Brazilian Journal of Medicine and Human Health (inactive / archive only)
Brazilian Journal of Medicine and Human Health (BJMHH) is a publication of Escola Bahiana de Medicina e Saúde Pública of manuscripts arising from scientific researches in the clinical, basic or applied area, on subjects involving epidemiological aspects
BAHIANA - School of Medicine and Public Health
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EDITORIAL: FROM A GENERAL APPROACH TO A SPECIFIC INITIATIVE
Copyright (c) 2017 Liliane Lins, Ana Marice Ladeia, Luis Claudio Lemos Correia
Using a new tool to evaluate the functional capacity of patients with HTLV-1 associated myelopathy/Tropical spastic paraparesis (HAM/TSP)
HAM/TSP patients experience impaired functional capacity. The use of categorical scales to accurately describe motor ability in these patients has been questioned. Aim: To evaluate the functional capacity of HAM/TSP patients by using the individual tests comprising the GDLAM protocol. Methods: Cross sectional study carried out in the CHTLV, Salvador, Brazil. Functional capacity was evaluated using the tests of the GDLAM protocol (timed 10-minute walk, getting up from a sitting position, rising from a prone position, getting up from a chair, and moving around the house). Functional classifications were made by comparing patient performance to that of uninfected control individuals. Results: Twenty-four HAM/TSP and 25 healthy individuals were enrolled. Only 75% HAM/TSP patients completed the GDLAM protocol. Six patients failed to perform the RPP test. Timed measurements were significantly higher in the HAM/TSP patients in comparison to uninfected controls. Conclusion: The use of alternative methods, such as the individual tests comprising the GDLAM protocol, may more accurately assess motor function in HAM/TSP patients.
Copyright (c) 2017 Isabelle Rocha-Santos, Ney Boa-Sorte, Maria Fernanda Rios Grassi, Cloud Couto de Sá, Thessika Hialla Araújo, Bernardo Galvão Castro
TREND OF ACUTE HEPATITIS A IN THE STATE OF BAHIA, BRAZIL OVER A 5-YEAR PERIOD
ABSTRACT INTRODUCTION: Hepatitis A virus (HAV) has a universal distribution. The prevalence of HAV infection varies greatly according to hygiene and sanitary conditions. OBJECTIVE: To determine the proportion of acute infection of HAV in the state of Bahia during a 5-year period. METHODS: This study was conducted at Central Public Health Laboratory of Bahia (LACEN-BA). All individuals referred for anti-HAV IgM serology from 417 municipalities from January, 2009 to December, 2013 were included. Percentages of HAV positive cases were presented according to age range for each year of the 5-year study and for each of the nine health districts (RHC) of Bahia. RESULTS: 21,175 samples were analyzed. Proportion of HAV infection was 7.2% (1,535 / 21,175) throughout the study period. The highest proportion was in 2009 (17.4%) and the lowest in 2012 (3.8%), demonstrating a decreasing trend (r = 0.7). The highest infection rates was found in children up to 10 years old. HAV infection was more frequent among males among all age groups. 52.4% (184/351) of the municipalities had acute HAV cases diagnosed. The North and West regions had the highest number of cases. CONCLUSION: There was a progressive decrease of approximately 70% in the proportion of acute HAV infection in the state of Bahia during a five-year assessment period. However, children up to 10 years old remain at higher risk, therefore the vaccine should be expanded to reach this age range.
Copyright (c) 2017 Felicidade Mota Pereira, Maria Conceição Chagas Almeida, Monique Lírio, Maria Fernanda Rios Grassi
SYSTEMIC ARTERIAL HYPERTENSION: SOCIAL REPRESENTATIONS OF PATIENTS ATTENDED AT PRIMARY CARE ABOUT THE DISEASE AND ITS TREATMENT
Introdução: Hipertensão Arterial Sistêmica (SAH) é considerado um problema de saúde pública muito relevante, devido à sua alta freqüência na população em todo o mundo. As Representações Sociais (SR) foram abordadas em estudos com o objetivo de compreender a relação do aspecto cultural e psicossocial com os meios de lidar com pessoas com SAH, justificando e orientando suas atitudes e expectativas em relação à sua condição. Objetivo: o objetivo era compreender SR de pacientes com Hipertensão Arterial Sistêmica em relação ao tratamento, adesão terapêutica e fatores de risco para complicações. Estratégia metodológica:Uma abordagem qualitativa foi utilizada de acordo com a perspectiva Minayo e entrevistas guiadas por um roteiro semi-estruturado como técnica de pesquisa em uma Unidade de Saúde da Família em Salvador-BA. Resultados: um total de 18 informantes-chave com idade variando de 32 a 72 anos participaram do estudo. Em geral, os usuários eram principalmente sedentários (83,4%) e tinham sobrepeso ou obesidade (44,5%). Os dados foram organizados em três fases para análise: ordenação, classificação e análise final, permitindo a determinação do priori e do emic. Os indivíduos relataram dificuldades quanto à necessidade de ingestão diária de medicamentos e à adoção de hábitos de vida saudáveis, sugerindo diferenças entre senso comum e conhecimento técnico. Considerações finais:Múltiplas influências foram percebidas sobre as crenças individuais e as redes sociais na adesão ao tratamento. A SR dos hipertensos interfere diretamente com sua percepção sobre a doença, orientando-os em seus comportamentos de saúde.
Copyright (c) 2017 Sabrina Nogueira Brito, Helena Maria Silveira Fraga-Maia, André Zarife
EPIDEMIOLOGICAL STUDY OF CLEFT PALATE IN THE STATE OF BAHIA, BRAZIL
The non-syndromic cleft palate (NSCP) is a common congenital defect in humans. This work has aimed to perform a descriptive epidemiological study of patients with NSCP in the State of Bahia, Brazil. A questionnaire was applied to patients and/or parents at three reference centres for treatment of craniofacial anomalies. Of the 135 patients with NSCP, 60% were female and 40% male. Blacks and mulattos were predominant. The most common systemic disorder was otologic findings. The average age of the surgery was 5 years and 2 months with a percentage of 74.8% operated. With regard to the mothers, 16.3 % consumed alcoholic beverages and 12.6 % smoked. The most cited vitamin supplementation was folic acid. Contact with chemicals involved 20.7 % of the fathers and 14.9 % of the mothers. The most frequent mother’s age gestational ranged between 15 and 25 years old. The results showed that the frequency of children with NSCP in the State of Bahia is related to the location of the reference centres. Younger mothers gave birth to cleft palate children even despite using vitamin supplementation. Although no surgical procedure has been performed at an ideal age, the majority of the children with cleft palate were submitted to surgical repair.
Copyright (c) 2017 Camila Sane Viena, Jamile Sá, Patricia de Castro Veiga, Ricardo Coletta, Alena Peixoto Medrado, Silvia Reis
Does histopathological examination still have value in detecting and preventing cancer?
Introduction: Cancer is a very dangerous disease causing a high mortality rate every year. The prevention or reduction of malignant disease required early detection, mainly depending on histological examination as the first step in the diagnosis. Methods: This study was designed to gauge the value of the numbers of histological specimen as an indicator for the level of education to prevent cancer development. Histological specimens of 14670 suspected cases of cancer diseases were histopathologically examined during seven years. Findings: Histopathological examination revealed that 960 patients had a positive result of 38 cancer types, while 13710 patients were clear of any type of cancer. More specimens were received from females, especially in 2014 and the most important organs for diagnosis of cancer, included the gastrointestinal tract (gastro-esophagus, gallbladder, and appendix), skin, lymphoid, and breast. Discussion: Increase the education level about the importance of histopathological examination of any suspected specimens is considered the first step in preventing and controlling the distribution of cancer disease. Some cancer types should receive greater attention in the diagnosis by increased use of the histopathological laboratories.
Copyright (c) 2017 Ali Abdul Hussein S. AL-Janabi
BLUE LIGTH EMITTING DIODE IN TREATMENT OF RECURRING VULVOVAGINAL CANDIDIASIS: A CASE REPORT
Introduction: Recurring vulvovaginal candidiasis (RVVC) is an infectious disease of the lower genitourinary tract, that occurs at least 4 times per year. Drug treatment can last months and favor the appearance of adverse effects and increase the chances of recurrence. Blue Light Diode (LED) is an electromagnetic spectrum light, with antimicrobial functions. Case Report: A case report was made of a patient with RVVC whose treatment consisted of three sessions of 60-minutes each, of application of blue LED in intervals of 15 days. Evaluation was carried out before, at the end of third application and three months after the last session by means of fungal culture, cervical cytology; analysis of patient´s clinical condition; and measurement of vaginal pH. After the third session, there was a reduction in fungal load and vaginal pH; absence of symptoms (pruritus, burning and dyspareunia) and vulvovaginal edema, but there were no alterations in the cytology and microflora, which remained with inflammatory markers. Three months after the end of the treatment, there was no Candida in vaginal secretion, neither signs nor symptoms of candidiasis, and vaginal pH was normal. As for cytology and microflora, cellular alterations associated with cytolysis and presence of lactobacilli was observed. Conclusion: The blue LED 401 nm may be a promising alternative to treat RVVC by eliminating signs and symptoms in women.
Copyright (c) 2017 Mariana Robatto, Maria Clara Pavie, Sibele Tozetto, Milena Bastos Brito, Patrícia Lordêlo
EXERCISES WITH AND WITHOUT VIRTUAL REALITY ON PAIN IN PATIENTS WITH PARKINSON DISEASE: A RANDOMIZED, CONTROLLED, SINGLE-BLIND TRIAL
Introduction: Pain in individuals with Parkinson's Disease (PD) may result from factors such as progressive changes of the disease, originating from the Central Nervous System (CNS), until coming from classic symptoms such as stiffness, dyskinesia and dystonia, having possible correlations with important functional markers such as balance and gait. There is no consensus with regard to the treatment of pain in this condition, and exercises associated with virtual reality (VR) may be an effective intervention. Objective: To evaluate the influence of an exercise program associated with virtual reality (VR) on pain intensity, correlating changes in this symptom with the functional performance of elders with Parkinson Disease (PD). Design: randomized comparative clinical trial. Setting: clinical facility from a school of physiotherapy in Brazil. Participants: 29 elders with PD. Interventions: exercises with VR and exercises without VR. Main Outcome Measures: pain, balance and gait, evaluated before and after 10 sessions, by Visual Analog Scale (VAS), Berg Balance Scale and 10 Meter Walk Test. Results: Reduction in pain intensity in the VR Group, and groups improved their balance and gait performance. Significant correlation was between the improvement in pain intensity and reduction in gait timing in the non VR Group (r = 0.713; p < 0.005). Conclusion: VR in elders with PD may be a tool for reducing pain intensity, and independently of the type, physical exercises had positive impact on their functional performance.
Parkinson's disease. Pain. Balance. Gait. Virtual reality exposure therapy.
Copyright (c) 2017 Matheus Silva d'Alencar, Jean Ribeiro, Rafael Cruz, Bruno Gonçalves, Kátia Sá, Elen Pinto, Abrahão Fontes Baptista
PREGNANT AWARENESS ABOUT ZIKA VIRUS INFECTION DURING PREGNANCY
Introduction: The infection by Zika virus (ZIKV) on pregnancy has been related to several birth defects such as congenital microcephaly and fetal deaths. According to what is currently known about this infection, the only way to avoid it is prevention. Objective: Evaluate the pregnant women awareness about usual ZIKV infection risks. Methods and materials: This is a quantitative descriptive observational report developed at a outpatient clinic in Salvador/BA. The analysis group was composed by 60 pregnant subjects of usual risk from September to October of 2016. The data acquisition was done by structured instruments such as questions regarding sociodemographic data and ZIKV infection risks. Results: Approximately 97% of the subjects affirmed to known how the disease spread occurs, and all of them have mentioned the Aedes aegypti mosquito. The most commonly reported indications and symptoms were maculopapular rash (77.8%), headache (66.7%) and pruritus (61.1%). The most frequent complication was microcephaly (98.3%). About ways of prevention from the disease, 93.3% affirmed that they are aware of the virus. The use of the repellent lotion was the most mentioned (96.5%). Just 51.8% claimed to always do some prevention measures in their daily basis. And 88.6% of the subjects who had unplanned pregnancy allege that they would not wish to become pregnant with real chances of being infected by the virus. Conclusion: the studied group is aware of the infection risks by ZIKV, but there is a lack of prevention acts.
Copyright (c) 2017 Taís Paiva da Costa, David da Costa Nunes Junior
WILMS TUMOR IN ADULTS: CASE REPORT AND REVIEW OF THE LITERATURE
Wilms Tumor (WT) is an extremely rare neoplasia in adults. It represents 95% and 1% of all renal tumors, in adults and children respectively. Clinical symptoms are also distinct between adults and children. In adults, symptoms are usually abdominal pain and hematuria, on the other hand, pediatric patients frequently present with an asymptomatic abdominal mass. The recommended treatment for WT in adults follows protocols established for pediatric patients. Currently, the 5-year overall survival rate for adults with WT is of approximately 90%. The adoption of multimodal therapy systematized, and proposed by current protocols, allowed the results to become much more robust, with a significant improvement from less than 30% to 90%. However, recent reviews suggest a worse outcome for adults when compared to children, even when submitted to the same treatment regimen, and comparable according to histology and tumor stage. We present a case of a 26 years-old male patient, who underwent surgery to treat a solid renal mass. Pathological report demonstrated a Wilms tumor. The patiente also received adjuvant chemotherapy with dactinomycin and vincristine. After 12 months follow-up, patient has no evidence of disease.
Copyright (c) 2017 Bruno Rafael Kunz Bereza, Tariane Friedrich Foiato Maneti, Vitor Arce Ferreira Cathcart, Raimundo Romilton Leal do Rosário, Paula Brandalise Nunes, Murilo de Almeida Luz
QUANTITATIVE AND QUALITATIVE NUTRITIONAL EVALUATION OF THE GENERAL ORAL DIET SERVED IN A UNIVERSITY HOSPITAL
Introduction: The high prevalence of hospital protein-energy malnutrition is associated with several factors, including implemented dietary conducts. Objective: Analyze nutritional characteristics of the general hospital oral diet (GHOD). Methods and materials: A prospective and descriptive study, with a qualitative and semi-quantitative approach, concerning the GHOD menu, was developed from May 2012 to August 2013. GHOD menu was established for 28 days and consisted of five meals: breakfast, lunch, mid-afternoon snack, dinner and bedtime snack. Weighing of each food served in the meals (lunch/dinner) from the GHOD menu was performed. Composition tables were used to calculate the total energy value (TEV) and the energy distribution percentage of macronutrients of the foods, as well as to quantify the food portions from different food groups. Results: The average energy distribution to TEV (2409.4±152.6 kcal/day) was adequate for proteins (13.4%), carbohydrates (64.7%), and lipids (21.9%). Variable energy supply was identified at breakfast (15.6-20.6%), lunch (26.2-36.6%), dinner (22.231.1%), mid-afternoon and bedtime snacks (8.4-15.5%). The overnight fasting period was up to 13h. In the evaluation of nutritional quality of the GHOD meals in accordance with food groups was identified excessive offer for beans, meat/eggs, oils/fats/oilseeds and sugar/sweets, and deficient offer for fruit/juices, legumes/vegetables and milk/dairy. Conclusions: It is essential to perform quantitative and qualitative nutritional characterization of the GHOD served to inpatients. Reducing the duration of the overnight fast, as well as adjustments in the supply of food groups and in food fractionation, can contribute to better meeting the nutritional needs and prevention of nutritional deficiencies.
Copyright (c) 2017 Fernanda Godoi Melo, Cibele Aparecida Crispim, Janser Moura Pereira, Laís Paulino Kaminishi, Flaviana Pereira Martins, Daurea Abadia De-Souza
FACTORS ASSOCIATED TO THE HISTORY OF ACUTE MYOCARDIAL INFARCTION IN HYPERTENSIVE PRIMARY CARE USERS
Objective: To investigate the factors associated to the history of acute myocardial infarction (AMI) in hypertensive patients attended at Primary Healthcare (PHC) units. Methods: A cross-sectional study was performed in a health district in the city of Salvador, Bahia, between May and September, 2013. Primary data was collected through trained interviewers. The magnitude of the association was estimated using the OR calculation, adopting the CI of 95%. Subsequently, multivariate analyses were carried out using logistic regression. The project was approved by CEP/UNEB (CAAE 09656012.0.0000.0057) and financed by PRO/PET-Saúde, 2012. Results: There were 297 hypertensive patients and, among these, 243 (81.3%) were of the female gender and had average age of 56 years (± 11.54). It was observed that 35 (11.8%) reported having suffered AMI. The risk factors associated the prior AMI were concomitant Diabetes Mellitus (DM) (OR=2.19; CI95% 1.03 – 4.68) and not being aware of the existence of health education groups (OR=5.31; CI95% 1.39 – 20.20); while the protection factors were absence of central obesity (OR=0.43; CI95% 0.20 – 0.95), taking part in health education groups (OR=0.19; CI95% 0.05 – 0.73) and having had an electrocardiogram during the past 06 months (OR= 0.37; CI95% 0.15 – 0,92). Conclusion: A high percentage of hypertensive patients with a background of AMI which was associated to the diagnosis of DM, central obesity, not having had periodic electrocardiograms and not having participated in health education groups. Strategies for the promotion of healthcare with the population and outpatient care may be considered as effective actions for the prevention of AMI.
Copyright (c) 2017 Helena Fraga-Maia, Fábio Simões Hafner Nascimento, André Sant'Anna Zarife, Helena Fraga-Maia, Luciara Leite Brito
Copyright (c) 2017 George de Araújo Silva
BULLOUS ERYTHEMA NODOSUM AS INITIAL MANIFESTATION OF LEPROSY
Introduction: Leprosy is a chronic granulomatous infectious disease caused by Mycobacterium leprae with protean manifestations, particularly prone to affect skin and peripheral nerves. The natural course of the disease may be associated with the development of type 1 or type 2 immunologic reactions. These immunologic reactions are reported to be caused by increased activity of the immune system, particularly a cell-mediated immune response against live leprosy bacillus or remnants of dead bacilli. Leprosy is one of the oldest diseases of mankind. Its clinical diagnosis can be challenging due to the varied manifestations. The first description of bullous erythema nodosum was made 1898 and since then there are few recorded reports. Case Report: Here we present a case of bullous erythema nodosum as leprosy first manifestation. A 35 year-woman presented with 1-year history of disseminated blisters on trunk, forearms and thighs, and multiple painful ulcerated nodules on her face. She reported that the lesions in her face became eroded and ulcerated spontaneously. There were no thickened nerves. Blood and Histopathological investigations were made. The treatment instituted was prednisone 1mg/kg without thalidomide. After two weeks with excellent response, specific therapy for Mycobacterium leprae was initiated by the infectious diseases assistant physician with a satisfactory response.
Copyright (c) 2017 Carlos Antônio Gusmão Guerreiro Moura, Raphael Sampaio, Paulo Góes, Gabriel de Magalhães Freitas, Constança Margarida Sampaio Cruz, Carlos Geraldo Guerreiro Moura
BRAZILIAN SOCIAL AND ECONOMIC DEVELOPMENT DEPENDS ON SCIENCE
Copyright (c) 2017 Atson Carlos de Souza Fernandes
NEURODYNAMIC MOBILIZATION REDUCES INTRANEURAL FIBROSIS AFTER SCIATIC CRUSH LESION IN RATS
Peripheral nerve lesions may be associated with abnormal scarring that lead to regenerative failure and dysfunction. Neurodynamic mobilization (NM) imposes controlled mechanical loads on the peripheral nerve and may influence inflammation and collagen deposition after a lesion. However, there is lack of experimental data to support these claims. Objective: To evaluate the impact of NM in the intraneural number of mast cells, collagen deposition and number of blood vessels after an ischiatic crush lesion in rats. Methods: This is a laboratory animal study, where 20 rats (Rattus norvegicus) were randomly divided into two groups, NM (n=10) and control (n=10), submitted to a right ischiatic nerve lesion. A tensioning NM began 10 days after lesion, and was maintained once a day, six times a week, for three weeks. After this period, the animals were euthanized and the nerves assessed for the number of mast cells, collagen area and number of blood vessels. Results: NM led to a lower number of degranulated mast cells (Kruskal-Wallis=0.29 p<0.05), organization of collagen deposition (Kruskal-Wallis = 0.01, p<0.05 ). There was no influence of NM on the number of intraneural blood vessels (Kruskal-Wallis=0.46 p<0.05). Conclusion: NM started 10 days after a ischiatic nerve crush lesion modulates the inflammatory process and prevents random deposition of collagen at the lesion site, but has no influence on blood vessels formation.
Copyright (c) 2017 Êmyle Lima Martins, Herman Henrique Silva Santana, Iasmyn Fernandes Oliveira, Diana Cavalcante, Kamyle Castro, Alena Peixoto Medrado, Ana Maria Blanco Martinez, Abrahão Fontes Baptista
USE OF RESVERATROL IN CARDIOVASCULAR DISEASES PREVENTION: A SYSTEMATIC REVIEW
Resveratrol, a polyphenolic compound found in blackberry and red wine, has properties that prevent the development of atherosclerosis, and therefore, cardiovascular disease. The aim of this study was, through a systematic review, to assess whether resveratrol reduces the incidence of cardiovascular events and improves inflammation and endothelial dysfunction in individuals at risk. Searches were conducted in databases such as LILACS, PubMed,SCIELO and selected randomized controlled trials in humans, including the use of resveratrol in the prevention of cardiovascular events or in the improvement of inflammation and endothelial function. The final sample consisted of 10 items. Of the four studies that analyzed the flow-mediated dilatation of the brachial artery, all showed significant improvement in endothelial function after the use of resveratrol, compared with placebo.In the 7 studies that evaluated subclinical inflammation, there were differences, 3 studies showed significant decreases in the values of TNF-?, 2 showed significant changes in plasma levels of C-reactive protein and interleukin 6 (IL-6), while 1 didn't showed changes in TNF-? and IL-6. In conclusion, resveratrol is capable of improving endothelial function when compared with placebo. However, it was not possible to infer an improvement or not in the parameters concerning endothelial inflammation, since the data extracted from the studies were insufficient. Moreover, it was not possible to evaluate the use of resveratrol in the improvement of survival, infarction or reduction in mortality, since there were no records in the literature of randomized controlled trials that analyzed the effect of resveratrol use on clinical outcomes in humans.
Copyright (c) 2017 Gabriela Marujo Góes, Amanda Silva Fraga, Ana Marice Teixeira Ladeia
IMMUNOPATHOGENESIS OF ORAL MUCOSITIS INDUCED BY CHEMOTHERAPY AND/OR RADIOTHERAPY: STATE OF ART
Introduction: Oral mucositis is a common and worrying clinical condition in patients undergoing radiotherapy of the head and neck regions and aggressive chemotherapy. Mucositis manifests as a continuous process, which begins with erythematous and atrophic lesions, which can progress to very painful ulcers. The immunopathogenesis of oral mucositis is considered a complex cascade of biological events, and advances in its understanding might result in promising and effective therapies. Objectives: The aim of this study is to highlight the recent findings of the immunopathogenesis of oral mucositis induced by chemotherapy and/or radiotherapy and their possible therapeutic agents. Methods and materials: scientific articles were selected in the PubMed and LILACS databases from December 2015 to May 2016, using the keywords in English "mucositis etiopathogenesis" and "mucositis". In PubMed 107 articles were found and, in LILACS, 61. The articles were selected after reading and those which reported detail on the immunopathology of oral mucositis were chosen. Results and conclusion: The literature indicates that histopathological changes related to oral mucositis, including apoptotic phenomenon, the action of certain chemical mediators and the influence of the oral cavity microbiota promote a better understanding of the immunopathogenesis of this type of injury and their biological development. Therefore, additional clinical studies based on scientific evidence are needed to get a better understanding of the immunopathology of oral mucositis and the determination of preventive agents and effective therapeutic for this deleterious effect arising from antineoplastic treatment.
Copyright (c) 2017 Juliana Borges de Lima Dantas, Gabriela Botelho Martins, Hayana Ramos Lima, Manoela Pereira Carrera, Sílvia Regina de Almeida Reis, Alena Peixoto Medrado
SNAKEBITE POISONING IN BRAZIL: SHAMEFUL, UNACCEPTABLE MORBIDITY AND LETHALITY
Copyright (c) 2017 Fernando Martins Carvalho, Yukari Figueroa Mise
PREVALENCE OF ATTENTION-DEFICIT/HYPERACTIVITY DISORDER, OPPOSITIONAL DEFIANT DISORDER AND CONDUCT DISORDER IN CHILDREN WITH AUTISM SPECTRUM DISORDER
Aim: To estimate the prevalence of attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and conduct disorder (CD) in children and adolescents previously diagnosed with autism spectrum disorder (ASD). Methods: A cross-sectional study involving 71 children and adolescents previously diagnosed by a psychiatrist as having ASD. All were enrolled at a school that accompanies only individuals with ASD. The evaluation instruments consisted of a sociodemographic questionnaire and the Brazilian version of the semi-structured interview Kiddie-SADS-PL for the investigation of psychiatric disorders in children and adolescents. Results: Overall, 62% of the children in the sample had some psychiatric comorbidity: 49.3% had some form of ADHD, 11.3% ODD and 1.4% CD. In relation to the children with ADHD, 11.3% fulfilled the criteria for the inattentive subtype, 12.7% for the hyperactive/impulsive subtype, 7.1% for the combined subtype and 18.3% for ADHD not otherwise specified. Conclusion: These results ratify the clinical heterogeneity of ASD and highlight the importance of diagnosing comorbidities that could affect the clinical status and functioning level of children and adolescents with ASD.
Cinthia Cristina Pinto Bispo de Oliveira
Copyright (c) 2016 Milena Pereira Pondé, Mirella Lins Matos, Cinthia Cristina Pinto Bispo de Oliveira
A CRITICAL ANALYSIS OF AN INTERPROFESSIONALISM ASSESSMENT SCALE APPLIED TO HEALTH SCIENCES UNDERGRADUATE STUDENTS
Introduction: The search for initiatives that stimulate interprofessionalism should incorporate activities developed by educational institutions. The Bahia School of Medicine and Public Health (EBMSP) runs a project, approved by the Government Program of Education for Work in Health - PET-Saúde, which promotes interprofessional practice. Objective: Evaluate the psychometric properties of the IEPS when applied to Brazilian students. Method: We conducted Exploratory Factorial Analyses and took into account the eigenvalues and the theoretical model in order to estimate the number of factors. The Cronbach alpha coefficient was also calculated. Results: A three-dimensional factorial solution was tested. These three factors jointly explain 66.5% of variance in interprofessionalism. Three items were excluded, due to empirical weaknesses. The Cronbach alphas obtained for each dimension were 0.84, 0.70 and 0.16. Conclusion: The study attained its objective, gathering initial evidence regarding the validity of this measure in a Brazilian context.
Interdisciplinary Education Perception Scale
CANDIDA SPECIES IN THE GENITAL TRACT OF WOMEN ATTENDING A UNIVERSITY HOSPITAL FOR GYNECOLOGICAL INTERVENTIONS
Introduction: Vulvovaginal candidiasis occurs in about 75% of all women during reproductive age, and around half of those will have at least one recurrent episode. Objectives: To evaluate the occurrence of Candida species in the genital tract of women attending a clinic of Gynecology and Obstetrics at the University Hospital for gynecological interventions, related to signs and symptoms of infection and also to evaluate the susceptibility to antifungal agents of the Candida isolates. Methods and materials: Samples of vaginal secretions were taken of 128 women during gynecological and colposcopic examination, through sterile swab, to carry out culture for fungi. Susceptibility tests were performed for fluconazole, itraconazole, voriconazole, nystatin and amphotericin B. Results: Twenty (15.6%) patients had positive culture for yeasts identified as: C. albicans (57.1%), C. glabrata (19%), C. parapsilosis complex (4.8%), C. lipolytica (4.8%), Trichosporon sp (9.5%), and Rhodotorula sp (4.8%). Ninety women (70.3%) reported no symptoms and 38 (29.6%) were symptomatic. The most frequent complaints were: discharge, vulval itching, and dyspareunia. All isolates were susceptible to the antifungal agents tested, except for some isolates of C. parapsilosis complex, which showed in vitro resistance to itraconazole. Conclusions: Although Candida species were isolated in only some of the women, C. albicans was the most common species. The more frequent complaints were discharge and vulvar itching. Most of the isolates were susceptible to the antifungals tested.
Copyright (c) 2017 Thais Chimati Felix, Ralciane de Paula Menezes, Marilia Cristina Berardi, Denise Von Dolinger de Brito Röder, Reginaldo dos Santos Pedroso
SEVERE INTESTINAL FAILURE IN A CHAGAS’S DISEASE PATIENT AFTER TOTAL COLECTOMY PLUS PARTIAL ILEECTOMY
Introduction: To report the clinical course of a Chagas’s disease patient with severe intestinal failure after resection of the total colon and terminal ileum. Case Report: The patient underwent rectosigmoidectomy (of the sigmoid volvulus, December 2009) and total colectomy plus partial ileectomy (May 2011). Patient evolved with multiple hospitalizations caused by severe diarrhea (up to 23 stools/day), hydroelectrolyte disturbance and acute renal failure, severe protein-energy malnutrition [loss of 34.9% of usual body weight (uBW)], and multiple episodes of sepsis. Were prescribed parenteral nutrition solutions exclusively or concurrently with very small volumes (e.g., 40ml/day) of semi-elemental diet with low fat and high protein. After several weeks predetermined amounts of carbohydrate-rich foods (potatoes, rice, pasta, cassava), vegetables (chayote, carrots), low-fat meat, cream crackers, coconut water and fruit (watermelon, melon, banana) were progressively introduced. After 36 months, the patient was metabolically stable (BW=67.2 kg, weight recovery of 23.6 kg), with hydroelectrolytic balance. Due to the recovery of the functional capacity, the patient was advised to return to his work activities. Conclusions: Chagas’s disease patient submitted to intestinal resection may have severe intestinal failure and protein-energy malnutrition. Specialized nutritional therapy and clinical and laboratory monitoring by a multidisciplinary team, can contribute to better prognostic.
Copyright (c) 2017 Thaís C. Duarte, Fernanda G. Melo, José Rodrigues Santos-Júnior, Marcel P. Moussa, Daurea A. De-Souza and the Multidisciplinary Residency Program in Clinical Nutrition
AGREEMENT OF NHP AND SF-36 SOCIAL DOMAINS: AN EXPLORATORY STUDY
Introduction: Health Related Quality of Life (HRQoL) is an important outcome measure to investigate and monitor patients with chronic diseases. In order to achieve such goal, it is essential to choose an appropriate tool to evaluate the peculiarities of each population. Instruments to investigate HRQoL, NHP and SF-36 are alike in several aspects and are considered by the scientific community as replaceable each other. However, there are doubts regarding the agreement of their social domains. Objective: The present study aim to assess whether the social domains of the NHP and SF-36 correspond when applied in a population with chronic disease. Methods: The present research was made by applying the two instruments to a population with chronic disease. The social domains agreement was evaluated by Pearson correlation, ROC curve, AUC, Youdex Index, and Bland-Altman plot. Results: It was achieve a weak correlation between the two social domais (r = 0.3), confirmed by ROC curve with small AUC (0.416) and Youdex Index around 0.0. The Bland-Altman plot reaffirmed the no agreement between the two subscale by achieving mean difference equal to 29.37 (± 38.51), which made the concordance Interval vary from 106.39 to -47.65. Conclusion: it was concluded that social domains of NHP and SF-36 do not agree to each other. However, reasons for that are not explained and need to be investigated in futures studies. The current research was approved by the Research Ethics Committee of the Bahiana School of Medicine and Public Health under the protocol CAAE 516.42315.5.0000.5544.
Copyright (c) 2017 Bianca Macêdo de Alencar, Israel Souza, Katia Nunes Sá
HAZARDS AND RISKS TO CONSUMERS’ HEALTH CAUSED BY POPSICLES ON SALVADOR BEACHES – BAHIA STATE
Introduction: Beaches are a place for interaction and leisure, as well as a scenery for the provision of services, including the street food trade. In this segment, different workers with different type of foods are included, especially the popsicles. Methods: This study aimed to characterize microbiologically the popsicles commercialized on the beaches of Salvador, Bahia State. A cross-sectional study was carried out on 13 beaches, with the application of semi- structured questionnaires to 33 vendors to characterize microbiologically the popsicles sold on the beaches of Salvador, Bahia State, and the collecting of 198 samples, which were submitted to analysis: counting of Psychrotrophic microorganisms and coagulase-positive staphylococci, estimation of the Most Likely Number of total and thermolerant Coliforms/Escherichia coli and Salmonella spp research. Results: The results showed that in the microbiological profile, most of the samples were in compliance with the standards. However, 34.3% (68) of non-compliance were recorded, including contamination by the various microorganisms studied, except for Salmonella spp., which was not identified. Conclusion: The study identified risks to the costumer's health, given the contamination in the products, for both groups of sellers.
Copyright (c) 2017 Renata Oliveira dos Santos Menezes, Ryzia de Cássia Vieira Cardoso, Alaise Gil Guimarães
THE EXPORT OF BRAZILIAN WORKERS TO THE U.S.: FROM WORK TO LIVE TO LIVE TO WORK
Copyright (c) 2015 Brazilian Journal of Medicine and Human Health