Efeito do tabagismo, atividade física e obesidade sobre os valores de proteína C reativa em adultos jovens de ambos os sexos: coorte de 12 meses

Pós-graduação em Fisioterapia - FCT

O brincar para conhecer o desenvolvimento de crianças com implante coclear

This research analyses the development of children presented with profound deafness and benefited by the cochlear implant, discovery of great significance in hearing health. The work is based, theoretically, on Winnicott, and methodologically, in anamnesis data and playing on a set of ludic scenes, systematically organized. Ten pre-school children with implants, selected by hospital and homogenization eligibility criteria participate in this study encompassing interviews with parents and playful observation sessions with the children, besides Lynn´s Dolls Structured Game. In the children, the results show immaturity, regression to earlier stages of their development, dependency and behavioral disorders, in particular, those related to language, interrelationship and anxiety. In the parents, family disorientation, partly overcome. The children and family participating are assisted by a multidisciplinary health team, at the hospital where they are attended.

Avaliação do consumo alimentar e percepção da imagem corporal de culturistas

In bodybuilding, sport that emerged in Brazil in the 70s, competitors are judged by physical appearance, size and muscle definition. The present study aimed to assess dietary intake, supplement use, and it also investigated body image perceptions of bodybuilders. Practitioners of three different gyms in the state of São Paulo participated in the study. They filled the anamnesis form containing data on food consumption and intake of supplements and also answered a questionnaire on the perception of body image (Satisfaction Scale with Body Appearance). The study showed a considerable food inadequacy with an average of carbohydrate intake of 41.84% ± 10.88%, of lipid, an average of 18.96% ± 6.40% and of protein 39.20% ± 10.41%. In pre-competition, the average of daily carbohydrate intake is reduced to 22.69% ± 12.34%, the lipid increases to 25.68% ± 14.0% and the protein increases to 51.63% ± 10.28%. It was observed that all individuals take some sort of supplement. Considering the perception of body image 60% of the appraised are fully satisfied with the muscular appearance and 40% has greater risk of developing vigorexia. As the bodybuilder has rigid dietary control, it is important nutritional monitoring. So it is necessary a better identification and guidance of risk groups for the development of body image disturbances through specialized professionals such as dieticians, psychologists and coaches for success training, aiming at physical and mental well being of the athletes.

Fatores de risco cardiovascular em mulheres com antecedente de pré-eclâmpsia e sua associação com hipertrofia miocárdica e espessamento médio-intimal de carótidas

Pós-graduação em Fisiopatologia em Clínica Médica - FMB

Diagnosis and management of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is probably one of the most prevalent diseases in the world that also compromises the quality of life of the affected significantly. Its incidence in Brazil is 12%, corresponding to 20 million individuals. OBJECTIVE: To update the GERD management and the new trends on diagnosis and treatment, reviewing the international and Brazilian experience on it. METHOD: The literature review was based on papers published on Medline/Pubmed, SciELO, Lilacs, Embase and Cochrane crossing the following headings: gastroesophageal reflux disease, diagnosis, clinical treatment, surgery, fundoplication. RESULTS: Various factors are involved on GERD physiopathology, the most important being the transient lower esophageal sphincter relaxation. Clinical manifestations are heartburn, regurgitation (typical symptoms), cough, chest pain, asthma, hoarseness and throat clearing (atypical symptoms), which may be followed or not by typical symptoms. GERD patients may present complications such as peptic stenosis, hemorrhage, and Barrett's esophagus, which is the most important predisposing factor to adenocarcinoma. The GERD diagnosis must be based on the anamnesis and the symptoms must be evaluated in terms of duration, intensity, frequency, triggering and relief factors, pattern of evolution and impact on the patient's quality of life. The diagnosis requires confirmation with different exams. The goal of the clinical treatment is to relieve the symptoms and surgical treatment is indicated for patients who require continued drug use, with intolerance to prolonged clinical treatment and with GERD complications. CONCLUSION: GERD is a major digestive health problem and affect 12% of Brazilian people. The anamnesis is fundamental for the diagnosis of GERD, with special analysis of the typical and atypical symptoms (duration, intensity, frequency, triggering and relief factors, evolution and impact on the life quality). High digestive endoscopy and esophageal pHmetry are the most sensitive diagnosctic methods. The clinical treatment is useful in controlling the symptoms; however, the great problem is keeping the patients asymptomatic over time. Surgical treatment is indicated for patients who required continued drug use, intolerant to the drugs and with complicated forms of GERD.

Retorno à atividade reprodutiva de touro angus após fimose traumática com obliteração parcial da luz prepucial: relato de caso

The main disturbs affecting the genital segment of bulls are balanitis, phimosis and preputial injuries, abscesses or prolapses, resulting in decreased libido or mating ability. One case of traumatic phimosis with partial obliteration of preputial lumen is reported in Aberdeen Angus bull. During anamnesis, it was reported that the animal was unable to expose the penis and presented increased penile and preputial volume of unknown etiology after being submitted to a libido test. During clinical examination, a firm preputial mass of 15 cm in diameter was observed in the middle third of the prepuce and stenosis of preputial lumen was detected approximately 17 cm from the preputial orifice. Reconstructive surgery was the chosen therapy, with amputation of the affected foreskin portion. A skin segment of about 12 cm and affected mucosal portion were removed. Postoperative therapy consisted of dressing with chlorhexidine digluconate based ointment, povidone iodine and topical insect repellent (cypermethrin and carbamyl), systemic antibiotic therapy with benzathine penicillin (30,000 IU / kg, repeated after 48 hours) and anti-inflammatory therapy with flunixin meglumine (2 , 0 mg / kg SID) for three days. After twenty days, semen was collected by massage of the accessory glands. The ejaculate volume was 3 mL, with 200x106 spermatozoa / mL, white color, "suis generis" odor, 88% of motile sperm, 64% of progressively motile sperm and 82% of rapid sperm. Thus, the chosen surgical treatment was effective to correct the pathology and reintroduce the animal into reproductive activity

O efeito da contração muscular de membros superiores sobre o sistema nervoso autonômico de pessoas com fatores de risco cardiovascular

Pós-graduação em Desenvolvimento Humano e Tecnologias - IBRC

A reumatologia em um curso de medicina com aprendizagem baseada em problemas

OBJETIVO: Apresentar a experiência de uma instituição brasileira no ensino da Reumatologia na graduação médica, cujo projeto pedagógico é estruturado em metodologias ativas de aprendizado. MÉTODOS: Realizou-se um estudo descritivo, com abordagem qualitativa dos conteúdos referentes à Reumatologia no curso de Medicina do Centro Universitário do Estado do Pará (Cesupa). RESULTADOS: O sistema musculoesquelético é abordado no segundo e sétimo semestres, nos módulos referentes ao sistema locomotor e Clínica Médica II, respectivamente, sendo que cada etapa e cada atividade apresentam objetivos específicos mínimos. Além do conteúdo teórico, no sétimo semestre, os alunos realizam atendimentos no ambulatório de Reumatologia, quando existe maior ênfase na elaboração correta de anamnese e exame físico. No internato, os alunos retornam ao ambulatório de Reumatologia e, neste momento, as habilidades de diagnóstico, de investigação e de terapêutica são as mais exigidas. CONCLUSÃO: Ainda há muito para evoluir em busca de um modelo ideal para o ensino da Reumatologia, porém, cumprindo as principais recomendações disponíveis para a boa prática do ensino na graduação, podemos proporcionar ao futuro médico conhecimento, habilidade e experiências capazes de ajudá-lo na condução desses pacientes.

O efeito da contração muscular de membros superiores sobre o sistema nervoso autonômico de pessoas com fatores de risco cardiovascular

Pós-graduação em Desenvolvimento Humano e Tecnologias - IBRC

Using the National Institute of Health Stroke Scale to Predict Dysphagia in Acute Ischemic Stroke

Background and Purpose: Oropharyngeal dysphagia is a common manifestation in acute stroke. Aspiration resulting from difficulties in swallowing is a symptom that should be considered due to the frequent occurrence of aspiration pneumonia that could influence the patient's recovery as it causes clinical complications and could even lead to the patient's death. The early clinical evaluation of swallowing disorders can help define approaches and avoid oral feeding, which may be detrimental to the patient. This study aimed to create an algorithm to identify patients at risk of developing dysphagia following acute ischemic stroke in order to be able to decide on the safest way of feeding and minimize the complications of stroke using the National Institutes of Health Stroke Scale (NHISS). Methods: Clinical assessment of swallowing was performed in 50 patients admitted to the emergency unit of the University Hospital, Faculty of Medicine of Ribeirao Preto, Sao Paulo, Brazil, with a diagnosis of ischemic stroke, within 48 h after the beginning of symptoms. Patients, 25 females and 25 males with a mean age of 64.90 years (range 26-91 years), were evaluated consecutively. An anamnesis was taken before the patient's participation in the study in order to exclude a prior history of deglutition difficulties. For the functional assessment of swallowing, three food consistencies were used, i.e. pasty, liquid and solid. After clinical evaluation, we concluded whether there was dysphagia. For statistical analysis we used the Fisher exact test, verifying the association between the variables. To assess whether the NIHSS score characterizes a risk factor for dysphagia, a receiver operational characteristics curve was constructed to obtain characteristics for sensitivity and specificity. Results: Dysphagia was present in 32% of the patients. The clinical evaluation is a reliable method of detection of swallowing difficulties. However, the predictors of risk for the swallowing function must be balanced, and the level of consciousness and the presence of preexisting comorbidities should be considered. Gender, age and cerebral hemisphere involved were not significantly associated with the presence of dysphagia. NIHSS, Glasgow Coma Scale, and speech and language changes had a statistically significant predictive value for the presence of dysphagia. Conclusions: The NIHSS is highly sensitive (88%) and specific (85%) in detecting dysphagia; a score of 12 may be considered as the cutoff value. The creation of an algorithm to detect dysphagia in acute ischemic stroke appears to be useful in selecting the optimal feeding route while awaiting a specialized evaluation. Copyright (C) 2012 S. Karger AG, Basel

Multiple Tooth Agenesis in Non-syndromic Patient: a rare case report

Dental agenesis is a term referred to the absence of one or more teeth. However, oligodontia is a severe type of tooth agenesis involving six or more congenitally missing teeth, excluding the third molars. Oligodontia has a low prevalence and is a very rare condition. The aim was to show this case report of a 13-year-old female patient who presented oligodontia with absence of eight permanent teeth and condylar atrophy on left side. The patient had no history of any syndrome or systemic disease according to the anamnesis. Is very important to know oligodontia features to perform a carefully treatment plan.

Dentomaxillofacial manifestations of Gaucher's disease: preliminary clinical and radiographic findings

Objectives: A wide variety of manifestations is presented in patients with Gaucher's disease (GD), including bone, haematology and visceral disturbances. This study was conducted to ascertain the main maxillofacial abnormalities by means of clinical survey, panoramic and cone beam CT (CBCT); to compare the patient's group with an age-sex matched control group; and to correlate clinical and radiological data. Methods: Ten patients previously diagnosed with GD were submitted to clinical and radiological surveys (CBCT and panoramic radiographs). The examination consisted of anamnesis, extra- and intraoral examinations and analyses of each patient's records. Imaging data were collected from the point of view of 3 observers, and the results compared with a healthy group (20 individuals) by means of statistical analysis (Fisher's exact test). Results: Gaucher patients had significantly more manifestations than otherwise healthy carriers. The most prevalent findings were enlarged marrow spaces, generalized osteopenia and effacement of jaw structures (mandibular canal, lamina dura and mental foramen). Here we describe a case in which thickening of the maxillary sinus mucosa was observed on CBCT rather than opacification of the sinus as seen on panoramic radiographs. Pathological fractures, root resorption and delay on tooth eruption were not observed. Conclusions: A poor relationship could be observed between clinical and radiological data. Patients showed important bone manifestations, which require careful diagnostic and surgical planning whenever necessary. Although panoramic radiographs have shown significant differences, CBCT is more effective in pointing out differences between patients and a control group, thus showing it as an important tool for evaluation of Gaucher patients. Dentomaxillofacial Radiology (2012) 41, 541-547. doi: 10.1259/dmfr/143023353

Habilidades auditivas e medidas da imitância acústica em crianças de 4 a 6 anos de idade

OBJETIVO: avaliar o desempenho em habilidades auditivas e as condições de orelha média de crianças de 4 a 6 anos de idade. MÉTODO: foram aplicados os testes de detecção sonora (audiômetro pediátrico em 20dBNA), a Avaliação Simplificada do Processamento Auditivo (ASPA) e as medidas de imitância acústica (handtymp com tom de 226Hz) em 61 crianças com média de idade de 5,65 anos. Para comparar os resultados das provas de habilidades auditivas e das medidas da imitância acústica foi aplicado o teste exato de Fisher com nível de significância de p< 0,05. RESULTADOS: houve alteração em pelo menos uma das habilidades auditivas investigadas em 24,6% das crianças. Houve alteração timpanométrica em 34,4% das crianças e 64% foram classificadas no critério "falha" para a pesquisa do reflexo acústico ispilateral. As crianças mais jovens apresentaram maior ocorrência de alterações de orelha média, mas não houve diferença estatisticamente significante entre as diferentes idades para as provas realizadas. CONCLUSÃO: as crianças mais jovens apresentaram maior ocorrência de alterações nas provas de habilidades auditivas e nas medidas de imitância acústica. Programas de investigação e acompanhamento das condições de orelha média e das habilidades auditivas em idade pré-escolar e escolar podem eliminar ou minimizar intercorrências que alterariam o desenvolvimento sócio-linguístico.

Clinical diagnosis of hyposalivation in hospitalized patients

OBJECTIVE: The aim of this study was to evaluate the effectiveness of clinical criteria for the diagnosis of hyposalivation in hospitalized patients. MATERIAL AND METHODS: A clinical study was carried out on 145 subjects (48 males; 97 females; aged 20 to 90 years). Each subject was clinically examined, in the morning and in the afternoon, along 1 day. A focused anamnesis allowed identifying symptoms of hyposalivation, like xerostomia complaints (considered as a reference symptom), chewing difficulty, dysphagia and increased frequency of liquid intake. Afterwards, dryness of the mucosa of the cheecks and floor of the mouth, as well as salivary secretion during parotid gland stimulation were assessed during oral examination. RESULTS: Results obtained with Chi-square tests showed that 71 patients (48.9%) presented xerostomia complaints, with a significant correlation with all hyposalivation symptoms (p <0.05). Furthermore, xerostomia was also significantly correlated with all data obtained during oral examination in both periods of evaluation (p<0.05). CONCLUSION: Clinical diagnosis of hyposalivation in hospitalized patients is feasible and can provide an immediate and appropriate therapy avoiding further problems and improving their quality of life.

Sindrome di cushing nel cane: Nuove prospettive diagnostiche e terapeutiche

La sindrome di Cushing (SC) è una delle endocrinopatie più comuni nel cane. La diagnosi richiede l'integrazione di anamnesi, segnalamento, segni clinici, esami ematobiochimici, test endocrini specifici e diagnostica per immagini . Nel corso degli anni diversi sono i principi attivi testati per la terapia della SC del cane. In passato, il mitotane è stato il farmaco più utilizzato, sebbene il suo uso risulti complicato e non privo di potenziali effetti collaterali. Recentemente, il trilostano ha dimostrato di essere un trattamento efficace per il controllo dei sintomi ed è stato approvato per tale uso nel cane. Al fine di testare metodiche non invasive per la diagnosi di SC nel cane abbiamo valutato le concentrazioni di cortisolo nel pelo (HCC) .Queste risultavano significativamente più elevate nei cani con SC rispetto ai cani sani e malati. Questo test può essere quindi considerato una procedura diagnostica non invasiva in cani con un elevato sospetto di SC. Inoltre, a causa della difficile reperibilità dell’ACTH esogeno sono state valutate le concentrazioni di cortisolo basale come strumento di monitoraggio in cani con SC trattati con trilostano. Tuttavia la singola valutazione del cortisolo basale non rappresenta un parametro efficace ed accurato per il monitoraggio della terapia con trilostano. Sono stati inoltre valutati i fattori prognostici in cani con SC alla diagnosi. L' iperfosfatemia è risultata un riscontro comune nei cani SC, rappresentando un fattore prognostico negativo. La terapia chirurgica non è una procedura di routine nella SC del cane, tuttavia abbiamo descritto l'approccio di ipofisectomia transsfenoidale in un Galgo spagnolo di 8 anni con SC . Il cane è stato sottoposto per due volte ad ipofisectomia transsfenoidale che ha permesso di rimuovere completamente il macroadenoma ipofisario. In conclusione, questi studi ci hanno permesso di indagare alcuni aspetti patogenetici, clinici e diagnostici della SC del cane.