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Item Coronariopatia assintomática em pacientes com cardiomiopatia chagásica em insuficiência cardíaca grave: prevalência e fatores de risco.(Universidade Federal de Goiás, 2011-03-21) CARVALHO, Gustavo; RASSI, Salvador; http://lattes.cnpq.br/7236834842677715Background: The concomitance of asymptomatic coronary heart disease in patients with Chagas cardiomyopathy with heart failure is not well known in medical literature, and both are very prevalent in some regions of Brazil. Objective: Determine the prevalence of coronary disease (lesion>50%) in a specific group of patients with Chagas cardiomyopathy and heart failure, in functional class III and IV, with no previous symptoms or diagnosis of coronaryopathy. Methods: Coronary angiography was performed in 61 consecutive patients with Chagas cardiomyopathy with heart failure, functional class III and IV, to exclude coronary heart disease. These patients were part of study protocol of cell therapy in heart disease, which required the implementation of coronary angiography before injecting stem cells. Risk factors for atherosclerosis also analyzed in this population were: age, hypertension, diabetes, dyslipidemia, smoking and overweight. Results: ages 51.6 + 9.6 years 65.5%(n = 40) men. The prevalence of coronary disease found in this population was 1.6%(1). The prevalence of risk factors were: hypertension 18%(11), smoking 59%(36), diabetes 1.6%(1) and dyslipidemia 6.5%(4). Conclusion: The prevalence of asymptomatic coronary disease in patients with chagasic etiology severe heart failure is low and among the risk factors for coronary heart disease, smoking was the most prevalent.Item Avaliação do uso de terapias biológicas em pacientes com artrite reumatoide no Estado de Mato Grosso, Brasil(Universidade Federal de Goiás, 2012-08-09) FERNANDES, Vander; SILVA, Nilzio Antonio da; http://lattes.cnpq.br/1780564621664455RA is debilitating autoimmune disease with serious physical, emotional and economic consequences, which affects about 0.5 to 1% of the adult population worldwide. Significant advances in the recognition of the pathophysiology of disease and injury mechanisms allowed the development of new treatment options with drugs that block inflammatory mediators involved in the mechanism of the disease, known as biologics. These drugs are expensive and of continuous use. They are complex to use due care and management of storage and the risk of immediate and delayed adverse reactions. These therapies are available at the Health System for 12 years, is necessary to evaluate the effectiveness of this drug group in the Brazilian public health system in the treatment of rheumatoid arthritis. OBJECTIVES: a) analyze the effectiveness of biological therapies in patients with rheumatoid arthritis of the State of Mato Grosso, through the assessment of disease activity index DAS28-ESR b) Review the laboratory characteristics of these patients; c) examine the safe use these therapies and to describe adverse events. d) analyze the efficiency of the program dispensing of biological therapies in the State of Mato Grosso, Brazil. METHODS: Two groups of patients with rheumatoid arthritis users Pharmacy High Cost of the State Secretariat of Health of Mato Grosso (FAC / SES) or the University General Hospital. Group I included 68 patients who were already in use of biological therapies. These were assessed for disease activity at the time of inclusion in the study and asked about the historical use of biological drugs, satisfaction with access to treatment and adverse events. Laboratory tests prior to treatment were obtained retrospectively. In group II were enrolled and followed prospectively for 24 weeks, 30 patients with early use of biologic therapies. They were evaluated at baseline and at weeks 4, 8, 12 and 24, the disease activity by DAS28-ESR, laboratory tests, satisfaction with access to treatment and adverse events. RESULTS: The groups were similar in demographic characteristics and laboratory related to rheumatoid arthritis. In group I, 80.6% of patients expressed satisfaction with the care of the FAC / SES. The average use of biological was 12.3 months, and 20.9% (14/68) reported an adverse event, all non-serious. The first medication was discontinued in 26.5% (18/68) of patients, 55.6% (10/18) for loss of efficacy and 22.2% (4/18) adverse events. The mean value of DAS28-ESR was 3.8, and 41.2% were in remission or low disease activity, 39,7% in moderate activity and 19,1% in intense activity. In group II, 91.7% of patients expressed satisfaction with the care provided by FAC / SES. Laboratory evaluation was significant change in the conversion of ANA from 13.3% to 23.3% and anti-DNA (ds), 0 to 6.7%, but no clinical significance. The anti-CCP (2) remained positive and stable at 63.3%. There was an adverse reaction in 23% (7/30) of patients. The only suspension of the first plants were by no severe adverse event (hypersensitivity). Following the DAS28-ESR was a significant reduction in the initial mean value of 4.3 to 3.3 (p = 0.002) after 24 weeks of treatment, 60% of patients were in remission or low disease activity, 23, 3% in moderate activity and 16.7% in intense activity. The average value of ESR-DAS28 after use of the biologic group II was significantly lower than in group I (p= 0.042). CONCLUSIONS: 1) Treatment with biologic therapies in the State of Mato Grosso was effective in prospective group. The response in DAS28-ESR was significantly better in the group where the monitoring and control has been programmed with a routine test and calculate the index of disease activity were used. 2) Among the laboratory characteristics were significant conversion in the profile of autoantibodies, confirming the potential immunogenicity of these drugs inducing the formation of autoantibodies, but no clinical significance in the study group. The anti-CCP remained stable in 63% of patients (group II). 3) Biological therapies were safe. There were no serious adverse events reported. There were no reports of infection or death. The most common reason for discontinuation of the first was the loss of biological effectiveness. 4) Patients with rheumatoid arthritis in the use of biologic therapies in the State of Mato Grosso showed satisfaction with the services offered by SES / MT and the majority of users in the metropolitan area of Cuiabá. The program dispensing biological therapies showed higher efficiency when linked to a reference center for this particular type of treatment.Item Perfil Neuropsicológico das Alterações de Linguagem nas Demências Subcorticais da Substância Branca e Cinzenta(Universidade Federal de Goiás, 2009-08-03) LACERDA, Maria Carolina Cabral de; CAIXETA, Leonardo Ferreira; http://lattes.cnpq.br/9536747113677509In the twentieth century, it was believed that the injury cortical was the substrate of cerebral dysfunction neuropathological. Studies of dementia were primarily focused on disorders of the cerebral cortex and sub cortical gray region, which originated the concepts of cortical and subcortical dementia respectively. The report of dementia mainly involving the white brain received less attention. The aim of this study was to achieve a profile of changes in language and cognitive processes involved in changes in the white sub cortical dementia (DSB) and dementia sub cortical gray (DSC) and then compared with the control group and among themselves. Thus 15 patients were evaluated with DSB, 8 with DSC and 14 control subjects. We applied the following tests: Boston for Diagnostic of Aphasia Examination (BDAE), the Boston Naming Test (BNT), Token Test, Verbal fluency - semantic category and board Theft of biscuits. The results showed that the subcortical group showed worse performance with the control group, showing significant differences in the Boston Naming Test and on the evidence of comprehension and oral production and graphics for the Boston Diagnostic Test of Aphasia. The DSB group showed more significant changes when compared with the control group than in the comparison between DSC X control group. Despite the language is related to cortical involvement, our study showed that such changes are found in subcortical dementia and receiving influence of cognitive processes involved in language. Symptoms of changes in language were similar between groups subcortical, but in greater or lesser degree of commitment. The DSB group showed more impairment of comprehension and oral apraxia and DSC group is highlighted by changes in prosody and the presence of hyperkinetic dysarthria.Item Adequabilidade dos esfregaços cervicais frente aos principais fatores pré-laboratoriais que podem interferir na análise do exame citopatológico.(Universidade Federal de Goiás, 2009-02-16) MARTINS, Marcelo Rodrigues; AMARAL, Rita Goreti; http://lattes.cnpq.br/3665611660713029Background: Cervical cancer in Brazil has one of the highest incidence rates. Screening this neoplasia is effective when a cytopathological test stained by Papanicolaou method is performed. However, the quality of cytopathological samples directly influences the screening effectiveness. Eventhough, this method has been criticized due to the high rates of false-negative, due to collection errors, routine scrutiny and the interpretation of cytological changes. Amongst the collection errors, the absence of endocervical cells and bad fixation are highlighted as one of the main concerns. Objectives: to assess the profile of professionals in charge of collecting cytopathological samples as well as verify whether the experience time and the working conditions are associated with sample adequability, verify the main difficulties and easiness reported by the professionals regarding cervical smears collection by using different fixation techniques, verify which fixation technique shows better performance concerning samples adequability and whether the fixation technique influences the detection of precursory injuries; verify the frequency of satisfactory cervical smears, the factors which could partially make samples obscure or make them unsatistactory for the analysis, as well as verify the presence or absence of transformation zone, and whether the presence of these cells is associated with the detection of cervical cancer precursory injuries. Methodology: 19 professionals -doctors and nurses- in charge of collecting cytopathological samples took part in this study. 1,354 cytopathological smears were included in this study, which were divided into three groups, submitted to different fixation techniques and distributed in the following manner: first group: 414 smears fixed with alcohol 95%; second group: 445 fixed with dropping fixation (alcohol 95% + polyethylene glycol) and third group: 495 fixed with spray (alcohol 95% + polyethylene glycol). The cervical material collected was referred to the cytology sector at the Rômulo Rocha Clinical Analyses Center and submitted to scrutiny routine regardless to the fixation technique. The cytopathological outcomes were classified in accordance with Brazilian Nomenclature for Cervical Diagnoses. At the end of the study, a questionnaire was applied to the professionals in which they reported difficulties and easiness concerning the use of different techniques. Data was inserted and processed in the Epi Info 3.3.2 software, and for statistic analysis we used the SAS 9.1.3 software. Outcomes: from the 19 professionals in charge of cytopathological screening 16 (84.2%) are nurses and 3 (15.8%) are doctors. From the 19 professionals in charge of collection, 58% pointed the spray technique as of very easy handling. In the limited smears the most frequent obscuring factor was leukocyte infiltration followed by dissecation, whereas for the unsatisfactory the majority was of dissecation followed by hypocellular material. Conclusions: this study showed that spray fixation technique had the worst performance concerning adequability of sample when compared to alcohol and drops, and that the professionals considered the spray fixation as of easier handling. There was no association between the precursory injuries diagnosis and the fixation technique used. The experience time and the Abstract proper collection environment influenced the quality of cervical material samples and the alcohol 95% fixation technique had the highest rate of difficulty reported, when compared to the drop and spray fixation. We also observed that the transformation zone representation was significant both for the most severe and less severe cervical cancer precursory injuries.Item Avaliação da composição corporal e qualidade de vida em pacientes submetidos ao esvaziamento cervical supraomohióideo(Universidade Federal de Goiás, 2012-04-24) PAULA JÚNIOR, Célio Antônio de; CURADO, Maria Paula; http://lattes.cnpq.br/3397823736381748Supraomohyoid neck dissection is an important procedure in the treatment of patients with malignancy in the oral cavity and oropharynx, however there are common side effects in the post operative period. Results of an elaborate review of literature in electronic databases to investigate the effect of a resistance exercise protocol in this population showed significant improvement in the quality of life of patients trained, however studies which deal with the issue are limited. To quantify the damage caused by post-operative supraomohyoid neck dissection, and thus develop a secure protocol of exercises for this population, this study evaluated changes in body composition, body mass index, range of motion and quality of life in patients undergoing unilateral or bilateral supraomohyoid neck dissection pre and post-operatively (30 and 90 days). In the post-operative period, the 28 patients observed showed a significant reduction in body weight, muscle weight, and fat percentage. In terms of range of motion, a reduction of flexion, extension, abduction, medial rotation and lateral rotation was detected in the post-operative period (30 and 90 days). Decreased range of motion of flexion and abduction post-operatively had a negative correlation with quality of life, especially in areas of activity, recreation, shoulder, and the total score. The results of this study indicate that a resistance exercise protocol in patients undergoing neck dissection supraomohyoid may be an alternative to reduce the adverse effects of surgery and thus improve quality of life of these patients.Item Infecção pelo Trypanosoma cruzi em doadores de sangue: Revisão Sistemática da Literatura e Estudo de Prevalência no Hemocentro de Goiás(Universidade Federal de Goiás, 2011-03-21) SANTOS, Cristiane Araújo Tuma; GARCÍA-ZAPATA, Marco Túlio Antonio; http://lattes.cnpq.br/3672512339058369Introduction: Chagas disease or American trypanosomiasis is one of several infectious diseases that can be transmitted via blood, justifying the rigorous screening of blood donors. The transfusion transmission of trypanosomiasis has been reduced in Brazil with the implementation of programs to control the quality of blood products. Objectives: a) To do Systematic Review addressing the issue of transfusion transmission of Chagas disease and b) determine the prevalence of Chagas' infection in blood donors attending the Coordinator Blood Bank of Goiás, regional blood centers of Catalão, Rio Verde and Jataí and mobile units that collect blood in 62 cities in Goiás, in the years 2005 to 2009. Methods: 1) Systematic Review using the keywords "Chagas' disease," "blood donor", "Trypanosoma cruzi" and "blood transfusion" and the qualifier "epidemiology" in databases: MEDLINE, LILACS PAHO and WHOLIS. 2) Cross-sectional study to determine the seroprevalence for Trypanosoma cruzi, using data from computerized laboratory files whose serological technique was immunosorbent assay (ELISA). The positive donors were characterized by sex, age, nationality and origin, through records of attendance. Confidence Intervals were calculated at 95%. To reach statistical significance was considered p <0.05. Results: There were 314 articles in different databases, with 48 included in the analysis. We analyzed 210,890 records of donations during the period January 2005 to December 2009. 653 were found positive for T. cruzi, resulting in a prevalence of 0.30%. Among the donors with positive serology for T. cruzi, 69.22% were men and 30.78% were women. Most donors was born in Goiás (53.45%). The prevalence of infection in new donors was 1.27% while in return donors was 0.02%. Conclusions: Advances in Hemoterapy practice in Latin America and effective vector control decreased dramatically in recent decades the occurrence of transfusion Chagas disease in endemic areas. But, because it is not restricted geographically, this disease represents a significant challenge to the developed countries that receive large numbers of immigrants, which can transmit the disease through blood transfusions. The prevalence of positive donors at the Coordinator Blood Bank and Regional transfusion centers of Goiás trend shows decline when compared with previous studies.Item Atividade Cicatrizante do Laser AlGaInP em Feridas Cutâneas Induzidas em Ratos Wistar(Universidade Federal de Goiás, 2011-03-14) SANTOS, Kelly Cristina Borges Tacon; CUNHA, Luiz Carlos da; http://lattes.cnpq.br/6349547031976679Objective: To analyze the healing activity AlGaInP laser in induced skin wounds in rats wistar. Materials and Methods: This is an experimental study, pre-clinical trial conducted in the room at the Center for Research and Toxic-pharmacological approaches. Were used for the experiment 54 Wistar rats divided into 3 groups of 18 animals and divided into 3 groups of 6 animals. The animals were weighed, tricotomiados anesthetized and then subjected to a surgical incision in the dorsal-neck of all animals using a punch of 1 cm (diameter). After 24 hours of surgery, we used the laser diode Aluminum Indium Gallium Phosphorus - AlGaInP (IBRAMED - Laserpulse) with a continuous power of 30 mW and wavelength (ʎ) of 660 nm for the treatment groups L3 and L6 (3 and 6J/cm2 + saline (0.9%) respectively and for the control group (CG) received only saline (0.9%). The animals (n = 6) for each group were euthanized at 5, 10 and 15th days after injury. The samples were embedded in paraffin, stained with hematoxylin-eosin and picrossírius. We observed the daily appearance of the wound during the healing process and noted in individual spreadsheet, by the same examiner. Data from histological evaluation were converted in quantitative variables by assigning scores: absent (0), mild (1-25%), moderate (25-50%) and severe (above 50%). For morphometric analysis, we used the program Image J. The count of the number of blood vessels was used for point counting planimetry. For analysis of collagen was used picrossírius staining and polarized light to scan images. The data were treated statistically by analysis of variance (ANOVA) and post-Tukey test. For the non - parametric variables we used the Kruskal - Wallis test. The significance level was set at (p<0.05). Results: There was a statistically significant difference in the contraction of the wound edge in L3 group compared to GC and L6 on the 10th day of the injury, indicating that the laser energy density 3J/cm2 acted positively in the healing process. During the histological assessment, we observed reduction of bleeding (p=0.007) L3 group compared to control and to the number of polymorphonuclear (p=0.045) treated groups L3 and L6 compared to control. Also on the 10th day there was also an increase in collagen content (p=0.003) L3 and L6 in the groups compared to control. On the 15th day was observed a significant increase in collagen content (p=0.034) of the L6 in the control group. Conclusion: The wound healing activity AlGaInP laser was evidenced by increased angiogenesis, decreasing inflammation and stimulation of fibroplasia. Thus it is assumed that the laser used in the study contributed positively tested in both phases (inflammatory and proliferative) to accelerate the healing process and also that the energy densities of three proposals 6J/cm2 and responded to the type of treatment proposed in this study.Item Análise do padrão do uso de medicamentos em idosos no município de Goiânia, Goiás(Universidade Federal de Goiás, 2012-03-30) SANTOS, Thalyta Renata Araújo; LIMA, Dione Marçal; http://lattes.cnpq.br/4310011929664114; AMARAL, Rita Goreti; http://lattes.cnpq.br/3665611660713029Introduction: The fact of elderly people live in a greater amount with chronic diseases, make the elderly a great consumer of health services and, probably, the most medicated group in the society. In this context serious problems arise, such as the use of multiple medications simultaneously (polypharmacy) that can lead to serious consequences to the elderly health. Another problem is the self-medication, which may exacerbate the associated risks with prescript drugs, delaying a diagnosis and masking a disease. There is, still, the use of drugs considered inappropriate for elderly, either by reducing the therapeutic efficacy or an increased risk of adverse effects that increase the advantages in elderly usage. Objective: Analyzing the pattern of use of medications in aged people in the city of Goiânia-GO, and associate it with socioeconomic aspects and with the self-rated health. Methods: A population-based study and cross-section, that evaluated the health of elderly in the city of Goiânia-GO. The data collection was carried out in December/2009 to April/2010 from 934 elderly. The questionnaire had questions about medications, in addition to information about self-rated health and socioeconomic profile. The drugs groups were classified according to the Anatomical Therapeutic Chemical and Classification-ATC. The inappropriate drugs for elderly were identified according to Beers Criteria. Used Mann Whitney (U) and Chi-square test, it was considered significant p<0.05. Results: Among 934 elderly participants of the survey, 783 (83.8%) had answered completely to the questionnaire. These 738 elderly used 2846 drugs (3.63 drugs/elderly). Women consumed more medication than men (3.94 and 3.06 respectively, p <0.001). The most frequently consumed drugs act on the cardiovascular system (38.6%). The prevalence of polypharmacy was 26.4% and 35.7% of the elderly told to practise self-medication. The drugs most commonly used by self-medication were the painkillers (30.8%). According to Beers-Fick Criteria, 24.6% of the elderly used inappropriate drugs, 90.2% of these drugs came from a current prescription. The inappropriate drugs more consumed were benzodiazepines (34.2%). Women, widows, elderly with 80 years or more and those who had a worse self-rated health practiced more polypharmacy (p<0.05). Elderly people with lower education and with worse self-rated health practiced more self-medication (p<0.05). Conclusions: The results of this study showed that the pattern of drug use by elderly of Goiânia was similar to that found in elderly people from other regions of Brazil. Since the number of drugs used, the prevalence of polypharmacy and self-medication practices and the use of inappropriate drugs were within the national average. Women, widows, aged 80 years or more and those who consider their health as poor more often practiced polypharmacy, the largest self-medication was associated with a lower education and poorer self-rated health.