregnantautonomy despite of the world tendency of mechanized and interventionistmedicine. The woman is called the birth owner, the obstetric is only a helper andthe birth is seen like a physiologic process which requires medical intervention inonly some restrict situations. This doctrine is based on scientific evidences and hasgained importance and visibility on the medical academic. The project is part of anannual project between de Botucatu Medicine College (Faculdade de Medicina deBotucatu- UNESP) and the Brazilian Health Ministry. The main objective is to searchhow much the health professionals (doctors and nurses) in the basic attention knowabout and apply this new obstetric doctrine on their assistance. This study gives aparameter of the professionals actualization levels and shows how the futuremothers are been taken cared in the local health system. Materials and Methods:The project involved a group [two tutors (Obstetrics and Gynecology Universityteachers), thirteen medicine students and four preceptors] that met fortnightly inthe respective Department at the Medicine College. The study duration expected tobe one year, starting in April 2011. The group started studying many articles anddiscussing about the theme. Then, a questionnaire with two descriptive asks waselaborated to be applied to the health professionals. The questions covered theknowledge about pregnant rights and the previous idea of humanized childbirth.After the interviews, the group divided itself and organized four meetings withthose professionals to discuss the theme Humanized Childbirth based on theiranswers at the questionnaire.Results: The project initial hypothesis was confirmed: most of the interviewedprofessionals have a superficial knowledge about the studied theme. These resultscan undertake the attempt to improve the medical assistance for the pregnant andshow how much the government still has to invest on the professionals capacity andon the society attention about this new obstetric tendency. The good new is that theprofessionals who participated of the meeting really approved and seemed to beinterest to learn more about it. Conclusion: The Humanized Childbirth focus is onthe pregnant and her son, never on the obstetric doctor. The doctor is only anadjuvant on the birth process. So the relevance of this project is to show theprofessionals the necessity of a medical care quality, especially on this mothersmoment, and to promote much capacity as possible. The next step is to extend thesemeetings for the others health professionals, besides doctors and nurses, like thetutors were asked.
COMPARISON BETWEEN 2D-SONOGRAPHY AND MAGNETIC RESONANCE IMAGINGIN ASSESSMENT OF BRAIN AND SPINE PARAMETERS OF FETUSES WITH NEURALTUBE DEFECTSMAYRA SATIKO LEMOS NAKANO - UNIFESP; EDWARD ARAUJO JUNIOR - UNIFESPObjective: Compare the two dimension ultrasonography (2DUS) and magneticresonance imaging (MRI) in assesing the parameteres of the brain and spine offetuses with neural tube defects. Methods: We conducted a prospective cohortstudy of 14 fetuses carrying neural tube defects (4 raquisquisis and 10meningomyelocele). We assessed the size of the atrium of the lateral ventricle, theshortening of the cerebellum, the involvement of the first vertebrae and the totalnumber of vertabrae affected by the herniation. 2DUS exams and MRI wereperformed within a maximum of 7 days. For comparison and correlationparameters of the two techniques, we used the paired t student test and correlationcoefficient (ICC), respectively. We also evaluated the correlation betweenmeasurements by Pearson correlation test.Results: There was no significant difference in any of the parameters evaluated bymeans of the two techniques (p<0.05), reliability, for example, between 2DUS andMRI seems to be satisfactory for the lateral ventricle atrium widht and the level ofthe first vertebra involved (ICC = 0.88 and 0.75, respectively). Measurementsobtained did not prove that there is a correlation between atrial width, level ofinjury and fractional shortening of the cerebellum. Conclusions: In this study wenoticed that both 2DUS and MRI have no statistically significant differences inmeasures to evaluate fetuses with neural tube defects. We also assess that there isno correlation between atrial width, level of injury and fractional shortening of thecerebellum in both 2DUS and MRI.
PREVALENCE OF PREGNANT ADOLESCENTS WOMEN ATTENDED AT UBS JARDIMCUMBICA I - GUARULHOS BETWEEN OCTOBER 2009 AND 2010 AND THEIRBIOPSYCHOSOCIAL IMPLICATIONS.ANDRÉ FREITAS CAVALLINI DA SILVA - UNICID; CYRO DE CAMPOS ARANHA PEREIRA NETO - UNICID;TALITA MACHADO BOULHOSA - UNICIDIntroduction: According to the World Health Organization, adolescence is the periodof biopsychosocial development between 10 and 19 years. The increasingproportion of sexually active adolescents is a public health problem because itimplies increasing the pregnancy rate in this age group and brings repercussionsfor the mother and the condition of newborn infants. Among others, is associatedwith increased incidence of cesarean sections, prematurity, intrauterine growthrestricted fetal distress and low birth weight.Objective: Conducting an epidemiological study to determine the prevalence ofpregnant adolescents attended at Basic Health Unit (BHU) Guarulhos-SP and reflecton their biopsychosocial implications. Methods: We analyzed medical records of 91pregnant women in BHU Jardim Cumbica I - Guarulhos with the first prenatal visitbetween October 2009 and October 2010. Data were entered and evaluated in anExcel spreadsheet. Developed, then a descriptive analysis of the object.Results: Of the 91 analyzed records, 29 were adolescents (32%), in agreement withthe literature and putting several issues about biopsychosocial implications.Conclusion: Conclude by the importance of preventive and focused accompanyingto decrease risk of pregnancy among adolescents (especially in the poorest socialclasses) and their fetuses. Accordingly, it is configured as a public health problemand a relevant topic to be discussed by managers, health professionals andresearchers.
TIME TO DIAGNOSIS AND TREATMENT OF BREAST NEOPLASM IN SÃO PAULOTânia Topis – UNIFESP; Luiz Henrique Gebrim - UNIFESPIntroduction: Breast cancer is a public health problem in Brazil and worldwide. InBrazil, breast neoplasm is the type that causes more deaths among womenaccording to data from Health Ministry. The aim of this study is to quantify the timeto diagnose and treat patients with breast cancer at the Hospital Pérola Byington inSão Paulo - SP - Brazil, the second largest Center of Reference for breast cancer,which serves about 1000 new cases/year exclusively on public health, identifyingthe stages of the process that are contributing to this fact.Methods: This is a retrospective study. One hundred and eighty women who werediagnosed with breast cancer were interviewed and their medical records wereconsulted from September 2011 to April 2012 at Hospital Pérola Byington. Weevaluated the elapsed time in each of the actions as: Waiting time to look for healthservice after symptoms appearance (Time A); waiting time for the first medical careat UBS(B), time between the first consultation from the General Practioner andmammography(C); time between the completion and outcome ofmammography(D); time between the scheduling of the ultrasound and itscompletion(E); interval between the ultrasound and its outcome(F); time betweenscheduling another subsidiary test and its completion(G); time between thecompletion of the subsidiary test and its result(H), time to make an appointment atthe Reference Hospital(I); time between first consultation at reference hospitaluntil the scheduling of the biopsy(J); and the interval between the biopsy and itsoutcome(K);time between biopsy outcome until start therapy (surgery orchemotherapy)(L).Results: Mean waiting time of symptomatic patients was 280,73 days, and medianwas 188,5 days; Mean waiting time of asymptomatic patients (time between asuspicious mammography result and the treatment) was 122 days, and median was107 days; and, the largest contributor to this was "Time L". We can cite as goodresult the median of "Time I" in both groups was 2 days, and, of "Time J" insymptomatic patients was 1 day, and in asymptomatic patients was 0 days.Conclusion: Average time to reach the Hospital Reference was excessive. We mustact so that the municipalities, responsible for primary care, enable physicians andnursing staff to triage patients, care of patients with medium complexity because80% of referrals are benign pathology. The time for diagnosis in the Hospital ofReference was shorter than the average of three months of others Reference PublicHospitals. "Time J" (1 day) is within international guidelines for biopsy (1-7 days),but the end result of the test has an average of 30 days because of the necessity ofimmunohistochemical technique. "Time L" had an average of 60 days (goldstandard of 15 to 30 days), because of difficulties in preoperative assessment,patients with co-morbidities and the need to wait for the immunohistochemicaltechnique to start appropriate chemotherapy. The prospect for continuation of thisproject is to increase the number of patients analyzed, thus achieving more reliabledata.
SYNCOPE DIAGNOSTIC IN CHILDHOOD AND ADOLESCENCEFRANCISCO CAETANO SILVA JÚNIOR - UNIVERSIDADE JOSÉ DO ROSÁRIO VELLANO - UNIFENAS BH;MARIANA PASA MORGAN - UNIVERSIDADE JOSÉ DO ROSÁRIO VELLANO - UNIFENAS BH; ANA CLÁUDIAQUEIROZ GOMES - UNIVERSIDADE JOSÉ DO ROSÁRIO VELLANO - UNIFENAS BHIntroduction: Syncope is characterized for the sudden loss of consciousnessassociated to the loss of tone and with fast recuperation. Even though it does nothave total physiology defined, is known that could be triggered by cardiology,neurology or metabolic stimulus, knowing that the neurocardiogenic alternationrepresents from 50 to 80% of total cases. It is estimated that up to 15% of childrenwill experience a syncopal episode before the end of adolescence. The diagnosesmust, in the very beginning, exclude the death potential conditions that requirehospitalization and treatment by a detailed anamneses and clinical exam, followedby complementary exams like electrocardiogram at rest, HOLTER, ergometric exam,electroencephalogram, tilt table testing, clinic pathologic exam, and others.Objective: Accomplish a research in literature to indentify the principal etiologicalfactors and clinic signs in relation to syncope in children and adolescents.Methodology: Accomplished researches in bases of electronic data using key words(children syncope, syncope psychogenic and neurocardiogenic syncope) and theirfellow in Spanish and English language. Among the articles achieved, were selected12 articles and 2 books for deeper analysis.Discussion: the diagnostic of one sycope event begins with and detailed anamneserealization, addressing three determined moments: before, during and after seizure.The syncopal event is frequently jumbled with epileptically crisis, differing itself byabsence of tonic-clonic seizuresThe psychogenic syncope is related to high levels ofsomatic symptoms, and to patients with more probability to present an syncopalevent are those who are affect by psychiatric disorders or that show rich pre-syncopal symptoms. The cardiogenic syncope is specially related to events thatchange directly the operation of cardiac bomb and can cause sudden death. Theprincipal causes are aortic stenosis, hypertrophic cardiomyopathy, coronarymalformation and primary arrhythmia. The pathophysiology of neurogenic syncopeis still not very known, however is known that few factors, since pain until keepyourself into orthostatism, could generate the syncope due to exaggerate responseof autonomy nervous system. Occurs sympatic inhibition and parasympatheticstimulation with resulting hypotension and bradycardia leading to cerebralhypoperfusion that explain the loss of consciousness. Some authors believe that onegenetic component is responsible for alterations on regular system of arterialpressure.Conclusion: verified a large number of divergences in the literature specially relatedto physiopathology of the three etiologic mechanisms of the syncope, proving theneed of realization for deeper studies about the subject. The correct approach ofsyncope requires the diagnosis clarify for proper clarification of patients or familymembers and the treatment institution when needed.
PROFILE OF PATIENTS WITH CHRONIC KIDNEY DISEASE AT PEDIATRICHEMODIALYSIS OF UNIFESP - ESCOLA PAULISTA DE MEDICINAGABRIELLA MAFRA ELIA - UNIFESPIntroduction: Data regarding pediatric patients in hemodialysis is valuable to theunderstanding of many questions such as health, nutritional and epidemiologicalissues of this population and to allow the formulation of strategies to clinicalapproach. Since there is few epidemiological study in this field in Brazilianliterature, it is very important to start research on this population, as it is theintention of the present study.Methods: This is an observational and descriptive study of the characteristics of 166patients who have been in hemodialysis at the Pediatric Dialysis Unit atUniversidade Federal de São Paulo between august 1999 and august 2010. Thevariables collected include: age at the beginning and at the end of treatment, sex,weight at the beginning, attendance to school and possible evasion, time intreatment, etiology of the Chronic Kidney Disease (CKD) that lead to hemodialysis,last treatment before hemodialysis, number of sessions, number of sessions withhypotension, vascular access used in the beginning and end, reason of exit, if returnto hemodialysis, time until the return, death and its causes and medication withintravenous iron.Results: In the period, 166 records were analyzed, which made up 156 patients,since 10 left but came back. One hundred and six (63,86%) patients were male. Theweight average was 25,54 kg (range:56,6 to 3,925 kg). Ninety one (54,8%) patientsdidn´t attend to school. Of the 75 (45,2%) patients who attended school, 13 (17,3%)abandoned it during the treatment. The average age at the beginning of treatmentand time in treatment was 108,9 months (m) (range:216,4 to 3,1m) and 12,7 m(range:71,3 to 0,1 m).The average number of sessions was 172,7 (range 932 to 3)and the average number of the percentage of hypotension was 17,9 (range:80 to 0).The most common vascular access in the entrance was Schilleys catheter with 61(36,7%) patients and arterial-venous fistula in 41 (24,7%) patients. The majorreason for the exit was renal transplantation: 96 (57,9%) patients. The mostprevalent causes of CKD was congenital structural anomalies with 56 (33,7%)patients and glomerular diseases with 55 (33,1%) patients. There were 20 deaths; 5(25%) were due to sepsis, 4 (20%) to cerebral vascular accident and 5 (25%) tounknown causes.Conclusion: In the follow up of pediatric patients with CKD, hemodialysis was aneffective method and the average of hypotension found stayed bellow the onedescribed in the literature, which is around 30% of sessions.
ENDOSCOPIC FINDINGS IN 58 PEDIATRIC PATIENTS WITH MOUTH-BREATHINGHADELLE HABITZREUTER HASSMANN - FURB; BEATRIZ BRITTES KAMIENSKY - FURB; EDUARDA RAQUELPRZYGODA ALVES - FURB; PEDRO GEISEL SANTOS - FURB; JAN ALESSANDRO SOCHER - FURBIntroduction: Mouth-breathing is a common symptom in childhood and ischaracterized by alterations in craniofacial and dental arch development, frequenttiredness, daytime sleepness, adinamia, low apetite, nocturnal enuresis and evenlearning and attention deficits. This symptom has several causes and it is thereforenecessary to clarify details about the clinical aspects according to its causes.Objective: This study aims to raise the main endoscopic findings in pediatricpatients with mouth-breathing signs who were attended in an specializedOtolaryngology service.Material and methods: We surveyed medical records of 58 patients, from bothsexes, between 5 to 16 years old referred for Otolaryngology service by Odontologyand Orthodontic pediatric professionals for mouth-breathing evaluation. All thepatients were evaluated by sinonasal and pharyngolaryngeal endoscopic exams.Results: The main findings were adenoid and/or tonsillar hypertrophy, rhinitissigns (allergic or non-allergic), septal deviation, inferior turbinate hypertrophy andhigh palate.Conclusion: The causes of mouth-breathing are diverse and multifactorial and theendoscopic exams are valuable on the evaluation of these cases forcomplementation.
FUNCTIONAL OUTCOME OF MODERATELY PRETERM AND FULLTERM BORN SMALLFOR GESTATIONAL AGE CHILDREN AT SCHOOL AGEJOZIEN C TANIS - NEONATOLOGY, BEATRIX CHILDRENS HOSPITAL, UNIVERSITY MEDICAL CENTERGRONINGEN; KOENRAAD NJA VAN BRAECKEL - NEONATOLOGY, BEATRIX CHILDRENS HOSPITAL,UNIVERSITY MEDICAL CENTER GRONINGEN; JORIEN M KERSTJENS - NEONATOLOGY, BEATRIXCHILDRENS HOSPITAL, UNIVERSITY MEDICAL CENTER GRONINGEN; INGER FA BOCCA-TJEERTES -NEONATOLOGY, BEATRIX CHILDRENS HOSPITAL, UNIVERSITY MEDICAL CENTER GRONINGEN; SIJMEN AREIJNEVELD - DEPARTMENT OF HEALTH SCIENCES, UNIVERSITY MEDICAL CENTER GRONINGEN; ARENDF BOS - NEONATOLOGY, BEATRIX CHILDRENS HOSPITAL, UNIVERSITY MEDICAL CENTER GRONINGENIntroduction: Being born small for gestational age (SGA) is one of the leading causesof adverse perinatal outcome, i.e. high mortality and impaired short-termdevelopment. Therefore, children born SGA are considered to be at risk for adversecognitive and motor outcomes. SGA birth can occur at all gestational ages and ismostly seen in moderately preterm (MP) and fullterm (FT) born children. As yet,their long-term functional outcome compared to appropriate for gestational age(AGA) children is unclear.Objective: To compare functional outcome at school age of moderately preterm andfullterm children born small for gestational age with appropriate for gestational agepeers.Materials and Methods: In this community based prospective study, we included248 MP born children (32-36 weeks, n[SGA]=28) and 130 FT born children(n[SGA]=11). SGA was defined as birth weight below the 10th percentile. At median6.9 years, intelligence (IQ), verbal memory, attention, visuomotor integration (thetransformation of visual information into motor action), and motor skills wereassessed. Parental reports of executive functioning were collected. We determinedthe differences in outcome between SGA and AGA children for the total group (MPand FT), and for MP and FT children separately.Results: Median birth weight was 1700 grams (range 705-2970) in SGA childrenand 2630 grams (range 1330-1540) in controls, median gestational age was 35weeks (range 32-41) in both groups. Of the SGA children, 61.5% was male versus50.4% in controls (ns). Overall, functional outcome did not differ between SGA andAGA children. An exception was visuomotor integration, on which SGA children hadsignificantly lower scores (P=0.046). No significant differences were found betweenSGA MP and FT groups separately, compared to AGA MP and FT groups.Conclusion: To our surprise, children born SGA had a comparable functionaloutcome at school age as their AGA peers. An exception was visuomotor integration.Our data suggest that being born SGA, whether moderately preterm or fullterm,hardly affects functional outcome at school age.