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Item Investigação da acalásia do esfíncter anal interno por meio da eletromanometria de pacientes chagásicos obstipados com e sem megacolo (Goiânia-Goiás-Brasil)(Universidade Federal de Goiás, 2012-02-02) ALMEIDA, Arminda Caetano de; MOREIRA, Marise Amaral Rebouças; http://lattes.cnpq.br/6390358577348486Chagas disease remains as an important public health challenge in South America. The Chagas colopathy is considered the second clinical digestive manifestation most common of the disease and constipation chronic, its main symptom. The general objective was to investigate the presence of achalasia, through electromanometry of the internal anal sphincter, in constipated chagasic patients with and without megacolon. This study evaluated clinical and electromanometry parameters of 64 patients with symptoms of constipation, attended on the service of coloproctologya on a university hospital in Brazil, central region. The achalasia was present in 91.3% (IC95% 74.13 to 98.52) of patients with megacolon and/or megarecto (Group 1), in 47.29% (IC95% 27.29 to 68.57) without megacolon and/or megarecto (Group2), and was not present in patients of the control group (Group 3). The rectal capacity was 309.1, 159.2 and 150.1 ml in the groups 1, 2 and 3 respectively. In conclusion the electromanometry detects achalasia of the internal anal sphincter in almost totality of patients with megacolon and/or megarecto. The megacolon presence in constipated patients with Chagas Disease alert to the possibility of occurrence of achalasia on the internal anal sphincter. In chronically constipated patients with positive serology for Chagas Disease, without megacolon the a finding of absence of the recto anal inhibitory reflex, by electromanometry, can definitively prove the Chagas colopathy, while the presence of reflection departs, at the time, this diagnosis, should these patients be followed and treated like other patients with constipation due to other causes The comparison of clinical manifestations in the three groups not evidenced differences that could distinguish patients with Chagas colopathy those with functional constipation, reaffirming the importance of holding the electromanometry in Chagasic and constipated patients.Item Desenvolvimento farmacotécnico e analítico de comprimidos revestidos de montelucaste: equivalência farmacêutica e bioequivalência(Universidade Federal de Goiás, 2011-03-18) ALVES, Carina Pimentel Itapema; LIMA, Eliana Martins; http://lattes.cnpq.br/7248774319455970Montelukast is a potent reversible selective inhibitor of cysteinilleukotrien- 1 receptor, avoiding that these mediators promote the asthmatic response. Its commercialization in Brazil, as a terminated product, is protected by patent up to 2010. Once the active ingredient Montelukast is recent in the pharmaceutical market and there is no methodology description in official compendiums capable to assure the quality of new formulations, the objective of this paper was the pharmaceutics of montelukast film coated tablets, the development and the validation of analytical and bioanalytical methodologies foreseeing the pharmaceutical equivalence and bioequivalence with the reference medication of the market. With this purpose, some physicalchemical parameters were characterized, assay and dissolution methodologies were developed and validated per high performance liquid chromatography with ultraviolet detection (HPLC-UV) for the quantification of montelukast present in 10.0mg film coated tablets. The quantification of montelukast sodium in human plasma was performed using Loratadine as internal standard and high performance liquid chromatography attached to mass detector (HPLC - MS / MS). The active ingredient was extracted from the human plasma using precipitation extraction. The results found for the parameters of specificity, linearity, accuracy, precision, quantification and detection limits and stability in the methodologies validation confirm they were adequate for the objective proposed. The analytical methodologies developed and validated were applied in the pharmaceutics of the tablets for the determination of the formulation similar to the market reference medication Singulair®. This formulation was submitted to stability assays to assure its quality and to allow the performance of pharmaceutical equivalence and bioequivalence with the purpose of registering as a generic medication.Item Estudo comparativo randomizado do tratamento da bexiga hiperativa com eletroestimulação vaginal e eletroestimulação transcutânea do nervo tibial posterior(PTNS)(Universidade Federal de Goiás, 2012-02-15) BERQUÓ, Marcela Souza; AMARAL, Waldemar Naves do; http://lattes.cnpq.br/4092560599116579INTRODUCTION: The overactive bladder syndrome (OAB) is a lower urinary tract pathology that negatively affects the quality of life (QOL) of women whose main symptom is your definition for urinary urgency, with or without incontinence usually accompanied by urinary frequency and nocturia in the absence of metabolic, infectious or local. The diagnosis of BH is defined from the clinical symptoms, but the voiding diary and urodynamic studies are good tools for objective evaluation of this pathology. There are several forms of treatment for OAB, are the main pharmacological and physical therapy, physical therapy has been being considered an important option in a clinical setting. OBJECTIVES: to do a systematic review article about physical therapy in the treatment of female miccional urgency, to evaluate and compare the effects, discomfort and improvement in quality of life (QOL) of vaginal electrostimulation and percutaneous tibial nerve stimulation (PTNS) in women with overactive bladder. METHODS: We conducted a comparative, prospective, randomized trial of physiotherapy in the sector of the Hospital Materno Infantil (HMI) in Goiânia-GO, from march 2010 to august 2011. We randomized 40 women with urodynamic diagnosis of detrusor overactivity, mixed incontinence with predominant symptoms of overactive bladder or urinary urgency only in two groups: vaginal electrical stimulation (n=20) and PTNS (n=20), being held 10 sessions in each group. We used urodynamic studies, voiding diary and QoL questionnaire of King's Health Questionnaire (KHQ) before and after the two procedures, and then visual analog scale. Statistical analysis used: Fisher exact tests, chi quadratic, U Mann Whitney and Wilcoxon tests with a significance level of 0.05. RESULTS: In voiding diary was a reduction in urinary frequency, urge incontinence, nocturia and urgency in both groups. The urgency was present in all women and disappeared in 90% in the PTNS group (p<0.001) and 80% in vaginal electrical stimulation (p<0.001). According to urodynamic evaluation, the group of vaginal electrostimulation showed disappearance of detrusor overactivity in 60% (p=0.005) and PTNS in 75% (p= 0.002). The urodynamics showed significant differences in some parameters analyzed within each specific group and to compare the two groups was not observed differences. The scale and the KHQ domains of the two procedures had similar results as physical therapy to improve QOL, but no significant difference between them. In relation to the discomfort of procedures, PTNS in 80% of women reported no discomfort and 80% reported vaginal electrostimulation mild to moderate discomfort (p<0.001). CONCLUSION: There was no significant difference in the effects and QOL between the vaginal electrical stimulation and PTNS. The PTNS promoted less discomfort for women.Item Efeito da dextrina de trigo na sensibilidade à insulina e estado nutricional de indivíduos com Diabetes Mellitus tipo 2(Universidade Federal de Goiás, 2012-02-27) CARVALHO, Ana Clara Martins e Silva; SILVA, Maria Sebastiana; http://lattes.cnpq.br/1329422634395496Introduction: The dietary fiber, particularly soluble, are assigned the physiological effects that are important for the treatment of patients with type 2 diabetes mellitus. Objective: To evaluate the effect of supplementing wheat dextrin in insulin sensitivity, glycemic control and lipid, and nutritional status of patients with type 2 diabetes mellitus. Methodology: This is a trial blind, randomized, lasting 12 weeks.The sample consisted of 27 type 2 diabetic subjects of both sexes with a BMI ≥ 25.00 kg/m2 and sedentary. These subjects were randomized into two groups, test (n = 14) and placebo (n = 13). The test group was supplemented daily with 200 ml of orange flavor beverage without the addition of sugar and added 10 g of wheat dextrin, 30 minutes before the lunch. The control group received the same drink daily, but without the addition of fiber. Participants were instructed to maintain their lifestyle (diet and physical activity). Fasting plasma glucose, glycated hemoglobin (A1c), insulin sensitivity, lipid profile, the level of physical activity, intestinal function, food intake, and anthropometric indicators were assessed at baseline, 45 and 90 days intervention. Results: The A1c, fasting glucose and lipid profile showed no significant differences within and between groups. There was an increase in the values of HOMA-IR (p = 0.0163) and fasting insulin (p = 0.0406) at 45 days in the placebo group, with significant difference. The increase in HOMA-IR and fasting insulin resulted in decreased insulin sensitivity in the placebo group. In the test group showed no changes in insulin sensitivity. The test group showed improvement in bowel function. The fiber intake was below the recommendation for the diabetic.Food intake, body weight, BMI and waist circumference (WC) also showed no significant change. The percentage of body fat increased in the placebo group at 45 days (p = 0.0342) and decreased in the test group compared to placebo (p = 0.0216 and 0.0285). The basal metabolic rate (BMR) increased in the test group and decreased in placebo (p = 0.0198 and 0.005). Conclusion: Wheat dextrin in 10g/dia dosage did not improve insulin sensitivity, glycemic control and lipid, did not reduce body weight and WC and does not cause changes in the consumption of energy and macronutrients. There was increased consumption of fiber for the minimum of the recommendation, regulate bowel function, reduced body fat and increased the BMR.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 de macrófagos e suas citocinas IL-10, IL-12, IL-23, INF-γ e TGF-β em carcinoma espinocelular de cavidade oral(Universidade Federal de Goiás, 2012-08-21) COSTA, Nádia do Lago; BATISTA, Aline Carvalho; http://lattes.cnpq.br/0199082642322002Tumor-Associated Macrophages (TAMs) can contribute with events involved in the progression and in the invasion of the tumor (angiogenesis, degradation of the extracellular matrix and local immunosuppression), or collaborate with an effective antitumor response and reduce the progression and metastasis. The purpose of these studies was to evaluate the macrophages (MA) presence in the microenvironment of oral cavity squamous cell carcinoma (OCSCC), and the relationship of these cells with clinicopathological factors. Additionally, we aimed also to characterize these cells through the expression of pro (IL-12/23 e INF-γ) and anti-inflammatory (IL-10 and TGF-β) by macrophages and globally in selected samples. Besides that, considering these goals, the techniques of immunohistochemistry, flow cytometry and qRT-PCR were used. The results revealed, even with the flow cytometry technique, that a predominance of M2 phenotype macrophage in the tumor microenviromment of OCSCC, because the proportion of macrophages expressed both cytokines IL-10/TGF-β (10.8%) was higher compared cytokines IL12/23/INF-γ (5.7%). Demonstrated although that a high proportion of MA (CD11b+CD11c-) present in OCSCC expressed cytokines IL-10, INF-γ and TGF-β compared to the control group, however this difference was significant only for TGF-β (Mann Whitney; P = 0,016). The evaluation of the expression of messenger RNA (mRNA) by qRT-PCR technique revealed a high overall expression of cytokines TGF-β, IL-10 and IL-23 in OCSCC in metastatic when compared with control (P < 0,05 for all groups). The proportion of macrophages (CD68+), identified by immunohistochemistry technique, was significantly lower in the control group (normal oral mucosa) when compared to OCSCC groups with and without cervical lymph node metastasis (Mann Whitney; P = 0,00001 e P = 0,044, respectively). Additionally, the proportion of these cells was significantly higher in metastatic OCSCC when compared with non-metastatic (Mann Whitney; P = 0,038). Survival analysis showed that patients with a high proportion of CD68+ cells showed a trend toward shorter survival (44 months) than those with low proportion of these cells (93 months) (Kaplan-Meier; Log Rank, P = 0,08). In conclusion, the results suggest that there is a predominance of the M2 phenotype on the microenviromment of OCSCCC. Additionally, these cells may promote metastasis and reduce survival of patients affected by OCSCC, probably contributing to a local immunosuppression via TGF-β production.Item Monitoração terapêutica do bussulfano oral, após uso de dose teste e durante condicionamento, em pacientes submetidos a transplante alogênico de células-tronco hematopoiéticas(Universidade Federal de Goiás, 2012-04-13) EFFTING, Cristiane; ARANTES, Adriano de Moraes; http://lattes.cnpq.br/2074071976957154; CUNHA, Luiz Carlos da; http://lattes.cnpq.br/6349547031976679Busulfan is an alkylating agent, used for conditioning patients undergoing hematopoietic stem cell transplantation (HSCT). It presents narrow therapeutic range and high variability in pharmacokinetics among patients and doses in the same patient. High plasma concentrations (> 1000 ng mL-1) have been related to toxicity, such as sinusoidal obstruction syndrome, whereas low levels (< 600 ng mL-1) have been associated with primary disease relapse or graft rejection. To avoid problems related to this treatment, therapeutic drug monitoring with dose adjustment has been proposed. Among the methods described, highperformance liquid chromatography (HPLC) is often used. This study aimed at optimizing and validating a technique to dose busulfan by HPLC coupled with photodiode array detector (PDA) and applying it to patientes undergoing HSCT in Goiás. We included eight patients in the group for therapeutic monitoring (MG) and eight in the control group (CG), i.e., with no intervention. Patients in the MG received the test dose (TD) 14 days before the treatment; after determining busulfan pharmacokinetic profile for each patient, the dose was adjusted to the therapeutic objective of 900 ng mL-1. The conditions for chromatography run were: HPLC/PDA, column ACE® C18 (150 mm x 4 mm); mobile phase methanol/water/acetonitrile (65:20:15, v/v/v); eluent flow rate of 1 mL min-1; internal standard 1,6-bis-(methanesulfonyloxy)hexane; UV detection λ = 276 nm; derivatization with sodium diethylcarbamate; liquid-liquid extraction with ethyl acetate after precipitation with acetonitrile. We included eight patients in the group for therapeutic monitoring (MG) and eight in the control group (CG). Results obtained: linearity, analyzed through the calibration curve, of 200 5000 ng mL-1; precision, in terms of repeatability (intra-run), of 1.25%-11.25%, and intermediary (inter-run), of 2.17%-10.71%; accuracy of 89.61%-102.18%; recovery of 89%. Half of the patients required dose increase and the mean dose administered was 1.02±0.19 mg kg-1. High variability was observed in assessed pharmacokinetic parameters: 38% variation in Css ____ between TD and conditioning regimen; half-life increased by 11%; ClT/F decreased by 30%, suggesting accumulation of busulfan when the drug is administered in a multiple dose regimen. Although lower than reported in the literature, this variation may be associated with toxicity or failure in treatment, justifying patient monitoring and enhancing validity of previous pharmacokinetic evaluation using TD regimen. Compared to the CG, this variation did not present impact on toxicity, mortality, and survival rates. Other studies with intervention during monitoring and a higher number of patients may present positive impact on the results of HSCT.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 Estudo da liberação in vitro de progestagênios em diferentes formas farmacêuticas usados para suporte da fase lútea no tratamento de infertilidade(Universidade Federal de Goiás, 2011-05-30) FINOTTI, Marta Curado Carvalho Franco; CONDE, Délio Marques; http://lattes.cnpq.br/8628571386803692; LIMA, Eliana Martins; http://lattes.cnpq.br/7248774319455970INTRODUCTION: The dissolution profile of a drug is an important tool for evaluating its biopharmaceutical quality. The pharmaceutical form must be guaranteed to release the appropriate quantity of the drug at the appropriate rate to assure that the therapeutic objective of the product, which is directly related to its bioavailability, will be achieved. In order to permit interchangeability between medications, quality, safety and efficacy must first be guaranteed. Failure to comply with these conditions may result in therapeutic failure. OBJECTIVES: To evaluate the dissolution profile of the principal pharmaceutical forms of progestogens available on the market in Brazil for luteal phase support in infertility treatment. METHODS: A laboratory study was developed and conducted in the Pharmaceutical Technology Laboratory of the School of Pharmacy, Federal University of Goiás (UFG). The following formulations were evaluated: coated tablets of dydrogesterone, micronized progesterone in the form of soft gelatin capsules produced by two different pharmaceutical companies (product A and product B) and a gel form. The study also included suppositories and ovules from three compounding pharmacies. Evaluation was made using physical and physicochemical tests and in vitro release assays. In the case of the pharmaceutical preparations in the form of soft gelatin capsules, dissolution kinetics and dissolution efficacy were also determined in addition to the profile of the preparation. The products with the same pharmaceutical form were compared. Different equipment, a dissolution apparatus equipped with an Enhancer Cell assembly and Franz diffusion cells, were tested and also compared in an attempt to determine the best method of evaluating semisolid forms. Statistical analysis was performed using the SPSS statistical software program for Windows, version 16.0. ANOVA, the Tukey test and Student s t-test were used in the comparative analysis. RESULTS: Evaluation of dydrogesterone in the pharmaceutical form of coated tablets showed the product to be in accordance with pharmacopeial specifications. The tablets were approved in the first stage of the dissolution assay, drug dissolution being above 85% at 60 minutes for all the units tested. With respect to the dissolution profile of the three batches of the micronized progesterone products evaluated (products A and B), in the form of soft gelatin capsules from different pharmaceutical companies, drug dissolution within 4 hours was 80%, i.e. all the products met the established dissolution specifications. The dissolution profiles and first-order kinetics of products A and B, which consisted of micronized progesterone in the form of soft gelatin capsules, were similar. The dissolution apparatus equipped with an Enhancer Cell assembly was found to constitute the best means of characterizing the rate and extent of release of the drug in gel form from its matrix. The in vitro release assay for micronized progesterone in the form of soft gelatin capsules conducted in the dissolution apparatus confirmed the prolonged release mechanism of the drug, which lasted for up to 72 hours. None of the ovules or suppositories from any of the compounding pharmacies evaluated met the criteria established by the regulatory agencies and official compendia with respect to the quality requirements for drugs. The dissolution profile differed between batches and between the different pharmacies investigated. Mean maximum concentrations of micronized progesterone failed to exceed 80% of the dose stated on the label. Statistically significant differences were found between batches originating from the same pharmacy and between the different pharmacies investigated. CONCLUSIONS: It was impossible to establish the interchangeability of the reference products with the compounded products tested. Further bioavailability studies and randomized clinical trials should be conducted to test the different products with the best performance in the dissolution studies conducted.Item Pesquisa de disautonomia, dor evocada por adrenalina e noradrenalina e efeito de beta-bloqueador na fibromialgia e no lupus eritematoso sistêmico.(Universidade Federal de Goiás, 2010-08-05) JACOMINI, Luiza Cristina Lacerda; SILVA, Nilzio Antonio da; http://lattes.cnpq.br/1780564621664455Lacerda Jacomini, LC. Investigation on dysautonomia, epinephrine and norepinephrine-evoked pain, and effect of beta-blocker in fibromyalgia and systemic lupus erythematosus. 2010, 169 p. Doctoral thesis - Universidade Federal de Goiás, Goiânia. Dysautonomia is a condition in which an altered autonomic function affects the health in an adverse way. The present study aims: to search for the presence of epinephrine and norepinephrine-evoked pain; to evaluate the cardiovascular autonomic function and the effect of propranolol in women with fibromyalgia (FM), systemic lupus erythematosus (SLE) and controls (CTR). For each objective a separate research was developed, including a clinical trial. Epinephrine and norepinephrine-evoked pain were diagnosed when the subcutaneous injections containing these substances (10 micrograms/ 0.1 mL saline solution) induced greater pain than the saline solution did (n=7). Autonomic function was assessed through the standard Ewing tests battery, through heart rate responses to Valsalva maneuver, deep breathing, standing and blood pressure responses to ortostatism and to hand grip (n=7). Functional symptoms related to autonomic manifestations were checked. In a randomized, double-blind, placebo-controlled, crossover clinical trial with 6 women with FM, SLE and CTR, propranolol (80 mg/day po/4 weeks) was added to the usual schedule of prescribed medicines and its effect was examined regarding: pain, fatigue, tender points, blood pressure, heart rate, health related quality of life (SF-36) and fibromyalgia impact questionnaire. Epinephrine-evoked pain was diagnosed in SLE and FM groups and norepinephrine-evoked pain was diagnosed in FM group. Epinephrine and norepinephrine-evoked pain intensity has a trend to be greater in FM patients when compared to healthy CTR. FM and SLE patients had an elevated number of functional symptoms related to autonomic manifestations. Cardiovascular autonomic function was altered in FM and SLE groups. Parasympathetic cardiovascular autonomic function tests were mainly abnormal in SLE patients while in FM patients both, parasympathetic and sympathetic tests were abnormal. Propranolol reduced tender points count and the number of symptoms related to autonomic manifestations in FM group. Four in six patients presented significant improvement in health related quality of life evaluated by SF-36. These results suggest that FM belong to the group of sympathetically maintained pain syndromes. The study demonstrates that FM and SLE patients have cardiovascular autonomic function alterations which can be detected by simple, standardized, non-invasive and inexpensively methodology and that propranolol has a potential benefit in FM 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 Análise do desempenho da revisão rápida de 100% na detecção de resultados falso-negativos dos exames citopatológicos cervicais(Universidade Federal de Goiás, 2009-06-30) MANRIQUE, Edna Joana Cláudio; AMARAL, Rita Goreti; http://lattes.cnpq.br/3665611660713029Objectives: analyze the performance of the 100% rapid re-screening in detecting falsenegative results of cervical screening cervical, in quality control, after routine screening, using the average time of one and two minutes, according to final diagnosis. Methodology: a total 5,235 smears, classified as negative and unsatisfactory by routine screening, were submitted to 100% rapid re-screening method, using the time average of one and two minutes. In these reviews, the smears classified as unsatisfactory or suspects were subjected to detailed review. The concordant results were considered final diagnosis; the differences were meeting for a consensus that defined the final diagnosis. Results: of 5,235 smears submitted rapid re-screening method, of using the time of one minute and two minutes there was sensitivity and specificity of the final method of 64.3% and 99.2% for the time of one minute and two minutes was 63.8% and 99.5%. In smears, with satisfy adequacy for analysis, the sensitivity and specificity of this method, using the time of one and two minutes, were 64.2%, 98.9%, 61.5% and 99.4% respectively. The smears, with the adequacy of the smears presented for analysis limits, the sensitivity and specificity, using the time of one minute, was 64.7%, 99.9% and for two minutes were 70.6% and 99.8%. Of the total of 5,121 cervical smears, had 958 (18.7%) clinical information, after being submitted to rapid rescreening, using the time of one minute, 18 of those were suspects, of which ten were confirmed by final diagnosis as abnormal. When submitted to rapid re-screening using the time of two minutes, 13 were suspects, nine of these were confirmed by final diagnosis as abnormal. A total 4,163 (81.3%) smears had no clinical information, after being submitted to rapid re-screening, using the time of one minute were 70 suspects, of which 35 were classified as abnormal. When submitted to rapid re-screening using the time of two minutes were 54 suspects, of which 35 were confirmed by final diagnosis as abnormal. A rapid re-screening showed a sensitivity to smear with clinical information, using the time of one minute of 83.3% and for two minutes of 75%. Conclusions: the rapid re-screening method of 100% showed no difference in the detection of falsenegative results using the time of a minute or two. The adequacy of the sample does not influence the detection of false-negative results, using both a time as two minutes, and there was no difference in the detection of false-negative smears with and without clinical information using a time-two minutes and finally, in smears with clinical informationItem 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 Staphylococcus spp. em úlceras venosas na perspectiva clínica e microbiológica(Universidade Federal de Goiás, 2012-04-05) MARTINS, Marlene Andrade; BACHION, Maria Marcia; http://lattes.cnpq.br/8503907944360635INTRODUCTION: In recent years, there has been the emergence of multidrug-resistant strains from patients seen in primary lesions with venous ulcers. OBJECTIVES: To determine the frequency and susceptibility profile of Staphylococcus sp.; verify the prevalence of methicillin resistant Staphylococcus aureus (MRSA) and minimum inhibitory concentration (MIC) of isolates; detect MLSB resistance in Staphylococcus sp. isolated from venous ulcers; describe the frequency of clinical signs and symptoms indicative of infection of venous ulcers (2005); identify the clinical stage of infection, to determine the relationship between clinical signs and symptoms of infection and culture results found for Staphylococcus sp. METHODS: Were evaluated 69 people with 98 ulcers in the period of October/09 to October/2010. The isolates resistant to cefoxitin and/or oxacillin (disk diffusion) were subjected to confirmatory test for detection of MIC, using tapes of oxacillin (E-test ®). The phenotypic detection of the inducible resistance to the MLSB group was performed by the D-test. The clinical signs and symptoms were investigated in accordance with criteria established by the document Identifying criteria for wound infection (EWMA, 2005). Were used the software Statistics Package for Social Sciences for Windows ® (SPSS 17.0) for data processing. For association analysis were used the Chi-square or Fisher's exact tests, adopting a significance level of 5% (α = 0.05). Legal ethical aspects have been respected. RESULTS: The prevalence of S. aureus was 83% and 15% of CoNS. Were identified 28% of MRSA and 47% MRCoNS. Among S. aureus, 69.6% were resistant to erythromycin, 69.6% to clindamycin, 69.6% to gentamicin and 100% to ciprofloxacin. 74% of MRSA showed high level resistance to oxacillin, MIC ≥ 256 μg/mL, and in 65.2% predominated MLSBc constitutive resistance. Of the two MRSA isolates with sensibility to clindamycin, just one was positive for D-test. Signs and symptoms of infection more frequent were: discoloration of the wound and increase the volume of exudate. The stage III of infection was identified in 70 (71.4%) ulcers. An association among friable granulation tissue and cultures positive for Staphylococcus sp. (P = 0.004) and increase the local temperature of the skin and multiresistant Staphylococcus (p = 0.002). CONCLUSIONS: Staphylococcus sp. multidrug-resistant were isolates of venous ulcers in people treated in primary care. The results confirm that the MRSA isolates, beyond resistance to beta-lactams, also exhibit cross-resistance to other antimicrobials such as clindamycin, erythromycin, ciprofloxacin, and gentamicin. Remain a challenge to find indicators of infection for venous ulcersItem 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 clínica e microbiológica de úlceras venosas de pacientes atendidos em Unidades Básicas de Saúde de Goiânia(Universidade Federal de Goiás, 2012-03-30) SANTOS, Silvana de Lima Vieira dos; BACHION, Maria Marcia; http://lattes.cnpq.br/8503907944360635This cross-sectional study was performed in the dressing rooms of the primary healthcare network of Goiânia, Goiás, Brasil, with the following objectives: to identify the prevalence of Gram-negative bacteria (GNB) in venous ulcers (VU) with clinical signs of infection; analyze the susceptibility profile of the isolates; detect the production of AmpC β-lactamases and metallo-beta-lactamases, and extended spectrum beta-lactamase (ESBL); describe the clinical signs and symptoms of infection in VU; evaluate the wounds clinical stage of infection and its relationship with the presence of GNB. The data were analyzed by means of descriptive statistics procedures, proportion and Chi-square tests (p<0.05). All ethical aspects were followed. The participants were 69 patients with venous ulcers, with or without arterial complication, totaling 98 wounds. It was verified that 74.5% of the wounds showed GNB growth, particularly enterobacteria (53.8%) and non-fermenting gram-negative bacteria (46.2%). The prevalent species among the enterobacteria was Escherichia coli (24.5%), followed by Enterobacter aerogenes, Pantoea agglomerans and Proteus mirabilis (12.2% each). Regarding the non-fermenting gram-negative bacteria, the prevalent genre was Pseudomonas (66.6%), particularly the species P. aeruginosa (59.5%), present in 25.5% of the analyzed wounds. Regarding the susceptibility profile of the enterobacteria, the highest resistance rates were to tetracycline (38.8%) and amoxicillin-clavulanic acid (26.5%). Among P. aeruginosa, the highest resistance was observed for cefoxitin (100%). Regarding the production of the AmpC enzyme, 30% of the microorganisms in the CESP (Citrobacter spp., Enterobacter spp., Serratia spp. and Providencia spp.) group, and 100% of the P. aeruginosa were resistant to cefoxitin. The remaining microorganisms of the CESP group (70%) that were sensitive to cefoxitin were subjected to a confirmatory test, and 37.5% were found to be positive for the production of the AmpC enzyme. Regarding metallo-beta-lactamase, 23.8% of the non-fermenting gram-negative bacteria showed reduced sensitivity to imipenem, meropenem or ceftazidime. When subjected to the confirmatory test, 8% of the P. aeruginosa were positive for the MBL enzyme. Regarding the clinical signs and symptoms of infection, the highlighted results with >70% frequency are: opaque and/or reddish brown discoloration; increase in exudate volume and pain. Stage-three infection was the most prevalent (71.4%). An association was found between cellulitis and friable granulation tissue that bleeds easily and the culture for GNB. In conclusion, the presence of gram-negative pathogens with resistance profiles in primary healthcare patients suggests the need to implement microbiological surveillance for patients with VU experiencing a prolonged or difficult healing process, and that the identification VU infection should be guided by knowledge regarding the etiology, classic characteristic and clinical stages of infection.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.Item Análise endotelial da córnea em pacientes submetidos à cirurgia corneal pela técnica de anel intraestromal(Universidade Federal de Goiás, 2012-06-12) SILVA, Rodrigo Salustiano Corrêa e; PEREIRA, Ricardo Antonio; http://lattes.cnpq.br/6293178284668220; ÁVILA, Marcos Pereira de; http://lattes.cnpq.br/3335187297522447To evaluate corneal endothelium by means of specular microscopy exam in patients with keratoconus, before and after Cornealring® corneal intrastromal ring surgery. A hundred and two eyes of sixty-seven patients, aged between 12 and 45, with the average age of 27,31 ± 8,15 years, 30 of whom females and 37 males, were selected to be submitted to the implant of Cornealring® corneal ring segments and evaluation of the corneal endothelium in the pre and post surgery (six months after the procedure) in the External Diseases and Cornea Ward of the Instituto Panamericano da Visão. Data have been stored for later analysis by software SPSS (Statistical Package of Social Science) for Windows 15.0. Only the eyes receiving two rings with 250 μ thickness showed significant statistical difference (p = 0,008). The remaining eyes showed no statistical difference (initial x final). In relation to the thickness and to the number of implanted rings, a decrease in the final coefficient was observed in most implanted rings. However, only the eyes that received two rings 250 μ thick showed significant difference (p=0,003), with a decrease of 10,1% in the coefficients of variation average. In relation to the thickness and number of implanted rings, a decrease in the percentage of hexagonal cells was observed (before and after surgery). Only the eyes that received two rings 250 μ thick showed a highly significant decrease (p=0,001) in relation to the hexagonal percentage of 9,7%. Although the parameters in the specular microscopy showed alterations mainly in the thicker rings, all the patients showed transparent corneas without clinical signs of endothelial suffering along the six months of follow-up. A longer period of study must be considered for better understanding and interpretation of the results obtained, in order to establish any relationship between eventual complications and the thickness of the implanted ring.