Orientações para o tratamento da tuberculose em pessoas vivendo com HIV/AIDS [folder]

Orientações ao paciente coinfectado por TB-HIV.

Curso EaD sobre saúde mental na Atenção Primária à Saúde para médicos: diagnóstico de transtorno de humor e depressão

Este vídeo integra o "Curso EaD sobre saúde mental na Atenção Primária à Saúde para médicos”, desenvolvido pelo TelessaúdeRS/UFRGS. O curso foi elaborado com o objetivo de qualificar médicos que atuam em unidades básicas de saúde do Brasil para o diagnóstico, a abordagem e o acompanhamento de pacientes com transtornos mentais. O vídeo apresenta informações básicas sobre transtorno de humor e depressão e formas de abordagem e tratamento de pacientes com tais problemas no nível da Atenção Primária à Saúde.

Serviço de Saúde Mental na comunidade de Sarzedo: uma inserção social dos portadores de transtorno mental

A Atenção Primária à Saúde é a porta de entrada do paciente no Sistema Único de Saúde (SUS). No Brasil, a Reforma Psiquiátrica culminou em uma maior interação entre a Atenção Primária à Saúde e a Saúde Mental, transformações das instituições, e transformações culturais de forma a romper paradigmas reconceituando a doença mental. O trabalho em tela realizado a partir de leituras exploratórias, analíticas e interpretativas sobre a reinserção dos portadores de transtornos mentais na comunidade, reflexão sobre a realidade da assistência à saúde mental, mediado pelo levantamento das informações já existentes no Serviço de Saúde Mental de Sarzedo, SESAMES, objetivou relatar o atendimento da rede de apoio secundária, SESAMES, e sua interlocução com a cidadania do portador de sofrimento mental mediada através das novas formas de abordagem a este usuário. A pesquisa resultou no achado de que o SESAMES acompanha constantemente 579 pacientes, realiza atividades e ações preconizadas pelas diretrizes e legislação pertinentes e ainda, é responsável por uma população que atualmente é de 27104 residentes. Todavia apesar das ações que estão sendo desenvolvidas verifica-se aumento significativo no número das internações nos anos de 2010 e 2011. Portanto apreende-se a importância de que novas formas de abordagem, dimensionamento dos aspectos relacionados ao tratamento e ao manejo clinico sejam efetivadas.

Elaboração de um projeto de intervenção para melhorar a adesão dos pacientes ao tratamento e medicamentos usados pelos usuarios com depressão maior da equipe do PSF Geraldo Alves da Silva no municipio de Virgolandia/MG

A depressão tem sido avaliada como um transtorno com alta prevalência, possibilidade de recorrência e cronicidade que pode afligir parcela considerável da população, independente de sexo, idade ou etnia. Essa doença vem sendo apontada como um grave problema de saúde pública, relacionado a elevados custos sociais e risco de suicídio. A comunidade de Virgolândia/MG, Brasil, reflete essa realidade sendo um dos principais problemas encontrados na análise situacional que abrange a área e está associado à não adesão ao tratamento médico e outros problemas derivados da qualidade dos serviços de saúde, com consequências que afetam o plano individual, familiar e na comunidade. Desse modo, é importante conhecer os fatores envolvidos para adesão do paciente ao tratamento na depressão, para implementação de ações que melhorem a adesão e contribuam para prevenção de agravos decorrentes do uso inadequado de medicamentos. Nessa perspectiva, este estudo tem o propósito melhorar a adesão dos pacientes ao tratamento na comunidade do estudo

Depressão:tratamento e acompanhamento de adultos com depressão

Este guia orienta sobre os principais cuidados a serem tomado ao se tratar um paciente com depressão e instrui sobre os sintomas, diagnostico e tratamento. Entre os tópicos abordados, estão: Princípios do cuidado; Reconhecimento, avaliação e abordagem inicial; Identificado o caso de depressão; Sintomas depressivos subliminares persistentes ou depressão leve a moderada com resposta inadequada às intervenções iniciais ou depressão moderada a grave; Depressão grave e complexa.

Transtorno do déficit de atenção e hiperatividade: proposta de avaliação neuropsicológica para diagnóstico

Attention deficit hyperactivity disorder (ADHD) is characterized by a persistent pattern of inattention and/or hyperactivity/impulsivity. The aim of this research was to contribute more precisely to the diagnosis of ADHD, to propose a battery of neuropsychological assessment and to analyze the contribution of each test. We studied 10 matched pairs of children with ADHD and normal controls (7 to 11 years). Inclusion criteria were: presence of ADHD typical behavior, positive diagnosis of ADHD based on DSM-IV, normal IQ, normal neurological examination and parental consent. We used extensive neuropsychological battery. The results showed differential sensitivity for detection of attentional problems in children with ADHD, although most tests did not reach statistical significance. The item, errors, of WCST revealed statistically significant difference between the two groups: ADHD performance was inferior to controls . In conclusion the neuropsychological assessment battery used in this research contributed to the diagnosis of ADHD.

PARAFAC: uma ferramenta quimiométrica para tratamento de dados multidimensionais. Aplicações na determinação direta de fármacos em plasma humano por espectrofluorimetria

Since the last decade, the combined use of chemometrics and molecular spectroscopic techniques has become a new alternative for direct drug determination, without the need of physical separation. Among the new methodologies developed, the application of PARAFAC in the decomposition of spectrofluorimetric data should be highlighted. The first objective of this article is to describe the theoretical basis of PARAFAC. For this purpose, a discussion about the order of chemometric methods used in multivariate calibration and the development of multi-dimensional methods is presented first. The other objective of this article is to divulge for the Brazilian chemical community the potential of the combination PARAFAC/spectrofluorimetry for the determination of drugs in complex biological matrices. For this purpose, two applications aiming at determining, respectively, doxorrubicine and salicylate in human plasma are presented.

Avaliação da qualidade de vida em pacientes idosos um ano após o tratamento cirúrgico de fraturas transtrocanterianas do fêmur

OBJECTIVE: Evaluate the impact that trochanteric hip fractures produce on life quality of elderly patients, treated surgically, during one year of monitoring. METHODS: Were selected 73 elderly with transtrochanteric femur fracture, aged equal or over than 65 years and of both sexes. All participants underwent a standardized questionnaire which obtained information on lifestyle habits, functionality, physical activity, ambulation and cognitive state. Were excluded patients who died, not walking, with neurological diseases and pathological fractures. RESULTS: The average age was 80.17 ± 7.2 years and 75% was female. When comparing the summation of activities of daily living (p = 0.04) and instrumental daily living (p = 0.004) obtained before and after fracture, the patients become more dependent after fracture. Activities of daily living that worsened after fracture were bathing (p = 0.04), toileting (p = 0.02) and dressing (p = 0.04). All instrumental activities of daily living showed a significant difference, with functional dependence after fracture, increased need for walking aid (p = 0.00002), aged (p = 0.01) and not doing housework (p = 0.01). The low score on the test Minimental was associated with a greater dependence to perform activities of daily living before (p = 0.00002) and after (p = 0.01) fracture. CONCLUSION: After a year, activities of daily living that depended on the lower limbs worsened significantly, all instrumental activities of daily living were significantly worse in more than 50% of patients and more than half of patients who walked without support lost this ability.

Sistema MINUS® - técnica minimamente invasiva para o tratamento das fraturas transtrocanterianas do fêmur

The MINUS system was developed as a minimally invasive procedure that uses a diaphyseal cephalic extramedullary implant for the treatment of transtrochanteral fractures of the femur in elderly patients. The implant consists of a sliding screw coupled to a plate adapted to the minimally invasive technique. The surgical access is approximately three centimeters in length located on the lateral surface of the hip, below the projection of the small trochanter. A perfectly adapted instrument was used for the procedure, which also requires the use of an image intensifier, reducing surgery time and rate of bleeding. The objective of this study is to present a new instrument and implant, developed specifically for treatment with the minimally invasive technique, reducing the length of the conventional surgical access from 10 to three centimetres. This new implant was given the commercial name of MINUS System.

O comportamento de crianças em tratamento odontológico: intervenção psicofarmacológica

The present investigation evaluated the effects of diazepam used to manage uncooperative behavior of child dental patients. Six participants received placebo or diazepam (0,3 mg/kg weight) before formal dental treatment at total 54 sessions that were all recorded in videotapes. The analysis of recorded child (crying, body and/or head movements, escape and avoidance) and dentist's behavior management procedures (distraction, explanation, positive reinforcement) indicates no differences by using a double-blind Wilcoxon design (p>0.05). It is suggested the necessity of methodological refinement in studies that combine psychological and pharmacological handling strategies.

Medo, ansiedade e controle relacionados ao tratamento odontológico

The aim of this study was to test fear, anxiety and control related to dental treatment. The subjects were 364 children with ages between 7 and 13 years. Three questionnaires with multiple choice questions were applied in groups of 10 children. The first instrument was the 15-item dental subscale from the Children’s Fear Survey Schedule9. The subjects rated their level of fear on a 5-point scale. The second survey instrument was the 20-item subscale from the State Trait Anxiety Inventory for Children16. This measure was used to capture how anxious the child was, in general. The third instrument was the Child Dental Control Assessment19. It contained 20 items to assess perceived control and 20 items to assess desired control. The results of the survey indicated that dental fear and anxiety were slightly higher for females when compared with male subjects (P < 0.05). Older children (11 to 13 years old) obtained higher fear scores than younger ones (7 to 9 years old). Concerning perceived control, the results indicate that younger children perceive more control than older ones. For desired control, the results indicate that younger children reported higher percentages than older ones. In this study, patients who had undergone anesthesia during treatment revealed higher fear scores when compared with those who had not. Dental fear etiology seems to be related to a procedure that may involve pain or lack of control.

Atypical antipsychotics in the treatment of pathological aggression in children and adolescents: literature review and clinical recommendations

Objective: To review the literature about the use of atypical antipsychotics in the treatment of pathological aggression in children and adolescents. Method: The databases MEDLINE, SciELO, and LILACS were searched for publications in Portuguese or English from 1992 to August 2011 using the following keywords: mental disease, child, adolescent, treatment, atypical antipsychotic, aggressive behavior, aggression, and violent behavior. Results: Sixty-seven studies of good methodological quality and clinical interest and relevance were identified. Studies including children and adolescents were relatively limited, because few atypical antipsychotics have been approved by the Food and Drug Administration (FDA). All the medications included in this review (risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole and clozapine) have some effectiveness in treating aggression in children and adolescents, and choices should be based on clinical indications and side effects. Conclusions: There are few studies about the effectiveness and safety of atypical antipsychotics for the pediatric population, and further randomized controlled studies with larger groups of patients and more diagnostic categories, such as severe conduct disorder and oppositional defiant disorder, should be conducted to confirm the results reported up to date and to evaluate the impact of long-term use.

Diabetologia intervencional: uma nova abordagem para o tratamento cirúrgico do diabetes tipo 2

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Consenso brasileiro para a abordagem clínica e tratamento do hipotireoidismo subclínico em adultos: recomendações do Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia

INTRODUCTION: Subclinical hypothyroidism (SCH), defined as elevated concentrations of thyroid stimulating hormone (TSH) despite normal levels of thyroid hormones, is highly prevalent in Brazil, especially among women and the elderly. Although an increasing number of studies have related SCH to an increased risk of coronary artery disease and mortality, there have been no randomized clinical trials verifying the benefit of levothyroxine treatment in reducing these risks, and the treatment remains controversial. OBJECTIVE: This consensus, sponsored by the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism and developed by Brazilian experts with extensive clinical experience with thyroid diseases, presents these recommendations based on evidence for the clinical management of SCH patients in Brazil. MATERIALS AND METHODS: After structuring the clinical questions, the search for evidence in the literature was initially performed in the MedLine-PubMed database and later in the Embase and SciELO - Lilacs databases. The strength of evidence was evaluated according to the Oxford classification system and established based on the experimental design used, considering the best available evidence for each question and the Brazilian experience. RESULTS: The topics covered included SCH definition and diagnosis, natural history, clinical significance, treatment and pregnancy, and the consensus issued 29 recommendations for the clinical management of adult patients with SCH. CONCLUSION: Treatment with levothyroxine was recommended for all patients with persistent SCH with serum TSH values > 10 mU/L and for certain patient subgroups.

Politetrafluoroetileno e esclera humana no tratamento cirúrgico de perfuração escleral em coelhos

Purpose: An experimental study to evaluate the behavior of polytetrafluoroethylene (Gore-Tex®) compared with human sclera, in scleral perforations induced in rabbits eyes was performed. Methods: Twenty-two eyes of rabbits were submitted to scleral perforation followed by Gore-Tex® graft in the left eye and human sclera graft in the right eye respectively. During one month the postoperative evolution was analyzed every day: intensity of hyperemia, presence of infection, secretion, rejection and tonicity of the eyes. Results: No cases of secretion, infection or rejection were observed. The histological sections showed fibrosis in the eyes with Gore-Tex®, good adhesion and epithelization. Conclusion: The Gore-Tex® showed to be a plausible material to be used as graft in scleral defects with some advantages such as easy obtention, good handling and durability.