Mestrado em Medicina

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Tuberculose cutânea : estudo descritivo dos pacientes atendidos no período de 1986-2011 no Hospital Universitário Cassiano Antonio Moraes-Vitória-Espírito Santo-Brasil
(Universidade Federal do Espírito Santo, 2013-05-24) Spelta, Karla; Diniz, Lúcia Martins; Palaci, Moisés; Trindade, Maria Angela Bianconcini
Introduction: Tuberculosis is a serious public health issue in Brazil. Therefore, it is important to understand the clinical aspects of its cutaneous manifestations, which has been rarely documented so far. Objective: To study the characteristics of patients diagnosed with cutaneous tuberculosis in the University Hospital Cassiano Antonio Moraes, in Vitoria, Espírito Santo, Brazil, and to contribute to the scarse literature available on this subject. Patients and Methods: This is a transversal, descriptive, observational, homodemic study of the charts of 29 patients diagnosed with cutaneous tuberculosis from the hospital s Dermatology and Pulmonology Departaments, consulted from 1986 to 2011. The inclusion criteria was the diagnostic confirmation of cutaneous tuberculosis, which considered clinical, epidemiological, immunological and bacteriological findings and response to specific treatment. Results: Out of the total number of patients, 18 came from the Dermatology Departament and 11 from the Pulmonology Department; 18 (62%) patients were female; the mean age was 35 years; the predominant clinical form was erythema induratum of Bazin in 12 (41,4%) cases and the cutaneous lesions were localized in the lower limbs in 19 patients (65,8%). Extracutaneous manifestations occurred in eight (27,6%) cases. The tuberculin skin test, performed in 19 patients, was positive in 15 (78,9%) of them, but the identification of the infeccious agent was unsuccessful in most cases. The standard treatment protocol was used in 23 (79,3%) patients. Discussion and Conclusion: The study revealed a low prevalence (0,44%) of cutaneous tuberculosis in an highly prevalent area of pulmonary tuberculosis. It was more frequent in females, and predominated in the forth decade of life. The erythema induratum of Bazin in the lower limbs was the most frequent clinical form. Other studies, on the contrary, found scrofuloderma to be the most common cutaneous manifestation, usually localized on the cervical region of children and young males. This was the first report on cutaneous tuberculosis in the state of Espirito Santo, Brazil.
Frequência do gênero dos pacientes com hanseníase em relação à baciloscopia nos municípios do Estado do Espírito Santo
(Universidade Federal do Espírito Santo, 2013-07-19) Maciel, Leonardo Bezerra; Diniz, Lúcia Martins; Rodrigues, Rodrigo Ribeiro; Frade, Marco Andrey Cipriani; Palaci, Moises
Background: Leprosy prevails as a public health problem in ten countries around the world, however, its control stops into complex cultural, social and biological questions. The frequency of the disease is apparently equal in both genders; however, there is a slight predominance of multibacillary forms in males, which could be explained by behavioral factors, or save some relation to biological factors. Objective: Evaluate the correlation of bacilloscopy with gender of leprosy patients in Espiríto Santo state (Brazil), in the period from 2001 to 2011. Patients and methods: Observational, descriptive and retrospective study of leprosy patients, notified at the Health Secretary of Espiríto Santo State. With these data we constructed a spreadsheet in SPSS Statistics 17.0 for statistical analysis. Results: From the 16030 leprosy cases reported was found that the majority were males (53%) had less than eight years of schooling (76%), they were concentrated in the north-central region of Espiríto Santo state (94%), predominated paucibacillary forms, however, multibacillary forms were most frequent among males (66%), with prevalence of positive bacilloscopy (72%) and neural involvement (62%). Conclusion: Men were the main responsible for the transmission and perpetuation of this endemic disease in the State of Espiríto Santo. Being men increased 2.54 times the risk of patients being multibacillary and increased 3.22 times the risk of patients presenting positive bacilloscopy.
Outbreak of Ochrobactrum anthropi endophthalmitis following cataract surgery
(Universidade Federal do Espírito Santo, 2013-11-11) Mattos, Fellipe Berno; Saraiva, Fábio Petersen; Passos, Angelo Ferreira; Santos, Daniel Vitor de Vascconcelos; Hadad, David Jamil
abstract
Análise histológica retrospectiva de glândula salivar menor em pacientes com síndrome seca
(Universidade Federal do Espírito Santo, 2013-11-18) Giovelli, Raquel Altoé; Santos, Maria Carmen Lopes Ferreira Silva; Valim, Valeria; Barros, Liliana Aparecida Pimenta de; Silva, Rita Elizabeth Checon de Freitas; Musso, Carlos
Introduction/Objectives: In spite of the fact that Sjӧgren’s Syndrome (SS) is prevalent, it is still poorly diagnosed. Labial salivary gland biopsy (LSGB) is the most accurate diagnostic method but little performed in clinical practice, although it is part of the last 3 criteria for disease classification. The study of the accuracy of LSGB in a sample of clinical practice can help establish when recommending this procedure. Objectives: This study assessed the usefulness of LSGB for the diagnosis of primary SS studying the sensibility and specificity and the clinical profiles of patients who were referred to biopsy. Methods: Retrospective analysis of the anatomopathological reports from LSGB and medical report data from patients who underwent LSGB between 2008 and 2011. Results: Two-hundred ninety biopsies were performed during this period, and 74 were excluded due to insufficient clinical data. Of the remaining 216 patients, 0.46% (n=1) was carrier of the hepatitis C virus, 30.1% (n=65) had primary SS and 8.8% (n=19) secondary SS. In the sample, 94.3% (n=203) presented with sicca syndrome with 51.6% (n=111) only having dryness and 42.7% (n=92) having other associated symptoms; 66.9% (n=114) presented unstimulated salivary flow and/or reduced Schirmer test. Among the patients with lachrymal and/or salivary gland dysfunctions associated with positive anti-Ro/anti-La, 70% also showed LSGB compatible with SS and all of them met the American-European Consensus Group criteria 2002 (AEGC) for SS. The majority (85.1%, n=23) with no lachrymal or salivary dysfunctions, besides negative antibody, had LSGB with < 1 focus score and no one met the AEGC. The LSGB was necessary in 67.6% (n=44) in order to conclude the presence of SS based on AECG criteria. The sensibility and specificity of LSGB were 86.57% and 97.36%, respectively. Of the 98 patients referred with sicca syndrome and fibromyalgia, 36.75% (n=36) presented SS and LSBG ≥ 1 focus score. In comparison with individuals without SS, patients with SS were older, showed more severe lachrymal and salivary dysfunctions, greater frequency of fibromyalgia, anti-nuclear antibodies (ANA), anti-SSA-Ro, anti-SSA-La and further systemic manifestations. Among the patients with primary SS, 38,46% (n=25) showed extra glandular manifestations and 3% (n=2) had lymphoma. Conclusion: LSGB has a high sensibility and specificity and has contributed to the majority of cases for the diagnosis of SS. It is especially useful in patients with gland dysfunctions and negative antibodies. The frequency of SS confirmed by LSGB in patients with dryness symptoms and fibromyalgia is high and should be investigated in these patients.
Inquérito sorológico para hanseníase em profissionais de saúde no Hospital Universitário Cassiano Antonio Moraes - Vitória - Espírito Santo - Brasil
(Universidade Federal do Espírito Santo, 2014-03-07) Landeiro, Luana Gomes; Diniz, Lucia Martins; Oliveira, Maria Leide Wand Del Rey de; Cerutti Junior, Crispim; Miranda, Angelica Espinosa Barbosa
Background: Leprosy is a major public health problem in Brazil, and the control programs that aim to break the chain of transmission are focused on household contact of leprosy patients. However, the importance of contact outside the home and from individuals with subclinical infections are being studied more than ever before. Health professionals, in addition to being placed in the same endemic context of their patients, come into contact, often recursively, to leprosy patients. Objective: To better understand health professional exposure levels of Mycobacterium leprae at the Cassiano Antonio Moraes University Hospital, by way of determining their PGL I seropositivity and the correlation of this seropositivity to several factors, such as gender, occupation, place of work, time of practice, working with leprosy patients, presence of household contact with leprosy, comorbidities related to false positive ML-Flow and consumption of beef, milk and related products. Patients and Methods: Cross-sectional, descriptive, observational and homodemic study methods using a sample of 300 health professionals from the Cassiano Antonio Moraes University Hospital. Results: Of the 300 health professionals recruited, 296 had valid ML Flow tests and were therefore included in the study. Of these 296 health professionals studied, 83 % were female, 59 % were nursing assistants, 22 % were physicians, 5 % worked in leprosy clinics, 71 % had their professions for more than ten years old, 79 % denied having worked with leprosy patients and 7 % reported household contact with leprosy. The PGL I seropositivity among participants was 30.7 %. Discussion and Conclusion: In addition to the high PGL I seropositivity identified among the health professionals studied, statistical analysis determined a significant association (p = 0.001) between positivity for anti-PGL-I and the presence of household contact with leprosy patients. We could not demonstrate an association between anti -PGL I positivity and the other factors analyzed.
Sobrevida e causas de descontinuidade do primeiro anti tnf na Espondilite Anquilosante comparado com Artrite Reumatoide : análise do BiobadaBrasil
(Universidade Federal do Espírito Santo, 2014-06-16) Fafá, Bárbara Petronetto; Valim, Valéria; Abreu, Mirhelen Mendes de; Zandonade, Eliana
Introduction: Treatment survival with biological therapy may be influenced by many factors and it seems to be different among various rheumatic diseases and biological agents. Objective: To compare the survival and causes of the discontinuation of antitumoral necrosis factor (anti TNF) therapy in Ankylosing Spondylitis (AS) with Rheumatoid Arthritis (RA). Methods: A population-based cohort of AS and RA patients from the Brazilian Registry of Biological Therapies in Rheumatic Diseases (BiobadaBrasil) included between 2008-2013. The observation time was up to 4 years following the introduction of the first treatment. Sex, age, disease duration, disease activity, comorbidities and concomitant therapies were assessed. Kaplan-Meier curve, Chisquare, Kruskal-Wallis and Wilcoxon-Mann-Whitney tests and Cox regression were used whenever appropriated. The p value < 0.05 was considered significant. Results: 1.303 patients were included, 67.2% were women, 50.5 ± 12.6 years old, 372 (28.5%) had AS and 931 (71.5%) had RA. As to the biological class of their anti TNF therapy, 38.7% (n = 504) used infliximabe (IFX), 34.9% (n = 455) used adalimumabe (ADA) and 26.4% (n = 344) used etanercepte (ETA). Patients with AS had highter retention rate (82.3 % vs 67.3%; p ≤ 0.001) and higher survival (42.67 ± 0.67, CI = 41.34-43.99 vs. 36.83 ± 0.54, CI = 35.77-37.89 months; p ≤ 0.001). Patients with SA have half risk of anti TNF discontinuation (odds = 0.455, p<0.001), regardless of sex and age. Discontinuation due to ineffectiveness (6.2% vs 15.8%, p<0.001) and adverse event (5.9% vs. 11.3%, p.003) was smaller in AS. Survival was similar to all 3 anti TNF for SA. The RA showed best retention rate for ETA compared to ADA and IFX in the RA. The risk of ETA discontinuation was lower than the IFX (HR = 0.72 (IC= 0.53-0.96). Age, sex, medication, disease activity, disease duration, HLA B27 and rheumatoid factor were not associated with treatment discontinuity in both disease. Conclusion: AS patients have higher survival by treatment with anti TNF independent of sex and age. They also have a lower rate of serious adverse events and seem to be related to the disease mechanism, since they have a lower rate of inefficiency.
A volumetria por ressonância magnética da substância cinzenta cortical frontal médio-rostral e cerebelar do lado esquerdo prediz o desempenho executivo frontal em alcoolistas
(Universidade Federal do Espírito Santo, 2014-10-23) Souza, Rodrigo Stênio Moll de; Gasparetto, Emerson Leandro; Nakamura-Palacios, Ester Miyuki; Gomes, Maria da Penha Zago; Mello, Ricardo Andrade Fernandes de; Santos, Alair Augusto Sarmet Moreira Damas dos
abstract
Uso da sutura compressiva em complicações e intercorrências da cirurgia antiglaucomatosa
(Universidade Federal do Espírito Santo, 2014-12-01) Agostini, Fernanda Spinassé; Passos, Angelo Ferreira; Saraiva, Fábio Petersen; Campos, Wesley Ribeiro
Objective: To present a comprehensive account of the use of compression sutures in complications and intercurrence of antiglaucomatous surgery. Material and Methods: Descriptive study. Using the medical records of patients who underwent compression sutures from 1999-2012, we analysed the methods used for complications and intercurrence of antiglaucomatous surgery. For post-operative complications: in Seidel, case results were evaluated based on immediate and long-term occlusion and changes in filtering blebs; hyperfiltering blebs: immediate and long-term outcomes in intraocular pressure and changes in filtering bleb; symptomatic filtering bleb: improvement in symptoms and the modification of the architecture and function of the bleb; For intraoperative complications: effectiveness at preventing external leakage through the conjunctival flap and undesirable filtering or hyperfiltering of the scleral flap. Results: A total of 41 cases of post-operative complications, 39 of Seidel and hyperfiltering bleb, and two symptomatic blebs were studied. For the 14 early Seidel cases, resolution was obtained immediately and in long-term in 92.8% of the cases. Bleb formation occurred in seven cases, maintenance of the bleb in four cases, and failure in three cases. In nine late Seidel cases there was immediate resolution in 85.7% of the cases and long-term resolution in 57% of the cases. Bleb failure occurred in two cases in which the Seidel had been occluded. In 14 hyperfiltering bleb cases in the early postoperative period there was immediate resolution of hypotony in 85.7% of cases and long term resolution in 78.5%, with maintenance of the bleb in 13 of these. In both hyperfiltering bleb cases in the late postoperative period, there was immediate and long-term resolution of hypotonia. For the two cases of symptomatic blebs there was resolution of symptoms and improvement in appearance with maintenance of filtering bleb function. Objectives were achieved intraoperatively for surgical complications in all 42 cases of external leakage of the conjunctival flap, two cases in which avoidance of excessive bleb extension was the aim, and in cases of excessive or unwanted filtration through the scleral flap. Conclusion: Isolated compression sutures represent an alternative for the treatment or prophylaxis of surgical complications in glaucoma surgery, and can be used as a complement to conventional sutures. Compression sutures are also useful to treat and to prevent symptomatic blebs. However, the results obtained for late Seidel in microcystic blebs and in hyperfiltering blebs in general do not encourage us to position them among the best options.
Avaliação da frequência de transtorno de déficit de atenção e hiperatividade em pacientes submetidos à cirurgia bariátrica e sua relação com a evolução ponderal no período pós-operatório
(Universidade Federal do Espírito Santo, 2014-12-10) Marchesi, Doglas Gobbi; Miguel, Gustavo Peixoto Soares; Ciríaco, Jovana Gobbi Marchesi; Santos, Maria Carmen Lopes Ferreira Silva; Palacios, Ester Miyuki Nakamura; Azevedo, Otávio Cansanção de
Introduction: Bariatric surgery shows effective and consecrated results in combating the obesity pandemic. However, few studies evaluate the prognostic factors in the success of the surgical treatment of obesity. Recently, studies described that the Attention Deficit and Hyperactivity Disorder (ADHD) is directly related to obesity and a greater difficulty in losing weight with nonsurgery therapy. This study intends to start analyzing possible negative effects of ADHD on the success of bariatric surgery. Methods: Forty patients that have undergone bariatric surgery and with minimal regular postoperative follow-up of one year were evaluated. All underwent the recommended questionnaire in the fourth edition of the Diagnostic and Statistical Manual (DSM-IV) of the American Psychiatric Association for ADHD and analyzed the postoperative data. Results: Thirteen (38%) patients had a positive questionnaire for ADHD. The patient with ADHD had higher BMI than patients without the disorder, keeping the difference in all stages of postoperative follow-up. No statistically significant difference in the success of surgery (p = 0.505) and in the reduction in BMI (p = 0.671) was found, after a year of the procedure. Conclusion: Patients with ADHD have higher BMI, however, the presence of ADHD has no influence on the success of bariatric surgery and reduction in BMI. Despite the findings, other studies evaluating other data such as postoperative complications, longer follow-up, improvement in comorbidities, among others, are necessary to define the actual influence of ADHD postoperative bariatric surgery.
Avaliação da função frontal pelo teste Frontal Assesment Battery (FAB) em pacientes portadores de cirrose hepática
(Universidade Federal do Espírito Santo, 2014-12-11) Souza, Karina Zamprogno de; Gomes, Maria da Penha Zago; Gonçalves, Luciana Lofego; Carvalho Filho, Roberto José de
Introduction: Within the spectrum of HE, the Minimal Hepatic Encephalopathy (MHE) is a milder form, characterized by subtle changes in cognitive function, as well as the absence of motor disturbances or changes in sleep-wake cycle. We must recognize the importance of this disease because of its negative impact on quality of life and the association of MHE with increased risk of developing overt HE. For while there are any diagnostic gold standard method of MHE. It would be important to have a test for screening of MHE so that treatment is not delayed. Objectives: To test the Frontal Assessment Battery (FAB), a psychometric and practical objective method that can be applied by the clinician during the out patient visit, at a time interval of 10 minutes, as an instrument for detection of MHE in patients with liver cirrhosis. Methodology: Frontal Assessment Battery(FAB) were applied in 87patients with liver cirrhosis and 40 non-cirrhotic controls including outpatient from the liver ambulatory, alcohol ambulatory and also inpatients from the gastroenterology wards of the HUCAM. Results: The FAB values observed in cirrhotic pacients were lower than in non-cirrhotic patients (10.6 ± 3.67 vs 12.25 ± 2.72, p=0.015). The cirrhotic patients without overt HE had lower values of FAB than non-cirrhotic patients (11.14 ± 3.25 vs 12.25 ± 2.72, p=0.067). We also observed that the score of the subtest GO-NO-GO was lower among cirrhotic patients without overt HE than among non-cirrhotic patients (1.72 ± 0.93 vs 2.2 ± 0.85, p=0.011). Comparing the cirrhotic patients with overt HE to the cirrhotic patients without overt HE, It was observed lower values of FAB among the cirrhotic patients with overt HE (8.25 ± 4.55 vs 11.14 ± 3.25, p=0.027). Conclusion: The FAB had lower values between cirrhotic than noncirrhotic patients, among cirrhotic patients with overt HE than among cirrhotic patients without overt HE and also among cirrhotic pacients without HE than among noncirrhotic patients. That fact suggests that the FAB must be a promising tool for the detection of MHE and for the classification of overt HE.
Análise crítica do rastreamento ultrassonográfico do carcinoma hepatocelular em pacientes cirróticos acompanhados em serviços de referência em hepatologia no Espírito Santo
(Universidade Federal do Espírito Santo, 2014-12-11) Signorelli, Izabelle Venturini; Gomes, Maria da Penha Zago; Pereira, Fausto Edmundo Lima; Carvalho Filho, Roberto José de
abstract
Comparação dos resultados da utilização de fígados de critério expandido versus enxerto padrão em transplantes de fígado realizados no Espírito Santo
(Universidade Federal do Espírito Santo, 2015-03-20) Ferreira Junior, Antonio carlos Lugon; Miguel, Gustavo Peixoto Soares; Lima, Agnado Soares
abstract
Aspectos da infecção pelo helicobacter pylori nos resultados da cirurgia bariátrica
(Universidade Federal do Espírito Santo, 2015-03-25) Silva, Fernanda Araújo Faber da; Miguel, Gustavo Peixoto Soares; Santos, Maria Carmen Lopes Ferreira Silva; Paulo, Danilo Nagib Salomão; Piras, Cláudio
BACKGROUND: Obesity is a multifactorial disease highly prevalent, increasing incidence and spread throughout the world. It is an independent risk factor for numerous comorbidities such as type 2 diabetes mellitus, hypertension, dyslipidemia, metabolic syndrome, hepatic steatosis, gastroesophageal reflux disease, cholelithiasis, osteoarthritis, sleep apnea, among outras. O role of gastric infection H. pylori in obesity still generates much discussion. Helicobacter pylori (H. pylori) is a gram-negative bacterium that is associated with 75% of gastric carcinomas. Studies are needed to better understand the biology of H. pylori characteristics in order to develop strategies to deal with Helicobacter pylori infection, especially in postoperative patients of gastric bypass surgery Roux-Y, as it is bariatric surgery "Gold Standard" and his technique is left excluded stomach without conventional endoscopic access being home to many complications, especially gastric adenocarcinoma. It is known that patients infected with H. pylori, about 1-3% will develop cancer. OBJECTIVE: To evaluate aspects of H. pylori infection in the postoperative results of two surgical techniques for morbid obesity. METHODS AND RESULTS: A prospective clinical study evaluated the incidence of H. pylori in patients undergoing bariatric surgery, analyzing the two surgical techniques and comparing them. It was observed that the prevalence of H. pylori preoperative for the first year after surgery (p <005), remained sustained by the fifth year. There was no interference with the surgical technique. And in the morbidly obese, leukocytosis is related to H. pylori infection (p <0006). As for H. pylori infection can be observed that in the Vertical Gastrectomy group (GVA) of 1 year postoperatively for the 5th year there was an increase of anemia and infection by H. pylori, contrary occurred with the Gastric bypass technique Roux-Y (DGA). CONCLUSION: reducing the prevalence of Helicobacter pylori after bariatric surgery. Leukocytosis can relate to H. pylori infection. Infection with H. pylori does not prejudice the outcome of the surgery and can contribute to anemia in the postoperative period in patients undergoing bariatric surgery.
Estudo retrospectivo sobre a variação pós-operatória do escore de Gleason do adenocarcinoma prostático e fatores correlacionados
(Universidade Federal do Espírito Santo, 2015-09-01) Zanettini, Luis Felipe Snel; Miranda, Marcio Maia Lamy de; Santos, Maria Carmen Lopes Ferreira Silva; Carvalhal, Gustavo Franco; Vargas, Paulo Roberto Merçon de; Pereira, Fausto Edmundo Lima
Introduction: Currently about 23% of cancers diagnosed in males are prostate adenocarcinoma (PA). Because of the indolent behavior observed in the early stages of PA, less invasive treatment methods are being used in an attempt to minimize comorbidities related with conventional treatments. After prostate needle biopsy tissue (BX) and histological analysis, the Gleason score (GS) is obtained. The GS alone is able to predict the prognosis of patients with PA and is used, along with other variables, for choosing the therapeutic option. Studies have shown variations in the postoperative GS in up to one third of cases. Objective: Identify the variation of the GS in cases of PA before and after radical prostatectomy (RP) and correlate to prostate volume, preoperative serum value of Prostate-Specific Antigen (PSA), age and PSA density (PSAd). Method: A retrospective, cross-sectional study of 279 cases submitted to RP due to PA between January 2008 and June 2013, assessing the postoperative variation of the GS, and performing correlation analysis of postoperative GS elevation with age, prostate volume, the preoperative PSA and PSAd, in a continuous and categorical manner. Results: The mean age, prostate volume, serum PSA and PSAd were, respectively, 63.8 years-old, 8.8 ng/ml, 33.37 cm3 and 0.32ng/mL/cm3. Postoperative GS variation was observed in 34% of the cases, with 27% having higher and 7% having lower values. When the GS was 6 or lower, 29% of all patients presented with an increase in postoperative GS values. Patients age and prostate volume were not statistically significant in postoperative GS elevation (p = 0,42 and p = 0,37, respectively). Preoperative serum PSA value demonstrated correlation with postoperative elevation of GS (p = 0.007), as a protection factor when less than 4 ng/mL (OR 0.41, p = 0.05) and as a causal factor when greater than 10 ng/mL (OR 2.62, p = 0.0008). The PSAd also proved to be related to postoperative elevation of the GS (p = 0,002), as a protection factor when less than 0,15 ng/mL/cm3 (OR 0,41 and p = 0,02) and as a causal factor when greater than 0,15 ng/mL/cm3 (OR 2,39 and p = 0,02). Conclusion: GS variation occurred in 34% of all cases, with 27% of patients having higher scores and 7% having lower scores. The high PSA value and the PSAd were associated with postoperative increase of GS values.
Hepatite C crônica e manifestações cutâneas : experiência no acompanhamento conjunto (dermatologia/hepatologia) dos pacientes em tratamento para hepatite C
(Universidade Federal do Espírito Santo, 2015-09-22) Capeli, Rafaela Lorenzon de Aragão; Diniz, Lucia Martins; Gonçalves, Patrícia Lofêgo; Santos, Omar Lupi da Rosa; Gomes, Maria da Penha Zago
Background: Extrahepatic manifestations.are numerous in chronic hepatitis C. Among them, cutaneous symptoms or findings are frequent and may be a clue to underlying HCV infection. Porphyria cutanea tarda, lichen planus and mixed cryoglobulinemia are some examples. The therapy available in Brazil presents many side effects such as anemia, leukopenia, dermatitis, alopecia, pruritus and may induce diseases such as sarcoidosis. Objective: To describe dermatological findings in chronic hepatitis C patients treated with interferon alpha pegylated and ribavirin with or without telaprevir or boceprevir. Patients and methods: Choronic hepatitis C patients treated at the hepatology outpatient clinic of the Hospital Universitario Cassiano Moraes (HUCAM), in Vitoria, ES., candidates for the treatment with a combination of interferon alpha pegylated and ribavirin with or without telaprevir or boceprevir. All patients were submitted to a standard questionnaire and to a complete dermatological evaluation prior to the treatment and reassessed after start therapy. Results: Thirty five (70%) out of 50 patients had skin findings prior to the treatment. The most common was the pruritus without cutaneous lesions (40%), followed by psoriasis and porphyria cutanea tarda. The degree of pruritus was related to liver fibrosis, genotype and viral load, but with no statistical correlation. After starting treatment, 37 (74%) patients showed alterations at Interferon injection sites. Nine (18%) developed drug reactions (one palpable purpura, one drug retaled vasculitis andseven drug rash). Eight (16%) patients presented telogen effluvium, six (12%) had oral aphthous ulcers, three (6%) recurrent herpes labialis and three (6%) angularis cheilitis angularis. Discussion and Conclusion: In agreement with literature the study found this dermatological findings prior to the treatment: pruritus, cutaneous xerosis, psoriasis and porphyria cutanea tarda. Itching was the most frequent finding in the study, justifying systematic investigation for hepatitis C in patients with this complaint. Adverse drug reactions observed were well tolerated without need for treatment discontinuation. Hepatitis C is a silent disease, in which most cases progress to liver cirrhosis and hepatocarcinoma. Therefore, we should intensify investigations in extrahepatic manifestations which will facilitate early diagnosis of Hepatitis C.
Resistência insulínica em pacientes com câncer de mama. Estudo preliminar da ocorrência e associação com fatores de risco e prognóstico
(Universidade Federal do Espírito Santo, 2015-09-23) Ferrugini, Carolina Loyola Prest; Vargas, Paulo Roberto Merçon de; Costalonga, Everlayny Fiorot; Chambô Filho, Antônio; Vieira Junior, Luiz Alberto Sobral
The co-occurrence of insulin resistance (IR) and breast cancer and the possible ethiologic and prognostic link between them has gained increasing importance, although the mechanisms involved are not fully understood. Clinically, the search for understanding of this association has stimulated studies on occurrence and empirical association between RI and risk factors (RF), prognostic factors (PF) and breast cancer subtypes, aiming to improve the treatment of these diseases. Objective. To determine the prevalence of RI and its association with RF and PF in patients with breast cancer. Patients and Methods. Study cases were selected from breast câncer in publicly assisted women at the Mastology Clinic of HUCAM/UFES, in Vitória city, Brazil, between november 2011 and november 2013 in which it was possible to obtain before treatment glucose and insulin blood level. IR was diagnosed by HOMA-IR index. Its occurrence and association with RF and PR was determined in all cases and in groups defined as reproductive and postmenopausal periods. Frequency between groups were contrasted by direct increment, simple rate, chi square test, and odds ratio, intrepreted by the recommended criteria for stochastic and quantitative magnitude significance. Results. In the 80 studied patients, the IR occurrence was 38.7%, higher in reproductive than postmenstrual periods (43.6% versus 28.0%), without significant variation according to RF. Breast cancer with Ki67 expression and HER2 hiperexpression were more frequent in IR patients of postmenopausal period and luminal A breast cancer more frequent in IR patients of reperoductive period. None significant occurrence variation was found in the others PR according IR, either in reproductive or postmenopausal women. Conclusion. These results show that 2 more aggressive PF occur more frequently in postmenopausal IR + patients as the Luminal A tumors, with better prognosis, occurs in reproductive age IR+ patients, adducing empirical evidence, although based on a small number of cases, for routine assessment of insulin resistance in breast câncer patients, especially during the postmenopausal period.
Fenótipo e tratamento da doença inflamatória intestinal em pacientes atendidos na Farmácia Estadual da Secretaria de Saúde do Espírito Santo, Brasil
(Universidade Federal do Espírito Santo, 2015-09-28) Martins, Adalberta Lima; Gomes, Maria da Penha Zago; Kotze, Lorete Maria da Silva; Cristo, Valeria Valim; Gonçalves, Luciana Lofego
abstract
Avaliação dos fatores tradicionais e não tradicionais de risco cardiovascular na Síndrome de Sjogren
(Universidade Federal do Espírito Santo, 2015-10-19) Balarini, Gabriela Moreira; Serrano, Érica Vieira; Valim, Valéria; Mill, José Geraldo; Ferreira, Gilda Aparecida
Introduction: Patients with primary Sjögren´s syndrome (pSS) have increased prevalence of some traditional cardiovascular risk, but the carotid atherosclerosis plaque and its correlation with traditional and non traditional risk are not fully understood. Objective: To identify the association of carotid atherosclerosis plaque with the traditional cardiovascular risk, disease characteristics, cytokine profile and calprotectin in pSS. Methods: Cross-sectional study with healthy control group including 63 pSS patients and 63 controls volunteers underwent clinical, laboratory and ultrasound of carotid arteries. The carotid atherosclerosis plaque variables were identified in univariate and multivariate regression analysis. Results: Patients with pSS had a higher frequency of carotid atherosclerosis plaque (13% vs. 2%; p <0.05). Calprotectin, tumoral necrosis factor receptor 2 (TNF-R2), hepatocyte growth factor (HGF), Chemokine (C-C motif) Ligand 2 (CCL-2) and adiponectin than controls. In univariate analyses, calprotectin, the most traditional cardiovascular (age, male sex, metabolic syndrome, hypertension, hypertriglyceridemia, and serum creatinine), and some disease-associated risk factors (glucocorticoid, saliva substitute use and ESSDAI) were associated with a higher risk for plaque. In a multivariate analysis, having SSp was risk factor for atherosclerosis plaque independent of traditional risk factors (OR= 28.76, [95% confidence interval 1.69-490.19], p=0.02). Higher serum calprotectin was the only biomarker associated with carotid atherosclerosis plaque independent of creatinine and hypertension (OR=1.001 [95% CI 1.0001-1.001], p=0.023). Conclusion: Patients with pSS have higher prevalence of carotid atherosclerosis, which are modulated by higher traditional cardiovascular risk, glucocorticoid use, disease activity and calprotectin. Calprotectin is a biomarker of subclinical atherosclerosis in pSS.
Avaliação dos fatores de risco para rabdomiólise no pós-operatório de cirurgia bariátrica
(Universidade Federal do Espírito Santo, 2015-12-04) Santos, Ivan Matavelli; Miguel, Gustavo Peixoto Soares.; Leal, Antonio José Gonçalves e; Santos, Maria Carmen Lopes Ferreira Silva; Ettinger, João Eduardo Marques Tavares de Menezes
abstract
Ressonância magnética na avaliação do acometimento ósseo na doença de Gaucher tipo 1
(Universidade Federal do Espírito Santo, 2016-02-17) Pessanha, Lais Bastos; Mello, Ricardo Andrade Fernandes de; Melo, Paulo de Assis; Palácios, Ester Miyuki Nakamura; Rosa Júnior, Marcos
Gaucher disease (GD) was the first reported lysosomal storage disease and is the most common lipidosis diagnosed worldwide. It is caused by an inherited deficiency of the lysosomal enzyme glucocerebrosidase, that leads to the accumulation of glycolipid mainly in liver, spleen and bone marrow. In the latter, it can lead to osteopenia, lytic lesions, pathologic fractures, chronic bone pain, bone crisis and bone infarcts, that on long-term tend to reflect in quality of life of affected patients. A descriptive and cross sectional study was conducted to assess bone changes by magnetic resonance imaging of patients with type I GD, using the method Bone Marrow Burden (BMB), relating it with the spleen volume and the quality of life. The study population comprised 18 patients, 8 male and 10 female, and the average age was 38.2 years (17-70 years). There were bone complications in 9 patients: bilateral bone infarction (6 patients), avascular necrosis of the femoral head (2 patients) and avascular necrosis of the femoral head associated with unilateral bone infarction (1 patient). There were a significant relationship between all BMBs scores (femur, lumbar spine and total) with spleen volume. However, none of the presented BMBs had significant relation with quality of life score. Quality of life score did not show a linear relationship with spleen volume. BMB score proved to be a good method to estimate bone disease and demonstrated a linear relationship with the spleen volume. Quality of life was related neither to the BMB nor with spleen volume, probably related to the progressive and indolent nature of GD, which determines silent and irreversible changes during the curse of the disease.

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