Repositório RCAAP

Asthma is a disease with high morbidity and mortality and is the major chronic respiratory disease of children and adolescents. In Brazil there is a prevalence of asthma from 16.1 to 27.2% and it represents the third cause of hospitalization by the Sistema Único de Saúde SUS (Unified Health System). It is not only a complex disease but also difficult to diagnose especially in children, because it is observed characteristic patterns of wheezing at this age. This study has aimed to describe the clinical features and verify the allergen sensitization profile of the skin prick test (SPT) in patients with asthma who were followed in Programa de Controle de Asma de Catalão-GO - Pro-asma - (Asthma Control Program of Catalão-GO) due to the high prevalence and the need for studies in the pediatric population in Brazil. The purpose is to have a better understanding of the disease and especially the way it behaves regarding the patterns of wheezing and atopy which have been observed in recent decades in childhood asthma. A clinical questionnaire has been prepared and applied to the SPT for the major aeroallergens. In a total of 301 study participants, 57% were male and had a median age of 74 months. In 80% of cases, at least one first-degree relative was atopic, 88% had clinical symptoms of rhinitis and passive smoking was found in 29% of the patients homes. The most prevalent aeroallergen was the mite and the sensitization to at least one aeroallergen was of 63%. In the analysis of the sensitization by age group, there was predominance of sensitization asthma in patients over 5 years old and non-sensitization asthma between 2 and 5 years old, with p<0,0001. It was also observed that as time passed, it took older patients more time to get the diagnosis and to initiate the treatment, also with p <0,0001. Therefore, the Pro-asma (Pro-asthma) patients were divided into two large groups: with sensitization and without sensitization. It was shown that the higher prevalence of non-atopic asthma at the age of 5 below coincides with large cohort studies of asthma in childhood. It may show that at this age group, recurrent wheezing can be transient, with no loss of lung function and without features of atopy. It is suggested that asthma may have different patterns according to age, changing the prognosis and severity of the disease.

Disabling chronic neurological diseases such as cerebral palsy (CP), myelomeningocele (MM), Down syndrome (DS) and autistic disorder (AD) are still prevalent in childhood and limit various aspects of child development. Although there is a major negative impact on the health related quality of life (HRQL) of the mothers of affected children, so far no comparative studies have been performed to tell whether these diseases compromise the mothers HRQL in a different way, and whether there is an association of demographic characteristics with HRQL. The intention of this study is to evaluate the HRQL of mothers of children and adolescents with CP, MM, DS and AD, comparing them to each other and to the group of mothers of healthy children and adolescents and to look at the demographic characteristics of mothers of children and adolescents with disabling neurological diseases and their association with HRQL. One hundred and thirty-seven mothers with children and adolescents with CP, MM, DS and AD and 208 mothers with healthy children and adolescents participated. All the mothers answered the Medical Outcomes Study 36- Item Short Form Health Survey (SF-36) and protocol with demographic information. The Alfa Cronbach coefficient was calculated to determine the reliability of the instrument. The demographic variables and the SF-36 scores of mothers of children and adolescents with disabling neurological diseases were compared to the healthy group together or separately according to their child`s diagnosis (Mann-Whitney, Kruskal-Wallis or Chi-Square tests). The SF-36 scores achieved by the mothers of the group with disabling neurological diseases were compared to the demographic variables (Kruskal-Wallis or Mann-Whitney tests) and correlated to the age of mothers, number of children and family income (Spearman correlation coefficient). Mothers in the group with disabling neurological diseases had lower scores than healthy group (p<0.05) in most domains, when compared together or separately according to their child`s diagnosis. There was no significant difference in the HRQL among the mothers of children and adolescents with CP, MM, DS and AD. Mothers of children and adolescents with disabling neurological diseases presented a lower frequency of continued employment, a higher frequency of stable marital unions and higher family income compared to the healthy group. Older mothers or widows had lower scores in the physical dimension of SF-36 (p<0.05). Concluding, mothers of children and adolescents with CP, MM, DS and AD presented multidimensional impairment in HRQL, compared to the mothers of healthy children and adolescents, but this negative impact was not different from the groups of mothers of children and adolescents with disabling neurological diseases. The negative impact on HRQL was greater in the physical dimension among older mothers or widows.

National curricular guidelines suggest a shift in healthcare model with the use of patient-centered practices and flexible physician behavior that meets patients\' preferences. This change requires appropriate evaluation of medical students\', physicians\' and patients\' attitudes with valid and reliable instruments. The objective of this study was to translate, culturally adapt and validate the Patient-Practitioner Orientation Scale (PPOS) to Portuguese spoken in Brazil. The PPOS is a measure of individual attitudes regarding medical/disease or patient-oriented practices. This instrument was translated according to international guidelines of translation. Two translated versions, a back-translation and author\'s observations were assessed by five reviewers through modified Delphi and the pre-final version of the PPOS was obtained. This pre-final version was then assessed by the author of the scale and pre-tested with 37 participants (12 resident physicians, 13 medical students and 12 patients). Pre-test results were analyzed by three evaluators (doctors) and two researchers to produce a final version of the Brazilian version of the PPOS - the EOMP. This final version was approved by the scale author and by a language coordinator. The EOMP was then applied to 360 participants (120 resident physicians, 120 medical students and 120 patients). We verified data quality (lost data, floor and ceiling effects), test-retest reliability (intraclass correlation reliability), internal consistency reliability (Cronbach\'s alpha coefficient) and construct validity (explanatory factor analysis with principal component analysis, two factors extraction, Oblimin rotation and Kaiser criterion; confirmatory factor analysis with maximum likelihood method and goodness-of-fit indexes: X2/df, RMSEA, SRMR, GFI, AGFI, NNFI and CFI). During independent review process (modified Delphi), only two items (04 and 17) did not reach a minimum of 80% agreement among the reviewers or produce answer stability throughout the different testing sessions. During pre-testing, seven items (38.9%) were modified according to pre-established criteria. The rate of lost data was 0.28%. Floor effect was observed in most of items answered by patients. Ceiling effect was detected in most of items answered by residents, students and patients. Internal consistency reliability (Cronbach s alpha = 0.605) and test-retest reliability (intraclass correlation coefficient = 0.670) were considered to be adequate. In the two-factor principal component analysis (a priori criteria), one item (item 09) did not achieve a loading factor higher than 0.3, one item (item 15) was considered factorially complex and two items (items 02 and 14) were inconsistent with a priori factors (explanatory factor analysis). A confirmatory factor analysis provided an acceptable adjustment for the observed variables (X2/df = 2.33; GFI= 0.91; AGFI= 0.89; CFI= 0.84; NFI= 0.75; NNFI= 0.81; RMSEA= 0.062 (p= 0.016) e SRMR= 0.065). These results show that the EOMP has adequate reliability and acceptable validity. This scale may be useful in evaluating physicians\', medical students\' and patients\' attitudes in Brazil.

Fundação de Amparo a Pesquisa do Estado de Minas Gerais

To evaluate the patterns of the ophthalmic artery Doppler velocimetry in pregnant women with gestational diabetes mellitus (GDM), comparing them with those found in normal pregnant women. This is an observational study that examined the ophthalmic artery Doppler indices in two groups: one consisting of 40 pregnant women diagnosed with GDM and the other for 40 normal pregnant women, treated at the Hospital Clinics of the Federal University of Uberlândia. The study was approved by the Ethics Committee and Research institution under the number 293/10. The patients underwent Doppler ultrasound of the ophthalmic artery from 27 weeks. The variables analyzed were: pulsatility index (PI), resistance index (RI), peak velocity ratio (PVR), peak systolic velocity (PSV) and end distolic velocity (EDV). To analyze the normality of the samples was used Lillefors test and Student st- tests and Mann-Whitney test to compare means and medians, as data normality. The significance level used was of 95%. The mean age of pregnant women with GDM was 30,0 ± 5,5 years and pregnant women at 24,2 ± 5,5 years. The mean gestational ages were 33,7 ± 2,7 weeks and 33, 9 ± 2,7 weeks in groups of GDM and normal pregnant women. There was no significant difference between the mean gestational age between the two groups analyzed (p = 0,701). The median and mean values with standard deviation of the variables of the ophthalmic artery Doppler group GDM and normal pregnant women were: PI = 1,68 ± 0,60 / 1,64 ± 0,46 (p = 0,695); RI = 0,75 / 0,75 (p = 0,980); RPV = 0,54 ± 0,11 / 0,50 ± 0,11 (p=0,117); PVS(cm/s)= 33,05 / 31,91 (p=0,721) e EDV(cm/s)= 6,24 / 7,89 (p=0,485). Twenty-six patients (65%) underwent mapping of the retina with normal results. There were no significant changes in flow patterns of ophthalmic arteries in the group of pregnant women with GDM, showing that the time of exposure to the disease during pregnancy was short to cause significant vascular disorders within central.

Objective: The purpose of this paper is to analyze the pre-gestational diabetes can modify the defaults maternal ophthalmic artery Doppler velocimetry. Methods: This prospective observational study that examined the ophthalmic artery Doppler 30 pregnant women with pre-gestational diabetes according to the criteria of the American Diabetes Association (ADA) and compared with data from a control group of 40 normal pregnant women. Inclusion criteria were pregnant women above 18 years with a diagnosis of diabetes mellitus type I, II, or secondary, with a gestational age greater than or equal to 20 weeks. We excluded patients with heart disease, and hypertensive smokers. All patients underwent obstetrical ultrasound examination, focusing on Doppler examination of the ophthalmic artery. The following variables were measured in the ophthalmic artery, resistance index (RI), pulsatility index (PI), peak velocity ratio (RPV), peak systolic velocity (PSV) and end diastolic velocity (EDV). Statistical analysis was performed calculating the average, median and standard deviation (SD) of variables and applying Student\'s t test and Mann-Whitney test as normality of the sample. The significance level was 95%. Results: The diabetic women had a mean age of 28 years (SD 8.5) and mean gestational age 30 weeks (SD 2.8). The average or median and SD of the indexes of the study group were: RI = 0.75, PI = 1.83 (SD 0.34); RPV = 0.53 (SD 0.01), PSV = 31.92; VDF = 7.89. When comparing the mean between the study group and normal group of patients showed an increase of PSV and EDV in the diabetic group compared to the normal group, with significant results (p = 0.020 and p = 0.005 respectively). The other Doppler indices did not differ significantly between the two groups. Conclusion: In this study it was observed that the ophthalmic artery Doppler signals identified orbital hyperperfusion in diabetic pregnant women, by high values of peak systolic velocity and end diastolic velocity in relation to pregnant women.

Gastro-esophageal Reflux Disease (GERD) resulting from acid reflux can be diagnosed by prolonged esophageal pH monitoring. This examination in the preterm newborns (PTNBs) seeks to establish some relationship between GERD and nonspecific symptoms. This study aimed to evaluate the esophageal pH monitoring in PTNBs hospitalized with clinically suspected of GERD. In a prospective cross-sectional study esophageal pH monitoring was performed in PTNBs with clinical suspicion of GERD, gestational age less than 37 weeks and birth weight less than 2000 grams, from February 2010 to March 2011. We analyzed the clinical and demographic data, the general parameters of pH monitoring for acid reflux, the index of symptoms and the measurements for positioning the inner esophageal electrode. Of the 225 preterm infants admitted, the clinical diagnosis of GERD was assigned to 34 (15.1%). In 31 (93.9%) was found reflux index (RI) >10% and 12 (38.7%) linking the RI >10% and oscillatory index <15%, increasing the reliability of the results of RI. The mean (standard deviation) number of long refluxes and the time of the longest reflux were respectively 19.3 (9.4) and 69.2 minutes (33.2), with strong positive correlation between RI (r = 0.77 and r = 0.78, p <0.05, respectively). The association of reflux with oxygen desaturation occurred in 8 (30.8%) PTNBs. The phasic pattern of the pH monitoring tracing, suggesting allergy to cows milk protein was found in 5 (15.1%) examinations. The positioning of the inner esophageal electrode, by using the Strobel s formula and PTNBs equations for weight was highly positive correlated with fluoroscopy (r = 0.79 and r = 0.77, p <0.05, respectively). There was an expressive RI positivity indicating abnormal acidification of the esophagus in most patients clinically suspected of having GERD. Consider the other parameters used in this study for analysis of esophageal pH monitoring in PTNBs can be helpful.

Introduction: Chronic complications of Diabetes Mellitus (DM) are responsible for incapacity for work. In Brazil, however, the role of this disease in early retirement due to disability has not been much studied. The purpose of this study is to evaluate diabetes mellitus as a cause of retirement among employees of the city administration of Uberlandia. Methods: Data were obtained on city employees retired due to permanent disability as a consequence of accidents at work/occupational disease and common diseases from January 1990 to December 2009. The data were collected from the reports of the Official Board of Medical Inspection (Junta Oficial de Inspeção Médica) of Uberlandia (IPREMU). The causes were computed according to the International Classification of Diseases (ICD10). A data base built using the Epi Info program version 3.5.1 (CDC, Atlanta, in the Public Domain) was evaluated statistically by this and by the SPSS computer program. Results: Four hundred and three (94.16%) of the 428 benefits of retirement due to disability granted during the period studied were evaluated: 210 (52.1%) were motivated by a single cause. In this group mental and behavioral disorders, osteomuscular system diseases and circulatory system diseases were the three main causes, and endocrine diseases accounted for 4.29%. Among the retirees, 53.8% were women; their mean age was 49 years, and 53 years for the men. Retirement due to disability occurred among men, on the average, 19 ± 6.9 years earlier than it would occur due to time worked, and among women 17 ± 5.9 years earlier (p=0.001). Among all ICDs responsible for retirement, diseases of the osteomuscular system, circulatory system diseases, and mental and behavioral disorders also predominated. Endocrine diseases were 7.45%. Diabetes mellitus was responsible for only 8.44% of the benefits, but for 62.96% among the endocrine diseases. The age at which diabetic women retired was on average 53.8 ± 9.3 years, and the men, 55.2 ± 9.5 (p=0.67). Diabetic women lost, on average, 13.6 ± 6.3 years of productivity and men 19.5 ± 7.4 years (p=0.017). Productive time lost was greater among non diabetic than among diabetic women (p=0.002). As to type of diabetes, 55.88% had type 2 DM, with an average age of 56 ± 8.8 years, and 44.12% were type 1, with an average of 52.6 ± 9.8 years (p=0.306). There was a higher proportion of women among the people retired due to DM 2 (82.35%) (p =0.0049) and among the men, in those whose retirement was caused by DM 2 (70.59%) (p=0.002). Diabetics retired later than non diabetics (p=0.001) and compared to those with mental disorders (p<0.001) and neoplasias (p=0.001). There was no difference when productive time lost in retirements due to diabetes and retirements due to mental and behavioral disorders, osteomuscular system diseases, circulatory disorders and neoplasias are compared. Conclusions: Among the city employees of Uberlandia, osteomuscular system diseases, circulatory system diseases and mental and behavioral disorders are the most frequent causes of retirement. Diabetes mellitus is the main endocrine disease responsible, mainly due to neuropathies, nephropathies, retinopathies and multiple complications. Those who retired due to complications of DM are older than those who retired due to other diseases. Productive time lost was similar among diabetics and non diabetics, and in the two groups it was greater among the men. Productive time lost was greater among non diabetic women than among the diabetic ones.

Correction of large abdominal wall defects leads to the use of synthesis material. There is no ideal prosthesis and, polypropylene is the most used material, although it causes a lot of adhesions formation. Many prosthetic materials have been tested, but until now none have been found to be totally satisfactory. In 1994 a latex based material was developed and used in humans as a biologic dressing for chronic phlebopathic cutaneous ulcer and for pterygium surgery. Objective: To determinate if the biologic activities for adhesions formation in the abdominal wall reconstruction using a polypropylene latex coated mesh is more adequate than polypropylene mesh alone. Methodology: 90 male Wistar rats were distributed in 3 equal groups. Group I (control) - The animals were submitted to a 4 cm medial laparotomy with peritoneal cavity exposition and posterior closure (synthesis); Group II (polypropylene) - The animals were submitted to the resection of a 2.0 cm x 3.0 cm of abdominal wall, and the defect was corrected with a polypropylene mesh; Group III - The animals were submitted to the same procedure, but using the new material (polypropylene latex coated). After 45 days the euthanasia procedure was done and the adhesions were evaluated in 2 ways: 1) classification in a grading system from 0 to 5 according to the number, resistance and structures evolved; 2) Evaluation of the adhesion area that was calculated by dying with India ink the abdominal wall segment that had adhesions, though producing a clear area in contrast with the rest of the dyed areas. Results: The group I animals did not have any complications, whereas in Group II eight animals died, nevertheless one occurred in the immediate post operative period because of bleeding. In Group III nine animals died, one because of the anesthetic procedure, and 8 because of complications related to the surgical procedure (fistula, evisceration and obstruction). The classification in a grading system showed that Group III animals had lesser adhesions formation (P<0.05), but the evaluation of the adhesions area did not show the same result (P>0.05). The severe complications (fistula, evisceration and obstruction) that caused the death were not reduced by the latex coated material. Conclusion: The polypropylene latex coated material causes lesser adhesions formation than polypropylene alone, nevertheless does not diminish the severe early complications.

Violence against children and adolescents reaches alarming levels all around the world, especially in Brazil, where it is a deep public health problem as it causes strong impact on population morbidity and death rate. The main purpose of this study is to distinguish the aspects of violence against children and adolescents, the victims and their aggressors in the town of Uberlandia. Health records of violence cases confirmed against children and adolescents (from 0 to 18 years old) had been carried through in two public institutions, references in the city of Uberlandia: the Hospital de Clínicas de Uberlândia (HCU), in the period of 1996 to 2003, and the Centro de Referência à Infância e Adolescência Vitimizada (CRIAV), from 1993 to 2003. Later the information desired had been collected through forms of collection of data elaborated exclusively for the accomplishment of the research. In the HCU, 663 medical records had been analyzed and 711 cases of violence were registered. In the CRIAV, 1210 adolescents and children had been victimized, totalizing 1389 cases. In the Hospital, they had been 607 (85.4 %) cases of physical violence, most of cases of violence were with male victims (437; 61.5 %) and mainly adolescents (477, 71.9%). In the CRIAV, the usual cases were: physical violence (586; 42.1%) and neglect (583; 42.0 %), there was no great difference between the genders of victims (726; 52.3 % were male) and most of them younger than 12 years old (979; 80.9%). The cases of violence had occurred mainly at home (HCU - 61.4% and CRIAV - 94.2%). The injuries most described in the HCU had been excoriations (191; 28.8%), the wounds cut-contusions (187; 28.2 %) and hematomas (143; 21.6%), in the CRIAV, hematomas (106; 14.4%) and bruises (82; 11.1%). At the Hospital, 98 (14.8%) children or adolescents had been interned and 88 (13.3%) submitted to surgeries, 32 (4.8%) cases had been directed to the Legal Medical Rank and 22 (3.3%) to the Tutorial Council for children and adolescents. The main behaviors in the cases of the CRIAV were family orientation (380; 51.6%) and domiciliary visits (266; 36.1%). The aggressors were victims relatives in the great majority of the cases from CRIAV (911; 94.1%) and about half of medical records where this information had been registered (115; 53.7%). Among these, the mother was the main aggressor at the Reference Center (482; 52.9 %) and the father in the cases at the Hospital (41; 35.7%). At CRIAV, most of the aggressors were between the age of 20 to 40 years old (446; 73.8%), didn t finish elementary education (321; 67.1%) and kept a steady conjugal relationship (484; 50.0%). Considering drugs, 250 (25.8%) aggressors used to drink alcohol and 99 (10.2%) used to take other drugs (99; 10.2%). The conclusions are that the characteristics of the victims and the types of violence vary according to the attendance institution. At the HCU, attendance is motivated mostly due to physical violence and it reaches mainly male adolescents, with injuries that, in many cases, request internments and surgical treatment. The service doesn t include the guiding of the cases to the Tutorial Council. At CRIAV, the main cases are physical violence and neglect that mainly reach children younger than 12, (cases number decrease as the age goes up). The aggressors are between 20 to 40 years old, did not accomplish basic education, half of them are married or live with a partner, 1/4 have alcohol and about 10% take other drugs. At both institutions most cases of violence takes part at home and is perpetrated by victims own parents.

Alcohol and hepatitis C virus (HCV) can act synergically increasing the liver disease progression. The aim of this study was to evaluate the impact of alcohol consumption among patients undergoing treatment for HCV. For this, 121 patients were included in this study, of which 78 (64.5%) were men; aged 28-70 years. It was evaluated the relationship of alcohol with pre-treatment viral loads, liver histology, adherence to treatment, early virologic response (EVR), end-of-treatment response (ETR) and sustained virologic response (SVR). For the statistical analysis it was used the X2 test or Fisher\'s exact test and multivariate analysis, calculating odds ratios and 95% confidence intervals. P value ≤0.05 was considered significant. Among patients who consumed >60g/day of alcohol lifetime, the frequencies of viral load ≥106 IU/mL and discontinuation of treatment (50% and 32.4%, respectively) were higher (p <0.05) than among abstainers (27.3% and 9.4%, respectively); treatment discontinuation was more frequent (p<0.05) among those who continued consuming alcohol during treatment (66.7% vs. 21.4%) and more frequent among those who were not abstinent for at least six months prior to treatment (72.7% vs. 15.4%), it was also more frequent among those with CAGE ≥ 2 (19% vs. 2%) or AUDIT diagnosing harmful use or probable alcohol dependence (57.1% vs. 3.3%). Liver fibrosis was more frequent (p<0.05) among men who drank >60g/day of ethanol for over 10 years (87.9%) than among those who drank smaller amounts (60.9%) or were abstinent (61.1%). Through univariate analysis, the SVR rate was similar among patients with different patterns of alcohol consumption. Multivariate analysis showed a positive association between adherence ≥80% and the treatment näive patient with EVR; only HIV coinfection was negatively associated with SVR. The small number of patients did not allow statistical analysis to evaluate predictors of ETR. In conclusion, patients with heavy lifetime alcohol consumption had, more frequently, liver fibrosis, high viral loads and treatment discontinuation; however, among those who have not discontinued, the frequencies of SVR were similar when compared to abstinent or moderate drinkers. Thus, alcoholics should be treated for HCV infection with the accompaniment of a multidisciplinary team, in order to encourage their adherence to treatment and alcohol abstinence.

Leprosy, a chronic infectious disease caused by Mycobacterium leprae, still persists as a public health problem in Brazil due to its high potential to cause physical disabilities triggered mainly by leprosy reactions that can occur before, during and or after multidrug therapy. The aim of this study was to characterize the leprosy reactions in its clinical aspect, epidemiological and laboratory in patients diagnosed from 2002 to 2009, a National Reference Center. In this cross-sectional observational study, we used secondary data source, which evaluated 440 cases, with predominance in the reaction of the operational classification MB 80.5% (202/251) of the clinical DT 33.9% (85 / 251), male 68.5% (172/251), Caucasians 53.4% (134/251) and aged 40 to 59 years 52.2% (131/251). Of the total cases, 57% (251/440) had leprosy reactions, 47.9% (211/440) during treatment and 35.9% (158/440) after discharge. The type of reaction was the most prevalent type 1 with 64.5% (136/211) during treatment, and 73.5% (155/211) of reactional episodes occurred in the first three months, averaging 1.6 episodes per patient and 63.9% (101/158) with post treatment reaction, which in 91.1% of leprosy reactions occurred within 15 months the period mentioned, whose average response was 1.9 per patient. Dermal smear (OR: 6.39, p <0.001) and ELISA serology anti-PGL-1 (OR: 4.77, p <0.001) positive at diagnosis, presence of leukocytosis (OR: 9.97, p < 0.001), thrombocytopenia (OR: 5.72, p <0.001) and elevated serum lactate dehydrogenase (OR: 2.38, p = 0.001) were predictive factors for the emergence of both reactions (Type 1 and Type 2) during treatment, and there was a positive correlation between the number of reactions that period with the bacterial index (BI) ≥ 2.3 (r = 0.217, p = 0.0019) and index values ELISA anti-PGL-1 ≥ 2.8 (r = 0.248, p = 0.0007). For the occurrence of post treatment reaction, a positive smear (OR: 8.47, p <0.001) and PCR for detection of DNA of M. leprae (OR: 6.46, p <0.001) in the upper dermal smear, anemia (OR: 2.36, p = 0.013), leukocytosis (OR: 4.14, p = 0.007), thrombocytopenia (OR: 3.70, p = 0.008) were the findings related to potential markers of both leprosy reactions during this period. This epidemiological study identified clinical and laboratory predictors related to the occurrence of leprosy reactions during and after treatment and characterized target groups for interventions to improvements in prevention, monitoring and timely treatment to prevent neurological damage and, consequently, physical disabilities, which has been related stigma to leprosy.

Conselho Nacional de Desenvolvimento Científico e Tecnológico

The aim of this study was to quantify the number of vessels with stenotic points in the coronary circulation of lean and overweight individuals submitted to coronary angiography and ventriculography, in order to verify the possible associations with glomerular filtration and the systolic ventricular function. Eighty-six patients with a previous history of myocardial ischemia were studied. Two groups were formed: non-elderly (G1), n = 38; 52.8 ± 1.2 years old, and elderly (G2), n = 48; 70.1 ±1.2 years old. Both groups were divided into 2 subgroups according to the estimated glomerular filtration rate (eGFR): 60 ≥ and <60 ml/min/m 2. The results showed that G1 had 0.36 ± 0.11 versus 1.25 ± 0.45 stenosis/patient (≥60 vs <60 ml/min/m2; p <0.05, respectively) and G2 had 0.91 ± 0.28 versus 1.83 ± 0.33 stenosis/patient (≥60 vs <60 ml/min/ m2, respectively). The other variables, such as central and brachial arterial blood pressures, did not manifest significant differences in relation to the eGFR. The following significant correlations were observed: between the quantity of coronary stenotic points and the eGFR (R2 = 11.2%; r = 0.33; p <0.001), and between eGFR and the ventricular ejection fraction (R2 = 5.1%; r = 0.57; <0.0001). The ejection fraction correlated significantly with the number of vessels with stenosis in the coronary bed (R2 = 13.4%; r = 0.36; p <0.008). In conclusion, although the correlations are considered weak, interrelationships between heart and kidney were demonstrated in this study, demonstrating that reduction in glomerular filtration influences the number of stenotic coronary vases, the existence of correlation between the number of coronary stenotic vases and left systolic ventricular function as well the existence of correlation between left systolic ventricular function and glomerular filtration.

The systemic hypertension is a disease with high prevalence and the major cause of cardiovascular morbid-mortality. Among the therapeutic measuresrecommendedare the modificationoflifestyle andregularphysical activity. It is knownthat someantihypertensive drugshaveeffects onexercise tolerancewhichcouldadversely affectadherenceto the practiceof thesephysical activities. The objective of this study was to evaluate the tolerance of the exertion in hypertensive during the use of, hydrochlorothiazide or enalapril associated to hydrochlorothiazide, comparing the results to a one group of normotensives patients. There were 59 adults of both gender, included in the study, 22 normotensive (C=22) and 37 hypertensive. The hypertensive ones were treated with enalapril (E=11), hydrochlorothiazide (H=11), hydrochlorothiazide/enalapril (H/E=15). The tolerance of the exertion was estimated by the consumption of VO2max, MET and lactate, ergometric test were made using Bruce protocol. At the same time the levels of blood pressure and heart rate were measured. CBC, total cholesterol, HDL, LDL, triglycerides, Na+, K+, Ca++, Mg++ , urea, creatinine, uric acid, TSH and fasting glucose, were also tested. The patients treated with enalapril, hydrochlorothiazide and an association of these two drugs showed that the maximum consumption of oxygen and metabolic equivalent were statistically alike. High values of lactate were found just at the initial stage of the test on the hydrochlorothiazide group compared to the normotensives one. The potassium of the hydrochlorothiazide group was lower compared to the ones patients in usingenalapril and the normotensives. The diastolic blood pressure of both fasting and exertion was significantly higher in the enalapril group than in the normotensive group. The other variables did not present statistical differences. The patients, whom were taking enalapril, hydrochlorothiazide and hydrochlorothiazide/enalapril showed tolerance to exercise as well as the normotensive. The best control of systolic blood pressure and diastolic blood pressure occurred in the hydrochlorothiazide group.

The detection of in-stent restenosis is important in clinical practice by providing useful information to guide therapy. The objectives of this study were to evaluate the effectiveness of the exercise test (ET) in the detection of restenosis after percutaneous transluminal coronary angioplasty with stent conventional implantation (Stent-ATC) and, as a gold standard, coronary angiography. We studied 25 asymptomatic patients, aged between 44 and 83 years, who underwent PTCA-Stent for at least six months. The patients underwent TE employing the Bruce protocol. The positivity criteria for ischemia was ST segment depression > 1mm, measured at the J point and with horizontal or descending. The results obtained in TE were compared with those of coronary angiography is considered the in-stent restenosis lesions with obstruction > 50%. We estimated the sensitivity and specificity and positive predictive value and negative procedure. Of the individuals studied, 10 (40%) had in-stent restenosis by angiographic criteria, and only 3 (12%) had positive TST tests for ischemia. The relationship between the TE and coronary angiography was not significant (p = 0.315), indicating that the tests are independent. The concordance between the diagnoses was low (Kappa coefficient: 0.151), the same occurring with the sensitivity (20%). The specificity of the test was high (93%) and positive predictive value 65.56% and negative predictive value 63.63%. The overall efficiency of the test is estimated with accuracy low 63.98%. We conclude that the TE has low sensitivity and high specificity in detecting in-stent restenosis in asymptomatic patients. The overall efficiency of ET is low.

The healthy alimentation comprises an alimentary pattern suitable for the biological and social necessities of individuals, being fundamental for the attainment of a good health. A healthy alimentation must contain nutriments from all food groups responsible for the provision of energy and nutrients fundamental for a good nutrition, such as carbohydrate, protein, lipid, water, fiber, vitamins and minerals. The binomial alimentation and nutrition is present in the national legislation of the Federative Republic of Brazil. In the year of 2006, the Ministry of Health published the Alimentary Guide for the Brazilian Population, including oficial guidelines around the healthy alimentary practices for the population. On account of the importance of the student assistance as a strategy for the struggle against social and regional inequalities and enlargement and democratization of the conditions of access and permanency of young at the public superior education, the Ministry of Education (MEC) instituted, in 2007, the National Student Assistance Program (PNAES). Among the guidelines attended by PNAES, alimentation is one of the prioritary issue areas and focuses on the supply of meals for the students with low socioeconomic condition. This way, in the Institutions of Public Superior Education part of the financial resources of PNAES must be directed to the acquisition of alimentary genders that attend to a specific and balanced menu, previously elaborated by a nutritionist. Despite these considerations, until this moment, it wasn t possible for us to identify in the literature any study evaluating the conformity of the alimentary practices of UR with the recommendations advocated by the Alimentary Guide for the Brazilian Population. Considering the importance that healthy alimentary practices features to the attainment and maintenance of normal nutritional status and health, and also to the prevention and control of chronic non-communicable diseases (NDC), the present study had as objective evaluate the alimentary practices of UR users from Federal University of Uberlândia (UR-FUU). After the determination of the sample of study, it was collected information related to the alimentary habits for the classification of UR-FUU users based on the ingestion or not of meat and derivates, and it was performed an evaluation utilizing the Test: how is your alimentation? , proposed by the Ministry of Health. In addition, it was requested the filling of the Alimentary Register of three days . On the final study analysis, it was included 364 individuals, being 340 students, and 24 administrative technical professionals. The users were distributed into strata, in accordance with the age group [(18 Ⱶ 20 years); (21 Ⱶ 24 years); (25 Ⱶ 29 years); (30 years or more)] and gender [198 men (54,4%) and 166 women (45,6%)]. Between users, 353 informed the consumption of meat and derivates and seven denied this possibility. In relation to the number of meals/snacks it was identified that the mode is concentrated in four meals per day. A total of 257 users (70,6%) consumed meats or eggs daily, in quantities superior than the recommended (only 27% of individuals performed the daily recommended consumption). In relation to the consumption of milk and derivates it was observed that 72 (19,8%) users performed the consumption in accordance with the recommended [270 users (74,1%) presented consumption inferior to the recommended]. In the analysis of the medium consumption of leguminous it was observed that 295 users (80,96%) performed the consumption in accordance with the recommended, with the variable mode located in the recommended quantity of leguminous. The recommended consumption of fruits and leguminous / vegetables was demonstrated for 132 (36,69%) and 136 (37,38%) users, respectively. Sixty and eight UR-FUU users (18,9%) related the addition of an extra quantity of chicken salt on food already prepared. In the analysis of the results of alimentary register (AR) (N=48) it was identified that the total caloric value (TCV) of the diet was superior than the recommended to the majority of UR-FUU users, being demonstrated a statistically significant difference in the consumption of energy between men and women (p=0,001). The values of the medium consumption of carbohydrate (277,05 g, 58% and 344,77 g, 55%), lipid (59,47 g, 28% and 77,52 g, 28%) and protein (77,59 g, 16% and 101,16 g, 16%) for women and men, respectively, are compatible with a balanced diet, with discreet increase in the medium amount of protein daily consumed. In the descriptive analysis of the alimentary consumption variables of UR-FUU users relative to vitamin A, it was observed a great variation between the minimum (164,13 μgEqRe/day; 0,23 times the reference value) and maximum values (26.327,36 μgEqRe/day; 37,61 times the reference value) in the consumption of this nutrient for both sex, however, with emphasis for women. The medium consumption value of folic acid for men (208,68 μg/day; 0,52 times the reference value) and for women (150,87 μg/day; 0,37 times the reference value) was inferior to the recommendation of the Institute of Medicine (2002). Minimum values very low was identified for men (69,17μg/day; 0,17 times the reference value) and for women (50,05 μg/day; 0,12 times the reference value). In relation to the daily medium consumption of vitamin C it was identified ingestion superior than the recommended with values of 274,20 mg/day and 129,64 mg/day for women and men, respectively. The daily medium consumption of vitamin E, thiamine and niacin presented values near the recommended ingestion. In relation to the distribution of minerals ingested by RU-FUU users it was observed that the daily medium consumption of iodine, zinc, iron and calcium was under the recommended value for 100%; 52,1%; 52,1% and 95,8%, respectively, of the population analyzed. The under recommended consumption of iron was significantly higher for women (p=0,000). Sodium was the single mineral analyzed that presented medium consumption above the recommended value (83,3% of analyzed population). Conclusion is that alimentary practices of RU-FUU users attend to the basic principles of macronutrients distribution among a balanced diet and number of meals, provides the regular and expressive consumption of leguminous, being, however, necessary to carry out orientation about excessive energy ingestion. In addition, although the quantity of protein ingested has values slightly above the recommendation, the daily ingestion of milk and derivates, and also of calcium, is inferior to the recommendation. The daily ingestion of fruits and leguminous / vegetables is inferior to the recommendation for the majority of UR-FUU users, being possible deduce that this alimentary practice is contributing to the low daily medium consumption of folic acid, iodine, zinc, iron and calcium. The habit of extra chicken salt addition to prepared food and the excessive consumption of sodium identified for the totality of UR-FUU users are altogether worrying. In synthesis, the PNAES and UR-FUU have contributed in a decisive way to the alimentary and nutritional security of the Federal University of Uberlândia community. However, effective and enduring corrective measures are necessary, in such a way that the alimentation supplied for RU-FUU users can contribute even more for the attainment and maintenance of their normal nutritional status and health, particularly in prevention and control of NDCs.

All the objects present in the operating room, as well as the table of surgical instruments can be a source of contamination of the surgical site. Its fitting, following rules of asepsis, as well as the adequate sterilization of materials that will be exposed on the table, are key to reducing the rates of ISC. The use of fields of fabric covering the table surgical instrument reduces contamination of the material and consequently the ISC. But there is no work in the medical literature on the prior use of sterile plastic covering the table of surgical instruments in the field of sterile, routinely used in most surgical centers. The objective of this study was to analyze the use of field sterile plastic or friction of a solution of 70% alcohol and iodine to 1 %, used in tables of surgical instruments, as extrinsic factor to prevent contamination trans-operative surgical site. This was a randomized experiment, with collections of samples of the areas of tables of surgical instruments, before and after each procedure, with subsequent microbiological analysis for identification of microorganisms and its antimicrobial resistance. Results: In surgeries in which the sterilized plastic was used, the bacterial growth was 5.71 % before and 28.6 % after surgery while in disinfections with solution of 70% alcohol and iodine to 1 %, growth was 2.9 % before and 45.7 % after, without significant difference between the methods employed. To identify the microorganisms present in the tables of surgical instruments, we had prevalence of Micrococcus spp, and small percentage of Staphylococcus spp, they do not behave as multidrug-resistant front the classes of antimicrobial agents tested. As to the remaining factors evaluated, as surgery time, ASA classification of patient, use of antimicrobials, quantity of persons present in the operating room during the procedure, etc. , we noticed that the two groups were similar, it is not these determining factors of difference of contamination of tables of surgical instruments in two methods employed. Conclusions: the two methods have the power of similar protection, whereas the solution of 70% alcohol and iodine 1% does not generate solid waste.

Fundação de Amparo a Pesquisa do Estado de Minas Gerais

The cerebral palsy (CP) characterizes a heterogeneous group of posture and movement conditions, of non-progressive nature, which occurs in the developing brain and causes motor limitations in several degrees. The disability caused by the disease generates repercussions in the life and well-being of subjects and their families. Mothers, who often are the main caregivers, may present negative impact on their health and quality of life, but it isn t possible yet to state if the clinical and demographic factors are determinant to this injury. This study has, as its objectives, evaluating the health related quality of life (HRQOL) of mothers of children and adolescents with cerebral palsy (CP) in comparison with mothers of healthy children; verify the association between clinical/demographic variables and the HRQOL of mothers; evaluate the association between the HRQOL of the mothers compared with the HRQOL of their children. In this transversal study, it was accounted the participation of 100 mothers of children and adolescents with CP and 100 mothers of healthy children and adolescents. Every mother answered the generic questionnaire of HRQOL SF-36 by interview and Beck s Depression Inventory (BDI) through self-application. Both CHQ-PF50 and CHAQ were answered through self-application method by the mothers of patients with ages between 5 and 20 years and utilized for the correlation between the HRQOL of the patients and their mothers. Mothers of the PC group presented lower scores than the healthy group in every domain of the SF-36 (p&#8804;0.05). Some associations were found between the SF-36 and the clinical/demographic variables: BDI presented a negative correlation (r= -0,21 a r= -0,60) with the domains of the SF-36; mother s age, patient s age, mother s scholarity were correlated with the mental component of the SF-36 (p&#8804;0.05); unemployed mothers had lower scores in 3 domains of the SF-36 (p&#8804;0.05); mothers of children in medication use had lower scores in the physical component with small effect size (p&#8804;0.05). The motor gravity type of CP and scores in CHAQ had no correlation with the SF-36 (p&#8804;0.05). Some correlations occurred between the physical and mental summaries (p&#8804;0.05). Mothers of children and adolescents with CP presented negative mental and physical impact in their HRQOL in comparison with mothers of healthy children and adolescents. The greater the intensity of depressive symptoms was, the greater the injury in the HRQOL of the mothers. The mother s age, patient s age, mother s scholarity, employment situation and some dimensions of the HRQOL of their children presented association with the HRQOL of the mothers.