Diagnóstico e tratamento do TDA/H: investigação dos critérios utilizados por diferentes categorias profissionais da cidade de Natal-RN

TDA/H is usually considered among the most frequent psychological malfunctions in both childhood and adolescence. It covers a complex combination of neurocognitive deficits leading to developmental troubles linked to attention failure, hyperactivity and impulsivity. On the other hand, diagnosis of TDA/H is frequently a hard task, since sociocultural aspects concerning the evaluation of symptoms lead to some etiologic vagueness. Additionally, the large extent of evaluation tools, together with the diversity of therapeutic approaches referred by specialized literature justify the interest of investigating the diverse ways of diagnosing and treating TDA/H by medical doctors, psychologists and psycho-pedagogues developing professional activities in Natal-RN (Brazil) in the assistance of children and teenagers with TDA/H diagnosis hypothesis. A sample of thirty-four professionals participated in this study in a convenience-basis, and submitted to a semi-directed interview. Information from this procedure was analyzed, categorized and submitted to a multidimensional descriptive analysis (cluster analysis procedure), allowing to verify the partition of the sample in two groups: Group 1, basically composed by medical professionals, and Group 2, composed by psychologists and psycho-pedagogues. The categorized variable “Number of sessions” – average time used for arriving to a diagnosis – was the partition-variable showing the larger amount of statistical contribution for the partition, followed by the variables “Professional formation” and “Use of diagnostic tools”. Variables such “Comorbidity”, “TDA/H Definition” and Modalities of Intervention” also showed contribution to the partition obtained, even though their lesser amount of statistical contribution. Despite some similarity between these two groups, data allowed to demonstrate specific association between academic source-formation of the professional concerned and diagnosis and intervention modalities shown by these professionals when dealing with TDA/H. These data confirm relevant heterogeneity in dealing with TDA/H due to professional formation of professionals involved in diagnosis and treatment tasks.

Diagnóstico e tratamento do TDA/H: investigação dos critérios utilizados por diferentes categorias profissionais da cidade de Natal-RN

TDA/H is usually considered among the most frequent psychological malfunctions in both childhood and adolescence. It covers a complex combination of neurocognitive deficits leading to developmental troubles linked to attention failure, hyperactivity and impulsivity. On the other hand, diagnosis of TDA/H is frequently a hard task, since sociocultural aspects concerning the evaluation of symptoms lead to some etiologic vagueness. Additionally, the large extent of evaluation tools, together with the diversity of therapeutic approaches referred by specialized literature justify the interest of investigating the diverse ways of diagnosing and treating TDA/H by medical doctors, psychologists and psycho-pedagogues developing professional activities in Natal-RN (Brazil) in the assistance of children and teenagers with TDA/H diagnosis hypothesis. A sample of thirty-four professionals participated in this study in a convenience-basis, and submitted to a semi-directed interview. Information from this procedure was analyzed, categorized and submitted to a multidimensional descriptive analysis (cluster analysis procedure), allowing to verify the partition of the sample in two groups: Group 1, basically composed by medical professionals, and Group 2, composed by psychologists and psycho-pedagogues. The categorized variable “Number of sessions” – average time used for arriving to a diagnosis – was the partition-variable showing the larger amount of statistical contribution for the partition, followed by the variables “Professional formation” and “Use of diagnostic tools”. Variables such “Comorbidity”, “TDA/H Definition” and Modalities of Intervention” also showed contribution to the partition obtained, even though their lesser amount of statistical contribution. Despite some similarity between these two groups, data allowed to demonstrate specific association between academic source-formation of the professional concerned and diagnosis and intervention modalities shown by these professionals when dealing with TDA/H. These data confirm relevant heterogeneity in dealing with TDA/H due to professional formation of professionals involved in diagnosis and treatment tasks.

Um sistema inteligente de teleoftalmologia para o auxílio no diagnóstico de catarata

The increasing in world population, with higher proportion of elderly, leads to an increase in the number of individuals with vision loss and cataracts are one of the leading causes of blindness worldwide. Cataract is an eye disease that is the partial or total opacity of the crystalline lens (natural lens of the eye) or its capsule. It can be triggered by several factors such as trauma, age, diabetes mellitus, and medications, among others. It is known that the attendance by ophthalmologists in rural and poor areas in Brazil is less than needed and many patients with treatable diseases such as cataracts are undiagnosed and therefore untreated. In this context, this project presents the development of OPTICA, a system of teleophthalmology using smartphones for ophthalmic emergencies detection, providing a diagnostic aid for cataract using specialists systems and image processing techniques. The images are captured by a cellphone camera and along with a questionnaire filled with patient information are transmitted securely via the platform Mobile SANA to a online server that has an intelligent system available to assist in the diagnosis of cataract and provides ophthalmologists who analyze the information and write back the patient’s report. Thus, the OPTICA provides eye care to the poorest and least favored population, improving the screening of critically ill patients and increasing access to diagnosis and treatment.

Avaliação comparativa da eficácia dos meios de diagnóstico das vulvovaginites: implantação de tecnologia no ensino prático da ginecologia

Inaccurate diagnosis of vulvovaginitis generates inadequate treatments that cause damages women's health. Objective: evaluate the effectiveness of methods when diagnosing vulvovaginitis. Method: a cross-sectional study was performed with 200 women who complained about vaginal discharge. Vaginal smear was collected for microbiological tests, considering the gram stain method as gold standard. The efficacy of the available methods for diagnosis of vaginal discharge was assessed (sensitivity, specificity, positive predictive value and negative predictive value). Data were inserted to Graphpad Prism 6, for statistical analysis. Results: the following results were obtained: wet mount for vaginal candidiasis: sensitivity = 31%; specificity = 97%; positive predictive value (PPV) = 54%; negative predictive value (NPV) =93%; accuracy = 91%. Wet mount for bacterial vaginosis: sensitivity = 80%; specificity =95%; positive predictive value (PPV) = 80%; negative predictive value (NPV) = 95%; accuracy = 92%. Syndromic approach for bacterial vaginosis: sensitivity = 95%; specificity=43%; positive predictive value (PPV) =30%; negative predictive value (NPV) = 97%; accuracy = 54%. Syndromic approach for vaginal candidiasis: sensitivity = 75%; specificity =91%; positive predictive value (PPV) = 26%; negative predictive value (NPV) = 98%; accuracy = 90%. Pap smear for vaginal candidiasis: sensitivity = 68%, specificity = 98%; positive predictive value (PPV) = 86%; negative predictive value (NPV) =96%; accuracy = 96%. Pap smear for bacterial vaginosis: sensitivity = 75%; specificity = 100%; positive predictive value (PPV) = 100%; negative predictive value (NPV) =94%; accuracy = 95%. There was only one case of vaginal trichomoniasis reported – diagnosed by oncological cytology and wet mount – confirmed by Gram. The syndromic approach diagnosed it as bacterial vaginosis. From the data generated and with support on world literature, the Maternidade Escola Januário Cicco’s vulvovaginitis protocol was constructed. Conclusion: Pap smear and wet mount showed respectively low and very low sensitivity for vaginal candidiasis. Syndromic approach presented very low specificity and accuracy for bacterial vaginosis, which implies a large number of patients who are diagnosed or treated incorrectly.

Estudo de efeitos de um extrato de Arctium lappa (Bardana) na marcação dos constituintes sangüíneos com Tecnécio-99m, na biodisponibilidade do radiofármaco pertecnatato de sódio e na morfologia de hemácias de ratos Wistar

Radionuclides have been used in Nuclear Medicine for diagnostic and treatment. In basic research, cellular and molecular structures are labeled with technetium-99m (99mTc) and used as radiobiocomplexes. Some natural or synthetic drugs are capable to alter the labeling of blood constituents with 99mTc, as well as in the biodistribution of radiobiocomplexes. Arctium lappa (Bardana) has been used to treat inflammatory processes. The aim of this work was to evaluate the effects of an extract of Bardana on the labeling of blood constituents with 99mTc, on the morphology of red blood cells, on the perimeter/area ratio of red blood cells and on the biodistribution of radiophamaceutical sodium pertechnetate in Wistar rats. Extract of Bardana was capable to alter the labeling of cellular compartment with 99mTc. Plasma and cellular proteins did not present alteration on the percentage of radioactivity (%ATI). Extract of Bardana was also capable to alter the morphology and the perimeter/area ratio of red blood cells. On the biodistribution of sodium pertechnetate in animals treated with the extract of Bardana, it was observed a small and significant uptake in liver, tooth and tongue, and a high and a significant uptake in stomach, lung and testis (p<0.05). In conclusion, these findings could be justified due to the effects of some chemical compounds in the Bardana extract. This study was a multidisciplinary experimental research. It was developed with the contribution of the different Departments and Services of the Hospital Universitário Pedro Ernesto of the Universidade Estadual do Rio de Janeiro

Morbimortalidade perinatal associada à infecção clamidiana: uma revisão sistemática

Universidade Federal do Rio Grande do Norte

A organização do dots em um distrito sanitário de Natal/RN, 2009

Tuberculosis is an ancient disease that remains a serious problem of Public Health, requiring a pressing attention. Advances in the knowledge and technology available to control it has not been sufficient to significantly impact on morbidity and mortality, especially in developing countries. To enable patient compliance with TB treatment, preventing the abandonment of this to ensure the correct use of medicines has been suggested the DOTS (Directly Observed Treatment - Short course) or directly Observable Short Course Treatment. This study focuses on the incorporation of two technical components of the DOTS strategy at the Family Health, namely, active search for respiratoy symptoms and Supervisioned Treatment (ST). The West Sanitary District was considered best suited to be the focus of study because it is assumed that those sites that were better structured would provide better information about the situation of the strategy in the municipality. Its purpose is to analyze the organization of DOTS as the active search for respiratory symptoms and Directly Observed Therapy in Health Teams Family belonging to a Health District in the city of Natal, Brazil. An exploratory descriptive study with a quantitative approach which involved health professionals from 11 units of Family Health, West Sanitary District, Natal, Rio Grande do Norte. We interviewed 62 professionals on the professional category, their involvement in the DOTS strategy, managers' contributions to the sustainability of the strategy, actions Search for symptomatic diagnosis and supervised treatment of TB cases and difficulties and facilities for the sustainability of the DOTS strategy. It is concluded that the actions taken by the professionals of the FHS West Health District are organized in more supervised treatment, a fact noted in their perceptions about DOTS

As ações de controle da tuberculose na atenção primária à saúde: a visão do doente

Tuberculosis is a disease of great impact on the world context today. In Brazil, the disease management was directed to the Primary Health Care, due to the determination of the Ministry of Health to decentralize health actions for primary care. Thus, since the actions of diagnosis, treatment and control of the disease should happen in this context, however, there are still many barriers that may hinder the realization of these determinations. This study aims to analyze the development of tuberculosis control activities conducted in the services of primary health care from the patient's vision. This is a descriptive, cross-sectional and quantitative study. The population consists of 517 tuberculosis patients treated in units of Primary Health Care in the city of Natal-RN; the sample consists of 93 TB patients. The collect instrument is structured, based in The Primary Care Assessment Tool (PCAT), validated in Brazil and adapted to assess attention to TB in Brazil, with modifications. This instrument was divided into blocks: the first one describes the socio-demographic information of patients with TB and the second one describes the health services working in control, diagnosis and treatment of TB, and includes issues related to the dimensions of primary care: access, bond, services, coordination of care, guidance to the community and family focus. For quantitative analysis, were built indicators for each item of the instrument. The response patterns are followed according to the Likert scale, which was assigned a value between one and five meant that the degree of preference relation (or agreement) of the statements. Values between 1 and 3 were considered unsatisfactory for the indicator, between 3 and less than 4, regular, and between 4 and 5, satisfactory. The results indicate that 62.37% of patients are male, 27.96% aged 41 to 50 years old, and 34.41% unemployed, with low education and low family income. It was found that the reference hospital services are the front door to the patient (59.14%), and are also the local diagnosis of the disease (72.04%). On access, the conditions satisfactory found are: the number of times the patients need to pick up the health care issue, the marking and the facility to get a consultancy in the HS, assistance provided without harm to the individual's attendance labor and facilities related to the proximity between the residence and services; were considered unsatisfactory conditions related to travel to the HS, and on hours and days of operation of services. As for the cast of services were satisfactory and regular actions related to the request for examination to become viable in the first HS, the availability of pot to perform smear and medicines for the treatment, as well as consultations control and receiving information about the disease and the treatment performed; it is considered unsatisfactory the performance of the home care for patients with TB by the HS that acts as a front door, for implementation of the Directly Observed Treatment (DOT), home visits during treatment, the provision of transportation allowance to the patient and the existence of groups for TB patients. Regarding the coordination of care, resulted in regular the action of referring the patient to other HS to obtain examinations, and as unsatisfactory referral to obtain medications. The relationship bond between patient and health team were considered satisfactory in the majority or regular. As for the family and community focus, is satisfactory only the indicator relating to questions from professionals to the patient about the existence of respiratory symptoms in the family. It is considered that there is need for greater commitment from government entities to the incentives required to TB control, as well as the availability of necessary inputs and training of human resources working in the PHC in the ongoing quest to strengthen primary care, as a place of broader host needs to contact the user with the actions and health professionals. It is recommended the adoption of management mechanisms possible to expand the capacity of the health PHC, promoting the service delivery to the user and ensuring attention to population health.

Hanseníase: a implicação da educação em saúde para o autocuidado

A hanseníase é um problema de saúde em nível mundial devido principalmente ao seu potencial incapacitante. A estratégia de combate à doença adotada pelo Ministério de Saúde é o diagnóstico e tratamento precoces, prevenção e tratamento de incapacidades físicas e vigilância dos contatos domiciliares. Tudo isso fundamentado na educação em saúde como sustentáculo para compreensão do processo de adoecimento, da doença em si, sua aceitação e, principalmente, das ações de autocuidado para prevenção de sequelas. Nesse contexto, questiona-se: Qual a implicação da assistência de enfermagem focada na educação em saúde para o autocuidado em portadores de hanseníase? O objetivo geral desse estudo é avaliar os conhecimentos adquiridos pelos portadores de hanseníase sobre a doença, o tratamento e autocuidado abordados durante a consulta de enfermagem. Trata-se de um estudo exploratório-descritivo com abordagem qualitativa, realizado no Hospital Universitário Onofre Lopes. Respeitou a resolução 466/12 do Conselho Nacional de Saúde e foi aprovado pelo comitê de ética sob nº 387.769 e CAAE 17468213.0.0000.5537. Envolveu 14 portadores de hanseníase em tratamento no ambulatório de dermatologia do HUOL. Os dados foram coletados no período de 23 de setembro a 04 de novembro de 2013 por meio de entrevista semi-estruturada; e analisados a partir da analise de conteúdo de Bardin. Os resultados e discussões são apresentados através de um artigo, o qual atende os objetivos propostos, denominado O autocuidado realizado por portadores de hanseníase . Esse objetivou identificar as ações de autocuidado de portadores de hanseníase em uma unidade de referência a partir de três eixos temáticos emersos dos discursos dos sujeitos: 1.as complicações/sequelas da hanseníase conhecidas pelos portadores da doença; 2. as ações de autocuidado adotadas pelos portadores de hanseníase; 3. as possíveis contribuições de um grupo de autocuidado para os portadores de hanseníase. Constou-se aparente superficialidade no conhecimento dos pacientes sobre as complicações da hanseníase, como também, das ações de autocuidado realizadas por eles. Verificou-se também a importância da assistência de enfermagem ao portador de hanseníase, tanto na atenção primária, quanto nos demais níveis de complexidade 11 da assistência. Considera-se que o enfermeiro é um potencial colaborador da educação em saúde como alicerce para o controle e eliminação da hanseníase

Diagnóstico, estadiamento e tratamento cirúrgico do adenocarcinoma de pâncreas

O adenocarcinoma pancreático é um dos tumores sólidos de pior prognóstico, sendo o tratamento cirúrgico o único potencialmente curativo. Na grande maioria dos pacientes o tumor é diagnosticado em fase avançada, comumente na presença de doença metastática. A introdução de modernos métodos diagnósticos associados ao aperfeiçoamento dos já existentes tem gerado controvérsia quanto à melhor maneira de se estabelecer o diagnóstico e estadiamento do tumor. Da mesma forma, o papel da cirurgia na paliação e aspectos técnicos da ressecção de lesões localizadas estão longe de alcançarem consenso na prática. Método - Revisão da literatura sobre os aspectos controversos relacionados ao tema e um algoritmo para a abordagem dos pacientes com suspeita de tumor de pâncreas são apresentados. Foram utilizados os descritores: “adenocarcinoma” e “pâncreas” para pesquisa no PubMed (www.pubmed.com) e na Bireme (www.bireme.br) e a seguir selecionadas as publicações pertinentes a cada tópico escolhido com atenção especial para metanálises, estudos clínicos controlados, revisões sitemáticas e ainda publicações de grandes centros especializados em doenças pancreáticas. Conclusões - Na suspeita de adenocarcinoma de pâncreas é possível realizar estadiamento muito próximo do real sem a necessidade da exploração cirúrgica sistemática em virtude da disponibilidade na prática de exames modernos e eficientes. Isso permite que paliação menos invasiva seja praticada na maioria dos pacientes com lesões avançadas e incuráveis. Nos em que a cura é possível, a operação deve ser realizada objetivando-se, essencialmente, a remoção da lesão com margens livres e com aceitáveis índices de morbi-mortalidade

Diagnóstico, estadiamento e tratamento cirúrgico do adenocarcinoma de pâncreas

O adenocarcinoma pancreático é um dos tumores sólidos de pior prognóstico, sendo o tratamento cirúrgico o único potencialmente curativo. Na grande maioria dos pacientes o tumor é diagnosticado em fase avançada, comumente na presença de doença metastática. A introdução de modernos métodos diagnósticos associados ao aperfeiçoamento dos já existentes tem gerado controvérsia quanto à melhor maneira de se estabelecer o diagnóstico e estadiamento do tumor. Da mesma forma, o papel da cirurgia na paliação e aspectos técnicos da ressecção de lesões localizadas estão longe de alcançarem consenso na prática. Método - Revisão da literatura sobre os aspectos controversos relacionados ao tema e um algoritmo para a abordagem dos pacientes com suspeita de tumor de pâncreas são apresentados. Foram utilizados os descritores: “adenocarcinoma” e “pâncreas” para pesquisa no PubMed (www.pubmed.com) e na Bireme (www.bireme.br) e a seguir selecionadas as publicações pertinentes a cada tópico escolhido com atenção especial para metanálises, estudos clínicos controlados, revisões sitemáticas e ainda publicações de grandes centros especializados em doenças pancreáticas. Conclusões - Na suspeita de adenocarcinoma de pâncreas é possível realizar estadiamento muito próximo do real sem a necessidade da exploração cirúrgica sistemática em virtude da disponibilidade na prática de exames modernos e eficientes. Isso permite que paliação menos invasiva seja praticada na maioria dos pacientes com lesões avançadas e incuráveis. Nos em que a cura é possível, a operação deve ser realizada objetivando-se, essencialmente, a remoção da lesão com margens livres e com aceitáveis índices de morbi-mortalidade

Diagnóstico de enfermagem risco de quedas em pacientes com angina instável

O risco de quedas pode ser reconhecido como fenômeno ou diagnóstico de enfermagem. Pesquisas relacionam diretamente isquemias miocárdicas, como a angina instável e o risco de cair. Objetivou-se analisar o diagnóstico de enfermagem Risco de quedas na ocorrência de angina instável por um estudo transversal realizado em 57 indivíduos internados em um hospitalescola, mediante exame físico e formulário. Para o tratamento estatístico foram utilizados teste qui-quadrado, teste exato de Fisher, Mann-Whitney, teste-t e Coefi ciente Phi (p<0,05). O Risco de quedas foi o diagnóstico de enfermagem mais prevalente (87,71%), sobretudo em homens, mais velhos, com menos anos de estudo e renda inferior. Presença da angina instável, hipertensão arterial, medicação anti-hipertensiva, doença vascular, difi culdades visuais e insônia apresentaram associação com o diagnóstico de enfermagem Risco de quedas. Conclui-se que é imprescindível o desenvolvimento de parâmetros claros e objetivos à mensuração mais acurada do risco de quedas no âmbito hospitalar

Diagnóstico ecotoxicológico dos efluentes lançados no complexo estuarino do Jundiaí/Potengi, Natal/RN

Untreated effluents that reach surface water affect the aquatic life and humans. This study aimed to evaluate the wastewater s toxicity (municipal, industrial and shrimp pond effluents) released in the Estuarine Complex of Jundiaí- Potengi, Natal/RN, through chronic quantitative e qualitative toxicity tests using the test organism Mysidopsis Juniae, CRUSTACEA, MYSIDACEA (Silva, 1979). For this, a new methodology for viewing chronic effects on organisms of M. juniae was used (only renewal), based on another existing methodology to another testorganism very similar to M. Juniae, the M. Bahia (daily renewal).Toxicity tests 7 days duration were used for detecting effects on the survival and fecundity in M. juniae. Lethal Concentration 50% (LC50%) was determined by the Trimmed Spearman-Karber; Inhibition Concentration 50% (IC50%) in fecundity was determined by Linear Interpolation. ANOVA (One Way) tests (p = 0.05) were used to determinate the No Observed Effect Concentration (NOEC) and Low Observed Effect Concentration (LOEC). Effluents flows were measured and the toxic load of the effluents was estimated. Multivariate analysis - Principal Component Analysis (PCA) and Correspondence Analysis (CA) - identified the physic-chemical parameters better explain the patterns of toxicity found in survival and fecundity of M. juniae. We verified the feasibility of applying the only renewal system in chronic tests with M. Juniae. Most efluentes proved toxic on the survival and fecundity of M. Juniae, except for some shrimp pond effluents. The most toxic effluent was ETE Lagoa Aerada (LC50, 6.24%; IC50, 4.82%), ETE Quintas (LC50, 5.85%), Giselda Trigueiro Hospital (LC50, 2.05%), CLAN (LC50, 2.14%) and COTEMINAS (LC50, IC50 and 38.51%, 6.94%). The greatest toxic load was originated from ETE inefficient high flow effluents, textile effluents and CLAN. The organic load was related to the toxic effects of wastewater and hospital effluents in survival of M. Juniae, as well as heavy metals, total residual chlorine and phenols. In industrial effluents was found relationship between toxicity and organic load, phenols, oils and greases and benzene. The effects on fertility were related, in turn, with chlorine and heavy metals. Toxicity tests using other organisms of different trophic levels, as well as analysis of sediment toxicity are recommended to confirm the patterns found with M. Juniae. However, the results indicate the necessity for implementation and improvement of sewage treatment systems affluent to the Potengi s estuary