Medicina (desativado)

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http://repositorio.ufes.br/handle/10/17587

Programa de Pós-Graduação em Medicina

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A rede padrão de repouso parece preservada intrinsecamente mas sua conectividade funcional extrínseca pode estar comprometida em usuários de crack-cocaína
(Universidade Federal do Espírito Santo, 2016-06-17) Martins, Diego Lima Nava; Palácios, Ester Miyuki Nakamura; Pacheco, Felipe Torres; Rosa Júnior, Marcos; Volpato, Richard; Mello, Ricardo Andrade Fernandes de
Default Mode Network (DMN) seems to be affected in drug addiction. Decreased functional connectivity has been described in psychostimulants users (cocaine, nicotine, and caffeine) and also in addicted to depressant drugs (alcohol, heroin, prescribed opioids) but no study has investigated the DMN functional connectivity in crack-cocaine dependents so far. Here, inpatient crack-cocaine users in abstinence for at least 4 weeks and age-matched non-addicted controls underwent to functional Magnetic Resonance Imaging acquired when they rested with eyes closed (rs-fMRI) in 1.5 T or 3.0 T scanners. After data preprocessing, DMN were defined by spatial independent component analysis (ICA) and seed-based correlation analysis, by chosen regions of interest centered in the ventral Anterior Cingulate Cortex (vACC) and in the Posterior Cingulate Cortex (PCC). Global DMN functional connectivity was not different between crack-cocaine users and age-matched controls in rs-fMRI acquired in both scanners. The seed-based analysis showed greater negativity of the connectivity between vACC and superior parietal lobe when compared to agematched controls (p < 0.0322). No differences between groups were found in the functional connectivity between PCC and other brain regions. Thus, the total DMN functional connectivity searched by ICA was found preserved in crack-cocaine dependents in abstinence. When a seed-based correlation analysis was applied searching for a single metric functional connectivity between specific brain regions, a greater negativity was found between medial frontal region and the posterior brain region, suggesting that although a broad DMN was unaffected a selective functional connectivity may be compromised in crack-cocaine addiction.
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
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
Análise do perfil epidemiológico dos pacientes submetidos a tratamento cirúrgico do carcinoma bem diferenciado da tireoide em hospital terciário
(Universidade Federal do Espírito Santo, 2016-12-16) Rocha, Ricardo Mai; Musso, Carlos; Santos, Maria Carmen Lopes Ferreira Silva; Costalonga, Everlayny Fiorot; Kalil, Mitre; Pereira, Walter Jose Fagundes
Introduction: The well-differentiated thyroid carcinoma (WDTC) corresponds to 90% of all the existing thyroid malignant neoplasm. The primary therapy for differentiated thyroid cancer is surgery. The efficiency of the surgical therapy is one the main prognostic factors in the evolution of the disease. Objective: Study the epidemiological profile of patients who have undergone surgical therapy of WDTC at HUCAM; obtain oncological outcomes in the follow-up of patients who have undergone surgical therapy, analyze the post-operative complications and compare them with the literature review. Method: A retrospective study with clinical data obtained in histopathological reports filed in electronic registration of the Pathological Anatomy Department of HUCAM/UFES and the analysis of their medical records filed in the Statistical and Medical Archive Service of HUCAM/UFES between January 2008 and December 2015. Results: 95 records of WDTC patients who underwent surgical therapy have been analyzed. Papillary Thyroid Carcinoma (PTC) was the most common (91,57%) and the Follicular Thyroid Carcinoma counted for 8,43% of the cases. The total thyroidectomy was performed in 65,26% of patients, the partial thyroidectomy in 12,63% and the total thyroidectomy combined with neck dissection in 22,11 %. Postoperative complications were observed in 6,31% of the patients. Hemorrhagic complications were observed in 1,05% of the patients. The average follow-up time was 36,9 months. The loco regional recurrence was observed in 4 patients (4,21%) and all of them have undergone surgical therapy once again and have been free of disease. We have analyzed the prognostic factors: gender, age group above 45 years, size of tumor, lymph nodes metastasis, stage of the disease, surgical treatment performed, microcarcinoma, histologic type and post-operative radioactive iodine. There was no statistical significance in relationship with any of the prognostic factors analyzed. Conclusion: WDTC is the most common malignant neoplasm of the thyroid. Women are the group most affected by the disease and the median age was 49 years old. Loco regional recurrence was observed in 4 patients who have been treated and they are free of the disease. The most common post-operative complication was hematoma.
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.
Aplicação do índice de pacientes transfundidos e do índice de utilização de concentrado de hemácias no serviço de hemoterapia do Hospital Universitário Cassiano Antônio de Moraes, como ferramenta para melhoria das práticas hemoterápicas transfusionais
(Universidade Federal do Espírito Santo, 2017-04-06) Marcondes, Sibia Soraya; Carraretto, Antônio Roberto; Paulo, Danilo Najib Salomão; Figueira, Cecília Maria Guimarães
Introduction: Studies show that about 30-60% of blood units prepared for transfusion are not transfused. Prepared and non-transfused blood products (BPs) cause greater reagent consumption and the demand of human ressources. Reducing the preparation of blood products is a good way to minimize the costs and optimize their rational use. Objectives: a) Identify the request profile and utilization of BPs in the elective surgeries and the impact of the demographic, clinic and laboratory variables and surgery time in the number of transfusions; b) Develop a Maximum Surgical Blood Order Schedule (MSBOS) in the Hospital Universitário Cassiano Antônio de Moraes (HUCAM); c) Demonstrate the reagents costs for the pre-surgery reservation and the possibility of savings. Methods: Observational Study, carried out in the period from 01/02/2015 to 31/01/2016 at the teaching hospital HUCAM. During this period, clinic, sociodemographic (gender, age, diagnosis, type of surgery) and quantitative data (regarding the number of request and utilization of red blood cells (RBC) in the electives surgeries) were collected. Using the blood consumption rate it was possible to create a MSBOS and calculate the standard costs for the RBC request and the possible savings using the MSBOS. Results: 822 procedures with PRC demand were evaluated. The average age was 55,1 years (95% IC 54,1; 56,2). The median of PRC was a total of 3 units (0-8). The median of platelets reservation was zero, except in the cardio surgeries (8 units (0-10)). The median of fresh-frozen plasma request was 3 units (0-10). 135 patients were transfused (16,4%). The transfusion rate in the cardio surgeries was 50%, followed by gastrointestinal surgery (25%), vascular (16,5%), gynaecological (11%), urology (9,5%) and thoracic (8,1%). The factors which affected the transfusion were: age (OR 1.025, 95% IC 1.006, 1.045), surgery time (OR 1.004, 95% IC 1.001, 1.006) and the cardio surgeries (OR 7,83 95% IC 1.58, 38.74). Among the 51 types of evaluated surgeries, 22 presented an index of transfused patients (ITP)> 10% and 29 ITP <10%, and the MSBOS was developed. Cardio surgery has the most significant PRC request cost (median: R$ 49,73; min 35,5 – max 77,89), ginecologiy the lowest (median: R$ 35,65; min 28,61 – max 49,73) p<0,01. When apllying any MSBOS methodology the savings are about 17% - 37%. Conclusion: The median of RBC request was lower for gynecology and greater for cardio surgery. Most surgeries did not use the requested PRCs. Factors such as age, surgery time and cardio surgery increased the chance of RBC use. All the specialties could save with the costs of requesting RBC and the possibility of saving is greater in the cardio surgeries.
Área placentária em casos de morte perinatal
(Universidade Federal do Espírito Santo, 2015-03-05) Sodré, Larissa Kerr de Araujo; Vargas, Paulo Roberto Merçon de; Chambô Filho, Antônio; França, Luiz Cláudio; Silva, Rita Elizabeth Checon de Freitas
The placental area (PA) mirror the endometrium covered by the placenta and the uteroplacental blood flow to the fetus. Recently, has been demonstrated that PA is an early and independent determinant of fetal growth and a marker of adverse reproductive outcome and of adult health conditions and chronic diseases (Barker’s hypothesis). There are few studies regarding PA in fetal diseases and none in perinatal deaths. Objective: To describe the PA distribution and abnormalities in perinatal deaths. Material and methods: Out from all perinatal deaths placentas examined between 2004 and 2014 at two Pathology Laboratories in Vitória City, Espírito Santo State, Brazil, we selected for the study 258 cases in which the gestational age (GA) was confirmed by ultrasound. The placental edge was outlined in a transparent plastic sheet and the PA measured by point counting planimetry, converted to z score (z/GA), classified as small (SGA, z/IG < -1,28), adequate (AGA), and large (LGA, z/IG > +1,28) for GA, and its occurrence calculated according to the socioeconomic status, the environment (fetal or neonatal) and the chronology of death. Results: The PA distribution in perinatal deaths showed a leftward deviance and large variation (z/GA -0,89 ± 1,81), a high proportion of SGA (46,5%), the expected proportion of LGA (12,8%), and not any significant variation according to socioeconomic status, environment or chronology of death. Conclusion: These results confirm that PA is a marker of adverse perinatal outcome, adducing evidence for its routine measurement and assessment in ultrasound and pathological examination.
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.
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.
Avaliação da prevalência de sintomas de ansiedade associados ao trabalho dos peritos médicos da previdência social no Espírito Santo, Brasil
(Universidade Federal do Espírito Santo, 2018-06-26) Marchiori, João Guilherme Tavares; Silva, Liliane Calil Guerreiro da; Saraiva, Fábio Petersen; Souza, Maria das Graças Caus de
The medical-expert act within the scope of the Brazilian Social Security consists of the medical evaluation of the examinee, to draw a conclusive opinion on the work capacity and characterization of disability for social security and assistance purposes. Forensic decisions inevitably converge on two opposites: concession or refusal. The rejection goes against the interests of the candidates, who can project their disappointment and dissatisfaction on the professional, exposing the latter to potentially stressful situations. Objectives: the present study aimed to evaluate the presence and intensity of occupational stress among Social Security Medical Experts, comparing it to medical experts from other public careers. It also intended to identify the target causal factors, in order to provide organizational managers with essential principles that guide strategies aimed at preserving the mental health of medical specialists. Methods: The evaluation was made through a specific, previously validated job related stress questionnaire and a series of questions about subjectives perceptions on work performance, labor stressors and emotional status. Results: we found overwhelming and alarming prevalence of stress and dissatisfaction related to occupational aspects among social security experts, culminating, in many cases, with emotional exhaustion, characteristic of Burnout Syndrome. Conclusion: there is a high prevalence of job related stress among social security doctors in Brazil, warranting implementation of specific measures in order to ensure the adequate provision of social security services to the population, thus avoiding social injustice and damage to the erary.
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
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.
Carcinoma basocelular em áreas incomuns : aspectos epidemiológicos, clínicos e terapêuticos em hospital universitário de Vitória-Espírito Santo-Brasil
(Universidade Federal do Espírito Santo, 2017-01-20) Nascimento, Kamila Paschoal Magno do; Diniz, Lucia Martins; Luz, Flávio Barbosa; Santos, Maria Carmen Lopes Ferreira Silva; Musso, Carlos
Introduction: Basal cell carcinoma (BCC) is the commonest type of cancer among humans. About 85% are located on the face and trunk and 10-15% in usually photoprotected areas. Objective: To compare epidemiological, clinical and histopathological aspects of BCCs from non-photoexposed areas with those of photoexposed areas. Patients and methods: Observational, retrospective and casecontrol study of patients with clinical and histopathological diagnosis of BCC by the Dermatology Service of Vitória-ES, from 2008 to 2015. A total of 107 BCCs were assessed, from which 32 (29 , 9%) were located in non-photoexposed areas and 75 (71.1%) in photoexposed areas (nose). Results: The median age was 70 years; 62% of the patients were women as for the BCCs in the non-photoexposed regions; The commonest histological subtype in the two groups was the nodular one, followed by the superficial one in the non-photoexposed area, with 10 (31.3%) cases (OR = 2,051-5,267; p = 0,0001). Micronodular and baso-squamous subtypes were not observed in this group. Twelve (37.5%) cases in the non-photoexposed areas presented mild or absent elastosis (OR = 1,789-4,919; p = 0,0001). There was a predominance of a large number of mononuclears in the group of non-photoexposed areas: 12 (37.5%) cases, compared to eight (10.7%) cases in the photoexposed areas group (OR: 1,543-4,414; p = 0.002). Regarding the pattern of growth of BCCs, in the group of cases of the non-photoexposed areas, there was a predominance of the low risk pattern in 23 (71.9%) cases of nonphotoexposed areas versus 42 (56%) cases in the group of photoexposed areas (P = 0.137). Discussion: Despite the higher frequency of the nodular subtype in the two analyzed regions, the superficial subtype was more frequent in the non-photoexposed area, with a statistical difference, validating the literature. There was a higher frequency of moderate / severe elastosis in both regions, similar to the literature, but its absence was three times more likely to occur in the non-exposed area. The predominance of mononuclear cells in the non-photoexposed areas, possibly prevented the tumor from spreading. Regarding the pathological condition, the BCCs of the non-photoexposed areas were categorized as low risk in 65.5% of the cases. Conclusion: In the study, the BCCs in the non-photoexposed regions showed a better prognosis than the photoexposed areas, assessed through the histological factors.
Colecistectomia laparoscópica com 02 portais e anzóis acessórios: padronização técnica e avaliação dos resultados em 415 pacientes consecutivos
(Universidade Federal do Espírito Santo, 2016-08-31) Batista, Gustavo Adolfo Pavan; Miguel, Gustavo Peixoto Soares; David, André Ibrahim; Leal, Antonio José Gonçalves e; Carneiro, João Luiz de Aquino
Introduction: Cholecystectomy is one of the most performed abdominal surgical procedures in Brazil and worldwide. Its surgical technique development benefited most from the advent of laparoscopy. The laparoscopic cholecystectomy with two ports and traction hooks was idealized as a less invasive, low cost alternative to the golden standard. This study intends to determine the safety and feasibility of the procedure and also establish its technical standardization. Methods: The proposed technique (two trocar portals with the addition of two traction hooks) was performed to 415 patients over the course of 6 years. All subjects were operated by the same surgeon, in the same institution. Results: Surgical mean time was 49 minutes, with the majority of the procedures (79.76%) under the 60 minutes time frame. The conversion rate for conventional laparoscopy or laparotomy was 2.10%; if the adding of extra traction devices were considered, 4.10%. In those cases, there was a significant correlation between the complexity of the procedure and the conversion rate (p = 0.026), xvii xvii considering acute cholecystitis, exploration of biliary tract and concomitant procedures as criteria for higher complexity. The length of hospital stay was characterized by predominance of discharge on the next day after surgery (93,73%), also related to the procedures complexity (p < 0.001). These results were comparable to the medical literature regarding the gold standard procedure. Conclusion: Laparoscopic cholecystectomy with two ports and accessory traction hook-shaped devices is a safe procedure and can be offered as a therapeutic option to patients with a clinical indication for cholecystectomy.
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
Distribuição espacial da hanseníase em menores de 15 anos no Estado do Espírito Santo, entre 2010 e 2014
(Universidade Federal do Espírito Santo, 2016-12-19) Rodrigues, Taciana Gabrielle Pinheiro de Moura; Hadad, David Jamil; Pereira, Fausto Edmundo Lima; Zandonade, Eliana
Introduction: Known since Ancient History, Hansen’s disease still presents a challenge to Public Health. According to the Ministry of Health, the diagnosis of Hansen’s disease in people under 15 needs to prioritized, since cases in that age group can represent the individuals exposed, but still not diagnosed by the healthcare system. Therefore, an analysis was made of the spatial distribution of the detection coefficients of new cases of Hansen’s disease in people under 15 years old in the State of Espírito Santo. Methods: Descriptive, ecological study of the spatial distribution of Hansen’s disease in people under 15 in the state of Espírito Santo between 2010 and 2014. The information was collected at the Hansen’s disease database of the Health Secretariat of the State of Espírito Santo. The global and local Empirical Bayes method was applied in order to produce an estimate of the incidence of Hansen’s disease, smoothing out the effect of the fluctuation of the detection coefficients. Results: High incidence rates in people under 15 were found in the Northern region of the state. The corrected rates by the Ebest Global method produced significant changes in value: of the 42 municipalities with zero incidence, none remained with the adjusted number equals zero. Conclusion: The Hansen’s disease distribution in people under 15 years old took place in a heterogenic form among the municipalities, identifying possible high-risk sickening regions. The employment of the spatial analysis allows knowing the priority places to be controlled in order to guide health-care public policies, helping to plan the vigilance actions.
Estratégias de troca para segundo imunobiológico na artrite reumatoide : resultados do registro brasileiro de agentes imunobiológicos em doenças reumáticas-BIOBADABRASIL
(Universidade Federal do Espírito Santo, 2017-08-21) Falcão, Jansen Giesen; Cristo, Valéria Valim; Zandonade, Eliana; Gavi, Maria Bernadete Renoldi de O.; Hadad, David Jamil
OBJECTIVE: To compare different strategies of switching to a second biological therapy in Rheumatoid Arthritis (RA) in patients from BIOBADABRASIL register. METHODS: Data from a population-based cohort including 1,109 patients with RA according to American College Rheumatology / European League Against Rheumatism (ACR/EULAR) 2010. Patients were followed from beginning of the first biologic therapy up to 7 years (2009-2015). Sex, age, disease duration, DAS 28 and concomitant treatments at baseline were considered. Kaplan-Meier estimates, Chisquare, Kruskal-Wallis and Wilcoxon-Mann-Whitney tests, Cox regression analysis were applied when appropriate. Results were expressed as mean ± SD and %(n). Small sample size precluded the inclusion of Golimumab (GOLI) and Certolizumab (CERTO) in the survival analysis. RESULTS: From all, 85% were women, mean age of 50 years and disease duration of 11 years. Rheumatoid Factor (RF) was positive in 87%, DAS 28 5.36 ±1.35, 76% using corticoid and 71% taking Methotrexate (MTX). Ninety one percent started AntiTumor Necrosis Factor (Anti-TNF), as followed: Adalimumab (ADA) 33% (370), Infliximab (INF) 32 % (356), Etanercept (ETA) 23% (258), Tocilizumab (TOCI) 3% (35), Golimumab (GOLI) 2% (19), Certolizumabe (CERTO) 1% (9), Abatacept (ABA), 1% (14) e Rituximab (RTX) 4% (48). Considering first treatment, survival of non anti-TNF (58.50 ± 3.46; 95%CI 51.71 – 65.28) was higher than anti-TNF (53.43 ± 1.21; 95%CI 51.05 – 55.77), p=0.042. Tocilimumab (TOCI) showed higher survival (57.22 ± 4.57; 95%CI 48.27 – 66.17) when compared to anti –TNF (53.41±1.21; 95%CI 51.05 – 55.77); p=0.023. Only 32.28% (358) switched to a second biological therapy. 65.92% (236) switched from anti-TNF to anti-TNF (ETA=105, ADA=83, INF=33, others anti-TNF=15); 27,93% (100) switched from anti-TNF to non anti-TNF (RTX=38, TOCI=32, ABA=30) and few 6,13% (22), from non anti-TNF to any class. 336 patients who started using anti-TNF (INF= 140, ADA=120, ETA=69) and switched to a second biological therapy were included for survival analysis. The best switching strategy was from anti-TNF to non anti-TNF: 50.72 ± 3 months (CI95% 44.84-56.60) versus 44.67±2.46 months (CI95% 39.85-49.49), p=0.010. Even using less corticoid and showing higher DAS 28 in the beginning of treatment, patients who changed from anti –TNF to TOCI achieved better survival (55.80 ± 4.74; CI95% 46.51-65.09 months, p=0.029) compared to ETA (50.06 ±3.61; IC 95% 42.99-57.14), RTX (47.75 ± 4.93; CI95% 38.10-57.40), ABA (44.89±5.94; CI95% 33.25-56.53), ADA (39.45±3.89; CI95% 31.83-47.08) and INF (34.43±4.65; CI95% 25.31-43.55). The reasons for switching were inefficacy or loss of efficacy (64%, n = 216), adverse effects (26%, n=87), and others (10%, n = 33). When the reason for switching was adverse effects, the best option was a non antiTNF with 50.29 ± 4.93 months (95%IC=40.62 – 59.95) versus 43.23 ± 4.22 months (95%IC= 34.96 – 51.51), p=0.038. CONCLUSION: The anti-TNF is the most prescribed drugs at BIOBADABRASIL register as first and second biological therapy. The option for a non anti –TNF as first biological therapy showed better survival. Switching from anti-TNF to non anti-TNF was better too. TOCI was the drug with better survival as second biological therapy. The main reason for switching was inefficacy or loss of efficacy. When the reason was adverse effect the best option was switching to non anti –TNF.
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.
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
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