International Archives of Medicine (E-Journal)
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Atopic Eczema Simulating Mammary Paget’s Disease in an Adult: Case Report
Get PDFAn atopic breast eczema is usually bilateral, with intense pruritus and good response to corticosteroids. The differential diagnosis with mammary Paget’s disease is fundamental, mainly in unilateral clinical manifestations, since it is frequently associated to adjacent breast tumors. The aim of the present report was to present a clinical condition of an atopic breast eczema through an exuberant and unilateral clinical presentation, emphasizing the need of the differential diagnosis for malignant diseases at this location
Healthcare Advocacy And Moral Distress In The Practice Of Nurses
Get PDFBackground: By focusing in prioritizing patients and their rights, occasional limitations may arise and prevent nurses from doing their work according to their social and professional commitment. This may culminate in Moral Distress, resulting from the incoherence between the nurses' actions and their personal convictions.
Research question: Is there any relationship between healthcare advocacy and moral distress in the practice of nurses working in hospitals?
Objective: Analyzing the relation between healthcare advocacy and moral distress in the practice of nurses working in hospitals.
Research design: Quantitative, analytical cross-sectional study. The data collection instruments comprise the Moral Distress Scale Revised – Brazilian version and the Protective Nursing Advocacy Scale – Brazilian version. Data analysis was carried out with elements of descriptive statistics, Pearson's correlation and linear regression analysis.
Participants and research context: The participants comprised 157 nurses working in two hospitals located in a city in southern Brazil. One of the institutions is a public university hospital and the other is a philanthropic institution.
Ethical considerations: All the international directives for research with human beings were observed.
Findings: The constructs barriers to the advocacy practice and negative implications to the advocacy practice were pointed out as predictors of moral distress.
Discussion: The situations approached in this study illustrate that certain organizational and cultural contexts have negative impacts on nurses, who are in constant contact with the necessity of promoting patient well being and increasing access to healthcare, especially under the perception of vulnerability in risk situations, or when the quality of the services provided decreases and patients are not given adequate assistance.
Conclusion: We hope that this study encourages the reflection about the relationship between patient advocacy and moral distress, and the search for resources that may contribute to the quality of the assistance provided by nurses
The current profile of the patient with atrial fibrillation
No full textAbstract: Atrial fibrillation (AF) is the most common supraventricular arrhythmia, characterized by an irregular and extremely rapid atrial electrical activation that causes loss of atrial mechanical function and important hemodynamic consequences. AF classification is important in both the therapeutic approach and the prognosis. Several classifications based on the ECG patch, epicardial or endocavitary records have been performed over time, but no classification can take into account all the characteristics of AF and especially associated diseases, which may be both the cause and consequence of arrhythmia. Aim: The aim of the study is to establish the current profile of the patient with atrial fibrillation in the new era of oral anticoagulant therapy and sinus rhythm restoration.
Material and methods: The trial was conducted on patients with atrial fibrillation hospitalized between 01.10.2014-31.03.2015 at Institute of Cardiovascular Diseases ”Prof. Dr. G. Georgescu”, Iasi. Patients included in the study were analyzed according to age and sex, criteria for the clinical and paraclinic definition for atrial fibrillation.
Results: Atrial fibrillation is an extremely common cardiovascular pathology and is present in about one-third of patients admitted to our clinic. Cardiovascular diseases such as hypertension, ischemic coronary artery disease, and valvulopathy are common in patients with AF. Patients with AF are usually elderly patients with many associated diseases in whom sinus rhythm restoration treatment and anticoagulant therapy are difficult to establish. AF is one of the most common arrhythmias that complicates the evolution of acute myocardial infarction, association between dual antiplatelet therapy and anticoagulation treatment, increasing the risk of bleeding complications.
Conclusions: Atrial fibrillation is an extremely common cardiovascular pathology and is present in about one-third of patients admitted to our hospital. The data obtained revealed that this arrhythmia occurs in a small number of cases as the only pathology of the patient, usually associated with numerous comorbidities. Cardiovascular diseases such as hypertension, ischemic coronary artery disease, valvulopathy are common in our practice. Patient with AF is a patient who requires long-term anticoagulant therapy and in whom sinus rhythm recovery therapy is dependent on the precocity of presentation to the physician, as well as on the therapeutic resources of current medicine
Symptomatic Bochdalek Hernia in Adult: a Case Report
No full textBackground: The congenital malformation of the posterolateral portion of the diaphragm is called the Bochdalek hernia, and was first described in 1948 by anatomy professor Bochdalek. The diagnosis in adults is extremely rare, being in the majority, an occasional finding in a chest x-ray.
Case: The authors report a Bochdalek Hernia case in an adult pacient, with complaints of dyspnea and epigastralgia refractory to pharmacological treatment. The diagnosis was confirmed after a chest CT scan.
Conclusion: Bochdalek hernias are extremely rare in adults, commonly diagnosed in childhood. The importance of recognition of its diagnosis is crucial, so it should be always among differential diagnoses in radiology, due to the range of complications that may affect the patients
Effect of Different Photoiniciers of Experimental Adhesive Systems on Adhesive Interface Union Resistance
No full textAim: The objective of this study was to investigate the performance of experimental resinous adhesives containing different combinations of photoinitiators systems through the bending test.
Material and Methods: Resinous adhesive formulations were prepared with monomer mixtures consisting of 50% by mass of bisphenol dimethacrylate glycidyl (BisGMA) and 50% by mass of triethyleneglycol dimethacrylate (TEGDMA). The photoinitiators were used, camphorquinone (CQ) and bis-alkyl phosphinic oxide (BAPO). The co-initiators were diphenyliodonium hexafluorophosphate (DFI) and the amine (dimethylamino methylmethacrylate - DMAEMA) in the 1:1 proportion by mass. The photopolymerizable initiator systems were dissolved in the organic matrix at 0.5% by mass concentrations, creating eight groups (G1- CQ, G2- CQ/amine, G3- CQ/DFI, G4- CQ/amine/DFI, G5- BAPO, G6- BAPO/amine, G7- BAPO/DFI, G8- BAPO/amine/DFI). Samples with 7.0 mm in length, 2.0 mm wide and 1.0 mm height were prepared (n=12). The curing light used was VALO – Ultradent and the curing time was 20 s. The samples were subjected to evaluation of bending test at three points at a speed of 1 mm/min to evaluate the flexural resistance (FR).
Results: The results were submitted to analysis of variance with one criterion (p < 0,001) and multiple comparisons were performed using Tukey test. Systems with the photoinitiator BAPO showed higher or equivalent bending values that demonstrated by the conventional system containing CQ/amine. Systems with the DFI had higher flexural values in relation to those demonstrated by systems without the DFI to CQ.
Conclusion: The use of systems with alternative photoinitiators and co-initiators allows to obtain superior properties to the conventional system, making these promising systems to act both in isolation as associated with conventional systems
Maternal-fetal acute responses to two moderate-intensity exercise types: a randomized clinical trial
Get PDFObjective: This study aims to compare maternal and fetal responses during two physical exercise types.
Design: A randomized clinical trial compared 120 pregnant women, gestational age of 35-37 weeks, 56 exercising on a stationary bicycle (Group A) and 64 on a treadmill (Group B).
Methods: Participants were monitored for three 20-minute phases: resting, exercise and recovery. Fetal heart rate (FHR) and maternal heart rate (MHR) were monitored. Glucose and lactate levels were evaluated at rest and during exercise.
Results: After the beginning of exercise, maximum lactate (L) levels were reached at 20 minutes and never exceeded 4 mmol/l. FHR decreased by 22 bpm during exercise in relation to resting values, irrespective of the exercise type (p<0.001). Comparing the exercise types, the incidence of bradycardia after 10’ was 23.2% in Group A and 35.9% in Group B (p>0.05), increasing at 20’ to 32% and 40.6%, respectively, (p>0.05). The FHR decrease during exercise was accompanied by a simultaneous increase in its variability (p<0.001), nevertheless a rapid return to resting values was observed shortly after exercise end. Glucose decreased in both groups irrespective of the exercise type (85 mg/dl at rest; 79 mg/dl during exercise and 81 mg/dl during recovery; p<0.001). There were no hypoglycemia cases.
Conclusions: FHR variability increase and the rapid return to resting values after exercise suggests that the FHR fall and the presence of bradycardia during exercise is the fetal physiologic response to blood flow redistribution, with maintenance of fetal well-being.
Key-words: Exercise; fetal heart rate; glucose; maternal heart rate; pregnancy
Clinical Trial Registration: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01383889
Morphological expression of the extrahepatic bile duct. A study in a sample of Colombian mestizo population
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Background: The great variability of the extrahepatic bile duct (EBD) has clinical-surgical implications. The objective of this study was to characterize the morphological expressions of EBD.
Methods and findings
This descriptive study, done by injecting a semi-synthetic (Palatal GP40L 85%; styrene 15%) impregnated with mineral green dye into the gallbladder, to determine the anatomical characteristics and the biometrics of EBD in 33 blocks formed from the supra-mesocolic floor.The gallbladder presented a length of 66.9 ± 1.7 mm. The Hartmann´s Pouch was observed in 16 specimens (50%). The lengths of the cystic duct (CD), common hepatic duct (CHD) and common bile duct (choledoch duct) were 27.8 ± 1.6 mm, 28.6 ± 11.39 mm and 60.6 ± 11.6 mm respectively.
The presence of accessory hepatic ducts (AHD) was found in three samples (9.1%). In 29 specimens (87.9%) the cystic duct presented medium length, while in 4 cases (12.1%) the CD was long (P < 0, 05). The trajectory of the lateral oblique of CD was present in 23 cases (69.7%), with statistically significant differences in relation to the other trajectories of the CD (P <0, 05). In 18 samples (55%) the cystic-hepatic union appeared at the level of the middle third of the EBD, while in 15 (45%) cases the union of the CD was low (P<0,05).
Conclusions
The mathematical distribution of the segments of the EBD, carried out in this study, provides reliability to the assessment of the cystic-hepatic junction level. The presence of CHA and the level of the cysto-hepatic junction are important anatomical references, especially in emergency room procedures
Primary health care in leprosy, assessed by users and professionals
Get PDFObjective: Evaluate the performance of primary health care in control of leprosy in Teresina, Brazil from the perspective of users and professionals.
Methods: This cross-sectional, descriptive study involved 25 healthcare users with leprosy and 34 professionals (physicians and nurses) working in 13 municipal health units within the urban area of Teresina. The data were collected from January to June, 2017, using the Instrument for Assessing the Performance of Primary Care in Leprosy Control Actions, a document based on the Primary Care Assessment Tool/PCATool Brasil which measures the presence and extension of essential and derived attributes from primary health care.
Results: The mean scores obtained for the essential, derived and global attributes, through the perception of the users, were lower than 6.6, indicating that the primary health services in Teresina are not sufficiently oriented to carry out leprosy control actions, mainly in terms of access, integrality of services provided, family orientation and community orientation. The professionals showed a contrasting view, with averages exceeding 6.6 for all attributes and scores. The difference in perception between the groups was significant for all attributes except for coordination (Mann-Whitney U test, p = 0.479).The overall evaluation of quality was not influenced by the user’s clinical or socioeconomic variables, but rather by the organization/provision of services.
Conclusions: The municipal health units within the urban area of Teresina must be strongly guided by primary health care attributes in order to reach higher levels of user satisfaction.
 
The Analysis Of Psychopathology In Alfred Hitchcock Movies
No full textINTRODUCTION: During the 20th century, psychiatry began to use the cinema as didactic-pedagogical help resource in the study of psychopathology. The Films of Alfred Hitchcock usually present as main themes mental disorders and the psychoanalysis. However, these films were not created with academic goal and it is natural that there are distortions.
OBJECTIVES: To evaluate the importance of Hitchcock films as didactic resource in the study of psychopathology, identify possible distortions and seek to justify them on the basis of the historical context.
METHODOLOGY: The abstracts of the 53 feature-length films of the director were read and deleted the movies that did not have the mental disorder as a central theme; they were dumb; or those who had only the antisocial personality disorder. It was performed a narrative review.
RESULTS: Six films were selected through an intentional sampling. When he speaks of the Heart (1945) shows a picture of amnesia with dissociative fugue. The psychoanalysis is represented in a very superficial. The Indiscreet (1954) describes a voyeuristic disorder and should not be indicated. The Wrong Man (1956) depicts a severe depressive episode with psychotic symptoms. A body that falls (1958) presents the themes of specific phobia of height and the acute stress disorder. Psychosis (1960) represents a framework of dissociative identity disorder, but the scenes of violence may cause a negative view of the mentally ill. Marnie (1964) has as themes the specific phobia and sexual aversion disorder. The psychoanalysis is presented in distorted form and caricature.
CONCLUSION: The films directed by Alfred Hitchcock can be useful in the study of psychiatry and should be considered the distortions that can worsen the stigma
The Effect of Deep Oscillation Therapy in Fibrocystic Breast Disease. A Randomized Controlled Clinical Trial
No full textIntroduction: Fibrocystic breast disease is the most widespread disorder in women during their phase of sexual maturity. Deep oscillation (DO) therapy has been used on patients who have undergone an operation for breast cancer as a special form of manual lymphatic drainage.
Method: Experimental, prospective case-control studies were conducted in 401 women diagnosed with fibrocystic breast disease. The sample was selected at random and was divided into three groups, a study group and two control groups.
Results: Pain was reduced in the three therapies applied. This was statistically significant in the study group. The sonography study presented a predominance of its fibrous form. Upon completion of the treatment a resolution of the fibrosis was observed in the study group. The women were using their bra in an incorrect manner.
Conclusions: Pain was reduced in the three therapies applied. In the study group this reduction was statistically significant. It is possible to verify the magnitude of the resonant vibration in the connective tissue from surface to deep layers by viewing the effect of the deep oscillations through the use of diagnostic ultrasound. The most frequent sonographic finding was fibrosis. Deep oscillation therapy produces a tissue-relaxing, moderate vasoconstriction effect, favours local oedema reabsorption and fibrosis reduction. A factor that may affect breast pain is incorrect bra use. The majority of women studied were using their bra incorrectly