Repositório RCAAP

Fundação de Amparo a Pesquisa do Estado de Minas Gerais

Fundação de Amparo a Pesquisa do Estado de Minas Gerais

Objective: To determine the association between systolic blood pressure (SBP) values at the start and end of a hemodialysis (HD) session in intradialytic hypertension (IDH) patients. Methods: This study evaluated the systolic blood pressure patterns in 154 chronic kidney disease patients; among these patients, 18 were identified as having intradialytic hypertension. After patient selection, four consecutive hemodialysis sessions were prospectively evaluated for each patient, totaling 72 sessions. SBP, diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP), and heart rate (HR) were measured at 30, 60, 90, 120, 150, 180, 210, and 240 minutes. PP was calculated using the formula PP= SBP - DBP. The results for each pressure represent the arithmetic mean of the 72 sessions analyzed at the previously specified times. Results: A linear relationship was revealed between the systolic blood pressure levels measured after 30 minutes and those obtained after 240 minutes of HD (r=0.742, p=0.001). This association became stronger at 90 minutes (r=0.937; p <0.001), indicating that for intradialytic hypertension patients, systolic blood pressure values at the start of HD were correlated to systolic blood pressure values at the end of the session. Conclusion: For intradialytic hypertension patients, values obtained at the end of HD are correlated with the initial values. This information could facilitate planning and earlier treatment.

The pelvic floor muscles (PFM) are responsible for supporting the pelvic viscera and for promote urinary and fecal continence. Several studies observed the consequences of the perineal trauma during childbirth on the PFM, but there is lack of research in order to evaluate these muscles during pregnancy, so, although the physiological changes of pregnancy is known, there is not enough data on how these changes influence the PFM function. Therefore, this study aims to evaluate the functions of PFM during pregnancy and compare with nulliparous pelvic floor (PF) function. It is a cross-sectional study, observational, comparative, conducted between April and July 2015.The study population consisted of 141 women: 36 nulliparous (C group), 31 primiparous on first trimester pregnancy (1T group), 42 on second trimester (2T group) and 32 on third (3T group). The PF was evaluate by measuring the size of the genital hiatus (HG) and the perineal body (CP) and measuring the strength of the muscles through the bi-digital palpation (Pb), perineometry (Pe) and dynamometry (Din). The Levene test was used to check homogeneity of the samples regarding age, the Kruskal-Wallis test (ANOVA non-parametric) was applied on the variables to assess significant differences in the groups (C, 1T, 2T and 3T) and U test of Mann-Whitney for paired comparison. For correlation of the variables, we calculated the correlation coefficient by Spearman\'s Rank. The level of significance was establish at 0.05. Regarding the HG and CP variables, when comparing the groups, the lowest values were observed in C group (HG = 1.75cm and CP = 2.5cm) and increased in 3T group (HG = 2.25 cm and CP = 3, 5cm). Concerning the strength variables (Pb, Pe and Din) the initial study hypothesis was confirmed, with the group of nulliparous higher (Pb = 3.2; Pe = 45.6 cmH2O and Din = 1.2 kgf) of strength compared to the third trimester primiparous group (Pb = 2.1; Pe = 17.3 cmH2O and Din = 0.7 kgf). The correlation between the HG, CP and the strength measurements, demonstrated that the variable HG was not found and the CP was negatively correlated with Pe and Din (r = - 0.219 and r = - 0.228). Already comparing Pb variables, Pe and Din, it was possible to establish a positive correlation (Pb x Pe (r = 0.757); Pe x Din (r = 0.755) and Pb x Din (r = 0.564). For variables HG and CP, the highest numbers in 3T group were expected due to changes during pregnancy. The highest values for Pb, Pe and Din found in C group can also be explained when compared to lower values in 3T group, also for sustained changes by pregnant women. The positive correlation between the strength of assessment methods (Pb, Pe and Din) proven by this study, strengthened our results and concluded that there is a significant difference in PFM strength between primiparous on third trimester of pregnancy and nulliparous, suggesting pregnancy as a risk factor for reduction of the PFM strength.

Concentrations of leptin - a hormone that contributes importantly to the central regulation of food intake - seem to be influenced by the shift work schedule. Soluble leptin receptors (OB-Re) are the major leptin-binding protein in blood and can affect leptin transport in the brain. As the daily concentrations of OB-Re have not been described in shift workers, we hypothesized that OB-Re concentrations and the free leptin index (FLI) do not vary throughout the day in shift workers as they do in day workers. To evaluate the daily profiles of OB-Re and FLI in shift and day workers, two shift-working groups (early morning and night shifts) and one group of day-shift workers were studied. They completed sleep, nutritional and metabolic assessments. Venous blood samples were collected every 4 hours over 24 hours to measure leptin and OB-Re levels. FLI was calculated by the ratio of free leptin to OB-Re levels. The Mixed-model ANOVAs indicated that OB-Re showed a significant main effect of shift, with the day workers showing higher OB-Re levels than the early morning (p=0,001) and night (p=0,004) groups. No effect of time or interaction between time x shift was observed in OB-Re. No main effect of shift, time or interaction between shift x time was observed for FLI (p>0.05). No significant differences were observed in mean 24-hours concentrations of Ob-Re and FLI between shift and day workers (p>0.05). We conclude that the concentration of OB-Re is altered by working on atypical schedules (early morning and night shifts) compared to day shifts.

Fundação de Amparo a Pesquisa do Estado de Minas Gerais

Cryptococcus is a yeast-like fungus, capsuled, which has the ability to infect and cause disease in a wide variety of hosts; is the causative agent of cryptococcosis, systemic disease, subacute or chronic, occurring before the AIDS epidemic was sporadic and usually associated with patients with low cellular immunity. Two species are the main pathogenic to humans: C. neoformans and C. gattii; generally C. neoformans cause disease in immunocompromised individuals, manifested as a disease in immunocompetent individuals generally have as C. gattii agent. The laboratory diagnosis of cryptococcosis is usually performed by microbiological examinations (direct and culture research) in various clinical specimens and also by serological methods (latex reaction). Molecular techniques may also be used, but still have limited application in clinical diagnostics. Treatment is with amphotericin B in the induction phase and with fluconazole in the phases of consolidation and maintenance. The objectives of this study were to investigate the phenotypic and molecular characteristics and determine the antifungal susceptibility of Cryptococcus neoformans isolated from samples from patients treated at Uberlândia Clinical Hospital in the 2004-2013 period; and also examine the demographic characteristics of the patients. The phenotypic characteristics have been studied through the use of conventional biochemical tests, such as melanin production and urease and sensitivity to canavanine; to have the molecular characteristics, conventional PCR reactions and research have been used in the URA-5 gene by PCR-RFLP. The antifungal susceptibility was performed either by disk diffusion technique and the dilution technique broth through VITEK® 2 system. The demographic characteristics of patients suffering from cryptococcosis were studied by analyzing the records. Between 41 samples were stored Cryptococcus identified as C. neoformans. During molecular analysis it was found that 40 were C. neoformans var. grubii (VNI) and one was C. gattii (VGI). All strains were mating type α. All isolates were susceptible to antifungals front tested by automated method of broth microdilution (Vitek® 2, Biomerieux). Patients affected by cryptococcosis were mostly men 31-40 years old, coming from urban areas. The meningoencephalitis was the predominant form of the disease; most were immunocompromised, AIDS being the predominant underlying disease. Most of them receive appropriate treatment according to the proposed guidelines; however, 58% of patients progressed to death.

The Acute Myocardial Infarction (AMI) is a vascular disease that generally results from the aterosclerotic process with thrombotic occlusion of the coronaries. This acute situation unbalances the offer and consumption of oxygen, leading to a necrosis of the tissue. Due to the higher number of AMI survivors, we tend to be more concerned about clinical care, what motivates the search for methods that enable an objective and quantitative assessment of the quality of life, anxiety and depression. These factors must be particularly focused during medium and long-term treatments. We also need to compare the various types of treatment presently used in post-infarction, especially the percutaneal or surgical revascularization and the clinical treatment, with the aim of choosing the ones which are more efficient and present more correlation with a better quality of life, with lower levels of anxiety and depression. The purpose of this study is to evaluate the quality of life, anxiety and depression in patients after acute myocardial infarction (AMI), through the application of Mac New QLMI, IDATE and BDI questionnaires, respectively, and confront them to risk factors and the kind of treatment established before the recruitment. We evaluated 59 patients, being 46 (78%) males and 13 (22%) females, with an average age of 57,70 +/- 6,96, selected from the medical file of the Clinics Hospital of the Federal University of Uberlândia, MG. All of them presented an AMI episode before the evaluation started. The questionnaires were firstly applied in August 2003, and reapplied in August 2004. The results were analyzed through descriptive techniques, using also the Pearson and the Spearman correlation coefficients. The results demonstrate that: a) there was a reduction in anxiety and depression levels added to a worsening in life quality between the two evaluations; b) stress and tobaccoism positively correlated with the existence of depression; c) the arterial hypertension and the medicamental treatment showed correlations with a higher anxiety only in the first evaluation; d) the worsening in life quality was correlated with tobaccoism, in the first evaluation, and with the presence of dislipidemy, after twelve months; e) depression showed significant correlation with the black race and widowhood. These results showed the necessity of accompanying these patients through special rehabilitation programs, with multidisciplinary scope and with protocols, established trough a clinical approach, but always followed by an evaluation of life quality, anxiety and depression, which deserve special attention from the team.

Hip fractures occur frequently in the aged and have a considerable impact on health-related quality of life (HRQOL) of the elderly affected. This study aimed to assess the psychometric properties of the Brazilian version of the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36) in elderly with hip fractures and the HRQOL of this population over 4 months following fracture. Forty five elderly (60% female) aged between 62 and 92 years (mean= 74.4; SD=8.81) answered the SF-36. Patient scores at baseline, 1 and 4 months after surgery (ou hospital discharge), were compared to 135 controls (mean age=72.3;SD=6.92), and according to fracture type (femoral neck or trochanteric). Psychometric qualities assessed were: on floor and ceiling effect, item internal consistency, internal consistency reliability, reprodutibility, discriminant validity, item discriminant validity, convergent validity, divergent validity, criterion validity, concurrent validity, construct validity and minimallyl important difference. All psychometric properties assessed were deemed adequate as a whole. Patients scores at baseline were lower (p<0.05) than the controls for vitality, mental health and social aspects domains. Similarly, patients scored lower at 4 months after surgery (p<0.05) than controls, except for the general state of health domain, and also lower at baseline, except for pain, general state of health, social aspects, mental health and vitality domains. No significant difference was observed amongst scores according to type of fracture. Brazilian version of the SF-36 demonstrated good reliability, validity and responsiveness as applied to patients with hip fracture. Independent of type of hip fracture, elderly patients presented significant compromise in their quality of life, at one and four months after hip fracture, both in physical and psychosocial aspects, while experiencing partial recovery only within the fourth month.

Cancer in children and adolescents can compromise the health and well being of both patients and their family members. Over time, exposure to pain, suffering and the likelihood of death become sources of emotional, family and social instability, particularly for the parents who tend to be directly responsible for their children s care. The objective of the present study were to assess health related quality of life (HRQL) of caregivers of children and adolescents with cancer using a generic instrument 36-item Short Form Health Survey Questionnaire (SF-36) and to verify the psychometric properties of this instrument. The SF-36 was completed by 73 caregivers (mean age =38.4 years; SD=8.5) of children and adolescents with cancer (mean age =10.4 years; SD=3.7). The scores achieved for SF-36 domains were compared to scores of caregivers who had no chronic diseases (mean age=37.2 years; SD=9.1) who cared for healthy children and adolescents (control group), according to cancer type (central nervous system, leukemias and solid tumors), treatment phase and presence of chronic disease or mood disorder in caregivers. The psychometric properties (data quality, reliability and validity) of the SF-36 were verified. The reliability (Chronbach s alpha coefficient> 0.5) and the discriminant validity proved acceptable for all domains of the questionnaire. The scores achieved by caregivers of children and adolescents with cancer were significantly lower than scores of the control group (p<0.05) on both physical and mental components. Mood disorder in caregivers correlated with physical and mental function compromise as well as presence of chronic disease for functional capacity only (p<0.05). There was no significant difference amongst scores achieved according to cancer type or treatment phase. The Brazilian version of the SF-36 is valid for assessing health related quality of life (HRQL) of caregivers of children and adolescents with cancer. These caregivers present a significant negative impact on both physical and psychosocial function.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Several studies found a higher prevalence of Autoimmune Thyroid Disease (AITD) in patients with Chronic Urticaria (CU). This relationship may be due to the possible autoimmune etiology in up to half of the cases of Chronic Idiopathic Urticaria (CIU). However the frequency of AITD ranged from 1.14% to 28.6%. The study began by determining whether there is an association between AITD and CU, in a population seen at the same clinic. We compare the frequency of anti-thyroid antibodies and thyroid dysfunction in 49 patients with CIU (group 1) and 112 controls (Group 2). In order to support the result found, we studied the prevalence of CIU in 60 patients with AITD (group 3), compared with 29 patients who had non-immune thyroid disease (NAITD) (group 4). We did not find a statistical difference for the presence of anti-thyroid antibodies or thyroid dysfunction between groups 1 and 2. The same occurred for the presence of CIU among groups 3 and 4. In our study it was not possible to demonstrate a relationship between AITD and CIU, which means that different populations may present a higher or lower degree of association between these illnesses.

The intrafamiliar violence against children and teenagers is a public health problem that injures the right to life and dignity, causing serious physical, psychological and moral losses. The Programa de Saúde da Família (Family Health Program), PSF, is an important vehicle for the in locus comprehension of this phenomena, and it s an integrated part of a social support network. The objective of the study was to evaluate the knowledge and behavior of the professionals of PSF and Programa de Agentes Comunitários de Saúde (Health Communitarian Agents Program), PACS, about the intrafamiliar violence against children and teenagers. Interviews were conducted with the professionals that acted directly in the 34 teams of PSF e 3 PACS from the Secretaria Municipal de Saúde de Uberlândia (Uberlândia Municipal Department of Health), from April to October 2005. There were two versions of questionnaires: one with the term denounce in the questions and the other in which this term has been switched by notification . Most of the 233 interviewed professionals were female (187; 80%), most were between 18 and 39 years old (167; 71,7%) and most worked in the programs for more than one year (164; 70%). Many (138; 59,2%) said they had read or studied about violence in childhood and teenage, principally in newspapers and magazines (66; 47,8%). Between the participations (123) in classes or lectures mentioned by 114 (48,9%) professionals, only 16 (13%) occurred during graduation. About the definition of intrafamiliar violence against children and teenagers, explicit acts such as disrespect and aggression were easily included (193; 82,8%), and the parents (89; 38,2%) were the most mentioned as aggressors. The most identified classes of violence were the physical (215; 92,2%) and psychological (163; 69,9%). From the total, 106 (45,5%) considered themselves able to attend or recognize this phenomena. When the question was about the reason for such aptitude, the personal knowledge was the most cited criteria (71; 89,9%). In one of the 14 hypothetical situations presented, the violence has not been recognized by some (8; 3,4%) and the children was considered guilty for such act (27; 11,6%). While working in PSF and PACS, 142 (60,9%) professionals faced actual situations, most commonly related to negligence (39; 27,5%) and to the combination of physical and psychological violence (36; 25,4%). Nonetheless, most (83; 58,4%) did not notify or denounced any case. The fear for retaliation was the most cited reason (71; 30,4%) for not notifying. Among the professionals that answered the questionnaire with the term denounce (115; 49,3%), only 16 (13,9%) denounced all the cases; among the ones that answered the other version term notification (118; 50,6%), 52 (44%) didn t notify any case. The Tutelary Council was considered (141; 60,5%) the most adequate institution to receive the notifications, however a great part (193; 82,8%) was unknown of the obligatoriness of such conduct. Most (99%) expressed interest in receiving information about the subject, pointing systematic meetings and lectures (142; 60,9%) as the best means for obtaining knowledge. It was concluded that the configuration of the Equipes de Saúde da Família (Family Health Teams), ESF, in Uberlândia, specially follows the biomedical pattern of health attention, disrespecting the integrality, basic principle of PSF and Sistema Único de Saúde (Unique Health System), SUS. Most professionals are women, with a preponderance of young adults, reinforcing the tendency to feminization in health work market, and the destination of early graduated to the public system. There is few theorycal subsides for the identification of the intrafamiliar violence, once there is a lacuna in the knowledge and formation of the health professionals. They find difficulties in delimitating what is or is not violence, and the classes are not strictly defined and structured. Even though, many of them considered themselves able to recognize and attend potential situations, guided by personal criteria. The notification, as a resource of intervention, is not included in their technical procedure. Although most know the institution they should notify the cases of suspicion or confirmation of such violence, when facing reality, they don t do so, finding difficulties about the legal destinations and not assuming their paper of protectors of childhood and teenage. The fear for retaliation, the misconception of lack of need and the misinformation about what institution to communicate the cases are the most important factors for not notifying. The words denounce or notification did not influence the answers about the conduct towards the violence situations. Anyway, the need for a process of capacitation is urgent, once there is the risk of violence reproduction in its institutional form.

One of the greatest problems that humanity faces today is the violence phenomenom, is in most people s lives and, together with the accidents, represents one of the main injuries to health resulting from outside causes. This study shows epidemiological and clinical aspects of violence, using the medical handbooks data from the Hospital de Clínicas de Uberlândia (HCU); from the expertise reports of bodily harm and of autopsies of Posto Médico Legal (PML) and service reports of the Organização-não Governamental SOS Mulher Ação Família (ONG SOS Mulher). It prevailed physical agressions in the HCU medical supports (98.2%) and PML (96%), and psycological violence (36.2%) in the ONG SOS Mulher. The services were more frequent during the weekend, as much as those performed in HCU (36%) as the services in PML (38%), and in the ONG SOS Mulher, mainly on Mondays (24.3%). In the HCU and the PML, the medical supports were common in the period between 6pm until 12am (36.5% and 42.3%, respectively). The victims were 18 to 39 years of age (77.5% and 76.2%, respectively HCU and PML); those with services in HCU (49.4%) and PML (34,9%) declared themselves mainly singles, and in the ONG SOS Mulher, joined together (50.3%), more than half (50,9%) hasn´t finished elementary school; their professions/occupations were mainly housewives (40.2%) of those with services in the PML, and domestics (30.5%) in the ONG SOS Mulher and these lived in their own property (55.2%). Among the aggressors, 87.8% were between 20 and 49 years of age, 57.7% haven t concluded elementary and junior high; most had little professional qualification, were joined together/ex-joined together (50.2%) of the victims attended in the ONG SOS Mulher and husbands/ex-husbands those with services in HCU (51.5%) and of those with services in the PML (30.4%). According to the reports from the women taken care in the ONG SOS Mulher, 86.3% of the aggressors were stylists, 20.7% drug addicts and 10.3% practised games of chance. According to victims, the main reason to continue living with the aggressor after the suffered violence was the hope that the conjugal relationship would improve (33.8%). The victims taken care of in the HCU and the PML, presented mainly wounds (62.3% and 74.8%, respectively), that they had reached especially, head/neck (39.1%) according to given data of the HCU, and upper limbs (35.1%) as the findings of the PML. The deaths mainly had resulted from the use of cold steel weapons (36.4% and 44.0%, respectively HCU and PML) and firearms (36.4% and 20.0%, respectively HCU and PML). One concludes that the violence against women is frequent and a health problem; the medical supports occur mainly weekends and the nocturnal period. The victims are young, with little scholarity and little professional qualification and habits in their own property. The profile of the aggressors resemble to the one of the victims, generally, being their own companions, the addictions and the jealousy are the main reasons for the aggressions that occur mainly inside their homes, and the hope that the conjugal relationship improves, makes the victims remain in the violent relationship. The injuries deriving from the aggressions are wounds, especially in the head/neck and the upper limbs. The deaths are not rare. They occur mainly by the use of cold steel arms and firearms.

To ascertain epidemiological characteristics of hospitalizations due to external causes of children and adolescents admitted to a Pediatric Intensive Care Unit (PICU). This descriptive, observational study assessed hospitalizations due to external causes (Chapters XIX and XX of the International Disease Classification IDC-10) of children and adolescents under the age of 15 years, admitted to the PICU of the Clinicas Hospital of the Uberlândia Federal University Medical School between August 1989 and August 2003. Of the 2455 admissions, 372 (15%) were due to external causes; chiefly caused by transport accidents (49.2%), poisoning (9.1%) and falls (8.9%). The mean age was six years while most incidents occurred among the five to nine year-old bracket (39.8%) in boys (60.2%). The majority of incidents (75.6%) occurred during daytime, between 12:00 and 18:00 hours on any day of the week but with a marked predominance on Sundays. The number of incidents per month ranged from 24 (6.5%) in May, to 36 (9.7%) in January, April, November and December. The most common accident sites were in streets and on highways (47.5%), and within the home (35.4%). Victims were predominantly hospitalized for up to three days (64.5%) and with head trauma (251; 52,5%). Of the 47 (12,6%) deaths, 25 (53.2%) were due to transport accidents, and 44.1% had head trauma. The study concluded that admissions to the PICU due to external causes were predominantly school-goers, mainly caused by transport accidents, and that death was most common in pedestrians. The adopting of safe behavior and provision of safe environments, together with continuous educational programs and traffic control measures, are needed to ensure improved health and safety in children and adolescents.

Asthma and allergic rhinitis are mediated by IgE antibodies through the development of allergen-specific Th2 cells in genetically predisposed and sensitized subjects. Asthma and rinithis are frequently associated, suggesting the concept of one airway, one disease . The aims of this study were to analyze spirometrics parameters and IFN-&#947; and IL-5 levels in the induced sputum from patients with asthma or allergic rhinitis (AR) and non-atopic subjects. Thirty-three subjects aged 18 to 60 years, both sexs, were analyzed. From these, eight were asthmatics and 16 had allergic rhinitis (AR), and both groups had positive skin prick test (SPT) to aeroallergens. The nine remaining subjects were healthy non-atopics with negative SPT to aeroallergens. Spirometry was performed through evaluating the forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and forced expiratory flux between 25 and 75% (FEF25-75%) pre and post-bronchodilators. Induced sputum samples were collected and IFN-&#947; and IL-5 levels were quantified by immunoassays. Significant pre- and post-bronchodilator variation was observed only for FEV1 with higher values in asthmatics compared to patients with RA and non-atopics. There was no significant difference in pre- and post-bronchodilator parameters among the three groups, although there was a tendency for pre-bronchodilator lower FEF25-75% values in asthmatic patients. IFN-&#947; levels in the induced sputum showed no significant difference between the groups but, IL-5 levels were higher in patients with asthma and AR compared to non-atopics. It can be concluded that Spirometric alterations were not able to predict the occurrence of broncoconstriction in patients with AR, but predominant IL-5 levels in the induced sputum of these patients reinforce the role of the Th2-type immune response in low respiratory airways that could contribute to the development of asthma in patients with AR.

The physical handicaps resultant of transportation accidents (TA) cause great locomotion, professional and financial losses to the individual and his or her family. Besides, they affect society as a whole because they bring about productivity losses in the workplace and material losses as well. Studies with the victims who survived and developed sequels are still scarce, especially in developing countries. The goal of this study was to recognize the epidemiological aspects of TA victims that led to limb amputation and characteristics related to the rehabilitation. A series of cases were studied through interviews based on a semi-structured questionnaire composed of multiple-choice and discursive questions. 43 people that went through amputation due to TA took part in the interviews and were filed as research subjects in the period ranging from December of 2002 to December of 2004, after they were discharged from treatment at the Association for the Aid of Handicapped Children of Minas Gerais, Brazil (Associação de Assistência à Criança Deficiente - AACD/MG). Most victims ranged from 20 to 39 years old (22; 51,1%), were men (36; 83,7%) and single (22, 51,1%). 25 (58%) of them had not finished elementary school, 40 (93%) had a job/occupation and, after the accident, all the subjects became inactive for an average 27,6. At the time of the interviews, amputated people ranged from 20 to 49 years old (29; 67,4%), 22 (51,1%) were single and 27 (62,8%) hadn t concluded elementary school. Out of the 35 subjects that worked for an income, 14 (40%) returned to their jobs but only six (17,1%) to the same professional activity they had before and 12 (34,3%) retired due to invalidity. Most TA (29; 67,4%) occurred in Uberlândia, 26 (60,5%) within the city limits, and motorcycles were the vehicles most involved in TA (21; 48,8%). Out of these 21 cases, 17 (81%) were motorcycle riders and, out of these, 14 (82,4%) used helmets at the moment the accident happened. Collision (31; 72%) and trampling (12; 28%) were the most common types of TA. 41 (95,3%) people had lower limb amputations and 16 (37,2%) were rescued by Fire Department personnel. 28 (65,1%) individuals went to the Uberlândia Federal University Hospital (Hospital de Clínicas de Uberlândia da Universidade Federal de Uberlândia/HCU-UFU) for initial care and the overall length of treatment decreased after AACD/MG began service. All the lower limb amputated people (41; 95,3%) received their prosthesis but found some difficulties using it, after discharge. The Unified Public Health System (Sistema Único de Saúde - SUS) afforded more than half the rehabilitations (24; 55,8%) and the majority of the prosthetic (31; 75,6%). One of the conclusions regarding the TA that lead to limb amputation is that they are more frequent among young, single men who, at the time of the accident, when riding motorcycles, often wore helmets. The Fire Department usually rescues these victims who are, then, taken to the HCU-UFU. The presence of a AACD unit seems to favour an specialized and early treatment of the amputations that are often located in the lower limbs region. The pacients ended their rehabilitation with the prosthetic adaptation but some difficulties with the prosthesis remain after they are discharged from treatment. SUS affords approximately half the rehabilitations and most of the prosthetic. Few amputated people return to the same professional activities they had before and many retire due to invalidity. The implementation of public policies that reduce the cases of TA is indispensable, specially those that are more serious and involve a motorcycle because these are the ones that lead the most to amputation, incapability and invalidity, when not death.

Allergic rhinitis (AR) is clinically defined by ARIA (Allergic Rhinitis and its Impact on Asthma) as a symptomatic disorder of the nose, induced after allergen exposure by an IgE mediated inflammation of the nasal membranes.The symptoms of allergic rhinitis include rhinorrhoea, nasal obstruction, nasal itching and sneezing. AR represents a global health problem and its prevalence has increased in the last years. Therapy for allergic rhinitis aims to control symptoms and improve the quality of life. Nowadays the treatment of allergic rhinitis includes allergen avoidance, environmental control, pharmacologic treatment and specific immunotherapy. The aim of this study is to evaluate the clinical efficacy and changes in IFN-y and IL-5 levels in nasal lavage fluid from children with allergic rhinitis after different groups of treatment (mometasone, montelukaste or desloratadine). This is a prospective randomized open study. Twenty-three children were selected aged from six to twelve years, with moderate persistent allergic rhinitis which were randomly distributed in three groups of treatment during four weeks- (I) nasal corticosteroid (mometasone); (II) anti-leukotriene (montelukaste); and (III) antihistamine (desloratadine). Patients were submitted to the following steps- full-filling a clinical questionnaire and a diary symptoms for determination of the total symptom score (TSS), skin prick tested, sampling nasal lavage fluid before and after treatment for measuring IFN-y e IL-5 cytokines by immunoassay (ELISA), blood sampling for red and white cell counting and measurement of total serum IgE. A reduction in IL-5 levels was observed in the treated groups with mometasone and montelukaste, although a significant reduction (p = 0.0469) has been observed only in the group treated with mometasone. In contrast, there was a significant augment in IL-5 levels (p = 0.0469) in the group treated with desloratadine. A tendency of increasing in the levels of IFN-y was observed, especially in the treated groups with desloratadine and mometasone, although with no statistical significance. A tendency of symptoms improving was verified by decreasing the TSS in all therapeutic groups, although this improvement was not significant. However, there was a clear clinical efficacy by parents perception means only in the group treated with mometasone (p< 0,05). It can be concluded that the group treated with mometasone showed improvement of clinical symptoms as well as reduction in IL-5 levels in the nasal lavage fluido of children with allergic rhinitis.

Obesity is the most common chronic disease in developed countries and is associated to the most severe and morbid clinical situations, including respiratory disturbances that can be aggravated by surgical techniques, increasing the hospitalar permanence. The gastric reduction has been considered, after 45 years of study, the only efficient and lasting method in body weight reduction. To identify and quantify the impact of surgical method in pulmonary function considering the laparotomy and videolaparoscopy approaches, 37 patients were submitted to the gastroplasty by technique; 17 of them (8 woman and 9 man) by laparotomy (age and BMI means of 32±9,8 years and 47±7,2Kg/m2, respectively) and 20 (13 woman and 7 man) by videolaparoscopy (age and BMI means of 35±9,6 years and 44±5,9 Kg/m2, respectively). All of them were submitted to espirometry, blood gas transcutaneous (oximetry) and respiratory frequency monitoring before and after surgery (until the 30th hour) and were also evaluated by a modified pain visual analogic scale at the espirometry. In pre-operatory, all patients presented normal pulmonary function tests. We observed a significant mean reduction of 38.53% in Forced Vital Capacity (FVC), 39.11% in Forced Expiratory Volume in 1 second (FEV1) and 37% in Expiratory Peak Flow (PFE) in laparotomy group (LG). In the videolaparoscopy group (VG) there was a mean reduction of 38.37% in FVC, 35.53% in FEV1 and 41.57% in PFE. The respiratory frequency had a mean increase of 16.98 and 14.79% in LG and VG respectively, both with statistic significance. The mean reduction in oximetry was not statistically significant in both groups. The mean operating time was 179 minutes in LG and 163 minutes in VG. Pain scores were 3.58 in LG and 3.40 in VG. Based on these results, we concluded that the patients with degree 2 and morbid obesity presented normal espirometry values in pre-operatory and, after being submitted to gastroplasty by the surgical technique (laparotomy or videolaparoscopy), they developed an espirometric compatible with pulmonary restriction in early post-operatory.

Blomia tropicalis (Bt), Dermatophagoides pteronyssinus (Dp) and D. farinae (Df) are the prevalent house dust mites (HDMs). Concanavalin A-binding components derived from B. tropicalis (Bt-ConA extract) have shown to be highly immunogenic in allergic diseases. This study aimed to evaluate the humoral and cellular immune responses to B. tropicalis in sensitized patients. A total of 246 subjects aged 18 and 60 years were selected for this study. Among them, 137 (54 male and 83 female) had allergic rhinitis with or without asthma and 109 (37 male and 72 female) were non-atopic subjects. All subjects were tested for skin reactivity (SPT), total serum IgE and specific IgE levels to both Bt-total and Bt-ConA extracts, proliferative response and cytokine (IFN-&#947; and IL-5) production by peripheral blood mononuclear cells (PBMC) stimulated with both extracts. SPT showed that 70% of patients were sensitized to Bt (Bt+) and no patient was monosensitized to Bt. Similar levels of specific IgE to Bt-total and Bt-ConA extracts were found in Bt+ patients, while higher levels of total serum IgE were found in atopic than non-atopic subjects. Significant PBMC proliferation was observed in response to Bt-total extract in Bt-sensitized, but not in Bt-non-sensitized patients and non-atopic subjects. Bt-ConA extract induced increased proliferative responses in all patient groups, but these responses were decreased in the presence of ConA inhibitor (methyl-&#945;-D-mannopyranoside). Significant IFN-&#947; production was observed only after Bt-ConA stimulation in Bt+ patients, while Bt-total extract showed no changes. IL-5 production was consistently seen in Bt+ patients after allergen-specific stimulation or even with no stimulus, indicating that PBMC from allergic patients are prone to produce spontaneously or allergen-restimulation induced Th2-type cytokines. It can be concluded that the Bt-total extract contains relevant allergens that are involved in both humoral and cellular immune responses, while the Bt-ConA extract containing glycosilated components associated with ConA residues might be an important inducer of Th1 immune response and therefore, to present a potential use in immunotherapeutic procedures.