Acompanhamento de pacientes portadores de Hipertensão Arterial Sistêmica da UAPS Tancredo Neves, Tabatinga/AM: Plano de ação

A Hipertensão Arterial Sistêmica (HAS) é a doença cardiovascular de maior prevalência no Brasil e no mundo, por ser uma doença crônica, necessita de controle por toda a vida. Para o correto tratamento da hipertensão arterial é necessário a mudança dos hábitos de vida associadas ou não ao uso regular e diário de drogas anti-hipertensivas. O principal objetivo do tratamento da doença é a redução da morbimortalidade de origem cardiovasculares, aumentadas devido aos altos níveis tensionais e de outros fatores agravantes. A Hipertensão Arterial Sistêmica é uma das enfermidades mais prevalentes no município de Tabatinga-AM, registrando-se 1573 pacientes cadastrados. A dificuldade de a população adquirir hábitos de vida saudável, se dá, em grande, parte por desconhecimento em relação à sua condição de saúde e a falta de acesso a informações em saúde. Dessa forma, o presente estudo visa apontar sobre como superar o problema de esclarecer aos pacientes da Unidade Primária a Saúde Tancredo Neves a respeito do acompanhamento e tratamento adequado da hipertensão arterial sistêmica.

Plano de intervenção para diminuir o risco de complicações da hipertensão arterial na área de abrangência do PSF "Vereda", em Ribeirão das Neves- Minas Gerais

Ribeirão das Neves faz parte da região metropolitana de Belo Horizonte. Ela está situada a 32 km a noroeste da Capital e possui um número aproximado de 94.791 domicílios e 85.239 famílias.. Após análise da Equipe de Saúde da Família Veredas constatou-se um número elevado de pacientes com Hipertensão Arterial Sistêmica (HAS), com alta prevalência e baixas taxas de controle, e por isso foi considerado um dos problemas mais importantes da saúde pública, e a principal causa de mortalidade cardiovascular. É a doença crônica que ocasiona o maior número de consultas nos sistemas de saúde, e o seu controle representa um importante impacto a nível mundial, tanto econômico como social. Desta forma, o objetivo deste trabalho foi elaborar um projeto de intervenção para diminuir o risco de complicações da Hipertensão Arterial nos pacientes residentes na área de abrangência da Equipe de Saúde da Família Vereda. Realizou-se a identificação dos problemas através de uma Estimativa Rápida, e após a priorização dos mesmos e identificação dos respectivos "nós críticos", se estabeleceu o plano, fundamentado no Planejamento Estratégico Situacional (PES). Foi realizada uma revisão de literatura a partir do banco de dados do Ministério da Saúde, Secretaria Municipal de Saúde de Ribeirão das Neves e sites de busca, como: Cientifica Electronic Library Online (Scielo), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). O projeto representa um grande desafio para nós, pois através de medidas de prevenção dos agravos conseguiremos diminuir a incidência da doença crônica não transmissível, assim como os riscos de complicações

Plano de intervenção para diminuir o elevado número de usuários com o risco de desenvolver o diabetes mellitus no PSF Landi I, Ribeirão das Neves - MG

O município de Ribeirão das Neves está localizado na Região Metropolitana de Belo Horizonte, a 32 km da capital, e possui uma população de 296.317 pessoas. A Equipe de Saúde da Família Landi I fez o diagnostico situacional, e identificou vários problemas de saúde dando prioridade ao elevado número de usuários com risco de desenvolver diabetes mellitus. A prevenção do Diabetes Mellitus envolve várias medidas para diminuir os fatores de risco. O objetivo deste trabalho é diminuir o elevado número de usuários com risco de desenvolver Diabetes Mellitus com a criação de um plano de intervenção para a realização de ações de promoção e prevenção de saúde. Por meio do método de estimativa rápida foram identificados e ranqueados os principais problemas que afetam a comunidade. Após a priorização do problema e identificação dos respectivos "nós críticos", o plano foi feito fundamentado no Planejamento Estratégico Situacional (PES). Inicialmente foi realizada a revisão da literatura a respeito do tema proposto utilizando bases de dados online Lilacs e Scielo, com os seguintes descritores: educação em saúde, fatores de risco e diabetes mellitus. Em síntese, o autocuidado em relação ao diabetes mellitus e as doenças associadas, a educação em saúde, a prática sistemática de exercícios físicos, e a dieta adequada, constituem importantes pilares para controlar os usuários com risco a desenvolver o Diabetes.

Projeto de intervenção para redução do número de hipertensos na área de abrangência do PSF Neves no município de Araçuai

A hipertensão arterial é um problema de saúde pública que afeta grande parcela da população brasileira e deve ser tratada em toda rede integrada de Sistema Único de Saúde. No PSF As Neves a questão da hipertensão arterial afeta parcela significativa da população contribuindo para a piora da saúde dessa comunidade. A importância de um estudo sobre Hipertensão Arterial Sistêmica (HAS) no âmbito da atenção básica em saúde é muito grande quando tomamos conhecimento do tamanho deste problema de saúde. Assim elaborou-se esse projeto de intervenção com o intuito de executar ações para a prevenção da hipertensão arterial, melhorar o controle e tratamento desses pacientes. Como direcionamento das ações estão o trabalho multisetorial, centrado nas peculiaridades de cada indivíduo, voltado para a prevenção e promoção de saúde, abrangendo não apenas o indivíduo mais todo seu núcleo familiar. Acredita-se que a execução das ações do projeto de intervenção contribuirá para a melhora da saúde da população do povoado das Neves de Araçuaí /MG. A experiência de elaborar um projeto de intervenção com o olhar direcionado para a prevenção foi uma oportunidade de reconhecermos que as ações no âmbito da atenção básica em saúde precisam, necessariamente, abarcar a prevenção e a promoção de saúde. Para isso é necessário que toda a equipe direcione o foco de suas ações para as intervenções preventivas e, não mais procure olhar apenas para os sinais e sintomas das doenças. Implantar o projeto elaborado será, sem dúvidas, a prática necessária para toda a equipe atuar em conjunto com a população no enfrentamento à hipertensão arterial

Fine Needle Aspiration Cytology In The Diagnosis Of Perioral Adverse Reactions To Cosmetic Dermal Fillers.

Facial cosmetic procedures are increasingly requested, and dermal filler materials have been widely used as a nonsurgical option since the 1980s. However, injectable fillers have been implicated in local adverse reactions. Therefore, the aim of this article was to describe the use of fine needle aspiration cytology (FNAC) in the diagnosis of foreign-body reactions to the perioral injection of dermal fillers. A 69-year-old woman presented with a painful nodule on her right nasolabial fold. Intraoral FNAC was performed, and cytologic smears were examined under optical and polarized light microscopy, showing birefringent microspheres, confirming the diagnosis of an adverse reaction caused by polymethyl methacrylate filler. FNAC is a less invasive method to confirm the diagnosis of adverse reactions caused by perioral cosmetic dermal fillers.

[do Elderly Individuals With A Cognitive Handicap Have Worse Oral Health?].

A comparison of the oral health of elderly people with and without a cognitive handicap was assessed. The cognitive condition, the indices of decayed, missing, filled teeth (DMFT), decayed, filled roots (DFR), the need for dental treatment, the presence of plaque (P), calculus (C), the community periodontal index (CPI), the rate of periodontal attachment loss (PAL), edentulism, prosthetic use and the need for prosthetics were evaluated in a complex probabilistic sample by conglomerates of the elderly (65-74 years). PASW(r) 17.0 was used for the statistical analyses with correction for the design effect, applying the Mann Whitney and chi-square test with 95% reliability. A total of 736 elderly individuals were interviewed and examined. Those with cognitive impairment had higher average DMFT, DFR and lower average healthy sextant CPI, a lower prevalence of sextants without plaque/calculus, use of prosthetics and higher prevalence of edentulism and need for prosthetics. Elderly individuals with a cognitive handicap had poorer oral health.

Tubular Variant Of Basal Cell Adenoma Shares Immunophenotypical Features With Normal Intercalated Ducts And Is Closely Related To Intercalated Duct Lesions Of Salivary Gland.

The morphological criteria for identification of intercalated duct lesions (IDLs) of salivary glands have been defined recently. It has been hypothesised that IDL could be a precursor of basal cell adenoma (BCA). BCAs show a variety of histological patterns, and the tubular variant is the one that presents the strongest resemblance with IDLs. The aim of this study was to analyse the morphological and immunohistochemical profiles of IDLs and BCAs classified into tubular and non-tubular subtypes, to determine whether or not IDL and tubular BCA represent distinct entities. Eight IDLs, nine tubular BCAs and 19 non-tubular BCAs were studied. All tubular BCAs contained IDL-like areas, which represented 20-70% of the tumour. In non-tubular BCA, IDL-like areas were occasional and small (<5%). One patient presented IDLs, tubular BCAs and IDL/tubular BCA combined lesions. Luminal ductal cells of IDLs and tubular BCAs exhibited positivity for CK7, lysozyme, S100 and DOG1. In the non-tubular BCA group, few luminal cells exhibited such an immunoprofile; they were mainly CK14-positive. Basal/myoepithelial cells of IDLs, tubular BCAs and non-tubular BCAs were positive for CK14, calponin, α-SMA and p63; they were more numerous in BCA lesions. IDL, tubular BCA and non-tubular BCA form a continuum of lesions in which IDLs are related closely to tubular BCA. In both, the immunoprofile of luminal and myoepithelial cells recapitulates the normal intercalated duct. The difference between the adenoma-like subset of IDLs and tubular BCA rests mainly on the larger numbers of myoepithelial cells in the latter. Our findings indicate that at least some BCAs can arise via IDLs.

Bartonella Spp. Bacteremia In Blood Donors From Campinas, Brazil.

Bartonella species are blood-borne, re-emerging organisms, capable of causing prolonged infection with diverse disease manifestations, from asymptomatic bacteremia to chronic debilitating disease and death. This pathogen can survive for over a month in stored blood. However, its prevalence among blood donors is unknown, and screening of blood supplies for this pathogen is not routinely performed. We investigated Bartonella spp. prevalence in 500 blood donors from Campinas, Brazil, based on a cross-sectional design. Blood samples were inoculated into an enrichment liquid growth medium and sub-inoculated onto blood agar. Liquid culture samples and Gram-negative isolates were tested using a genus specific ITS PCR with amplicons sequenced for species identification. Bartonella henselae and Bartonella quintana antibodies were assayed by indirect immunofluorescence. B. henselae was isolated from six donors (1.2%). Sixteen donors (3.2%) were Bartonella-PCR positive after culture in liquid or on solid media, with 15 donors infected with B. henselae and one donor infected with Bartonella clarridgeiae. Antibodies against B. henselae or B. quintana were found in 16% and 32% of 500 blood donors, respectively. Serology was not associated with infection, with only three of 16 Bartonella-infected subjects seropositive for B. henselae or B. quintana. Bartonella DNA was present in the bloodstream of approximately one out of 30 donors from a major blood bank in South America. Negative serology does not rule out Bartonella spp. infection in healthy subjects. Using a combination of liquid and solid cultures, PCR, and DNA sequencing, this study documents for the first time that Bartonella spp. bacteremia occurs in asymptomatic blood donors. Our findings support further evaluation of Bartonella spp. transmission which can occur through blood transfusions.

[consensus Of The Brazilian Society Of Rheumatology For The Diagnosis, Management And Treatment Of Lupus Nephritis].

To develop recommendations for the diagnosis, management and treatment of lupus nephritis in Brazil. Extensive literature review with a selection of papers based on the strength of scientific evidence and opinion of the Commission on Systemic Lupus Erythematosus members, Brazilian Society of Rheumatology. 1) Renal biopsy should be performed whenever possible and if this procedure is indicated; and, when the procedure is not possible, the treatment should be guided with the inference of histologic class. 2) Ideally, measures and precautions should be implemented before starting treatment, with emphasis on attention to the risk of infection. 3) Risks and benefits of treatment should be shared with the patient and his/her family. 4) The use of hydroxychloroquine (preferably) or chloroquine diphosphate is recommended for all patients (unless contraindicated) during induction and maintenance phases. 5) The evaluation of the effectiveness of treatment should be made with objective criteria of response (complete remission/partial remission/refractoriness). 6) ACE inhibitors and/or ARBs are recommended as antiproteinuric agents for all patients (unless contraindicated). 7) The identification of clinical and/or laboratory signs suggestive of proliferative or membranous glomerulonephritis should indicate an immediate implementation of specific therapy, including steroids and an immunosuppressive agent, even though histological confirmation is not possible. 8) Immunosuppressives must be used during at least 36 months, but these medications can be kept for longer periods. Its discontinuation should only be done when the patient achieve and maintain a sustained and complete remission. 9) Lupus nephritis should be considered as refractory when a full or partial remission is not achieved after 12 months of an appropriate treatment, when a new renal biopsy should be considered to assist in identifying the cause of refractoriness and in the therapeutic decision.

Sim-xl: A Powerful And User-friendly Tool For Peptide Cross-linking Analysis.

Chemical cross-linking has emerged as a powerful approach for the structural characterization of proteins and protein complexes. However, the correct identification of covalently linked (cross-linked or XL) peptides analyzed by tandem mass spectrometry is still an open challenge. Here we present SIM-XL, a software tool that can analyze data generated through commonly used cross-linkers (e.g., BS3/DSS). Our software introduces a new paradigm for search-space reduction, which ultimately accounts for its increase in speed and sensitivity. Moreover, our search engine is the first to capitalize on reporter ions for selecting tandem mass spectra derived from cross-linked peptides. It also makes available a 2D interaction map and a spectrum-annotation tool unmatched by any of its kind. We show SIM-XL to be more sensitive and faster than a competing tool when analyzing a data set obtained from the human HSP90. The software is freely available for academic use at http://patternlabforproteomics.org/sim-xl. A video demonstrating the tool is available at http://patternlabforproteomics.org/sim-xl/video. SIM-XL is the first tool to support XL data in the mzIdentML format; all data are thus available from the ProteomeXchange consortium (identifier PXD001677).

Synchronous Oral Paracoccidioidomycosis And Pulmonary Tuberculosis In An Immunocompetent Patient.

Paracoccidioidomycosis (PCM) and tuberculosis (TB) are chronic granulomatous infectious diseases, in which the main form of contraction is through inhalation of the microorganism-Paracoccidioides brasiliensis and Mycobacterium tuberculosis. Oral involvement of PCM is observed in up to 70 % of the cases and usually presents clinically as ulcerations with granular surface showing tiny hemorrhagic areas. Oral presentation of TB is rare with prevalence smaller than 0.5 % of all cases. Clinical presentation of oral TB mainly consists of single ulcers with irregular limits and necrotic base. A 70-year-old immunocompetent man presented simultaneously oral PCM and pulmonary TB. Medical history revealed a previous diagnosis of pulmonary TB; however, even under treatment for TB, the patient remained with oral lesions and intense pulmonary fibrosis. The physician requested P. brasiliensis serological analysis, which resulted positive. Although the combination of PCM and TB has been reported in the literature, it is still considered an uncommon condition and their diagnosis may represent a challenge to healthcare professionals because of the similarity between their clinical and radiological presentations.

Vertical Bone Measurements From Cone Beam Computed Tomography Images Using Different Software Packages.

This article aimed at comparing the accuracy of linear measurement tools of different commercial software packages. Eight fully edentulous dry mandibles were selected for this study. Incisor, canine, premolar, first molar and second molar regions were selected. Cone beam computed tomography (CBCT) images were obtained with i-CAT Next Generation. Linear bone measurements were performed by one observer on the cross-sectional images using three different software packages: XoranCat®, OnDemand3D® and KDIS3D®, all able to assess DICOM images. In addition, 25% of the sample was reevaluated for the purpose of reproducibility. The mandibles were sectioned to obtain the gold standard for each region. Intraclass coefficients (ICC) were calculated to examine the agreement between the two periods of evaluation; the one-way analysis of variance performed with the post-hoc Dunnett test was used to compare each of the software-derived measurements with the gold standard. The ICC values were excellent for all software packages. The least difference between the software-derived measurements and the gold standard was obtained with the OnDemand3D and KDIS3D (-0.11 and -0.14 mm, respectively), and the greatest, with the XoranCAT (+0.25 mm). However, there was no statistical significant difference between the measurements obtained with the different software packages and the gold standard (p> 0.05). In conclusion, linear bone measurements were not influenced by the software package used to reconstruct the image from CBCT DICOM data.

Bartonella Clarridgeiae Bacteremia Detected In An Asymptomatic Blood Donor.

Human exposure to Bartonella clarridgeiae has been reported only on the basis of antibody detection. We report for the first time an asymptomatic human blood donor infected with B. clarridgeiae, as documented by enrichment blood culture, PCR, and DNA sequencing.

Estudo da capacidade de complexação e sua relação com algumas variáveis ambientais em cinco represas do Rio Tietê/Brasil

The copper and cadmium complexation properties in natural sediment suspensions of reservoirs of the Tietê River were studied using the solid membrane copper and cadmium ion-selective electrodes. The complexation and the average conditional stability constants were determined under equilibrium conditions at pH=6.00 ± 0.05 in a medium of 1.0 mol L-1 sodium nitrate, using the Scatchard method. The copper and cadmium electrodes presented Nernstian behavior from 1x10-6 to 1x10-3 mol L-1 of total metal concentration. Scatchard graphs suggest two classes of binding sites for both metals. A multivariate study was done to correlate the reservoirs and the variables: complexation properties, size, total organic carbon, volatile acid sulfide, E II and pH.

Sistema de monitoramento de perdas visíveis de cana-de-açúcar em colhedora de cana picada

In the last few years the sugar-cane mechanical harvested area has increased, especially in regions with appropriated slop. The use of this technology brings some inconveniences, such as, the increase in the percentage of extraneous matter, which causes the reduction of technological quality of the raw material, and losses in the field. Extraneous matter (trash) is composed of tops and leaves in major percentage, plus soil and roots, and eventually some metal parts. In the green cane harvest system the percentage of extraneous matter has a tendency to increase due to the great amount of vegetal matter to be processed. The increase in the blower fan speed to reduce the amount of extraneous matter can lead to an unacceptable economic level of raw material losses. The main objective of this work was, using a cane loss monitor, to evaluate and quantify the amount of visible losses of sugar cane through the primary extractor at two different fan speeds. Afterwards these losses were related to the harvester cleaning efficiency. The piezoelectric transducer shows a reasonable sensibility. The results show that the cleaning efficiency in the primary extractor (85% mean), the cane losses (between 5.68% and 2.15%) and fan speed are interrelated. The total losses and specially splinters (between 3.19% and 0.91%), showed a significant difference among the treatments.