Arquivos de higiene e patologia exóticas.

Includes supplements

Tratado de química patológica aplicada a la medicina práctica /

Mode of access: Internet.

La quimica ha contribuido a los adelantos de la medicina en general y de la toxicología en particular : Discurso leido en la Universidad Central por don José Gonzalez Zorrilla, en el acto solemne de recibir la investidura de doctor en la Facultad de Medicina y Cirujía.

Tesis Universidad Central, 1857.

La aspiración médica : revista teórico-clínica, eco de la clase médico-escolar española.

Mode of access: Internet.

Médicos acupuntores : Su visión de la alopatía y del potencial de la medicina integrativa

Basándonos en 18 entrevistas en profundidad con médicos que han incorporado en su práctica clínica la acupuntura, en este trabajo analizamos cómo ellos definen la medicina que practican y de qué modo la diferencian de la práctica biomédica convencional o alopática. El trabajo de campo se realizó en las ciudades de Buenos Aires y Tucumán durante los años 2005 y 2006. El estudio se centra en los significados y estilos terapéuticos desarrollados por los médicos, y más específicamente en sus perspectivas de cómo el ejercicio de la acupuntura en la atención primaria de la salud les ha permitido mantenerse próximos a la "esencia" de lo que debería ser la medicina. Los médicos construyen dicha esencia a partir de la crítica de la biomedicina actual hiper especializada y altamente tecnologizada, y de la recuperación de valores y prácticas perdidas de la medicina occidental moderna (el enfoque holístico y centrado en el paciente) así como de la posibilidades que abren las medicinas no convencionales de brindar tratamientos que no producen iatrogenia y de facilitar una relación terapéutica menos paternalista

O relacionamento entre Fé e Medicina no tratamento do câncer Uma análise sobre a influência da fé religiosa no processo de tratamento junto a pessoas com câncer

A presente pesquisa tem como objetivo analisar a influência da fé religiosa no tratamento junto a pessoas com câncer, de maneira mais específica com câncer de cólonretal, a fim de coletar dados de um grupo mais homogêneo. A pesquisa de campo foi realizada no Ambulatório de Oncologia do Hospital de Clínicas da UNICAMP (Universidade Estadual de Campinas). A motivação para o aprofundamento deste estudo surgiu a partir de nossa atuação pastoral, quando confrontados com as diferentes reações dos pacientes em relação ao câncer, ao observar que a fé desempenhava um papel fundamental no tratamento e na luta contra a doença. Para a elaboração de nossa pesquisa recorreu-se aos estudos em relação ao câncer pelos médicos e psicanalistas Carl Simonton e Stefanie M. Simonton, Com a vida de Novo; Bernie S. Siegel, Amor, Medicina e Milagres. Para a análise e compreensão da fé buscamos como referencial o pensamento de Paul Tillich, em A Dinâmica da Fé e James Fowler, Estágios da fé. Procuramos ainda verificar as hipóteses levantadas de acordo com a compreensão da Psicanálise e Religião segundo Erich Fromm, Psicologia e Religião desenvolvida por Carl Gustav Jung e Psicoterapia e sentido da vida segundo Victor Frankl. O desenvolvimento deste projeto se dá em três momentos. No primeiro é realizada uma análise entre medicina e fé, a partir dos autores mencionados acima. No segundo são apresentados o resultado da pesquisa de campo. No terceiro reflete-se sobre os resultados da pesquisa de campo à luz dos referenciais teóricos em questão.(AU)

QUALIDADE DE VIDA E STRESS DE CRIANÇAS E ADOLESCENTES COM CÂNCER EM ESTÁGIO DE REMISSÃO E RECIDIVA

O câncer em crianças até cerca de duas décadas, era considerado uma doença crônica, com prognóstico desfavorável, resultando na maioria dos casos, em morte. Atualmente, tem-se apresentado como uma doença com melhores perspectivas, onde 70% das crianças acometidas por essa doença podem ser curadas, quando diagnosticadas precocemente, e tratadas em centros especializados¹. Este estudo teve como objetivo, avaliar a qualidade de vida e o stress de crianças e adolescentes com câncer, em remissão e recidiva. Trata-se de um estudo correlacional, quali-quantitativo, transversal. Foi desenvolvido no ambulatório de oncologia pediátrica da Faculdade de Medicina do ABC, e na enfermaria do Hospital Mário Covas. Contou com a colaboração de 40 sujeitos, com idades entre 06 a 14 anos, de ambos os sexos. Como instrumento para medir a qualidade de vida, foi utilizado o Child Health Questionnaire (CHQ-PF50), que possui 15 conceitos em saúde, abrangendo aspectos físicos e psicossociais e para medir o stress, a Escala de Stress Infantil (ESI), que tem como objetivo, avaliar o stress da criança, através de reações físicas e psicológicas. Os resultados indicaram que no domínio físico (PhS), as crianças em situação clínica de recidiva e remissão não apresentam diferenças significativas em relação às variáveis: qualidade de vida e stress, porém, no domínio psicossocial (PsS), houve diferença estatisticamente significante, indicando que os meninos apresentam melhor qualidade de vida e menor stress, se comparados com as meninas, mostrando que o emocional interfere nesse resultado.(AU)

Análise imunoistoquímica após terapia fotodinâmica com cloro-alumínio ftalocianina em tecidos gengivais de humanos

Although photodynamic therapy have been used as a useful tool over the past 30 years in oncology, few clinical trials have been conducted in dentistry. Photodynamic therapy (PDT) uses non - toxic photosensitizers and selective which are administered in target cells followed by local application of visible light, producing reactive oxygen species capable of causing cell death by apoptosis or necrosis, injured the local vasculature, and exert important effects on the im mune system. New generations of photosensitizing agents, such as nanoparticulate phthalocyanines, has shown excellent results in antitumor and antibacterial activity . In this context, the present work constitutes the first clinical protocol of local appli cation of nanoemulsion chloro - aluminum phthalocyanine (AlClFc) followed by irradiation in human gingiva, and analyzed descriptively and comparatively , by means of immunohistochemistry , the expression of RANK , RANKL , OPG and VEGF in a split - mouth model . Eight healthy volunteers with clinical indication for extraction were included in the study . Seven days before the extraction, was injected in the gingiva of participants, 5 μ M of nanoemulsion AlClFc followed by irra diation with diode laser (660nm , 7 J/cm2 ), the contralateral side was used as control. Tissue specimens were removed seven days after the TFD is performed. Tissues sample were divided into two groups (test and con trol groups) for histological and immunohistochemical analysis. Patients were monitored at days, 0, 7, 14 and 30 to assess adverse effects of the therapy. Vascular alterations were seen in gingival samples that received PDT. Areas of edema and vascular con gestion, and intense vascularization were viewed . Additionally, dystrophic calcification in subepithelial region were observed in the test group. The results showed a similar pattern of immunostaining scores of RANK, RANKL and VEGF between the test and co ntrol groups, with no statistically significant difference (p = 0.317, p = 0.777, p = 0 .814, respectively). RANK and RANKL exhibited weak or absent immunostaining in most specimens analyzed. There was n o immunostaining for OPG. VEGF showed moderate to stro ng immunostaining in specimens from the test group. In addition, the clinical study showed that therapy was well tolerated by all patients. Adverse effects were short - time and completely reversible. Taken together, the results presented in this study showe d that PDT mediated by nanoemulsion containing AlClPc is safe for clinical application in gingival tissue and suggests that a strong immunostaining for VEGF after therapy .

Utilização de mapas conceituais como ferramenta de ensino para o desenvolvimento do raciocínio clínico no curso de medicina da Universidade Federal do Rio Grande do Norte

BACKGROUND: Among the wide range of skills displayed by a medical doctor is undoubtedly the need to use cohesive and well grounded clinical reasoning in order for medical care to be indeed effective. It is in this respect that conceptual maps emerge; these are a methodological innovation that allows a comprehensive, panoramic and associative outlook of theoretical content, making it more practical and applicable to the reality of clinical observation. Promoting learning, learning resources and a feedback system between professor and students, as well as assessing and monitoring the performance of students during their academic training, are the main features of this tool. OBJETIVE: Assess the use of conceptual maps as a teaching-learning tool in the training of undergraduate medical students at Universidade Federal do Rio Grande do Norte (UFRN). METHODOLOGY: Interventional, randomized, cross-sectional study conducted with students from the 3rd and 5th periods of the medical course at UFRN, during the second semester of 2014, totaling 86 participants, divided into two groups: GI (intervention – clinical case resolution with a conceptual map) and GII (control – clinical case resolution without a conceptual map) in each period. RESULTS: The use of conceptual maps to teach liver failure syndrome resulted in a statistically significant cognitive gain for G1 students from the 5th period (GI: 6.8±1.6 and 8.0±1.5, p = 0.024; GII: 7.2±2.1 and 8.0±1.7, p = 0.125, pre and post-intermediate means, respectively), a result not observed in the period 3rd (GI: 7.7±1.3 and 8.0±1.4, p = 0.501; GII: 6.7±1.8 and 7.8±1.8; p=0.068, pre and post-intermediate means, respectively). Students in the 3 rd period gave better responses to the first clinical case, with a larger number of suitable concepts and crosslinks, when they used conceptual maps (GI: 91.3±13.15 and GII: 64.84±22.84, p=0,002). Students in the 5th period exhibited better clinical reasoning and more complete responses using the tool (p=0,01). Most of the students were not aware of the tool (53.8% from the 3rd period and 65.3% from the 5th period). Among those who knew about conceptual maps, most (59.3%) had only used them during high school, 14.8% had never used them and only seven students (25.9%) used them during the medical course. Analysis of open responses, obtained in process assessment showed clear satisfaction and enthusiasm with learning about the new tool, and frequent suggestions to use it at other moments in the course. Assessment of learning profile, using the VARK questionnaire, showed that most students from both periods exhibited a multimodal style. CONCLUSION: Despite their scant knowledge regarding the tool, good acceptability and understanding was observed in the study participants. The conceptual maps allowed cognitive gains, better responses and clinical reasoning in teaching liver failure syndrome to 5th period students.

A simulação como método de ensino de habilidades no curso de medicina: relato de uma experiência com punção lombar

The teaching of the lumbar puncture (LP) technique with simulator is not well systematized in the curricula of medical schools. Studies show that training in the simulator provides learning technical skills, acquisition and retention of knowledge, improve self-confidence of the learner and enables the transfer to clinical practice. We intend this study to introduce simulated training in LP in medical course at the Universidade Federal do Rio Grande do Norte evaluating the experience taking into account quantitative aspects (performance on standardized tests) and qualitative (perception of the students regarding the method and the teaching process learning). The study was conducted in two phases. In the first phase practical training in PL was introduced in the 3rd year of medical school. Seventy-seven students were trained in small groups, guided by a checklist developed in the model Objective Structured Assessment of Technical Skill (OSATS), at this moment they knew they were not under performance evaluation. They were also asked whether they had prior chances to make an LP in patients. At the end of the first phase the students evaluated training in the following areas: teaching technique, simulator realism, time available per group, number of participants per group and relevance to medical practice. In the second phase, two years later, 18 students trained in first stage performed a new LP on the mannequin simulator, and its performance was evaluated through the same checklist of training in order to verify the technical retention. In addition, they answered a multiple choice test about practical aspects of the LP technique. Each participant received individual feedback on their performance at the end of their participation in the study. In the first phase of the study we found that only 4% of students had performed a lumbar puncture in patients until the 3rd year. The training of LP technique with simulator mannequin was considered relevant and the teaching methods was thoroughly evaluated. In the second phase, all participants were successful in implementing the lumbar puncture on the mannequin simulator, compliance with the most steps in a reasonable time, suggesting that would be able to perform the procedure in a patient.

Effects of a positive emotion-based adjuvant psychological therapy in colorectal cancer patients: a pilot study

Objective: To examine the effectiveness of an “Enhancing Positive Emotions Procedure” (EPEP) based on positive psychology and cognitive behavioral therapy in relieving distress at the time of adjuvant chemotherapy treatment in colorectal cancer patients (CRC). It is expected that EPEP will increase quality of life and positive affect in CRC patients during chemotherapy treatment intervention and at 1 month follow-up.Method: A group of 24 CRC patients received the EPEP procedure (intervention group), whereas another group of 20 CRC patients did not receive the EPEP (control group). Quality of life (EORTC-QLQC30), and mood (PANAS) were assessed in three moments: prior to enter the study (T1), at the end of the time required to apply the EPEP (T2, 6 weeks after T1), and, at follow-up (T3, one-month after T2). Patient’s assessments of the EPEP (improving in mood states, and significance of the attention received) were assessed with Lickert scales.Results: Insomnia was reduced in the intervention group. Treatment group had better scores on positive affect although there were no significantly differences between groups and over time. There was a trend to better scores at T2 and T3 for the intervention group on global health status, physical, role, and social functioning scales. Patients stated that positive mood was enhanced and that EPEP was an important resource.Conclusions: CRC patients receiving EPEP during chemotherapy believed that this intervention was important. Furthermore, EPEP seems to improve positive affect and quality of life. EPEP has potential benefits, and its implementation to CRC patients should be considered.

Fibrilación auricular en pacientes con insuficiencia cardíaca en el área de clínica del hospital Vicente Corral Moscoso durante los años 1980-1984

Doctor en Medicina y Cirugía

Aplicación de la computación en la descripción y autoevaluación de una entidad clínica: programa de computación aplicado al estudio de la enfermedad pulmonar obstructiva crónica

Doctor en Medicina y Cirugía

Detección de insuficiencia renal oculta y factores de riesgo asociados en pacientes ingresados en el área clínica del Hospital Vicente Corral Moscoso, Cuenca 2007

Estudio transversal. La muestra de 382 pacientes (universo de 1090), fue calculada en base a una prevalencia para insuficiencia renal oculta de 13, con un nivel de confianza del 95y el error de inferencia del 3. Los datos se analizaron en software SPSS 11.5 y Epidat 3.0. Resultados: La prevalencia general de la insuficiencia renal oculta fue de 12. La asociación estadística con: edad Mayor a 65 años proporciono una razón de prevalencia (RP) de 7,43 (IC 953,70 - 14,94), p = 0,0000; Sexo femenino, RP = 3,62 (IC 951,79 - 7,30), p = 0,0001; Hipertensión arterial, RP= 2,67 (IC 951,56 - 4,56), p = 0,0005; Diabetes mellitus tipo 2, RP= 2,36 (IC 951,35 - 4,11), p = 0,0027; Sobrepeso, RP= 2,014 (IC 951,09 - 3,70), p 0,02. La prevalencia de insuficiencia renal oculta estratificada de acuerdo a los factores de riesgo, determinó que estaban afectos: 18,2de las mujeres y el 5de los hombres; 27,2de los mayores de 65 años; 15,5de pacientes con índice de masa corporal por encima de 25; 24,3de los hipertensos; 23de los diabéticos; y el 29de los diabéticos e hipertensos. Conclusión: la prevalencia general de la insuficiencia renal oculta fue de 12. Existe asociación significativa con edad, sexo femenino, diabetes, hipertensión arterial, y sobrepeso

Características clínicas e inmunológicas de los pacientes diagnosticados de Lupus eritematoso sistémico, atendidos en los servicios de medicina interna y reumatología de los hospitales Vicente Corral Moscoso y José Carrasco Arteaga de la ciudad de Cuenca, durante el período comprendido entre octubre de 1993 a octubre de 2003

Investigación clínica descrptiva para determinar cuáles son las principales características clínicas e inmunológicas que se presentan en pacientes diagnosticados de Lupus Eritematoso Sistémico (LES)en los hospitales: Vicente Corral Moscoso y José Carrasco Arteaga, áreas de medicina interna y reumatología, en el período comprendido entre octubre de 1993 a octubre de 2003, a quiénes se les aplica un formulario (Anexo Nª 1), el que contiene información acerca de datos de filiación epidemiológicos antecedentes patológicos y los Criterios para el diagnóstico de LES según la Asociación Americana de Reumatoloría (ARA) 1982. Resultados: 96 pacientes con diagnóstico de LES; el 34.4sexo femenino, y el 15.6sexo masculino, manteniendo una relación mujer-hombre de 5.4 a 1, la edad de presentación más frecuente estuvo entre los 20 a 29 años, la ocupación principal de este grupo fueron los quehaceres domésticos y el mayor porcentaje de pacientes procedían de la provincia del Azuay. Según los criterios diagnosticados de LES, (ARA 1982) del total de pacientes, el 78.1presentaron artritis, el 97-9anticuerpos (ANA) y complemento (C4) disminuido en el 82.3anemia hemolítica en el 12.5; proteinuria en 81.3; VSG acelerada en un 85depresión 50, y pleuritis en 31.3de los pacientes. La prevalencia hospitalaria del LES fue de 3.87X 1000 pacientes. Esta investigación reune el mayor número de pacientes diagnosticados de LES en el medio tomando como centros de referencia y concentración las dos principales casas de salud de la Provincia del Azuay, para pacientes de otras provincias principalmente a la provincia de El Oro y la provincia de Loja, constituyendo una base de datos sólida para investigaciones futuras, puesto que hasta el día de hoy no se disponían de estadísticas reales de esta enfermedad, y únicamente se regla a literaturas extranjeras. El estudio dice demostrar que cada día se detectan más casos de LES, porque se han mejorado las técnicas diagnosticadas y se conoce mejor la enfermedad, de esta investigación se logró establecer un algoritmo para el diagnóstico de LES, que traerá como consecuencia, la instauración rápida del tratamiento y obviamente un pronóstico aceptable