The effects of clinical support surfaces on pressure as a risk factor in the development of pressure ulcers, from a radiographical perspective: a narrative literature review

Purpose: Pressure ulcers are a high cost, high volume issue for health and medical care providers, having a detrimental effect on patients and relatives. Pressure ulcer prevention is widely covered in the literature, but little has been published regarding the risk to patients in the radiographical setting. This review of the current literature is to identify findings relevant to radiographical context. Methods: Literature searching was performed using Science Direct and Medline databases. The search was limited to articles published in the last ten years to remain current and excluded studies containing participants less than 17 years of age. In total 14 studies were acquired; three were excluded as they were not relevant. The remaining 11 studies were compared and reviewed. Discussion: Eight of the studies used ‘healthy’ participants and three used symptomatic participants. Nine studies explored interface pressure with a range of pressure mat technologies, two studies measured shear (MRI finite element modelling, and a non-invasive instrument), and one looked at blood flow and haemoglobin oxygenation. A range of surfaces were considered from trauma, nursing and surgical backgrounds for their ability to reduce pressure including standard mattresses, high specification mattresses, rigid and soft layer spine boards, various overlays (gel, air filled, foam). Conclusion: The current literature is not appropriate for the radiographic patient and cannot be extrapolated to a radiologic context. Sufficient evidence is presented in this review to support the need for further work specific to radiography in order to minimise the development of PU in at risk patients.

An experimental study to compare the interface pressure and experience of healthy participants when lying still for 20 minutes in a supine position on two different imaging surfaces

Introduction: Pressure ulcers are a high cost, high volume issue for health and medical care providers, affecting patients’ recovery and psychological wellbeing. The current research of support surfaces on pressure as a risk factor in the development of pressure ulcers is not relevant to the specialised, controlled environment of the radiological setting. Method: 38 healthy participants aged 19-51 were placed supine on two different imaging surfaces. The XSENSOR pressure mapping system was used to measure the interface pressure. Data was acquired over a time of 20 minutes preceded by 6 minutes settling time to reduce measurement error. Qualitative information regarding participants’ opinion on pain and comfort was recorded using a questionnaire. Data analysis was performed using SPSS 22. Results: Data was collected from 30 participants aged 19 to 51 (mean 25.77, SD 7.72), BMI from 18.7 to 33.6 (mean 24.12, SD 3.29), for two surfaces, following eight participant exclusions due to technical faults. Total average pressure, average pressure for jeopardy areas (head, sacrum & heels) and peak pressure for jeopardy areas were calculated as interface pressure in mmHg. Qualitative data showed that a significant difference in experiences of comfort and pain was found in the jeopardy areas (P<0.05) between the two surfaces. Conclusion: A significant difference is seen in average pressure between the two surfaces. Pain and comfort data also show a significant difference between the surfaces, both findings support the proposal for further investigation into the effects of radiological surfaces as a risk factor for the formation of pressure ulcers.

Dynamic network data envelopment analysis for university hospitals evaluation

ABSTRACT OBJECTIVE To develop an assessment tool to evaluate the efficiency of federal university general hospitals. METHODS Data envelopment analysis, a linear programming technique, creates a best practice frontier by comparing observed production given the amount of resources used. The model is output-oriented and considers variable returns to scale. Network data envelopment analysis considers link variables belonging to more than one dimension (in the model, medical residents, adjusted admissions, and research projects). Dynamic network data envelopment analysis uses carry-over variables (in the model, financing budget) to analyze frontier shift in subsequent years. Data were gathered from the information system of the Brazilian Ministry of Education (MEC), 2010-2013. RESULTS The mean scores for health care, teaching and research over the period were 58.0%, 86.0%, and 61.0%, respectively. In 2012, the best performance year, for all units to reach the frontier it would be necessary to have a mean increase of 65.0% in outpatient visits; 34.0% in admissions; 12.0% in undergraduate students; 13.0% in multi-professional residents; 48.0% in graduate students; 7.0% in research projects; besides a decrease of 9.0% in medical residents. In the same year, an increase of 0.9% in financing budget would be necessary to improve the care output frontier. In the dynamic evaluation, there was progress in teaching efficiency, oscillation in medical care and no variation in research. CONCLUSIONS The proposed model generates public health planning and programming parameters by estimating efficiency scores and making projections to reach the best practice frontier.

Introdução e difusão de novas tecnologias : impacto do financiamento e do estatuto jurídico hospitalar

RESUMO - Os gastos com a saúde, em Portugal, como nos países da União Europeia e da OCDE, têm crescido a um ritmo superior ao do crescimento económico, assumindo uma importância crescente face ao PIB. Entre estes factores surge a velocidade da introdução da inovação e dos desenvolvimentos tecnológicos dos domínios do diagnóstico e da terapêutica. Uma das mais difíceis e importantes questões para as políticas de saúde é a relação entre a saúde e os gastos com a prestação de cuidados de saúde. Estudos recentes sugerem que os cuidados de saúde ocupam um papel importante na melhoria da saúde da população, e que os recentes avanços tecnológicos são custo-efectivos aceites na generalidade por cada ano de vida ganho. Este trabalho visa estudar a influência que o financiamento e o estatuto jurídico hospitalar têm na introdução e adopção de novas tecnologias em saúde. Para isso, além da revisão bibliográfica, foi realizada uma análise a uma base de dados, cujos elementos se cingem a pacientes com doenças cardiovasculares atendidos num dos hospitais do Serviço Nacional de Saúde, entre 2000 e 2006. --- ------------------------------------ABSTRACT - Health expenditures in Portugal, as in EU countries and in the OECD, have developed at a higher rate than economic growth, assuming an increasing importance to the GDP. Among these factors appears the speed of the introduction of innovation and technological development in diagnosis and therapy areas. One of the most difficult and most important questions for health policy is the relationship of health to health care spending. Studies now suggest that medical care has played an important role in improving the health of the population, and recent technical advances are cost-effective at generally accepted values of an added year of life. This work aims to study the influence that the prospective payment and the hospital’s legal status have in introduction and adoption of new technologies in health. For this, besides the literature review, an analysis was made to a database, whose elements are confined to patients with cardiovascular disease treated in the hospitals of t

Percepção do estado de saúde de doentes com anticoagulação oral

RESUMO - O aumento da incidência das doenças crónicas representa um desafio enorme para todos os Sistemas de Saúde, pelo que a assistência de Saúde a doentes crónicos se tornou num problema das sociedades ocidentais. Os países mais pobres são os que mais sofrem, embora nos países desenvolvidos também se verifique um aumento notável das doenças crónicas. Estima-se que estas representem mais de 60% do total das doenças mundiais no ano 2020 (WHO, 2001). A adaptação dos actuais modelos de saúde aos doentes crónicos não atingiu os objectivos, o que conduziu a que, de há alguns anos a esta parte, se procure alternativas mais eficazes e eficientes. Uma das pressões do mercado que se fazem sentir será caracterizada por uma maior aposta na Promoção da Saúde e Prevenção da doença. O conceito de “Saúde” migrou de “não existência de doença” para “Bem-estar Físico e Psicológico”. Desta forma, o foco dos cuidados de saúde teve que ser adaptado, o que conduziu a uma situação em que o âmbito da prestação de cuidados de saúde é um contínuo de serviços que vai desde a promoção da saúde, medicina preventiva e medicina curativa aos cuidados continuados e cuidados paliativos. As tecnologias de informação e comunicação desempenharão um importante papel nesta tendência, permitindo estabelecer ligações contínuas entre os consumidores e prestadores de cuidados de saúde. Por outro lado, as potencialidades da Internet, das comunicações móveis, dispositivos portáteis e do instrumental electrónico, tornam-se evidentes no desenvolvimento de serviços de e-Saúde: para monitorização, seguimento e controlo dos doentes extra hospitalar - serviços estes centrados no doente. O objectivo geral do presente estudo consiste no desenho de um projecto de investigação para posterior avaliação da percepção do estado de saúde dos doentes seguidos na consulta de hipocoagulação do Hospital de Santa Marta. Devido à escassez de investigação na temática deste trabalho em Portugal, procedeu-se a um trabalho exploratório, descritivo, de carácter comparativo e enquadrado na abordagem quantitativa. O campo de análise consiste em comparar doentes que fazem anticoagulação oral, seguidos na consulta de cardiologia (consulta convencional), com os doentes seguidos no programa Airmed (através das comunicações móveis). 4 Para avaliação da percepção do estado de saúde foi utilizado o questionário SF-36.----ABSTRACT - The increasing incidence of chronic diseases represents an enormous challenge to the Health Systems and on cause of that, the Health Assistance to chronic patients became a concern of the Occidental society. The Countries with lower economical resources are the ones that suffers the most, but also the Developed countries have a noticeable increase of chronic diseases. It is estimated these will represent over 60% of total diseases world wide in 2020 (WHO,2001). The adaptation of the actual Health Models to chronic patients did not achieved it’s goals, what leaded to look for more effective and efficient alternatives. One of the more sensitive market pressure factor is to look for a better Health Promotion and Disease Prevention. The concept of “Health” merged from “Disease absence” to “Physic and Psychic Wellness”. In this way the Health Care focus had to be adapted, what drove to a status where the scope of the Health care is a continuum of services that goes from the Health Promotion, Preventive and Curative to Continued and Palliative Medical Care. The Information and Communication Technologies will play a crucial role in this trend, allowing to establish continued connections between patients and Health Care providers. In parallel the potential of the Internet, mobile communications, portable devices and electronic instruments became evident to deploy e-Health services: to monitor, follow-up and control of patients outside the Hospital. The overall objective of the present study is an Investigation Project Design to further evaluate the health status perception of the patients followed in the consultation for Hypocoagulation in the “Hospital de Santa Marta”. Due to lack of investigation in this thematic, in Portugal, this study is developed in an exploratory way, descriptive, comparative, within a scope of a quantified approach. The analysis field consists on comparing patients prescribed with oral anticoagulants and followed-up at the

Autochthonous acute Chagas’ disease in São Paulo State, Brazil: Epidemiological aspects

Since the beginning of the seventies the natural transmission of Chagas’ infection has been considered to be under control in the State of São Paulo and not even a case of American Trypanosomiasis, transmitted by triatomine bugs, has been detected by the epidemiological surveillance system. This situation justifies the report of a case of acute Chagas’ disease that occurred in a forest area considered free of domiciliary triatomines along the Southern seacoast of São Paulo State. In May, 1995 the presence of trypomastigote forms of Trypanosoma cruzi had been diagnosed in a retired 57 year-old male patient, born and living in Santos (São Paulo State), complaining of fever, fatigue and malaise. The patient reported that 40 days before he had participated with 17 friends in a 7-day excursion in a forest area of the municipalities of Itanhaém and Peruíbe. During this period the group had been lodged in three houses located within the forest. Eight days after the end of the excursion the patient began to have fever, malaise and fatigue. During the next 31 days he had received medical care both as an inpatient and an outpatient, without any significant improvement. After the detection of T. cruzi trypomastigotes in his blood stream the patient began to be treated with benzonidazole in a hospital but died 8 days after the beginning of treatment. The epidemiological investigation carried out showed no signs of the presence of triatomine bugs in the three houses where the group had been lodged, or any indication of Chagas' infection in other excursionists

Aplicação móvel para registo clínico de pacientes

O registo clínico dos pacientes é já armazenado, numa grande parte dos casos, em formato eletrónico. O avanço da tecnologia permitiu a prevalência deste face ao antigo registo em papel. No entanto, e no sentido em que as tecnologias estão a evoluir, as várias áreas da medicina poderão vir a beneficiar desta evolução da tecnologia. A prestação de cuidados de saúde aos pacientes é muito importante numa sociedade e quanto mais evoluída estiver a medicina melhores serão estes cuidados tão essenciais. Os métodos de diagnóstico e tratamento efetuados pelos médicos só poderão beneficiar com as tecnologias e, consequentemente, melhores serão os cuidados prestados aos seus pacientes. Quanto mais informação o médico tiver acerca do estado de saúde e todo o tipo de intervenções dos seus pacientes, mais preparado ele estará para enfrentar a situação de cada paciente, e mais adequados e personalizados serão os métodos utilizados. Este projeto teve como base o registo clínico dos pacientes. Esta aplicação visa cobrir um grande leque de possibilidades de áreas onde possa ser implementada, que pode ir desde a medicina geral à fisioterapia e reabilitação. Uma aplicação móvel num smartphone ou tablet possibilita a qualquer profissional da área médica um registo e acesso simples e facilitado ao histórico dos seus pacientes, havendo consequentemente uma melhoria no acompanhamento dos mesmos. Além disso, o responsável médico é beneficiado pelo fator mobilidade oferecido pelos dispositivos móveis, podendo aceder a qualquer hora e em qualquer lugar a todas as intervenções que tenha efetuado. O médico pode ainda aceder à lista dos seus pacientes e respetiva informação. Um exemplo concreto da implementação desta aplicação é na área desportiva, em que os profissionais do quadro médico de um clube podem usar a aplicação para registar todo o histórico dos seus atletas e manter um acompanhamento contínuo a cada jogador. A possibilidade de armazenamento de todas as intervenções importantes de um desportista num dispositivo móvel e de acesso fácil e intuitivo é uma mais-valia para um clube desportivo de qualquer especialidade.

Clinical and epidemiological features of definitive and presumed loxoscelism in São Paulo, Brazil

A retrospective study analysed 359 proven or presume cases of loxoscelism seen at the Hospital Vital Brazil, Instituto Butantan, São Paulo, Brazil, between 1985 and 1996. The spider was identified in 14%. The bites occurred predominantly in the urban areas (73%) between September and February. Patients > 14 years were commonest inflicted (92%) and 41% were bitten while getting dressed. Only 11% sought medical care within the first 12 hours post bite. Cutaneous loxoscelism was the commonest form presenting (96%); commonest manifestations were: pain (76%), erythema (72%), edema with enduration (66%), ecchymosis (39%). Skin necrosis occurred in 53% of patients, most frequently seen on trunk, tigh and upper arm, and when patients seek medical care more than 72 hours after bite. Local infection was detected in 12 patients (3%). Hemolysis was confirmed in 4 cases (1.1%). Generalised cutaneous rash, fever and headache were also observed in 48% of the total of patients. None of them had acute renal failure or died. Treatment usually involved antivenom administration (66%), being associated with corticosteroids (47%) or dapsone (30%). Presumptive diagnosis of loxoscelism may be established based on clinical and epidemiological findings. Further investigations are required to prove the value of antivenom and other treatment schedules.

Study of chronic hemolytic anaemia patients in Rio de Janeiro: prevalence of anti-human parvovirus B19 IgG antibodies and the developement aplastic crises

The prevalence of anti-human parvovirus B19 IgG antibodies was determined in sera from 165 chronic hemolytic anemia patients, receiving medical care at Instituto Estadual de Hematologia (IEHE), Rio de Janeiro, during the year of 1994. This sample represents around 10% of the chronic hemolytic anemia patients attending at IEHE. Most of these patients (140) have sickle cell disease. Anti-B19 IgG antibodies were detected in 32.1% of patients. No statistically significant difference (p > 0.05) was seen between IgG antibody prevalence in male (27.8%) and female (35.5%) patients. Anti-B19 IgG antibodies were more frequent in older (37.6%) than younger (28.2%) than 20 years old patients, although this difference had no statistical significance (p > 0.05). Anti-B19 IgG antibody prevalence showed that 67.9% of patients enrolled in the study were susceptible to B19 acute infection. With the aim to detect acute B19 infection, patients follow up continued until February 1996. During this period four patients presented transient aplastic crisis due to human parvovirus B19 as confirmed by the detection of specific IgM antibodies. All four patients were younger than 20 years old, and 3 were younger than 10 years old. Three of them were sickle cell disease patients. Three of the four acute B19 infection occurred during 1994 springtime.

Perinatal Death: Epidemiology and Etiology

Perinatal mortality rate is an important mark to evaluate women and perinatal health care. It is of utmost importance to know causes and the evolution of its two components aiming to improve health care in different fields – sanitary conditions, diagnosis and treatment of infectious disease, immunisations, diagnosing and caring for medical diseases induced by pregnancy or directly related to it, providing skilled birth attendance, preventing birth asphyxia, preventing preterm birth complications and infections. In high-income countries the epidemiology varies mainly with social and economic conditions; in low-income countries, paired with poverty, undernutrition, superstition, lack of medical care, deficient basic sanitary conditions are also found. Also, in rich countries, responsible for 1% of deaths, data are published and improvements evaluated, while in low-income countries responsible for 99% of deaths numbers and causes are unknown, making difficult to implement cost effective interventions, a reason why “stillbirth rates in low-income countries are now where they were in high-income countries 50 to 100 years ago”. Knowledge on causes of death are very important as often what is needed are “simple” measures as improvement of sanitary conditions and immunisation programmes rather than high technologies. About four million babies dye each year in the first 28 days of life and another 3 million dye before birth in the third-trimester, with 98% occurring in low-income and middle income countries and more than 1 million occurring during labour and delivery. Classically stillbirths are the major component of perinatal mortality rate. Causes of death are even more difficult to know. In low-income countries a great proportion of women give birth at home. Worldwide the main causes of stillbirth are asphyxia due to obstructed labour, eclampsia, abruption placenta and umbilical cord complications - making valid the assumption that skilled birth attendance would decrease stillbirth; and infection - chorioamnioitis, syphilis and malaria. In high-income countries placental pathology and infection, congenital anomalies, complications of preterm birth and post term delivery, are the most common. If in low-income countries famine and lack of provisions and health care are common, in high-income countries, advanced maternal age and diabetes, obesity, hypertension, smoking, are frequent findings.

A família cuidadora perante a dependência do seu familiar idoso

RESUMO: O envelhecimento demográfico tem vindo a acentuar-se nas últimas décadas. É expectável um aumento mais acentuado no número de pessoas com mais de 80 anos, o que importará maiores custos médicos, mais suporte familiar e comunitário, maior probabilidade de cuidados de longa duração devido à prevalência de doenças crónicas. Conduzindo a uma maior procura de apoios formais e informais. A preocupação com aqueles que atingem idades avançadas tem vindo a suscitar inquietação face à urgência de necessidades de suporte, sentidas por familiares, amigos e vizinhos. A questão central que orientou este estudo diz respeito aos familiares cuidadores ou gestores de cuidados do seu familiar idoso dependente e ao idoso dependente. Procurei identificar quais as dificuldades sentidas e as estratégias desenvolvidas pela família cuidadora ou gestora dos cuidados prestados ao idoso dependente, descrever e caracterizar a dependência destes idosos. É um estudo transversal, exploratório, descritivo, de abordagem quantitativa e qualitativa. Apliquei um questionário a 25 familiares cuidadores ou gestores dos cuidados a idosos dependentes, internados nos serviços de medicina e cirurgia de um hospital privado, Hospital CUF Descobertas, possuindo previamente alguma dependência. Dos dados obtidos ressalta que as principais dificuldades sentidas pelos familiares cuidadores ou gestores dos cuidados são essencialmente na gestão do tempo e a saúde do cuidador. Estratégias mais desenvolvidas foram o recurso a empregada doméstica e a outros familiares. Posso Concluir que há uma tendência preferencial por parte da família, na complementaridade de apoios informais e formais para prestar os cuidados ao idoso dependente no seio da família.------------ ABSTRACT: Demographic aging has risen progressively over the past decades. The number of people over the age of 80 years old is expected to increase considerably and surely result in the rise of medical costs, the growing need for additional community and family support, higher probability of long-term medical care due to the increased risk of chronic disease and the seeking of help regarding formal and informal support. The concern with persons that attain advanced age has brought about a certain degree of uneasiness regarding the urgency of the need of support systems felt by family members, friends, neighbours. The main topic that has steered this study pertains to the family caregivers or the care managers of dependant elderly relatives and dependant elderly persons. I endeavoured to identify encountered difficulties and the strategies undertaken by family caregivers or care managers in regard to the elderly dependant, to describe and characterize the nature of the dependency of these elderly persons. Furthermore, this study could be defined as being wide-reaching, exploratory and descriptive, by means of a qualitative and quantitative approach. I utilized a questionnaire that involved 25 family caregivers and care managers of dependant elderly (hospitalized in medical or surgery wards of private hospital, CUF Descobertas Hospital and suffering from some type of dependency). Conclusions: The main difficulties felt by family caregivers or care managers are primarily related to time management and the health of the caregiver. Let it be mentioned that more developed strategies were adopted such as the employment/recruitment of a housemaid and the help of other relatives. In sum, it can be concluded that there is a preferential tendency by families in seeking the complementarity of informal and formal support in order to provide the necessary care to the dependent elderly in the family environment.

Low Socioeconomic Status is an Independent Risk Factor for Survival After Abdominal Aortic Aneurysm Repair and Open Surgery for Peripheral Artery Disease

OBJECTIVE/BACKGROUND: The association between socioeconomic status (SES), presentation, and outcome after vascular surgery is largely unknown. This study aimed to determine the influence of SES on post-operative survival and severity of disease at presentation among vascular surgery patients in the Dutch setting of equal access to and provision of care. METHODS: Patients undergoing surgical treatment for peripheral artery disease (PAD), abdominal aortic aneurysm (AAA), or carotid artery stenosis between January 2003 and December 2011 were retrospectively included. The association between SES, quantified by household income, disease severity at presentation, and survival was studied using logistic and Cox regression analysis adjusted for demographics, and medical and behavioral risk factors. RESULTS: A total of 1,178 patients were included. Low income was associated with worse post-operative survival in the PAD cohort (n = 324, hazard ratio 1.05, 95% confidence interval [CI] 1.00-1.10, per 5,000 Euro decrease) and the AAA cohort (n = 440, quadratic relation, p = .01). AAA patients in the lowest income quartile were more likely to present with a ruptured aneurysm (odds ratio [OR] 2.12, 95% CI 1.08-4.17). Lowest income quartile PAD patients presented more frequently with symptoms of critical limb ischemia, although no significant association could be established (OR 2.02, 95% CI 0.96-4.26). CONCLUSIONS: The increased health hazards observed in this study are caused by patient related factors rather than differences in medical care, considering the equality of care provided by the study setting. Although the exact mechanism driving the association between SES and worse outcome remains elusive, consideration of SES as a risk factor in pre-operative decision making and focus on treatment of known SES related behavioral and psychosocial risk factors may improve the outcome of patients with vascular disease.

Supplementary private health insurance: The characteristics of subscribers

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA – School of Business and Economics

Directivas antecipadas de vida : modelo de aferição da sua aceitabilidade nas unidades de saúde em Portugal

RESUMO - As Directivas Antecipadas de Vida, são instruções escritas ou orais formuladas por uma pessoa competente relativamente à prestação ou suspensão de cuidados médicos numa eventual situação de doença geradora de incapacidade para decidir ou expressar a sua vontade (Neves et al., 2010). No presente estudo, o problema de investigação centra-se em saber de que forma a construção de um modelo de Directivas Antecipadas de Vida pode contribuir para uma melhor gestão nas unidades de saúde? Para a realização do presente projecto de investigação, foi efectuada uma pesquisa bibliográfica sobre os principais conceitos e estado actual do conhecimento, os quais contribuíram para a definição dos objectivos de investigação empírica:  Contribuir para a criação de um corpo de conhecimento no que diz respeito às Directivas Antecipadas de Vida com a elaboração de uma proposta de um modelo de aferição da sua aceitabilidade nas unidades de saúde em Portugal.  Identificar os diferentes intervenientes, e qual o seu papel na implementação do modelo proposto. No que se refere ao estudo das Directivas Antecipadas de Vida em Portugal, e em especial nas unidades de saúde, recorreu-se a uma metodologia exploratória e descritiva, para identificar as principais características e trabalhos desenvolvidos na área em investigação. A primeira conclusão reside nas características da própria sociedade, a qual não parece ainda estar suficientemente desperta para a problemática em estudo, não obstante se verificar a existência de iniciativas legislativas recentemente apresentadas. Esta constatação verifica-se igualmente ao nível das unidades prestadoras de cuidados de saúde.

The association of Schistosoma mansoni infection with hepatocellular carcinoma

The association of Schistosoma mansoni infection with hepatocellular carcinoma (HCC) was studied in Espirito Santo State, Brazil. Schistosoma infection was diagnosed by stool examinations or by histological finding at autopsy. HCC was diagnosed by biopsy, laparoscopy and biopsy or at autopsy. Among 45 cases of HCC six had Schistosoma mansoni infection (13.04%). The occurrence of Schistosoma infection among HCC HBs Ag positive or negative was similar (13.3 3% and 13.63% respectively). The chi squared comparison showed no significant differences between the frequency of schistosomiasis in patients with HCC and the frequency of Schistosoma infection among people living in the Espirito Santo State (5.9% among children of elementary school from all the counties of the State and 6.7% in people that attended medical care in Vitoria, the capital of the State). Therefore, the authors believe that the association of schistosomiasis mansoni with HCC may be casual, specially in areas where the Schistosoma mansoni infection is frequent.