Qualificação da Prevenção do Câncer de Colo de Útero e Controle do Câncer de Mama na UBS/ESF Sofia Saldanha Silveira, Vila Nova do Sul/RS

Resumo Perez Guerra Katia. Qualificação das Ações de Atenção à Saúde da Mulher com ênfase na Prevenção e Detecção do Câncer de Colo de Útero e do Câncer de Mama na UBS Sofia Saldanha Silveira, Vila Nova do Sul/ RS. 2015. 79 fls. Trabalho de Conclusão de Curso (Curso de Especialização em Saúde da Família) - Departamento de Medicina Social, Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, 2015. Os cânceres de colo uterino e de mama são neoplasias que mais acometem as mulheres no mundo. No entanto, tanto o câncer de mama como o câncer de colo de útero apresentam um bom prognóstico se diagnosticados em estádios iniciais. Este trabalho teve como objetivo geral melhorar a atenção à saúde da mulher prevenindo o câncer de colo de útero e o câncer de mama na população da área de abrangência da Estratégia de Saúde da Família (ESF) Sofia Saldanha Silveira, município de Vila Nova do Sul/ RS. Trata-se de uma intervenção relacionada à especialização em Saúde da família da Universidade Federal de Pelotas (UFPel) desenvolvida durante os meses de abril, maio e junho, com foco na prevenção de câncer de colo uterino e mama. A população alvo da intervenção são as mulheres moradoras da comunidade que frequentam a ESF, pertencentes a faixa etária de 25 a 64 anos (no caso da pesquisa de câncer de colo uterino) e de 50 a 69 anos (no caso do câncer de mama). Após três meses de intervenção conseguimos que 450 (40,9%) mulheres tivessem os exames para detecção precoce de câncer de colo uterino em dia e 203 (58%) mulheres tivessem o exame para detecção precoce de câncer de mama em dia. Conseguimos melhorar a qualidade do atendimento destinado às mulheres garantindo 100% de coleta de amostras satisfatórias do exame citopatológico de colo uterino e exame de mama, melhoramos o registro das informações garantindo registro adequado do exame citopatológico de colo do útero e de mama das mulheres do Programa, realizamos avaliação de risco e pesquisa de sinais de alerta para identificação de câncer de colo de útero e de mama em 100% das mulheres nas faixas etárias-alvo, promovemos a saúde das mulheres orientando 100% das mulheres cadastradas sobre doenças sexualmente transmissíveis (DST) e fatores de risco para câncer de colo de útero e de mama. A intervenção foi sucesso para a comunidade, serviço e equipe de saúde. A população demonstrou muita satisfação e a equipe entusiasmo para continuar trabalhando a fim de alcançar 100% da população da área. Palavras-chave: Saúde da família; Saúde da Mulher; Neoplasias do colo do útero; Neoplasias da Mama.

Melhoria da Atenção ao Pré-Natal e Puerpério na UBS Almirante Tamandaré do Sul/Rs.

O trabalho desenvolvido pelo equipe de saudê da unidade básica de saudê de Almirante Tamandaré do Sul durante 4 meses trata-se sobre a melhoria em atenção a pacientes gestantes e puérperas do nosso município para assim elevar a qualidade de vida e elevar a qualidade em os atendimentos a este grupo de pacientes, foram 4 meses de muito trabalho, de intercâmbios com a comunidade, com as pacientes e familiares. O trabalho permiti-o melhorar que as gravidas e as puérperas tive sem atendimentos de qualidade, que se tenha um seguimento acorde a os risco de as pacientes, e logramos ter um acercam iento maior com a população estudada, durante o tempo que duro o trabalho se logro que todas as gravidas foram examinadas e tive sem exames de laboratório indicados em cada consulta e todas voltavam em a próxima consulta com os resultados de exames indicados pelo medico, isso foi muito importante para ter um controle sobre as gravidas, e também se logro uma melhor parceria com o gestor da saudê e comunidade para futuros trabalhos.

Melhoria da Atenção à Saúde da Pessoa com Hipertensão Arterial e/ou Diabetes Mellitus na UBS Dr. Joaquim Saldanha, Mossoró/RN

O presente trabalho, pertence a proposta da Universidade Federal de Pelotas em Rio Grande do Sul, para a especialidade em saúde da família. Este trabalho foi dessarroado na UBS Dr. Joaquim Saldanha, no municipio Mossoró/RN. O primeiro destaque positivo foi a melhora da cobertura da atenção aos usuários hipertensos e/ou diabéticos, assim como a adesão dos hipertensos e/ou diabéticos ao programa e os registros das informações, os quais foram atualizados e reorganizados de uma forma melhor. Outro ponto a se destacar foi à importância que teve na unificação dos profissionais da equipe como a população em geral, para seguir as recomendações do Ministério da Saúde relativas ao Programa Hiperdia. Ela fortaleceu a união da equipe de saúde promovendo o trabalho em conjunto, no qual houve a participação de todos, desde o médico até as ACS. No início da intervenção todos deram a sua disponibilidade e durante esse processo trabalharam muito forte para conseguir as metas e objetivos propostos, e mesmo sabendo que não foi possível atingir todas elas, eu fico muito satisfeito pelos resultados alcançados. Os profissionais da recepção também fizeram um excelente trabalho, baseado nas ações de saúde direcionadas à melhoria da atenção dos pacientes hipertensos e/ou diabéticos em nossa área de abrangência. Além dos benefícios que a intervenção proporcionou para o serviço em relação à atenção e organização, temos os benefícios recebidos na comunidade já que a população percebeu o impacto da intervenção e ficou mais integrada na rotina diária das atividades de nossa unidade. Devido aos resultados obtidos na intervenção, a mesma já está incorporada na rotina do serviço, e para conseguir atingir as metas propostas que não foram atingidas, pensamos em ampliar o trabalho de conscientização da comunidade em relação à necessidade de atendimento dos pacientes no programa de Hiperdia.

Melhoria da Atenção ao Programa de Prevenção do Câncer de Colo de Útero e Controle do Câncer de Mama na UBS Dr. Joaquim Saldanha, Mossoró/Rn.

O câncer de colo de útero é uma doença de evolução lenta que acomete, sobretudo, mulheres acima dos 25 anos. Embora sua incidência esteja diminuindo, o câncer de colo de útero ainda está entre as enfermidades que mais atingem as mulheres e levam a óbito no Brasil. No Brasil, as taxas de mortalidade por câncer de mama continuam elevadas, muito provavelmente porque a doença ainda é diagnosticada em estádios avançados. Em ambas as situações as ações de prevenção e promoção de saúde na APS se faz necessária para a melhoria de saúde das mulheres. Na UBS na UBS Dr. Joaquim Saldanha, Mossoró/ RN, a equipe em que atuo escolheu, após a análise situacional realizada através do curso de especialização em saúde da família da UFPEL – UNASUS, realizar a intervenção com esses temas, pois é um dos principais problemas de saúde de nossa unidade com uma alta incidência e prevalência e muita demanda das usuárias. O objetivo geral foi melhorar a detecção de câncer de colo do útero e de mama na UBS Dr. Joaquim Saldanha, Mossoró/ RN. Foi desenvolvido no período de três meses na área da equipe da ESF # 1 da UBS. Joaquim Saldanha e participaram da intervenção todas as mulheres na faixa etária de 25-69 anos, da equipe da UBS. As ações realizadas na intervenção foram baseadas no Caderno de Atenção Básica n. 13 do Ministério da Saúde. Portanto, para alcançar os objetivos propostos foram estabelecidas metas e ações nos quatro eixos de ações (Monitoramento e avaliação, organização e gestão do serviço, engajamento público, qualificação da prática clínica). Na intervenção foram acompanhadas 233 usuárias na faixa etária de 25-64 anos, e alcançamos a cobertura do programa de prevenção do câncer de colo de útero em 33% e 118 usuárias na faixa etária de 50-69 anos, com um indicador de cobertura pela planilha de coleta de dados de 52%. O estudo foi ótimo para a comunidade, pois nossas usuárias aprenderam a importância do cuidado, enriqueceram seus conhecimentos sobre a existência do Programa de Prevenção do câncer de colo de útero e Controle do câncer de mama, assim como características, complicações e prevenção dos cânceres de colo de útero e mama. Tiveram a oportunidade de receber avaliação integral medica e assim como da realização dos exames complementares. Cresceram os vínculos entre os membros da equipe e a comunidade. A ESF teve uma organização mais detalhada dos diferentes arquivos de atendimento das usuárias, assim como maior qualidade do acolhimento e a organização da agenda para a atenção, também a intervenção continuara e já ficou na rotina da UBS.

As adaptações das curvaturas da coluna vertebral as atividades fisicas praticadas

Universidade Estadual de Campinas. Faculdade de Educação Física

Serological survey of Rickettsia sp. in horses and dogs in an non-endemic area in Brazil

Brazilian Spotted Fever (BSF) is a lethal rickettsiosis in humans caused by the bacteria Rickettsia rickettsii, and is endemic in some areas of Brazil. Horses and dogs are part of the disease's life cycle and they may also serve as sentinel animals in epidemiological studies. The first human BSF case in the State of Paraná was reported in 2005. The present study was conducted in the municipality of Almirante Tamandaré, where no previous case of BSF was reported. Serum samples were collected from 71 horses and 20 dogs from nine properties in the area. Ticks were also collected from these animals. All farmers completed a questionnaire about their knowledge of BSF and animal health management. Serum samples were analyzed by indirect immunofluorescent-antibody assay (IFA) using R. rickettsii and R. parkeri as antigens. Ticks were analyzed by PCR for Rickettsia sp., and all of them were PCR-negative. Six horses (8.45%) and 4 dogs (20%) were identified as seropositive. Farmers were not aware of the correlation between the presence of ticks and risk of BSF. Although a non-endemic area, Almirante Tamandaré is a vulnerable environment for BSF and effective tick control measures are required.

A role for mammalian target of rapamycin (mTOR) pathway in non alcoholic steatohepatitis related-cirrhosis

Non-alcoholic fatty liver disease (NAFLD) encompasses the whole spectrum of steatosis, nonalcoholic steatohepatitis (NASH), and NASH-related cirrhosis (NASH/Cir). Although molecular advances have been made in this field, the pathogenesis of NAFLD is not completely understood. The gene expression profiling associated to NASH/Cir was assessed, in an attempt to better characterize the pathways involved in its etiopathogenesis. Methods: In the first step, we used cDNA microarray to evaluate the gene expression profiles in normal liver (n=3) and NASH/Cir samples (n=3) by GeneSifter (TM) analysis to identify differentially expressed genes and biological pathways. Second, tissue microarray was used to determine immunohistochemical expression of phosphorylated mTOR and 4E-BP1 in 11 normal liver samples, 10 NASH/Cir samples and in 37 samples of cirrhosis of other etiologies to further explore the involvement of the mTOR pathway evidenced by the gene expression analysis. Results: 138 and 106 genes were, respectively, up and down regulated in NASH/Cir in comparison to normal liver. Among the 9 pathways identified as significantly modulated in NASH/Cir, the participation of the mTOR pathway was confirmed, since expression of cytoplasmic and membrane phospho-mTOR were higher in NASH/Cir in comparison to cirrhosis of other etiologies and to normal liver. Conclusions: Recent findings have suggested a role for the cellular ""nutrient sensor"" mTOR in NAFLD and the present study corroborates the participation of this pathway in NASH/Cir. Phospho-mTOR evaluation might be of clinical utility as a potential marker for identification of NASH/Cir in cases mistakenly considered as cryptogenic cirrhosis owing to paucity of clinical data.

Determination of the Most Efficient Temperature for Radiofrequency Ablation of Renal Cells: A Prospective Study in Dogs

Background and Purpose: Radiofrequency (RF) ablation of renal tumors is a major technique for tumor cell destruction while preserving healthy renal parenchyma. There is no consensus in the literature regarding the optimal temperature, impedance, and time for RF application for effective cell destruction. This study investigated two variables while keeping time unchanged: Temperature for RF cell destruction and tissue impedance in dog kidneys. Materials and Methods: Sixteen dogs had renal punctures through videolaparoscopy for RF interstitial tissue ablation. A RF generator was applied for 10 minutes to the dog's kidney at different target temperatures: 80 degrees C, 90 degrees C, and 100 degrees C. On postoperative day14, the animals were sacrificed and nephrectomized. All lesions were macroscopically and microscopically examined. The bioelectrical impedance was evaluated at three different temperatures. Results: Renal injuries were wider and deeper at 90 degrees C (P < 0.001), and they were similar at 80 degrees C and 100 degrees C. The bioelectrical impedance was lower at 90 degrees C than at the temperatures of 80 degrees C and 100 degrees C (P < 0.001). Viable cells in the RF ablation tissue area were not found in the microscopic examination. Conclusion: The most effective cell destruction in terms of width and depth was achieved at 90 degrees C, which was also the optimal temperature for tissue impedance. RF ablation of renal cells eliminated all viable cells.

Psychogenetics of Turner syndrome: an investigation of 28 subjects and respective controls using the Bender test and Piagetian scales

Piagetian scales and the Bender visual motor gestalt test (BT) were applied to 28 subjects with universal 45, X Turner syndrome (TS), and their respective controls, in order to investigate their cognitive performance. Dermatoglyphics were also analyzed to obtain clues concerning embryological changes that may have appeared during development of the nervous system and could be associated with cognitive performance of TS patients. Dermatoglyphic pattern distribution was similar to that reported in previous studies of TS individuals: ulnar loops in the digital patterns and finger ridge, a-b, and A'-d counts were more frequent, while arch and whorl patterns were less frequent compared to controls. However, we did not find higher frequencies of hypothenar pattern, maximum atd angle, and ulnarity index in our TS subjects, unlike other investigations. Furthermore, we found significant differences between TS and control T line index values. The BT scores were also lower in probands, as has been previously reported, revealing a neurocognitive deficit of visual motor perception in TS individuals, which could be due to an absence of, or deficiency in, cerebral hemispheric lateralization. However, TS subjects seemed to improve their performance on BT with age. Cognitive performance of the TS subjects was not significantly different from that of controls, confirming a previous study in which TS performance was found to be similar to that of the normal Brazilian population. There were significant correlations between BT scores and Piagetian scale levels with dermatoglyphic parameters. This association could be explained by changes in the common ectodermal origin of the epidermis and the central nervous system. TS subjects seem to succeed in compensating their spatial impairments in adapting their cognitive and social contacts. We concluded that genetic counseling should consider cognitive and psychosocial difficulties presented by TS subjects, providing appropriate treatment and orientation for them and their families.

Effect of different resistance-training regimens on the WNT-signaling pathway

The purpose of the present study was to evaluate the effects of 8 weeks of strength and power training on the expression of genes related to the canonical WNT pathway and beta-catenin protein levels in physically active men. Twenty-five subjects (27.4 +/- A 4.6 years) were balanced based on their relative maximum strength in the squat exercise (squat 1RM/body mass) and randomly assigned to strength training (ST) (n = 10), power training (PT) (n = 10), and control (C) (n = 5) groups. The ST and the PT groups performed high and low intensity squats, respectively, thrice a week, for 8 weeks. Muscle biopsies from the vastus lateralis muscle were collected before and after the training period. Relative strength and power increased similarly in both ST and PT groups (P < 0.001). Fiber cross-sectional area also increased similarly in both ST and PT groups. Gene expression and beta-catenin protein expression levels were assessed by real-time PCR and Western blot. Certain genes were up-regulated in the ST group (WNT1: 6.4-fold, P < 0.0001; SFRP1: 3.3-fold, P < 0.0001 and LEF1: 7.3-fold, P < 0.0001) and also in the PT group (WNT1: 24.9-fold, P < 0.0001; SFRP1: 2.7-fold, P < 0.0001; LEF1: 34.1-fold, P < 0.0001 and Cyclin D1: 7.7-fold, P < 0.001). In addition, the expression of key WNT pathway genes was substantially more responsive to PT than to ST (WNT1: P < 0.0001; LEF1: P < 0.0001 and Cyclin D1: P < 0.001). Finally, the total beta-catenin protein content increased only in the PT group (P < 0.05). Our data indicate that a PT regimen triggers greater responses in key elements of the WNT pathway.

Resistance Training with Vascular Occlusion in Inclusion Body Myositis: A Case Study

GUALANO, B., M. NEVES JR, F. R. LIMA, A. L. PINTO, G. LAURENTINO, C. BORGES, L. BAPTISTA, G. G. ARTIOLI, M. S. AOKI, A. MORISCOT, A. H. LANCHA JR, E. BONFA, and C. UGRINOWITSCH. Resistance Training with Vascular Occlusion in Inclusion Body Myositis: A Case Study. Med Sci. Spot-is Exerc., Vol. 42, No. 2, pp. 250-254, 2010. Inclusion body myositis (IBM) is a rare idiopathic inflammatory myopathy that produces remarkable muscle weakness. Resistance training with vascular occlusion has been shown to improve muscle strength and cross-sectional area in other muscle wasting conditions. Purpose: We evaluated the efficacy of a moderate-intensity resistance training program combined with vascular occlusion by examining functional capacity, muscle morphology, and changes in the expression of genes related to muscle protein synthesis and proteolysis in a patient with IBM. Methods: A 65-yr-old man with IBM resistant to all proposed treatments underwent resistance training with vascular occlusion for 12 wk. Leg press one-repetition maximum; thigh cross-sectional area; balance, mobility, and muscle function; quality of life; and blood markers of inflammation and muscle damage were assessed at baseline and after the 12-wk program. The messenger RNA (mRNA) expression levels of mechanogrowth factor, mammalian target of rapamycin, atrogin-1, and muscle RING finger-1 were also quantified. Results: After the 12-wk training program, the patient`s leg press one-repetition maximum, balance and mobility function, and thigh cross-sectional area increased 15.9%, 60%, and 4.7%, respectively. All Short Form-36 Health Survey Questionnaire subscales demonstrated improvements as well, varying from 18% to 600%. mRNA expression of mechanogrowth factor increased 3.97-fold, whereas that of atrogin-1 decreased 0.62-fold. Muscle RING finger-1 and mammalian target of rapamycin mRNA levels were only slightly altered, 1.18- and 1.28-fold, respectively. Importantly, the exercise did not induce disease flare. Conclusions: We describe a novel, and likely the first, nonpharmacological therapeutic tool that might be able to counteract the muscle atrophy and the declining strength that usually occur in IBM.

ACUTE EFFECT OF A BALLISTIC AND A STATIC STRETCHING EXERCISE BOUT ON FLEXIBILITY AND MAXIMAL STRENGTH

Bacurau, RFP, Monteiro, GA, Ugrinowitsch C, Tricoli, V, Cabral, LF, Aoki, MS. Acute effect of a ballistic and a static stretching exercise bout on flexibility and maximal strength. J Strength Cond Res 23(1): 304-308, 2009-Different stretching techniques have been used during warm-up routines. However, these routines may decrease force production. The purpose of this study was to compare the acute effect of a ballistic and a static stretching protocol on lower-limb maximal strength. Fourteen physically active women (169.3 +/- 8.2 cm; 64.9 +/- 5.9 kg; 23.1 +/- 3.6 years) performed three experimental sessions: a control session (estimation of 45 degrees leg press one-repetition maximum [1RM]), a ballistic session (20 minutes of ballistic stretch and 45 degrees leg press 1RM), and a static session (20 minutes of static stretch and 45 degrees leg press 1RM). Maximal strength decreased after static stretching (213.2 +/- 36.1 to 184.6 +/- 28.9 kg), but it was unaffected by ballistic stretching (208.4 +/- 34.8 kg). In addition, static stretching exercises produce a greater acute improvement in flexibility compared with ballistic stretching exercises. Consequently, static stretching may not be recommended before athletic events or physical activities that require high levels of force. On the other hand, ballistic stretching could be more appropriate because it seems less likely to decrease maximal strength.

OCCURRENCE AND ANTIBIOTIC SENSIBILITY PROFILE OF Salmonella spp. ISOLATED FROM PORK MEAT CUTS COMMERCIALIZED IN THE OPEN MARKETS IN PELOTAS, RS (BRAZIL)

The objective of the present study was to evaluate the occurrence of Salmonella spp. in 15 samples of pork meat cuts (T-bone, shank, sausage and ribs) commercialized in open markets of Pelotas (RS, Brazil) and verify the prevalent serovars, and test the isolates profile of sensitivity to several antibiotics of importance in medicine (nalidixic acid, ampicillin, aztreonam, kanamycin, carbenicillin, cephalothin, cefoxitin, ceftriaxone, ciprofloxacin, chloramphenicol, gentamicin, sulfonamide, tetracycline and trimetoprina). Twelve samples (80%) were contaminated by Salmonella enterica, serovars Infantis, Derby, Panama and Typhimurium. All isolates were susceptible to trimetoprin, aztreonam, ciprofloxacin, ceftriaxone and cefoxitin. For the other antibiotics, the pattern of sensitivity varied as serovar. In addition, 39.1% of isolates showed up to be multiresistant.

Early Effects on T lymphocyte Response to Iron Deficiency in Mice. Short Communication

Iron deficiency is a common nutritional disorder, affecting about 30% of the world population. Deficits in iron functional compartments have suppressive effects on the immune system. Environmental problems, age, and other nutrient deficiencies are some of the situations which make human studies difficult and warrant the use of animal models. This study aimed to investigate alterations in the immune system by inducing iron deficiency and promoting recuperation in a mouse model. Hemoglobin concentration, hematocrit, liver iron store, and flow cytometry analyses of cell-surface transferrin receptor (CD71) on peripheral blood and spleen CD4+ and CD8+ T lymphocyte were performed in the control (C) and the iron-deficient (ID) groups of animals at the beginning and end of the experiment. Hematological indices of C and ID mice were not different but the iron stores of ID mice were significantly reduced. Although T cell subsets were not altered, the percentage of T cells expressing CD71 was significantly increased by ID. The results suggest that iron deficiency induced by our experimental model would mimic the early events in the onset of anemia, where thymus atrophy is not enough to influence subset composition of T cells, which can still respond to iron deficiency by upregulating the expression of transferrin receptor.