Untitled - Braincoms

Transcription

1
About BRAINCOMS.....................................................................................................3
2015 Committee...........................................................................................................4
Special Thanks.............................................................................................................7
Basic Science..............................................................................................................8
Poster Section...................................................................................................9
Oral Presentation............................................................................................30
Clinics/Internal Medicine..........................................................................................37
Poster Section.................................................................................................38
Oral Presentation............................................................................................79
Surgery........................................................................................................................81
Poster Section.................................................................................................82
Oral Presentation..........................................................................................103
Obstetrics and Gynecology.................................................................................... 112
Poster Section...............................................................................................113
Pediatrics. .................................................................................................................118
Poster Section...............................................................................................119
Extension...................................................................................................................139
Poster Section...............................................................................................140
Preventive..................................................................................................................161
Poster Section...............................................................................................162
Winning Posters.......................................................................................................180
Winning Oral Presentations....................................................................................206
Heads up for the 2016 edition..........................................................................213
2
The Brazilian International Congress of Medical Students – BRAINCOMS –
2015 is the fourth edition of this great and successful congress.
The congress was established in 2012 by students of the Escola Paulista de
Medicina – Universidade Federal de São Paulo (EPM/UNIFESP). Since then,
as it is nowadays, the Congress is entirely planned, built up and ran by and for
medical students. Since the first edition, the Congress has received many
foreigners students, focusing on the international flow of knowledge in the
medical area. We have grown and last year we received representatives from 9
different countries from almost all continents and Brazilian states.
BRAINCOMS is a unique opportunity for you to include yourself in the
international medical context by listening to amazing internationally acclaimed
speakers, practicing and improving your skills at hands-on workshops, building
up network with other medical students from everywhere, and much more! All
this in an engaging atmosphere with smart people, sense of humor, outstanding
scientific quality and – why not? – great food and social events! This congress
has everything to add a lot to your personal and medical formation. You couldn’t
spend these 3 days in a better way.
3
4
Marília Emi Sato Ito - 5th year
Keila Pereira Leite - 4th year
PRESIDENT
VICE-PRESIDENT
PUBLIC RELATIONS AND COMMUNICATION COMMITTEE:
André Moreira Nicolau – 2nd year
Fernando Monicci Navas – 2nd year
Gibrán Harcha Muñoz – 3rd year
Guilherme Niciunovas – 3rd year
SPONSORSHIP:
Yahsmin de Lima – 2nd year
Juan Fulgencio Welko Mendoza – 3rd
year
5
SCIENTIFIC COMMITTEE:
Fabio D’Arienzo – 2nd year
Hiran Gasparini dos Santos – 4th year
Laís Gabriele Vieira – 3rd year
Júlia Jiquilin Carvalho – 3rd year
Paulo Alberto Cervi Rosa – 6th year
Thaís Romera Bergamo – 4th year
LOGISTICS COMMITTEE:
Flávia Ortega Berbella – 5th year
Maria Victoria Bastos Tavares – 3rd
year
GENERAL CORDINATOR:
Brunna Luise Alvarenga e Silva – 4th year
2
On behalf of IV Brazilian International Congress of Medical Students,
BRAINCOMS, we would like to thank all of those who believed in our dream
project. In order to achieve BRAINCOMS success, we had lots of support,
especially from our professors, members of our Scientific Advisory Board. In
particular, professor José Osmar Medina Pestana have granted us with not only
advices and words of wisdom, but also provided us with the strength and
energy needed throughout our four editions. Without his help, our path would
have been much harder. Also, the belief of solid institutions, such as our
University and School of Medicine, has assured us the reliability among the
academic field required to settle BRAINCOMS as one of the most renowned
international student conferences. We would like to acknowledge our gratitude
to Professor Soraya Soubhi Smaili, dean of Universidade Federal de São
Paulo; Professor Rosana Puccini, headmaster of the São Paulo Campus of the
Universidade Federal de São Paulo; and Professor Emilia Inoue Sato,
headmaster of Escola Paulista de Medicina of the Universidade Federal de São
Paulo. Likewise, the construction of the fourth edition of BRAINCOMS
demanded not only human, but also financial resources. We knew that, due to
our condition (as an organizing committee, composed only by medical
students), it would be difficult to gather the financial aid, in order to cover up our
budget. However, some institutions have trusted and supported us all through
our fourth edition. We would like to thank: Universidade Federal de São Paulo,
Escola Paulista de Medicina, Santander, Secretaria de Estado dos Direitos da
Pessoa com Deficiência, Hospital Sirio Libanês, Instituto de Oncologia
Pediátrica (IOP), Grupo de Apoio ao Adolescente e à Criança com Câncer
(GRAACC), Associação Paulista para o Desenvolvimento da Medicina (SPDM),
Associação Atlética Acadêmica Pereira Barreto (AAAPB). At last, but not least,
we would like to thank all of the attendants, presenters and listeners, professors
and staff members that have shown that our effort had not been in vain. We
hope that you have all enjoyed BRAINCOMS as much as we have!
BRAINCOMS 2015 Organizing Committee
7
8
9
TITLE: The effects of linseed oil and macadamia oil on the metabolic changes
induced by a high-fat diet rich in saturated fatty acid in mice.
AUTHOR: Amanda Brevilheri Benassi.
MENTOR: Helenton Cristhian Barrena
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Benassi A. B. Faculdade
Ingá (Uningá); Schiavon, F. P. M. Universidade Estadual de Maringá; Cararra,
M. A. - Universidade Estadual de Maringá; Marques, A. C. R. - Universidade
Estadual de Maringá; Bazotte, R. B. - Universidade Estadual de Maringá.
BACKGROUND/INTRODUCTION: The mouse fed with high-fat diet (HFD) is a
suitable experimental model to demonstrate the possibility to prevent or reverse
the metabolic changes induced by HFD with drugs or food rich in unsaturated
fat acids.
OBJECTIVES: The main objective of this study was to evaluate the impact of
the replacement of soybean oil, rich in linolenic acid (ω-6) present in HFD by
macadamia oil, rich in oleic acid (ω-9) or linseed oil, rich in α-linolenic acid (ω-3)
on liver gluconeogenesis, glycemia and lipid storage.
METHODS: Male Swiss mice, 6 week old, were randomly divided in 4 groups.
The control group (NFD) received normal fat diet (4 and 1.5/100g of total fat and
saturated fat acid, respectively) and other three groups received HFD (35.2 and
12.9/100g of total fat and saturated fat acid, respectively). For comparative
purposes, the soybean oil present in the diet given to HFD-SO group was
replaced by linseed oil (HFD-LO group) or macadamia oil (HFD-MO group).
After 14 days receiving those diets the mice were fasted (18 h) and
anesthetized with intraperitoneal ketamine/xylazine (60/12 mg/kg). After
laparotomy, blood was collected from the cava vein for glucose determinations
or the liver perfusion was initiated. The liver glucose production (LGP) from Lalanine (0.5, 1.0 and 5.0 mM), L-lactate (2.0 mM) and glycerol (2.0 mM) were
compared. Moreover, the mesenteric, retroperitoneal, periepididymal and
inguinal fat were removed and weighed
RESULTS: Glycemia and fat distribution. HFD groups showed higher (P<0.05
vs. NFD) glycemia. HFD groups also showed increased (P<0.05 vs. NFD)
periepididymal fat weight while retroperitoneal fat weight remained unchanged.
In addition, body weight, inguinal fat weight and the sum of periepididymal,
mesenteric, retroperitoneal and inguinal fat weight were similar if NFD group
was compared with HFD-LO. HFD-LO group also showed lower (P<0.05 vs.
NFD) mesenteric fat weight. Moreover, body weight, inguinal fat weight and the
sum of periepididymal, mesenteric, retroperitoneal and inguinal fat weight were
higher if HFD-SO or HFD-MO were compared with NFD group.
10
Liver gluconeogenesis. In general, the liver glucose production (LGP) from
increasing levels of L-alanine (0.5 mM, 1.0 mM and 5.0 mM) showed higher
values (P<0.05 vs. NFD) to HFD groups. In addition, HFD-SO or HFD-MO
group showed higher LGP (P<0.05 vs. NFD) from glycerol or L-lactate while no
difference was observed to HFD-LO (HFD-LO vs. NFD)
DISCUSSION/CONCLUSION: It is well established that monounsaturated fatty
acids and polyunsaturated fatty acids could protect against the metabolic
changes like obesity, dyslipidemia, insulin resistance and hyperglycemia
induced by HFD. Although HFD containing excessive saturated fat promoted
lipid storage, linseed oil play a protective role on lipid storage, probably
mediated by its high content of α-linolenic acid oil (ω-3). However these
beneficial effects were not observed on glycemia and liver glucose production.
11
TITLE: The effect of obesity induced by a high-fat diet on the response to
cytoglycopenia
AUTHOR: Ana Agata Mezzomo Keinert.
MENTOR: Iracema Senna de Andrade.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Pacheco, R.L. - UNIFESP;
Silva, B.L.A. UNIFESP; Freitas, N.T.M. UNIFESP; Ribeiro, E.B. - UNIFESP;
Andrade, I.S. UNIFESP
BACKGROUND/INTRODUCTION: A high fat diet is a great risk factor for
obesity, which is a current public health issue. Diet nutrients such as glucose
and lipids act on hypothalamic neurons which control food intake, glycemia and
energetic homeostasis. The injection of 2-deoxy-D-glucose (2-DG), a
competitive inhibitor of glycolysis, promotes stimulation of glucose-sensitive
neurons, causing feeling of hunger, increase of digestive secretions and high
glycemia due to cytoglycopenia.
OBJECTIVES: The objective of this study is to evaluate if cytoglycopenia alters
food intake and serum glucose, triglyceride and cholesterol in mice chronically
fed with high-fat diet.
METHODS: Two-month old male swiss mice were randomly assorted into two
groups. The 24-hour intake of either control diet (Nuvilab, 2.77 kcal/g) or high
saturated-fat diet (Lard, 4.2 kcal/g) and the individual body weight were
measured weekly. The Lard diet was made of 50% commercial ration, 10%
sucrose, 20% casein, 2% soy oil and 18% lard. After 8 weeks, the mice
received an intraperitoneal saline or 2-DG injection and the food intake was
measured for 2 hours. The animals were then sacrificed and adipose tissues
(epididymal, retroperitoneal and mesenteric) were dissected and weighed;
serum glucose, triglyceride and cholesterol were determined by enzymatic
methods. Thus, 4 groups were studied, according to diet and injection received:
saline control, 2-DG control, saline lard and 2-DG lard. All procedures were
approved by UNIFESP’s Ethics Committee. Data was analyzed by ANOVA
followed by either Tukey or Student’s “t” test.
RESULTS: During diet treatment, the daily consumption was lower in animals
fed with high-fat diet (p=0.035), but energy intake was similar between groups.
There was no significant difference in body weight gain between the groups, but
the high-fat group had a bigger epididymal adipose tissue mass (p=0.009),
while the retroperitoneal and mesenteric adipose tissues only showed a
tendency to increase. After injecting 2-DG in the control group, the food intake
increased significantly in comparison to the saline control group (p=0.043). In
the high-fat group, however, the injection of 2-DG did not cause significant rise
in the food intake, indicating this diet had altered the central effect of 2-DG. The
saline high-fat group had higher serum glucose (p=0.026) and triglyceride
12
(p=0.032) in comparison to the saline control group, with similar serum
cholesterol.
The 2-DG injection caused an increase in glycemia in both groups (control:
p=0.015; high-fat: p=0.026), but increased serum triglycerides and cholesterol
only in the control group (p=0.038; p=0.041; respectively), in comparison to
animals that received saline injections.
DISCUSSION/CONCLUSION: The chronic consumption of high-fat diet caused
an increase of adiposity and serum glucose and triglycerides, without affecting
the body weight. This diet did not cause an increase of energy intake. The
chronic consumption of the high-fat diet affected the acute response to 2DG
injection on food intake and serum triglycerides and cholesterol, but did not
affect the response of serum glucose.
13
TITLE: Use of pluripotent stem cells in terpeutica of Stargardt's disease: a
review.
AUTHOR: Bruno Acharezzi.
MENTOR: Ana Cláudia Dinamarco Mestriner.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: ACHAREZZI, B;
RODRIGUES, A.M.; SANTOS, A.F.B.; LAVOR, E.B.; DAVID, J.R.M;
MESTRINER, A.C.D. - Institution: Centro Universitário Barão de Mauá
BACKGROUND/INTRODUCTION: Stargardt's disease is a retinal macular
disease, usually hereditary, autosomal recessive being the most common
(STGD1). Its incidence is 1: 10,000 live births (Cornor et al, 2013). There are
several causes for Stargardt's disease, including protein encoded by wrongly
ABCA4 gene; accumulation of a byproduct of this protein on epithelial cells of
the retina and eventual death of fotorrecpetores (Glazer; Dryja, 2012). Therapy
with stem cells is an alternative for macular regeneration.
OBJECTIVES: To analyze some results obtained from experiments with
pluripotent stem cells in Stargardt's disease.
METHODS: This is a literature review. Purposes by defining the problem, the
lines of inquiry and recommendations for future research were initially defined.
The search for scientific articles was conducted by the descriptors "stargardt"
and "pluripotent stem cell" in the period from January 1st of 2010 to January 1st
of 2015. Were found three articles in the Pubmed data base, no article in the
Scielo and 344 in Google Scholar, 31 patented in the study period. Thirteen
articles were selected for analysis: 3 Pubmed and 10, the most relevant by
Google Scholar.
RESULTS: Pluripotent stem cells differentiate into one type of tissue and this
therapeutic approach is still under study to knowledge of the effectiveness and
the amount of immunosuppression required to be successful in securing a
treatment with fewer side effects. In Stargardt's disease, the loss of the "fragile
photoreceptor" is responsible for the permanent loss of vision. Several studies
show an improvement in visual behavior in mice when transplanted tissues with
pluripotent stem cells in the subretinal space; where the viable cells have been
integrated into mature and differentiated into a retinal "fragile photoreceptor"
(Corner et al, 2013). According to Schwartz et al (2014), there was no rejection,
adverse event or serious problems by the use of implanted tissue; However,
there were problems associated with immunosuppression and vitreoretinal
surgery.
DISCUSSION/CONCLUSION: According to the raised articles, it can be said
that there have been advances in techniques and knowledge of therapy
adopted by the experiment in rats and humans for Stargardt disease, and
possibly other diseases with degenerative pattern. However, further studies are
14
needed and confrontation with other therapeutic forms still in development, as
encapsulated cell therapy, gene replacement therapy, among others, aimed at
improving the patients quality of life.
15
TITLE: New Hope For Leukemia: Cranberry
AUTHOR: Burak Isal.
MENTOR: Kiyoshi Itagaki, PhD.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Burak Isal*, Laura
Bystrom**, Stefano Rivella**; **Weill Cornell Medical Faculty/New York
Presbyterian Hospital
BACKGROUND/INTRODUCTION: The North American cranberry (Vaccinium
macrocarpon Ait Ericaceae) is receiving attention as “prophylactic” food and
source of “orthomolecular medicines”. Cranberry fruit is rich in polyphenolic
constituens with flavonols, anthocyanins, and proanthocyanidins (PACs) in
particular A-type PACs. In contrast, cocoa, grape and many other plant species
have B-type PACs. Iron is essential for normal cell function. Many cancer cells
exhibit an increased requirement for iron, because of the increased cellular
function rate. Our aim in this study is to identify the most effective compound /
fraction / combination of PACs with anti-leukemia activity. And to understand
how these effects are related to iron metabolism and ROS.
OBJECTIVES: This is a combined in vitro and in vivo study which is trying to
show the best dosage and time of treatment for acute leukemia cell lines. The
treatment includes the Pro Antho Cyanidine (PAC) Type A from natural
cranberry powder. In the mechanism of our treatment we are discussing about
iron and NFk-B pathways.
METHODS: All the experiments has done in New York Weill Cornell Medical
Faculty. In this study we have used four different leukemia cell lines: K562(CML), KG-1(AML), MV-4-11(BBML), REH (ALL) and used different
combinations of C-18(has 18% of PACs), Cysticran-40(has 40% of PACs), Lori
Trimers, and Piperlongumine. And used different concentrations of DMSO as
the solvent of the powders and cell medium solutions. We have incubated the
cells for 3,6,12,24 and 48hours for different types of experiments and used
MOXI-Z cell counting device to determine the cell numbers and viability of
different cell lines with different treatments. Also we have used flow cytometry to
show Apoptosis, ROS, and Transferrin receptor (CD-71) ratio changes.
RESULTS: In the first flow cytometry experiment, we have incubated the K-562
cell line for 3 hours with 60 and 120 microgram of Trimers. In the second flow
cytometry experiment, we have used 500 microgram of Trimers, tetramers and
cysticran-40 and incubated the K-562 cell line for 3 and 20 hours. According to
the results of Apoptosis, Transferrin receptor-1(CD71), ROS and IL-6 receptor
(CD126); the effectiveness of the treatment compounds depends on the
dosage and duration of treatment. And when we compare the results of each of
the compounds, the most effective compund was the Trimer that we have
collected from Cranberries.
16
DISCUSSION/CONCLUSION: Although we used an A-PAC trimer from peanuts
skins (Cinnamtannin B-1) at the higher concentrations, the trimer from
cranberries had similar activity at lower concentrations (the structure of one of
the cranberry trimers is identical to Cinnamtannin B-1). For future studies, we
aim to compare the effectiveness of A-PAC trimers against other resistant and
sensitive leukemia cell lines.
17
TITLE: Pupillary activity among images with different semantic content.
AUTHOR: Consuelo Esperanza Gatica Troncoso.
MENTOR: Jose Ignacio Egaña.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Gatica, Consuelo1.
Schwember Ian.1, Madariaga Samuel, .2 & Egaña Jose.Ignacio.1 1=Facultad
de Medicina, Universidad de Chile. 2 =Facultad de Ciencias Físicas y
Matemáticas, Universidad de Chile.
BACKGROUND/INTRODUCTION: Light is the principal stimulus for pupil
activity and it has been widely studied and accepted. Nevertheless, recent
studies have shown that cognitive processes might affect pupil dynamics as
well. Some of these previous reports indicates that positive and negative
emotions are related to pupillary dilation. Also, it has been observed that the
working memory tasks with increasing load are associated with larger
differences between pupillary constriction and dilation. In this work, we tested
the hypothesis that semantic content itself, regardless it's emotional or memory
load, affects pupillary dynamics.
OBJECTIVES: Record pupillary dynamics in healthy subjects exposed to a set
of images with different levels of semantic content, but the same level of
brightness and emotionality, in a free viewing task.
METHODS: Images were selected from the International Affective Picture
System (IAPS). They were selected by their neutral arousal and emotional
value [4-4,99]. Images with people, symbols or numbers were discarded.
Images were converted to a grayscale. For each Standard Image (SI), 3 other
images were generated as controls of semantic content: Inverted image (II),
Pink Noise Image (PN), which conserves spatial frequency properties, and
White Noise (WN). Luminance was the same for the four categories (SI = 11.2,
II = 11.2, PN = 11,2 and WN = 11,2 Lux). 8 medical students were exposed to a
set of 120 images (30 per category) and instructed to freely explore each
image. Images were preceded by a fixation cross in the center of the screen.
Subjects explored the image for 3 seconds. Pupil size (area) was recorded at
500 Hz using an EyeLink 1000 system (SR-Research). Data was analyzed
using MatLab (Mathworks). Preprocessing included low-pass filtering and
artifacts (blinks) removal. We used constriction velocity (CV) and dilation
velocity in the 1st second after maximum constriction (DV) as measures of
pupillary dynamics. Results were compared using One Way ANOVA with
Bonferroni correction.
RESULTS: 8 healthy medical students, 6 women 20-25 years were recorded.
Constriction velocity (z-score/sec) for different images categories were
(mean±SD): SI = 2,34±0,85, II = 2,28±0,71, PN = 2,36±1,09, WN = 2,63±0,92,
showing no difference between them (p = 0,88). Dilation velocity (z-score/sec)
18
were: SI = 0,91±0,43, II = 0,73± 0,60, PN = 1,22±0,36, WN = 0,15±0,2071,
showing significant slower DV for WN images (p = 0.0006).
DISCUSSION/CONCLUSION: Our data shows that constriction velocity was
very similar for all the categories, in contrast, dilation velocity exhibited
significant differences between categories. Constriction velocity is less prone to
modulation and may had a stronger relation to image luminance which was set
equally for all categories. On the other side, dilatation in the first second after
maximum constriction reflects the effect of cognitive processes over pupillary
dynamics.
Semantic content actually modulates pupillary dynamics as shown by dilatation
velocities in all SI, II vs WN images. Unexpectedly PN images generate larger
DV than SI and II. This phenomenon may reflect the Pink Noise’s induced
mental imagery. If this is true, mental imagery will generate semantic content
faster that explicit object recognition. Another explanation may be related to the
cognitive load imposed by the different categories. PN may call a larger number
of cognitive processes than SI and II. That “heavier” use of resources may be
reflected in DV.
19
TITLE: Patterns of technologies’ use in the learning of graduates in medicine
course at FAMERP.
AUTHOR: Giovanna Truyts Biscardi.
MENTOR: João Marcelo Rondina.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Biscardi, G.T. - FAMERP,
Pinto, M.J.T. - FAMERP, Rondina, J.M. - FAMERP
BACKGROUND/INTRODUCTION: The Y generation is that born under the
influence of the digital technologies, now represented by the university students.
This generation of immediate and multitasking young people has developed a
new kind of neuroplasticity entirely different of their antecessors and therefore
possess peculiar habits and mechanisms of learning that should be respected
and considered in the dynamics of teaching and learning, creating a pressure in
the educational institutions to adequate in this reality.
OBJECTIVES: As focus, this paper tries to identify the medicine students’
behavior related to digital technologies in learning process. The researchers
expanded its knowledge about Y generation, beyond evolution and
technological consequences acquired by Web 2.0 in the development of society
and, more specifically, in the medical teaching.
METHODS: A descriptive study was realized, the data was found first by a
bibliographic research, trough a literature review, and later by a questionnaire
application created by the researchers. The selected articles contemplated the
main aspects related to medical education associated to digital technologies’
use, they must be written or published between 2010 and 2014. The academic
searchers that were used are: Scholar Google, BVS, SciELO e Pubmed.
Graduates in Medicine at FAMERP answered the questionnaire voluntarily after
the signature of the Acceptance Form, both approved by the Ethics in Research
Committee of FAMERP. It was composed by questions answered by a five point
scale. The inclusion’s criteria for the participants will be: it must be coursing
Medicine at FAMERP (from first do sixth year), male or female, aged between
18 and 35 years. The researched population was 78 elements, distributed
according with the size of classes.
RESULTS: The responses indicated that most students consider technology as
a necessary tool for learning and also point out that even with new technologies
can focus more on the subject to be learned than the tool. Regarding the
frequency of use of technology, the survey indicate that is great but not
diversified, meaning the students use the same technology very often. The most
commonly used involve rapid communications and internet searches, such as
checking social medias, send and receive messages on the cellphone. The
study also found that students are favorable both to watching classes
20
(indirectly) as to realizing projects (directly), showing they recognize the need
for both forms of knowledge acquisition.
They consider short-term boredom generated by the classes as needed, and so
try to keep tuned. The teacher's task is therefore ease the dispersion during
class, interacting with students and helping them navigate the new technologies
and take advantage of them as best as possible.
DISCUSSION/CONCLUSION: This study analyzed the characteristics attributed
to Generation Y, evaluating the digital profile of students, their effective learning
habits, used technologies and their relationships. Obtained conclusion was that
technologies are an important influence on student’s lives, however continues to
be one among several others, which allows the teachers to keep a fundamental
role in the formation of these digital natives. Mainly leading them fully use new
technologies developed for learning.
21
TITLE: Sex dimorphism on lungs and heart histological characteristics after
brain death.
AUTHOR: Guilherme Konishi Kudo.
MENTOR: Ana Cristina Breithaupt-Faloppa.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Kudo, G. K. - FMUSP,
Ferreira, S. G. - InCor, Simão, R. R. - FMUSP, Armstrong Junior, R. - InCor,
Sannomiya,P. - InCor, Breithaupt-Faloppa, A. C. - InCor, Moreira, L. F. P. –
InCor.
BACKGROUND/INTRODUCTION: In the current practice of transplantation,
donor and recipient genders are not directly considered and might have an
impact on the outcome after transplantation. Because of the shortage of donor
organs and as brain death (BD) patients are the most common source of
transplanted organs, the understanding of the sex influence on BD changes can
be useful to influence the donor management and increase, therefore, the
percentage of organs suitable for transplantation.
OBJECTIVES: This study aimed to investigate sex differences in the evolution
of the inflammatory process in lungs and heart of rats subjected to brain death
(BD).
METHODS: Anesthetized rats (female=10; ovariectomized=5; and male=5)
were intubated, ventilated, and subjected to BD by rapid inflation of a balloon
catheter. After anesthesia interruption, drop of mean arterial pressure, apnea,
absence of reflex, and maximal pupil dilatation confirmed BD. Six hours after its
confirmation, histological evaluation was performed in lungs and heart (H&E).
Levels of estrogen, progesterone, and corticosterone were determined in
plasma.
RESULTS: In the lungs, female rats presented increased number of leukocytes
in comparison to male rats (p<0.01) and ovariectomized rats showed to be
more hemorrhagic paralleled to other groups (p<0.001). In the heart, female
rats had a higher leukocyte infiltration and tissue edema compared to male rats
(p<0.05). In female rats estradiol and progesterone were sharply reduced 6
hours after BD (p<0.001). Corticosterone levels were similar.
DISCUSSION/CONCLUSION: Our findings suggest that the
inflammation observed in female rats organs might be a result of
reduction in female hormones triggered by brain death and that sex
influence the development of inflammatory events and the status of
heart that may be used for transplantation.
increased
the acute
hormones
lungs and
22
TITLE: Renal function evaluation in rats exposed to Ayahuasca tea.
AUTHOR: Joana D'arc da Silva Selvante.
MENTOR: Ana Cláudia Dinamarco Mestriner.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Acharezzi, Bruno;
Selvante, Joana Darc da Silva; Tangerino, Gabriela Carolina; Sperandio, Lucas
Gabriel; Malfará, Wilson Roberto; Mestriner, Ana Claudia Dinamarco Institution:
Centro Universitário Barão de Mauá.
BACKGROUND/INTRODUCTION: The Ayahuasca tea is prepared by the
infusion of the Amazon region plants used in shamanic rituals where users
report psychological and hallucinogenic changes. The Ayahuasca tea combines
the action of hallucinogenic dimethyltryptamine (serotonin agonist) with
carbolines (inhibits MAO) and their disposal occurs by the kidney.
OBJECTIVES: The present study evaluates the urinary system through
biochemical and histological analyzes because the kidney is the route of
elimination of Ayahuasca tea metabolites.
METHODS: Have been used two groups (n = 24) of Wistar rats, males, adults,
weighing between 200-250 grams divided into two groups: Control: 1.0 mL
distilled water / 100 g of body weight and Testing: 1.0 ml tea / 100 g body
weight, both for four consecutive days by gavage. On the last day two hours
after dosing was held under anesthesia during surgery, blood collection by
abdominal aorta, then the kidney, which was fixed in Bouin, embedded in
paraffin and sectioned with five micrometers thick, and stained with
hematoxylin-eosin. Statistical analysis was performed using the "software"
GraphPadInstat®, Statgraphics® and Prisma® by non-parametric MannWhitney Test, with a significance level of p <0.05. By light microscopy were
observed cortical, spinal cord and peripheral areas. These areas were analyzed
nephrons (renal corpuscles, proximal and distal convoluted tubules, thin and
thick branches of the loop of Henle).
RESULTS: There were no differences in the observed structures in the renal
histological sections between the test and control groups. In the serum urea
parameter biochemical analysis showed no change (p = 0.7959) between the
test groups (minimum = 3.7, 1st quartile = 8.4; median = 9.9; 3rd quartile = 10.8;
maximum = 42.5) and control (Minimum = 3.9, 1st quartile = 6.1; median = 6.9;
3rd quartile = 9.8; maximum = 44.6), the analysis of serum creatinine parameter
no change (p = 0.87) between the control group (Minimum = 0.003, 1st quartile
= 0.1, median = 0.25, 3rd quartile = 0.25, maximum = 0.5) and testing (Minimum
= 0.025, 1st quartile = 0.1, median = 0.1, 3rd quartile = 0.37, maximum = 0.5).
DISCUSSION/CONCLUSION: There were no morphological changes. In
biochemical analysis did not change between serum creatinine and urea
parameters in the compared groups. Thus, it can be said that Ayahuasca tea at
23
the concentration used, dosing schedule and route employed, did not induce
changes in the evaluated parameters relating to the assessment of kidney
function and architecture in rats exposed to tea.
24
TITLE: Research on the effects of a genetically modified corn rich diet on the
kidneys of wistar rats.
AUTHOR: Julia Carvalho de Oliveira Almeida Queiroz.
MENTOR: Ana Claudia Dinamarco Mestriner.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: ZEULI, M. A.; QUEIROZ, J.
C. O. A.; ACHAREZZI, B.; PONTES, M. G. M.; MESTRINER, A. C. D Institution
Centro Universitário Barão de Mauá.
BACKGROUND/INTRODUCTION: The freeing of genetically modified crops
has raised several issues regarding the safety of genetically modified products.
The present study used Monsanto MON810 genetically modified corn, which is
a result of the genetic modification of the corn hybrid "Hi-Il" with the cry1Ab
gene for expressing resistance features to some species of pest insects of the
Lepidoptera Order.
OBJECTIVES: Kidneys carry out essential roles such as purifying the products
that are either ingested or produced by the human metabolism. Thus, it is
necessary to evaluate kidney histology by means of exposing said organ to
genetically modified corn products.
METHODS: Ten male albino rats, of the Wistar strain, weighing approximately
200 g, were used in this experiment. The animals were divided into groups of 5,
in both control and treated groups. The control group animals were fed normal
corn, and the treated animals were given genetically modified corn (MON810),
having received water freely throughout the entire experiment. After 90 days of
experimenting, the animals were euthanized by means of carbon dioxide
inhalation and sectioning of the abdominal aorta. Kidney fragments were
collected, stored in Bouins fixative, embedded in parafin, pigmented with
hematoxylin-eosin and analyzed under light microscopy.
RESULTS: The statistical analysis did not show significant differences between
the weights of controlled and treated animals (p = 0.232). The histopathological
analysis of these animals' kidneys indicated corpuscle integrity, with normal
Bowman capsule and capillary loops in both groups.
DISCUSSION/CONCLUSION: Given the time and form of exposure to
genetically modified corn by the Wistar rats, the intake of said corn did not
cause significant changes in the animals' weights, nor did it alter the histological
architecture of their kidneys.
25
TITLE: Evaluation of the small intestine in Wistar rats exposed to transgenic
corns.
AUTHOR: Marcela Zanini.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: ZANINI, M.;
BORTOLOTTO, V. F.; ACHAREZZI, B.; TEIXEIRA, J. C.; SANTOS, P. L. B;
DAVID, J. R. M; SELVANTE, J. D. S; MESTRINER, A. C. D.
BACKGROUND/INTRODUCTION: Genetically modified organisms (GMOs) are
those that had their genetic material altered by introducing one or more genes
using bio-molecular techniques.
OBJECTIVES: The small intestine is responsible for the absorption of various
substances found in food; this research aims to analyze this organ
histologically.
METHODS: 10 male albino Wistar rats, weighing approximately 200g, were
used. The rats were separated into control group (n=5) and treated (n=5). The
animals in the control group were fed with normal corn and the treated animals
with transgenic corn (MON810) ad libitum during 90 day of experimentation, on
the last day they were euthanized by inhaling carbon dioxide, and then
submitted to the section of the abdominal aorta. In continuation, fragments of
the small intestine were collected, fixed in Bouin, included in paraffin, stained
with hematoxylin-eosin and analyzed with light microscopy. The morphometric
analysis was performed using the Image J software by measuring 30 villi/animal
and 30 crypts/animal, randomly in 6 different fields. Statistical analysis was
performed with the aid of GraphPadInstat, Statgraphics and Prisma® software
by the parametric t-student test unpaired with significance level of p <0.05
RESULTS: The average animal weight gain in both the treated and control
groups, obtained by weighing the animals weekly during the 90 day period of
treatment showed no significant statistical differences during the trial period (P
= 0.232). Histopathological analysis of the small intestine sections (villi, crypt,
mucosa, muscle and serous tunics) showed no change between the groups. In
the morphometric analysis, there was no evidence of difference in the length of
villi (p = 0.10) and crypta (p = 0.86) between the control and treated groups.
DISCUSSION/CONCLUSION: In the conditions of time exposure and corn
consumption, it can be said that the transgenic corn intake did not qualitatively
and quantitatively alter the intestinal histology in this experiment.
26
TITLE: Investigations into the effects of a diet rich in transgenic corn on the
Wistar rat.
AUTHOR: Marcela Zanini.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: ACHAREZZI, B.; ZANINI,
M.; LETTIERI, J. P.; DAVID, J. R. M; PONTES, M. G. M; MESTRINER, A. C. D.
BACKGROUND/INTRODUCTION: Genetically modified organisms (GMOs) are
those that have had their genetic material modified by the introduction of one or
more genes by molecular biology techniques. (BARROS; OLIVEIRA; MARIN V,
2008).
OBJECTIVES: The aim of this work is to study, using a morphological approach
in light microscopy, the effects of a diet rich in GM maize (MON810) on liver
histological architecture.
METHODS: This study used 10 male albino Wistar rats, weighing
approximately 200g. The animals were divided into control and treated groups,
with 5 animals in each group. The animals in the control group were fed with
normal maize and the animals treated with GM maize (MON810), received
water at will during the experiment. experiment, water at will. After 90 days of
the experiment the animals were euthanized by carbon dioxide inhalation and
section of the abdominal aorta. Liver fragments were collected, fixed in Bouin,
embedded in paraffin, stained with hematoxylin-eosin and analyzed by light
microscope.
RESULTS: The average animal weight gain of the treated and control groups,
obtained by weighing carried out weekly during the period of 90 days of
treatment showed no statistically significant differences during the trial period (P
= 0.232). Histopathological analysis of liver sections revealed normal
histological architecture. DISCUSSION: In this experiment there was no
structural morphological changes in the liver of animals fed with GM maize
(MON 810), for 90 days. These results may be due to experimental period used
compared to the longest period studied by experimentation Vendrômois et al.
(2009) (14 weeks).
DISCUSSION/CONCLUSION: In the conditions in which this experiment was
carried out, the GM maize intake did not cause significant changes in the weight
of the animals, as well as in normal histological architecture of the rat liver.
27
TITLE: Evaluation of antimicrobial activity of extracted capsinoids of peppers
against bacterial strains of Escherichia coli and Staphylococcus aureus.
AUTHOR: Vitoria Pereira Marra.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: VITÓRIA PEREIRA
MARRA - UNIVERSIDADE DE ITAÚNA, TAINÃ BRITO PORTO UNIVERSIDADE DE ITAÚNA, ÉRIC BOTREL AMÂNCIO - UNIVERSIDADE DE
ITAÚNA, CAROLINE MENDONÇA ARRUDA - UNIVERSIDADE DE ITAÚNA,
MARÍLIA DE LACERDA SILVA - UNIVERSIDADE DE ITAÚNA, VÍTOR PORT
BACKGROUND/INTRODUCTION: It is known that peppers of the Capsicum
sp. genus contain capsinoids with potential antibiotic, particularly capsaicin.
Given to the importance of gastrointestinal bacterial infections and the
progressive increase of its antibiotic resistance, to confirm the effectiveness of
capsaicin in inhibiting the bacterial growth could provide effective prophylactic
and therapeutic measures, economically viable.
OBJECTIVES: Check the inhibit potential of capsinoids in the growth of
Escherichia coli and Staphylococcus aureus strains.
METHODS: 1.Microbial samples: The microorganisms tested were isolated
from urine, intestinal and saliva samples human and grown in selective media
and / or indicators. After isolation, they were identified by morphotypes analysis
and biochemical tests and stored under freezing method -20º C temperature,
using glycerol as a cryoprotectant. The microorganisms that were undergoing
the test were kept by successive samplings on solid medium (MH) or stored
under refrigeration (5-8 ° C).
2. Vegetable Extracts: Oil extracts from the following species were used:
Capsicum frutescens, Capsicum baccatum and Capsicum chinense. It is known
here in Brazil as malagueta,cumari and dedo-de-moça and biquinho,
respectively.
3. Antimicrobial activity: The extracts of the fruits of the referred peppers were
tested for antimicrobial activity in the test microbial strains by determining the
minimum inhibitory concentration method by addition and diluting increasing
amounts on a solid medium.
RESULTS: The pepper extracts of “malagueta” (Capsicum frutescens) inhibited
effectively the growth of 43,8% of the isolated, in the concentrations of 10 ug/ml;
in the concentration of 50 ug/ml was noticed inhibition of growth of 53,2% of the
samples; 56,25% and 62,5% of the samples were inhibited by tests in wich was
employed, respectively, 200 and 400 ug/ml. The pepper extract of “cumari”
(Capsicum baccatum) didn't show effectiveness by inhibiting the growth of none
of the isolated tested. The pepper extracts of “dedo de moça” (Capsicum
baccatum) were effective in the concentrations of 5ug/ml ,by inhibiting 37,5% of
28
the bacterial; 10 ug/ml, by inhibiting 37.5%; 50 ug/ml by inhibiting 50%; 200
ug/ml by inhibiting 50%; and 400 ug/ml by inhibiting 56%.
The pepper extracts of “Biquinho” (Capsicum chinense) were not effective to
inhibit none of the bacterial isolated in any concentration employed. Controlled
experiments (without extracts addition) were included; in these, as was
expected, there weren't growth inhibition.
DISCUSSION/CONCLUSION: It was noticed good power of inhibition by
peppers “malagueta” and “dedo de moça”, suggesting that the same must be
investigated in more depth to verified possible uses of the same by their
prophylactic-therapeutic and inexpensive antibacterial action. The better
inhibitory capacity was verified in the pepper extracts of “malagueta” and “dedo
de moça”. The pepper “cumari” and “dedo de moça” belong to the same
species; therefore, would be expected similar inhibitory results. However, the
former did not inhibit growth of the samples, while the latter was surprisingly
effective.
29
30
TITLE: Adenosine methylation impact on human immunodeficiency virus gene
expression.
AUTHOR: Arlette Estefanía López Esturillo.
MENTOR: Ricardo Soto Rifo.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Lara N1*, Dellarossa A(1),
Ricci EP(2) and Soto-Rifo R(1)-(1)Faculty of Medicine, Universidad de Chile
and (2)ENS-Lyon, France.
BACKGROUND/INTRODUCTION: N6-methyladenosine or m6A is the most
abundant internal modification present in eukaryotic mRNA. Such a reversible
chemical modification has been shown to impact gene expression at the posttranscriptional level by regulating different aspects of mRNA metabolism
including splicing, nuclear export, translation and mRNA stability. This exquisite
fine regulation of gene expression involves the activity of three functional
groups of proteins, which are classified as m6A writers, erasers and readers.
The m6A writers correspond to METTL3, METTL14 and WTAP, which together
form the methyltranferase complex responsible of adding the m6A modification
to the mRNA molecule into the consensus sequence RRACH. The enzymes
ALKBH5 and FTO, which have demethylase activity and are responsible of the
mRNA demethylation, compose the group of m6A erasers. Finally, the third
group involves the m6A readers, proteins able to recognize the m6A
modification in mRNA and transform this information into a specific function.
The best-characterized m6A readers are members of the YTH-containing
domain family of proteins, which include YTHDF1 and YTHDF2. These proteins
can recognize the m6A-modified mRNA in the cytoplasm and induce either
enhanced mRNA translation (YTHDF1) or mRNA decay (YTHDF2). Despite the
available knowledge of the presence of m6A in some viral transcripts, there is
no current data relating this mRNA modification to the gene expression
mechanisms of the Human Immunodeficiency Virus (HIV). Interestingly,
transcriptome-wide bioinformatics analysis revealed that the methylation
consensus sequence RRACH is twice as frequent in HIV genomic RNA than in
the cellular transcriptome, suggesting that m6A could have a role in viral gene
expression.
OBJECTIVES: Evaluate the role of m6A pathway proteins in HIV gene
expression in human cells.
METHODS: In order to enlighten the possible impact of m6A on HIV gene
expression, we conduct a functional study in which we analyzed the impact of
overexpressing m6A writers, erasers and readers on HIV gene expression. For
this, we co-transfected immortalized cervical carcinoma cells with expression
vectors for the protein of interest together with a Renilla luciferase-based
reporter proviral DNA. Subsequently, we determined the impact of each m6A-
31
realted protein on HIV-1 gene expression through the quantification of the
luminescence emitted by the HIV-1 Gag-Renilla fusion protein.
RESULTS: Interestingly, our results showed that overexpression of the m6A
writers, METTL3-METTL14, together but not individually, has a great impact on
viral protein synthesis reaching 6-fold stimulation. Consistent with this
observation, we observed that overexpression of the m6A writer YTHDF2
resulted in 3-fold stimulation of viral protein synthesis.
DISCUSSION/CONCLUSION: Together, these results suggest that the
reversible m6A modification could be an important checkpoint in the regulation
of HIV-1 gene expression.
32
TITLE: Mitochondrial Scars in Circulation Cause Inflammatory Response to
Injury.
AUTHOR: Burak Isal.
MENTOR: Kiyoshi Itagaki, PhD.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Kackmarek E, Li H, Sursal
T,Itagaki K, Hauser CJ, Beth Israel Deaconess Medical Center, Harvard
Medical School.
BACKGROUND/INTRODUCTION: Injury causes a systemic inflammatory
response syndrome (SIRS) clinically much like sepsis. Microbial pathogenassociated molecular patterns (PAMPs) activate innate immunocytes through
pattern recognition receptors. Similarly, cellular injury can release endogenous
damage associated molecular patterns (DAMPs) that activate innate immunity.
Mitochondria are evolutionary endosymbionts that were derived from bacteria
and so might bear bacterial molecular motifs. We show here that injury releases
mitochondrial DAMPs (MTD) into the circulation with functionally important
immune consequences. MTD include formyl peptides and mitochondrial DNA.
These activate human neutrophils (PMN) through formyl peptide receptor-1 and
TLR9 respectively.
OBJECTIVES: Stimulation by PMA induced widespread NET formation in PMN
from both young volunteers and young trauma patients. NET response to PMA
was much less pronounced in both elderly volunteers PMN and in trauma
patients PMN. We conclude that mtDNA is a potent inducer of NETs that
activates PMN via TLR9 without NADPH-oxidase involvement. We suggest that
decreased NET formation in the elderly regardless of higher mtDNA levels in
their plasma may result from decreased levels of TLR9 and/or other molecules,
such as neutrophil elastase and myeloperoxidase that are involved in NET
generation. Further study of the links between circulating mtDNA and NET
formation may elucidate the mechanisms of trauma-related organ failure as well
as the greater susceptibility to secondary infection in elderly trauma patients.
METHODS: All studies were approved by the IRB of Beth Israel Deaconess
Medical Center. Animal care was IACUC-approved per NIH guidelines.
Preparation of mitochondria, mitochondrial DAMPs (MTD) and mitochondrial
DNA (mtDNA),PMN studies done by their protocols. Male Sprague-Dawley rats
were given intravenous MTD based on weight 30. qPCR of plasma showed
mtDNA levels of 122Â±22 ng/ml 1h after injection (nlâª1ng/ml). Leukocytes in
bronchoalveolar lavages were counted visually. Lungs were inflated gently and
formalin fixed prior to stain with H&E or for 4-HNE.
33
RESULTS: In a very brief summary without numerical resuts; MTD promote
PMN Ca2+ flux and phosphorylation of MAP kinases, thus leading to PMN
migration and degranulation in vitro and in vivo. Circulating MTD can elicit
neutrophil-mediated organ injury. Cellular disruption by trauma releases
mitochondrial DAMPs with evolutionarily conserved similarities to bacterial
PAMPs into the circulation. These can then signal through identical innate
immune pathways to create a sepsis-like state. The release of such
mitochondrial enemies by cellular injury is a key link between trauma,
inflammation and SIRS.
DISCUSSION/CONCLUSION: Inflammation occurs after both major trauma and
infection. Recognizing sterile SIRS is critical since empiric antimicrobial use will
be ineffective whereas other therapies might be effective. After tissue trauma
MTD circulates and stimulates PMN, causing systemic inflammation. The
molecular similarity of mitochondria to their bacterial ancestors helps explain
why traumatic and infective SIRS appear similar. Mitochondrial DAMPs express
at least two molecular signatures (formyl peptides, mtDNA) that act on PRRs
recognizing bacterial PAMPs.
34
TITLE: Transparent brain with CLARITY histology.
AUTHOR: Fábio Zanini.
MENTOR: Gabriel Maisonnave Arisi.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: FABIO ZANINI; MARIA
CLAUDINE VARGAS CHEIM; GABRIEL MAISONNAVE ARISI. EPM .UNIFESP, SAO PAULO - SP - BRASIL.
BACKGROUND/INTRODUCTION: Microscopy and histological techniques had
greatly advanced our understanding of the fine celular structure of nervous
tissue. Nonetheless, the complex tridimensional organization of neurons, glial
cells and vasculature is lost in sectioning the brain in order to analyze it under
the microscope. Laborious and time consuming methods are employed to
reconstruct the 3D organization of cells. Advanced histological techniques like
CLARITY, that preserves the cellular protein structure “in situ” and renders the
nervous tissue transparent to light by removing the cellular lipid layers, may
allow studies encompassing large volumes of different brain regions, without the
errors of reconstructions.
OBJECTIVES: Implant the CLARITY for CNS study and realize a morfology
study of neuron, microglia and astrocytes.
METHODS: This histology is performed by perfusion of hydrogel monomers
that, after polymerization, creates a hybrid protein-monomer which allows lipids
electrophoretic removal. Before that the transparent hydrogel can be scanned in
a fluorescent microscope after protein immunolabeling, At short time frame it is
possible to map complete neural circuits, neurotransmitter systems and glianeuron cellular structures.
RESULTS: CLARITY histology is being implemented in our laboratory in a
electrophoretic chamber adapted to rat brains. Five animals were perfused
(IACUC/CEUA 6744240414) and after thermic polymerization the brains were
positioned in the electrophoretic chamber at 37 ºC and 40 V for 4 days and in
37 ºC bath for more 4 days. All brains become transparent.
Immunohistochemistry for Iba-1 was performed in 1 mm blocks and visualized
in confocal laser microscopy. Neurons and microglia were visible in large areas
of both cortex and hippocampus.
DISCUSSION/CONCLUSION: Transparent blocks of nervous tissue allow the
study of large cell populations; this histological preparation saves time in 3D
studies of complex structures. Nevertheless a new technique (light sheet
microscope) of microscopy has to be developed to take full advantage of
CLARITY histology. Standard confocal laser scanning fluorescent microscope
was employed to visualize the labeled cells while our lab implement that new
technique.
FAPESP PROCESS: 2015/04098-0 AND 2014/21984-1
35
36
37
TITLE: Finger Tapping and Release Test as an objective assessment of
bradykinesia in Parkinson Disease.
AUTHOR: Alysha Susana Drisell Hernández Montiel.
MENTOR: Dra. Lizbeth Sandoval, Dr. José Gerardo García Aguirre, Dr. Juan
José Plata Muñoz, Dr. Jorge Eugenio.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Gómez P.1, Hernández
A.2, Bruggeman B.1, González L.1, Santana D.1, Jiménez F.1, Sandoval L.1 - 1
Servicio de Neurocirugía, Hospital General de México, Ciudad de México, 2
Escuela Nacional de Medicina del Tecnológico de Monterrey, sede Ciudad de
México.
BACKGROUND/INTRODUCTION: Bradykinesia is one of the most disabling
symptoms of Parkinson disease (PD). Clinical evaluation is predominantly using
the UPDRS, however several groups have developed tests in order to obtain an
objective assessment of bradikynesia, which involve the use of complex
techniques that are not available in health institutions.
OBJECTIVES: To find a new reliable method to measure bradykinesia as a tool
in the objective diagnosis of Parkinson disease.
METHODS: We assessed 180 people without history of PD and 40 PD patients.
We evaluated each subject through two tests based on the UPDRS Items 3.13
y 3.14. We took the number of repetitions in 10 seconds of the clamp test
(finger tapping) of each hand and the same for the release test (RT, open and
shut hands). PD patients were evaluated in OFF status. Evaluations were made
by two investigators in all cases. Statistical analysis was performed through
SPSS V.18.
RESULTS: For healthy subjects, finger tapping mean value obtained was:
20.46 for the right hand and 19.23 for the left hand; right and left release test
18.52 (p < 0.05). For PD patients finger tapping mean value was 11.25 for the
right and 10.5 for the left hand, and right RT showed 10.75 and left RT 10.
Mean value of the results obtained with UPDRS for PD patients was 53.75
points yielding an inverse relationship with the values obtained in the finger
tapping and release test (R-0.52, p < 0.05).
DISCUSSION/CONCLUSION: Finger tapping (10 seconds) and RT constitute
an easy and objective method to assess bradykinesia in PD patients, and
moreover it does not need any advanced tools.
38
TITLE: Atrial fibrilation in a patient under hemodialysis: balancing the risk of
thromboembolic event versus bleeding.
AUTHOR: Ana Paula Moreira Reis.
MENTOR: Humberto Graner Moreira.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Reis, A. P. M. UniEvangélica; Ferreira, G. C. O. - UniEvangélica; Carvalho, D. D. UniEvangélica; Carneiro, R. F. - UniEvangélica; Siqueira, M. P. UniEvangélica; Graciano, A. R. - UniEvangélica;
BACKGROUND/INTRODUCTION: Atrial fibrillation (AF) is the most common
cardiac arrhythmia in clinical practice. Patients with severe chronic kidney
disease (CKD) on hemodialysis are at a particularly increased risk for the
development of AF compared with the general population, due to the presence
of comorbidities like heart failure (HF), hypertension and diabetes. They also
have a five-fold higher risk for a stroke. Usually the prophylaxis of stroke events
in patients with AF includes using an oral anticoagulant, warfarin. However,
patients with severe CKD also have an increased risk of bleeding using
anticoagulant therapy.
OBJECTIVES: To describe a challenging case of a patient with CKD under
hemodialysis with a recent diagnosis of AF with also symptoms of HF.
METHODS: This is a case report of a 66 years-old man with previous history of
hypertension who presented with symptoms of congestive HF (NYHA III). He
started hemodialysis 3 months ago due to CKD. The physical exam revealed
bilateral pulmonary crackles, mild ascites, peripheral edema and an irregular
cardiac rhythm. The BP was 156/82mmHg and the HR ~110 bpm. The ECG
confirmed AF. Echocardiogram showed left ventricular ejection fraction (LVEF)
of 78%, mild cardiac hypertrophy and enlarged left atria (48mm). The X-Ray
also confirmed moderate pulmonary congestion.
RESULTS: The therapy for HF was optimized, and a beta-block for controlling
HR due to AF was initiated. An anticoagulant therapy has not been started
because of hemodialysis, and aspirin was prescribed even recognizing the
weak evidence in favor of this strategy in this setting. The case was also
discussed with the nephrologist in order to optimize the volemic status after
dialysis sessions. Ten days later, the patient returned with improvement of the
HR and the congestive HF, as well as better functional class (NYHA I). Since
this patient could not be anticoagulated, cardioversion was ruled out and the
strategy of rate control was maintained.
39
DISCUSSION/CONCLUSION: This patient has a high risk of stroke due to AF
according to CHA2DS2-Vasc score and could receive anticoagulant therapy.
Otherwise, the risk of bleeding according to HAS-BLED score is also very high.
Due to lack of evidence from randomized controlled trials, the management of
the risk of stroke among patients with AF undergoing dialysis is mainly based
on observational studies and specialists’ opinion. Current and previous
observational studies on warfarin use in these patients failed to provide much
evidence in favor of it, yet there was a trend for an increased bleeding risk. That
is why we opted for not initiating anticoagulant therapy on this case. Of note,
unfortunately the new oral anticoagulants recently available excluded patients
under dialysis from their clinical studies, and could not be used in this setting.
The risk of stroke is still elevated, but for now we do not have an efficient choice
for reducing it without increasing bleeding risk in these patients.
40
TITLE: Epidemiological analysis of neoplasms in Brazil
AUTHOR: Annah Rachel Graciano.
MENTOR: João Baptista Carrijo.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Ana Carolina dos Santos
Torquato, Lara Cristina Alvarenga, Bráulio Brandão Rodrigues, Luís Mário
Mendes de Medeiros, Karla Cristina Naves de Carvalho. UniEvangélica.
BACKGROUND/INTRODUCTION: The cancer problem in Brazil becomes
relevant by the epidemiological profile that this disease presents. It is a major
cause of morbidity and mortality on the world. It is important to anticipate that
the number of new cases will be increased by approximately 70% over on the
next 20 years. The knowledge about the situation of this disease allows to set
priorities and allocate resources directed for positive changes on this scenario
in the Brazilian population.
OBJECTIVES: To measure the data related to morbidity from cancer according
to the most prevalent types by correlating with age and sex (male or female).
METHODS: It is a quantitative study with cross-sectional design. It was
considered the total cases of cancer occurred in Brazil in the period 2012 to
2015, analyzing the quantitative variables and the reported cases. The data
used had a secondary origin, extracted from the Sistema de Informação
Hospitalar (SIH). Subsequently, were performed descriptive statistics, it was
synthesizing the numerical data, which have been categorized and after
analyzed by scale and relative proportions frequency.
RESULTS: The number of cases occurred in Brazil between the years 2012 to
2015 corresponded to the total of 2,378,010. The most prevalent type in general
was the uterine leiomyoma (10%), followed by the breast cancer (7.6%).
According to sex, malignant neoplasm of the prostate matches the most
common entity in males, followed by malignant neoplasms of the lip, oral cavity
and pharynx. For women, the frequencies are related to the overall index. In
patients aged 0 to 29 years, it was the most frequent leukemia. After 29 years,
leiomyoma of the uterus takes on more frequency, but this rate is modified from
50 years ago when the malignancy of the breast is the most prevalent. Between
60 and 69 years, malignant neoplasm of the prostate has a higher frequency,
and between 70 and 79 years, malignant neoplasms of the skin.
DISCUSSION/CONCLUSION: It is well known that most types of cancer can be
prevented by the elimination exposure of the determinant factors. The
prevention and cancer control need to acquire the same focus and the same
attention as the area of healthcare services in order to avoid premature and
unnecessary deaths. Thus, preventive measures will be implemented according
41
to demand studied through the epidemiological study, which justifies the
importance of this study.
42
TITLE: Alien hand syndrome: anatomical and functional correlations between
the affected central nervous system regions and their main symptoms.
AUTHOR: Bruno Paladini Camargo.
MENTOR: Romualdo, G S; Calixto, P A
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Sousa, A P S - Centro
Universitário de Araraquara/UNIARA; Filho, D R F - Centro Universitário de
Araraquara/UNIARA; Aranha, J S L - Centro Universitário de
Araraquara/UNIARA; Lisboa, T V S V; Romualdo, G S - Centro Universitário de
Araraquara/UNIARA.
BACKGROUND/INTRODUCTION: The Alien Hand Syndrome (AHS) is a rare
disease defined as an upper limb’s involuntary motor activity associated to a
strange perception of the limb.
OBJECTIVES: Correlate the AHS main symptoms with the functions of the
possible affected brain regions by the condition.
METHODS: The information present in this article is descendant of a systematic
review of 2001 to 2014’s literary bibliography publicated on Pubmed and Scielo
websites.
RESULTS: The AHS is mainly caused by brain strokes or corpus callosum,
frontal lobe, parietal lobe and occipital lobe injuries, enabling the distinction of
three main types: frontal AHS, calloused AHS and posterior AHS. These types
present distinction in relation to most of their symptoms. However, the
autonomous movements perceived as involuntary and non-recognition of the
member’s property if removed visual cues, are common to all three types. The
development of AHS involves known pathophysiology just in case of calloused
AHS and the information regarding the prognosis of the syndrome are still
scarce.
DISCUSSION/CONCLUSION: This review established a correlation between
the symptoms in each type of AHS to the physiology of each region affected by
the syndrome. Thus, it was possible to highlight and distinguish between the
common and specific symptoms of AHS types.
43
TITLE: Correlation between oxidative stress biomarkers and antioxidant
potential with the degree of disability in patients with ischemic stroke.
AUTHOR: Camilo Sotomayor Campos.
MENTOR: Ramon Rodrigo.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Camilo Sotomayor C,
Rodrigo Gutierrez.
BACKGROUND/INTRODUCTION: Stroke is the second most common cause
of death, after heart disease. For many years it has been postulated that
oxidative stress (OS) plays a key role in the pathogenesis of ischemic events.
The OS corresponds to an imbalance between oxidative species and
antioxidant defense system. The aim of the present study is to determine the
correlation between plasma levels of lipid peroxidation and total antioxidant
capacity of plasma with the degree of disability in patients with ischemic stroke.
OBJECTIVES: To establish the correlation between oxidative stress biomarkers
and antioxidant potential with the degree of disability in patients with ischemic
stroke
METHODS: Five patients with recent ischemic stroke were evaluated. Seven
blood samples were collected for every patient (at days 1, 2, 3, 4, 5, 6 and 30
post stroke event). One sample from control group, without ischemic stroke,
was also collected. Blood F2-isoprostane levels and plasma malondialdehyde
levels were measured as OS biomarkers. To evaluate the antioxidant defence,
the ferric reducing ability of plasma (FRAP) and uric acid levels were measured.
The National Institute of Health Stroke Scale (NIHSS) was applied for the
neurological evaluation.
RESULTS: From the first day post stroke we found elevetad levels of F2isoprostane in ischemic stroke patients compared to control group, reaching a
significantly difference on the fourth day post stroke. In addition, the total
plasma antioxidant capacity of patients with stroke is significantly lower on days
1 and 4, compared with the control group. There was no significantly differences
on the malondialdehyde levels compared to the control group.
DISCUSSION/CONCLUSION: These preliminary results do not allow us to
stablish the correlation postulated as general objective because of the small
sample size of patients that we have recruited until now. However, the results of
oxidative stress biomarkers and plasma antioxidant capacity are promising and
support the role of oxidative stress in the ischemic stroke injury. Moreover,
these results open the possibility of continuing with this study. Finally, it is
imperative to increase the sample size, in order to obtain results with statistical
significance allowing us to stablish the correlation postulated as general
44
objective. These findings could lead to the understanding of the underlying
mechanisms by which OS is involved in the neurological damage of ischemic
stroke patients.
45
TITLE: Cutaneous tuberculous gummas in a patient with polymyositis.
Author: Carolina Oshiro Yeh.
MENTOR: Ana Maria da Silva Vasconcelos.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Yeh, C. O. - Unirio, Paiva,
V. R. - Unirio, Dantas Neto, L. - Unirio, Oliveira, G. G. - Unirio, Ferry, F. R. A. –
Unirio.
BACKGROUND/INTRODUCTION: Tuberculosis (TB) is a chronic infectious
disease caused in most cases by Mycobacterium tuberculosis, (or Koch’s
bacillus). The infection is usually acquired by inhalation and pulmonary
involvement is the most common form of the disease. Nevertheless, several
organ systems may turn to be affected by hematogenous dissemination,
causing extra pulmonary tuberculosis.
OBJECTIVES: This study aims to report cutaneous tuberculous gummas in a
patient with polymyositis.
METHODS: Report a case of gummy tuberculosis occurred in a patient with
polymyositis. This patient was treated at the Hospital Universitário Gaffrée
Ginle, Federal University of Rio de Janeiro - UNIRIO, where was made all the
diagnostic research and treatment.
RESULTS: At admission, the patient had tachypnea, tachycardia and fever.
The laboratory tests showed leukocytosis, thrombocytosis and normocytic
normochromic anemia. Increased levels of lactate dehydrogenase, creatine
phosphokinase and glucose. Empiric antibiotic therapy with oxacillin has been
initiated against Staphylococcus infection without improvement. On the seventh
day of treatment, the antibiotic agent was changed to vancomycin, again with
no improvement.
DISCUSSION/CONCLUSION: Cutaneous tuberculosis is a rare form of the
disease with some differentiation in clinical features and natural history. The
presence of mycobacteria in the skin does not necessarily mean clinical
disease. Clinical manifestation may depend on multiple factors as bacilli
accessed the skin, the strain`s virulence, number of inoculated bacilli, immune
state of the patient and the relationships of Mycobacterium with the anatomical
region affected.
46
TITLE: Huntington`s Desease: A review of the future prospects of treatment for
improving the quality of life of patients.
AUTHOR: Caroline Esteves Serra.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Ana Beatriz Meschieri
(UNIARA); Caroline Piovesa Garutti (UNIARA); Kelly Scapin Viola (UNIARA);
Fabíola Queiroz (UNIARA); Lucas Raffa Silveira (UNIARA), Cristiane Coquejo
(UNIARA).
BACKGROUND/INTRODUCTION: In 1872, George Huntington described a
series of changes, in which the most striking feature is the clonic spasm that
affects the voluntary muscles without loss of sensation or consciousness. It is
an autosomal dominant inheritance, therefore, the risk of inheriting the disease
is 50% when only one parent is affected, and carrying a copy of the affected
gene.
OBJECTIVES: This work has as main objective the study of Huntington's
disease (HD), and new scientific discoveries regarding their treatment.
METHODS: The information used in this work were based on literature review
of scientific publications indexed in Pubmed and Scielo.
RESULTS: Treatment of HD is symptomatic by drug therapy based on the
dopamine blocking drugs. Benzodiazepines have light antichorea effect, and
affective symptoms can be treated with serotonin reuptake inhibitors.
Furthermore, is ongoing studies demonstrate that Tetrabenazine also reduces
the severity of chorea, but due to its side effects should be slow titration, as well
as studies involving the use of stem cells in order to produce BDNF, the which
appears to protect neurons from degeneration caused in HD. Currently, new
lines of research focusing on gene therapy applied in the early stages of the
disease, in order to reduce the translation of mutated huntingtin protein from
iRNA, without this influence on the normal HTT allele, and also the technical
PRECREST which investigate creatinine effects on the delay of progression of
HD, that because images that demonstrate the use of energy in the brain show
that the HD-causing mutation seems to reduce the levels of energy of the
affected cells and body tissues, and may lead them to apoptosis thus it was
suggested that the reduced energy in the affected tissues could be suppressed
by the energy stored in creatine.
DISCUSSION/CONCLUSION: The HD is characterized by neurologic,
autonomic and neuropsychiatric manifestations and until the present moment
there is no effective treatment for this disease, a fact that raises important
ethical questions on the impact of diagnostic confirmation. However there are
many research on development, allowing a better understanding of the disease
and motivating new studies. These surveys have attempted to better
understand the pathophysiological mechanism, in order to develop therapies to
47
slow the progression of the disease in order to offer a better quality of life for
patients with DH.
48
TITLE: Description of 16 cases of granulomatosis with polyangiitis (Wegener
vasculitis) diagnosed between 2008 to 2015 in Hospital Escuela Universitario,
Honduras.
AUTHOR: Clara Melissa Bustillo Sierra.
MENTOR: Francisco Javier
Calidonio(Pediatric Geneticist).
Godoy(reumatology)
/
Ramon
Alvarenga
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Clara Melissa Bustillo
Sierra( Sixth year medicine student,UNAH) Estefany Gabriela Romero( Sixth
year medicine student,UNAH).
BACKGROUND/INTRODUCTION: Granulomatosis with polyangiitis (GP),
formerly known as Wegener’s vasculitis, is an autoimmune rare disease with an
estimated prevalence of 3 per 100,000, affect vessels of small and medium
caliber by leukocyte infiltration and it’s associated with antineutrophil
cytoplasmic antibodies (ANCA).
OBJECTIVES: Describe epidemiological and clinical aspects of a total of 16
patients with GP and compare with previous studies.
METHODS: Retrospective-comparative study, 16 patients were diagnosed in
GP between 2008-2015. Epidemiological information, analytical data,
histopathological studies and received treatment was collected. Biopsy was
inclusion criteria.
RESULTS: 16 patients were diagnosed with GP, 8 men and 8 women with an
average age at diagnosis of 42.25 years (11-66): The most common clinical
manifestation was the involvement of paranasal sinuses, 56.25% of patients,
37.5%, presented destruction of the nasal septum, 31.25% showed skin
involvement, 25% had chronic kidney disease, ocular involvement was reported
in 18.75% of cases and 12.5% presented arthralgia, CNS involvement and
lungs were the least frequent finding in 1 patient respectively. Biopsies were
performed in all patients, which were diagnostic. Only 8/16 patients had ANCA
studies for lack of supplies in the hospital and the specific conditions of each
patient, of these only 3 were positive. All patients were started with
glucocorticoids in combination with cyclophosphamide or mycophenolate. Only
one patient of the study died.
DISCUSSION/CONCLUSION: The characteristics of the described cases differ
from described in other studies, specially about most common clinical
manifestation and ANCA results, the most commonly drug used in the treatment
were glucocorticoids, patient progress has been favorable and have shown no
serious complications for side effects of the drugs but it's important careful
surveillance.
49
TITLE: Clinical characteristics of patients with Acute Myocardial Infarction and
No Significant Coronary Artery Lesions in 20 Chilean Hospitals (2011-2013).
AUTHOR: Constanza Marlen López Tapia.
MENTOR: Dr. Juan Carlos Prieto.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Maldonado, R. Universidad de Chile; Madariaga, A. - Universidad de Chile; Lopez, C. Universidad de Chile; Prieto, J. C. - Universidad de Chile.
BACKGROUND/INTRODUCTION: Acute myocardial infarction (AMI) is a
consequence of disruption of coronary artery lesions leading to intracoronary
thrombosis. Some patients with AMI show no significant lesions in a
coronarography. This condition is a challenge for the clinical management.
Available sources that analyze this condition describe a prevalence between 112% of all AMI, depending to the definition “no significant coronary lesions”,
from the absence of stenosis to the presence of <50% coronary lesions.
OBJECTIVES: To compare clinical characteristics, intrahospital treatment and
hospital mortality in patients with AMI with or without coronary artery lesions.
Also, evaluate the association between patients with or without significant
coronary lesions and coronary risk factors.
METHODS: Infarction during the period 2011-2013. Patients were divided into
two groups: no significant lesions (NSL) and with significant lesions (SL). NSL
was defined as the presence of <50% coronary stenosis.
Inclusion criteria considered those patients admitted with diagnosis of AMI that
were studied with coronarography during hospitalization. The analysis
considered Demographic characteristics, Cardiovascular history, Clinical
presentation and evolution, Biomarkers of myocardial damage, Drug therapy
and Hospital mortality.
Age and ejection fraction (EF) were described by mean and standard deviation
and compared between groups using student’s t-test. The variables CK Peak,
CK-MB Peak and troponin peak, were described by the median, 25th and 75th,
and compared with median test. Categorical variables were compared between
groups using chi-square test. Logistic regression was used to determine
predictors of AMI without coronary lesions. Significance was p <0.05, and
confidence intervals of 95% were established. STATA 11 software was used.
50
RESULTS: Of the 3194 selected patients, 116 (3.6%) had NSL. Compared to
the SL group, patients from NSL group were younger (60±14 years vs 62±12
years, p<0,024) and the proportion of women was higher (39,7% vs 25,2%, p
<0,0001). NSL patients had lower prevalence of hyperlipidemia (30,2% vs
42,8%, p<0.007), diabetes mellitus (14,7% vs 28,9%, p<0.001) and smoking
habit (40,5% vs 61,3%, p<0.0001). NSL patients had a higher prevalence of
non ST elevation in admission electrocardiogram (62,9% vs 30,1%, p<0,00001).
NSL patients had lower levels of CK and CK-MB. EF was higher in the NSL
group (57 ± 12 vs 50 ± 12, p<0,0001).
Comparing intrahospital treatment, in NSL group it was less used aspirin,
clopidogrel, betablockers, intravenous heparin and LMW heparin, but they
received calcium antagonists more frequently.
There was not significantly difference between NSL group and SL group when
comparing intrahospital mortality (2,6% vs 4,2%, p 0,402).
DISCUSSION/CONCLUSION: Patients with AMI and no significant coronary
lesions have a lower prevalence of coronary artery disease risk factors. They
usually have an excellent prognosis, a low recurrence of AMI and a survival rate
at 10 years of 85%.
This cases are usually associated with female gender. A greater frequency of
non ST elevation AMI, lower rates of myocardial necrosis and better EF was
also observed. The intensity of intrahospital therapy with platelet
antiaggregants, anticoagulants and betablockers was lower and there was a
higher utilization of calcium antagonists.
51
TITLE: Outdoor gyms: a necessary harm?
AUTHOR: Cristina Casagrande Miranda Teixeira.
MENTOR: Evandro Palacio.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Dias, A.S. - FamemaStaut,
C. A. - FamemaAntonio, E. M. S. D.- Famema Oliveira, L. S. - Unesp Silva, L.
H. B. - Unesp Cano, A. S. - Unesp Proença, D. S. - Famema Cruz, A. C. Unesp Morini, S. M. - Unesp Honda, L. H. T. - Famema Chen, E. – Unesp.
BACKGROUND/INTRODUCTION: Outdoor gyms aim to improve people’s life
quality. There are many benefits regarded to them referred to the life quality of
users. However, probably the cons are in the same proportion.
OBJECTIVES: Analyze the main factors, which may influence the life quality of
users in outdoor gyms.
METHODS: The authors have studied 205individuals, minimum age of 18, who
used to attend the premises at least twice a week, data collection protocol
(“yes” or “no” answers), feasible injuries, pros and cons. Variables: users
(gender, age, week attendance), equipment (its application, if the users read
and understood the instructions), benefits and harms (before and after the
series of exercises). Results: gender: 118women, 86 men (p = 0.02). Age:
53.8in women, 54 in men (p = 0.07).Attendance per week: 3.8 among men, 4.1
among women (p = 0.06). Concerning to the purpose of each equipment, 134 of
the users did not know what they were doing, 70 people knew it (p<0,001).
RESULTS: Although there are severe problems to be resolved, the outdoor
gyms provide health improvement in people’s life quality.
DISCUSSION/CONCLUSION: The average age bracket of the users of outdoor
gyms did not comply the goals recommended by the World Health Organization.
The week attendance of the exercises was ideal. The users did not know the
application of the equipment. The great majority read the instructions before
using the equipment; however, those people do not understand them. There
was a great improvement in the life quality of users (regarded to osteomuscular
pain).
52
TITLE: New criteria for diagnosis of Fibromyalgia: Presentation and
Justification.
AUTHOR: Danilo Dias De Francesco.
MENTOR: Egídio Lima Dórea.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: De Francesco, D.D.;
Lopes, D.S.S.; Junkert; W.M.; Fascina, A.F.; Bigatão, V.L.; Roveri, D.C.; Dórea,
E.L. – Unicid.
BACKGROUND/INTRODUCTION: At present Fibromyalgia is a disease that
affects 5% of world population, disabling many people each year. A patient with
Fribromyalgia can retire on disability, making this illness one of most important
rheumatic diseases responsible for reducing the percentage of young adults
(mostly women) working age in the labor market. Therefore, diagnostic methods
and possible treatments of this condition are studying reason worldwide since
its negative impact on the economy of a country and the lives of individuals with
fibromyalgia.
Fibromyalgia is a painful chronic Muscle-skeletal syndrome described in a
scientific article first by Mohammed B. Yunus in 1981 as synonymous with
fibromyositis, a term more accepted in time to designate such infirmity. This
syndrome can be seen as a state of central pain. The term "Central" mentions
the central nervous system, place of origin and amplification of pain. The
presence of central sensitization to pain has polygenic nature, and a different
feel pain reported by individuals can result from an imbalance of
neurotransmitters of different natures, which would explain why centrally acting
analgesics improve symptoms in some people, but others don’t.
This disease begins in adolescence or in young adults, manifested by pain in
different locations and moments in life. It is characterized by the presence of
diffuse pain throughout the body, heightened sensitivity to palpation of certain
muscle sites called tender points and continuous display for at least 3 months. It
can also present with many other symptoms such as fatigue, unrefreshing
sleep, anhedonia, headache, cognitive difficulties, anxiety, stiffness and other
symptoms without a defined etiology. Furthermore, it is known that individuals
with close relatives who have this disease has a greater likelihood 1.8 X to have
the disease.
OBJECTIVES: This work aims to translate into Portuguese and introduce the
new tool for diagnostic criteria for fibromyalgia presented by the American
College of Rheumatology (ACR) in 2011.
METHODS: To obtain the data used as a reference , we use the following
databases: UpToDate , PubMed , MedScape ,. The terms Mesh / DESC
ultilizados were : Fibromyalgia Fibromyalgia Pain.
53
RESULTS: The global prevalence of fibromyalgia ranges from 2% to 8%. In
Brazil, it is the second most common rheumatologic disorder after osteoarthritis.
The Brazilian Society of Rheumatology, indicates that the proportion of women
to men diagnosed with fibromyalgia is approximately 6 to 10:1. Carries of
fibromyalgia are used more analgesic therapies and seek medical and
diagnostic services more often than the normal population. Thus, it is not
surprising that the US its annual health costs reach U $ 9,573.00 per patient,
representing a spending 3-5 times higher than the general population. A
considerable portion of these costs can be saved when the patient has his
diagnosed and treated properly, avoiding unnecessary additional tests and
useless medicines for their treatment.
DISCUSSION/CONCLUSION: Full understanding of fibromyalgia requires a
comprehensive assessment of pain, function and psychosocial context. In
addition to pain, it is important to assess the severity of other symptoms such as
fatigue, sleep disturbances, mood, cognition and their impact on the quality of
life of the patient. Fibromyalgia is still unclear and under-diagnosed disease,
and this new criterion is intended to diagnose many individuals who suffer from
the disease without knowing it. It is known that the fact that the patient have a
defined diagnosis improves your clinical picture. Thus acknowledging the need
for better diagnostic criteria for fibromyalgia.
54
TITLE: Isolated lymphadenopathy: do you remember the cat?
AUTHOR: Eduardo Kaiser Ururahy Nunes Fonseca.
MENTOR: Tatiana Goberstein Lerner and Endrigo Emanuel Giordani // Maris
Salete Demuner
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Andrea Ribeiro Gonçalves
de Vasconcelos Medeiros; Felipe Melo Nogueira;Sarah Simaan dos Santos;
Tatiana Goberstein Lerner; Endrigo Emanuel Giordani. All From Escola Paulista
de Medicina/UNIFESP.
BACKGROUND/INTRODUCTION: Cat Scratch Disease (CSD) is caused by
Bartonella henselae. It is more common in children, even thought it also can
affect adults. The typical presentation is a unilateral regional lymphadenopathy
following the report of a bite or scratch of a cat.
OBJECTIVES: To alert the attending physicians on the possibility of CSD as a
differential of a chronic regional lymphadenopathy without systemic symptoms,
even at atypical age of presentation.
METHODS: We reported the case of a patient that presented to emergency
service of a university hospital after obtaining her fully consent and made a
review of the current literature on CSD.
RESULTS: A 63-year-old female presented to our service complaining of a
painful “mass” in her right arm. She referred that it had appeared over the last
15 days, and was now stable. She denied other symptoms as fever, chills,
fatigue, cough, night sweats or weight lost. She also denied any history of
recent direct trauma to the region or starting any new medications. Her
examination was unremarkable with exception to the enlargement of the lymph
nodes at the epitrochlear chain that have about 4 cm in her right upper limb.
They were non-adherent and tender on palpation. She also had a small injury
on her palm, not referred before. As she presented with isolated
lymphadenopathy, we actively asked, for her surprise, about contact with cats.
She told that about a month before, the cat of her working place had scratched
her on her right palm. She said she presented an important but self-limited
inflammatory lesion on her palm (what we have seen on her palm was just the
remnant of inoculation lesion) and forgot about that episode.
DISCUSSION/CONCLUSION: Based on the above, our hypothesis was CSD.
As she did not have other systemic symptoms and well oriented, we decided
not to biopsy the enlarged node nor to proceed with laboratory serology but to
try a course of antibiotics (Azithromycin in 5 days regime - 500 mg on day 1 and
250mg from Day 2 to 5). We also asked her to return for revaluation in case of
new symptoms or red flags or absence of improvement and at the end of the
therapy. She returned after 10 days in clinical department without further
complains and her diagnosis was endorsed by the attending physician that
discharged her with general orientations. Although more common in the
55
childhood, CSD should be considered in the differential of lymphadenopathy in
older adults, in which the history of contact with cats should be actively
searched. The treatment of these cases can be relatively simple, using
Azithromycin for 5 days.
56
TITLE: Great auricular nerve thickening in leprosy - Clinical sonographic
correlation
AUTHOR: Eduardo Kaiser Ururahy Nunes Fonseca
MENTOR: Tatiana Goberstein Lerner and Endrigo Emanuel Giordani // Maris
Salete Demuner.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Andrea Ribeiro Gonçalves
de Vasconcelos Medeiros; Felipe Melo Nogueira;Sarah Simaan dos Santos;
Tatiana Goberstein Lerner; Endrigo Emanuel Giordani. All From Escola Paulista
de Medicina/UNIFESP.
BACKGROUND/INTRODUCTION: Leprosy is an endemic mycobacteriosis in
Brazil, which has broad clinical spectrum characterized by nerve and skin
lesions, mainly hypochromic and hypoesthesic with perineural thickening.
Generally the neural thickening occurs after the onset of skin lesions. Recently,
several papers have proposed measuring the nerve thickening with highresolution ultrasonography. This test has provided a good evaluation of
peripheral nerves, and good morphological characterization.The increase in the
epineurium can be measured by the device and provide data relating to the
degree of neural damage.
OBJECTIVES: To report what we believe is the first case of sonographic
evaluation of the great auricular nerve (GAN) thickening in leprosy.
METHODS: We made clinical diagnosis of leprosy and ultrasonographic
assessment of the left ulnar nerve (according to the current literature practice)
and the GAN. After obtaining fully consent of the patient, we made the report
and a review of the current literature on sonography assessment of neural
thickening in leprosy.
RESULTS: We could assess and describe GAN enlargement in the present
case. Also, we evidenced the enlargement of the left ulnar nerve, getting the
picture about 2 cm above the elbow, as is done by Visser et al, showing the
important involvement of this nerve also in this case.
Despite the lack of literature on specific quantification of thickening of the GAN,
we believe that this case illustrates this process exuberantly, as this nerve is
generally smaller than the ulnar and the evaluation of the epineurium of the
GAN in our patient, had similar thickening parameters to the cutoff points of the
ulnar epineurium seen in other studies.
DISCUSSION/CONCLUSION: The use of ultrasonography (US) for neural
thickness may have an important impact on the early diagnosis of neuropathy,
since its changes appear even before the neural thickening is palpable at
clinical examination.
57
TITLE: Carvedilol or omega-3 fatty acids ameliorates the biomarkers related
oxidative stress in breast cancer patients subjected to anthracyclines
chemotherapy.
AUTHOR: Eliseo Andrés Fuentes Foncea.
MENTOR: Dr. Ramón Rodrigo.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Rodrigo Carrasco, MD.
Molecular and Clinical Pharmacology Program, Institute of Biomedical
Sciences, Faculty of Medicine, University of Chile.
BACKGROUND/INTRODUCTION: The successful use of anthracyclines as
antineoplastic agents against breast cancer is limited by the generation of
reactive oxygen species, which are unrelated to the therapeutic effect of the
drug and leads to the development of acute and chronic cardiotoxicity.
Therefore, we put forward the hypothesis that the reinforcement of the
antioxidant defense system, through carvedilol or omega-3 FA, should result in
oxidative stress biomarkers accounting for a protective effect against
cardiotoxicity
OBJECTIVES: Improve biomarkers related to oxidative stress through
pharmacological agents with highly antioxidant power such as carvedilol or
omega 3 fatty acids.
METHODS: A placebo-controlled, randomized, double-blind clinical trial was
performed including 36 women with breast cancer, having indication of
anthracyclines chemotherapy. They were divided into three randomized groups:
1) omega-3 fatty acids (DHA:EPA ratio = 2:1) plus carvedilol placebo; 2)
carvedilol therapy plus omega-3 fatty acids placebo; 3) carvedilol and omega-3
fatty acids placebos, all patients received one guideline treatment during the
first cycle of chemotherapy since 7 days before until 7 days post treatment with
anthracyclines. Throughout the study, we evaluated the blood biomarkers
related to the antioxidant potential and the levels of lipid peroxidation. Statistical
analyses through Kruskal-Wallis, Dunn's multiple comparison, and Mann
Whitney U tests, with P value <0.05 were considered as significant, GraphPad
software analysis.
RESULTS: Placebo group showed higher lipid peroxidation serum levels and
lower erythrocyte antioxidant potential, but these effects were significantly
attenuated by both interventions.
DISCUSSION/CONCLUSION: The use of carvedilol or omega-3 fatty acids was
able of reducing the systemic oxidative injury and of preventing the decrease of
the antioxidant potential during the first chemotherapy cycle. Data of this pilot
study are consistent with a reduction in the oxidative stress-related
58
anthracyclines cardiotoxicity; however, more large-scale clinical trials have to be
performed before the effectiveness of this treatment could be established.
59
TITLE: Socioeconomic and diabetes knowledge level assessment among
diabetes mellitus hospitalized diabetic patients in a tertiary hospital.
AUTHOR: Gabriel Ayub Lopes.
MENTOR: Maria Candida Ribeiro Parisi.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Karina Saiuri Takatori,
Mariana Moreira Resende, Mariana Chiaradia Dominguez, Julia Boccato,
Jefferson Douglas Camargos Moreira.
BACKGROUND/INTRODUCTION: According to WHO, until 2020, chronic
diseases will be the leading cause of disability worldwide. Currently, about 387
million people have diabetes worldwide, and in Brazil, this number reaches 11,6
million. Proportionally, this increase in prevalence will generate economic and
social pressure on the Heath Care System. Considering that, WHO considers
expansion of knowledge and education as one of five areas of intervention,
given that studies in several centers show a deficit in knowledge of the disease
by up to 80 % of cases. Education regarding diabetes and its essential risk
factors, as in treatment as in prevention, however, little is known about what our
patients know about their disease.
OBJECTIVES: Quantify and qualify socioeconomic level and diabetes
knowledge among diabetic patients hospitalized in adult nursing tertiary
hospital.
METHODS: From September 2013 to June 2014, through the DKN-A and a
socioeconomic questionnaire we have studied 43 diabetic patients in the
general ward of high complexity tertiary hospital .At the same time, we have
studied sociodemographic data.
RESULTS: n = 43, 17 male patients and 16 female , aged between 88 and 31
(median = 60), average duration of disease: 9.43 years. Insulin treatment
(48.5%), oral hypoglycemic ( 39.4 % ) diet alone ( 3%) and untreated ( 9% ).
Right answers average rate in DKN-A: 6.3 (42%), with only 12 patients (44.44
%) giving the right answer above the validated average (8 hits). The
Socioeconomic questionnaire revealed that 81.9 % of inpatients are located in
low and medium-low socioeconomic levels, while the remaining patents are in
intermediate levels, and none of them in higher levels.
DISCUSSION/CONCLUSION: Although patients have an average of nine years
of disease and medium to high complexity treatment, knowledge about the
disease fell far short of needed. Furthermore, considering the entire sample, the
socioeconomic status have not shown any significant difference.
60
TITLE: The impact of vitamin D levels on glycemic control and bone mineral
density in postmenopausal women with type 2 diabetes.
AUTHOR: Hillary Kimberly Osorio Landa.
MENTOR: Dr. Iván Pérez Díaz, Dr. José Gerardo García Aguirre, Dr. Juan José
Plata Muñoz, Dr. Jorge Eugenio.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Gabriela Sebastián-Barajas
1, Zulema Guadalupe Hernández-Flores 1, Raúl Rivera-Moscoso 1, Hillary
Kimberly Osorio-Landa 1, 2, Armando Flores-Rebollar, 1 Instituto Nacional de
Ciencias Médicas y Nutrición.
BACKGROUND/INTRODUCTION: Diabetes mellitus (DM) and osteoporosis
(OP) are two very common pathological entities. DM is a chronic metabolic
disease mostly affecting adults and is associated with high morbidity and
mortality rates. OP refers to the asymptomatic loss of bone mass and is most
prevalent in postmenopausal women; nearly 40% of these women develop an
osteoporosis-related fracture in their lifetime. Recently, a strong increase in risk
fractures due to bone fragility in patients with T2DM has been described. The
benefits of maintaining good glycemic control to prevent micro and
macrovascular complications are well known. However, whether glycemic
control contributes to a decreased number of fractures or might favorably
impact bone density has not been well established.
OBJECTIVES: Whether glycemic control contributes to a decreased number of
fractures or favorably impacts bone density in patients with type 2 diabetes
mellitus (T2DM) has not been well established. Vitamin D (25 (OH) D3)
deficiency appears to be related to glycemic control in patients with T2DM. The
aim of this study was to determine the relationship between 25 (OH) D3 levels,
glycemic control, bone mineral density (BMD), and the development of
osteoporotic fractures (OPF) in postmenopausal women with T2DM.
METHODS: We reviewed the charts of 110 postmenopausal women diagnosed
with T2DM. Glycosylated hemoglobin A1c (HbA1c) values over the previous 5
years were recorded and an average was obtained. Based on these values,
patients were divided into three groups: optimal, suboptimal, and poor control.
Bone mineral density and 25 (OH) D3 levels were also recorded.
RESULTS: In the group of patients with poorly controlled T2DM, 25 (OH) D3
levels were significantly lower in comparison with the other groups (p=0.002). A
statistically significant linear relationship between HbA1c and 25 (OH) D3 levels
(rs= -0.19, p= <0.05) was established. The frequency of osteoporosis and
osteopenia was not significantly different between groups. The group with
optimal glycemic control had an increased number of OPF events (p=0.036).
61
DISCUSSION/CONCLUSION: 25 (OH) D3 levels are inversely related to the
adequacy of glucose control. Therefore, more studies are needed to identify the
specific effect of 25 (OH) D3 in T2DM physiopathology.
62
TITLE: Tourette Syndrome: Differential Aspects and Treatments.
AUTHOR: Isabela Fernandes Rossi.
MENTOR: Profa. Dra. Genair Silva Romualdo.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Caroline Gimenes de
Almeida; David Rafael Ferreira Filho; Daniele Rangel; Francielly Teles Silva;
Júlio de Souza Leite Aranha.
BACKGROUND/INTRODUCTION: The Tourette Syndrome (TS) is a
neurological disorder characterised by the occurrence of motor and vocal
involuntary tics.
OBJECTIVES: The purpose of this essay is to carry out a bibliographical review
about the main aspects related to Tourette Syndrome; considering
aetiopathogenic theories, the diagnosis, the clinical picture and the available
treatments.
METHODS: All information employed to the development of this article was
from a systematic study of the bibliographical review from the database of the
following websites: Pubmed, Scielo and ScienceDirect, from 1997 until 2015.
RESULTS: The etiology of the Tourette Syndrome is still not completely
cleared, therefore, there are hypothesis concerning possible mutations on
certain chromosomal regions, which results in the deficit of the inhibition of
cortico-striato-thalamo-cortical circuits, and the decrease of the inhibitory
activities to the projection of GABAergic of the striato to the globus pallidus and
abnormalities of the dopaminergic and noradrenergic systems. The clinical
picture is composed, mainly, by motor and vocal tics, that are subdivided in
simple and complex, and its diagnosis consists in an elementary clinical
observation.
DISCUSSION/CONCLUSION: At the same time, this bibliographical review
established a correlation between TP’s symptoms and the influence of those
symptoms in the psychological and social scopes of the people that suffer from
this syndrome. In this manner, it was possible to note and discriminate the
common manifestations and the symptoms associated with TS.
63
TITLE: Effects of Carvedilol treatment in electrocardiogram - QT alterations in
acute anthracycline induced cardiotoxicity
AUTHOR: Joaquín Matías Palomo Gaete.
MENTOR: Ramón Rodrigo.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Carrasco R.
BACKGROUND/INTRODUCTION: Anthracyclines (AC) are chemotherapeutic
agents used for cancer treatments. One of the main disadvantages in its use is
the cardiotoxicity they induce. The mechanism which this occurs is related to
oxidative stress. The studies about AC-induced cardiotoxicity are focused to the
long-term damage they cause, however, It has been described that the tissue
damage starts from the first AC dose (with non-specific ECG changes), and
chronic cardiotoxicity is a lesion detected lately. Therefore, avoid AC acute
damage could be a relevant fact to prevent future heart injury.
OBJECTIVES: Decrease the acute electrocardiogram changes caused by
anthracyclines in breast cancer treatment, through the antioxidant system
reinforcement
conducted on a group of 36 female patients with breast cancer, which had
indication to receive chemotherapy with anthracyclines. Randomly assigned to
3 intervention groups to receive during the first cycle of chemotherapy since 7
days before until 7 days post treatment with anthracyclines, some of the
following interventions: a) omega-3 (DHA:EPA ratio = 2:1) in dose of 3 tablets
(1g) orally every 12 hours plus carvedilol placebo 1 tablet orally every 12 hours;
b) carvedilol 1 tablet (12.5 mg) orally every 12 hours plus omega-3 placebo with
3 tablets orally every 12 hours; c) carvedilol placebo 1 tablet orally every 12
hours plus omega-3 placebo with 3 tablets orally every 12 hours. During the first
cycle of chemotherapy, electrocardiographic corrected QT (QTc) interval
distance and dispersion were evaluated.
RESULTS: The electrocardiographic QTc interval distance and dispersion not
show statistically significant differences between intervention groups. However,
if we evaluate each group by separate, in carvedilol group there is not a
significative increasing between DAY+1 (3 - 6 hours post-quemotherapy)
compared to BASAL control (pre-quemotherapy), different respect to placebo
and omega-3.
DISCUSSION/CONCLUSION: There is not a significal reduction of acute QT
alterations through the antioxidant system reinforcement. However, carvedilol
could have a potential role in decrease the ECG alterations. Further studies are
needed to confirm it.
64
TITLE: Structural assessment in craniocervical dystonia: global and differential
analyses.
AUTHOR: Larissa N N Vilany.
MENTOR: D´Abreu A.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Vilany L1, Rezende TJ2,3,
Piovesana LG2, Campos LS2, Torres FR4, FrançaJr MC1,2, Amato-Filho AC5,
Lopes-Cendes I4, Cendes F1,2 and D'Abreu A1,2.
1Neuroimaging
Laboratory,2Neurology
Department,3Chronology
and
Cosmic
Rays
Department, 4Genetics Department.
BACKGROUND/INTRODUCTION: Dystonia is a movement disorder, probably
associated with circuit alterations instead of a mainly basal ganglia disturbance.
Previous neuroimaging studies in craniocervical dystonia (CCD) showed
controversial findings. Freesurfer (FS) has presented better results than other
techniques when applied to cortical thickness. Additionally, although sharing
common features, subtypes of CCD show clinical peculiarities that may indicate
different patterns of structural changes.
OBJECTIVES: To investigate in CCD: (1) cortical thickness and subcortical
volume, (2) clinical correlations between structural changes, (3) steps (1) and
(2) in cervical dystonia alone (CD) and blepharospasm/oromandibular dystonia
isolated or combined (B&O), through the use of FS.
METHODS: We studied 49 subjects (17 with CD, 18 with B&O) and 79 healthy
controls. We performed a whole group analysis, followed by a subgroup
analysis. We used Freesurfer to obtain cortical thickness, subcortical volume
and to perform an exploratory analysis. We then selected significant areas from
previous studies and performed a generalized linear model corrected by false
discovery rate to further investigate and confirm the affected areas and possible
clinical correlations.
RESULTS: The exploratory analyses demonstrated atrophy in visual areas in
CCD; visual and motor areas in CD; and visual, sensory, and limbic areas in
B&O. We also observed increase of cortical thickness in sensory area in CD
and visual area in B&O. The generalized linear model showed cortical atrophy
in visual, sensorimotor and limbic areas in CCD; and atrophy in sensorimotor,
and visual areas in the subgroup analysis. We found no atrophy in subcortical
structures. We observed a significant clinical correlation between visual,
sensorimotor areas and age of onset and sensorimotor areas and the clinical
score and time on toxin treatment in CCD, as well as between sensory areas
and age of onset and time on botulinum toxin treatment in the B&O group.
DISCUSSION/CONCLUSION: We detected the involvement of motor,
somatosensory and visual processing areas in CCD, with a possible differential
pattern of involvement in CD and B&O.
65
TITLE: The Inter-hospital transference of a high-risk patient: ethics on dialogue
between health care services - a case report.
AUTHOR: Marcelo Gobbo Júnior.
MENTOR: Cesar Augusto Masella.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Borges, G. R. - Centro
Universitário Barão de Mauá; Gobbo, M. - Universidade Federal de Uberlândia;
Masella, C. A. - Centro Universitário Barão de Mauá.
BACKGROUND/INTRODUCTION: Instable patients, often with comorbidities,
are complexes and usually need of transference of health care unities. Thus,
the dialogue between all the health care teams is very important and needs of
ethics, mainly on the contact with relatives who can feel embarrassed by the
behavior of health care professionals. In this way, discuss cases with respect
and attempt to improve technical of dialogue and bad news given is a duty of
health care professionals.
OBJECTIVES: To report a case of transference of an instable patient with
complications and ethical aspects on dialogue between health care teams.
METHODS: It was used medical notes of the inter-hospital transport service of
the patient.
RESULTS: Hospitalized patient with pneumonia using ceftriaxone for five days.
It presents Mellitus Diabetes, glycaemia above 600 mg/dl after bolus infusion of
regular insulin, and it is in use of midazolam and quelicin on 2050 ml of fluid at
20 ml/h and norepinephrine (4 ampoules and 250 ml of fluid) at 15 ml/h. The
Patient has presented inaudible blood pressure since the case reception. It is
attempted an unsuccessful stabilization for the transport. Patient presents a
worse hemodynamic status with cyanosis of tongue and fingers, 30 bpm,
absence of carotid pulse. The transport team has suggested return (returning)
to the original hospital. The Patient has evaluated to death.
DISCUSSION/CONCLUSION: The report highlights the discussion of accuracy
and quality of the hospital transport service and the necessity of improvement
on team working between the healthcare teams that take care of high-risk
patients. It is interrogated about the ethics in communication between
healthcare teams and the ethical actuation of each healthcare professional in
the decision-making of following or not a protocol. Furthermore, variations on
the dialogue between healthcare teams emphasizes the reflection about the
necessity of clearly dialogues, uniform language between different healthcare
teams and continuous graduation that priories team working, quality on health
care of high-risk patients and the ethical and respectful dialogue with the
relatives.
66
TITLE: Association between azygos artery and epilepsy: A CASE REPORT.
AUTHOR: Mariana Soares Pinheiro.
MENTOR: João Pedro Oliveira Junior.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: CRUZ, PP - UNEB;
OLIVEIRA JUNIOR, JP - UFBA; PINHEIRO, MS – FTC.
BACKGROUND/INTRODUCTION: Azygos artery is a rare anatomical variation
of the proximal portion of the anterior cerebral artery, it is formed by the union of
the two segments A1. It has anterior way for inter-hemispheric fissure and it is
present in about 0.3 to 2% in the adult population. It may be associated with
cerebral arteriovenous malformations, corpus callosum dysgenesis and
aneurysm, this is a rare condition.
OBJECTIVES: To report a clinical case of a patient with seizure of difficult
control and its probable association with azygos artery.
METHODS: Case report of patient followed for 10 years in epilepsy service the
Foundation of Neurology and Neurosurgery iat Salvador, Bahia. He agreed that
the report was published for academic and scientific purposes.
RESULTS: Man, 20 years, with report seizures of difficult control since 10 years
old. The seizures are generalized tonic-clonic, absence relaxation of sphincter
tone, lasting a few minutes, frequency three to five seizures for week.
Refractory to use maximum doses of anticonvulsivants drugs like acid valproic,
phenobarbital, lamotrigine, carbamazepine and oxcarbamazepine. In the period
post-ictal, he is sleepy and confused. Refers memory operating difficulties and
difficulty of concentration and learning. Denies headache and epileptic auras.
Patient was born of natural birth without complications during pregnancy, with
normal growth and development and normal neurodevelopment. The clinical
neurological examination presents with impaired cognition. The cranial nerves
are preserved. Muscle strength preserved. Absence change sensitivity,
syndrome cerebellar and autonomous nervous system preserved. The
complementary exam of electroencephalogram waves acute focused in areas
temporooccipitais.
67
DISCUSSION/CONCLUSION: Complementary images of brains show
encefalomalacia area and gliosis circumjacent, predominantly right frontal lobe.
The cranial magnetic resonance angiography concludes union of branches A2
of anterior brain arteries is forming single arterial trunk, it is known as azygos
artery. Therefore, this case report is about azygo artery, a rare anatomical
variation, there are no reports about its association with changes circumjacent
brain parenchymal and causing neurological disorders. In this case, it was
suggested to hypothesis of reduction of blood flow in brain parenchyma
secondary to anatomic variation which creates areas of gliosis and subsequent
formation difficult control epileptogenic focus. The conduct of surgical derivation
may not offer good results due to gliosis perivascular. This could increase
bleeding in this region. It was attributed the patient's condition to circumjacent
gliosis due to arterial anatomical variant. It was chosen to optimize drug control
and follow the outpatient treatment more often.
68
TITLE: Where are teratomas in the human body? A cross-sectional study
AUTHOR: Marlon Moura Dos Santos
MENTOR: Marbele Guimarães de Oliveira .
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Josenice Gomes Trindade
da Silva (Universidade Estadual de Feira de Santana), Laila Vanessa de Jesus
(Universidade Estadual de Feira de Santana), Maria Eliza Faria (Universidade
do Estado da Bahia).
BACKGROUND/INTRODUCTION: Teratomas are germ cell tumors, benign or
malignant, composed of cells of the three germ layers: endoderm, mesoderm
and ectoderm. The ovaries and testes are the most frequent sites in adults. In
children, the sacrococcygeal region is often the most common topography. The
injury can be classified into solid, multicystic or formed by a single cyst and can
be composed of mature and immature tissue.
OBJECTIVES: The aim of this study was to determine the cases of patients
diagnosed with teratoma in a specialized laboratory of pathology between 2002
and 2015.
METHODS: It is a cross-sectional descriptive study performed in a specialized
laboratory of pathology in the period between 2002 and 2015. The Ethics
Research Committee of the State University of Feira de Santana (UEFS)
approved this study. We analyzed 452 cases of teratoma by evaluating the
following variables: age, sex, topography and laterality.
RESULTS: A total of 452 patients were detected and characterized, of which
438 (96.9%) were women and 14 (3.1%) men. Ages ranged from 9 months to
83 years with a mean age of 30 years.
The most commonly affected organ in women was ovary, with 430 (98.2%)
cases, in which 161 (37.4%) in the right ovary, 156 (36.3%) in the left ovary, 30
(7%) in both and in 83 (19.3%) cases it was not specified. Regarding men, half
had testicular teratoma and another half had extragonadal sites.
Of all patients, 15 (3.3%) had extragonadal teratoma, particularly in the early
years (median of 4 years), noting that the most affected topography was head
and neck region, accounting for 13 cases (86.7%). Hepatic hilum and pelvis
were the other affected regions.
CONCLUSION: Among other findings, the present study showed that the
topography of teratoma is directly related to the age at diagnosis. Greater
occurrence of extragonadal teratomas early in life became evident and the high
number of cases located on head and neck motivates more research on the
subject.
69
TITLE: Frontal fibrosing alopecia: case report of corporal initial presentations.
AUTHOR: Mirley Galvão Pereira
MENTOR: ALVES, L.D.- Hospital das Clínicas da Faculdade de Medicina UFG.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: PEREIRA, M.G.Faculdade de Medicina UFG; GUERRA, T.A.- Faculdade de Medicina UFG;
QUEIROZ, L.R.A.- Faculdade de Medicina UFG; KRETZMANN, M.T.- Hospital
das Clínicas da Faculdade de Medicina UFG.
BACKGROUND/INTRODUCTION: Frontal fibrosing alopecia (FFA) is a kind of
progressive and frequently irreversible cicatricial alopecia marked by a lichenoid
infiltrate in histology. It is an uncommon condition characterized by progressive
frontotemporal recession due to inflammatory destruction of hair follicles. Little
is known about the natural history of this disease. Differential diagnosis from
other types of alopecia, including alopecia areata (AA), is necessary in some
cases.
OBJECTIVES: To report a case of frontal fibrosing alopecia (FFA), which is
considered a rare disease , including the corporal initial presentation, an
extracapillary area, collected at the Hospital das Clínicas, Universidade Federal
de Goiás (UFG); with review of the literature.
METHODS: It is a Case Report based on primary analysis of data collected
during the service in Alopecia’s Clinic of the Hospital das Clínicas, UFG,
correlated to secondary data obtained from the study of literature sources
specific to the medical field of Dermatology.
RESULTS: In Alopecia’s Clinic of UFG Dermatology Service was attended
EDPP patient, 47, merchant, who sought the service in November 2011 with
loss of hair on forearms, legs and eyebrows started 2 years ago. She denied
appearance of skin lesions. She gradually evolved with thinning of the terminal
portion of the eyebrows and on November 2014 regression of hair implantation
line in the frontal region. She reports that she has hypertension and is in use of
Micardis (anti-hypertension). She had performed hysterectomy 22 years ago.
She denied dermatological diseases or similar cases in the family and
performed dermatological physical examination was detected alopecia area on
the distal third of upper and lower limbs. The thinning of the terminal portion of
the eyebrows and regression of hair implantation line in the frontal region, with
the absence of vellus hair and micropapules normochromic on the forehead led
to the diagnosis of Frontal Fibrosing Alopecia.
DISCUSSION/CONCLUSION: FFA's typical initial clinic is the symmetrical
recession of the frontal and temporal margins of deployment of scalp hair in
postmenopausal women. In EDPP, the thinning started in other body regions,
rare area, that prompted a misdiagnosis and also treatment without results. It is
important to know that in literature are reported different types of clinical course
70
of this disease, therefore on patients of any age who show signs of thinning by
whatever body part should be investigated FFA.
71
TITLE: Alzheimer's disease depicted in the self-portraits of William Utermohlen.
AUTHOR: Monique Almeida Vaz.
MENTOR: Lucy Gomes Vianna.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Vaz, M. A. - UCB; Bezerra,
A. J. C. - UCB; Vianna, L. G. – UCB.
BACKGROUND/INTRODUCTION: Alzheimer's disease (AD) is defined as a
progressive decline of cognitive function, associated with impairments in
memory areas. It represents the main cause of dementia in elderly people. Its
diagnosis is clinical, but the cognitive tests can help during anamnesis,
including the Clock Drawing Test (CDT) and Mini-mental State Examination
(MMSE), which are screening tools for deficits in memory, praxia, language,
temporal and spatial orientations, and in visuospatial abilities.
OBJECTIVES: This work aims to describe the changes in visual style of
Utermohlen's self-portraits, produced during the progression of his AD, and to
correlate with the analysis of skills graded by cognitive tests, highlighting the
magnitude of spontaneous graphical expressions to diagnosis of AD.
METHODS: It was performed a qualitative descriptive study about two selfportraits of the painter William Utermohlen (1933-2007), produced before and
after he had been diagnosed with AD. The shifts in visual style of artworks was
compared with skills screened in CDT and MMSE. All pictures were provided by
Chris Boïcos Fine Arts. It was made a literature review in scientific articles
indexed in the data bases PubMed, BIREME and SciELO with the describers
"Alzheimer's disease", "William Utermohlen" and "self-portraits" in last 10 years.
The second search was conducted with the describers "Clock Drawing Test",
"Mini-mental State Examination" and "Alzheimer's disease" in last five years.
RESULTS: William Utermohlen was an American contemporary painter,
diagnosed with AD at the age of 61 years. On the MMSE, he scored 22/30 and
delayed recall was worse for verbal than material. Analyzing a selection of his
two self-portraits, one produced in the early phase of AD and other in the
progressive phase of the disease, it was verified changes in visual style of his
artworks that progressed according to the deterioration in his cognitive state,
specifically with his visuoperceptual and visuospatial skills. The self-portrait
created at the age of 60 years represents a stylistic and technical reference
point, expressing the realism, with typical quality of his work before the onset of
his illness. In the other hand, it is possible to identify on his last self-portrait, at
the age of 65 years, a more primitive style. The picture is abstract and realism is
no longer attainable, which suggests a dramatic expression of progressive AD
absorbed by artwork.
72
DISCUSSION/CONCLUSION: The study suggests that an attention to details in
graphical shifts of elderly people has critical value to the anamnesis of
dementia. It is noteworthy in paintings an impairment of visual sensory
capacities, impaired point localization and poor judgment of relative object
position, all that could be analyzed by the clock drawing test. On the whole,
CDT has a high correlation with MMSE, and not only CDT but also graphical
expression are easy tools to document in clinical records and they have real
coherence for use as a Alzheimer's disease-screening instruments in a general
setting.
73
TITLE: Phytotherapy as an alternative therapy to fight obesity.
AUTHOR: Otavio de Morais Marques.
MENTOR: Marques, F. M – Unifesp.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Coutinho, I. R. A. B Famene. Dias, M. M. M. - Famene. Macedo, M. A. L - Famene. Sousa, A. R. O
– Unifesp.
BACKGROUND/INTRODUCTION: Obesity is a multifactorial chronic disease
associated with various pathologies and mortality increase. It is a public health
issue worldwide. The use of medicinal plants to combat obesity and
dyslipidemia has always been widely used. The acceptance of treatments
based on natural products has greatly increased. However, despite the vast use
of these products, little is known about the effects of these plants in humans
and validation in disease treatments.
OBJECTIVES: This study aims to identify and characterize some herbal or
plant species which can be used in the treatment of obesity, therefore
highlighting the importance of herbal medicine as a viable, affordable, safe,
effective and low cost alternative.
METHODS: A literature review was conducted through the analysis of scientific
papers from databases such as PubMed and Medscape and also related
medical literature.
RESULTS: Most studies performed with herbal aid in weight loss, mentioning
the Camelia sinensis (green tea), the Cynara Scolymus (artichoke) and the
Phaseolus vulgaris (white beans) to be effective in the obesity treatment and
weight loss. It was observed that these plants operate effectively in reducing
body weight but with different mechanisms of action. However, despite the wide
use of such products, we have not awakened yet to more interest in scientific
research to ensure greater security in its use. It is noteworthy that although
natural products, they are not exempt from adverse effects, contraindications
and interactions with other medicines or nutrients.
DISCUSSION/CONCLUSION: Therefore, because of the consequences that
obesity can bring to the individual's overall health, it is important to address
therapeutic alternatives for this pathological condition, to allow access to a
secure, effective and low cost method of treatment.
74
TITLE: Action of cannabis sativa in fighting emesis caused by antineoplastic
drugs.
AUTHOR: Otavio de Morais Marques
MENTOR: Marques, F. M – Unifesp.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Coutinho, I. R. A. B Famene. Dias, M. M. M. - Famene. Macedo, M. A. L - Famene. Sousa, A. R. O
- Unifesp.
BACKGROUND/INTRODUCTION: Marijuana (Cannabis sativa) has been used
over the last centuries for various purposes such as food, religious rituals, as a
hallucinogen and in medicinal practices. Cannabis derivatives are used as
medicines, due to its safety and efficacy and it is also scientifically proven.
OBJECTIVES: This study aims to describe the therapeutic actions of cannabis
in order to raise awareness about legalizing its medicinal use.
METHODS: This is a literature review, which used databases such as PubMed,
Scielo and Academic Google.
RESULTS: The marijuana’s compound responsible for the therapeutic effects of
the plant, including antiemetics, is THC (tetrahydrocannabinol), which acts on
the CB1 and CB2 receptors in the nervous system, triggering a series of
reactions that will culminate in the opening of potassium channels and closing
of calcium channels, leading into a decrease in the release of several
neurotransmitters, why it has such a wide spectrum of actions. It is scientifically
supported that this drug has antiemetic effects, which are, in fact, more potent
than other drugs used for the same purpose.
DISCUSSION/CONCLUSION: Despite showing limited use due to its wide
range of side-effects induced by the drug, especially psychotropic effects, it is
scientifically proven that cannabinoid compounds have the potential to produce
therapeutic effects. To continue researching in this field is important in order to
find a way to mitigate the negative effects of the herb and benefit thousands of
patients from its therapeutic use.
75
TITLE: Prevalence of osteodystrophy in a group of cirrhotics.
AUTHOR: Pauline Nallim Lobão.
MENTOR: Liliana Mendes.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Rafael Oliveira Universidade Católica de Brasília; Bárbara Neves - Universidade Católica de
Brasília; Pauline Nallim Lobão - FACIPLAC; Ana Loísa Silva de Menezes FACIPLAC; Liliana Mendes - Hospital de Base do Distrito Federal; Marcos V.
Carneiro.
BACKGROUND/INTRODUCTION: The hepatic osteodystrophy consists in a
bone mineralization disturb caused by a chronic liver failure. According to WHO
(World Health Organization), osteoporosis is a systemic disease, defined by a
bone mass decrease and deterioration of the bone tissue, increasing bone
fragility and fracture susceptibility1. Many studies demonstrate that the
prevalence of the association of cirrhotics with bone mass loss is between 12%
and 55%2, being proportional to the hepatic involvement level. It has been
demonstrated that cirrhotic patients have tendency to decrease the levels of
calcium and vitamin D3. and have many risk factors to osteoporosis, as
alcoholism, use of corticosteroids, malnutrition, hypogonadism, vitamin D deficit
and sometimes advanced age. The sum of those factors creates more
propensity to osteopenia and osteoporosis, increasing the possibility of bone
fractures, morbidity and mortality of these patients.
OBJECTIVES: Analyze the bone status of the cirrhotic patients, correlating
bone mineral density with biochemical markers of bone metabolism and
comparing the results of the groups according to age, sex, cirrhosis level and
etiology.
METHODS: Along 6 months, 42 patients were selected from a hepatology clinic
in order to research their bone mineral density associated to biochemical
markers of bone metabolis, such as 25-Hidroxi-Vitamin D, parathormone,
phosphorus e calcium. It is important to accentuate that none of the patients did
hormone replacement therapy to osteoporosis.
After the results, the patients were selected and grouped according to the
etiology and CHILD-POUGH and then, they were classified based on T-Score, if
the patient was a man over 50 or a woman on menopause, or based on ZScore if the patient was a man under 50 or a woman in fertile period.
Patients with Tscore > -1 DP were considered normal, Tscore between -1 and 2,5 DP was considered diagnosis of osteopenia and Tscore < -2,5 was
diagnosed with osteoporosis. Considering Z-score, the cut-off used was related
to adequate bone mass for patients age with Z-score > -2 DP or low bone mass
density with Z-score <-2 DP.
76
RESULTS: From the 42 selected patients, there were 24 men and 16 women,
and the most prevalent etiologies were (Picture 1) infection by hepatitis C virus
(16 ou 38%), alcohol (8 ou 19%), hepatitis B virus (7 ou 16%), autoimmune
hepatitis (4 ou 9,5%), primary biliary cirrhosis (1 ou 2,4%) and other causes (6
ou 14%). The average age was 52 years old.
On the male patients, the average age was also 52 years old and bone mineral
density disturb was found in 11 (45,83%) from 24 (100%) patients of this group
(picture 2).
In a sample of 15 male patients, the T-score was analyzed singly (Grafic 3) and
in this group the average age was 58 years old and the average T-score was 1,7. On those patients, the prevalence of hepatic osteodystrophy was 66,3%
and 5 of them were diagnosed with osteoporosis. Analyzing the men with
osteoporosis, the average T-score in this group was -3,18.
From the male patients under 50 years old, the average age was 42, and
average Z-score -0,63. In this group just 1 patient was diagnosed with low bone
density for his age.
In the female group, the average age was 55 years old and 4 patients only had
adequate bone mass.
In female patients with more than 50 years and/or menopausal (13) the average
age was 61 years old. In those women was detected lower bone mass in 11
(85%) of the patients (Imagem 4), osteopenis in 4 (31%) and osteoporosis em 7
(54%).
In a sample of 3 female patients under 50 years or on fertile period, the average
age was 24 and none of them had significant bone mass loss.
On the laboratorial exams analysis, the global patient’s average results were:
25-Hidroxi Vit D : 27 , parathormone: 40,58 , phosphorus: 5,2 e calcium: 9,0.
DISCUSSION/CONCLUSION: Although there was not a clear association
between bone mineral density and etiology of cirrhosis, neither with severity, on
the group, the osteopenia and osteoporosis prevalence is clearly superior to the
average numbers on the general population.
The average age of the male patients diagnosed with osteporosis was 56,3
years old, while on the female group was 61 years old.
It can be concluded that the bone mass decrease is a commom finding on
patients with liver failure and that are two evident risk factors: female sex and
advanced age. We believe that this research collaborates with the current
evidences that hepatic cirrhosis is an important risk factor for bone mass loss
and warns to a closer medical care, especially on female and advanced age.
77
TITLE: Time perception and age.
AUTHOR: Vanessa Fernanda Moreira Ferreira.
MENTOR: João Aris Kouyoumdjian.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Ferreira V.F.M. - FAMERP;
Kouyoumdjian J. A. - FAMERP; Paiva G. P. - FAMERP; Prando N. - FAMERP;
Graça C. R. - FAMERP.
BACKGROUND/INTRODUCTION: Time perception varies individually and
probably there is a relationship with aging. Although the sense that we perceive
time as accelerating as we age is very common, it is hard to prove
experimentally. The neurotransmitter dopamine is critically important to our
ability to process time; attention and memory also play a part in it. So, to
accurately measure time interval with confidence, persons have to be able to
focus and remember a sequence of tasks or information.
OBJECTIVES: Measure the time interval of 2 minutes counted mentally in
subjects of different age groups.
METHODS: Two-hundred and thirty-three healthy subjects, 129 women, were
studied. They were divided into 3 age groups: G1, 15-29 years, n = 86, mean
age = 22.4 years; G2, 30-49 years, n = 76, mean age = 38.9 years; G3, 50-89
years, n = 71, mean age = 59.7 years. The subjects were asked to close their
eyes and mentally count the passing of 120 seconds; when finished up, the
examiner took the elapsed time.
RESULTS: All the time values (seconds) from the groups had normal
(Gaussian) distribution. G1, mean = 114.9 ± 35 seconds; G2, mean = 96.0 ±
34.3 seconds; G3, mean = 86.6 ± 34.9 seconds. The ANOVA-Bonferoni multiple
comparison test-showed very significant comparison G3 versus G1 (P < 0.001).
DISCUSSION/CONCLUSION: Mental calculation for 120 seconds time interval
was reduced in average 24.6% (28.3 seconds) in persons over 50 years of age
when compared to young persons up to 30 years of age. In diseases, it could
be related to dopamine decrease. In healthy subjects, aging are usually related
to decrease interest in learning something new, that requires sustained effort,
slowing down our internal sense of time.
78
ORAL
PRESENTATION
79
TITLE: Carvedilol ameliorates the decrease of left ventricle ejection fraction in
patients with acute cardiotoxicity induced by anthracyclines treatment.
AUTHOR: Raúl Osvaldo Parra Otárola.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Raul Parra, Rodrigo
Carrasco, Fernando Florenzano, Ramon Rodrigo.
BACKGROUND/INTRODUCTION: The successful use of anthracyclines as
antineoplastic agents against breast cancer is limited by the generation of
reactive oxygen species, which are unrelated to the therapeutic effect of the
drug and leads to the development of acute and chronic cardiotoxicity.
Therefore, we put forward the hypothesis that the reinforcement of the
antioxidant defense system, through carvedilol or omega-3 FA, should result in
oxidative stress biomarkers accounting for a protective effect against
cardiotoxicity
OBJECTIVES: Improve biomarkers related to oxidative stress through
pharmacological agents with highly antioxidant power such as carvedilol or
omega 3 fatty acids.
performed including 36 women with breast cancer, having indication of
anthracyclines chemotherapy. They were divided into three randomized groups:
1) omega-3 fatty acids (DHA:EPA ratio = 2:1) plus carvedilol placebo; 2)
carvedilol therapy plus omega-3 fatty acids placebo; 3) carvedilol and omega-3
fatty acids placebos, all patients received one guideline treatment during the
first cycle of chemotherapy since 7 days before until 7 days post treatment with
anthracyclines. Throughout the study, we evaluated the blood biomarkers
related to the antioxidant potential and the levels of lipid peroxidation. Statistical
analyses through Kruskal-Wallis, Dunn's multiple comparison, and Mann
Whitney U tests, with P value <0.05 were considered as significant, GraphPad
software analysis.
RESULTS: Placebo group showed higher lipid peroxidation serum levels and
lower erythrocyte antioxidant potential, but these effects were significantly
attenuated by both interventions.
DISCUSSION/CONCLUSION: The use of carvedilol or omega-3 fatty acids was
able of reducing the systemic oxidative injury and of preventing the decrease of
the antioxidant potential during the first chemotherapy cycle. Data of this pilot
study are consistent with a reduction in the oxidative stress-related
anthracyclines cardiotoxicity; however, more large-scale clinical trials have to be
performed before the effectiveness of this treatment could be established.
80
81
82
TITLE: Face transplantation: technical description and evaluation of the
reproducibility in swine model.
AUTHOR: Caroline Cunico.
MENTOR: Renato da Silva Freitas.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Cunico, C. - UFPR; Silva,
A. B. D. - UFPR; Brum, J. S. - UFPR; Robes, R. R. - UFPR; Freitas, R. S. –
UFPR.
BACKGROUND / INTRODUCTION: Patients with severe facial deformities
represent a challenge for plastic surgery because the current approaches are
not able to offer good aesthetic and functional results. The alternative that has
been explored to overcome these disadvantages is the face transplantation.
This is an approach that retrieves the face functionally and aesthetically. As
their applications are new concepts within the medical field, further studies are
needed to clarify aspects involved in their approaches.
OBJECTIVES: To describe the hemiface transplantation technique used in
swine experimental model, showing the reproducibility of the method and the
feasibility as training model in face transplantation, as well as the
implementation by medical student supervised.
METHODS: This study was conducted in Surgical Technique and Experimental
Surgery Unit of the Federal University of Paraná (UFPR), Brazil. It received
previous authorization from Ethics Committee on Animal Use of the Agricultural
Science Sector (CEUA-SCA - 007/2014). All animals were treated following the
principles of Brazilian law 11.794 / 08.
Seven swines were operated weight between 10 and 20 kg, regardless of the
gender. The procedure took place after euthanasia. In all swines the hemifacial
flap was removed from the left side of the face, which was subsequently
reimplanted at the same site on the same animal from which it was removed.
The periorbital and perioral region were not included in the flap. The vascular
pedicle was made using the facial artery, caudal auricular artery and external
jugular vein. It was taken within the flap the ventral buccal and dorsal buccal
branches from facial nerve and the transverse facial branch from auricular
nerve.
The vascular and nervous microanastomosis were performed with an optical
microscope on increase of 10x and 20x, using monoylon thread 9-0.
RESULTS: It was possible to perform all methodology within the UFPR. The
steps proposed were done by an medicine student supervised by a plastic
surgeon and a veterinary. To make the microanastomoses the student had a
83
basic training in microsurgical techniques based on latex model and spleen
recently removed from a swine.
A total of seven animals were operated immediately after euthanasia or after
cooling. The mean time of procedure was about four hours and a half.
It was not possible to identify the superficial temporal artery as vascular pedicle,
as proposed in the literature, because its location is deep to the mandible
branch. It was found that the vessel that provides blood supply is identified as
caudal auricular artery. The vascularization of the lower facial region is done by
facial artery, as described on the literature.
The vascular anastomosis must be done end-to-end to the structures
corresponding to the same name on the recipient site.
DISCUSSION/CONCLUSION: It was described an experimental model in facial
transplantations in swine, which provide the basis for other studies and training
in face transplantation. The methodology proposed is reproducible in any midst
where offers devices in experimental surgery and microsurgery.
The difficulty of the surgical procedure is proportional to the amount of fat
presented by the animal, but the entire procedure is possible to be performed
by academic supervised and trained in microsurgery previously.
84
TITLE: Determinant factors for treatment and prognosis of patients with
rheumatic valve disease: Case report.
AUTHOR: Gabriella Carolina Vilerá.
MENTOR: Silva, João Clima.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Almeida, Franciny Basilio UNIARA; Darcin, Daniele Ronchi - UNIARA; Domingues, Priscilla Weber UNIARA; Martins, Aleska Sanches - UNIARA; Zavan, Bruno Eduardo Cagnin UNIARA; Silva, João Clima – UNIARA.
BACKGROUND / INTRODUCTION: Rheumatic heart disease is rheumatic
fever’s main complication and has its prognosis given by the degree of valve
dysfunction, providing mitral and / or aortic insufficiencies installation. The
therapeutic approach includes clinical management, repairing procedures
through valve exchange or valve repair and heart transplantation, dependent on
the degree of valve impairment and functional capacity of each patient.
OBJECTIVES: The objective of this report is to highlight the determinants for
the management of valve disorders, correlating them with prognosis and
mortality.
METHODS: The identification of the conduct and the appropriate time for
intervention, considering the prognostic factors of each case justify the
preparation of this report.
RESULTS: Male patient, 30 years old, with history of rheumatic disease in
childhood, presented recumbent dyspnea, associated with asthenia and
syncope, diagnosed with rheumatic mitral and aortic valve disease. Submitted
to valve exchange presented unfavorable evolution and death.
DISCUSSION/CONCLUSION: Valvular disease due to rheumatic heart disease
determines reduced quality of life by symptoms of heart failure and requires
early diagnosis and treatment to improve morbidity and mortality.
85
TITLE: Personal experience along with an observational elective on the Service
of Urgency Medical Care: A model of learning set for surgery and accurate prehospital trauma care.
AUTHOR: Géssica Ribeiro Borges.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Borges, G. R. - Centro
Universitário Barão de Mauá; Fernandes, L. E. - Centro Universitário barão de
Mauá; Lima, L. M. - Centro Universitário Barão de Mauá; Forcin, G. - Centro
Universitário Barão de Mauá; Fuganti, D. V. - Centro Universitário Barão.
BACKGROUND / INTRODUCTION: Urgency and emergency are two great
fields of work of medical specialties. A qualified pre-hospital trauma care is
decisive on a successful treatment. Strategies for teaching improvement that
include these experiences are necessaries to the enhancement of health care in
Brazil.
OBJECTIVES: To describe a personal experience on a learning model based
on suitable pre-hospital trauma care and the impact of it on the undergraduation and early professional experience.
METHODS: Observational and elective internship for 70h on the Service of
Urgency Medical Care (SUMC) of Ribeirão Preto - SP and awareness. Regular
attending to the urgency calls and case’s discussion with the precepts in
service. Execution of basic medical procedures in the pre-hospital trauma care
and inter-hospital transferences. Writing of a report to describe every cases
attended.
RESULTS: Was possible by these experiences practice the previous
knowledge from the under-graduation. It was possible to complete the learning
process of under-graduation with activities such as complete a death certificate,
execute a cardiopulmonary resuscitation, evaluate the hemodynamic status of a
patient and its stabilization. Therefore, it was possible to determine systematic
conducts on stressful environment, experience a humanized trauma health
care, development of emotional control and fast decision-making. In addition, it
was possible to an ethical comprehension and dialogue with high-risk patients
and its family and interdisciplinary health care team as well. Finally, it was
possible to recognize the field of surgical work of the general practitioner and
the improvement of the urgent care medical technic.
DISCUSSION/CONCLUSION: This experience creates a new learning set of
practice and service training. It is possible to take an early professional
experience on urgent medical care and create practical learning mechanisms to
theoretical topics of the under-graduation process. The SUMC is a learning set
86
of practice that can make possible the enhancement of surgery teaching in
Brazil.
TITLE: Bariatric Surgery Techniques: Literature Review
AUTHOR: Henrique Jin Son Kim.
MENTOR: Doctors Nelson Mesquita Junior, Valdecir Volpato Carneiro, Sidon
Mendes de Oliveira, José Maria Lopes.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Corrêa, G. G.- FEPAR;
Pichel, H. L.-FEPAR; Kim, H. J. S.-FEPAR; Okada, J.M.-FEPAR; Woll, J. L.P. FEPAR; Lopes, J. T.-FEPAR; Deboni, V. S.-FEPAR;
BACKGROUND / INTRODUCTION: Obesity is a disease in which the main
feature consists in the excess of body fat. It occurs when the calories offered
are larger than the energy spent. Bariatric surgery is the group of surgery
interventions that aim the patient´s weight loss. The name came from the
Greek, Baros = weight and iatren = to treat. The metabolic and bariatric surgery
gathers techniques with scientific support design to treat obesity and its
comorbidities.
OBJECTIVES: To describe the bariatric surgery intervention’s techniques used
nowadays for better comprehension of the surgeon’s decisions about the choice
of the surgery procedures, based on comparison between the techniques.
METHODS: In the research, 15 articles were used between 2004 to 2014, in
Spanish, Portuguese and English from the data base Lilacs, Medline, Bireme
and Scielo. Also the books “Anatomia Humana” by M. Latarjet, “Histologia
Básica” by L. Junqueira e J. Carneiro and “Anatomia Orientada para a Clínica”
by K.L. Moore. Descriptors : “Cirurgia Bariátrica”, “Técnicas em cirurgia
Bariátrica”, “ Y de Roux”, “Técnicas disabsortivas”, “Técnicas restritivas”,
“Derivação biliopancreática”.
RESULTS: All the 18 references about Bariatric Surgery techniques and the
Digestive system’s anatomy were used.The procedures reviewed
were:Restrictive procedures and Mixed predominantly restrictive and
predominantly disabsorptive procedures.Restrictive procedures are those that
the only modified organ is the stomach and have as objective the gastric cavity
space reduction(ZEVE et al.,2012).Mixed procedures combine restrictive and
disabsortive procedures principles(PRUNELL,2011).Disabsortive procedures
consist of an intestinal diversion that causes reduction of the absortion
area.There are variations in the types of surgery based on those
principles.However bariatric surgery is not a consistent method and it has
metabolic and nutritional effects for the patient caused by malabsortion
(COELHO, 2012).Restrictive procedures limits solid food volume the patient
eats each meal,causing weight loss.The main techniques are adjustable gastric
band and vertical banded gastroplasty(RODRÍGUEZ,2006).
87
DISCUSSION/CONCLUSION: There is a broad variety of bariatric surgery
techniques known and recommended currently. The doctor’s technique choice
is based in information about the function, mechanism, results and risks,
however the bariatric surgery is always the last resource.
88
TITLE: Experimental model in inguinal herniorrhaphy.
AUTHOR: Jéssica Palma Soares.
MENTOR: Marcio Rivison Silva Cruz.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Lopes, H. D. P. - Escola
Bahiana de Medicina e Saúde Pública (EBMSP); Porto, J. S. - FTC; Santana, J.
C. – EBMSP.
BACKGROUND / INTRODUCTION: The practical learning of surgical
technique is changing. Traditionally, animals are used as biological models for
this practice. In order to reinforce the ethical principles and animal rights,
academics from Liga Bahiana de Clínica Cirúrgica (LBCC) have considered
developing inanimate models for training, including the experimental model in
inguinal herniorrhaphy, so that this model could besides replacing the animal
model, also expand the development of surgical skills.
OBJECTIVES: Approach the medical student to surgical practice by using an
experimental model in inguinal herniorrhaphy prepared by LBCC, expanding the
teaching quality of surgical technique. Show the manufacturing process of the
experimental model, demonstrate practical applicability, overall average cost
and maintenance and the estimated average time for the mounting process.
METHODS: For the construction of the experimental model in inguinal hernia
repair there are used inexpensive inorganic materials with easy accessibility,
creating a reusable base formed of an MDF box 17x6x6 cm, with an inner lining
of common foam 2cm thick, simulating right inguinal region. To make the
inguinal canal and layers of the abdominal wall canal it was used a varnished
polyurethane sheet simulating the transverse fascia and the transverse muscle
of the abdomen, being attached to this sheet a sheet of polyurethane sickle to
simulate the tendon portion of the internal oblique muscle, and a clothesline
below that, simulating the inguinal ligament. To simulate the funiculus was used
a pantyhose as tubular structure containing a string and hernia sac consisting of
cami tissue. A latex hose is placed inside the bag reproducing a content to be
reduced. These structures are fixed at the polyurethane sheet and covered with
an EVA sheet with an external inguinal ring, which is covered by foam and
polyurethane, simulating the skin and the subcutaneous tissue. Such structures
are disposable and can be prepared previously for making and replacement of
the experimental model.
RESULTS: The model is easy to reproduce and has an overall average cost of
R$ 50.00 to manufacture five reusable bases with its lining and R$ 3.00 as
maintenance cost for replacement of disposable structures for each
experimental practice. The estimated average time for assembly line for twentyfive structures is equivalent of one hour.
89
Its use in theoretical and practical extracurricular courses of an academic
league (LBCC) had proved to be capable to approach the medical students to
the technique of this surgery, increasing their quality of execution of surgical
maneuvers and the anatomical and surgical expertise required to the
understanding of the inguinal region. Besides, LBCC had positive response
from the course participants, showing that the experimental model brought them
better learning of the surgical technique without the worry about animal’s rights.
DISCUSSION/CONCLUSION: The construction of inguinal hernia model is
easy to manufacture, inexpensive and can be used as an important study tool
and training. It enable to approach medical students to the surgical reality.
90
TITLE: Coconut Water Solutions for the Preservation of Spleen, Ovary, and Skin
Autotransplants in Rats.
AUTHOR: Matheus Sewastjanow Silva.
MENTOR: Andy Petroianu.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: J.M. Schettino César¹, A.
Petroianu¹, L. de Souza Vasconcellos¹, V.N. Cardoso¹, L. das Graças Mota¹,
A.J.A. Barbosa¹, C.D. Vianna Soares¹, A. Lima de Oliveira¹, M. SewastjanowSilva¹; ¹Universidade Federal de Minas Gerais – UFMG.
BACKGROUND / INTRODUCTION: Techniques for organ and tissues
preservation for transplantation replace blood with other solutions to render the
organ tolerant to hypothermia, reduce metabolism, and avoid vascular
obstructions caused by blood clots. The composition of the preservation
solution is determinant of the tolerance of the organ to storage in hypothermic
conditions. The solution developed at the University of Wisconsin (Belzer) at the
end of the 1980s has allowed for significant advances in organ preservation.
Studies that used gametes of different animal species have shown that green
coconut water (ie, the endosperm of Cocos nucifera L.) preserves the pre-antral
follicles of goat, sheep, and human semen. This solution also preserves bovine
oocytes and embryos.
OBJECTIVES: The objective of this study was to verify the efficacy of coconut
water in the preservation of splenic, ovarian, and skin tissues for
autotransplants.
METHODS: Fifty female Wistar rats were divided randomly into 5 groups on the
basis of the following tissue graft preservation solutions: group 1, lactated
Ringer's; group 2, Belzer's solution; group 3, mature coconut water; group 4,
green coconut water; and group 5, modified green coconut water. In group 5,
the green coconut water solution was modified to obtain the same electrolyte
composition as Belzer's solution. The spleen, ovaries, and a skin fragment were
removed from each animal, stored for 6 hours in one of the solutions, and then
re-implanted. The recoveries of tissue functions were assessed 90 days after
surgery by means of spleen scintigraphy and blood tests. The implanted tissues
were collected for histological analyses.
91
RESULTS: Higher immunoglobulin G levels were observed in the animals of
group 5 than in the animals of group 1. Differences in follicle-stimulating
hormone levels were observed between groups 1 and 2 (P < .001), between
groups 4 and 2 (P = .03), and between groups 5 and 2 (P = .01). The spleen
scintigraphy results did not differ among the groups. The ovarian tissue was
better preserved in the mature coconut water group (P < .007).
DISCUSSION/CONCLUSION: Solutions containing coconut water allowed for
the preservation of the spleen, ovaries, and skin for 6 hours, and the normal
functions of these tissues were maintained in rats.
92
TITLE: Influence of local or systemic corticosteroids on skin wound healing
resistance.
AUTHOR: Matheus Sewastjanow Silva.
MENTOR: Andy Petroianu.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Luiz Ronaldo Alberti¹;
Leonardo de Souza Vasconcellos¹; Matheus Sewastjanow Silva¹;Andy
Petroianu¹; ¹Universidade Federal de Minas Gerais – UFMG.
BACKGROUND / INTRODUCTION: The effect of prolonged use of
corticotherapy on surgical wound healing shows conflicting results in literature.
Several factors participate in this controversy, depending on the type and
dosage of corticosteroids used, species of animals, period of treatment, and
methods of evaluation of healing efficacy.
The need for further studies in order to understand the effects of corticosteroids
on skin healing motivated this project, which is part of a line of research on
wound healing.
OBJECTIVES: The purpose of this study was to compare the resistance of skin
wound healing of mice submitted to local or systemic hydrocortisone
administration, in different postoperative periods.
METHODS: An incision and suture was performed on the thoracic skin of 130
male mice: Group 1 (n = 10) resistance of the integer skin; Group 2 (n = 30)
submitted only to skin incision and suture; Group 3 (n = 30) skin incision and
suture followed by administration of saline fluid; Group 4 (n = 30) skin incision
and suture followed by administration of local hydrocortisone; Group 5 (n = 30)
skin incision and suture followed by administration of systemic hydrocortisone.
The resistance of the wound healing and the weight of the animals were studied
on the seventh, 14th and 21st postoperative days. Histological examination was
also performed.
RESULTS: The mice that received corticoid (groups 4 and 5) presented
significant decreasing on their weight (p = 0.02). The Groups 3, 4 and 5 showed
lower scar resistance than Group 2 on the seventh postoperative day (p < 0.05).
On the 14th and 21st days, there was no difference on the skin would healing
resistance (p > 0.05).
DISCUSSION/CONCLUSION: Administration of hydrocortisone in mice is
responsible for weight decreasing and reduction of the skin wound healing
resistance during the first postoperative week.
93
TITLE: Profile of surgical procedures performed on trauma victims in a
countryside public hospital of Bahia.
AUTHOR: Murilo Fernandes de Souza.
MENTOR: Aline Silva Gomes Xavier
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Silva, B. B. - UEFS; Araújo,
T. C. D. - UEFS, Rios, F. M, A. - UEFS; Souza, M. F. de - UEFS; Paz, M. S. A HGCA; Xavier, A. S. G. - UEFS; Santos, S. S. B. – UEFS.
BACKGROUND / INTRODUCTION: Trauma can be defined as a cluster of
disorders. It is any organ damage, tissue or body part, caused by unforeseen
events of unwanted derivations, from a physical agent of etiology, nature and
varied extension predominantly caused by external sources. The traumatic
injury generally has a surgical outcome, being the treatment of high risk since
there is no time for proper evaluation of the patient, with the intraoperative
element as the most serious, since there is a possibility of adverse events
during the treatment.
OBJECTIVES: Thus, the objective of this study was to describe the profile of
surgical procedures performed on trauma patients in a countryside public
hospital of Bahia.
METHODS: This is a retrospective, exploratory, descriptive, with quantitative
approach study. It was conducted at the Medical Archive and Statistics Service
(SAME) of a public hospital in Bahia, through the analysis of medical records of
men and women with multiple trauma. The following inclusion criteria were
used: over 18 years, admitted to the unit in April to May 2013 and be submitted
to any surgical procedure, because these are more severe trauma cases. Data
collection was performed using document analysis technique, with an
investigative record previously designed to standardize the information collected
from the medical records. Data were analyzed using statistical program
Statistical Package for the Social Sciences version 22.0.
RESULTS: Hence, 112 medical records were analyzed between the months of
April and May 2013. Regarding gender, there was a prevalence of males 80.3%
(90). There was a higher incidence of trauma victims in the younger age group
18-28 years, with 33.9% (38). It should be noted that the third place was
occupied by the elderly population with a prevalence of 16.9% (19). Moreover, it
was observed that the procedure more performed were surgical treatments of
extremities, particularly the lower limbs, involving 24.1% of this procedures.
Also it was noticed that the laparotomy, a highly invasive procedure, was in
second place with prevalence of 20.5%, followed by thoracic drainage with
19.6%. Osteosynthesis had the prevalence of 11.6%. The use of blood bags
94
was observed in 18% of the cases(21). On the need for intensive care unit
(ICU), 7.14% of the victims were admitted to this care unit.
DISCUSSION/CONCLUSION: The young and economically active population
are part of a significant portion of trauma patients. These require invasive
surgical procedures, blood bags and ICU, as well as it raises costs to the state
and the society due to the increase of disability and the need of
orthosis/orthopedic prostheses. Therefore, educational public policies are
required mainly on this population, as also more staff training and qualified
hospital institutions to assist victims of trauma, reducing possible and after
complications caused by overloaded services.
95
TITLE: Peripheral Vascular Disease Evaluation of Elderly in a Long-Stay
Institution.
AUTHOR: Rebeca Florence Portaro Blum.
MENTOR: Dr. Murillo Couto.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Murilo Cazellato Pacheco
de Mello; Murillo Antonio Couto.
BACKGROUND / INTRODUCTION: This study aims to verify the existence and
incidence of peripheral vascular disease in institutionalized elderly and observe
if there were previous diagnosis of the same. The lnstitution analyzed (Recanto
Monsenhor Albino) has 60 seniors, but only 28 were able to be evaluated. With
the data we got, it was revealed that among our sample, there are signs of
vascular disease in the majority of patients analyzed. Some patients have both
arterial and venous signs of vascular diseases. Some skin changes were noted
(hyperkeratosis, hyperpigmentation) in our sample, and there is a need of
making differential diagnosis of skin diseases. Conclusion: Vascular diseases
have high incidence in the elderly of our institution and only one patient had a
previous diagnosis. We believe that the results may contribute to a better
diagnosis, treatment and prognosis for the elderly of our institution. Keywords:
Long stay institutions. Peripheral vascular disease.
OBJECTIVES: This study aims to verify the existence and the incidence of
vascular diseases in the elderly of our institution (Recanto Monsenhor Albino)
and check if there is a previous diagnosis of the same.
METHODS: The institution has 60 seniors, but some could not be examined by
the poor general condition. Our series included 28 patients Recanto Monsenhor
Albino. As methods, we have used history and clinical examination aimed to
vascular diseases that were applied on June 7th 2014. Each patient has a
registration form which states: identification, main complaint and duration, the
current disease history and medical history and data of venous and arterial
physical examinations.
RESULTS: Among the participants (28), 10 were male (35.7%) and 18 were
female (64.3%); Ages ranged from 55 to 102 years with an average of 72.07 ±
12.76 years. Only 13 seniors were able to answer or had reliable answers.
Complaints consistent with a possible peripheral vascular disease were found in
6 elderly.In arterial inspection it was revealed several findings that may indicate
a lack of perfusion in the lower limbs. Twenty-two seniors presented absence of
pulse in one or more places in the lower limbs examined (femoral, popliteal,
anterior tibial, posterior tibial and dorsalis pedis. Twenty-six of the 28 study
96
participants aged containing one or more signs of venous insufficiency or DVT.
The majority (96.42%) of patients had no previous diagnosis of peripheral
vascular diseases and in the minority of patients (21.42%) had a typical
vascular complaint. Venous signals (92,85%) were more common than arterial
(78.57%). Sixteen residents (61.53%) had both venous and arterial signals.
DISCUSSION/CONCLUSION: According to our data, it was revealed that
among our sample, there are signs of vascular disease in a large number of
patients studied. Some patients have signs of both arterial and venous
diseases. Some skin changes were noted (hyperkeratosis and
hyperpigmentation) and it is necessary to make differential diagnosis with skin
diseases because they are very common due to age and are located in large
solar exhibition areas (in the northwest of São Paulo state, region where this
work was done, there is a lot of rural workers who are exposed to solar radiation
many hours a day). The population analyzed, despite being high risk and
showing signs of vascular diseases, got no routine monitoring of these
diseases, nor confirmed his previous diagnosis. Twenty-two seniors presented
absence of pulse in at least one location analyzed in the lower limbs, which may
indicate a chronic peripheral arterial disease. This condition can lead to various
consequences, such as claudication and chronic pain. Chronic pain interferes in
various aspects of quality of life, including sleep quality. As the pain interferes
with an individual's sleep quality, people who sleep little feel more pain. There is
a strong association between sleep disorders and disease and / or death, and is
known fact that poor or insufficient sleep is enough unpleasant and is reflected
in the performance, behavior and well-being, during activities of daily living.
Swelling, pain to palpation, cyanosis of the lower limbs, hyperthermia and calf
tenderness are signs that may indicate deep vein thrombosis. Twenty-six of the
twenty-eight participants had at least some of these signs. DVT should always
be diagnosed and treated, because among its complications, the most feared is
pulmonary embolism, potentially fatal. Pressure ulcers are possible
complications to occur in people in fragile situations, particularly those with
mobility restrictions and old age, often in long stay institutions. No pressure sore
was found in our sample which indicates that the nursing care is being effective.
These institutions should have regular assessments of vascular surgeons,
dermatologists and angiologists to diagnose and treat the most common
morbidities in its residents. The prevalence of these diseases in the elderly is
high, but the outcome would be much better with early diagnosis. One reason
that the monitoring of professional experts not occur is the difficulty to train
specialists due to the small number of medical residencies, hindering the care
of the elderly. According to the study "National Assessment of medical experts
demand perceived by health managers" of the Universidade Federal de Minas
Gerais (2009), the medical specialty recognized with fewer specialists is
vascular surgery, with less than one professional for every 100 000 inhabitants.
More than half of these professionals are in the Southeast, and even in this
region, there are less professional than recommended. CONCLUSION Vascular
97
diseases have high incidence in the elderly of the institution analysed and only
one patient had a previous diagnosis. We believe that the results may
contribute to better diagnosis, therapy and prognosis for the elderly of the
institution. The results should be a warning to other long stay institutions and
health professionals working in similar locations, as these diseases proved to
be very common in our sample, including those who did not complain with
specific complaints for vascular diseases.
98
TITLE: Transcatheter Aortic Valve Implantation: A Review.
AUTHOR: Stephanie Senna.
MENTOR: Professor Doctor Luiz César Guarita Souza.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Advisor teacher: Professor
Doctor Luiz César Guarita Souza (Universidade Federal do Paraná).
BACKGROUND / INTRODUCTION: Consequent to the progressive increase in
life expectancy, the prevalence of valvular diseases is on the rise. Acquired
Aortic stenosis (AS) is the most frequent cause of valvular heart disease in the
Occident (BRAUNWALD, 2003), reaching about 5% of the population over 70
years. With gradual obstruction and myocardial overload, and result in death
within 2 years after the onset of symptoms, the search for an effective treatment
is imperative. The "gold standard" advocated for decades is surgical valve
replacement, often disregarded because of the severity of the disease,
advanced age and pre-existing comorbidities. In 2002, Cribier brought
percutaneous aortic valvuloplasty as an alternative and from the advance
techniques and devices, their use has potentially expanded. Aiming to review its
feasibility, progress and results this study was developed.
OBJECTIVES: Reviewing feasibility, progress and results of Transcatheter
aortic valve implantation.
METHODS: Research database in Medline (PubMed), Cochrane Library and
Science Direct (Elsevier) selecting articles related to the topic "Transcatheter
aortic valve implantation." Keywords: "tavi", "transcatheter aortic valve
replacement / implantation," "minimally invasive," cardiac surgery "and" aortic
valve stenosis." Inclusion criteria: review articles, systematic reviews, metaanalyzes or randomized controlled trials; Posted over the last 3 years; studies in
humans; full text. Exclusion criteria: inespecific themes; editorial articles;
incomplete articles; access not granted by the University; languages other than
English. There was a selection of 62 articles, besides other 11, as indicated by
teacher advisor; totaling 73 jobs.
RESULTS: Heart team involvement; advanced image methods; consideration
of comorbidities; use of scores (such as EuroSCORE, EuroSCORE II and the
Society of Thoracic Surgeons / STS); and improvement of first-generation
prostheses - Edwards SAPIEN and SAPIEN XT (Edwards Lifesciences) and
CoreValve (Medtronic Inc) - were essential factors to the clinical outcomes,
according to the analyzed studies. It emphasizes the approach from different
access - transfemoral (TF), transapical, subclavian, axillary and transaortic -
99
and the influence of cerebral protection devices and vascular anticoagulant /
antiplatelet therapy and progressively smaller catheters. Searching for more
durable and less invasive techniques devices, percutaneous approach has
been showing similar mortality to surgical methods, including in specific
conditions such as "porcelain aorta." Favorable results has been presented with
consequent increase in valve area, reduced mean valve gradient and improved
ejection fraction; associated with improved quality of life, NYHA functional class
/ New York Heart Association and hemodynamic performance with no
significant valvular deterioration. Morbid outcomes: peripheral vascular disease
(VARC criterion / Valve Academic Research Consortium), TF access; and
higher risk of early cerebrovascular events and valvular regurgitation, with
recent trend to decreasing. Prognosis determinants: kidney damage, inherent to
the contrast, and high implantation rates of "pacemaker" for consequential
conduction defects. Finally, there is the effect of the learning curve, and the
resulting reduction in operating time and radiation exposure. Other alternatives
are also identified, such as sutureless valve implantation, using a minimally
invasive approach.
DISCUSSION/CONCLUSION: The percutaneous approach has proven to be a
safe and effective option for the treatment of AS, aggregating structural and
functional improvement; especially in high-risk surgical patients. Its use must
comprehend proper anatomical and clinical evaluation. Greater experience in
the use of this technique is essential. Likewise, there is a need for development
of further studies, comparing multiple approaches - surgical, percutaneous,
minimally invasive, as sutureless implant - and including not only extreme risk
patients; as well as the consideration of factors such as associated diseases,
gender, ethnicity and age.
100
TITLE: Non-heart beating donor: an alternative for increasing organ donor pool.
AUTHOR: Verônica Westphal
MENTOR: Fabio Tremea Cichelero. Sandra Maria Gonçalves Vieira.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Westphal, V. - ULBRA;
Farret Jr, A. - ULBRA; Cichelero, F.T. – ULBRA.
BACKGROUND / INTRODUCTION: Due to medical advances in the last few
years, there have been improvements in intensive care and accidents
prevention, such as stroke. This decreased brain death (BD) diagnosis, which
evidences the need of a bigger donor pool. Therefore, organ transplantation by
non-heart beating donor (NHBD) has become an alternative.
NHBD is categorized by Maastricht classification. NHBD type I and II is the
donor who has suffered cardiorespiratory arrest (CRA) before (type I) or after
(type II) having attended the hospital. In those cases, CRA is unpredicted and
not controlled, and there are resuscitation attempts. Furthermore, there is
NHBD by CRA in medical control context. It may be type III, when there is
programming and limitation of vital support treatment, or be type IV, when there
is CRA during BD diagnosis.
OBJECTIVES: To clarify if NHBD could contribute and constitute a benefit for
society or if, otherwise, it may be prejudicial to the donor or to the receptor. To
gather bibliographic information about how to determine time of death from
CRA. To evaluate obstacles in relation to NHBD application in Brazil with regard
to the need of short time in CRA, so that the organs don’t suffer too long
ischemia.
METHODS: Literature review realized with information from 9 studies about
NHBD. Those studies included clinical trial, case-control and reviews, all found
in Scielo database.
RESULTS: In one study, six cases of NHBD were attended. They were realized
in presence of a surgical team when CRA was diagnosed, with immediate liver
removal. All the receptors had an excellent post operatory evolution.
In another article, six cases of kidney transplantation by NHBD Maastricht III
were attended. It reports some kidneys have had significant ischemic damage.
Otherwise, despite some of the studies state that kidneys from NHBD have
101
inclination to suffer acute rejection, they describe that at average term there are
no distinctions between patients and grafts survival in relation to BD donors.
Thus, a major problem of NHBD is ischemia, which can lead to decreased
organic function transplants. Some techniques identified in the studies are
useful to protect organs for more successful outcomes, such as thoracic
compression mechanic dispositive and ECMO (extracorporeal membrane
oxygenation).
With regard to form and moment of death time determination, one study claims
that it must exceed the time of CRA by 10 minutes so that CRA and BD death
can be declared simultaneously. Thenceforth, it is not possible to recover
myocardial function and there could be irreversible loss of all neurological
functions.
DISCUSSION/CONCLUSION: Our review led to the conclusion that NHBD
could contribute beneficially to the society. Despite the apparently increased
risk of organ ischemia, the clinical outcome related in major studies has
achieved good results for both kidney and liver transplantation.
NHBD type III has been demonstrated as the most effective and ethic model,
due to the preservation and respect of family desires. However, Maastricht III is
not legally available in Brazil, due to the necessity of programming CRA.
According to our legislation, NHBD application will be only possible in our
country if under I, II and IV Maastricht classification.
The implementation criteria for NHBD must be subjectively analyzed creating a
protocol that will ensure an effective opportunity to increase the pool of
available organs for transplantation.
102
103
TITLE: A new method to measure intestinal secretion using FITC-Inulin in small
bowel of rats.
AUTHOR: Omar Gabriel Torres Valencia.
MENTOR: Dr. José Gerardo García Aguirre, Dr. Juan José Plata Muñoz, Dr.
Jorge Eugenio Valdez García.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: A. Munoz-Abraham1, G.
Torres-Valencia1,2, T. Alfadda1, C. Jasinski1, R. Patron-Lozano1, M. I.
Rodriguez-Davalos1, J. P. Geibel1
1Yale University School Of
Medicine,Surgery - Transplant,New Haven, CT, USA, 2Escuela Nacional de
Medicina, sede Ciudad de México.
BACKGROUND/INTRODUCTION: Intestinal ischemia remains a major
limitation in successful intestinal transplantation. Several animal intestinal
ischemia models have been developed and used. However, rats remain as the
most commonly used. The fragile balance of the intestinal mucosa relies on
stable homeostatic mechanisms.
OBJECTIVES: To develop a new method to objectively measure osmotic
changes in the intestinal lumen of rats that equate to injury.
METHODS: We used Sprague Dawley rats (401 to 442 grams).The rats were
anesthetized and euthanized with isofluorane. 20 cm of distal ileum were taken
and stripped from the mesentery. The intestinal lumen was flushed with regular
HEPES solution (pH 7.408, mosm 297) to remove any remaining intestinal
debris . The intestinal loops were then attached to two custom perfusion
chambers that received a constant flow of regular HEPES solution. The
chambers were submerged in a bath of deionized water at 37 C . At time 0, a
known concentration of 3 ml of 0.001 mM FITC-Inulin was perfused into both
lumens. Samples were collected and Relative Fluorescence Units (RFU) were
measured using the NanoDrop 3300 Fluorospectrometer. The control intestine
remained receiving a flow of regular HEPES, while the experimental intestine
was bathed with a flowing solution of 10 M Forskolin in a perfusion volume of
200 ml regular HEPES. Samples from the lumen were again collected from both
intestines at times 25 and 35 minutes, and measured.
RESULTS: A significant increase in luminal secretion was observed after the
administration of the 10 M Forskolin solution by observing the decrease in RFU
units by almost half in the experimental intestine compared to the control.
104
DISCUSSION/CONCLUSION: It can be concluded that the use of FITC-Inulin
can be an effective and objective method to measure fluid secretion or
absorption in the small bowel, thus giving a more accurate estimate of the
viability of the organ. By measuring the difference in RFU of a known solution
after stop flow in the small bowel we demonstrated that absorption and
secretion processes take place depending on the pathophysiological state of
the organ. Absorption was observed when the intestine was maintained in
physiological-like conditions, while secretion of large amounts of water into the
lumen occurred when FSK was administered. In both cases the change in RFU
using the method proposed gave accurate reproducible results with small
sample variations demonstrating the usesfulness of this model system for
assessing intestinal viability.
105
TITLE: Monitoring the effectiveness and safety of surgical techniques for
repairing retinal detachment.
AUTHOR: Petra Haluzová.
MENTOR: MUDr. Oldrich Chrapek, PhD.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Boriincová Eva.
BACKGROUND/INTRODUCTION: Detachment of the retina is a separation of
its neurosensory and pigmented cell layer. We meet with the rhegmatogenous
detachment of the retina most frequently. This type is caused by retinal tear and
we use three surgical techniques for solving this problem - cryosurgery
(historically the oldest one), pars plana vitrectomy (PPV) or pneumatic
retinopexy.
OBJECTIVES: The targets were to evaluate the results of surgical techniques
for solving the detachment of the retina - to assess the success rate of first
operations in dependence on the selected operation technique, to evaluate the
number of re-operations.
METHODS: The evaluated team (totally 334 patients) included patients with
non-complicated idiopathic rhegmatogenous retinal detachment operated on in
the Eye Clinic of the University Hospital Olomouc from 2003 to 2013. The
patients were treated with the cryosurgical technique or PPV, respectively with
their combination. The repositioning of the retina was evaluated one to three
months after the operation.
RESULTS: Using cryosurgery the surgeons managed to reposition the retina to
its proper position with one operation with 106 (88%) from totally 120 patients.
The retina could not be returned to its proper position with 14 (12%) patients in
the first operation. These 14 patients were re-operated, Totally the repositioning
of the retina was unsuccessful with 3 patients. Using the PPV the surgeons
managed to reposition the retina to its proper position with one operation with
193 (84,6%) from totally 228 patient. The retina could not be returned to its
proper position with 35 (15,4%) patient in the first operation and a re-operation
was necessary. After re-operations the retina could not be returned to its proper
position with 1 patient.
DISCUSSION/CONCLUSION: The results show that there is no significant
difference between the success rates of the respective methods. It is however
up to four times more probable with the PPV method that a cataract might
develop within one year after the operation. The cryosurgical methods are more
gentle in this respect. We should not therefore forget them, especially with
patients with their own clear lens and preserved accommodation.
106
TITLE: Critical Analysis of Treatment Protocol applied to Complicated Thoracic
Surgical Wounds after Sternotomy.
AUTHOR: Sumaya Abdul Ghaffar.
MENTOR: Samuel Terra Gallafrio.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Thomaz Tourinho de
Menezes - University of São Paulo; Franklin Monaco - University of São Paulo;
Rolf Gemperli - University of São Paulo.
BACKGROUND/INTRODUCTION: One of the inherent complications that
actually can happen to any procedure is the surgical wound infection. The most
common surgical access used in cardiac surgery is the median sternotomy,
which can complicate with infection. The clinical presentations of median
sternotomy infection vary from simple hyperemia, local pain and edema around
the surgical wound, to dramatic mediastinitis, and sternal osteomyelitis. The
Association of critical inflammation and comorbidities decompensation, results
in high mortality rates and morbidity, long time hospitalization and wide patient
manipulation and invasion, worsening the prognosis of the infection. The name
to be used also generates some confusion. Searching on the ICD-10 there’s no
correspondence for the following terms: mediastinitis, operatory wound
infection, sternotomy infection or sternal osteomyelitis. For this reason, in this
study, these terms will be, initially, treated as synonymous - deep sternal wound
infection (DSWI). The USA Center of Disease Control and Prevention (CDC)
defines mediastinitis as the presence of at least one of the following criteria:
1. Patient has organisms cultured from mediastinal tissue or fluid obtained
during an invasive procedure.
2. Patient has evidence of mediastinitis seen during an invasive procedure or
histopathologic examination.
3. Patient has at least 1 of the following signs or symptoms: fever (>38°C),
chest pain*, or sternal instability*
And at least 1 of the following:
a. purulent discharge from mediastinal area
b. organisms cultured from blood or discharge from mediastinal area
c. mediastinal widening on imaging test.
* With no other recognized cause"
DSWI results of multiple factors: previous colonization of the wound edges;
surgical materials asepsis; human asepsis failure; extended wound exposition
environment, immunosuppression (base diseases); low prophylactic antibiotics
efficiency among others. The best strategy on dealing with diseases will always
107
be its prevention. Medical literature shows DSWI rates between 0,5% and 10%;
while the mortality rates reaches up to 50%.
The treatment used for DSWI was redo sternal suture, wound washing,
continuous irrigation until its resolution by second intention. This treatment
demands extended hospitalization, wide wound manipulation, open wound with
constant secretion and the patient confinement to its bed. The need of enhance
the quality of DSWI care, reduce the hospitalization time, improve the patient’s
quality of life and reduce treatment global costs, lead up an alternative surgical
treatment. It resumes, in generally way, in aggressive wound debridement in the
first procedure, using negative pressure wound therapy (NPWT), to prepare the
wound bed for definitive closure using myocutaneous or fasciocutaneous flaps.
The DSWI high morbidity and mortality rates, leads us to apply the surgical
protocol at the simple DSWI suspect.
OBJECTIVES: This study aims to perform a retrospective data collection of
patients that developed DSWI after cardiac surgery, and were treated by the
Plastic Surgery team at the Heart Institute of Clinics Hospital of Medicine
Faculty of University of São Paulo (InCor - HCFMUSP) during 2014. The data
will be analysed for epidemiologic profile and prognosis factors. The results can
improve the standardized treatment protocol used at InCor and improve
knowledge about DSWI
METHODS: 1. Medical Records Analysis
The medical records of the patients that were treated at InCor - HCFMUSP
during the year of 2014 were evaluated. Data were collected from those who
evolved DSWI and were treated by the Plastic Surgery team. The variables
collected refer to some epidemiologic aspects such as age, gender, and
comorbidities: systemic arterial hypertension (SAH), diabetes (DM),
dyslipidaemia, and coronary arterial disease. The use of thoracic internal
arteries when the cardiac surgery was a myocardium revascularization coronary artery bypass graft (CABG), body mass index (BMI), smoking habit,
number of procedures, and blood test results such as C-Reactive Protein (CRP)
and Leucogram were also collected
2. Statistical Analysis
The pure data was collected using Microsoft® Excel®, and the statistical
analysis was made using Prism® 6 for Mac® OSX®. There were two groups of
data to be compared: the first one of the patients who evolved DSWI, were
treated using the plastic surgery systematized protocol and survived, and the
second group of the patients who evolved DSWI, were treated using the plastic
108
surgery systematized protocol, but died. The data between this two groups were
statistically compared.
3. Research for risk factors and bad prognosis markers
This study will serve to future studies which aims to relate specific
comorbidities, its combination, or blood test results as risk factors for bad
prognosis. At the same time, looking for information that allows the
development of new prevention strategies to enhance the DSWI treatment,
reducing its mortality rate.
4. Improving the Systematized Treatment Protocol
At the end of the study, based on the data collected and in pertinent medical
literature, the specific Systematized Treatment Protocol that is applied by the
Plastic Surgery Team will be improved and actualized, aiming on reach the best
therapeutic choice for each patient, in continuous and sustained evolution.
RESULTS: 64 patients data was collected. All of them submitted to cardiac
surgery with median sternotomy and evolved DSWI in the postoperative period,
immediate or late. All the patients were treated with the surgical approach
previously mentioned, with the systematized treatment protocol at InCor HCFMUSP. Out of the 64 patients, 30 were women (47%) and 34 were men
(53%); the median age was 62 years old. Among the patients, 84% (54 out of
64) had at least one comorbidity; which 81% had SAH, 50% had DM, 46% had
dyslipidaemia and 53% had arterial coronary disease. Obesity (characterized as
BMI value higher than 30kg/m2) was present in 47% of the patients, but had
some lack of data in this factor. 40% of the patients were smokers. The use of
the internal thoracic artery for myocardium revascularization was found in 37
patients - which corresponds to 57% of the total - which developed DSWI and
the levels of CRP got lower in 75% of the patients after the first approach (wide
debridement) of the plastics surgery team. The average elapsed time between
the cardiac surgery and the first approach of the Plastics Surgery was of 35,7
days. The average number of procedures done by the plastic surgery team in
each patient was de 2,5 and varied from 1 to 7. There were 5 patients that a
new procedure was necessary after the wound closure. The most common
used technique was the bilateral fasciocutaneous flap. There were 11 deaths,
which characterizes 17% of the patients. 1 single patient had to undergo
another hospitalization after discharge, because of new wound dehiscence and
chronicity of osteomyelitis (recurrence). Looking only at the data of the 11
patients that died, the following data was obtained: the median age was 61
(versus 57 years in the group of successful treatment, p=0,91) and all of them
(100%) had at least one comorbidity. 81% of these patients had SAH (the same
81% in the group of successful treatment, p=0,96), 63% had DM (versus 47% in
the group of successful treatment, p=0,32), 63% had arterial coronary disease
(versus 51% in the group of successful treatment, p=0,44) and 45% had
109
dyslipidaemia (versus 47,2% in the group of successful treatment, p=0,91).
When counting only these specific comorbidities, 2 patients (18%) had at least
two of them associated and 6 (54%) had three or more associated. Besides,
72% of the patients had others comorbidities such as congestive heart failure
renal failure, or immunosuppression because of some organ transplantation.
36% of the patients who died were smokers (versus 39% in the group of
successful treatment, p=0,84) and 40% were obese, with no comparison with
the successful treatment group because of the lack of data. The use of internal
thoracic arteries was verified in 63% of the patients and the most common
cardiac surgery performed was CABG with extracorporeal circulation (5
procedures - 45%).
Considering that 6 of these patients didn’t have complete data in CRP levels, a
reduction was verified in the average levels of CRP after the plastic surgery first
approach on 71% of the cases. The average initial CRP level in the patients
who died - before the approach of the Plastics Surgery - was 143,2mg/L,
decreasing to 65,12mg/L after the wound closure procedure - decrease of 55%
from the initial value. Still about the CRP, the average initial level was
143,2mg/L (versus 44,1mg/L in the group of successful treatment, p= 0.0053).
The same was found about the Leucogram: 11.490 leukocytes as the average
initial counting, versus 6.750 leukocytes in the group of successful treatment,
p=0,0374. The average elapsed time between the cardiac surgery and the first
approach of the Plastics Surgery was 22 days (versus 30 days in the group of
successful treatment, p=0,059). The average number of plastic surgery
procedures per patient was 3,0 and 36% of the patients died after the wound
closure with flaps.
DISCUSSION/CONCLUSION: Present in 84% of the analysed patients and in
100% of those who died, the comorbidities are prevalent in patients that
developed DSWI. The SAH is the most common, representing 81% of the total,
but the data fail reveal some relation between comorbidities and death once the
DSWI is installed. Maybe it can have his role on the development of DSWI, but
once installed, it fails to prove some relation with bad prognosis. Among all the
variables analysed, obesity and smoking are the behavioural comorbidities,
therefore the ones that could be treated before the cardiac surgery in those
elective cases. The study has found considerable prevalence of these two
comorbidities, with rates of 47% and 40% respectively. The values are also
significantly in patients that died, with 40% and 36% respectively. Again, the
data fail in show some relation between these two comorbidities and a higher
risk of death once DSWI is already installed. The use of internal thoracic
arteries was present in 57% of the all patients and a similar presence in the
deaths, of 63%. Because of the low number of patients, it’s not possible yet to
take definitive conclusions. The CRP levels show relation with bad prognosis:
the initial level of 143,2mg/L was significantly higher in those patients who died
110
than in the patients who survived (44,1mg/L), with p=0.0053. This suggests that
the patients who have higher levels of CRP at the first evaluation have a higher
risk of death of DSWI, regardless the surgical protocol. It would be very
interesting if there were a "cut-off" number for that risk. Maybe in the future, with
a higher number of patients treated. The same happened with the leukocytes
blood counting: 11.490 in the group that died versus 6.750 in the group of
successful treatment, with p=0.0374. The same suggestion of CRP applied to
the leukocytes blood counting. There was one more information that was
significant: the gender. Between the patients that died, 81% were male, versus
47,2% of male in the group of successful treatment, with p=0,0361. These
numbers suggests that male have a higher risk of death when developed DSWI
than female. The technique used by the plastic surgery team for the wound
closure has shown to be diverse and individualized, as usual for the speciality,
depending on the wound and sternal condition.
Finally, looking at the data numbers of the adopted protocol, considering the
deaths (11 in 64 - 17%) and readmissions at the hospital (1 - 1,5%) the plastic
surgery team is on the expected mortality rate, but there were only patients who
have surgical indication. On the other hand, the numbers of recurrence are
exciting, and show that the adopted protocol succeeds on treat DSWI
definitively, with lower risk of recurrence, when compared with literature. Our
group is also developing a prospective project for data analysis in real time, and
soon new data will be available, increasing the numbers - which may allow
further conclusions with a higher level of evidence.
111
112
113
TITLE: Sentitnel node biopsy in breast cancer surgery.
AUTHOR: Mila Koledin.
MENTOR: Prof. Dr Andrija Golubovic.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Mila Koledin, dr Milan
Ranisavljevic, prof. dr Andrija Golubovic; Institute of oncology Vojvodina,
Serbia.
BACKGROUND / INTRODUCTION: Sentinel node biopsy (SN) technique is in
clinical usage on Surgery department of oncology in Institute of oncology,
Vojvodina, since 1999. and until now, it has been done more than 800 SN
biopsies.
OBJECTIVES: Aim of this study is presentation of our results in usage of SN
biopsy in treatment of the early staged breast cancer. To explore potential
measures of surgical expertise within the role of SN in breast cancer, given the
ascertained improvement in the view of treatment, morbidity and survival, within
certain amount of patients with breast cancer. Which, eventually could be
considered “cured” of illness, as a result of less invasive modern
multidisciplinary treatment approach. Aim of this study is presentation of our
results in usage of SN biopsy in treatment of the early staged breast cancer. To
explore potential measures of surgical expertise within the role of SN in breast
cancer, given the ascertained improvement in the view of treatment, morbidity
and survival, within certain amount of patients with breast cancer. Which,
eventually could be considered “cured” of illness, as a result of less invasive
modern multidisciplinary treatment approach.
METHODS: After marking SN, in all patients it was done SN biopsy. Mapping of
SN was done using double contrast (radiotracer Antimony-sulfide marked with
Tc 99m + vital blue dye Panteblau V). In all patients, after biopsy, it has been
performed mastectomy or conservative breast operation, with or without
complete dissection of axillary lymph nodes after pathohistology (PH) analyses
of the SN.
RESULTS: 91.2% of total (n= 791 (100,00%)) number of patients had
diagnosed solitary tumor. Within 31.3% patients, SN was positive, while 68.7%
of them had diagnosed negative SN, after PH status and verification of SN. 726
patients, after confirmation of SN status, had conservative breast operation,
while 65 had mastectomy.
DISCUSSION / CONCLUSION: SN is a good and certain predictor of negativity
of other axillary lymph nodes equilateral with breast carcinoma until 3 cm
diameter.
114
TITLE: Successful term pregnancy in APS secondary to Rhupus.
AUTHOR: Ubiratan Augusto Lima.
MENTOR: Sue Yazaki Sun.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Eduardo Kaiser Ururahy
Nunes Fonseca.
BACKGROUND / INTRODUCTION: Antiphospholipid syndrome (APS) is an
autoimmune disease mediated by the production of so-called antiphospholipid
antibodies (anticardiolipin antibodies and lupus anticoagulant). In women in
reproductive age it constitutes a significant impediment to successful pregnancy
as it can lead to repeated miscarriages. It can be primary or secondary. When
secondary, it occurs in association with other autoimmune diseases, such as
systemic lupus erythematosus (SLE). Anticoagulation with heparin is a wellestablished strategy for the management of thrombosis and the improvement of
the prognosis of pregnancy.
OBJECTIVES: To report a successful case of a successful term pregnancy in a
woman who was diagnosed with SLE at 9 months of age, and later diagnosed
with Rhupus.
METHODS: We report a case of a patient who underwent prenatal care service
of a university hospital after obtaining her full consent and made a review of the
literature on Rhupus and pregnancy in women with APS and SLE.
RESULTS: Upon diagnosis of pregnancy the patient was sent to us for prenatal
care by the Rheumatology discipline, and remained under our care during the
entire pregnancy. Considering her diagnosis of APS and her obstetrical history
of one previous pregnancy which had ended in miscarriage at 16 weeks without
proper prenatal care, she was prescribed with profilatic anticoagulant
(Enoxaparin 40 mg per day, administered subcutaneously) in addition to
hydroxychloroquine sulfate 400 mg per day orally. The introduction of
methyldopa 500 mg every 8 hours orally was later necessary due to arterial
hypertension. The pregnancy came to a successful conclusion through the
delivery of a healthy male newborn through lower segment Caesarean section.
DISCUSSION / CONCLUSION: The outcome of this case reinforces the thesis
that the management of pregnancy in APS and SLE/Rhupus is not only viable
but can yield good results in the form of uneventful pregnancies, healthy
newborns and good maternal post-partum recovery.
115
116
TITLE: Premenstrual syndrome prevalence, sleep disturbances and influence of
environmental factors: results from a Sao Paulo Epidemiologic Sleep Study
(EPISONO).
AUTHOR: Zaira Fernanda Martinho Nicolau.
MENTOR: Dra.Helena Hachul.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Nicolau, ZFM - UNIFESP;
Bezerra, AG - UNIFESP; Polesel DN - UNIFESP; Andersen ML - UNIFESP;
Bittencourt, L - UNIFESP; Tufik, S - UNIFESP; Hachul, H - UNIFESP.
BACKGROUND/INTRODUCTION: Premenstrual syndrome (PMS) is
characterized by psychological and physical symptoms that happen during the
luteal phase of the menstrual cycle. It affects the majority of women at least
once in their lifetime and the symptoms impair functioning by interfering with
daily activities and relationships.
OBJECTIVES: Describe the prevalence of self-referred PMS in Sao Paulo's
population and compare the differences in sleep quality and pattern in patients
with and without PMS regarding subjective and objective recordings. We also
sought to examine the association of PMS with environmental factors.
METHODS: 336 women, aged 20 to 55 years, were included in this study. The
data were extracted from an epidemiologic survey conducted in Sao Paulo,
Brazil. To evaluate the sleep pattern it was analyzed subjective assessments,
including survey and validated questionnaires, and objective polysomnography
records. The presence of PMS and environmental factors were obtained by
survey.
RESULTS: The mean age of the subjects was 34 years old. The self-referral of
PMS was 68.75% on Sao Paulo's population. The PMS group had a poor sleep
quality, increased daily somnolence, more fatigue and a worse perception of
insomnia. There was no significant difference in all polysomnographic variables
between the groups. It was identified environmental factors associated with
PMS, such as social class (high family income) and marital status (women with
partner). It was not observed an association of employment, hours of service,
alcohol intake, smoking, and physical activity.
DISCUSSION/CONCLUSION: Due to its high prevalence, the consequences of
PMS can potentially impact in productivity, distress and influence in daily
activities. When this happens, women often seek for medical care and the
physician that has an understanding of PMS modulators can propose a more
accurate treatment. Therefore, an approach involving not only physical aspects,
but also sleep and living conditions is noteworthy to guide a more precise
clinical management.
117
118
119
TITLE: Compartmental syndrome caused by snakebite.
AUTHOR: Annah Rachel Graciano.
MENTOR: João Baptista Carrijo.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Ana Carolina dos Santos
Torquato, Lara Cristina Alvarenga, Bráulio Brandão Rodrigues, Luís Mário
Mendes de Medeiros, Ana Paula Moreira Reis, Karla Cristina Naves de
Carvalho.
BACKGROUND/INTRODUCTION: In Brazil, it is reported approximately 20,000
cases of poisoning by snake bites and more than 100 deaths annually. 90.5% of
snake bites correspond to the Bothrops. Among the complications described, it
highlights the compartment syndrome, tissue
necrosis,
shock
and
acute
renal
failure
(ARF). The compartment syndrome is rare,
and difficult to manage.
OBJECTIVES: This research reports a clinical case of compartment Syndrome
due to envenomation by bothrops snakebite.
METHODS: It was realized a review of medical records and literature review
based on the articles avaible on MEDLINE , LILACS , SciELO and MD Consult.
RESULTS: EFM, female, 2 years and 2 months old, 14 kg. She was bitten in
her right hand by a snake identified as a bothrops gender (jaracuçu). The
patient started the clinical frame with edema and local erythema, and as a
treatment
it was administered eight ampoules of antivenom. There was
rapid evolution of symptoms with pain and swelling to the right axillary region.
The clinical frame was reclassified as serious, and administered more 4
ampoules of antivenom. The patient developed compartment syndrome, and it
had been indicated emergency fasciotomy. After admission, postoperative
laboratory tests were performed and the results were: complete blood count
on the first day of hospitalization with hemoglobin (Hb) 11g / dl, hematocrit (Ht)
of 34.5%, platelet count of 323,000, a PTT 27 and TP 13.3 "without electrolyte
disturbances noteworthy. In the following days of hospitalization new exams
were required which showed apparent worsening of hemoglobin levels with
8,1g / dl, 24.8% hematocrit, platelet count of 208,000, and investigated
renal and hepatic functionwhose values revealed creatinine 0 4 mg / dl,
Hg 1.7, LDH 277 U / l CK 385 U / L, aspartate aminotransferase
of 43 U / L and ALT
24
U
/
L.
During the days of
hospitalization, the patient developed progressive improvement of symptoms,
received orientations about using the medication and anti-hypertensive diet.
120
CONCLUSION/DISCUSSION: Only in 2005 were reported by the SINAN
(Sistema de Informação de Agravos de Notificação) 28702 cases of poisoning
by snakes. The compartment syndrome is rare, featuring severe cases, being
difficult to manage. Delayed diagnosis increases the risk of non-responsive
treatment, possibility of amputation and loss of function. In our case, after the
elucidation and analysis of the risks and benefits of surgery in the treatment of
compartment syndrome, emergency fasciotomy was performed and
demonstrated clear improvement in the prognosis of the patient.
121
TITLE: Myasthenia gravis: repercussions on the fetus, newborns and children
before two months old - Partial Results.
AUTHOR: Bruna Gutierres Gambirasio.
MENTOR: Acary Souza Bulle Oliveira.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: OLIVERA, Acary Souza
Bulle; ANNES, Marcelo; CAVALCANTE, Valéria.
BACKGROUND/INTRODUCTION: Myasthenia gravis (MG) is a rare
neuromuscular disease that affects the neuromuscular junction. It main
symptoms and signs are weakness and muscular fatigue, that come and go as
the disease progresses.
OBJECTIVES: The objectives are not only obtaining more data about the
occurrence and clinical presentation of TNMG from the fetus until the child is
two months old, but also comparing pregnancies that happened before MG first
symptoms and pregnancies that happened after MG’s first symptoms.
METHODS: A questionnaire was elaborated and myasthenic women that got
pregnant before and/or after MG first symptoms answered it. It contains four
topics: patient’s identification; MG’s development in the patient; pregnancies
before MG; pregnancies after MG. Through these topics, data about delivery,
clinical presentation of TNMG, diagnosis and treatment will be collected. The
questionnaire was answered at the Investigation of Neuromuscular Diseases
Section of EPM - UNIFESP.
RESULTS: The partial results came from 47 questionnaires, answered by 47
myasthenic women, reaching a total of 74 pregnancies before MG’s first
symptoms and 39 pregnancies after MG’s first symptoms.
CONCLUSION/DISCUSSION: The results about the rate of babies born to
myasthenic mothers that present TNMG are
totally
compatible
with
those
presented
by
literature. The mother’s disease can cause
some impacts on the fetus, newborns and children in their first months but
these impacts can be controlled if obstetricians, neonatologists and
pediatricians are able to manage TNMG, identifying clinical presentation of the
disease
and
providing
proper
diagnosis
and
treatments.
Therefore, TNMG is a rare condition but potentially deadly that requires more
research, because, even though it leads to temporary signs and symptoms, it’s
extremely important not only to avoid, for example, chokes and respiratory
distress that happen due to muscular weakness caused by the disease, but
also give support to myasthenic women that wish to become mothers and
make them understand that the possible risks for her and her baby can be
almost completely controlled.
122
TITLE: Fraser syndrome, a case report and short review.
AUTHOR: Clara Melissa Bustillo Sierra.
MENTOR: Ramon Alvarenga Calidonio.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Clara Melissa Bustillo
Sierra (Sixth year medicine student, UNAH).
BACKGROUND/INTRODUCTION: Fraser syndrome is a rare autosomal
recessive disease, has major and minor criteria for diagnosis, all criteria are
clinical, has an stimated frequency of 0.043 / 10,000 live births, in Honduras and
Central America there are no previous studies published.
OBJECTIVES: Expose characteristics and images of the case and compare
them with the literatures described.
METHODS: An exhaustive interrogatory and physical examnination was
performed to the parents and the patient and all laboratory information and
images was compiled during hes hospitalization.
RESULTS: Patient with 41 weeks born at south hospital, with respiratory
problems, cyanosis and multiple malformations, is refer to University Hospital
(HEU) on the ninth day of life. Father of 20 years and mother of 18, deny
consanguinity, come from rural areas, mother obstetric history of deeds 2,
births 2 and living children 2. affirm previous child was healthy, she had six
prenatal controls with an auxilar nurse, she refers leucorrea in the last two
weeks of gestation, no treatment. On physical examination the patient has
normal heart rate, tachypnea (66 x '), saturation at ambient 68%, temperature
37 ° C, 3.1 kg weight, size 51 cm, head circumference 32cm, patient presents
depression and hair on biparietal area, also microtia with low implantation,
bilateral Cryptophthalmos and coloboma at left eyelid, nose flattened,
excavatum chest, teletelia, inspiratory stridor, presence of umbilical hernia,
without falling umbilical stump, hypertrophy of clitoris, vaginal atresia, partial
syndactyly of hands and feet. Studies and laboratory: CBC: hemoglobin 15.7g
/ dl; Hematocrit 44.6%; WBC 11,830 / mm3; 31,100 platelets / mm3.
Biochemistry: BUN 23 mg / dL total bilirubin: 1.2mg / dl; indirect bilirubin 0.9mg
/ dl. Urinalysis: bilirubin +; Proteins +; 10-12leukocytes for field, hyphae and
yeast. Echocardiogram: IVC of 2mm, abdominal USG: presence of Mullerians
and posterior third of vagina. Brain TAC: no eyeballs, rest was normal,
laryngoscopy: subglottic stenosis, chest X-ray: Normal. Patient died secondary
to respiratory failure at month and 2 days old.
CONCLUSION/DISCUSSION: The patient showed multiple major criteria (3/4)
and several minor criteria, the survival time coincided with what is described by
previous studies, provide genetic counseling in these cases may prevent a new
case which is very important.
123
TITLE: Multidisciplinary Workshop about Sexual Abuse Prevention in
Elementary School.
AUTHOR: Isadora Barazzetti Rigon.
MENTOR: Jaime Cofre.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Gabriel de Almeida Calado
(UFSC); Jaime Cofre (UFSC).
BACKGROUND/INTRODUCTION: Childhood sexual abuse is linked to higher
risks of physical and emotional disorders. In public schools, children who were
abused have been found more likely to be sexually active at an early stage and
to use contraceptives inconsistently, what can lead to unplanned pregnancies,
and also result in infection by sexually transmitted diseases (STDs). Activities
such as group workshops, undertaken in school settings, may act as
prophylactic elements against sexual abuse.
OBJECTIVES: Check how students feel about issues such as respect, health,
self-esteem and sexuality; observe the participation and effectiveness of a
multidisciplinary workshop prepared and conducted by medical students, along
with teachers and health professionals. Make sure that the workshop is a
protective factor against sexual abuse.
METHODS: The workshop was developed by an UFSC medical student, and
applied in an elementary school classroom under the supervision of health
professionals through the curricular component of Community Interaction. The
activity is part of a project approved by the UFSC Committee of Research with
Human Beings under the number 15017813.0.0000.0121. The objective of the
workshop, in addition to warning students about sexual abuse, was to
discourage rash decisions about when to have the first sexual experience by
discussion of its consequences. Three gift boxes were exposed. Children sat in
a circle and played a game in the “hot potato” style: music was played and,
when it stopped, the child who was with the “hot potato” won the first gift:
chocolate. The game would follow that mold: the second gift would be an apple;
the third, a lemon. Children who won gifts were invited to taste them in front of
the class. As a final reflection, the text "A House with Termites" would be read
by the children.
RESULTS: The workshop was conducted with 12 students and lasted 1 hour
and 10 minutes; the last 20 minutes were reserved for questions. No student
refused to participate in the workshop. To evaluate the activity and prepare
future interventions, the students answered a questionnaire about respect, selfesteem, health and sexuality. Approximately 58% of the students said they
respect their colleagues, while the rest admitted not to always do so. About 83%
said they are satisfied with their bodies; however, 50% would change something
in the body if they could. All students said it is important to take care of their
body and health. Regarding sexuality, 33% of students said that an adult had
ever talked to them about sexuality until that date; furthermore, 50% of students
124
would not feel free to talk to their families about the subject, choosing instead
friends or colleagues.
This ignorance is likely to be the reason for the workshop’s effectiveness: 67%
of students had questions at the end.
CONCLUSION/DISCUSSION: The students, probably due to their young age
(11.5 years on average) and lack of knowledge regarding sexuality, were very
attentive during the activity. All questions asked during and after the workshop
were answered; teachers and health professionals collaborated in clarifying
lingering doubts. Interdisciplinary workshops are, then, decisive forms of
intervention in education, and the medical student is an effective vessel of
knowledge for students in elementary school.
125
TITLE: How deep should the puncture be to obtain central venous access in
pediatric oncology?
AUTHOR: Lícia Bertanha de Lima.
MENTOR: Profa. Dra. Simone de Campos Vieira Abib.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: LIMA, L. B., RIBEIRO, R.
C, DUARTE, A. A.B., YURI, F., IMADA, A.C., ABIB, S.C.V. Pediatric Oncology
Institute of the Federal University of São Paulo - GRAACC/ UNIFESP –
BRAZIL.
BACKGROUND/INTRODUCTION: Central venous puncture with Seldinger
technique is often used to obtain short and long-term catheters. Although safe,
this technique can have some complications and the depth that the needle is
inserted is not standardized.
OBJECTIVES: In order to avoid such problems, we developed a study to
determine the maximum depth that should insert the needle in an internal
jugular vein catheter insertion.
METHODS: Anthropometric data of pediatric patients submitted to long-term
catheter implantation were collected. A portable ultrasound evaluated the
morphometric parameters of the internal jugular during surgery and the needle
insertion depth was calculated. Relationship between depth, weight and age
were analyzed by scatter plots and linear correlation coefficients of Pearson.
Age and weight were categorized and constructed graphs of average depth
(with respective 95% confidence intervals). For the comparison between age
groups and depth was used analysis of variance technique (ANOVA). The
results were analyzed by the software "STATISTICA".
RESULTS: The study included 275 patients. The depth of needle insertion was
positively correlated with age (r = 0.433670, p <0.05) and weight (r = 0.595541,
p <0.05). Mean graphs show that the depth increases with age and weight rise.
This result was confirmed by ANOVA that showed statistically significant
differences (p <0.001) between the subgroups of age categories. By multiple
regression analysis, unsatisfactory quality adjustment was observed (R² =
0.382) to develop a mathematical model. However, linear regression could
be a guide to know which depth we can insert the needle securely. The
formula to calculate how insert the needle is 1,7 + 0,017X weight.
CONCLUSION/DISCUSSION: This study showed a positive relationship
between depth of needle insertion, age and weight. Moreover it is possible to
know which depth insert the needle in a jugular vein puncture. An approximate
formula is 1,7 + 0,017X weight.
126
TITLE: Inadequate nutrition in early childhood as risk factor for diseases in
adolescence and adulthood.
AUTHOR: Maria Eliza Faria.
MENTOR: Feizi Masrour Milani.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Marlon Moura dos Santos
(UEFS).
BACKGROUND/INTRODUCTION: The eating habits in early childhood,
especially in the first two years, reverberate in the health-disease process for a
lifetime. The most common forms of poor nutrition are: shortening the
exclusive breastfeeding period, high consumption of fats and sugars, and
macro and micronutrient deficiencies. The nutritional deficiency in that stage
can contribute to childhood morbimortality, growth retardation, school delay,
intestinal diseases and obesity.
OBJECTIVES: This literature review aims to identify the main pathologies
caused directly or indirectly by inadequate nutrition in
early childhood. It is
hoped that this study will contribute to a greater awareness of students and
health professionals about the fundamental importance of promoting a healthy
and balanced diet early in life by preventing, that so many diseases in
adolescence and adulthood.
METHODS: The meeting information was made from the collection of material
data platforms Scientific Electronic Library Online (SciELO) and Latin
American and Caribbean Health Sciences (LILACS), using as keywords the
terms '' early childhood '', health, disease, maternal and child health, obesity
and "food + childhood " in the period from 2000 to 2014. Of the
articles identified, 23 met the inclusion criteria namely: food in childhood,
adolescence and diseases in adulthood. Among these, there are crosssectional studies, case studies, literature reviews, and editorials quantitative
studies, basic care and research books and booklets.
RESULTS: The World Health Organization (WHO) recommends exclusive
breastfeeding for the first six months of life. Your intake below the
recommended relates to anemia, respiratory infections, intestinal diseases and
chronic diseases, as well as failures in the physical and cognitive development
- these conditions can extend into adolescence and adulthood.
Added to this, its deficiency is a risk factor for overweight and obesity, which
currently reach 22 million children under five. Other food problem is the
protein-energy malnutrition, the leading cause of infant death in developing
countries, caused by a poor diet, both in infants and in young children. It can
cause low anthropometric index, endocrine disorders and neurological motor
problems (mainly memory, visual-motor coordination and language) and is
related to 40% of deaths in children under one year.
127
CONCLUSION/DISCUSSION: Access to and the supply of healthy food for
children is very important, especially in the first five years, because it is during
this period that are created eating habits, which can increase or reduce the risk
of developing diseases such as atherosclerosis and obesity in adolescence.
This fact shows the importance of food control in early childhood, so that
children from disadvantaged social classes are the most benefited due to its
exposure to precarious socio-environmental conditions.
128
TITLE: The importance of measuring blood pressure at school: an intervention
in Canudos-BA.
AUTHOR: Patrícia Pontes Cruz.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: CRUZ, PP - Universidade
do Estado da Bahia; VIEIRA, TS - Universidade do Estado da Bahia.
BACKGROUND/INTRODUCTION: The definition of hypertension in children
and adolescents is statistical. There are no studies that determine what would
be the pressure levels associated with future diseases in children. References
most used in pediatrics are from North American studies. The blood pressure
(BP) values greater than the percentile 90 and below the percentile 95 are
classified as prehypertension. Values above the percentile 95 are classified with
hypertension, that is according to sex and height percentile.
OBJECTIVES: To evaluate the blood pressure level of elementary school.
METHODS: Cross-sectional analysis, of a convenience sample, two municipal
schools of Canudos - BA. Students from elementary school were the age group
between 6 and 16 years. The BP measurement in children was performed with
the patient calm, in quiet place and the patient has been previously informed of
the procedure would be submitted. The sphygmomanometer was calibrated.
The cuff was 16 cm to 20 cm.
RESULTS: We evaluated 126 children, 71 boys (56.35%) and 55 girls
(46.65%). The mean age was 10.3 years (maximum 16 years and minimum 6
years), between the second and fifth year of elementary school. The mean
systolic blood pressure (SBP) was 104.88 mmHg (maximum 140 and minimum
80 mm Hg) and diastolic blood pressure (DBP) was 69.688 mmHg (maximum
80 and minimum 50 mmHg). Among girls, the mean SBP and DBP found were
103.91 mmmHg and 69.91 mmHg respectively and among boys, the SBP was
104.15 mmHg and DBP was 68.54 mmHg. Based on the World Health
Organization table (WHO), just a girl of 14 years old and 164 cm height was
evaluated with a high pressure; SBP was 140 and DBP 70.
CONCLUSION/DISCUSSION: The population was considered normotensive,
with a case of high pressure.It is important to conduct a practice continuous
pressure measurement in schools, for early diagnosis of prehypertension and
hypertension.
129
TITLE: Nutritional Evaluation of Students at Canudos - Bahia, a crosssectional analysis.
AUTHOR: Patrícia Pontes Cruz.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: CRUZ, PP - Universidade
do Estado da Bahia; VIEIRA, TS - Universidade do Estado da Bahia.
BACKGROUND/INTRODUCTION: In Brazil, there is a reduction of malnutrition
and there is an increased prevalence of overweight and obesity in children. The
use of anthropometric indices has been considered a valid strategy to generate
sensitive indicators of nutritional status and living conditions of children.
OBJECTIVES: To evaluate the nutritional status based on anthropometric
indices and age of the students.
METHODS: Cross-sectional analysis, of a convenience sample, two municipal
schools of Canudos - BA. Students from elementary school were the age group
between 6 and 16 years. The intervention was performed by three medical
students. Children were weighed barefoot. Height was measured with use of
tape fixed vertically on a wall. The children were back, with feet together.
Anthropometric measurements were classified by different reference curves
according to the percentiles of the World Health Organization (WHO). The
scales percentile body mass index (BMI) / age, by age group, that individual
with low weight is one that has percentile below 3; adequate nutritional status.
between percentiles 3-85; overweight, percentiles 85-97 and obesity above the
percentile 97.
RESULTS: We evaluated 128 children, 73 boys (57.03%) and 55 girls
(42.97%), mean age 10.3 years (maximum 16 years and minimum 6 years),
between the second and fifth year of elementary school. The anthropometric
measurements were evaluated weight, height and BMI. The mean weight was
33.75 kg (61.8 kg maximum and minimum 17 kg); height 140.57 cm (max
169 cm and minimum 118.5 cm) and BMI 16.9 kg /
m² (maximum
26,01Kg / m² and minimum 10.7 kg / m²). BMI was used to identify overweight
in children and adolescents. In the population studied, 82.8% were classified as
adequate nutritional status. Among the girls was identified 5 (9%) overweight
children and 7 (12.7%) with obesity. And in the group of boys 9 (12.3%)
overweight and 1 (1.36%) with obesity. No child was classified as underweight
or malnutrition. This confirms the epidemiology that there is an increase in the
prevalence of overweight in the school population.
CONCLUSION/DISCUSSION: There is a need for monitoring of nutritional
status and the articulation between schools and health services for the
prevention and control of nutritional problems. Schools should be used as a
strategic space for nutritional intervention and expansion of children's
experiences in the formation of healthy eating habits. Schools should be used
130
as a strategic space for nutritional intervention and child encouragement in the
formation of healthy eating habits.
131
TITLE: Presentation of the protocol concerning the approach of the Abstinence
Syndrome by opioids adopted in a Neonatal Intensive Care Unit of Belo
Horizonte.
AUTHOR: Radassa de Avelar Nogueira Herculano.
MENTOR: Síuria Aparecida Borges Silma.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Radassa de Avelar
Nogueira Herculano - UIT, Carolina Cristina Rezende Ferreira - UIT, Marcus
Vinícius Gonçalves Moreira – UIT.
BACKGROUND/INTRODUCTION: Abstinence Syndrome (AS) is a clinical
condition caused by the use of opioids for pain and stress relief in the newborn
(NB). AS can interfere negatively in the evolution of the NB, so it should be
diagnosed, prevented and treated properly, becoming a part of the pain
protocols in every unit.
OBJECTIVES: Present the protocol regarding the approach of AS by opioids
held in a Neonatal Intensive Care Unit (NICU) of Belo Horizonte.
METHODS: Protocol description which was elaborated based on bibliographic
review and the experience of the service in the pain and abstinence protocol.
RESULTS: As a general rule, minimize the continuous use of opioids. For NB
who have used opioids continuously for a period < 3 days: discontinue use
abruptly. For the NB who have used opioids continuously for 3 to 7 days:
reduce the dose of the venous opioids in 25 to 30 % per day, and then suspend
it according to tolerance in 72 hours. For the NB who have used opioids for
more than 7 days: convert the maximum dose of fentanyl used for methadone
and use it for every 12 hours. Perform Finnegan score each 12 hours until the
control dose of methadone is reached (The one which is able to leave the NB
without signs of abstinence: Finnegan score <8 in 3 consecutive evaluations).
Once the control dose have been reached, administer it every 24 hours and
initiate reducing 0,05mg/kg, as tolerated, until its withdrawal. For the NB with
suspected abstinence who are no longer using opioids: confirm the suspicion
about the AS by the Finnegan score, start methadone in empirical dose of
0,05 to 0,1 mg/kg every 6 hours, which may be increased to 0,05 mg/kg until
the stabilization of the symptoms. Once the control dose is reached, increase
the interval of methadone for hours and begin the reduction of 0,05 mg/kg/day,
according to tolerance, until its removal.
CONCLUSION/DISCUSSION: As important as approaching the pain in this
NICU, is to be aware of the NB risks regarding AS. Establishing a standardized
approach for those NB, based on judicious use of opioids and the use of a
pattern drug to prevent and treat symptoms, is the main purpose of this
protocol.
132
133
TITLE: Evaluation of pre-medication use for elective tracheal intubation of
critically ill newborn infants.
AUTHOR: Karina Yoshimi Ishikura.
MENTOR: Ruth Guinsburg.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Ishikura, K. Y. - Unifesp,
Guinsburg, R. - Unifesp, Balda, R.C.X.- Unifesp.
BACKGROUND/INTRODUCTION: In the last 30 years, several studies have
shown that newborn infants (NB) are able to feel, express and interpret pain.
Tracheal intubation is not exempted of risks and it is associated with pain and
discomfort. Even though its adverse events can be reduced with the use of
analgesics, sedatives and muscle relaxants, several studies have reported the
underuse of pre-medication for elective tracheal intubation (ETI) in NB.
OBJECTIVES: To evaluate the frequency of analgesia medication use before
the ETI in NB admitted in a neonatal intensive care unit (NICU). To assess the
demographic and clinical characteristics of NB submitted to ETI with and
without analgesia. To evaluate factors associated with the use of analgesia prior
to intubation in the studied population.
METHODS: This is a cross-sectional study with prospective data collection
about the prescription and administration of medications prior to ETI of NB
admitted in a university hospital NICU from Jan/2014 to March/2015. The
following information was collected: maternal and neonatal demographic data;
neonatal morbidity; presence of congenital malformations; previous or current
surgical procedures; clinical support at intubation; intubation procedure data
(date and time of intubation, number of attempts, professional that performed
the ETI, presence, time and hour and type of analgesics and/or sedatives
prescribed for the procedure). For statistical analysis, the intubations were
divided in 2 groups: those performed with (group 1) and without (group 2) prior
analgesia. Descriptive statistical analysis compared both groups and variables
associated with analgesia for ETI were evaluated by logistic regression analysis.
RESULTS: In the period, 148 elective intubations were done on 84 NB. Among
patients, 57% received pre-intubation analgesia. When medication was applied,
the preference was for low and inadequate doses of opioids. Compared to
those that did not receive analgesia neonates that received pre-medication had
a higher mean birth weight and gestational age at birth, and lower clinical
severity score SNAPPE-II. Of the 148 intubations, 51% were performed with
prior analgesia. Variables associated with a higher chance of analgesia for ETI
were: current weight (each 100g more in weight was associated with a 10%
increase; p= 0.019) and the need of oxygen support prior to ETI (OR 3.28; 95%
CI 138-7.84).
134
Variables associated with a higher chance of analgesia for ETI were: post-natal
age (each extra day more of life was associated with a decrease of 2.2% in the
use of analgesia; p=0.007) and presence of metabolic morbidities (OR 0.21;
95%CI 0.06-0.732).
CONCLUSION/DISCUSSION: Only half of ETI performed in critically ill NB
were done under analgesia and/or sedation, despite the unit's guidelines
recommending analgesia for all ETI. Factors associated with medication use
were diverse and did not determine a pattern of patients more likely to receive
analgesia. Continued education and constant auditing are essential for a
change in attitude regarding pain management in the neonatal period.
135
TITLE: Neuroblastoma in adolescents and young adults.
AUTHOR: Paula Casteleti.
MENTOR: Eliana Maria Monteiro Caran.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Authors: Paula Casteleti Medical Student; Eliana Maria Monteiro Caran - Pediatric Oncologist Institution:
IOP - Pediatric Oncology Institute - GRAACC/ UNIFESP - Paulista Medical
School.
BACKGROUND/INTRODUCTION: Neuroblastoma, a common childhood
malignant tumor of the sympathetic nervous system, occurs predominantly in
early childhood and less than 5% of cases occur in patients older than 10 years
of age at diagnosis. A more indolent course with long- term relapses and fatal
outcomes has been described in small series of adolescents and young adults.
However, due to its rarity the published series of adolescents and young adults
makes it difficult to draw definitive conclusions.
OBJECTIVES: To describe the presentation, treatment, and outcome in six
patients who were older than age 10 years at the time they were diagnosed with
neuroblastoma at our institution during the period from 1991 to 2012.
METHODS: Medical records of six patients older than 10 years diagnosed with
neuroblastoma admitted at IOP - Oncology Pediatric Institute - GRAACC/
UNIFESP from February 1991 to August 2012 were reviewed. Descriptive
statistics were reported as absolute frequencies and percentages for qualitative
data.
RESULTS: From February, 1991 to August 2012, a total of 249 cases of
neuroblastoma were admitted. A frequency of 2.4% for the older patients was
found. Age ranged from 10.4 to 30.1 years and a slight predominance of
females was observed. The primary tumour was paravertebral in 3 cases, left
adrenal in 2 cases and undetermined in one case. All patients were
symptomatic at presentation. The most common signals and symptoms were
bone pain (3 cases), abdominal mass (2 cases), weight loss (2 cases), fever (2
cases), abdominal pain (1 case) and neurological disorders (1 case). The
median time from onset of symptoms to diagnosis was 10 months (range, 1 to
24 months). Half of the patients presented unfavorable histology. There was a
predominance of advanced stages, 5 patients had metastases at diagnosis
and one was stage 3. Bone metastases (3 cases) and bone marrow
metastases (3 cases) were the most frequent metastasis, followed by lymph
node metastasis (2 cases). MYCN was not amplified in the only case studies;
Patients were treated according to their stages in different protocols. Two
patients presented relapses, one only locally and another with disseminated
metastases. The time to first relapse ranged from 2.5 to 9.3 years; mean was
5.9 years. Both patients had received autologous hematopoietic stem-cell
transplantation. All patients had disease progression and died after a median
time of 39.3 months (range, 25.1 to 50.4 months).
136
CONCLUSION/DISCUSSION: Neuroblastoma is rare in adults and
adolescents, and the few published studies consequently refer to small series,
with a dismal prognosis. As previous series of adolescents with neuroblastoma
reported to date, most of our patients were diagnosed as stage 4. In the present
series, the adolescents and young adults had a lengthy interval between the
appearance of the first symptoms and the diagnosis. This interval was also far
longer than the delay reported in the literature in children. There may be several
explanations for such a difference. An epidemiological reason would be the
rarity of neuroblastoma in adolescents and adults, which makes it less suspect
by physicians. A biological reason could be a different neurobastoma growth
pattern between children and older patients. However, the passive course of the
disease in most of the patients in our serie does not reflect a more favorable
outcome than in younger patients. All patients experienced disease progression
followed by death.
137
TITLE: Evaluation of the approach in the Abstinence Syndrome by opioids in a
Neonatal Intensive Care Unit held in Belo Horizonte.
AUTHOR: Radassa de Avelar Nogueira Herculano.
MENTOR: Síuria Aparecida Borges Silma.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Radassa de Avelar
Nogueira Herculano - UIT, Carolina Cristina Rezende Ferreira - UIT, Marcus
Vinícius Gonçalves Moreira – UIT.
BACKGROUND/INTRODUCTION: In order to treat pain and psychomotor
agitation, which are common symptoms in Neonatal Intensive Care Units,
sedatives/opioid analgesics are used. However, its prolonged use, mainly in the
continuous base, can provoke the Abstinence Syndrome (AS).
OBJECTIVES: Evaluate the approach of Neonatal Abstinence Syndrome by
opioids in newborns (NB) admitted in a Neonatal Unit in Belo Horizonte.
METHODS: Analysis of NB medical records who used methadone, from June
2013 to July 2014, from the survey which was made in the Pharmacy of the
unit, therefore with diagnosis or risk of abstinence by opioids, confirmed
clinically by Finnegan score.
RESULTS: All the NB who received methadone in the study period were
evaluated. From the total of 17 NB, 6 were eliminated as they were transferred
to other services or evolved towards death, making it impossible to complete
the data analysis. From 11 NB included, 7 were premature with gestational age
under 28 weeks. There was a prevalence of the male gender (72,7%). All of
them received fentanyl continuously, which period of use was 37 days in
average in the preterm NB whereas it was 25 days in the mature NB. The time
spent to reach the control dose of methadone, or the sufficient dosage to avoid
abstinence syndrome symptoms (Finnegan score < 8 in 3 consecutive
evaluations) was in average 6 days and the time for suspension of the drug
ranged from 10 to 159 days. From the 11 NB, 8 presented signs of abstinence
after the beginning of methadone with the need of dosage adjustment.
CONCLUSION/DISCUSSION: The study allowed a preliminary evaluation of
the protocol of abstinence approach and use of the methadone in the service
where it was held. There was a relation between the use of methadone and the
continuous sedation, which duration was prolonged in the NB of male gender
and the premature ones. Although a more detailed approach should be carried
out, considering the total number of ventilated NB in the period (256 NB), the
number of NB with possible abstinence was relatively small (6,6%), which may
mean a judicious use of opioids in this population.
138
139
140
TITLE: Talking about healthy eating to elderly people - an experience report
AUTHOR: Arthur Henrique Santos Veloso
MENTOR: Edsaura Maria Pereira
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Azevedo, J L –
UniEvangélica, Mesquita, G A M - UniEvangélica Ferro, J S – UniEvangélica
BACKGROUND/INTRODUCTION: With the increase in the rhythm of aging of
the population, it is essential to plan and develop health actions that can
contribute with the improvement of the quality of life of Brazilians elderly.
Among these actions there are the measures related to healthy eating, which
should be part of the guidelines worked out by academics and health
professionals for the elderly and their family.
OBJECTIVES: Emphasize the importance and encourage healthy eating for the
elderly as a strategy of nutrient replenishment and vitamins necessary for the
proper functioning of the body and disease prevention in this phase of life.
METHODS: Academics of UniEvangélica Medical School, accompanied by their
tutors and together with the professionals of the Basic Health Unit district of
Recanto do Sol in the city of Anapolis - GO, planned and carried out an
educational activity about healthy eating for seniors aiming to prevent diseases
and improve the quality of life of the target audience. Ten academics, one
doctor, three nurses and twentyfive elderly participated of this activity. In
addition, were performed blood glucose tests and blood pressure measurement
of people there.
RESULTS: In the development of the activity, it was observed that elderly
people despite showing interest in participate, had doubts about which foods
were appropriate for their age and how to reconcile and adapt this new
knowledge to their daily reality. In addition, most had abnormal blood glucose
and blood pressure.
DISCUSSION/CONCLUSION: With this activity it was possible to know the
eating habits and doubts of this the public about healthy eating, showing the
need and the importance of having meetings about this topic, strategize and
plan activities based on questions, favoring the appreciation of the elderly as a
process agent in the construction of their own health.
141
TITLE: Breast and cervical cancer and its influence on women’s health: an
experience report.
AUTHOR: Arthur Henrique Santos Veloso.
MENTOR: Edsaura Maria Pereira.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: AZEVEDO, J. L.; TIAGO,
D. C.; FERRO, J. S.; MESQUITA, G. A. M., RAMOS, B. M.
BACKGROUND/INTRODUCTION: The cervical and breast cancers in Brazil,
which represent the second cause of death in the country, has been reaching
an increasingly large number of women in younger age groups, demonstrating
also an increasing mortality rate. This situation points out the importance of
strengthening the prevention strategies and early diagnosis of these
pathologies.
OBJECTIVES: Highlight the importance of public policies on the primary health
care and of the prevention of breast and cervical cancer, emphasizing the
relevance of these diseases in the morbidity and mortality of the women who
acquire them.
METHODS: Academics from the medical school of UniEvangélica,
accompanied by their preceptors and in conjunction with the health
professionals from Cais Mulher, planned and executed an educational activity
about cervical and breast cancers due to its important incidence and prevalence
in the target audience. This activity counted on 20 women, 15 academics, a
nurse and a doctor, being utilized two explanatory banners on each disease and
a breast prototype to illustrate self-examination.
RESULTS: With the accomplishment of this educational activity, the academics
realized that the audience still presented many doubts regarding the breast and
cervical cancers, also having attitudes that suggested fear and insecurity before
the word "cancer". These attitudes prevent the early diagnosis of these
diseases and influence negatively the quality of life.
DISCUSSION/CONCLUSION: The development of this educational activity
evidences the need and importance of elaboration and implementation of more
effective public policies in the primary health care, that emphasize the integral
attention to women's health, ensuring actions related to the promotion and
control of such cancers.
142
TITLE: Brazilian Association of Academic Leagues of Ophthalmology:
perspectives and challenges.
AUTHOR: Bárbara Sampaio Ruiz.
MENTOR: Pedro Carlos Carricondo, André Luis Portes.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Kato, J M , Albuquerque,
G P , Yeh, C O 1 , Resende, M F , Barros, M F.
BACKGROUND/INTRODUCTION: The Brazilian Association of Academic
Leagues of Ophthalmology (ABLAO in portuguese) is an academic entity with
the intuit of promote the scientific-social integration of Medicine students
interested in this medical speciality. Created in 2013 in the First Nation Meeting
of the Academic Leagues of Ophthalmology, the ABLAO has established bonds
with leagues from various regions of Brazil, now it counts with 30 registered
leagues from 10 States.
OBJECTIVES: Present and spread the ABLAO and your activities.
METHODS: Activities: It is the ABLAO mission The diffusion of knowledge and
the constant actualization of its members about the evolutive changes that
happens in the ophthalmological cenario. So, as other activity of university
extension, it is based on the tripod: Teaching-Research-Extension. In the first
principle, it promotes classes and discussions every week focused on many
themes selected previously by the academics through partnership with Brazilian
Society of Contact Lens, Cornea and Refractometry (SOBLEC in portuguese).
When it comes to Research, it aims to the increase of scientific academic
production by spreading successful projects during the official meetings and the
development of multicentric projects. Extension-wise, it helps the health
promotion through digital media with videos about ocular health for the general
population, also with the support of SOBLEC. The Official National Meeting of
the members occurs annually as part of the Congress of the Brazilian Society of
Ophthalmology (SBO). The meeting, hence, is open for all physicians
attendants to this Congress. The structure of the leagues are discussed as well
as successful projects. It has also share of experiences, stimulus and support
for the creation of new leagues. Organization and structure: Each league
indicates one or two Members to take part in the directory of ABLAO. This
representatives are responsible for a lecture in the annual ABLAO meeting and
for divulge the event in your faculty dependences. The Directory also makes
contact with the president of SBO Congress and with the administrative
company to officialize the programmation of the meeting.
RESULTS: The ABLAO has had significant achievements since its inception, as
the growing number of participants in the National Meeting of the Academic
Leagues of Ophthalmology. In the first edition was attended by representatives
of five national colleges, in the second, a significant increase to 23. Today the
association provides 30 leagues in the Third Meeting. The Brazilian Journal of
143
Ophthalmology has accompanied the event of progress with the publications
about the association's achievements across the ophthalmic universe.
DISCUSSION/CONCLUSION: The formation of associations between leagues
from different institutions of the country is a trend in various specialties within
medicine, illustrating the early contact and the exchange of successful
experiences among academics to the different areas of the profession. National
events play a fundamental role in disseminating innovative ideas and pioneering
projects developed and shared between the leagues, and contribute to the
strengthening of the alloys newly created providing a continuity of social and
educational tool. The act of bringing together representatives from different
regions of the country is a challenge for the ablation that has been overcome
with the frequent use of social and digital media networks.
144
TITLE: Implementation of Brazil's National Policy for Men's Health in a Health
Basic Unit.
AUTHOR: Bruno Miranda
MENTOR: José Clóvis Vieira da Silva.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Besteiro, A. V. M.. Lucena,
A. S.. Silva, B. M. Mandrick, H. Magalhães, I. P. A. Almeida, M. L. R. O.
BACKGROUND/INTRODUCTION: Brazilian population has experienced the
increasing of life expectancy. However, there is a great gender’s disparity: men
live on average seven years less than women. Some causes of this situation
are lower demand for health services and greater exposure to risk factors such
as violence and drugs. To solve this problem the Brazilian Ministry of Health
developed a National Policy for Men's Health that advocates greater access to
the National Health System through the Primary Health Care services.
OBJECTIVES: This study aimed to understand the causes of illness of the
Brazilian male population that impacts in lower life expectancy of men
compared to women, thus explaining why men seek less health services in the
country.
METHODS: In a Health Basic Unit were held a serie of activities for the
community's male population during one year. In these activities, which included
conversation circles, educational lectures, medical appointments and calls to
request laboratory tests, were collected information about the level of
knowledge of these men regarding their health, their evaluation of the national
health services and what are the main difficulties encountered by them to have
access these services. All information harvested this year were recorded for
analysis and were exposed in text form according to the interpretation of the
authors.
RESULTS: The causes of most illness and mortality in the Brazilian male
population are several; one of them is the incompatibility between the health
units' opening hours and the working hours of these men. In addition, as
symbolized virility and often plays the role of support of the family, the man is
tied to gender stereotypes, believing himself invulnerable by considering the
disease as a sign of fragility. Thus, for various reasons, such as fear that
doctors discover that something goes wrong with your health, affecting their
ability to work, the man is more resistant to seeking medical care.
DISCUSSION/CONCLUSION: The Brazilian man is still very ignorant about
matters relating to their health. This is due, in part, by the lack of access to
health services. This detachment occurs often due to lack of preparation of
these services to understand the working dynamics and cultural aspects of
men's lives to better provide services that can benefit the health of this
population.
145
TITLE: Application of Coelho-Savassi’s Risk Classification in an area with high
elderly presence.
AUTHOR: Bruno Paladini Camargo.
MENTOR: Romualdo, G S; Calixto, P A.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Rett, D M; Fernandes, I G;
Jesus, N S; Calixto, P A.
BACKGROUND/INTRODUCTION: The Coelho-Savassi’s Scale is an
instrument used in the primary care that allows a family’s risk classification,
favoring, from this information, a better greeting of Equity. For this purpose,
medical students of UNIARA, members of an academic league of family
medicine (LUMFC), classified 272 families covered by one team of Estratégia
de Saúde da Família (ESF) in Araraquara/Brazil.
OBJECTIVES: Ensure individual attention to each classified family to promote
the greeting of Equity principle, concomitantly with the learning by the students
involved in the application of the Coelho-Savassi’s Scale.
METHODS: Medical students of UNIARA associated to LUMFC were separated
in 5 groups. Each group went to Unidade de Saúde da Família (USF) Jardim
Brasil, in Araraquara, on one Saturday morning, where analyzed data (already
collected by health community workers) present in Ficha A of SIAB, sorting by
Coelho-Savassi’s Scale the families of micro areas 10 and 11 under the
responsibility of team 2 of ESF Jardim Brasil in Risk 0, Risk 1, Risk 2 and Risk
3. Finally, the results were grouped into a table and the records of properly
identified families with colored stickers for easy recognition of these families by
professionals of team 2.
RESULTS: The students obtained satisfactory knowledge in the management,
relevance and application of CoelhoSavassi’s Risk Classification Scale. 272
families were studied, 224 (82,4%) were classified as without risk/Risk 0 (109
from micro area 10, and 115 from micro area 11); 27 (9,9%) as low risk/Risk 1
(17 from micro area 10, and 10 from micro area 11); 11 (4%) were classified as
moderated risk/Risk 2 (4 from micro area 10, and 7 from micro area 11; and 10
(3,6%) as high risk/Risk 3 (1 from micro area 10, and 9 from micro area 11). In
total, 48 (17,6%) families are in risk, which 22 (16,8%) are from micro area 10,
and 26 (18,4%) from micro area 11.
DISCUSSION/CONCLUSION: The results allow us to claim that the CoelhoSavassi’s Scale for evaluation of family risk is an excellent instrument to the
scheduling in primary care, as the Equity principle must be respected. It can be
concluded that the multidisciplinary work is of utmost importance in the context
of primary care, since the role of health community workers was essential for
conducting the survey.
146
TITLE: Effectiveness of smoking cessation groups in a Family Health Strategy
at Araraquara-SP.
AUTHOR: Carolina Esteves Serra.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Meschieri, A B;Garutti, C ;
Viola, K S, França, T S.
BACKGROUND/INTRODUCTION: Smoking is a public health problem due to
the high prevalence of smoking and mortality resulting from tobacco-related
diseases, and is considered the second leading cause of death worldwide. For
the reduction of prevalence are used smoking cessation groups. These groups
are based on a cognitive behavioral therapy (CBT) and pharmacological
interventions.
OBJECTIVES: The main objective is determine the number of patients
successfully quit smoking after smoking cessation group of a FHS located at
Jardim Brasil in Araraquara, Brazil.
METHODS: This is a cross-sectional study on the smoking cessation group of
FHS Jardim Brasil (Araraquara / SP). 210 patients attended the group between
2009-2014, aged between 22-72 years. In this study, we analyzed the
participants' answers on the amount of cigarettes smoked per day, how long
smoke, and after attending the group stopped smoking, did not stop, or given up
attending the group. After this survey, we focus on the issue of smoking
cessation, including the withdrawal in attending the group. In this group
participants underwent CBT and drug therapy when needed.
RESULTS: Of the 210 participants, 97 patients were able to stop smoking, 47
did not succeed in the process, and 66 given up attending the group. Of those
who completed all the processing steps, the rate of success is 67.4%, whereas
the failure rate, that is, those who quit smoking is 32.6%. Among those who quit
smoking, 60.8% are women and 39.2% are men.
DISCUSSION/CONCLUSION: Some data say the number of patients who want
to quit smoking is high at present due to health campaigns that convey the
dangers of this addiction. In our study the number of abstinent patients exceeds
the data of the literature, because according to research from 2009 abstinent
patients after treatment is between 18-24%. Those patients who made use of
adhesives and those who used bupropion had the best results, followed by
those who used only the nicotine replacement. The patient did not use any
pharmacological method and remains abstinent demonstrates the importance of
group support as a means of motivation and success. Therefore, the
combination of pharmacological methods and CBT proved effective for smoking
cessation. In addition, the increasing number of women seeking groups is
mainly due to the time when the approaches are made. Thus, the reduction of
smoking and its cessation should be goals of health professionals, due to the
reduction of mortality and diseases such action will result.
147
TITLE: National Day Against Hypertension: 8 years' Campaign in Rio de
Janeiro.
AUTHOR: Carolina Oshiro Yeh.
MENTOR: Ana Maria da Silva Vasconcelos.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Vasconcelos, A.M.S.,
Paiva, V. R., Venturotti, C.O., Rocha, J.B.
BACKGROUND/INTRODUCTION: Hypertension or High Blood Pressure (HBP)
is an important risk factor for Cardiovascular Disease (CVD) and a relevant
problem for Brazilian public health.Thus, the students of a Federal University of
Rio de Janeiro - UNIRIO's Extension Project called 'Juntos Contra a
Hipertensão' aims combat and prevent this disease through annual campaigns
in the National Day Against Hypertension (April 26th).In these campaigns in the
community, we identify individuals with abnormal blood pressure values in order
to educate them about lifestyle changes and, also, the need of regular medical
follow-up.
OBJECTIVES: Report results and experiences about the eight campaigns
(2008-2015) that Extension Project: 'Juntos Contra a Hipertensão' have done
through these years.
METHODS: Initially, the project’s students are trained by the guiding teacher
how to measure blood pressure by indirectly methods (palpation and
auscultation), following the 'Brazilian Guidelines on Hypertension VI' - 2010.
Then, the campaign’s venue is chosen and a prior disclosure is put in there to
attract public. Finally, on April 26th, we performed the population’s
measurement of blood pressure in the previously selected location and, also,
make active search to reach a larger number of people. During the event, which
lasts about 4-6 hours, educational flyers focusing on HBP and prepared by
students of the project (with guidance from the responsible teacher) are
delivered.
RESULTS: In these eight campaigns, 1695 people attended. 621 people
(36.6%) said they were hypertensive. In the others, measured values were
normotensive (707 people, 41.7%), borderline pressure (113 people, 6.7%) and
ones that were compatible with HBP that did not have the HBP diagnosis (254
people, 15.0%).
DISCUSSION/CONCLUSION: We note the importance and the need of
conducting more educational campaigns nationwide for the population, which
aims preventive counseling and early diagnosis of hypertension, in order to
prevent its complications, which is a burden to our public health system. As for
the project’s participating students, having the medical experience early in a
medical graduation such as guiding the population, exercising anamnesis (by
research of age, risk factors and the prior existence of hypertension), training
148
the measurement of blood pressure or producing explaining materials to the
population as well as scientific studies, both based on the disease.
149
TITLE: Report of Academic League of Family and Community Medicine
(LAMFAC) participation in the Northern District’s pre-conference of the 9th
Municipal Health Conference.
AUTHOR: Gabriel Grici Cascaldi.
MENTOR: Marcelo Motta Dutra.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Quagliatto, F.F., Vieira,M.
H. S., Dutra, M M.
BACKGROUND/INTRODUCTION: The community participation is a strategy
that has been preconized for a long time in the public health systems. In 1978,
the World Health Organization (WHO) gathered in Alma-Ata (USSR) set goals
that aimed to Health for All in the Year 2000. The members of LAMFAC
participated as collaborators of the Northern District’s Health pre-conference in
Ribeirão Preto - Brazil, to formulate proposals in agreement with the health care
needs in northern district for the 9th Municipal Health Conference
OBJECTIVES: The pre-conference aim to stimulate popular participation,
organized civil society, public and non-public workers, managers and service
providers, for the social control of the Brazilian public health care system (SUS);
raise the problems and the health care needs of the population; formulate
proposal in agreement with the needs of population’s health in district range;
elect delegates that represent segments from users, workers, managers to
participate the 9th Municipal Health Conference. During the pre-conference
eight thematic axis were discussed.
METHODS: The participants were segregated in four groups with one
intermediary and one reporter for committee, each group was responsible for
discussion and formulation of proposals of two thematic axes.
RESULTS: 15 new proposals were formulated and 2 from elder’s proposals
non-accomplished or partially accomplished were reaffirmed. The discussion
had an idiosyncratic trend in the SUS financing axis and its public-private
relation.
DISCUSSION/CONCLUSION: The SUS underfinancing is alarming, because
no management proposal will sustain the progressive deficit of health repass.
Factors such as primary surplus, high interests, overvalued currency, and the
Constitutional Amendment 86/2015 that reduce federal resource to 15% of net
revenue, suffocate SUS. The conferences must make an effort to regroup a fair
financing, in order to allow SUS to fully attend to its doctrinal principles of
Universality, Equity and Integrality.
150
TITLE: Correct practices in front of drowning situations: an experience report.
AUTHOR: Giovanna Agda Moraes Mesquita.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Azevedo, J L; Ferro, J S;
Alves, R M C; Veloso, A H S .
BACKGROUND/INTRODUCTION: According to the World Health Organization
(WHO), Brazil is the third country in the world in deaths by drowning, most of
the victims are children under five years and more than half of people, under 25
years. Thereby, there is a need for basic prevention in communities, schools
and others. Objectives Teach people how to act against drowning situations.
METHODS: Academics from UniEvangélica Medical School, accompanied by
health professionals linked to the Academic League of Forensic Medicine LML, planned and carried out educational activities in the XIII Meeting of
Academic Leagues (ELA), in Goiania - GO, about prevention and first aid on
drowning situations. Participated in the activity a coroner, firefighters and twenty
students, who attended an audience of about 60 people. We used banners and
figures for basic life support simulation (SBV) to demonstrate how to do
compressions and ventilations, drowning images and pre-selected phrases
written on a paper, through which the public would answer how they would act
in each exemplified situation. Subsequently we distributed leaflets with further
information.
RESULTS: In the development of the activity could be observed that most of
the people "thought" that knew how to act against drowning situations, but had
ideas that endangered the lives of both drowned and the possible "savior".
Furthermore, by presenting types of pre selected sentences for each situation,
most of the people chose the same answers, however with incorrect
information. When asked about the risk situations for drowning and whom to call
for immediate help, they had lots of doubts, because they were surprised with
examples of common situations in everyday life, as children drowning in
bathtubs, but unusual for the interviewed. The dynamics used for development
activities were satisfactory. Thus, the work answered our prospects and was
very helpful, besides knowing the reality of the local public population.
DISCUSSION/CONCLUSION: With the completion of this educational activity,
the students realized that the audience had a deficiency of information about
drowning situations and especially how to act properly against them,
highlighting the need for a greater number of actions that address this issue
because modifications made since the basic education for both children and
adults, can prevent a hazardous situation and especially deaths.
151
TITLE: A Professional And Social Investment: The Future Of Medicine.
AUTHOR: Gisele Maria Belloli.
MENTOR: Fernando Starosta Waldemar and André Wajner.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Fabris, M. V. - ULBRA;
Souza, V. - UFCSPA; Cobalchini, M. D. - ULBRA; Crusius, T. F. - UFRGS;
Razera, M. V. - UFRGS; Adami, W. - UFCSPA; Wajner, A. - SIMERS;
Waldemar, F. S. - SIMERS.
BACKGROUND/INTRODUCTION: Improving Medical training is a recurrent
theme in debate. Medical students are constantly seeking for information on
alternatives that include professional excellence and social participation. Núcleo
Acadêmico SIMERS (NAS) is an association of medical students created with
the support of our state Medical Union that works to reduce the difficulties
encountered in the formation of these future professionals
OBJECTIVES: To describe the role of the NAS on the support of medical
students the regarding medical knowledge acquisiton and improvement, training
of the future physician, socially active and responsible attitude.
METHODS: Collected and analyzed historical data of the institutional
NAS/SIMERS archive.
RESULTS: Founded in 2007, NAS seeks for improvements in medical
education, which has significant shortcomings. It represents 600-associated
medical students, conducting weekly meetings, working to assist in technical
improvement on physician formation and their social role during and after their
graduation. Directors do not receive any financial benefit, being recognized by
participating in extension activities with semiannual certificates. Individual
development as a physician is not limited to the acquisition of knowledge for
technical excellence, it involves also charitable and social aspects; political
background, counciousness of ones rights and duties and how government and
society influence in medical practice in aspects such as the labor market. NAS
supports medical students engagement in medical meetings and events and
stimulates them to have an active participation in discussions and lectures . It
has proved its value having been part in scientific productions, with 34
presented poster in scientific meetings and also receiving awards for its quality.
In medical policy aspect, in 2008, NAS has had an active role in the
maintenance of the Brazilian Medical Diploma as it has always been issued
thus avoiding jeopardous modifications proposed by the governemnt. In 2011,
NAS worked against the creation of the Primary Care Professional
Enhancement Program (PROVAB), which started offering abusive bonuses for
participants in residency programs. In 2013 NAS medical students were very
envolved in the defense of the National Examination for Medical Revalidation of
Diplomas (REVALIDA) , upholding quality in the medical certification process for
foreign medical graduates who would like to work in Brazil They also worked
152
togheter with medical authorities, organizing debates on this subject, with more
than two thousand participants.
In the social aspect, the “Trote Solidário” takes place since 2008 under
coordination of NAS. It is an innovative alternative to traditionally hazing applied
in freshmen inauguration. Since 2012 in partnership with the “Banco de
Alimentos do RS” , assisting in logistics of collection and distribution of
donations to previously selected institutions. It has already resulted in 2,500
bags of blood, benefiting up to 10,000 people and collected more than 160 tons
of food and new registrations in the Bone Marrow Transplant Bank, receiving
national awards for this initiation.
DISCUSSION/CONCLUSION: NAS is made up of medical students motivated
for education and medical improvement. It has been recognized as an important
representative body of medical students, aimed to benefit society and improve
physician satisfaction in their daily practice. A well-formed physician is one who
understands its social role and knows how to look not just for the patient, but
also to an integrated individual in the community.
153
TITLE: Project Student to Student.
AUTHOR: Guilherme Henrique Novaes de Souza
MENTOR: Bruna Casiraghi.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Sarzedas, A R M; Santos,
G H P; Coelho, O C; Peloggia, S M M; Huguenin, T F; Freitas, R C C.
BACKGROUND/INTRODUCTION: Project Student to Student ( P.S.S.) is a
project that aims to help the students who are entering in UniFOA´s medical
school to learn about the process of clinical thinking. The Active Learning
places the student as the primary element of their learning, and the integration
of a wide range of topics allow a better understanding and more connection with
clinical practice.
OBJECTIVES: The project has the objective to encourage not only the new
students to face the module's content improving their ability to understand
clinical cases, but also the preparation to execute practical activities, such as
the test named by Practical Skills Assessment- PSA, by simulating practical
tests.
METHODS: During the first semester, activities were carried out with students
of Module 1 and clinical cases were presented to them. From that beginning,
some doubts related to the contents taught during the week were questioned
and discussed, assuring to the students the importance of each content for
clinical practice. At the end of the first bimester, the students took part in the
simulation of what would be the main evaluation practice, the PAS. Faced with
a case related to the contents studied and with the coordinator’s module’s help,
the students perform a very similar activity in compare to what is done in the
evaluation day, from the moment of reading of clinical cases to the achievement
of the practical activities itself. In the end, the issues and wrong answers had
been discussed with the students, followed by correction of evaluation. After
that, the group handed out the assessments, along with highlights of the major
difficulties that the class as a whole presented.
RESULTS: During the project, a good relationship was established with
students of the module 1 and the performers of the support activities, favoring
the aid and the resolution for the students’ doubts. Therefore, a better
understanding of proposed activities by the course curriculum became possible
and the integration of academic content by entering the first period.
DISCUSSION/CONCLUSION: From these activities, it was possible not only to
academics better adapt the way we are evaluated the module practical
contents, but also managing to improve their learning, bringing significant
experience for the students as a whole.
154
TITLE: Violence against women: educational activity in a primary unit of health:
an experience report.
AUTHOR: Jéssica Souza Ferro.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Mesquita, GAM Azevedo,
JL, Veloso, AHS.
BACKGROUND/INTRODUCTION:
Data
from
the
Anuário
das
MulheresBrasileiras of 2011, released by the Department of Politics for Women
and the Dieese, show that four out of every ten Brazilian women have suffered
domestic violence and other violence and this is a serious problem for
confronting various sectors, among these, the healthcare. This reality demands
actions that aims prevent and eradicate violence against women.
OBJECTIVES: To guide women on the types of violence, which they are
vulnerable on aneveryday life, encouraging them to report, since the question
rarely appears in the diagnostics and in the conduits carried out in health care
services.
METHODS: Academics of UniEvangélica, Medical School together with the
professionals of the Basic Unit Family Health (UBSF) Recanto do Sol
inAnapolis - GO planned and carried out an educational activity about violence
against women. This activity included the participation of 30 women who were
instructed about the risks when they do not denounce the aggressor, and also
how to make complaints.
RESULTS: With the completion of this educational activity, the students
realized that the audience proved to be afraid to debate about it and the word
"violence" left them apprehensive, seeming to have a strong meaning in their
lives. We also realized the need of health services to provide psychological
support to the abused women, because many do not denounce for fear of the
author of violence, or by the condition of financial dependence, of the same
DISCUSSION/CONCLUSION: We conclude with this, that it is extremely
necessary to carry out more educational activities and discussions on the
subject, in order to better guide the women and all the people on the
identification of domestic violence and how to report it.
155
TITLE: Medical students quality of life and reform in Brazil medical curricula.
AUTHOR: Luiz Eduardo de Freitas Xavier.
MENTOR: Nathan Mendes Souza.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Lima, B J C;Souza, N M.
BACKGROUND/INTRODUCTION: Academic overload, reduced leisure and
rest time, and conflicting interpersonal relationships are major causes of poor
quality of life (QL) among Brazilian medical students. Low QL negatively
impacts motivation for developing cognition, skills, and attitudes expected within
the competency profile of medical programs enshrined in national curriculum
guidelines. Some strategies have been implemented in medical schools to
address students’ psycho-social needs, to develop social skills and to increase
their QL. The impact of these strategies and services, however, needs further
assessment.
OBJECTIVES: To assess the effects of strategies to enhance Brazilian medical
students’ quality of life and its impact on competency attainment in the context
of Brazil’s medical curriculum reform
METHODS: Non-systematic review of the literature using the keywords
"qualidade de vida", "avaliação educacional" and "educação médica", and their
English versions in BVS, Scielo and Medline (by Pubmed) up to 26/06/2015 for
articles focusing the impact of strategies to promote medical students’ QL and
their impact on competency attainment. The synthesis of the findings of the
included studies will be analyzed taking into account the recent National
Curriculum Guidelines reform.
RESULTS: This is an ongoing research, but preliminary findings received an
award in the category Physicians Training and Labour Market of the 2014
National Health Congress. An important finding was the omission of the
recommendation to adhere to the QL development parameters along medical
programs within the 2014 edition of the Curricular Guidelines for Medicine
Course. International medical education literature confirms direct correlation
between QL and good academic and professional performance. Hence, the
suppression of student QL article in the newly issued Curricular Guidelines for
Medicine Course represents a drawback.
DISCUSSION/CONCLUSION: Brazil’s national medical education reform must
be informed by the best available evidence including evidence that support QL
as means for successful competency attainment. Medical Schools have
responsibility in reform process so that medical students’ QL is not excluded
among strategies to improve medical training.
156
TITLE: Report on experience about an educational action against dengue in the
sector Filóstro, Anápolis-GO.
AUTHOR: Murilo de Paiva Siqueira
ALL CO-AUTHORS NAMES AND INSTITUTIONS:
APM,Carvalho, DD, Siqueira, MP, Carneiro, RF.
Ferreira,G.,
Reis,
BACKGROUND/INTRODUCTION: Dengue is nowadays the most important
arboviral disease that affects humans and constitutes a serious public health
problem worldwide. In Brazil, until the month of May 2014, 483 516 were
confirmed cases of the disease. The dengue virus is transmitted by the
mosquito Aedes aegypti, which can affect people of all ages. Thinking about it,
a group of academics from medical school UniEvangélica, for the discipline of
Family and Community Medicine, conducted an educational theater about it.
OBJECTIVES: The objective of this study is to report the experience obtained
by academics from the second period of medical school in the planning and
execution of an educational activity for children between 2-5 years, talking
mainly about the characteristics signs and symptoms of the disease, ways to
prevent and vector recognition.
METHODS: Consisting of eight academics, the group has developed in the last
two weeks of May a theater script, which was in a playful and fanciful
environment, about two magical kingdoms that fought against dengue. The
medical students were careful to compose a distinctive clothing of fairy tales
and giving special attention to the appearance of the mosquito Aedis aegypti by
focusing on the white stripes that permeate his black body. At the end of the
play, everyone (including the kids) danced an illustrative music. This work was
presented in the afternoon of May 27th, on a Municipal Center for Early
Childhood Education (CMEI) next to the Basic Health Unit (UBS) Filóstro, in the
city of Anápolis, Goiás.
RESULTS: Knowledge does not represent a copy of reality; it is the result of
intense creation, meaning and redefinition. Through this educational action, it
was possible to understand the ease of children to assimilate knowledge
through a fictional stage play. The scholars were always paying attention. While
singing the song, all of them, even not knowing the lyrics, tried to follow both the
music and the dance. During the play, at the time when the two dengue
mosquitoes hid behind the children, there were agitated and started screaming
at them to leave, but quickly returned to focus on the presentation. The team
coordination and CMEI teachers have shown true excitement. The teacher who
accompanied the student group was delighted with the creativity and the
effectiveness of the learning of the children.
157
DISCUSSION/CONCLUSION: The lack of an effective and safe vaccine and
the high adaptability of A. aegypti in the urban environment turns the prevention
of dengue a nearly impossible to achieve mission. The academics believe it will
be through the community, including the awareness of young children, which
will reduce the incidence of dengue. Although the target audience is pretty
young, they assimilated all the knowledge imparted and assured that they would
do their part.
158
TITLE: LITROS: the first League of Organs and Tissues Transplantation of
UFRGS.
AUTHOR: Verônica Westphal.
MENTOR: Fabio Tremea Cichelero. Sandra Maria Gonçalves Vieira.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Wieth, D. M. - UFRGS;
Silva, A.B. - UFRGS, Sommer, F. - UFRGS; Souza, D.S. - UFRGS; Silva, J.P.A.
- UFRGS; Vicente, S. - UFRGS; Silva, W.I.C. - UFRGS; Marquiol, M. - UFRGS;
Pereira, M.A.R - PUC-RS; Almeida, T.G. – UFRGS.
BACKGROUND/INTRODUCTION: There is a direct relationship between
organs caption and healthcare providers' knowledge about transplantation.
However, this subject is not much discussed in Brazilians medicine academies.
The League of Organs and Tissues Transplantation (LITROS), from
Universidade Federal do Rio Grande do Sul (UFRGS), was planned and
implemented in order to fill this gap.
OBJECTIVES: To describe the purpose of LITROS creation and its results.
METHODS: This is an extension project, which involves learning and research.
14 students and 1 coordinator professor have participated on LITROS creation.
The bases of strategic planning (SP), the accomplished meetings and the ongoing projects will be presented.
RESULTS: LITROS is active since March 2015. Its mission is to mobilize
students of the University and also the population in order to improve the
understanding of organs donation, caption, allocation and transplantation
processes. We prime for complementation on medical training, social
comprehension and making health services better. Vision: being a center that
provides information about organs transplantation. Values: quality forward
ethics, service, professionalism, interaction and humanization. Meetings have
been happening once a week since LITROS was created. Some tasks were
distributed along those meetings, such as SP implementation, selection of new
members, submission of 3 abstracts to the Congress of ABTO, internal training
and organization of LITROS opening ceremony. In this ceremony, we have had
the presence of representatives of UFRGS, Regional Center of Transplantation
- RS, and Intra Hospital Center of Transplantations (CIHDOTT-HCPA). There
have also had attendance to ambulatories consultations, in both pediatrics
hepatic ambulatory and cardiac ambulatory. 5 new members were selected.
They were evaluated by an interview and an extension project which they were
tasked to elaborate. Also, other projects are being elaborated, such as a
symposium about brain death, an organized race as an organ donation
campaign, attendance to HCPA transplantation programs, visits to High Schools
and discussion sessions about organs and tissues transplantation.
DISCUSSION/CONCLUSION: LITROS creation has been well accepted
between academic learners and teachers. Our main challenge is to concretize
159
LITROS' projects, in order to promote organ donation and education about that
subject in medical training.
160
161
162
TITLE: Mortality attributable to hypertension in Brazil from 1980-2010.
AUTHOR: Ana Paula Moreira Reis
MENTOR: Humberto Graner Moreira
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Reis, A. P. M. UniEvangélica; Ferreira, G. C. O. - UniEvangélica; Carvalho, D. D. UniEvangélica; Carneiro, R. F. - UniEvangélica; Siqueira, M. P. UniEvangélica; Graciano, A. R. - UniEvangélica;
BACKGROUND/INTRODUCTION: There are no estimates of mortality
attributable to Hypertension (HTN) in Brazil, since this is a risk factor and an
underlying condition for numerous immediate causes of death, such as
cerebrovascular disease (CeVD), coronary artery disease (CAD) and heart
failure.
OBJECTIVES: To estimate the mortality attributable to Hypertension in Brazil
from 1980 to 2010.
METHODS: Data about deaths from cardiovascular diseases in Brazil from
1980 to 2010 were obtained from the Ministry of Health/DATASUS. Besides the
specific mortality from hypertensive diseases (ICD10 I10-I13 and corresponding
ICD9), cardiovascular mortality attributable to Hypertension was estimated
using data from the 2000 Global Burden of Disease study, recently updated
(Lancet 2008;371:1513-18). In this study, 54% of all deaths for CeVD (ICD10
I60-69 and corresponding ICD9), 47% of deaths for CADs (ICD10 I20-I25 and
corresponding ICD9), and 25% of deaths from other cardiovascular disease
(ICD10 I26-28, I34-37, I44-51, I70-99, and corresponding ICD9) can be
attributed to Hypertension. Mortality rates (deaths/100,000 population) were
adjusted by gender and age group, by the direct method, using the Brazilian
population from the 2000 Census (IBGE). For trend analysis, data were
adjusted by Poisson regression model.
RESULTS: Approximately 3,660,313 deaths could be attributed to Hypertension
over the analyzed period. These deaths accounted for 11.4% of all deaths
recorded in 1980, increasing proportionally to 14.5% of all deaths in 2010.
Cerebrovascular diseases were the most cause of those deaths (37.4%),
followed by CADs (29.0%). There was an increase of mortality rates attributed
to Hypertension in this period: adjusted mortality increased from 74.7 to
89.8/100,000 inhabitants, which was more pronounced among women (66.8 to
81.8/100,000, R² = 0.627).
DISCUSSION/CONCLUSION: Between 1980 and 2010 in Brazil, there was an
increase in mortality rates for causes directly attributable to Hypertension.
Despite the limitations of risk estimate studies, there are evidences that the
hypertension control is still not ideal in Brazil, with significant impact on related
mortality.
163
TITLE: Sexual Profile of Teenagers.
AUTHOR: Bruna Gabryela Busoletto dos Santos.
MENTOR: Liliane Teixeira Rodrigues.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Pedro Bragato Romanhol,
Danilo Dias de Francesco, Aline Calixto, William Michael Junkert.
BACKGROUND/INTRODUCTION: Sexuality is a set of expressions or
behaviors of human beings, which influence their life cycle, being related to
biological, psychological and social factors associated with procreation and the
social and personal self-assertion. This process begins in adolescence, with
most teen's attention start in their own bodys, taking care to enhance their
appearance and taking sexual behaviors assigned to each individual. Among
adolescents, the use of condoms is low and sexual activity is usually
unplanned, which contributes to an increased occurrence of sexually
transmitted diseases (STDs). The STDs are one of the most common health
problems of the world and it has various morbidities consequences as female
infertility, male infertility, vertical transmissibility, determining pregnancy loss,
congenital disease and increased chance of HIV infection. This study, in front
the wide range of STDs present, deals with more specificity syphilis and AIDS,
highly prevalent diseases of the epidemiological Brazilian profile. Objective: The
aim of this epidemiological study is to increase the operation area of Primary
Health Care on the population of an age group that has the characteristic of not
regularly attend health facilities and therefore be at risk group with high
propensity to acquire STD: the adolescents. For that reason, as part of the
School Health Programe, inter sectoral policy of Health and Education,
established in 2007 was conducted an active search with college students from
state the public school - Barbosa to find out if indeed teenagers were having
access to information on STDs, if they were practicing safe sex with condom
use or not, the number of sexual partners in the last 12 months and if they were
using drugs. The specific goal of the active search was to analyze the sexual
profile of adolescents, students from estate public school - Barbosa, present in
the age group 13-23 years in order to find out if they could present risk
behavior, using the definition of "risk behavior "as any action that its results can
be attributed to risk practitioners of action or involved in the same, examples of
this being the lack of condom use, presence of multiple partners and substance
abuse, both licit and illicit. In addition, rapid tests were performed for HIV and
syphilis with the study participants.
164
OBJECTIVES: The aim of this epidemiological study is to increase the
operation area of Primary Health Care on the population of an age group that
has the characteristic of not regularly attend health facilities and therefore be at
risk group with high propensity to acquire STD: the adolescents. For that
reason, as part of the School Health Programe, inter sectoral policy of Health
and Education, established in 2007 was conducted an active search with
college students from state the public school - Barbosa to find out if indeed
teenagers were having access to information on STDs, if they were practicing
safe sex with condom use or not, the number of sexual partners in the last 12
months and if they were using drugs. The specific goal of the active search was
to analyze the sexual profile of adolescents, students from estate public school Barbosa, present in the age group 13-23 years in order to find out if they could
present risk behavior, using the definition of "risk behavior "as any action that its
results can be attributed to risk practitioners of action or involved in the same,
examples of this being the lack of condom use, presence of multiple partners
and substance abuse, both licit and illicit. In addition, rapid tests were
performed for HIV and syphilis with the study participants.
METHODS: Personal interviews were conducted with 52 adolescents from the
city of Guarulhos, São Paulo, between the age group 13-23 years, representing
a profile of the population that does not have the habit of attending basic health
units. The following variants were asked during the interview: age, sex, race
(self-reported), marital status, sexual preference, number of partners in the last
12 months, type of exposure if it has been diagnosed with STD and has already
made use of licit / illicit substances. For situation of diagnosis, the chosen
laboratory test was rapid testing (RT) for HIV and syphilis.
RESULTS: From the data we concluded that the majority of sexually active
individuals do not use condoms (73.91%). Many of these (58.82%) use alcohol
or some kind of illicit drug.
DISCUSSION/CONCLUSION: Although this research included with a
considerably small number of teenagers, there was some similarity data with
national indices, which analyzed adolescents aged 14-25 years and almost 40%
of all women in this age group do not use or barely use condoms in their sexual
relations. Among men of the same age, 1 in 3 said no condom use or use it
infrequently. Furthermore a survey of knowledge, attitudes and practices in the
Brazilian population aged 15 to 64 conducted by the Ministry of Health in 2008
showed other important data. We conclude that, regardless of whether use or
not illicit drugs or alcohol, the children of that area does not have a significant
adhesion to condom, like many other regions of Brazil.
165
TITLE: Epidemiological analysis of C and B Hepatitis associated to HIV/AIDS in
the metropolitan area of Florianopolis between the years of 2007 to 2015.
AUTHOR: Ester Borges Nunes.
MENTOR: Eleonora d'Orsi.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Martins A. (UFSC), Ramos
J. L. (UFSC), Maia L. (UFSC), d'Orsi E. (UFSC), Marques L. P. (UFSC),
Confortim S. C. (UFSC).
BACKGROUND/INTRODUCTION: The Hepatitis B and C infection is highly
prevalent worldwide and its co-infection with HIV worsens the clinical condition,
facilitating the evolution to cirrhosis.
OBJECTIVES: Analyse the relation between the independent variables and the
HIV/Hepatitis co-infection.
METHODS: It was made a cross-sectional study with data from 2007 to 2015
from the Information System on Communicable Diseases of the state of Santa
Catarina. The following variables were analysed considering the HBV or HCV
infected people: gender, age, scholarity, vaccine calendar of Hepatitis B, coinfection with other STDs and the way of contamination. To make the analysis,
EpiData Analyses and Microsoft Excel 2014 have been used. Chi-squared has
been applied and proportions, incidences and 95% confidence interval were
calculated.
RESULTS: The incidence rates of Hepatitis were higher between men, at the
30 to 39 years old age range, between not vaccinated people and between not
co-infected with other STDs. Besides, an intimate relation between low
scholarity and Hepatitis/HIV incidence rates has been observed.
DISCUSSION/CONCLUSION: The high incidence HBV and HCV rates on the
state of Santa Catarina and the high lethality by the HIV/Hepatitis co-infection
indicate the importance of planning stronger public policies on this health area,
expanding the vaccination coverage and ensuring the awareness of
HBV/HCV/HIV prevention.
166
TITLE: A Rubella Identification Pamphlet for Health Workers: Identifying Key
Social and Clinical Variables Associated with the Disease.
AUTHOR: Gabriel de Almeida Calado.
MENTOR: Eleonora D'Orsi.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Isadora Barazzetti Rigon,
Beatriz Ferreira Cordeiro, Pedro Henrique de Souza Peters - Universidade
Federal de Santa Catarina.
BACKGROUND/INTRODUCTION: Contraction of exanthematous diseases of
viral etiology by adults and children alike, chiefly among them common measles
and rubella, is still a worryingly common occurrence in Brazil. Even after the
country's national vaccination campaign, Brasil Livre da Rubéola, which sought
to eradicate the disease, there are still a significant number of reported cases of
rubella every year, which require ever more knowledge and preparedness on
the part of health professionals to reach an accurate diagnosis.
OBJECTIVES: To identify statistically relevant factors and tendencies, both
social and clinical in nature, of potential use in future diagnostic tools aimed at
possible cases of rubella for both medical professionals and the general
population and construct an accessible, informational pamphlet as a proof of
concept of just such a diagnostic tool.
METHODS: The data used was extracted from compulsory notification
datasheets for exanthematous diseases from 2007 to 2015 in the state of Santa
Catarina, all supplied by the state’s local epidemiologic notification system,
SINAN. Of these, cases of measles and other diseases except rubella were
excluded, leaving 586 datasheets of suspected cases of rubella. These were
further divided into confirmed and disproved cases, and each of these were, in
turn, compared to one another regarding the difference in contraction rates
among the evaluated variables: age, gender, vaccination status, socioeconomic
factors and different clinical signs and symptoms (p = 0.05). From this
comparison, the relative risks for contraction of rubella for these variables were
calculated and used to construct an informational pamphlet meant to facilitate
the identification of potential rubella cases by both health professionals and the
general population, particularly parents of small children and infants in at-risk
areas.
RESULTS: After definitive laboratory tests of the 586 suspected cases, 539
(92.0%) were negative for rubella and 47 (8.0%) were confirmed positive. While
children up to 9 years old formed the majority of suspected cases, 65.0%, it was
actually adults 20-29 years old who made up the majority of the confirmed
cases, 63.9%. Also of note demographically was that men made up 76.6% of all
confirmed cases and that, of those whose educational background was known,
94.3% of the confirmed cases had finished, at least, primary school. Vaccination
exerted a protective effect against confirmation, with a relative risk of 0.25.
167
Among the analyzed signs and symptoms, arthralgia, conjunctivitis,
retroauricular pain and presence of palpable lymph nodes had, respectively,
relative risks of 6.3, 6.1, 5.2 and 4 for confirmation of rubella. The finished
pamphlet presents and discusses upon these findings in language designed to
be accessible to the average person.
DISCUSSION/CONCLUSION: The study successfully used identified many
statistically relevant factors and tendencies, both social and clinical in nature, of
potential use in future diagnostic tools aimed at possible cases of rubella for
both medical professionals and the general population in Santa Catarina, and
possibly all of Brazil. Exemplifying this, a pamphlet designed to alert people as
to the most relevant presentations and contexts in which rubella manifests itself
in patients was built as a proof of concept.
168
TITLE: Prevalence of arterial hypertension and diabetes mellitus in men and
women in the city Anápolis - GO.
AUTHOR: Jackson Lima Azevedo.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: AZEVEDO, J. L. UNIEVANGÉLICA; RAMOS, B. M. - UNIEVANGÉLICA; MESQUITA, G. A. UNIEVANGÉLICA; VELOSO, A. H. S. - UNIEVANGÉLICA; FERRO, J. S. –
UNIEVANGÉLICA.
BACKGROUND/INTRODUCTION: Arterial Hypertension (AH) and diabetes
mellitus (DM) are two pathologies very commonly seen in clinical practice,
either singly or in combination. Recently, there is an increased prevalence of
both diseases, very commonly related to the advancement of the life
expectancy of the population, as well as the incidence of overweight and
obesity.
OBJECTIVES: List the epidemiological variant "sex" with the incidence of
associated cases of hypertension and diabetes mellitus in the population of
Anápolis, GO, through HiperDia program, from January 2010 to April 2013.
METHODS: We conducted a retrospective cross-sectional ecological
population-based study including a total of 1,288 individuals with hypertension
and diabetes mellitus associated, they were 416 males and 872 females. The
data were analyzed based on the Health Information System (DATASUS) as
well as the epidemiological variant displayed. The data analysis was performed
with the aid of TabWin and Excel programs.
RESULTS: The cases of hypertension associated with diabetes mellitus, based
on the sex of the individuals, which occurred between January 2010 and April
2013, totaled 1,288 cases. Of this total, there was a predominance of females,
which amounted to the sum of 872 reported cases (approximately 67.7% of the
total). And there were 416 male cases (approximately 32.3% of the total).
DISCUSSION/CONCLUSION: The prevalence of hypertension among women
in most of the country is higher than in males, according to data from the
Ministry of Health in 2006. The same situation occurs for diabetes mellitus, a
fact that corroborates with this study. Thus we see the need for more
educational activities in this area, aiming to combat the risk factors of such
diseases and stimulate their forms of control.
169
TITLE: Quaternary prevention and their impacts on contemporary medicine.
AUTHOR: Laila Dias Rodrigues.
MENTOR: Leonardo Brandão Barreto.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Xavier, Luiz Eduardo de
Freitas - Federal University of Ouro Preto; de Paulo, Laila Dias Rodrigues Federal University of Juiz de Fora.
BACKGROUND/INTRODUCTION: The quaternary prevention (QP) is a
concept developed by the Belgian GP Marc Jamoulle which searchs to deal
with doctors excesses and iatrogenic complications. Lately, the influence of the
pharmaceutical industry, the media and the transmission of equivocated
medical information contributes to overmedicalization and other circumstances
such as overdiagnosis and overtreatment, which reinforces the importance of
understanding QP in contemporary medicine.
OBJECTIVES: Analysing the quaternary prevention and what could be made to
use it in order to protect patients against the excesses of medicine.
METHODS: This paper was prepared from a review of the available literature
on the topic "Quaternary Prevention”. Articles were selected in LILACS and
Scielo tools using the keywords "Quaternary Prevention", "overmedicalization”
and "overtreatment”. Once selected articles, the study sought to relate the
information found to summarize the updates on the subject explaining the
importance and application possibilities of QP in contemporary medicine.
RESULTS: The quaternary prevention focuses on the relationship between
doctors and patients, recognising the singularity and autonomy of the patient,
such as the value of process by sharing decisions. It stimulates a medical
practice focusing on individuality of each patient, not in the set of symptoms
globally brought by he/she. The QP is, therefore a preventing which, unlike the
others, aimed at a change of medical behavior. It is considered a review of the
doctor's work quality. It reiterates the principle "Primum Non Nocere", once the
medical practice must first, do not harm, which is the main purpose of QP
avoiding iatrogenic. Preparing doctors from that principle enables them to better
guide their patients to excessive positions the patients themselves take such as
self medication or esthetics interventions. In addition, it stimulates physicians to
reflect on the benefits and harms that the proposed intervention will result to the
patient and thus consider whether it is really necessary and it is appropriate to
the context.
DISCUSSION/CONCLUSION: Contemporary doctors are potential agents of
medicalization. Thus the application of QP is essential to reduce the damages
of their actions, respecting an ethical, critic and reflexive practice of medicine.
The QP can be very useful in order to stimulate physicians to reflect more on
170
the context of each patient and the convenience of guidance given to them. This
change of behavior avoids unnecessary sufferin.
171
TITLE: New decade, new students in medical school of PUC- SP
AUTHOR: Maria Carolina Coelho Gozzano.
MENTOR: José Otávio Alquezar Gozzano.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Maria Carolina Coelho
Gozzano - PUCSP, Thays Brunelli Pugliesi - PUCSP, Felipe Ladeira Caracuel PUCSP, José Otávio Alquezar Gozzano – PUCSP.
BACKGROUND/INTRODUCTION: The negative behavior of university
students, mainly medicals, including from the Faculty of Medical Sciences and
Health - PUCSP (FMSH-PUCSP), was recently highlighted in controversial
news. However little has been written about their potential and qualities.
Nowadays there are many challenges in terms of knowledge. In studies, they
allow new forms of learning, study by distance and better access to information;
and, in medicine, the implementation of a new learning curriculum.
OBJECTIVES: To compare the profile of medical students of FMSH-PUCSP,
(1st and 2nd grades) with a 10-year gap, with the first data, of 2005, in the
traditional teaching method, and the current in 2015, in the PBL method.
METHODS: 143 students in 2005 (A) and 127 in 2015 (B). Vertical study with
10 years apart with a survey answered freely by the participants, with open
questions and "Social Adaptation Self-evaluation Scale “SASS” test, composed
by 21 questions, which evaluates social relationships, study, leisure and
conduct. Each question worth 0 to 3 points; and the test result, 0 to 60. Score
above 55 indicates superadaptation; between 35 and 52, normal; and below 25,
social misadaptation. It’s possible to know the areas of greatest motivation.
Parametric and nonparametric comparative analysis, considering the
categories: studies, relationships and leisure. Significant p-value of <0.05.
RESULTS: Age: A=20.2±1.5, B=20.4±2.3 years old. In A: 56% women; B: 55%.
Only 1 out of normal >55, in A. Studies: like searching information: A= little (L)
10.4%, moderately (M) 54.9%, very (V) 34.7%; B= not at all (N) 0.8%, L 10.2%,
M 39%, V 50%. Dedication: A= L 7.6%, M 68.8%, V 23.6%; B= L 2.5%, M 55%,
V 42.5%. Ability to organize for goals: A= L 36.8%, M 56.3%, V 6.9%; B= N
0.8%, L 7.9%, M 55.9%, V 35.4%. Difficulty of expression: A= V 2.8%, M
67.4%, L 28.5%, N 1.4%; B= V 2.4%, M 17.3%, L 61.4%, N 18.9%.
Relationships: Community participation: A= N 13.9%, L 31.3%, M 47.2%, V
7.6%; B= N 3%, L 30%, M 56%, V 11%. Outside family: A= with few people 3%,
some 29%, many 68%; B= 9.4%, 45.7%, 44.9%, respectively. Appreciation of
relationships: A= L 1.4%, M 35.4%, V 63.2%; B= L 1.6%, M 15.7%, V 82.7%.
Social rejection: A= N 1.4%, L 9.1%, M 64.3%, V 25.2%; B= N 34.6%, M 61.4%,
L 3.9%. All p-value <0.05. Interest in leisure: A= L 2.8%, M 25.7%, V 71.5%; B=
N 1.6%, L 2.4%, M 30%, V 66%; p=0.39.
172
DISCUSSION/CONCLUSION: SASS result was similar between both years.
Profile of students only changed regarding the studies and relationships. Today
there’s more strategic capacity, commitment to study, ability of expression and
interest in the information. Students participate more in community, appreciate
more their relations and feel more esteemed, despite the unfamiliar
relationships be more limited. Therefore, students’ bad examples reported don’t
reflect their educational and behavioral profile.
173
TITLE: Trends in Heart Failure Hospitalizations and Mortality Rates in Brazil,
2008-2014.
AUTHOR: Murilo de Paiva Siqueira.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Glenda Ferreira, Ana Paula
Moreira Reis, Débora Duarte de Carvalho, Murilo de Paiva Siqueira, Raquel
Freitas Carneiro.
BACKGROUND/INTRODUCTION: Heart failure (HF) is one of the leading
cause for hospitalizations due to cardiovascular diseases in Brazil. In the last 30
years, efforts have been made to reduce the mortality and morbidity related to
this disease, which includes medical and device-based therapies. Despite
dramatic improvement in outcomes with those therapies, admission rates
following HF hospitalization remain high.
OBJECTIVES: To evaluate the trends in HF hospitalization rate in the Public
Health System in Brazil, between 2008 and 2014.
METHODS: This was an ecological study of temporal series. Data on hospital
admission, mean length of stay, and in-hospital mortality were obtained from the
database of the Brazilian Unified Health System/Ministry of Health (DATASUS).
We included HF hospitalizations between 2008 and 2014 for patients -20 years
of age. The data were analyzed nationally and by State or Region.
RESULTS: From 2008 to 2014, there were an estimated 1,741,343
hospitalizations with diagnosis of HF in Brazil. Overall, absolute hospitalizations
reduced from 264,103 in 2008 to 220,340 in 2014. Rates of hospitalizations also
decreased during the study period, from 214 per 100,000 people in 2008 to 160
per 100,000 people in 2014 (25% of reduction). This reduction was consistent
among all Brazilian Regions, but more intense on Mid-West Region (-34%).
Despite these decrease in HF admission, in-hospital mortality rates significantly
increased over these years from 8.2 deaths/100 admissions to 9.9 deaths/100
admissions (+20%). In Goias, Sergipe, Paraiba and Maranhao the in-hospital
mortality increased by more than 60%. Length of stay remain stable over this
period (aproximately 6,6 days).
DISCUSSION/CONCLUSION: Although the number and rate of hospitalizations
due to HF reduced from 2008 to 2014, the in-hospital mortality increased over
the same period. However, data from other reports does not allow us to
conclude that the primary care have improved in the recent years. Considering
the report from Ministry of Health that there has been a decrease in hospital
beds availability in the Public Health System over this period, these data
suggest that patients with more severe disease are being admitted, which also
could explain the higher In-hospital mortality rate.
174
TITLE: Alcohol Brands Advertisement on Facebook and youth health: a
transversal study.
AUTHOR: Wilson Nunes Hirata.
MENTOR: Ilana Pinsky Streinger.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Wilson Nunes Hirata,
Universidade Federal de São Paulo, Brazil; Ilana Pinsky Streinger, PhD,
Universidade Federal de São Paulo; Antonio C. Pazinatto, BA.
BACKGROUND/INTRODUCTION: Facebook is the biggest social network
worldwide and it accepts advertisement, including alcoholic beverages. But
there are few restrictions applied to regular alcohol advertising in this network
and then, people underage can see these advertisements without any age
restriction.
Support: FAPESP (2011/18963-4; 2013/16252-9)
OBJECTIVES: This study has the aim to evaluate the themes and the main
alcohol beverages pages strategies to raise the consume in younger people in
Brazil.
METHODS: Eleven beer brands and a vodka brand were selected. One of the
beer brands, Brahma (owned by AB InBev, the world largest bewer) has many
profiles because it sponsors some major soccer teams and the national
Brazilian soccer team (pages Brahma Oficial, Brahma Seleção, Brahma Fla and
Brahma Timão were selected in this study). So, the total pages followed were
15 (four of them are Brahma pages). The posts were colected with the tool
“alcool digest” (CrowdTangle). The five main posts during every week between
June/2013 to October/2014 were selected. These posts were analysed taking
into account strategic trends and themes based on Nicholls’ (2012) and
Gordon’s (2011) works. The posts were evaluated by two researchers ensuring
consistency in coding with a minimum level of agreement set at 85% inconsistencies were discussed and solved with a third investigator.
RESULTS: The most important theme in the most liked posts were sports,
specially soccer. The pages were very active in soccer games like show results,
goals, teams and classification tables of National Soccer Cup and 2014 FIFA
World Cup Brazil.
Another themes and strategies were sponsored videos, direct suggestions to
where, when and how to drink, interactive games and surveys. Humour was
very frequent on posts.
Erotism was not a important theme in the most liked posts.
175
DISCUSSION/CONCLUSION: Themes like sports, national symbols and
holidays were similar to ones used by traditional media (TV, magazines,
external media), but the strategies are especially attractive to young people
because the posts have a “dynamic talk” to stimulate association with everyday
life and alcohol use. As the importance of social networking to alcohol
advertising increased, public policies must focus in prevent growth in alcohol
consumption in underage people and young adults.
-References: Gordon R, Harris F, MacKintosh AM, Moodie C. Assessing the
cumulative impact of alcohol marketing on young people’s drinking: Cross
sectional data findings. Addiction Research and Theory. 2011. 19(1): 66-75.
Nicholls J. Everyday, everywhere: alcohol marketing and social media--current
trends. Alcohol Alcohol. 2012 Jul-Aug;47(4):486-93.
176
177
TITLE: Prevalence of cytological cervix examination in Brazil, in 2007 and 2013.
AUTHOR: Thais Vicentine Xavier.
MENTOR: Marcelo Capilheira.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Xavier, T.V. - UFPel; Zibetti
W. – UFPel.
BACKGROUND/INTRODUCTION: Cervix cancer is caused by the persistent
infection by some oncogenic strains of the Human Papiloma Virus. It happens
due to the abnormal growth of cells that have the capacity of locally invade and
metastatize to distance. Cervix cancer is the third more frequent tumor among
women and the fourth greater cause of death due to cancer in this population.
For this reason, the cervix cytological examination becomes fundamental to
track and diagnose this pathology, avoiding a metastatic role of it.
OBJECTIVES: To determine the prevalence of the cervix cytological
examination in the years 2007 and 2013, in all regions of Brazil, and compares
them.
METHODS: Descriptive cross-sectional study, based on a secondary data of
Chronic Diseases Risk and Protection Factors Vigilance by Telephone Inquiry
(VIGITEL) of years 2007 and 2013. VIGITEL’s objective is to monitor the
frequency and distribution of noncommunicabel chronic diseases main
determiners by phone inquiry. This questionnaire is anually performed since
2006 and, from 2007 on, questions about cancer prevention were included,
being 2013 data the latest available up to the moment. The presente research is
performed with adults over 18 years old, residentes in the 26 capital cities of
Brazil and Federal District. The outcome approached the performance or not of
preventive cervix cancer examination at some point and in the last 3 years,
being included women between 25 and 64 years old. In 2007, 32704 women
were interviewed and in 2013, 32653. This data was organized according to
year and region for further analysis.
RESULTS: In 2007, from all Brazilian women interviewed, 84.67% said they
have already done the cervix cancer tracking examination, while 79.81%
claimed to have it done in the last 3 years. By regions, South region was
highlighted with 92.85% and 88.21%, for the same variables. Northeast region
had the lowest rates in the country, 80.12% and 75%, respectively. Southeast
region showed high rates, near South. Midwest was in third place, getting over
North region. In 2013, 85.61% of women said they have already done the
examination at some point in life, and 80.68% were updated with it. By regions,
South regions was again highlighted, with 92.75% of women having done the
examination at some moment and 87.81% being updated with it. Northeast
region had the worst performance, with 80.8% and 75.59%, respectively. Still,
the Midwest was supplanted by the North, after slight improvement of the later
in relation to 2007.
178
DISCUSSION/CONCLUSION: South, Southeast and Midwest regions kept with
high rates of the examination, similar to developed countries. In 2007, North
region, which was under the coverage of 80% demanded by WHO, managed, in
2013, to supplant it. Northeast had a quick increase; however, it remains short
of this goal. With this, it was concluded that in Brazil, in general, the tracking
coverage has increased, overtaking, in 2013, the goal of this Organization.
179
180
181
TITLE: Proconvulsant properties of a CB2-selective cannabinoid agonist on
pentylenetetrazole-induced seizures in Wistar rats.
AUTHOR: Gabriel Roman Souza.
MENTOR: Cristiane Ribeiro de Carvalho.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Souza, G.R. - UFSC;
Franco P.L.C. - UFSC; Martini A.P.S. - UFSC; Soares F.M.S. - UFSC; Formolo
D.A. - UFSC, Hoeller A.A. - UFSC, Walz R. - UFSC, De Carvalho C.R. - UFSC
BACKGROUND/INTRODUCTION: Epilepsy is marked by spontaneous
recurrent seizures caused by abnormal neural activity. Evidence shows the
protective role of the endocannabinoid system in suppressing neuronal
excitability through activation of cannabinoid receptors (CB1 and CB2) by
anandamide and 2-arachidonylglycerol. Cannabinoid agonists, including 9tetrahydrocannabinol (THC), are anticonvulsants in different animal models of
seizures and their effects seem to be mediated by CB1 receptor. However, the
role of cannabinoid type CB2 receptors (CB2R) on modulation of seizures is
poorly investigated.
OBJECTIVES: This study aimed to investigate the effects of a CB2-selective
cannabinoid receptor agonist, AM1241, on seizures induced by
pentylenetetrazole. Also, whether the pretreatment with a CB2-selective
cannabinoid receptor antagonist, AM630, may block seizure activity induced by
AM1241.
METHODS: Adult Wistar rats were submitted to stereotaxic surgery to implant
guide cannula into the right lateral ventricle. The experimental procedure started
5-6 days after surgery. Rats received acute i.c.v. microinfusion of AM1241 at
doses of 0.01, 1.0 or 10.0 µg/2µl or vehicle (n=11-14/group) 5 min before
intraperitoneal (i.p.) injection of pentylenetetrazole (PTZ, 70 mg/kg).
Independent groups of rats were pretreated with a dose of AM630 (1.0 mg/kg,
i.p.) or vehicle (n=8-6/group) 30 min prior to AM1241 (1.0 µg/2µL; i.c.v.)
microinfusion. All rats were observed for 30 min and the behavioral seizure
severity was measured by modified Racine's scale. All results were statistically
analyzed using one-way ANOVA followed by Newman-Keuls’ test as a multiple
comparison post hoc test. A p-value < 0.05 was considered as statistically
significant.
RESULTS: Our findings showed that AM1241 treatment significantly increases
the mean seizure stage score as compared to the control group (mean of
maximum Racine score: 6 vs 4 AM1241-treated groups and control,
respectively). The AM1241-treated groups had a significant shorter latency and
also increased the incidence and the duration for first generalized seizures
compared to the control group.
182
There is no significant difference among AM1241-treated groups in these
parameters, suggesting that pro-convulsant effects of AM1241 are not induced
in a dose-dependent manner. Overall, AM1241 treatment did not affect
significantly both the incidence neither the duration for the first myoclonic jerk.
Further, AM630 alone exerts no effects on seizure activity, but the preteatment
with AM630 significantly prevents the proconvulsant effects of AM1241
compared with the control group. This indicates that proconvulsant effects of
AM1241 are mediated by CB2 cannabinoid receptors.
DISCUSSION/CONCLUSION: The present study shows for the first time that
selective activation of CB2R increases seizure activity in rats that received a
single injection of PTZ. These findings shed light the putative role of
endocannabinoid signaling on epileptic seizure processes, suggesting that the
hyperexcitability phenomena may be differently regulated by targeting CB2
receptors.
183
184
TITLE: Cognitive Reserve in Patients with Alzheimer’s Disease.
AUTHOR: Luiz Eduardo de Freitas Xavier.
MENTOR: Leonardo Brandão Barreto.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Xavier, Luiz Eduardo de
Freitas - Federal University of Ouro Preto; de Paulo, Laila Dias Rodrigues Federal University of Juiz de Fora.
BACKGROUND/INTRODUCTION: The aging of the population worldwide
associated with epidemiological transition led the prevalence of infectious
diseases be replaced by chronic diseases, such as neurodegenerative illness
and dementia, like Alzheimer's Disease (AD). According to Brazilian Academy
of Neurology, AD is the most common mental illness in humans. Recent
discovers of Neuroscience confirm that the human body is capable to create a
cognitive reserve (CR) which would be a resilience agent against brain damage,
slowing the symptomatic progression of AD.
OBJECTIVES: To evaluate the influence of RC in AD progression.
METHODS: The present work searched articles related to Alzheimer´s Disease
and its relationship with Cognitive Reserve. The research was based on the
following key words: “Cognitive Reserve” and “Alzheimer´s Disease”. The
research used LILACS, Scielo and BVS tools. After colecting the articles, the
aim of the abstract was to develop a review of the available literure, pointing out
the benefits of studying Cognitive Reserve in order to help patients with
Alzheimer´s Disease to develop a better quality of life. The research also
demonstrates experiments and recent discovers involving humans with AD. The
results reinforces the importance of CR to improve the healthcare with these
patients.
RESULTS: The CR is the ability to improve the mental performance through
alternative brain resources, creating flexible and efficient cognitive strategies
(Stern, 2002). Theoretical models of CR permits to clarify that it is divided in
passive and active models. The Active model understands CR differences, like
the way that individuals make proceedures. The passive model understands the
CR like the period of time that a pacient has until the beginning of clinical
expression. The CR’s concept reinforce the suggestion that high levels of
education and professional occupation are associated with the ability of
sustaining brain damage in order to delay or slow down functional deficits.Thus,
the clinical aspects of the disease are the imbalance between aggression of AD
and the protection offered by CR.
185
DISCUSSION/CONCLUSION: The development of CR is related to schooling,
professional occupation and intelligence. People who are encouraging to
develop a CR since childhood have more possibilites to enjoy a better quality of
life in old age. It can be done through games, sports lessons and reading, for
exemple. It’s necessary to maintain cognitive activities as much as possible in
old age because the brain continues stimulating CR and preserving itself. The
AD’s pathology won’t be avoided improving the CR, but the progress of clinical
disfunction can be reduced by it.
186
TITLE: Reinforcement of plasmatic antioxidant capacity through massive
infusion of vitamin c in patiences with acute myocardial infarction submitted to
percutaneous coronary angioplasty.
AUTHOR: Sebastián Ignacio Fourniés Aracena.
MENTOR: Ramón Rodrigo.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Felipe Maira Bénd, Nicolás
Valls Jiménez, Ramón Rodrigo Salinas.
BACKGROUND/INTRODUCTION: The reperfusion therapy, specifically
percutaneous coronary angioplasty (PCA), is the main tool in the management
of acute myocardial infarction (AMI). However, associated with reperfusion
comes a secondary myocardial injury generated mainly by oxidative stress,
which is called isquemia-reperfusion injury (IRI). It is described in the literature
that the IRI is responsible for up to 50% of the resulting infarct size. Considering
this, antioxidant treatment could largely benefit the result of the PCA. Vitamin C
has been shown to have powerful antioxidant effect in general, but there are no
actual records of its antioxidant capacity by high intravenous doses. We
hypothesize that the massive infusion of Vitamin C increases the antioxidant
capacity of plasma in patients with AMI undergoing PCA.
OBJECTIVES: To determine the antioxidant capacity of plasma before infusion
of high doses of vitamin C in patients with AMI undergoing PCA.
METHODS: A clinical randomized double blind placebo controlled trial was
performed. FRAP, thiol index and MDA levels were compared in patients with
AMI treated with PCA, infused with Vitamin C versus placebo. Data analysis
was performed using ANOVA, p <0.05.
RESULTS: Patients with elevated serum levels of vitamin C had significantly
higher levels of FRAP and lower ones of thiol index and MDA compared with
patients with low levels of Vitamin C.
DISCUSSION/CONCLUSION: These results suggest that high doses of Vitamin
C attenuate the IRI in patients with AMI undergoing PCA by strengthening the
plasmatic antioxidant capacity. Therefore, it is valid to consider the use of
massive intravenous infusion of vitamin C as part of therapy in this type of
patient.
187
188
TITLE: Floppy ACL reconstruction - a growing cause of early onset osteoarthritis
in young athletes.
AUTHOR: Tiberiu-Ciprian Munteanu.
MENTOR: Gabriel Dinu.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Ana-Raluca Mihalcea,
University of Medicine and Pharmachy Carol Davila, Bucharest Romania;
Bogdan Nistor, Clinical Emergency Hospital, Bucharest Romania; Gabriel Dinu,
Clinical Emergency Hospital, Bucharest Romania.
BACKGROUND / INTRODUCTION: The floppy Anterior Cruciate Ligament
(ACL) sign is a well-established arthroscopic and MRI indicator of Posterior
Cruciate Ligament (PCL) insufficiency. When the PCL is incompetent, the tibia
sags posteriorly and the ACL becomes lax. Often, this ACL laxity is mistaken for
an ACL injury, and ACL reconstruction follows, in the context of a PCL defficient
knee. The result is an aggravated PCL insufficiency, with the tibia fixed in a
posterior position, due to the ACL graft tensioning.
OBJECTIVES: Our aim was to review the diagnostic and therapeutic options in
such delicate cases, and stress the importance of correct initial PCL defficiency
diagnosis.
METHODS: We retrospectively analyzed the management of a series of 5
consecutive cases of iatrogenic floppy ACL reconstructions, with fixed posterior
drawer. All patients were young athletes,with a mean age of 23.6 years, 4
males, 3 football players and 1 rugby player and 1 female, a handball player.
They were referred to our department during their ACL rehabilitation program
which was failing. At the time of presentation, all patients had patellofemoral
pain and some degree of meniscal or chondral damage due to the incorrect
tibial loading during weight bearing.
RESULTS: In all cases arthroscopic PCL reconstructions were performed and
the aquired injuries after the initial ACL reconstruction were treated. Two cases
required techniques to induce fibrocartilage regeneration for the lesions
involving the medial femoral condyle, two cases required partial medial
meniscectomies and one case required a medial meniscus suture. The PCL
graft was protected 4 weeks postoperatively with a specific brace and all
patients were enrolled in PCL specific rehabilitation. All patients regained full
range of motion and stable knees.
DISCUSSION/CONCLUSION: We would like to put an emphasis on the
importance of the right diagnosis at the right time for a PCL injury. Confusion
between a PCL and an ACL injury still seems to be high. If a floppy but intact
ACL is reconstructed and the PCL tear is neglected, than a secondary much
more complex surgery will be mandatory in order to reestablish the knee’s
189
kinematics and stability. A fixed posterior drawer may lead to irreversible
damage, especially in the medial compartment and patellofemoral joint.
190
191
TITLE: Cases report. Extraction management of 14 non palpable contraceptive
implants.
AUTHOR: Alejandra Lavin Bravo.
MENTOR: Lavin Pablo.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Lavín A. - U Chile; Lavín P.
- UPV; Bravo C. - U Chile; Lavín P. - U Chile.
BACKGROUND / INTRODUCTION: Implanon is a hormone-releasing
contraceptive implant to prevent pregnan-cy for up to 3 years. It should be
inserted and extracted under local anesthesia with a specific technique, to
guarantee a correct positioning and minimize the risks of damaging other
adjacent structures, placed just under the skin in the mid portion of the inner
side of the non dominant upper arm at the Sulcus Biscipitalis Medialis. It should
be always palpable when correctly applied. A faulty technique can lead to
misplacement of the implant, eventual damage of blood vessels and nerves,
and extraction complications.
OBJECTIVES: Description of 14 cases of non palpable implant extractions,
ambulatory managed, between January 2014 and July 2015, at the Unidad de
Investigación Clínico Epidemiológica en Reproducción Humana (UNICERH) del
Departamento de Obstetricia y Ginecología Sur Facultad de Medicina,
Universidad de Chile, Hospital Barros Luco-Trudeau, Servicio de Salud
Metropolitano Sur, Santiago, Chi-le.
METHODS: UNICERH, a university run outpatient clinic at Hospital Barros
Luco-Trudeau, is a secondary level contraceptive clinic, which runs clinical trials
and solves contraceptive methods complications of cases derived from primary
care clinics from Santiago (and all around the country) since 1976. Descriptive
data is registered at clinical records of all patients at the time of consultation.
From 77 records of non palpable implants, collected from January 2014 to July
2105, 14 (18%) implant cases with “sub aponeurotic layer” location were
selected for analysis. Descriptive statistics and some associations are
presented of: patient characteristics, location of the implants and management
to extract the implants. Extraction of the implants was done in all cases in an
ambulatory fashion despite of the location (adjacent to nerves, artery or veins:
brachial, medial, axillaries, cephalic or ulnar), through a minor surgical
procedure under local anesthesia, guided by previous ultrasound markings.
RESULTS: The mean age of cases is 28.2 (SD 7.4), min 16 and max 44 years.
13 (92.9%) cases had a non palpable implant and 1 (7.1%) dubiously. 12
(85.7%) implants were within the Biceps brachialis muscle and 2 (14.9%) in the
Triceps brachialis.
192
Insertions were done from oct-2006 to nov-2014 at primary level. It was the first
implant for 6 cases (42.9%) and second for 8 cases (57.1%). Midwifes inserted
12 (85.7%) and Physicians 2 (14.3%). Women’s left arm was used in 12
(85.7%) cases and the right arm in 2 (14.3%).
Months of use: mean of 44.2 (SD 21.2), min 5.3 and max 92.3.
Distance in cm of distal portion of implant from:
Epitroclea: mean 11.6 (SD 3.4), min 5 and max 18.
Application scar: mean 2.2 (SD 1.9), min 0.5 and max 5.5.
Sulcus Biscipitalis Medialis: mean 1.8 (SD 2.3), min 3 and max 5. Only 1 placed
at the level of the SBM.
Depth in mm from:
Skin: Mean 7.2 (SD 3.6), min 5 and max 13.
Aponuerotic layers: mean 2.1 (SD 1.5), min 1 and max 5.
DISCUSSION / CONCLUSION: Implants are the most efficacious
contraceptives presently known. Only well trained personnel should perform
insertion. Non palpable implants due to faulty insertion, is not a frequent event,
but extractions could be very risky depending on the location of the implant. 14
cases of non palpable contraceptive implants were satisfactorily taken care in a
standard outpatient clinic, using simple and low cost surgical techniques.
Reference centers with high experienced professionals should be part of the
sanitary network for contraceptive implant complication management.
193
194
TITLE: Early sepsis incidence and risk factors in newborns from a neonatal unit of Belo
Horizonte in 2014.
AUTHOR: Juliana Andressa Lopes Silva.
MENTOR: Síura A. Borges Silva.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Higor Kenedy Ramos, José
Ronaldo Sousa Júnior, Juliana Andressa Lopes Silva, Letícia Monteiro Silva,
Lucas Dantas Pedrosa, Marina Guimarães Ribeiro (Universidade de Itaúna)
Síura A. Borges Silva (Universidade de Itaúna, Maternidade Odete Valadares ).
BACKGROUND / INTRODUCTION: Early neonatal sepsis is defined as a
clinical syndrome characterized by systemic signs of infection and / or isolation
of bacteria in blood culture that manifests itself within 72 hours after birth and is
directly related to pregnancy and / or the peripartum period factors. This
bacterial infection frame remains a major cause of mortality and morbidity in
neonates. Newborns with very low birth weight (VLBW) infants and premature
(preterm infants) are more susceptible to this disease.
OBJECTIVES: To evaluate the incidence of early-onset sepsis and its risk
factors in newborns (RN) in a Neonatal Unit (NU) of Belo Horizonte, in 2014.
METHODS: This is a prospective study evaluating 570 infants admitted to the
neonatal unit (UN) and listed by the Hospital Infection Control Service. The
variables studied were: birth weight (BW), gestational age (GA), mode of
delivery, Apgar 1 and 5 minutes, need for resuscitation, the presence of rupture
of membranes (BR)> 18 hours, the presence of maternal chorioamnionitis and
use and time use of antibiotics (ATB). It also investigated the colonization by
group B streptococcus and results of blood cultures. Confirmed cases of sepsis
were considered to ATB used for five or more days period suspected sepsis
and those used for one to four days ATB. The Chi Square was used to compare
proportions; and the Kruskal-Wallis test to compare means. The value of p
<0.05 was considered as statistically significant threshold.
RESULTS: Of the 570 infants evaluated with PN average of 2522 + 937 g and
average GI 36 + 4 weeks 134 (23.5%) had a suspected sepsis, but not
confirmed (ATB use by one to four days) ; and 100 (17.5%), confirmed sepsis
(ATB use for five or more days). Of the confirmed cases, 48% occurred in
infants <1500g and 69% in premature infants (infants <37 weeks). Among the
variables associated with sepsis, there was significant statistical difference for
the presence of chorioamnionitis, lower GI, lower BW and lower Apgar 1 and 5
minutes and need for resuscitation (p <0.0001 for these six variables). This did
not occur when they were analyzed the type of delivery (p = 0.65) and the
presence of us, even when they were analyzed for the latter variable, the
median and the lower cutoff and greater than or equal to 18 hours (respectively
p = 0.63 and p = 0.10). Of the total cases analyzed, only 15 were in research
record for streptococcus.
195
For others, the research was not carried out or there was no information in the
medical record. As for blood cultures, only 11 were positive.
DISCUSSION / CONCLUSION: The study reinforces the appreciation of
chorioamnionitis as an important risk factor for early-onset sepsis. It also
reaffirms the impact of prematurity, low birth weight and birth conditions as
relevant factors associated with increased risk of early sepsis. Some risk
factors, documented in the literature, as aminiorrexe time, were not statistically
significant in this study. Further research within the study unit may be necessary
to further conclusion in this regard.
196
TITLE: Head and neck teratomas: a series of 13 cases
AUTHOR: Marlon Moura
MENTOR: Marbele Guimarães de Oliveira.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: José de Bessa Júnior
(UEFS), Josenice Gomes Trindade da Silva (Universidade Estadual de Feira de
Santana), Laila Vanessa de Jesus (Universidade Estadual de Feira de
Santana), Maria Eliza Faria (Universidade do Estado da Bahia).
BACKGROUND / INTRODUCTION: Head and neck teratomas are rare benign
tumors, corresponding to 3% of all teratomas. They are usually diagnosed early
in children, due to frequent symptoms such as respiratory distress, facial
changes and influence on vision. The prognosis is usually favorable after a
complete excision surgery, with a recurrence lower than 7% in the case of
dermoid cysts, or mature cystic teratomas.
OBJECTIVES: Describe all cases of head and neck teratoma diagnosed in a
specialized laboratory of pathology, in the period between 2002 and 2015.
METHODS: It is a cross-sectional descriptive study, performed in a specialized
laboratory of pathology in Feira de Santana - BA, in the period between 2002
and 2015. During this period, the laboratory diagnosed 452 cases of teratoma,
in which 13 are head and neck teratomas. All teratomas underwent excision
and subsequent submission to conduct examination of surgical pathology. The
following variables were analyzed: age at diagnosis, sex, macroscopic
appearance and diagnostic conclusion. Quantitative variables were analyzed as
mean, median, percentage and standard deviation using the EXCEL tools.
RESULTS: The studied group consisted of 13 children, with age at diagnosis
ranging from 9 months to 13 years with a mean of 4 years. The group is
composed of 6 girls and 7 boys with an average age of 2 and 6 years,
respectively. About macroscopic appearance, all but one were of cystic aspect
(Mature Cystic Teratoma) with whitish or yellowish dense contents. The other
one was presented as polypoid lesion of lobulated surface, covered with
brownish mucous, being diagnosed as Mature Teratoma. The most common
location was the periorbital region, with 6 (46.1%) cases, but there were other
involved regions such as left preauricular in 2 (15.4%) patients. Anterior
cervical, sternum, left ear and nasopharynx were affected in 1 (7.7%) patient
each and In 1 (7.7%) case, the location was not specified. The diameters of
mature cystic teratomas ranged from 0.4 cm to 1.3 cm, with a mean of 0.9 cm
(median of 0.9 cm). The largest injury was the mature teratoma, identified in
nasopharynx with a diameter of 3.0 cm.
DISCUSSION/CONCLUSION: It was observed that the head and neck
teratomas occur in children with no cases found in adults in our study. Also
noteworthy is the relatively small size of these teratomas compared with tumors
of other parts of the body. Probably this is the result of an early diagnosis of
these lesions in exposed areas of the head and neck due to easy viewing and
197
the symptomatology usually respiratory and visual. This justifies the fact that the
major lesion have been found in the nasopharynx.
198
199
TITLE: Pet Assisted Activities in a rest home: does it change the elderly's health
and welfare?
AUTHOR: Mariana Theozzo Padovani.
MENTOR: Rita de Cássia Helú Mendonça Ribeiro.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Vivian Romanholi Cória,
Laís Maria Milani, Laura Carolina Marchesi Torrezan, Mariela Pereira Graner,
Érika Mendonça Lari Nobrega, Isabella Ferrari dos Reis, Ludmilla Laura
Miranda, Renata Borges Marchiori, Sabrina Sayuri Mor.
BACKGROUND/INTRODUCTION: Pet Assisted Activities (PAA) is a fun and
free activity, promoting interaction between animals and people. This approach
differs from others by promoting communication and providing an activity based
on the emotional bond developed among patients, dogs and staff.
Communication plays an important role in monitoring the elderly, whether
institutionalized or not. Sometimes it is more difficult starting to talk than
keeping the conversation, and animals can be valuable at this time.The League
of Geriatrics and Gerontology (LGG) of FAMERP seeks to promote the
integration and improve life’s quality of institutionalized elderly, to provide
health, improving social interaction and self-esteem through the visit and
recreational activities with trained dogs.
OBJECTIVES: Avaluate the elderly’s behavior, interaction, mobility, humor and
body language, throught the LGG participant’s perception, comparing if there
was an improvement before and after starting the PAA.
METHODS: The questionnaire used consisted of six multiple choice questions,
for which the answers had a grading scale, based on negative, indiferent or
positive as options, so each item about the aspects of dogs and elderly
interaction could be evaluated. Among the 39 members of the league, three did
not answer the questionnaire. All those who participated in the survey
authorized the use of data by signing the consent term.
RESULTS: 88,9% (n = 32) of the students noticed improvements in the elderlyelderly and elderly-dog interaction and changes in the elderly’s behavior
(86,1%, n=31) on the first date with the dogs. Most of them noticed
improvements in the elderly’s humor (91,7%, n=33) and in their body language
in the first encounter. As for the elderly’s mobility 58,3% (n= 21) noticed any
difference and 94,4% (n=34) believe that PAA was valid.
DISCUSSION/CONCLUSION: The analysis of results elucidated that PAA
seemed to have positive impact on the elderly’s welfare, quality of life,
interaction and behavior. In addition, the animal's presence favors the
mobilization (for instance, comb the dogs) and the elderly make the necessary
effort to overcome limitations and achieve their goal. Thus, the LGG FAMERP
believe it is valid to continue with the PAA, taking the dogs to spend some hours
every two weeks in this rest home.
200
TITLE: A new perspective of medical learning model: Suture Course - Learning
and Improving Technics of General Surgery.
AUTHOR: Tayla Aum Malaspina.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Borges, G. R.; Faria, V. R.;
Fernandes, L. E. ; Guarnieri, R.R; Lima, L. M. ;Forcin, G.; Fuganti, D. V.
BACKGROUND/INTRODUCTION: The model of medical teaching and learning
has suffered many changes and innovations recently, mainly in Brazil.
Searching adequate alternatives to the new guidelines for active learning and
development of multiple skills of future healthcare professional has been being
the aim of a great part of Brazilian medical schools. Work fields with major
complexity, strongly marked by the Flexner’s model, and evident aspect of
technical skills a requirement, such as General Surgery, have been shown
many possibilities for creating experimental models and the teaching
improvement.
OBJECTIVES: To report the experience of offering a training course of
techniques of suturing by students members of coordination of the Medical
League of General Surgery and Trauma (MLGST) of University Barão de Mauá
as a model of medical teaching and learning.
METHODS: To offer the training course of techniques of suturing the
coordinators members of MLGST, after a discussion with the preceptor, made a
teaching plan. After that this group wrote an own handout regards materials and
techniques of suturing to be used along with the course's period. Therefore, a
specialized precept trained this group to improve the own technic of suturing
and teaching skills. Finally, this group and their precept offered training to the
applied students. After that, a feedback was made between the teaching group
and the training group.
RESULTS: A group with 60 students attended to offered training. Four basic
techniques of suturing on animal material were trained and seminars regarding
techniques, threads and auxiliary material were made. The teacher students
during their own training improved their technical skills and during the offering
course improved their didactics and oratory abilities. The trained students had a
high level of satisfaction with the course. The group of them who did not have
contact with those techniques during the under-graduation time had an early
contact and an interest awaken to active and autonomous learning. The group
of them who had had contact with those techniques during the under-graduation
time remembered previous knowledge and expand their abilities and fixation,
developing more security on surgical techniques.
201
DISCUSSION/CONCLUSION: The process of creation of an event with great
structure develops many skills such as team working, pro-activity, planning,
organization, logistics and responsibility about the execution quality. Abilities
such as didactics and oratory, which are involved into the teaching process, are,
also, an active learning model able to offer memorization of information. The
learning model by pairs used on this experience turns possible involvement,
experience with information and personal growth. This model is efficient,
ensures teaching qualification and development of many skills to the teaching
group and learning group either.
202
203
TITLE: A Rubella Identification Pamphlet for Health Workers: Identifying Key
Social and Clinical Variables Associated with the Disease.
AUTHOR: Gabriel de Almeida Calado.
MENTOR: Eleonora D'Orsi.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Isadora Barazzetti Rigon,
Beatriz Ferreira Cordeiro, Pedro Henrique de Souza Peters - Universidade
Federal de Santa Catarina.
BACKGROUND/INTRODUCTION: Contraction of exanthematous diseases of
viral etiology by adults and children alike, chiefly among them common measles
and rubella, is still a worryingly common occurrence in Brazil. Even after the
country's national vaccination campaign, Brasil Livre da Rubéola, which sought
to eradicate the disease, there are still a significant number of reported cases of
rubella every year, which require ever more knowledge and preparedness on
the part of health professionals to reach an accurate diagnosis.
OBJECTIVES: To identify statistically relevant factors and tendencies, both
social and clinical in nature, of potential use in future diagnostic tools aimed at
possible cases of rubella for both medical professionals and the general
population and construct an accessible, informational pamphlet as a proof of
concept of just such a diagnostic tool.
METHODS: The data used was extracted from compulsory notification
datasheets for exanthematous diseases from 2007 to 2015 in the state of Santa
Catarina, all supplied by the state’s local epidemiologic notification system,
SINAN. Of these, cases of measles and other diseases except rubella were
excluded, leaving 586 datasheets of suspected cases of rubella. These were
further divided into confirmed and disproved cases, and each of these were, in
turn, compared to one another regarding the difference in contraction rates
among the evaluated variables: age, gender, vaccination status, socioeconomic
factors and different clinical signs and symptoms (p = 0.05). From this
comparison, the relative risks for contraction of rubella for these variables were
calculated and used to construct an informational pamphlet meant to facilitate
the identification of potential rubella cases by both health professionals and the
general population, particularly parents of small children and infants in at-risk
areas.
204
RESULTS: After definitive laboratory tests of the 586 suspected cases, 539
(92.0%) were negative for rubella and 47 (8.0%) were confirmed positive. While
children up to 9 years old formed the majority of suspected cases, 65.0%, it was
actually adults 20-29 years old who made up the majority of the confirmed
cases, 63.9%. Also of note demographically was that men made up 76.6% of all
confirmed cases and that, of those whose educational background was known,
94.3% of the confirmed cases had finished, at least, primary school. Vaccination
exerted a protective effect against confirmation, with a relative risk of 0.25.
Among the analyzed signs and symptoms, arthralgia, conjunctivitis,
retroauricular pain and presence of palpable lymph nodes had, respectively,
relative risks of 6.3, 6.1, 5.2 and 4 for confirmation of rubella. The finished
pamphlet presents and discusses upon these findings in language designed to
be accessible to the average person.
DISCUSSION/CONCLUSION: The study successfully used identified many
statistically relevant factors and tendencies, both social and clinical in nature, of
potential use in future diagnostic tools aimed at possible cases of rubella for
both medical professionals and the general population in Santa Catarina, and
possibly all of Brazil. Exemplifying this, a pamphlet designed to alert people as
to the most relevant presentations and contexts in which rubella manifests itself
in patients was built as a proof of concept.
205
206
207
TITLE: Comparison of tympanometric parameters in scuba-divers and nondiving healthy volunteers.
TYPE OF RESEARCH: CLINICS/INTERNAL MEDICINE.
AUTHOR: Anna Maria Cyran.
MENTOR: Miroslaw J. Szczepanski MD PhD.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Kosla, A. - Medical
University of Warsaw.
BACKGROUND/INTRODUCTION: The Eustachian tube (ET) plays a key role
in middle ear (ME) pressure equalization. While descending scuba-divers are
subjected to relatively high ambient pressures. Hence the need to perform
equalizing maneouvers (e.g. Valsalva), which open the ET, and allow air into
the ME cavity. Insufficient ET opening leads to middle ear barotrauma (MEB),
which is the most common injury associated with scuba-diving. Its
manifestations range from oedema of ME mucosa to tympanic membrane
rupture. It is postulated that all scuba-divers experience MEB to some extent.
OBJECTIVES: The aim of this study was to determine differences in
tympanometric findings between scuba-divers and non-diving individuals.
METHODS: Sixty scuba-divers participated in the study (21 women, 39 men;
38.2 yrs +/- 10.6). Control consisted of 90 non-diving volunteers (48 women, 42
men; 25.0 yrs +/- 3.7) without history of otolaryngologic problems. All
participants of the study were asessed in otoscopy and tymapanometry with
evaluation of ipsilateral stapedial reflexes. Subjects in the group studied were
requested to answer questionnaire regarding occurence of MEB and diving
competence. Barotrauma was defined as otic pain or pressure sensation,
despite performing equalizing maneouvers, during the dive or immediately after.
Diving competence was evaluated on basis of diving certificate carried, number
of dives and length of diving experience.
Statistical analysis of results was performed with the use of Mann-Whitney U
test and chi-squared test and Spearman’s correlation coefficient (rho); P-value
<0.05 was considered significant.
RESULTS: Among 60 divers, 31 (51.7%) have experienced MEB, the most
common symptoms included earache reported by 20 divers (65%), impaired
hearing and headache present in 14 (45%) and 10 (32%) cases respectively.
Comparison of mean tympanometric parameters between the group studied
(n=120 ears) and control (n=180 ears) revealed lower ME pressure (p<0.0001),
gradient (p<0.0001) and compliance (p<0.05) in scuba-divers. Percentage of
present stapedial reflexes at 4000Hz 100dB among scuba-divers was
significantly lower (p<0.05).
208
Higer number of dives performed correlated directly with lower percentage of
present stapedial reflexes at 4000Hz 100dB (rho= -0.285; p<0.05). In scubadivers with MEB longer time from injury correlates with greater ME pressure and
compliance (p<0.05, rho= 0.301 and p<0.05, rho=0.364 respectively).
DICUSSION/CONCLUSION: Middle ear pressure, gradient and complance are
significantly lower in scuba divers, however are still within the norm. Percentage
of positive stapedial reflexes at 4000Hz 100dB is lower in scuba divers and
decreases with numer of dives performed. Differences in tympanometric
parameters between scuba-divers and non-diving inviduals may result from
subclinical form of middle ear barotrauma.
209
TITLE: The supplementation with high doses of ascorbate reduces the left
ventricular function impairment following acute myocardial infarction.
AUTHOR: Ignacio Antonio Cortés Fuentes.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Valls N, Hasson D, Libuy
M, Brito R, Contreras C, González J, Gormaz J, Rodrigo R - Institute of Medical
Sciences, Faculty of Medicine.
BACKGROUND/INTRODUCTION: Acute myocardial infarction (AMI) is the
leading cause of mortality worldwide. Percutaneous coronary angioplasty (PCA)
is the election treatment for patients with AMI. Paradoxically, the tissue
reperfusion during this procedure increases the initial damage, which could
explain up to 50% of the final infarct size. Oxidative stress may contribute to this
injury. The antioxidant reinforcement through high doses of ascorbate should
reduce the reperfusion injury and it structural consequences, which could be
expressed by an amelioration of left ventricular function impairment.
OBJECTIVES: To compare the ventricular function at 84 day following PCA
between patients treated with high doses of ascorbate with patients treated with
placebo.
METHODS: A double-blind placebo controlled trial was performed in 40 patients
with first AMI scheduled for PCA. At least 30 min prior to PCA, they received a
sodium ascorbate infusion (320mmol/L) or placebo. Blood samples were taken
prior and following reperfusion to measure final ascorbate/initial ascorbate ratio
(AR) to separate patients in two groups: AR>10 (HA) and AR<10 (LA). The
antioxidant potential was measured through ferric reducing ability of plasma
(FRAP). The ventricular function was estimated from left ventricular ejection
fraction (LVEF), which was evaluated by cardiac magnetic resonance (CMR) at
6 and 84 days following PCA. To assess the LVEF change experimented
between the two CMR periods, we calculated the difference between the LVEF
obtained at day 84 and the initial LVEF measured at day 6 for each patient
(delta 84th-6th). Results are expressed in mean ± standard deviation. ShapiroWilk test was applied to determine distribution. Qualitative and quantitative
variables were compared using Chi-square test and Mann-Whitney U-test
respectively. To determine correlation Spearman test was applied. A p-value
<0.05 was considered statistically significant.
RESULTS: 21 patients were in LA group. 19 patients were in HA group. There
are not demographic significantly differences between the groups (p>0.05).
Prior to PCA, both groups showed similar antioxidant potential (p>0.05). After
210
reperfusion, in HA group there was a significant higher plasma antioxidant
potential than in LA group (p<0.01).
Ascorbate levels were positively correlated with FRAP at time of reperfusion.
(p<0.01; r=0.65). At 6 day, LVEF was 50.27 ± 12.1% in LA group and 48.95 ±
10.5% in HA group (p>0.05). At 84 day, LVEF was 49.41 ± 11.9% in LA group
and 54.96 ± 11.5% in the HA group (p>0.05). Comparing the delta of LVEF
between days 84 and 6 for each patient, in LA group was -0.54 ± 6.7% and in
HA group was 5.78 ± 12.4%, showing significant differences (p<0.05).
DISCUSSION/CONCLUSION: The administration of high doses of ascorbate
prior PCA ameliorates the ventricular function impairment at 84 day after PCA.
Also, high ascorbate levels increased antioxidant potential at reperfusion with a
positive correlation with ascorbate levels, which support the idea that the
antioxidant reinforcement could be beneficial to diminish the morphologic and
functional reperfusion injury associated to AMI. (Supported by FONDECYT,
grant number 1120594)
211
TITLE: Alexithymia and fibromyalgia: a sistematic revision
AUTHOR: Vivian Romanholi Coria.
MENTOR: Gerardo Maria de Araújo Filho.
ALL CO-AUTHORS NAMES AND INSTITUTIONS: Lucas Romagnolli, Sérgio
Henrique Navarro Júnior, João Eduardo Torrecillas Sartori, Júlio César Morgan
de Oliveira, Alethea de Souza Romanelli, Bruno Soleman Martin, Livia
Gabrielle, Marina Leite de Fornasari, Vivian Romanholi Coria, Gerardo Maria de
Araújo Filho.
BACKGROUND/INTRODUCTION: Fibromyalgia is a chronic musculoskeletal
pain syndrome characterized by the presence of painful points on digitopalpation in anatomical Specific areas , called trigger points, followed by
psychological disorders like sleeping problems and alexithymia. Alexithymia is a
dimension defined as the absence of words for emotions. The patient does not
know how to process their own emotions and fail to externalize what they feel.
The investigation of possible relationship between Fibromyalgia and alexithymia
can increase knowledge about the clinical features resulting from both diseases,
specially because alexithymia is poorly explored and has a significant impact in
life-quality of the patients.
OBJECTIVES: To execute a literature review searching for a clinical
association between Alexithymia and Fibromyalgia (FM), highlighting psychiatric
and psychological aspects.
METHODS: Folowing PRISMA statement the research used Scielo, Pubmed,
PsychLit and ISIweb of knowledge data base between 2009 and 2014 with the
key-words: “alexithymia”, “fibromyalgia”, “psychosomatics”, “chronical pain”,
“psychotherapy”, “psychoanalysis”.
RESULTS: Nine studies were selected for analysis which used intruments like
the Toronto Alexithymia Scale, the psychoanalysis and cognitivel
comportamental therapy showing that the patient with FM has a worse pain
interpretation, deals badly with it and suffer the consequences in their physical
and mental health due to that.
DISCUSSION/CONCLUSION: This study suggested the important impact that
alexithymia has in patients with FM, since the psychiatric and psychological
factors lead to a bigger decrease in life quality of people who have already
worse aspects in that, which warn for the importance of this emotional state,
since it is under-diagnosed. Since there were a small number of reviewed
articles, more research about the relation between FM and Alexithymia must be
done.
212
On the behalf of the V BRAINCOMS Organizing Committee, I would like to
invite all of you, presenters and listeners of the IV BRAINCOMS as well as the
readers of this book, to come to our next event. We are working hard to make
an even bigger, greater and better Congress. We intend to promote an
incredible experience under the theme “Creativity enriching Medicine”! You
can’t miss it! Remember the date: October 20th, 21st and 22nd 2016.
See you!
André Nicolau
President 2016
Brazilian International Congress of Medical Students - BRAINCOMS
213

Untitled - Braincoms

Transcription

Similar documents

Success from Your first flip

YOU GAVE ME A JOB

Meeting Mentor Magazine

ASL Open Video Chat

Full steam ahead for Iron Maidens as business mentor helps to

Dec 2012 - Jasper County Mentor Program

Leaders Digest Vol 2 No 3

MFI Employee Benefits

ALUMINATE eMentoring: Visual Guide

Nancy N. Manister DNS, FNP-BC Keville Frederickson EdD, RN, FAAN