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ABSTRACT Objective: Our aim was to assess the ability of serum magnesium (Mg), measured on the first postoperative day (Mg1PO), to predict the need for calcium (Ca) replacement in patients undergoing total thyroidectomy (TT). Subjects and methods: Eighty patients undergoing TT, with Mg1PO and PTH dosage in the first (PTH1h) and eighth (PTH8h) hours after TT, were evaluated for the need for Ca replacement. Data were evaluated by uni/multivariate logistic regression and Receiver Operating Characteristic (ROC) curve. Results: 32 patients (40%) required Ca replacement. Median PTH1h, PTH8h and Mg1PO were higher in the no replacement group: 17 versus (vs) 3 pg/mL (p < 0.001), 18.2 vs 3.0 pg/mL (p < 0.001) and 2 vs 1.6 mg/dL (p < 0.001), respectively. Mg1PO was the isolated predictor for this replacement (odds ratio = 0.0004, 95% confidence interval: 0.000003-0.04; p = 0.001), with the cut-off value of 1.8 mg/dL showing sensitivity and specificity of 78.1% and 87.5%, respectively. Conclusions: In this group of patients, serum Mg1PO was the isolated predictor for the need for Ca replacement.

https://doi.org/10.20945/2359-3997000000581

Panorama das Intervenções Coronárias Percutâneas em Oclusões Totais Crônicas em Centros Participantes do LATAM CTO Registry no Brasil
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Silva, Antonio Carlos Botelho da

; Paula, João Eduardo Tinoco de

; Campos, Carlos M.

; Ribeiro, Marcelo Harada

; Martins Filho, Evandro

; Oliveira, Marcos Danillo Peixoto

; Côrtes, Leandro Assumpção

; Abelin, Aníbal Pereira

; Zukowski, Cleverson Neves

; Martinelli, Gustavo Cervino

; Brito, Fábio Sândoli de

; Muniz, Antônio José

; Cantarelli, Marcelo José de Carvalho

; Andrade, Pedro Beraldo de

; Medeiros, César Rocha

; Falcão, Breno de Alencar Araripe

; Fuchs, Felipe Costa

; Silva, Leonardo Sinnott

; Fattah, Tammuz

; Degrazia, Ramiro Caldas

; Mangione, José Armando

; Bezerra, Cristiano Guedes

; Baradel, Sandra

; Silveira, João Brum

; Ybarra, Luiz Fernando

; Weillenmann, Daniel

; Gottschall, Carlos

; Lemke, Viviana

; Silva, Franciele Rosa da

; Schmidt, Marcia Moura

; Belli, Karlyse Claudino

; Oliveira, Pedro Piccaro de

; Quadros, Alexandre Schaan de

Arquivos Brasileiros de Cardiologia

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2023, Volumen 120 Nº 4 elocation e20210462

Resumen: En Pt | Texto: En Pt | PDF: En | PDF: Pt

Abstract Background Major advances have been seen in techniques and devices for performing percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs), but there are limited real-world practice data from developing countries. Objectives To report clinical and angiographic characteristics, procedural aspects, and clinical outcomes of CTO PCI performed at dedicated centers in Brazil. Methods Included patients underwent CTO PCI at centers participating in the LATAM CTO Registry, a Latin American multicenter registry dedicated to prospective collection of these data. Inclusion criteria were procedures performed in Brazil, age 18 years or over, and presence of CTO with PCI attempt. CTO was defined as a 100% lesion in an epicardial coronary artery, known or estimated to have lasted at least 3 months. Results Data on 1196 CTO PCIs were included. Procedures were performed primarily for angina control (85%) and/or treatment of moderate/severe ischemia (24%). Technical success rate was 84%, being achieved with antegrade wire approaches in 81% of procedures, antegrade dissection and re-entry in 9%, and retrograde approaches in 10%. In-hospital adverse cardiovascular events occurred in 2.3% of cases, with a mortality rate of 0.75%. Conclusions CTOs can be treated effectively in Brazil by using PCI, with low complication rates. The scientific and technological development observed in this area in the past decade is reflected in the clinical practice of dedicated Brazilian centers.

Resumo Fundamento Tem sido observado um grande avanço nas técnicas e nos dispositivos para a realização de intervenções coronárias percutâneas (ICP) em oclusões totais coronarianas crônicas (OTC), mas existem poucos dados da prática do mundo real em países em desenvolvimento. Objetivos Relatar as características clínicas e angiográficas, os aspectos dos procedimentos e os resultados clínicos da ICP de OTC em centros dedicados a esse procedimento no Brasil. Métodos Os pacientes incluídos foram submetidos à ICP de OTC em centros participantes do LATAM CTO Registry, um registro multicêntrico latino-americano dedicado à coleta prospectiva desses dados. Os critérios de inclusão foram procedimentos realizados no Brasil, idade acima de 18 anos e presença de OTC com tentativa de ICP. A definição de OTC foi lesão de 100% em uma artéria coronária epicárdica, conhecida ou estimada como tendo pelo menos 3 meses de evolução. Resultados Foram incluídos dados de 1.196 ICPs de OTC. Os procedimentos foram realizados principalmente para controle da angina (85%) e/ou tratamento de uma grande área isquêmica (24%). A taxa de sucesso técnico foi de 84% e foi alcançada com técnicas de fios anterógrados em 81%, dissecção/reentrada anterógrada em 9% e retrógrada em 10% dos procedimentos. Os eventos cardiovasculares adversos intra-hospitalares ocorreram em 2,3% dos casos, sendo a mortalidade de 0,75%. Conclusões As OTC podem ser tratadas no Brasil por intervenção coronária percutânea de forma efetiva e com baixas taxas de complicações. O desenvolvimento científico e tecnológico observado nessa área na última década reflete-se na prática clínica de centros brasileiros dedicados a essa técnica.

https://doi.org/10.36660/abc.20210462

Is there a relationship between preoperative cytological diagnosis and evolution in patients with differentiated thyroid carcinoma? A retrospective study
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Colenci, Renato

; Minicucci, Marcos Ferreira

; Soares, Carlos Segundo Paiva

; Oliveira, Cristiano Claudino de

; Marques, Mariângela Esther de Alencar

; Tagliarini, José Vicente

; Mazeto, Gláucia Maria Ferreira da Silva

Archives of Endocrinology and Metabolism

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Abr 2022, Volumen 66 Nº 2 Paginas 237 - 246

Resumen: En | Texto: En | PDF: En

ABSTRACT Objective: Cytological analysis and Bethesda classification of thyroid nodules is the standard method of diagnosing differentiated thyroid carcinoma (DTC). However, even for nodules with a non-malignant cytological diagnosis, there is a not insignificant risk of cancer. There are doubts whether this lack of certainty would influence patient prognosis. Our aim was to compare patients with DTC, classified according to the preoperative cytological diagnosis, regarding their evolution. Subjects and methods: A retrospective study was carried out with 108 DTC patients submitted to total thyroidectomy (TT) between 2009 and 2015, divided into three groups according to preoperative cytological diagnosis (Bethesda classification): classes I/II, III/IV, and V/VI. Groups were compared for evolution considering response to treatment at last evaluation as well as time disease free. Statistical analysis used ANOVA, chi squared, and Kaplan-Meier curves with p<0.05 considered significant. Results: Groups differed for time between nodule puncture and TT [in months; V/VI (2.35 ± 2.48) < III/IV (7.32 ± 6.34) < I/II (13.36 ± 8.9); p < 0.0001]. There was no significant difference between groups for evolution at final evaluation (disease free status; classes I/II: 71.4%; classes III/IV: 60%; classes V/VI: 66.6%; p = 0.7433), as well as time disease free (in months; classes I/II: 34.57 ± 25.82; classes III/IV: 38.04 ± 26.66; classes V/VI: 30.84 ± 26.34; p = 0.3841). Conclusions: DTC patients classified according to preoperative cytological diagnosis did not differ for evolution. Although patients with non-malignant cytological diagnoses were submitted to TT later, this did not affect the evolution of the cases.

https://doi.org/10.20945/2359-3997000000458

Thyroglobulin/thyrotropin ratio for predicting long-term response in differentiated thyroid carcinoma: a retrospective study
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Marchi Junior, Adriano Francisco De

; Macedo, Ana Bárbara Trizzotti de

; Soares, Carlos Segundo Paiva

; Bolfi, Fernanda

; Iessi, Mariana Riello Gomes

; Oliveira, Cristiano Claudino de

; Koga, Katia Hiromoto

; Moriguchi, Sonia Marta

; Tagliarini, José Vicente

; Mazeto, Gláucia Maria Ferreira da Silva

Archives of Endocrinology and Metabolism

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Ago 2021, Volumen 65 Nº 4 Paginas 428 - 435

Resumen: En | Texto: En | PDF: En

ABSTRACT Objective: Thyrotropin-stimulated thyroglobulin (STg) after total thyroidectomy is a prognosis marker for differentiated thyroid carcinoma (DTC). As Tg level is influenced by thyrotropin (TSH), perhaps the STg/TSH ratio is also a prognosis marker for these tumours. We aimed to compare STg/TSH ratio and first STg level in differentiated thyroid carcinoma patients for their ability to predict the long-term response to initial treatment. Subjects and methods: This retrospective study evaluated data from 181 DTC patients for first (1st) STg and STg/TSH ratio, at 1-3 months post-total thyroidectomy and before iodine-131 therapy, according to response to initial therapy [Excellent/Indeterminate or Incomplete (Biochemical/Structural)] observed at final evaluation, and with the survival time with excellent/indeterminate response. Results: Cases with incomplete response presented higher STg level [225.13 ± 585.26 ng/mL versus (vs) 20.4 ± 192.9 ng/mL; p < 0.001] and STg/TSH ratio (3.01 ± 7.8 vs 0.27 ± 2.58; p < 0.001). Cutoffs of 5 ng/mL for STg and 0.085 for STg/TSH displayed sensitivities of 76.7% and 76.9%, and specificities of 79.2% and 82.6%, respectively, in predicting response to therapy. Values below these cutoffs were associated with longer survival time in excellent/indeterminate response (140.4 vs 15.9 and 144.6 vs 15.9 months, respectively). Conclusion: STg/TSH ratio has a similar performance to the 1st STg in predicting long-term response to initial therapy.

https://doi.org/10.20945/2359-3997000000387 204 descargas

Septic embolism by Candida albicans
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Claudino Oliveira, Cristiano

; Hellmeister Camolese, Viviane

; Alencar Marques, Mariangela Esther

Revista Cubana de Medicina Tropical

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Ago 2021, Volumen 73 Nº 2 elocation e613

Resumen: En | Texto: En | PDF: En

Follicular Lesions with Papillary Nuclear Characteristics: Differences in Chromatin Detected by Computerized Image Analysis
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Coelho, Bárbara Parente

; Valentim, Flávia de Oliveira

; Miot, Hélio Amante

; Jaune, Danilo Takeshi Abe

; Hayashi, Caroline Yuki

; Oliveira, Cristiano Claudino de

; Marques, Mariângela de Alencar

; Tagliarini, José Vicente

; Castilho, Emanuel Celice

; Soares, Paula

; Mazeto, Gláucia Maria Ferreira da Silva

Archives of Endocrinology and Metabolism

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Oct 2020, Volumen 64 Nº 5 Paginas 630 - 635

Resumen: En | Texto: En | PDF: En

ABSTRACT Objective: Follicular lesions of the thyroid with papillary carcinoma nuclear characteristics are classified as infiltrative follicular variant of papillary thyroid carcinoma-FVPTC (IFVPTC), encapsulated/well demarcated FVPTC with tumour capsular invasion (IEFVPTC), and the newly described category “non-invasive follicular thyroid neoplasm with papillary-like nuclear features” (NIFTP) formerly known as non-invasive encapsulated FVPTC. This study evaluated whether computerized image analysis can detect nuclear differences between these three tumour subtypes. Materials and methods: Slides with histological material from 15 cases of NIFTP and 33 cases of FVPTC subtypes (22 IEFVPTC, and 11 IFVPTC) were analyzed using the Image J image processing program. Tumour cells were compared for both nuclear morphometry and chromatin textural characteristics. Results: Nuclei from NIFTP and IFVPTC tumours differed in terms of chromatin textural features (grey intensity): mean (92.37 ± 21.01 vs 72.99 ± 14.73, p = 0.02), median (84.93 ± 21.17 vs 65.18 ± 17.08, p = 0.02), standard deviation (47.77 ± 9.55 vs 39.39 ± 7.18; p = 0.02), and coefficient of variation of standard deviation (19.96 ± 4.01 vs 24.75 ± 3.31; p = 0.003). No differences were found in relation to IEFVPTC. Conclusion: Computerized image analysis revealed differences in nuclear texture between NIFTP and IFVPTC, but not for IEFVPTC.

https://doi.org/10.20945/2359-3997000000282 439 descargas

Sarcoid-like reaction: Hodgkin’s lymphoma is a hypothesis
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Oliveira, Cristiano Claudino

Autopsy and Case Reports

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2020, Volumen 10 Nº 2 elocation e2020172

Resumen: En | Texto: En | PDF: En

https://doi.org/10.4322/acr.2020.172 206 descargas

Case for diagnosis. Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder
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Valentim, Flávia de Oliveira

; Oliveira, Cristiano Claudino

; Miot, Hélio Amante

Anais Brasileiros de Dermatologia

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Feb 2019, Volumen 94 Nº 1 Paginas 99 - 101

Resumen: En | Texto: En | PDF: En

Abstract: Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder is a rare disease, with an indolent evolution and benign course. The classic presentation is a solitary nodule on the face or trunk. The disorder’s rarity and clinical and histopathological characteristics, can make the diagnosis difficult. We present the case of a 36-year-old Caucasian woman with a purplish erythematous nodule, hardened, shiny, asymptomatic, on the left nasal ala, which had grown progressively for 45 days. Histopathological examination and immunohistochemistry panel demonstrated alterations consistent with primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder. There was complete remission of the condition within 60 days of treatment with potent occlusive corticosteroids.

https://doi.org/10.1590/abd1806-4841.20198513 1024 descargas

Lymphoepithelioma-like carcinoma of the skin
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Oliveira, Cristiano Claudino

; Nóbrega, Vinicius Cardoso

; Marques, Mariângela Esther Alencar

Anais Brasileiros de Dermatologia

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Mar 2018, Volumen 93 Nº 2 Paginas 256 - 258

Resumen: En | Texto: En | PDF: En

Abstract: Primary cutaneous lymphoepithelioma-like carcinoma is a rare disease with low metastatic potential. Its morphologic and pathological features are similar to those of nasopharyngeal lymphoepithelial carcinoma. We report the case of a 60-year-old man with an infrapalpebral pearly papule, measuring 0.6 cm in diameter. The lesion was excised with a clinical hypothesis of basal cell carcinoma or squamous cell carcinoma. Histopathological analysis revealed a malignant neoplasm with syncytial arrangement of cells with vesicular nuclei, associated with dense lymphocytic infiltrate. Immunohistochemistry revealed cytokeratin-positive cells (AE1/AE3) and p63 protein, indicating epithelial histogenesis and squamous differentiation. A negative Epstein-Barr virus test result was achieved by immunohistochemistry. Primary lymphoepithelioma-like carcinoma of the skin is a differential diagnosis of lesions with prominent inflammatory infiltrates.

https://doi.org/10.1590/abd1806-4841.20187205 2320 descargas

10.

Granuloma faciale: clinical, morphological and immunohistochemical aspects in a series of 10 patients
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Oliveira, Cristiano Claudino

; Ianhez, Pedro Eugênio de Carvalho

; Marques, Silvio Alencar

; Marques, Mariângela Esther Alencar

Anais Brasileiros de Dermatologia

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Dic 2016, Volumen 91 Nº 6 Paginas 803 - 807

Resumen: En | Texto: En | PDF: En

Abstract Granuloma faciale is a chronic, benign, cutaneous vasculitis with well-established clinical and morphological patterns, but with an unknown etiology. This study describes clinical and pathologic aspects of patients diagnosed with granuloma faciale. The authors analyzed demographic, clinical, morphological and immunohistochemical data from patients with a final diagnosis of granuloma faciale, confirmed between 1998 and 2012. There was a proportional and mixed inflammatory infiltrate, Grenz zones were present in almost all the samples. Immunophenotyping confirmed a higher intensity of T lymphocytes than B lymphocytes in thirteen samples, with a predominance of T CD8 lymphocytes in 64% of cases, in contrast to the literature, which indicates that the major component is T CD4 lymphocytes. All cases were positive for IgG4 but the majority (12/14) had less than 25% of stained cells. The pathogenesis of granuloma faciale remains poorly understood, making studies of morphological and immunohistochemical characterization important to better understand it.

https://doi.org/10.1590/abd1806-4841.20164628 1525 descargas

11.

Absence of Wharton's jelly: case report
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Oliveira, Cristiano Claudino

; Dufloth, Rozany Mucha

; Coelho, Kunie Iabuki Rabello

Jornal Brasileiro de Patologia e Medicina Laboratorial

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Dic 2014, Volumen 50 Nº 6 Paginas 452 - 455

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Na literatura, há poucos relatos sobre a ausência de geleia de Wharton. Relatamos o sétimo caso em uma primigesta de 22 anos, admitida após parto vaginal de feto natimorto. O cordão umbilical apresentava longo segmento com esfacelo da geleia e três vasos sanguíneos completamente separados uns dos outros, com mínima quantidade de geleia de Wharton remanescente ao redor de cada vaso. Ausência de geleia de Wharton associa-se a estresse, restrição de crescimento e óbitos fetais. Estudos quantitativos/ qualitativos sobre a geleia de Wharton representam campo de pesquisa aberto para possíveis correlações com condições e doenças obstétricas e óbitos fetais.

There are few reports in the literature of the absence of Wharton's Jelly. Here we report the seventh case in a primigravida, 22 years old, admitted after vaginal delivery of stillborn. The umbilical cord have a long segment with disruption of cord structures and the three blood vessels were completely separated from each other, with a minimum amount of Wharton's jelly remaining around each vessel. The absence of Wharton' jelly is associated with fetal distress, intrauterine growth restriction, and fetal death. Quantitative/qualitative studies of Wharton's jelly represent an open field of research for possible correlations with obstetric conditions and fetal deaths.

https://doi.org/10.5935/1676-2444.20140056 4382 descargas

12.

EVOLUTION OF PATIENTS WITH AIDS AFTER cART: CLINICAL AND LABORATORY EVOLUTION OF PATIENTS WITH AIDS AFTER 48 WEEKS OF ANTIRETROVIRAL TREATMENT
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Fukumoto, Ana Esther Carvalho Gomes

; Oliveira, Cristiano Claudino

; Tasca, Karen Ingrid

; Souza, Lenice do Rosario de

Revista do Instituto de Medicina Tropical de São Paulo

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Jul 2013, Volumen 55 Nº 4 Paginas 267 - 273

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO A terapia antirretroviral na aids visa inibir a replicação viral, retardar a progressão da imunodeficiência e melhorar a sobrevida do paciente. O objetivo do estudo foi comparar dois esquemas de tratamentos antirretrovirais, quanto à carga viral plasmática (CV) e contagem de linfócitos T CD4+, durante 48 semanas de tratamento, pela revisão de 472 prontuários no período de 1998 a 2005, em um Serviço de Ambulatórios Especializados. Foram incluídos para o estudo 58 pacientes que receberam esquema tríplice como terapêutica inicial, os quais formaram dois grupos: Grupo 1 (G1): 47 indivíduos em tratamento com dois inibidores de transcriptase reversa análogos de nucleosídeos (ITRN) e um inibidor de transcriptase reversa não análogo de nucleosídeo; Grupo 2 (G2): 11 pacientes em tratamento com dois ITRN e um inibidor de protease. Entre os pacientes de G1 e G2, 53.2% e 81.8%, respectivamente, foram classificados como portadores de aids com doença definidora. A contagem de linfócitos T CD4+ aumentou progressivamente até a 24ª semana de tratamento, em todos os doentes e, a CV tornou-se indetectável em 68,1% dos casos de G1 e em 63,6%, do G2. O estudo concluiu que, em ambos os grupos de tratamento, houve evolução laboratorial semelhante e essa observação foi compatível com evolução clínica favorável dos pacientes estudados.

SUMMARY Combination Antiretroviral Therapy (cART) aims to inhibit viral replication, delay immunodeficiency progression and improve survival in AIDS patients. The objective of this study was to compare two different schemes of cART, based on plasma viral load (VL) and CD4+ T lymphocyte count, during 48 weeks of treatment. For this purpose, 472 medical charts of a Specialized Outpatient Service were reviewed from 1998 to 2005. Out of these, 58 AIDS patients who had received a triple drug scheme as the initial treatment were included in the study and two groups were formed: Group 1 (G1): 47 individuals treated with two nucleoside reverse-transcriptase inhibitors (NRTI) and one non-nucleoside reverse-transcriptase inhibitor; Group 2 (G2): 11 patients treated with two NRTI and one protease inhibitor. In G1 and G2, 53.2% and 81.8% respectively were patients with an AIDS-defining disease. The T CD4+ lymphocyte count increased progressively up until the 24th week of treatment in all patients, while VL became undetectable in 68.1% of G1 and in 63.6% of G2. The study concluded that the evolutions of laboratory tests were similar in the two treatment groups and that both presented a favorable clinical evolution.

https://doi.org/10.1590/S0036-46652013000400008 2901 descargas

13.

Feedback de usuários como subsídio para avaliação do estudante de medicina
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Hamamoto Filho, Pedro Tadao

; Oliveira, Cristiano Claudino

; Silva, Ludmila Almeida

; Carvalho, Lídia Raquel de

; Peraçoli, José Carlos

; Borges, Vera Therezinha Medeiros

Revista Brasileira de Educação Médica

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Sep 2012, Volumen 36 Nº 3 Paginas 381 - 386

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

A avaliação é fundamental para o processo ensino-aprendizagem. Diferentes métodos de avaliação e diversos atores envolvidos na avaliação podem fornecer elementos distintos, que, somados, fornecem melhor compreensão sobre a efetividade do processo educacional em suas variadas dimensões. A avaliação de habilidades e atitudes de estudantes tem recebido grande atenção recentemente. O envolvimento de pacientes no processo pode ser contributivo, pois sua perspectiva acrescenta informações ímpares. O presente estudo avaliou a aquisição de competências e habilidades de estudantes de Medicina no internato de Obstetrícia, sob o ponto de vista de gestantes. As pacientes responderam a um questionário segundo escala de Likert, com itens de avaliação divididos em habilidades de comunicação, exame físico e profissionalismo. Os resultados mostraram boa avaliação dos estudantes em geral, o que atribuímos ao sentimento de gratidão das pacientes. Algumas questões com maiores frequências de respostas negativas, porém, apontam aspectos que merecem maior atenção da escola médica pelo impacto que podem trazer à prática profissional. A perspectiva de pacientes na avaliação do estudante de Medicina poderá balizar estratégias de feedback para qualificar a formação médica.

Evaluation is a very important part of the teaching-learning process. Different methods and actors may provide distinct elements for a better comprehension on the efficacy of the educational process. This way, there is an increasing attention for evaluation of students' abilities and attitudes. To involve patients in the evaluation may also provide special information. The present study evaluated students abilities and competences during Obstetrics clerkship through patients' perspectives. The questionnaire used a Likert scale and it was divided into three aspects: abilities of communication, clinical exam and professionalism. The results showed a good evaluation possibly due to a gratitude bias. However some items had a higher percentage of negative answers and these points should be noted by medical schools, as they can impact professional behavior. Patients' perspectives to evaluate medical students may provide feedback in order to improve medical education.

3727 descargas

14.

Violência e saúde: concepções de profissionais de uma Unidade Básica de Saúde
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Oliveira, Cristiano Claudino

; Almeida, Margareth Aparecida Santini de

; Morita, Ione

Revista Brasileira de Educação Médica

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Sep 2011, Volumen 35 Nº 3 Paginas 412 - 420

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

INTRODUÇÃO: A Organização Mundial da Saúde (OMS) e o Ministério da Saúde (MS) brasileiro definem violência como fenômeno multicausal, de múltiplas manifestações, cujas consequências afetam também o setor da saúde. OBJETIVOS: Identificar concepções dos profissionais de uma Unidade Básica de Saúde (UBS) sobre violência. MÉTODOS: A metodologia desenvolvida foi qualitativa, identificando-se as representações sociais sobre violência. Realizaram-se 17 entrevistas semiestruturadas, audiogravadas, cujo conteúdo foi analisado pela identificação de núcleos recorrentes nas falas dos sujeitos. RESULTADOS: Independentemente da formação, os profissionais reconheceram a pluralidade da violência, destacando suas manifestações, revelando, porém, despreparo para sua abordagem, reflexo da formação fundamentalmente biomédica. A violência, nessa comunidade, é subnotificada, pois a população é intimidada pelo problema, e o profissional não consegue abordá-lo. CONCLUSÃO: A violência subnotificada nessa localidade representa um microcosmo das fragilidades do sistema de saúde na capacitação de profissionais e assistência multidisciplinar, justificando a inserção da temática da violência na agenda da saúde pública.

INTRODUCTION: The World Health Organization (WHO) and the Brazilian Ministry of Health define violence as a multi-causal phenomenon with multiple manifestations whose outcomes affect the healthcare sector, among others. OBJECTIVES: The study aimed to identify perceptions of violence among professionals in a primary healthcare service. METHODS: The methodology was qualitative, identifying social representations of violence. Seventeen semi-structured interviews were conducted and audio-taped. The content was analyzed for recurrent core themes in the subjects'statements. RESULTS: Regardless of their training, the professionals acknowledged the plural nature of violence and emphasized its manifestations. However, they displayed a lack of preparedness to deal with violence, thus reflecting their essentially biomedical training. Violence in the community in question is underreported, since the local population is intimidated by the problem, and health professionals are unprepared to deal with it. CONCLUSION: Underreported violence in this community reveals weaknesses in the healthcare system to train professionals and organize multidisciplinary care, thus justifying the inclusion of violence on the public health agenda.

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15.

Avaliação da utilização de biópsia transbrônquica em pacientes com suspeita clínica de doença pulmonar intersticial
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Oliveira, Cristiano Claudino

; Fabro, Alexandre Todorovic

; Ribeiro, Sérgio Marrone

; Defaveri, Julio

; Capelozzi, Vera Luiza

; Queluz, Thais Helena Thomaz

; Yoo, Hugo Hyung Bok

Jornal Brasileiro de Pneumologia

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- SciELO Analytics

Abr 2011, Volumen 37 Nº 2 Paginas 168 - 175

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

OBJETIVO: Estudar os padrões clínicos, radiológicos e histopatológicos da biópsia transbrônquica (BTB) utilizados para a confirmação diagnóstica em pacientes com suspeita clinica de doença pulmonar intersticial (DPI) atendidos em um hospital universitário de nível terciário. MÉTODOS: Os prontuários, laudos radiológicos e de biópsias transbrônquicas de todos os pacientes com suspeita de DPI submetidos a BTB entre janeiro de 1999 e dezembro de 2006 no Hospital das Clínicas de Botucatu, localizado na cidade de Botucatu (SP), foram revisados. RESULTADOS: Foram incluídos no estudo 56 pacientes. Desses, 11 (19,6%) apresentaram o diagnóstico definitivo de fibrose pulmonar idiopática (FPI), que foi significativamente maior nos casos nos quais DPI era uma possibilidade diagnóstica em comparação com aqueles nos quais DPI era a principal suspeita (p = 0,011), demonstrando a contribuição da BTB para a definição diagnóstica dessas doenças. O exame histopatológico dessas biópsias revelou que 27,3% dos pacientes com FPI apresentavam o padrão de pneumonia organizante, o que pode sugerir doença mais avançada. O padrão histológico indeterminado foi o mais frequente, refletindo a característica periférica da FPI. Entretanto, o padrão fibrose apresentou alta especificidade e alto valor preditivo negativo. Para os padrões sugestivos de FPI em TC, a curva ROC indicou que a melhor relação entre sensibilidade e especificidade ocorreu com a presença de cinco alterações radiológicas, sendo o aspecto de favo de mel fortemente sugestivo de FPI (p = 0,01). CONCLUSÕES: Nas DPIs, a TC de tórax deve ser sempre realizada e a BTB usada em situações individualizadas, conforme a suspeita e distribuição das lesões.

OBJECTIVE: To study the clinical, radiological, and histopathological patterns of transbronchial biopsy (TBB) used in order to confirm the diagnosis in patients with clinical suspicion of interstitial lung disease (ILD) treated at a tertiary-care university hospital. METHODS: We reviewed the medical records, radiology reports, and reports of transbronchial biopsies from all patients with suspected ILD who underwent TBB between January of 1999 and December of 2006 at the Hospital das Clínicas de Botucatu, located in the city of Botucatu, Brazil. RESULTS: The study included 56 patients. Of those, 11 (19.6%) had a definitive diagnosis of idiopathic pulmonary fibrosis (IPF), the rate of which was significantly higher in the patients in which ILD was a possible diagnosis in comparison with those in which ILD was the prime suspect (p = 0.011), demonstrating the contribution of TBB to the diagnostic confirmation of these diseases. The histopathological examination of the biopsies revealed that 27.3% of the patients with IPF showed a pattern of organizing pneumonia, which suggests greater disease severity. The most common histological pattern was the indeterminate pattern, reflecting the peripheral characteristic of IPF. However, the fibrosis pattern showed high specificity and high negative predictive value. For CT scan patterns suggestive of IPF, the ROC curve showed that the best relationship between sensitivity and specificity occurred when five radiological alterations were present. Honeycombing was found to be strongly suggestive of IPF (p = 0.01). CONCLUSIONS: For ILDs, chest CT should always be performed, and TBB should be used in specific situations, according to the suspicion and distribution of lesions.

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