#1IJMS eISSN 2076-6327 INTERNATIONAL JOURNAL of MEDICAL STUDENTS Year 2015 | Volume 3 | Supplement 1 www.ijms.info Editorials XXVI Colombian Scientific Congress of Medical Students CECIM: 26 years promoting medical student research. - The 2nd International Medical-Academic Congress of Maranhão. -The 21 years of Academic Medical Congress of Piaui! 11th Warsaw International Medical Congress, 2015 ECIM 2015 C Medicalis xxxxxxXxXxXO- Cáncer Cirugía Genética International Congress for Medical Students and Young Doctors MMI Malaysian Medics International" 11TH W MC#2International Journal of Medical Students Year 2015 • Volume 3 • Supplement 1 Table of Contents Int J Med Students 2015;3(Suppl 1) IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS International Journal of Medical Students The International Journal of Medical Students (IJMS), is a peer-reviewed open- access Journal, created to share the scientific production and experiences of medical students worldwide. Editorials XXVI Colombian Scientific Congress of Medical Students CECIM: 26 years promoting medical student research Yeimer Ortiz-Martínez. The 2nd International Medical-Academic Congress of Maranhão Yuri Lopes Nassar and Marcos Antonio Custódio Neto da Silva. The 21 years of Academic Medical Congress of Piaui! Anielle Memória Da Silva 11th Warsaw International Medical Congress, 2015 XXX Schisto SXie1 Sand Art. Scene from "Neglected: A Story of Schistosomiasis Infection in Ghana" By Shelly Xie (with authorization). 1st Year Medical Student, University of Texas Southwestern Medical Center, Dallas, TX, USA Email: [email protected] Abstracts Abstracts of XXVI Colombian Scientific Congress of Medical Students (CECIM) Abstracts of the 2nd International Academic Medical Congress of Maranhão (COIMAMA) Abstracts of Academic Medical Congress of Piaui (COMAPI) Abstracts of International Congress for Medical Students and Young Health Professionals (MEDICALIS) Abstracts of Malaysian Medical Student Summit (MMSS) Abstracts of 11th Warsaw Internation Medical Congress (WIMC) www.ijms.info . 2015 Vol 3 Supp 1 Page S4 S6 S8 S9 S11 S16 S40 $57 $58 S63 INTERNATIONAL JOURNAL of MEDICAL STUDENTS S3#3IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS Editorial Editorial Ortiz-Martínez Y. XXVI Colombian Scientific Congress of Medical Students CECIM: 26 years promoting medical student research XXVI Colombian Scientific Congress of Medical Students CECIM: 26 years promoting medical student research Yeimer Ortiz-Martínez.* The Colombian Medical Student Association of Scientific Societies (ASCEMCOL) has as one of its main objectives, promote the scientific culture on medical students and in its 26 years of experience has integrated students from 33 faculties of the country in carrying out activities of scientific character. The Colombian Scientific Congress of Medical Students (CECIM) organized annually by the ASCEMCOL, is the most important congress on medical student research of the country, where students can present and communicate the results of their researches, protocols, clinical cases, medical photographs and videos, having the opportunity to make a presentation based on the same requirements used in the international scientific events. The XXVI version of the CECIM was held on 4-6 June 2015 at the city of Santiago de Cali, Colombia. The theme of this important national congress was "Surgery, Cancer and Ge- netics: from the forefront of medical science to research, the art of generating knowledge". It was organized by the ACEMVAL (Scientific Association of Medical Students of the Universidad del Valle) and endorsed by the Faculty of Health of the Universidad del Valle, the Cancer Registry of Cali, the Colombian Association of Human Genetics and the Colombian Association of Inborn errors of metabolism and neonatal screening. More than 400 students and healthcare workers participa- ted in our congress, the medical conferences and the com- petition of scientific works were a total success. About 30 national and international experts in the fields of surgery, cancer and genetics were present at this national event and additional courses were organized in subjects as evidence based medicine, palliative care, research methodology and how to write scientific articles, sexual education, human rights and electrocardiography. Among the international guests were Dr. Nubia Muñoz from France, Dr. Armando Sardi from USA, Dr. King Jordan from USA and Dr. Juan Fernando Cabello from Chile. Our national congress has more international visibility thanks to the partnership with the International Journal of Medical Students (IJMS), because all the abstracts presen- ted during the annually events will be published in the supplements of the journal. We encourage you to submit your research papers to IJMS and don't miss the chance to participate in the XXVII edition of CECIM, which will take place in Bucaramanga in May of 2016. niversidad Hel Valle acultad כ Figure 2. Delegates of associations belonging to ASCEMCOL during the XXVI Colombian Scientific Congress of Medical Students 2015. Cali, Valle del Cauca, Colombia. ¡We're ready! ECIM03 C Cáncer Cirugía Genética Junio Llego la hora! Figure 1. Local Presidents of associations belonging to ASCEMCOL. Photo taken during the XXVI Colombian Scientific Congress of Medical Students 2015. Cali, Valle del Cauca, Colombia 1*Scientific Director of the Colombian Medical Student Association of Scientific Societies, ASCEMCOL. University of Sucre. Sincelejo, Sucre, Colombia. * Regional Ambassador for South America. International Journal of Medical Students IJMS. Correspondence Address: University of Sucre, Faculty of Health Sciences, Carrera 14 No. 15C-132. Sincelejo, Sucre, Colombia. Email: [email protected] S4 INTERNATIONAL JOURNAL of MEDICAL STUDENTS Hoy gran inicio con el Pre Congreso Falta 01 día Para el inicio del CONGRESO Cali te espera! ASCEMCOL Asociación de Sociedades Científicas de Estudiantes de Medicina de Colombia Figure 3. Promotional Poster of the XXVI Colombian Scientific Congress of Medical Students 2015. Cali, Valle del Cauca, Colombia. Fig 4. Dr. Nubia Muñoz from France, during her presentation in the XXVI Co- lombian Scientific Congress of Medical Students 2015. Cali, Valle del Cauca, Colombia. www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS $5#4S6 INTERNATIONAL JOURNAL of IJMS MEDICAL STUDENTS Editorial Editorial Yuri Lopes Nassar and Marcos Antonio Custódio Neto da Silva. The 2nd International Medical-Academic Congress of Maranhão The 2nd International Medical-Academic Congress of Maranhão Yuri Lopes Nassar and Marcos Antonio Custódio Neto da Silva. I International Medical-Academic Medical Congress of Ma- ranhão (COIMAMA) came through an innovative and bold proposal to mobilize the medical student and class in order to integrate the state universities, stimulate the production of scientific research and address current and important topics of medicine. With the presentation of works of the oral free theme, poster presentation and lecture renowned physicians of Maranhão and guests, with a total audience of 980 people. Moreover, it was held the I VER-SUS National Meeting in order to integrate and enables the exchange of experien- ces with the program in stages held in the National Health System. Thus, provoking reflections on the student's role as an agent social reality, contributing to the construction of the expanded concept of health and contribute mainly to the maturation of multidisciplinary and interdisciplinary practice, thus, integrate teaching and service-management- control social in the health field. In the first edition of COIMAMA, we have the | Maranhen- se Meeting Medical Academic Leagues, with participation alloys of state universities, which held workshops aimed at the public, aiming to upgrade and empower Congress on Clinical management in the medical community. Santo, Minas Gerais, Paraná and Rio Grande do Sul). Fur- thermore, there was the participation of Doctors Sthephan Schimttgens (Drachten - Netherlands) and Didier Guy J. Du- pront Rozes (France), and scientific works from other cou- ntries (Peru), contributing to the internationalization and greater coverage of the event. In 2015, in its second edition, the event has expanded fur- ther, with greater involvement of medical schools across the state and from other states, more scholars from other areas of health, as well as medicine and nursing. In this issue, we also have the following events: I Shows State Experiences in Primary Care and Health, I North-Northeast Meeting of Academic Leagues and Medical Symposium of Pharmaceutical Care. The Organizing Committee has also been expanded, with the participation of academics of Nursing, Pharmacy, Speech Therapy and Psychology of public and private University of Maranhão (UFMA - São Luís, Pinheiro and Imperatriz, UEMA and CEUMA) as well as of Piaui universities, Tocantins and Espírito Santo, contributing to the exchange between scho- lars from various states. In this second edition, the theme of the congress was Inte- ractive. There were 9 rooms with concurrent programming including lectures, discussions, roundtables, clinical case discussions, workshops, scientific papers, courses and short courses with the participation of professionals from various fields, local, national and international prestige. In addition, we expanded the functions of our application, in which there were many new developments before and du- ring the event, where lawmakers were able to interact with each other and with the lectures, clinical case discussions and other audiovisual resources. Repeating the success of the first edition, the II Photographic Exhibition of COIMAMA honored the renowned physician and anthropologist ma- ranhense Raimundo Nina Rodrigues, important social figu- WTSCHADOL DAMANTY m CEUM II COIMAMA CONGRESSO INTERNACIONAL MEDICO ACADÉMICO DO MARANHÃO tatti Sa INCONTRO NON ACADEMEU BEO COIDADOS CO BOSSONE Figure 2. Photo from the II COIMAMA, 2015. re, legal and development of the country's health. We also had the participation of Mexican neurologist Rosana Huerta Albarrán, further contributing to the internationalization of the event We can say that we are very glad to develop this partner- ship with IJMS. Here, you will read the abstracts of our presented scientific works. We invite you to visit COIMAMA'S webpage at www.coimama.com.br to participate in next editions of this remarkable scientific event. We are very proud to offer you this abstract book and we sincerely hope you appreciate it! Figure 1. The team of COIMAMA. The Organizing Committee was formed by medical students at the University Ceuma, Federal University of Maranhão and State University of Maranhão, in addition to the sup- port of several doctors, dentists, nurses, physiotherapists and other health professionals together, they subdivided into committees specific organizational, such as commu- nication and marketing committee, secretariat, cultural, molding and workshop, multidisciplinary, scientific and teaching. The collaboration of Maranhão and especially the medical faculty medical organizations was fundamental to the event. Teachers, as well as coordinate modules and giving lectures, also participated in the approval and eva- luation of scientific research. I COIMAMA did not restricted to the State of Maranhão: about 40% of the papers presented at the conference were academics and professionals from other 18 states (Piauí, Pará, Tocantins, Ceara, Pernambuco, Rio Grande do Norte, Alagoas, Sergipe, Rondônia, Mato Grosso do Sul, Goiás, Distrito Federal, São Paulo, Rio de Janeiro, Espirito INTERNATIONAL JOURNAL of MEDICAL STUDENTS CRUMAN Ex ICN www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 COIMAMA Figure 3. Photo from the II COIMAMA, 2015. MILA INTERNATIONAL JOURNAL of MEDICAL STUDENTS S7#5IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS Anielle Memória Da Silva Editorial Editorial The 21 years of Academic Medical Congress of Piaui! XXX 11th Warsaw International Medical Congress, 2015 11th Warsaw International Medical Congress, 2015 The 21 years of Academic Medical Congress of Piaui! XXX Anielle Memória Da Silva' comap WCC 11TH WIMC MTMC Figure 1. Anielle Memória Da Silva, President of the 21th Academic Medical Congress of Piaui 2014 at Opening The 21th Edition Academic Medical Congress of Piaui was performedduring the 17 to 21 September, 2014, in Teresina - Piauí. In this year, the COMAPI had also consolidated as V Medical Academic Congress ofBrazilian Northeast, a trajec- tory that valorizes this scientific event, already recognized as one of the largest academic medical congress in the Northeast. It is important to note that we live today in the COMAPI is a merit of the work of successive generations that have had great success in their organization of this event in all these 21 years. The I Academic Medical Congress of Piaui was performed in 1994 with a "scientific spirit" that began in the 90s in Medicine of Piauí. In 2010, the COMAPI crosses borders and becomes the I Medical Academic Congress of Brazilian Northeast. At the time, COMAPI's objectives were governed by an orchestra of impossible almost dreams! In this 21th edition, I can say that these dreams are today, our reality. First of all, it is an honor and a great responsibility to re- present the Organizing Committee of the XXI COMAPI that 1. School of Medicine, University Center Uninovafapi, Teresina, PI, Brazil. Correspondence: Anielle Memória Da Silva Address: Ceará Street, nº2026, Teresina, Piauí, Brazil. E-mail: [email protected] through a big effort performed another edition of this event. There were 11 months of intense work, compromise and learning, valuable for developing our enterprising spirit which was essential to plan, to choose and to make deci- sions to cooperate in some way with the construction of a basic knowledge to our lives as lifelong learners of science. We are also thankful to physician and professor who hel- ped you to prepare our scientific program: André Gonçalves Da Silva, MD, PhD, president of our scientific committee. We thank all the lecturers, especially Fabio Biscegli Jatene, MD, PhD, national reference in teaching and cardiovascular surgery. Certainly, every new COMAPI, students and professionals in Health will be better and will be better prepared, proud and anxious to be involved in a great and endless struggle for the improvement of health. For all these reasons - and mostly we are investing in the greatness of principles, we strongly believe that together we can offer students a work of the highest scientific, medical and social! Figure 1. Photo from the 11th WIMC, 2015. For over 25 years Students Scientific Association of Medical University of Warsaw has organized scientific conferences for biomedical students - first at national level and since 2005 on an international scale. 11th Warsaw International Medical Congress was held at the Medical University of Warsaw between 7th and 10th May 2015. During 4 days of Congress we have hosted over 500 bio- medical students from 31 countries. That places us in the group of 4 biggest conferences in Europe and undeniably the most powerful medical student congress in Poland. Scientific jury, after detailed review process qualified 331 from over 600 submitted abstracts. Selected papers were presented in 23 different thematic sessions. In order to engage even more students and enable presentation of interesting medical cases, there were four Case Report Ses- sions: Dentistry Case Report, Internal Case report, Pediatric Case Report and Surgical Case Report. Case report sessions attracted wide interest. Altogether 63 case reports were ac- cepted in the review process. Due to this wide range of topics every student could find a proper session for the paper. Every research and case report was presented as an oral presentation in front of jury which consisted of Professors and Assistant Professors from different academic centers. Sessions were also open to every interested person active participants, passive participants and people who did not register. Absence of restrictions for listeners (registration was not required for - participation in sessions and lectures) enabled unlimited presence for every person interested in the field. We believe that WIMC is a great place for young resear- chers to meet and build their scientific network. Based on this we try to invite top-class speakers to perform Keynote Lectures. During 11th WIMC participants could learn about out-of-body experience from prof. Henrik Ehrsson (Karolins- ka Institutet, Stockholm), Enhanced Recovery After Surgery (ERAS) system from prof. Nicolas Demartines (CHUV Lousan- ne), brain at extremes of physiologyfrom Mark Wilson, MD PhD (Imperial College of London), genetics of breast cancer from prof. Jan Lubiński (Pomeranian University of Medici- WTMC Figure 2. Photo from the 11th WIMC, 2015. s8 INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info • 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS $9#6IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS XXX Editorial Abstracts 11th Warsaw International Medical Congress, 2015 ne), mirror neurons from prof. Jerzy Vetulani (Institute of Pharmacology in Cracow), preventing amputations from prof. Aleksander Sieroń (Silesian University of Medicine in Katowice), heart team from Michał Zembala MD PhD (Sile- sian Centre for Heart Diseases in Zabrze, Poland), microRNA from Wojciech Fendler MD PhD (Medical University of łódź) and the science of ageing from Jolanda Lindenberg PhD (Le- yden Academy on Vitality and Ageing). We prepared 25 interactive and practical workshops where everybody had an opportunity to trainuseful clinical skills. Finally, we would like to invite you for 12th WIMC which will take place on May 12-15th 2016. Among our speakers you will find a Nobel Prize winner - prof. Bert Sakmann and a guest from Stanford School of Medicine - prof. Homero Rivas. This year we are introducing new thematic sessions including Public & Global Health Session, Law & Medicine Session and sessions for PhD Students. Submit your abs- tract before February 21st and become part of one of the greatest medical congresses for students. Abstracts of XXVI Colombian Scientific Congress of Medical Students (CECIM) 01 03 Isolation of Phages For Salmonella Sp. Manure From A Barn Calarcá MC S10 INTERNATIONAL JOURNAL of MEDICAL STUDENTS THE Figure 3. Photo from the 11th WIMC, 2015. Figure 4.Photo from the 11th WIMC, 2015. XXVI CECIM WILC ORIGINAL RESEARCH Psychoactive Substance Use In The Faculty Of Health In Sur- colombiana University, Period 2014 - 1. Ana María Gómez Aroca, Adriana Zamora Suarez. Scientific Society: Organización Científica de Estudiantes de Medicina de la Universidad Surcolombiana, OCEMSUR. Introduction: The psychoactive substance use represents a problem of high public health impact in universities, especially among stu- dents of health sciences, which reframes the dimension of factors related to consumption, their consequences and the intervention measures towards it. Objective: Determine the prevalence of con- sumption and characterize the related variables towards it. Methods: A descriptive cross-sectional study conducted during the academic year of 2014-1. An adapted survey from WHO was applied to 825 students. 375 of them were discarded due to failures in completing the survey. Results: From total population: 46.33% were men and this group had the highest intake of alcohol (53.59%). Cigarette use was more frequent in women (53.66%). The age of onset ranged from 16- 20 years (52.88%). The most used illegal psychoactive substance was marijuana (14.25%). The main reason for the consumption was fun (36.43%), followed by depression (8.51%), anxiety (7.72%), and aca- demic difficulties (5.54%). Discussion: Psychoactive substance use sets out the challenges in front of low educational achievements, depression, anxiety and substance abuse. Conclusions: Efforts to modify the increasing consumption are unsatisfactory, which neces- sitates the approach of new strategies. Keywords: Consumption, Psychoactive drugs, Risk Factors. 02 Expression Pattern Of MMP-2 During Late Cardiogenesis In An Experimental Model Of Obesity Leidy Alexandra García Gutiérrez, Juan Manuel Jaramillo Me- jia, Alejandro Osorio, Erick Andrew Vargas C, Juan Camilo Londoño, Jhon Carlos Castaño Osorio, Claudia Viviana Grano- bles Velandia. Scientific Society: Asociación Científica de Estudiantes de Medicina de la Universidad del Quindío, ASEIMUQ. Introduction: In Colombia Salmonellosis is one of the largest zoono- sis. Lately it has increased its resistance, considering the bacte- riophages as therapeutic alternative. Objective: To establish the experimental conditions for the isolation of phage for Salmonella sp. in samples taken from manure G. gallus. Methods: Study type, technological transfer. Manure samples and soil be took from a farm of Calarca. Phage was isolated by two methods, one centrifugation, adding PEG, NaCl and meat extract; other microfiltration (filter 0.45 .mu.m). Later by plaque technique coculture was determined. Re- sults: Salmonella was obtained from a clinical isolate and a donation from Dr Manuel Alfonso Patarroyo (ATCC). Bacteriophages obtained by these two methods were cocultivated with both Salmonella thypi, observing the presence of phage in the plaques. Discussion: With the microfiltration was observed between 4 and 10 pfu and bald small (0.5 to 1 mm), with best results in the clinical isolate. Consistent with the literature, many enterobacteria phages used as hosts gene- rate bald difficult to observe. The Centrifugation method increased the number of plaques (10-15 pfu). Conclusion: The two isolation methods showed results, but was more effective centrifugation. Pha- ges acted against the two strains of Salmonella, however had greater activity against clinical isolate. Keywords: Salmonella, Bacteriophages, Gallus gallus. Farah El-Sharkawy Navarro, David Moreno Martínez, María Carolina Pustovrh, Liliana Salazar Monsalve. 04 Scientific Society: Asociación Científica de Estudiantes de Medicina de la Universidad del Valle, ACEMVAL. Introduction: Heart defects are the most common birth defects in humans. Maternal obesity is associated with abnormalities in cardiac development, but the mechanisms involved are unknown. Matrix metalloproteinase-2 (MMP-2) plays an important role in cardiogene- sis. Objective: To evaluate the expression pattern of MMP-2 during late cardiogenesis in normal-weight and obese rats. Methods: Expe- rimental study. A model of obesity was established in adult female Wistar rats by feeding them a high-calorie diet. Obese rats (OB) and controls (CTROL) were mated with healthy males and were sacrificed on day 16.5 of gestation. Fetal hearts were processed for the de- tection of MMP-2 by immunohistochemistry. To analyze the density and distribution of MMP-2 the integrated optical density (IOD) was evaluated. Results: A significant decrease in the expression pattern of MMP-2 was observed in the ventricles of the OB fetal hearts com- pared with CTROL (IOD OB: 10.45 ± 0.73, CTROL: 13.59 ± 0.72, p<0.05). In contrast, immunostaining of MMP-2 in the atria was similar in both groups (OB: 15.19 ± 2.22, CTROL: 13.66 ± 2.10; NS). The expres- sion of MMP-2 was equivalent in the four heart chambers of CTROL, while in OB the ventricles showed a decreased MMP-2 expression relative to the atria. Conclusion: This study revealed alterations in the expression pattern of MMP-2 associated with obesity, which may be a key factor in the increase in congenital heart defects caused by this disease. Keywords: Maternal obesity, MMP-2, congenital heart defects, car- diogenesis Morphometry Of The Thyroid Gland In A Colombian Popula- tion Sample And Its Clinical Importance Gloria Patricia Baena-Caldas, Mario Alejandro Ortiz-Salazar, Luis Gabriel Parra-Lara Scientific Society: Asociación Científica de Estudiantes de Medicina de la Universidad del Valle, ACEMVAL. Introduction: The thyroid gland is located in the anterior neck. It's shaped like U or H and of two lobes: left and right, joined by the isthmus. Occasionally there is a pyramid lobe, which is an anato- mical variant. In the adult dimensions are 4 to 6 cm x 2 cm x 2 cm craniocaudal, sagittal and transverse direction respectively. At the level of the isthmus, measuring less than 0.3 cm in anteroposterior sense. However, dimensions outside this range does not necessarily mean a thyroid pathology. Methods: A descriptive cross-sectional study, a sample of 8 complete corpses was performed. After dissec- ting the thyroid glands, their qualitative and quantitative variables were characterized. Descriptive statistics were used to data analy- sis. Results and Discussion: Corpses were recruited, which two had pyramidal lobe with a length of 5.7 ± 0.85. The length of left to right lobe was 6.39 cm ± 1.95 cm. An average of 1.4 cm ± 0.64 cm for the length of the isthmus was recorded upper to higher. Conclusions: Of- ten, the organogenesis of the thyroid gland is altered, which lead to the development of multiple morphological variations of the glands known as Thyroid dysgenesis. Additionally there are changes due to changes in thyroid migration. The normal length of the thyroid gland depends on variables such as age and geographic distribution, hence the importance of knowing their prevalence in our population. Keywords: anatomy, thyroid gland, morphology, Colombia. www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info • 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS S11#7IJMS XXVI CECIM S12 INTERNATIONAL JOURNAL of MEDICAL STUDENTS Abstracts Abstracts 05 Prescription Patterns Of New Oral Anti-Coagulants And Their Economic Costs In Colombia Federico Villegas Cardona, Santiago García Betancurt, Diego Alejandro Medina Morales, Jorge Enrique Machado Alba. Scientific Society: Asociación Científica de Estudiantes de Medicina de Risaralda, ACEMRIS. Introduction: Atrial fibrilatrion is the the most common arrhythmia with an incidence of 8% in people older than 80. It creates a risk of thromboembolic events but this can be prevented by using warfa- rine and new oral anticoagulants (NOACS), which can reduce this risk in 83%. Objective: To determine the patterns of prescription of NOACS and variables associated with its use in a population of patients affiliated to the Colombian Health System during the year 2014. Methods: Cross sectional observational descriptive study. A group of patients treated with dabigatran, rivaroxaban and apixaban were observed, from February to April 2014 using a database with 6,5 million patients affiliated to the Colombian Health System. Socio- demographic, pharmacologic, comedication and economic variables were measured. SPSS 22.0 was used with statistical tools such as: T student, chi squared and logistic regression. Results: A total of 1310 patients were treated with NACOS, 57.2% were men; treated in monotherapy (88%); and the association with inhibitors of platelet aggregation was presented in an 10.5%. Comedication was present in 77% of cases. The most commonly drug prescribed was ribaro- xaban (52.9%). The cost by 1000 inhabitants/day was COP$143.9 to dabigatran, COP$106.0 to rivaroxaban and COP$12.3 to apixaban. Dis- cussion: Dabigatran was the drug with higher cost by patients and day. From these patterns can be determined that are being emplo- yed primarily NOACS in monotherapy. Further studies evaluating the effectiveness and safety in Colombians are required. Keywords: Dabigatran, Rivaroxaban, Apixaban, Drug Prescriptions, Pharmacoepidemiology, Colombia. 06 Prevalence of Respiratory Symptoms And Risk Of Obstruction To The Air Flow In Ginebra - Valle Del Cauca. Alirio Rodrigo Bastidas Goyes, Jorge Luciano Villán Gaona, Valeria Betancourt, Andrea Suarez, Gustavo Adolfo Hincapié Díaz. Scientific Society: Asociación de Estudiantes de Medicina de la Universidad Militar Nueva Granada, ACEMED-UMNG. Introduction: The research of Respiratory Symptoms provide informa- tion about the condition of health of the community. It's a Commu- nity research with the purpose of determine the prevalence of res- piratory symptoms and prediction of airflow obstruction. Methods: Transversal cohort research in April 2014 in Ginebra (Valle del Cauca), was maked a sampling by conglomerate, minimum sample size of 115 subjects (prevalence 50%, accuracy 10{5 and loss rate 20%}), application of validated questionnaire about symptoms respiratory and lung function. Results: 146 subjects, 2 loss, median of age 60,5 years (IQR:22), 55.1% male, Prevalence of cough 18,1% (CI: 95% 11.8 to 24,3), expectoration 20,1 (Cl: 95% 13,9 to 27,1), wheezing 28,2 (CI: 95% 14,6 to 28,5) Dyspnea 33,3% (CI: 95% 25 to 41), people at risk airflow limitation 19,4% (CI: 95%: 14,2 to 28,4). Discussion: Respira- tory Symptoms of cough, expectoration, wheezing and dyspnea are common in the community and theirs frequency distribution is simi- lar in other countries worldwide, the reporting of chronic bronchitis is 2,8%, emphysema 0,7%, COPD 3,5% ASMA 4,9% is low with lesser extent than that observed with a questionnaire of lung function, the smoking history 41,7% and cooking with firewood ever is 54,4% are most common risk factors, as well as smoking, the number of packs year and the exposure to wood smoke is associated with the presence of cough, expectoration and wheezing (p<0,05). Conclusion: Dyspnea is the most common symptom mentioned, the use of a questionnaire about the respiratory symptoms shows the highest percentage in patients with possible airflow limitation that usually referred. Keywords: Signs and respiratory symptoms, cough, dyspnea, test of pulmonary function. 07 Chronic Use Of Drugs Related To Long Qt Syndrome In Elderly Population From Colombia Andrés Gaviria Mendoza, Paula Andrea Moreno, Mauricio Montoya Cañón, Jorge Enrique Machado Alba. Scientific Society: Asociación Científica de Estudiantes de Medicina de Risaralda, ACEMRIS. Introduction: Medication is the main cause of long QT syndrome (LQTS) and elderly population is at higher risk. Objective: To describe the prescription patterns of drugs that may cause LQTS in Colom- bian elderly population. Methods: Descriptive retrospective study. Patients older than 65 years whom received medication that causes LQTS during three months, were selected. The medication was obtai- ned and classified according to the list from Crediblemeds.org. The data was analyzed using SPSS 22, a p<0.05 was considered signifi- cant. Results: 37559 patients were receiving chronically drugs that cause LQTS; 61.8% of them were woman and average age was 76.2 years. One drug related to LQTS was consumed by 92.3% (n=34682) of patients and 6.7% (n=2521) received two. Conditional risk drugs were consumed by 97.4% of patients, 3.0% received known risk drugs and 2.0% received drugs with possible risk. Patients had an ave- rage of 2,9 risk factors for LQTS (Range: 0-7, sd: 0.86). Discussion: Most patients consume medication with conditional risk of LQTS, which means that it depends on the presence of another risk factors. However, a great proportion of patients had additional risk factors. Conclusion: The widespread use of medication related to LQTS and the extensive presence of additional risks in elderly population, raise the need of a warning system for this issue. Keywords: Colombia, Drug-Related Side Effects and Adverse Reac- tions, Elderly, Long QT Syndrome. rentiation of Human Stromal Cell-Derived Adipose Tissue. Liliana Elizabeth Sussmann Estrada, Carlos H. Escobar-Soto, Luz Dary Gutierrez, Orlando Chaparro. Scientific Society: Sociedad de Investigación Científica de Estudiantes de Medicina de la Fundación Universitaria de Ciencias de la Salud, SICEM-FUCS. Introduction: TRPM8 is a nonspecific channel of mono- and divalent cations, which is blocked by activated clotrimazole and menthol. It has been linked to the proliferation and viability of undifferentiated cells, but has not been described expression in mesenchymal stem cells derived from human adipose tissue (HASC). Objective: Evaluate the expression of TRPM8 in hASC and its modulation effect menthol and clotrimazole, have on the proliferation and differentiation of hASCs. Methods: By immunofluorescence TRPM8 expression was de- monstrated in the hASC. The effect Clotrimazole (10 uM) and Menthol (300 mM), on the proliferation of hASC and PC3 cell lines (positive control) and SH-SY5Y cells (negative control) was characterized. By staining with alizarin red oil red O and the effect Clotrimazole (10) uM) and Menthol (300 mM), on the adipogenic and osteogenic di- fferentiation of hASC evaluated. Results: TRPM8 expression in hASC is demonstrated. Both as menthol clotrimazole significantly reduced proliferation hASC (46 and 53% respectively) after 14 days of culture and clotrimazole abolished the ability of the osteogenic differentia- tion hasC. Conclusion: HASC demonstrated that express TRPM8 and blocking its activity suppresses the proliferation clotrimazole and osteogenic differentiation of these cells. Keywords: Adult Stem Cells, cell proliferation, cell differentiation, Ca- tionic Channel TRPM8. 10 08 Efectiveness of Lipid-Lowering Therapy In A Sample Of Co- lombian Patients Maria Camila Yepes Echeverri, Santiago Manrique Castaño, Manuel Enrique Machado Duque, Luisa Marcela Patiño, Jorge Enrique Machado Alba. Scientific Society: Asociación Científica de Estudiantes de Medicina de Risaralda, ACEMRIS. Introduction: The prevalence of cardiovascular disease has increased and is associated with hypercholesterolemia as a risk factor. Few pa- tients take adequately lipid-lowering therapy and treatment effecti- veness is unknown in some populations. It was set out to determine the effectiveness of the lipid lowering therapy in patients affiliated to the Colombian Health System. Methods: Case-control study to compare the effect of lipid lowering drugs, in a random sample of 211 patients treated with statins, over 18 years, in four Colombian cities between 2012 and 2013. Sociodemographic, anthropometric, cardiovascular, pharmacological and laboratory variables (total cho- lesterol (TC), LDL, HDL, triglycerides) were obtained. Results: Female predominance (56.4%), mean age 64±12 years, monotherapy with atorvastatin (63.9%) or with lovastatin (35.0%) was found. The 91.5% of the sample had hypertension, 32.2% diabetes mellitus and 19.9% history of cardiovascular disease. On average the reduction of TC was 11.5% and 8.8% at 6 months and 7.4% and 12.0% at 12 months with atorvastatin and lovastatin respectively. There were no statisti- cally significant differences found between the final LDL treated with lovastatin and atorvastatin (p=0.059). Discussion: The therapy was effective in reducing TC in patients with atorvastatin and lovastatin. The effectiveness was comparable for the two statins. It is important to adjust the therapy according to comorbidities and patient needs. Conclusions: It is important to adjust the therapy according patient's needs and their comorbidities. Finally, it was found significant va- riables associated to a major risk of control, as: being treated with atorvastatin, co-medicated with ẞ-Blockers and have had a previous heart attack. Keywords: Dyslipidemia, effectiveness, therapy, cardiovascular disea- se, lovastatin, atorvastatin, pharmacoepidemiology. 09 Clotrimazole Represses Proliferation And Osteogenic Diffe- Alterations In Brain Imaging In Congenital Toxoplasmosis: Case Series In Quindio (Colombia) 2004-2014 Carlos Fernando Moreno Rendón, Jorge Gómez Marín. Scientific Society: Asociación Científica de Estudiantes de Medicina de la Universidad del Quindío, ASEIMUQ. Introduction: There are few studies analyzing brain imaging in conge- nital toxoplasmosis and presumptive diagnosis sometimes is based on imaging characteristics. Objective: to report the cerebral imaging characteristics of children with confirmed congenital toxoplasmosis. Methods: A case series based on clinical charts of 85 patients with confirmed congenital toxoplasmosis (2004-2014) in the external con- sultation of the health care center of the Quindio's University. Were selected those with cerebral tomography (CT). Results: 25 patients had brain imaging studies, between them, 19 had imaging abnorma- lities. Of these, 5 (26,3%) presented only calcifications, in 2 (10,5%) there were hydrocephalus + calcifications, 4 (21,1%) other findings, 1 (5,3%) had hydrocephalus + other findings, in 1 (5,3%) other fin- dings and calcifications. In 6 (31,6%) there were calcifications + hydrocephalus + other findings. The incidence of hydranencephaly in symptomatic congenital toxoplasmosis was 5,3 %. In 1 case there were periventricular calcifications exclusively. Improvement in brain imaging (reduction in size and number of calcifications) was ob- served in 4 patients treated with pyrimethamine- sulfadoxine. Dis- cussion: The most frequent finding was diffuse parenchymal calci- fications. Postnatal treatment was associated with improvement in neurological imaging. Isolated periventricular calcifications are also found in congenital toxoplasmosis. Conclusion: postnatal treatment with Pyrimethamine-Sulfadoxine could reduce the finding of altera- tions in brain tomography. Keywords: Hydranencephaly; Hydrocephalus; Pyrimethamine; Sulfa- doxine; Toxoplasmosis, Congenital. CASE REPORTS 01 Bone Cyst Of The Sacrum Post Hemophilic Pseudotumor Laura Alejandra Chica Quintero, Francisco Mesa Cadavid, Mauricio Montoya Cañón Scientific Society: Asociación Científica de Estudiantes de Medicina de Risaralda, ACEMRIS. Introduction: Pseudotumor is an encapsulated hematoma secondary to chronic bleeding that presents in 1 to 2% of all patients. Depen- ding on its localization, it may affect bones, nerves or surrounding tissues and organs, although the bone cyst is an uncommon pre- sentation of this rare condition. Case report: In this case report, a 53 years old male patient with moderate type A haemophilia con- sulted because of pelvic mass sensation. The patient was receiving prophylactic management with 2500 units of recombinant VII factor and had a factor activity of 1.3%. Previous medical history included a haemophilic recidivate pseudotumor dependent of the right iliac psoas that was surgically removed 16 years ago. Additionally, the patient was diagnosed in 2012 with inhibitors of low response and managed successfully through immunotolerance. A contrast-enha- ced magnetic resonance found an expansive haemophilic pseudotu- mor dependent of the right iliac muscle that caused emaciation of the iliac aileron. In addition, there was an image with non-contrast uptake located in the right iliac fin, in relation with a unicameral bone cyst. Conclusion: Pseudotumor surgical resection has been the first choice of treatment for this condition. However, the localization and size of this particular mass increased significantly the risk of large bleedings, therefore other treatment options like tumor artery embolization or irradiation are being considered. 02 Thyrotoxic Hypokalemic Periodic Paralysis, A Case Report Adriana Margarita M Trejos Tenorio, Farah El-Sharkawy Nava- rro Scientific Society: Asociación Científica de Estudiantes de Medicina de la Universidad del Valle, ACEMVAL. Introduction: Thyrotoxic hypokalemic periodic paralysis (THPP) is a rare complication of hyperthyroidism and an unusual initial presen- tation of the disease. Its pathophysiology is yet not well known and there are few cases reported in the literature. Case report: We present the case of a 22-year-old Colombian male, with no rele- vant personal or family history of disease. He was admitted to the emergency department in the context of sudden upward and rapidly progressive paraparesis, inability to stand, and multiple emetic epi- sodes. Several hours before the onset of symptoms he had drunk a moderate amount of alcohol. The initial findings on the physi- cal examination were diaphoresis, tachycardia, and areflexia in the lower limbs. His symptoms progressed to quadriplegia and marked respiratory compromise, requiring intubation and management in an Intensive Care Unit. Guillain-Barré syndrome and methanol poisoning were considered amongst the differential diagnoses, but were dis- missed by the Internal Medicine and Toxicology departments. The lab report showed severe hypokalemia (potassium 1,7mEq/L) and hy- perthyroidism (TSH 0.0023 mU/L and free T4 2.37 mg/dL). Treatment was ensued with potassium chloride, propranolol, methimazole, hy- drocortisone, and lugol, obtaining a positive clinical and paraclinical response with resolution of the paralysis. Conclusion: THPP is not well known or suspected in our healthcare setting despite being a life threatening condition. Treatment is directed towards a rapid control of hypokalemia and hyperthyroidism, by which the condition is reversed. Keywords: Hypokalemic periodic paralysis, hypokalemia, hyper- thyroidism. 03 Globicatella Sanguinis: Descripción De Un Caso De Meningitis En El Hospital Militar Central Sergio Díaz Martínez, Jorge Luciano Villán Gaona, Samuel Vega Hurtado, Alberto Fabio Caballero Restrepo, Diana Patri- cia Pachón. Scientific Society: Asociación de Estudiantes de Medicina de la Universidad Militar Nueva Granada, ACEMED-UMNG. Introduction: Globicatella Sanguinis is a rare pathogen, Gram positive coccus, catalase negative, which is isolated but in sheep, has been described as an infectious agent causing meningitis in humans. Part of the cases was reported as meningitis due to S. viridans could be INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS XXVI CECIM S13#8IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS XXVI CECIM S14 Abstracts Abstracts caused actually by G. sanguinis due to the lack of identification of the latter and the great similarity in morphology and biochemical test results. The available literature is scarce G. sanguinis. There has been a case of meningitis associated with G. Sanguinis after a surgical procedure on a patient 1 year old at the Central Military Hospital. Case report: Female patient, 1 year old, who came HOMIC with emesis, irritability, fever, altered state of consciousness and bulging anterior fontanelle. She have an antecedent of surgical pro- cedure (endoscopic ventriculostomy), with discharge six days ago due an adequate evolution. The paraclinics showed a G. sanguinis (tipification in LCR with StrepⓇ kit). Vancomicin and cefepime is ad- ministrated to the patient with satisfactory evolution, and discharge. Conclusion: The meningitis caused by unusual microorganism have a low frequency, clinicians should be vigilant about that germs, rapid diagnosis and treatment ensures proper patient recovery and less serious sequelae. Keywords: Gram positive cocci, Meningitis, Gram Positive Bacterial Infections. 04 Sarcoidosis: A Diagnostic Challenge. Jorge De Jesús Gómez Villa, Belis Teresa González Cogollo, Danith Judith Estrada Osorio, Omar Enrique Cárdenas Luque, César Redondo, Karina Ruíz Cáez, Liney Mendoza Suárez. Scientific Society: Asociación Científica Acta médica de Carta- gena, ACAMC. Introduction: Sarcoidosis is a chronic granulomatous disease of unk- nown cause, histologically characterized by the presence of nonca- seating granulomas. The course of the disease is variable, presenting possible remission periods during its evolution. The lungs are the sites more frequently implied and the most common reason of mor- bidity and mortality. Its highest incidence rates are in the northern European countries (5 to 40 cases per 100.000 inhabitants). Case re- port: 50-year-old feminine patient, to whom an incidental finding of hepatic nodules is made during cholecystectomy, which are biopsied with a histopathology result of chronic granulomatous inflammation. In subsequent consultations, patient reports clinical picture of diffi- culty breathing, cough and diffuse abdominal pain. A thoracoabdo- minal CT is ordered, with a final report that demonstrates multiple nodules with predominance of the right lung. Clinical impressions are made of malignant neoplasia of lung, pulmonary tuberculosis and fewer probable sarcoidosis. A new biopsy of the nodules is per- formed and it shows noncaseating chronic inflammation, consistent with infectious process. It was considered appropriate to start anti- tuberculosis antibiotic treatment with the standard scheme. After 6 months of treatment, the clinical picture persists, and new hysto- pathologic, histochemical and PCR exams are ordered, concluding the diagnosis of sarcoidosis. Conclusion: Sarcoidosis is a systemic disease, a challenge of diagnosis due to its variable morbidity, low incidence and geographical distribution. Other more frequent patho- logies, like infections or malignancies, must be ruled out and specific studies should be done to reach the diagnosis of this illness. Keywords: Diagnosis, granuloma, inflammation, multiple lung nodu- les. 05 Cerebrovascular Events In Young Patients: Coexisting With Acquired Thrombophilia. Santiago Loaiza Betancurt, Lisceth Paola Quintero González, Aída María Gonzáles Correa. Scientific Society: Asociación Científica de Estudiantes de Medicina de Universidad de Caldas, ACEMCAL. Introduction: The strokes acquire a major epidemiologic importance in patients over 65 years old and associated to heart and metabolic diseases. Nevertheless, this type of events in patients under 30 years old, is usually associated to other etiologies, like acquired prothrom- botic disorders such as Antiphospholipid Syndrome. Case report: In this particular case, the patient is a young woman with 18 years old, and she has experienced two clinical episodes compatible with a stroke, the first of them involved headache and right paresis; the second event occurred two months later, consisting of palpitations and right paresis as well. At her physical examination, the malar rash or "butterfly rash" is notable, referred as constant since two years ago by the patient. After the first described event, several studies were performed in order to establish its etiology, like a Holter that showed alterations compatible with Variable Atrial Fibrillation, which encourages the start of anticoagulation with Rivaroxaban, besides Amiodarone. Likewise, in order to find an underlying autoimmune disorder, different specific blood antibodies are measured, finding high titers of lupus anticoagulant and IgG anti-ẞ2-glycoprotein, and a more extended partial thromboplastine time. Conclusion: This par- ticular case becomes interesting given the pharmacological control of the cardiac arrhythmia when the second stroke occurred, making more likely the coexistence of a prothrombotic disorder that had triggered the event; likewise one of the main goals is establishing an anticoagulation scheme that shall be effective for both pathologies. Keywords: Anticoagulation, antiphospholipid syndrome, atrial fibri- llation. 06 Umbilical Myiasis In A Neonate From Colombia, Case Report Juan David Ruiz Zapata, Luis Mauricio Figueroa Gutiérrez, Jaime Alberto Mesa Franco. Scientific Society: Asociación Científica de Estudiantes de Medicina de Risaralda, ACEMRIS. Introduction: Myiasis is the infestation in live vertebrate animals, including humans, with dipterous larvae. It is distributed around the world in tropical areas with low socio-economic levels and pre- sence of cattle. Neonatal umbilical myiasis is an important cause of death in bovines and produces major economic losses in livestock. However, its presentation in humans is rare, with 9 cases reported worldwide. Case report: A 7 days old newborn was taken to the hospital because she had sero-hematic discharge, foul smelling and visualization of larvae in the umbilical stump. On admission, a blood test showed leukocytosis, and two blood cultures at admission and 48 hours later were negative. The umbilical stump was covered with gauze soaked in ivermectin and nitrofurazone. Due to the risk of late onset sepsis, intravenous oxacillin and gentamicin were admi- nistered. In total, 55 larvae were removed from the wound and the patient recovered without complications. The causative agent was identified as Cochliomyia hominivorax. Conclusion: Cochliomyia ho- minivorax is an obligated parasite in its larval state, which invades open wounds and can penetrate deeply, causing tissue destruction and peri-lesional inflammation that facilitates bacterial superinfec- tion. Umbilical myasis is especially dangerous because of the risk of migration to deeper tissues, omphalitis and sepsis. The management of this disease includes the administration of antiparasitics, applying toxic substances to facilitate the larvae extraction and antibiotic treatment for the prevention of secondary infections. Keywords: Cochliomyia, neonate, umbilicus. 07 Flu-Like Syndrome In A Patient With Antitubercular Therapy Andrés Gaviria Mendoza, Nini Johana Erazo Bravo, Andrés Gaviria Mendoza, Jorge Enrique Machado Alba. Scientific Society: Asociación Científica de Estudiantes de Medicina de Risaralda, ACEMRIS. Introduction: The flu-like syndrome is a clinical state characterized by fever, malaise, headache, myalgia and vomiting that can be ge- nerated by different infectious agents or drugs, including interfe- ron, bisphosphonates and levamisole. A case of flu-like syndrome induced by antitubercular therapy in a first level hospital (Pereira, Colombia) is presented. Case report: A 69 years-old man, living in crowded conditions in urban area of Pereira. He had presented cough with purulent sputum, fatigue and night sweats for 4 months. Se- rial sputum smear was reported as positive. Treatment began with Rifampicin + Isoniazid + pyrazinamide + ethambutol, three tablets daily. Three hours after consumption of antitubercular treatment the patient presents with malaise, chills, vomiting and fever. The next day he reported improvement of his condition, but upon taking the second therapy dose, the referred symptoms recurred. Considering that the flu-like syndrome has been described as an adverse reac- tion to antitubercular therapy (especially rifampin), the chronologi- cal relationship of symptoms with intake/re-administration of drugs and improvement of the case when consumption was avoided, the diagnosis of flu-like syndrome was done. Conclusion: The flu-like syndrome is a rare entity that must be promptly identified to seek al- ternative therapies and avoid hindering the diagnosis, management and the patient adherence to pharmacotherapy. Keywords: Adverse Drug Reaction, Flu-like syndrome, Pulmonary tu- berculosis, Rifampin, Therapeutics. 08 Massive Empyema By Streptococcus Constellatus, Case Re- port Felipe Vera Polanía, Julián Andrés Hoyos Pulgarín, Alexander Alzate. Scientific Society: Asociación Científica de Estudiantes de Medicina de Risaralda, ACEMRIS. Introduction: Streptococcus constellatus is a member of the group now called Streptococcus anginosus, which includes 3 species. These microorganisms are considered normal flora of the mouth, throat, gastrointestinal and genitourinary tracts, but can cause opportunistic infections such as pharyngitis, bacteremia and have been associated with serious purulent infections. In this paper the case of a patient with an unusual presentation of infection by S. constellatus with multiorgan involvement is described. Case report: Presents the case of an adult male patient with no relevant medical history who pre- sented to emergency department with nonspecific abdominal pain, whose laboratory test results show an important systemic inflamma- tory response and in whom is achieved to establish Streptococcus constellatus spp constellatus, with radiographical evidence of mul- tiorgan abdominal engagement, with poor response to medical and surgical management. Conclusion: As this is the first case report of infection by S. constellatus found in the national literature is deci- ded describe for the unusual presentation of massive empyema and severe septic shock, so that future studies be undertaken to enable facilitate early recognition of this disease, assess risk factors and prognostic factors. Keywords: Streptococcus constellatus, Gram-Positive Bacterial Infec- tions, Gram-Positive Bacteria, Empyema, Septic Shock. 09 Urofacial Ochoa's Syndrome (UFOS): A Case Report Of 16 Years of Clinical Evaluation In Medellín, Colombia. Pérez Velásquez Camilo Andrés, Osorio Rico Sebastián, Quin- tero Vanegas Santiago, Cristian David Ramírez Lujan, Laura Elisa Villegas Sierra, Paul Bryan Vélez Taborda. Scientific Society: Asociación de Estudiantes de Medicina de la Universidad de Antioquia, ASCEM-UDEA. Introduction: The Urofacial Ochoa's Syndrome (UFOS) is characteri- zed by inversion of facial expression and bladder dysfunction, spe- cifically non neurogenic neurogenic bladder without any obstructive abnormality. There have been reported about 100 cases of this syn- drome and according to researches the mutation of the gene that is associated with the symptoms has been mapped to chromosome 10923-924. This syndrome is recessively inherited. Case report: A case of an 18-year old young man with urofacial syndrome is repor- ted. He was diagnosticated at 2 years of age because of absence of bladder and bowel control, frequent urinary infections and inversion of his facial mimic. There was not any familiar antecedent the syn- drome present. Based on that, many clinical examinations and diag- nosis as well as chirurgical procedures have been done. They include a vesicostomy at age 4, where thick bladder walls were observed, a barium enema because of the constant constipation, where an alte- red function of the colon was diagnosticated. A Mitrofanoff procedu- re was done at age seven as well as a clam ileocistoplasty. At age 10, a renal echography showed mild bilateral hydroureteronephrosis, which was more severe in the left kidney. Since age 13, the patient has been stable and presents oliguria, but his paraclinical studies are within normal limits. Conclusion: His signs and symptoms are very similar to those observed in the description of the UFOS. He was clinically diagnosed, so it is important to do genetical and neurop- sychological studies to him and his family to confirm the diagnosis. Keywords: Urofacial Ochoa's Syndrome, neurogenic bladder, Elimina- tion dysfunction. INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 XXVI CECIM INTERNATIONAL JOURNAL of MEDICAL STUDENTS S15#9IJMS II COIMAMA INTERNATIONAL JOURNAL of MEDICAL STUDENTS Abstracts Abstracts Abstracts of the 2nd International Academic Medical Congress of Maranhão (COIMAMA) ORAL Presentations 01 Cytotoxic Effects of Euterpe oleracea Mart. in Malignant Hu- man Cells Dulcelena Ferreira Silva; Flávia Castello Branco Vidal; Marcos Antonio Custódio Neto da Silva; Rebeca Costa Castelo Branco; José Andrés Morgado Díaz; Maria do Desterro Soares Brandão Nascimento Introduction: Juçara, Euterpe oleracea Mart., an indigenous fruit from Amazon, is rich in phytochemicals with antioxidant, anti-inflamma- tory and anti-cancer activity. Objectives: This study aims to analyze the effects of the hydroalcoholic extract of the bark, seed and to- tal fruit of juçara in different human malignant cell lines. Methods: Fruits were collected at the Maracana Ecological Park, in São Luís, followed by excicata manufacturing that remains registered in the Herbarium Rosa Mochel from the Nucleus of Biological Studies at the State University of Maranhão. The hydroalcoholic extracts of bark, seed and fruit were all obtained in the Laboratory of Pharmacolo- gy and Psychobiology UERJ. The cell lines used in the tests were MCF-7 and MDA-MB-468 (breast adenocarcinoma) and CACO-2 and HT-20 (colorectal adenocarcinoma). Results: Strains were treated with 10, 20 and 40µg/mL of extracts for 24 and 48 hours. Control MCF-7 cells showed prominent nucleus with evident nucleoli. After treatment with the hydroalcoholic extract from the bark of juçara, the cells showed rounded morphology with retraction of the cyto- plasm. The MTT viability assay showed a reduction in cell viability. After 48 hours, treatment of cells with 20µg/mL of bark extract re- duced cell viability and the cytotoxic effect of treatment with 40μg/ mL extract of the bark was potentiated. Cells treated with 10μg/mL of the bark extract were rounded with consequent reduction in cell volume. The concentration of 20µg/mL of bark extract caused seve- re reduction in volume of the cells and caused the appearance of intracellular vacuoles. The same was observed after treatment with 40μg/mL. Treatment with 40μg/mL of the hydroalcoholic extract of total fruit dramatically changed the morphology of the MCF-7 cells causing vacuolization and lysis with apparent loss of cytoplasmic contents. MTT assay showed a reduction in viability of MCF-7 cells treated with 20 and 40µg/mL after 24 hours of treatment. Analysis by electron microscopy showed the appearance of autophagic vacuoles. Autophagosome protein LC3BII was identified by Western Blotting technique. Conclusion: It is confirmed that the isolated fractions of the bark extract from juçara promotes cellular changes indicative of autophagy from 10μg/mL in 24 hours. The nuclei remained intact, showing no apoptotic features. The data are conclusive for the occu- rrence of autophagy in carcinoma cell line MCF-7 breast treated with hydroalcoholic bark, seed and fruit from juçara. 02 Correlation between Hepatitis Type A and Helicobacter pylori Infection In São Luís Maranhão - Brazil Fernando Félix Calvet Campêlo; José de Macêdo Bezerra; Ro- drigo Duart Martins Souza; Marcos Antonio Custódio Neto da Silva; Graça Maria de Castro Viana; Maria do Desterro Soares Brandão Nascimento Introduction: The infection by Helicobacter pylori occurs in more than half the world's population. Objectives: The objective of this study was to associate infection of Hepatitis type A with Helicobacter pylori in adults of São Luis - MA - Brazil. Methods: The sample consists of 143 patients aged between 17 and 70 years attending the University Hospital Presidente Dutra, Universidade Federal do Maranhão, with complaints of the upper digestive tract, conveyed to Endoscopy Cen- ter and collected medical history simplified, fragments for biopsy of the antral region and venous blood. Results: The positive results for H. pylori infection was 75,5% (108/143), and seroprevalence for Hepatitis A virus was 94,9% (130/137), there was no significant di- fference when compared to sex. The analysis of the association of infection by H. pylori by serology for HAV showed that, of the 134 individuals who have made tests for both infections, 97 (72.4%) were positive for both tests, 3 (2.2%) negative for H. pylori and HAV, 30 (22.4%) only positive for HAV and 4 (3%) only positive for H. pylori. Conclusion: Data presented in this study corroborate the findings in the literature that there is no association of infection by the hepatitis A virus and H. pylori infection. 03 Mapping of Technologies on Leishmania Vaccines through Patent Documents Abner De Oliveira Freire; Emerson Lucas Frazão Sousa; Vitor Fernandes Rios; Lilalea Goncalves Franca; Maria Do Socorro De Sousa Cartágenes; João Batista Santos Garcia Introduction: The genus Leishmania involves intracellular parasi- tes protozoans of monocytic phagocytic system cells, causers of the Leishmaniasis, which may affect skin, mucous membranes or viscera, also being significant between emerging parasitic diseases in the world, affecting widely mammals and presenting ineffective treatment methods. However, vaccines development have been seen as a possible tool to combat the disease. Objectives: Map the exis- ting leishmaniasis vaccines technologies through patent documents. Methods: Searches for patent documents were conducted through INPIⓇ, EspacenetⓇ and The LensⓇ databases between June 3rd and 19th 2015 with "Leishmania", "patent" and "vaccine" as keywords, and data were treated at Microsoft Excel version 2013, analyzing the following criteria: publication year, document depositor institu- tion and its nationality, and the employed technologies according to International Patent Classification. Results: 144 patent documents were recovered, being the deposit increase remarkable over past 10 years, with the highest patents number in 2010. The United States of America were highlighted with 50,3% of depositors institutions and the remaining belong to European Union (14,1%), Brasil (13,4%) and other countries (21,9%). The most frequent technology involves class A61K39 (Medicinal preparations containing antigens or antibo- dies), with 123 documents. Conclusion: Leishmaniasis vaccine deve- lopment embraces global effort including significant participation of Brazil, a country which comprises huge scientific and technological potencial and, in the same time, carries the disease as a severe public health problem. Furthermore, the analysis of new technolo- gies in Leishmania vaccines through patent documents proved to be efficient, because of large amount of information cointained in, such as new technological trends, potentials, progression and industry characteristics, showing new and promising directions for research in the area. 04 Anal exposure ventricular-peritoneal catheter: Case report Taynara Luna de Oliveira; Caroline Carvalho de Araújo; Igor Leonardo Vieira Caetano; Larissa Gomes Farias; Jonas Bran- dão Pereira; Elis Raquel da Silva Araújo Introduction: Ventricular shunt (PVD) is a surgical procedure that establishes a communication between the ventricles and the perito- neum (the membrane covering the abdominal wall) using a catheter. This implies the deviation of cerebrospinal fluid (CSF) into the ab- dominal cavity. PVD is a surgical procedure used primarily to treat a condition called hydrocephalus, which occurs when excess cere- brospinal fluid (CSF) is accumulated in the ventricles of the brain. The most frequent complications of shunt dysfunction and infections are. The most common sites of gastrointestinal perforation are sig- moid, followed by transverse colon and stomach. The Case: Female child, four months old was born with myelomeningocele and hydro- cephalus still detected prenatally. Surgery to dysraphism correction on the third day of life and ventricular-peritoneal shunt (VPS) to the right to 15 days of life was submitted. The mother arrived at the hospital complaining that he had realized the output of clear liquid through the anus child the night before, with rear projec- tion transparent tube through which liquid dripping this after a few hours. He said, even if the baby was more sleepy. On examination, the child was afebrile, alert, depressed anterior fontanelle, without signs of meningeal irritation. The proctoscopy showed the presence of exposed shunt catheter approximately 10 cm from the anal verge. The path-ray showed a perforation through the catheter in the sig- moid segment of the intestine and its path to the anus. The CT scan showed the location of the proximal catheter within the pellucid septum absence of hydrocephalus and signs of depression anterior fontanelle. The child was hospitalized for 15 days when he received antibiotics and was discharged in excellent neurological status, nor- motensive fontanelle and outpatient guidance. Conclusion: Given the above, indicating the surgical removal of the shunt brought a great benefit to the patient by the urgency of the frame. After the with- drawal, the patient had no need of replacement ventricular shunt. 05 Epidemiological Profile of Children 0-4 Years Aged Reported with Meningitis in Araguaína-To, between January 2010 and June 2015. Tamires Lopes Oliveira; Fabiana Silva dos Santos; Ana Bárbara Feliciano Souza Santos. Introduction: Meningitis is a relevant public health problem, res- ponsible for high mortality and morbidity in children, despite the improvement of diagnostic methods and treatments. About 5% to 40% of children die from the disease, and 5% to 30% of the survivors suffer from neurological sequelae. Meningitis is generally caused by infection of viruses, bacteria, fungi, parasites, and protazoa. In the majority of cases, the caused by bacteria. Clinical manifestations vary with age and duration of the disease. Nonspecific symptoms may be present, like myalgia, hypotension, tachycardia, arthralgia, petechiae, fever, irritability and bulging fontanelle. The key to the diagnosis is the cerebrospinal examination, which is analyzed by cell count, chemistry, Gram staining and cultures. Immediate empirical antibiotic therapy is imperative, and must consider the most fre- quent pathogens. Prior to treatment, lumbar puncture and a blood culture should be obtained. Objectives: This study aims to evaluate the epidemiology of children aged 0-4 years, who had been noti- fied with meningitis in Araguaína-TO, between January 2010 and June 2015, confronting the literature. Methods: It is a study epidemiolo- gical, quantitative and retrospective. The electronic health databa- ses SINAN (Sistema de Informação de Agravos de Notificação) were used to collect information about age, gender, lethality and etiology. Analyses were performed using Epilnfo 7 and Excel. Results: During the selected period, 74 cases of meningitis was reported: 37(50%) were children younger than 1 year of age, 37 (50%) male and 37 (50%) female. Four (5,4%) deaths were reported due to complica- tions of meningitis. Regarding the etiology, 54 (72,97%) were viral, 19 (25,68%) bacterial and 1 (1,35%) not specified. The year 2014 stand out as having the largest number of incident cases, with 24 (32,4%) new reported cases. Conclusion: Despite the high number of cases of meningitis in this age group, lethality rate for this cause, proved to be low, at the lower limit found in the literature. The incidence of the disease in children younger than 1 year accounted for half of the cases, possibly reflecting their immaturity of the immune system. There was no difference in the incidence of meningitis among the sexes, as in literature, the male was identified as being the most affected. The literature suggests bacterial etiology as the more fre- quent, however, in this study, the viral was the most incident. 06 The Ethical Perception of Medical Students from a Private College and a Public University in Teresina-PI Evellyn Batista da Silva Flizikowski; Joycce Huanna de Souza Silva; Ravena Vilarinho Santos Soares; Jessica da Silva Prates; Thalyta Batista de Sousa; Edison de Araújo Vale Introduction: Ethical issues has been constant targets of discussions in view of the growing number of occurrences due to the neglect of life, especially in the medical field. This fact constitutes a social concern that could impact on public health in Brazil. Objectives: The aim of this study was to analyze the ethical perception of medical students from a private college and a public university in Teresina- Pl. Methods: The study is descriptive and analytical character, with quantitative approach, performed from a standardized questionnaire after the approval of the 920.192 number of ethics committee and then analyzed using SPSS version 20.0. The students were questio- ned in the period from August to December 2014, as the knowledge of the medical code of ethics, perceptions about the poor ethical behaviour of teachears, change in desing and ethical behaviour com- pared to the beginning of the course, the appropriate time to teach discipline and update frequency as medical ethics. Results: It was analyzed 162 students, from 1, 2, 7 e 8 periods, which 53,09% of private institution and 49,61% of a public institution. Of this total, 92 students were males and 70 were females. As the knowledge of CEM, 124 said they had read in part, 29 never read and 9 read completely. 66,05% had teachers with poor ethical behaviour and 45,06% said physicians teachers struck the CEM. About 143 of the students sur- veyed said they had changed their ethical behaviour when compared to the beginning of the course, 42 prever to have the subject taught in the first half, 51 in all periods, 18 as optional and the remaining 51 students, in other periods. 109 rarely are update, not 18, 17 annually, semi-annually 13 and 5 monthly. Conclusion: Despite the low interest in the knowledge of CEM and medical update, most scholars consi- der it necessary to be given the subject in every semester, report changes in moral behaviour from the beginning of the semester and highlight the bad example of teachers regarding compliance with the CEM and behaviour to ethical and profissional. 07 Epidemiological profile of patients with diabetes mellitus by the Family Health Strategy in the Health Center Djalma Marques, Turu, São Luís, Brazil. Bárbara Lima Ribeiro; Acácia Pinto Morais; Lianna Paula Gu- terres Corrêa; lolanda Margarete De Araújo Rego Introduction: Diabetes mellitus (DM) is not a single disease but a heterogeneous group of metabolic disorders has in common hyper- glycemia, which is the result of defects in insulin action, in insulin secretion or in both. The number of diabetic patients is increasing due to the growing and aging population, greater urbanization, the increasing prevalence of obesity and sedentary lifestyle, as well as the longer survival of patients with diabetes and it is estimated that by 2030 will be 300 million adults with DM. Objectives: Analyze and demonstrate the epidemiological profile of patients with DM followed by the Family Health Strategy (FHS) at the Health Centre Djalma Marques, Turu, São Luís, Brazil in relation to gender, age and current medications, and were taken into account only those provided by the Unified Health System (SUS). Methods: It is a health profile, descriptive and quantitative approach. The survey was con- ducted through the Records Book of Hypertensive the Basic Health Unit (BHU) in question by means of master data Installation and Ope- rating Manual - HIPERDIA in period April 2013 to July 2015. Results: It was observed that 100 of the patients analyzed, 54% were between 61 and 80 years; 34% between 41-60 years; 8% between 81 and 100 years; 2% under 40 years and 2% over 100 years. As to gender, 65% were female. As for medication, 75% make use of Glibenclamide; Metformin 68% and 11% of Insulin. Conclusion: The epidemiological profile of the stroke study shows most female patients. The predomi- nant age group is between 61-80 years. The medication predominant in use is Glibenclamide. This research demonstrates the importance of the ESF program and the free distribution of anti-diabetic drugs to patients as a way to get better adherence to treatment and improved quality of life. It is noteworthy, too, the need for constant improve- ment to preventive actions, thereby reducing hospitalizations, and therefore preventable public expenditure, enabling the use of these resources in other health areas. 08 Epidemiological profile of patients with systemic hyper- tension accompanied by the Family Health Strategy in the S16 INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info • 2015 Vol 3 Suppl 1 II COIMAMA INTERNATIONAL JOURNAL of MEDICAL STUDENTS S17#10IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS II COIMAMA Abstracts Abstracts Health Center Djalma Marques, Turu, São Luís, Brazil. Bárbara Lima Ribeiro; Lianna Paula Guterres Corrêa; Acácia Pinto Morais; Iolanda Margarete De Araújo Rego Introduction: Systemic hypertension (SH) is a multifactorial clinical condition, characterized by high and sustained levels of blood pres- sure (BP). Hypertension has a high prevalence and low rates of con- trol, it is considered one of the main risk factors (RF) modifiable and one of the most important public health problems. Mortality from cardiovascular disease (CVD) increases progressively with increased BP 115/75 mmHg from linear, continuous and independent. CVD are still responsible for high frequency of hospitalizations, resulting in high medical and socioeconomic costs. Objectives: Analyze and de- monstrate the epidemiological profile of patients with hypertension accompanied by the Family Health Strategy (FHS) at the Health Cen- tre Djalma Marques, Turu, São Luís, Brazil in relation to gender, age and current medications, and were taken into account only those provided by the Unified Health System (SUS). Methods: It is a health profile, descriptive and quantitative approach. The survey was con- ducted through the Records Book of Hypertensive the Basic Health Unit (BHU) in question by means of master data Installation and Ope- rating Manual - HIPERDIA in period April 2013 to July 2015. Results: It was observed that 386 of the patients analyzed, 50% were between 61 and 80 years; 28.92% between 41-60 years; 17.5% between 81 and 100 years; 6.25% below 40 years and 6.25% over 100 years. As to gender, 65.9% were female. As for medication, 55.95% use Captopril; 50% of Hydrochlorothiazide; 19.43% of Enalapril and 18.39% of Pro- pranolol. Conclusion: The epidemiological profile of the stroke study shows most female patients. The predominant age group is between 61-80 years. The medication predominant in use is Captopril. This research demonstrates the importance of the FHS program and the free distribution of anti-hypertensive drugs to patients as a way to better adherence to treatment and improved quality of life. It is noteworthy, too, the need for constant improvement to preventive actions, thereby reducing hospitalizations, and therefore preventable public expenditure, enabling the use of these resources in other areas of health. 09 Syphilis and Pregnancy: Evaluation of Risk Factors of Preg- nant Women Attending the Mother and Maternal Child Hospital Nossa Senhora das Mercês of the Municipality of Pinheiro-MA Ana Beatriz Barbosa Lima; Andreia Aline Santana Guida; Hyanka Maria Bastos Padre; Gabriel Mendes Costa; Antonio Joatan De Barros Filho Introduction: Syphilis is a contagious infectious disease, sexually transmitted and also transmitted vertically during pregnancy, which can cause serious health problems and consequences to the fetus. Knowledge of the main risk factors involved in disease infection pro- cess enables better approach to diagnosis and treatment. Objecti- ves: To determine the risk factors for syphilis infection in pregnant women from January 2010 to June 2015, the Maternal Child Hospi- tal Nossa Senhora das Mercês of the municipality of Pinheiro-MA. Methods: The study included 100 women who had their birth in this hospital. All pregnant women with non treponemal test (VDRL) positive, with any title and at any time during pregnancy was consi- dered to be carrying the infection. The positive VDRL was correlated through a questionnaire answered by pregnant women, with age and marital status of the mother, the mother's level of education, the frequency of prenatal care, and the occurrence of neonatal death. Results: There was a statistically significant relationship between positive VDRL and the degree of maternal education, as well as the frequency of application of prenatal care. Conclusion: The low educa- tion level of the mother, prematurity the start of sexual activity and quality of prenatal care are the main risk factors for syphilis infection during pregnancy. 10 Peripheral Primitive Neuroectodermal Tumors of the Chest Wall (Askin's Tumor): Case Report Layanna Bezerra Maciel Pereira; Rodrigo Torres da Costa; Maria Iracenny Moura Pessoa Lima; Elaine Pires Ferreira de Ferreira; Antônia Darlene dos Santos Medeiros; Evandro Mag- no Firmeza Mendes Introduction: Askin's tumor is a type of malignant cancer of small round cells in the toracic-pulmonar region. It is considered member of the peripheral primitive neuroectodermal tumors family (pPNET) and typically are developed from the periosteum, soft tissues and extrapulmonary tissue of the chest wall. It is uncommon, accounting for 4-17% of the soft tissue tumors in children. They originate from totipotent cells from the neural crest due to a reciprocal transloca- tion t (11.22) (q24 q12) similar to that existing in Ewing's tumors, for which are included in the same family. The main goal of this study was to describe the clinical features, imaging features and evolution of a Ewing's sarcoma/PNET of the chest wall (Askin's tu- mor). The Case: Female child, four months old was born with myelo- meningocele and hydrocephalus still detected prenatally. Surgery to WMPS, male, 17 years old, caucasian, presented with asthenia from 6 months ago, referring NSAID use with no improvement of symptoms. About 2 months ago he had an episode of fever that was ceased after the use of antipyretic, aside the recurrent asthenia. A week later, he developed a fever and tiredness seeking medical attention. The physical examination showed a mucocutaneous pallor, dyspnea and absence of breath sounds in the left hemithorax (HTL). It was performed a chest X-ray from PA and profile views which revealed opacification of the 1/3 lower HTL, obliterated costophrenic recess and enlarging of the same pleural sulci. In helical chest CT with contrast showed up an heterogeneous tumor mass in the 5th left rib with intense enhancement after contrast, and a large lesion in tra- toracic region and left pleural effusion. Video-assisted thoracoscopy with tumor biopsy and chest drainage confirmed the hemothorax and large lobed mass in the anterior and lateral chest wall reaching the mediastinum. The Immunohistochemical analysis of tissue was conclusive for Ewing sarcoma / PNET of the chest wall. Chemothera- py was started as the initial treatment of choice, in order to perform a surgical approach afterwards. Conclusion: This study demonstrates the complexity that characterizes the diagnosis and treatment of sarcomas. The importance is given by the rarity of peripheral primi- tive neuroectodermal tumors, especially those from the chest wall,m and the need for immunohistochemistry for diagnostic confirmation. 11 Pharmacotherapeutic Follow-Up in Patients with Metabolic Syndrome Roberta Sabrine Duarte Gondim; Nathália Torres Araújo; Ma- ria Luiza Cruz Introduction: Pharmaceutical Care is a pharmacy practice model de- veloped in the context of Pharmaceutical Care. The pharmacothera- peutic follow-up is considered a component of pharmaceutical care defined as "a process in which the pharmacist responsible for the user needs related to medicine, detecting, preventing and resolving problems related to Medicines. Objectives: The objective of this stu- dy was to provide pharmacotherapeutic monitoring service on a ran- domly selected known patient, in order to investigate the drugs that were prescribed and those used by means of self-medication and drug interactions; advise on possible problems related to drug use; advise on correct use of drugs and non-pharmacological treatment. Methods: It conducted a case study and descriptive data collection with the use of Dader method. The patient accepted the participation of the research by signing the Informed Consent and Informed - IC. Data collection was carried out during the month of June 2015, based on the forms filled in during interviews and laboratory tests to com- plement. The recordings were made in the form Pharmaco Dader method. To discuss the results out regular publications of journals used. Results: I .V.S, woman 79 years, 1,40m, 65 kg, BMI of 23.88 kg /m 2, has not completed elementary school. It is hypertensive, ma- king use of antihypertensive medication for more than 20 years, use drugs for diabetes, cholesterol and hypertension. The user reported not be alcoholic, not being a smoker, does not perform physical activities at the time and places no restrictions on food. By having arthritis, complains of joint pain, she was recommended monitoring expert and some exercises that help in treating and alleviating pain. Conclusion: There was the great importance of pharmacist interven- tion and advice on health issues, improving the quality of life of patients with chronic disease patients. In this case, according to patient reports, the monitoring was very important for the drugs to be used as needed, so that the biochemical parameters remained within normal limits and with other forms of treatment such as the use of products natural, so that the metabolic syndrome which re- mained controlled. 12 Old also Speak: Report of the Elderly in Primary Care Jaqueline Oliveira Introduction: This experience report is the result of a basic stage project of Psychology: "Buildings Speeches Women" held in a Family Health Strategy (FHS) located in the municipality of Ijuí in the state of Rio Grande do Sul (RS) in neighborhood Getulio Vargas. What will be performing is a clipping from the countless stories constructed with women. Is centralized, in the words of old people, as formerly ca- lled, elderly as currently designated. The Experience: This "listening" opened the possibility of reconstructing older stories 70-107, who are examples of those who often gets the margin of a society in which the old is discarded because it is no longer productive as well they are forgotten by their own families has "no time" for them. However, when faced with another willing to you "listen" bring very rich life stories in detail and named by them as a "novel", narratives that sometimes are hidden in the depths of thought or even fixed time ever lived, it is a chest to open. This discursive space allows these seniors can regain their symbolic and social references in this way they can get out of this alienation and anonymity that sometimes the social and scientific discourse reduces. Conclusion: We realized that the elderly / old have a knowledge, a knowledge, they can be productive, not in the sense of generating profits (capital) or produ- ce scientifically, but its construction results in benefits to the social context. They are the link in the history of each family, the "know" that when not transmitted in form of history, life version, appears as repetition and symptom in the following generations. When it opens up the possibility of speaking of these "old" as they call themselves, something new is included: the chance to look at your life differently and understand situations that previously went unnoticed, or even traumatic. This way they can transmit also has effects on children, grandchildren and later generations, allowing a family network sup- ported by symbolic references, avoiding the repetition of what is not spoken symptoms, suffering, physical and mental illnesses. 13 Between Trains of Crazy and Utopia of a Society Without Asylums: The Harm Reduction as a New Job Outlook for Mul- tiprofessional Team in Caps AD Jaqueline Oliveira Introduction: The aim of this report is to present the Harm Reduction policy and its possibilities as the reception and listening to the users in a Psychosocial Care Center for Alcohol and Other Drugs (CAPS ad). Importantly, to talk about harm reduction is necessary to contextua- lize historically, taking into account the history of Brazilian madness until the current of mental health care model, which enabled the strengthening of Psychosocial Care Centers (CAPS). The Experience: The development of this report was raised at the stage of realization in Psychology and Social Processes in CAPS ad. With so many job possibilities for professionals that service, the Harm Reduction stood out for not having focused on abstinence. From this perspective, what is at issue is the subject, his life story and not the substance that it consumes. The Harm Reduction originated in England in 1926 and arrived in Brazil in 1989, it shows in practice that there is a drug- free society, it is necessary to think about new possibilities for users of legal and illegal substances. It is therefore of paramount impor- tance to bet on these users of alcohol and other drugs as subjects responsible for their choices, entitled to have a treatment at liberty and their desire to be heard by the professionals. Conclusion: The Harm Reduction as a new model approach appears to break with this ideal of abstinence and building interventions in order to allow the choices of each user and self-care process. It is from him, his desires and choices, the multidisciplinary team will work, and not under the ideals established socially. Thus the output will happen motion new possibilities of being in the world and therefore, inclusion, and we conclude that this movement produces health. The focus of not being in pathology, the goal is not to cure the user, but rather the production of subjectivity, ie the redefinition of living, tissue along the history of the subject. It is the intervention of professionals in the CAPS ad, from the Harm Reduction, based on equal rights, res- pect for the choices and singularities of each user, it will weave together with the subject being treated a new biography, enabling its displacement that was previously submissive to the substance. 14 Carotid cavernous fistula associated with traumatic aneurysm in the left internal carotid artery supraclinoid. Mohammed Damasceno Guimarães; Mateus Carvalho Mota; Morgana Carvalho Mota; Yuri De Castro Machado; Bárbara De Morais Borba; Mário Gomes De Campos Neto. Introduction: Carotid- cavernous fistulas are abnormal communica- tions between carotid system and the cavernous sinus and may be traumatic or spontaneous etiology. The most common cause is traumatic craniofacial trauma, which can cause lacerations of the in- ternal carotid artery in its intracavernous portion due to acceleration - deceleration mechanism or because of bone spurs formed in skull base fractures. The main symptoms include proptosis, chemosis, re- tro orbital blows, diplopia and ophthalmoplegia. The differential diagnosis for this syndrome are cavernous sinus thrombosis, orbital fracture, breast aplasia sigmoid and eye cancer. The Case: WRR, 25, male, car crash victim. It was admitted on the day of the accident, at a hospital in Itauna-MG 6 in Glasgow, due to multiple trauma. It was referred to the John XXIII Hospital the next day. Since the admission it was anisocórico left. Cervical CT was performed and the skull, which showed Hsat, hemoventrículo, pneumoencephalus, fractured skull base (sphenoid and posterior ethmoid) and C3 and C4 on the right facet. It was suggested diagnosis of LAD. Developed severe rhabdomyolysis. After suspension of the vasoactive drugs, it evolved with coagulation disorder and presented a significant increase in transaminase. Subsequently submitted nystagmus, proptosis, expo- sure keratitis and chemosis. Auscultation revealed a murmur in the lateral region of the left orbit. Skull CT angiography was performed, which confirmed the diagnosis of carotid cavernous fistula. The sur- vey showed an increase in the caliber of the left ophthalmic vein and the left cavernous sinus aneurysm and left internal carotid artery supraclinoid. Proposal embolization of the fistula carotidocavernosa. Conclusion: The carotid -cavernous fistulas are relatively uncommon frames being present in 0.2% of closed head traumas. Their signals are often common to several other injuries, but diagnosis should not be discarded in the presence of frames as described, even in the presence of other injuries that could justify some symptoms, such as orbital fractures. The use of imaging tests such as CT an- giography and angiography, it is essential to make the diagnosis in cases suggestive of vascular lesions like this. Early diagnosis and treatment are needed to prevent blindness and major neurological complications. 15 Thanatophoric dysplasia: a case report. Mohammed Damasceno Guimarães; Aldo Francisco Veras Pereira; Lorena da Mata Alves; Neylon Rodrigo de Souza Amorim; Fernanda Carolina Borges Avelino; Moisés da Cunha Filho Introduction: Thanatophoric dysplasia is a congenital chondrodys- plasia with bone and neurological effects, almost always fatal. Is characterized by macrocephaly, platyspondyly (vertebral body height lowered and flattened), shortening of the limbs and hiploplásica rib cage, pelvis reduced size, increased head circumference with frontal nasal prominence and depression. It shows approximate incidence of 1/33000 to 1/55000 in the population. The patient is the third daughter of cesarean delivery of a young mother, single, white race held two consultations in prenatal care. The child was born with 3090 g with Apgar score of 4 in the 1st minute, 7 at 5 minutes and 10 minutes.Head circumference of 37, chest circumference of 31 and waist circumference of 35. Presented oligohydramnios, required res- uscitation and did Nasal CPAP use. Held Ultrasound transfontanellar S18 INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS II COIMAMA S19#11IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS II COIMAMA S20 Abstracts Abstracts likely to atrophy of the frontal lobes. The Case: The patient is the third daughter of cesarean delivery of a young mother, single, white race held two consultations in prenatal care, with no family history of genetic disorders, with no history of tobacco use and alcohol. The child was born with 3090 g with Apgar score of 4 in the 1st minute of 7 at 5 minutes and 10 minutes. With head circumference of 37, 31 and girth of waist circumference of 35 presented oligohydramnios, required resuscitation and made use of nasal CPAP. On examination the patient macrocrania, prominent and broad forehead, flattened face and narrow chest, abdominal bulging, upper and lower short and pulmonary hypoplasia. Held transfontanellar ultrasound likely to atrophy of the frontal lobes. Conclusion: The diagnosis of Thana- tophoric dysplasia is based on physical examination and radiologic studies. As the disease caused by mutations in the FGFR3 gene. Most individuals with the disease do not survive to adulthood, minimizing the risk of recurrence. In the case of this study, the diagnosis of dys- plasia Thanatophoric was specified in the postnatal period through physical examination of ultrasound evidence. The patient underwent a gastrostomy, to nurture it and evolves with wound infection, being hospitalized and being released with clinical improvement. 16 Agenesis of the Corpus Callosum: Case Report Israel Amâncio Mendes; Maria De Jesus Torres Pacheco; Mônica Da Cunha Machado Resende; Tárcia Heliny Nojoza; Talyta Garcia Da Silva; Rayanne Layla Morgado Fonseca Introduction: The corpus callosum the greatest inter-hemispheric commissures is formed by a large number of myelinated fibers that cross the mid sagittal plane and penetrate on either side of the spi- nal cord white center of the brain, symmetrical joining areas of the cerebral cortex from each hemisphere. Your training begins around the 12th week of pregnancy and it is fully developed between the 18th and 20th weeks of intrauterine life. Their injuries determine the incidence of mental illness, characterized by apathy, poverty of thought and movements, loss of memory for recent events, chan- ges in character (irritability, mood versatility, distrust), deficit of vo- luntary and spontaneous attention and great mental fatigue. The estimated prevalence of agenesis of the corpus callosum is 1% of the population. The Case: Child Female, 18 months, weighing 13 kg, living in São Luís, accompanied by mother attended the pediatric cli- nic at Children's Hospital Dr. Juvêncio Matos in São Luís. - Maranhão. Mothers' reports that had the diagnosis of agenesis of the corpus callosum-ACC body shown in US Gestational. After birth were per- formed MRI and CT scan which confirmed the diagnosis of ACC and electroencephalogram that was normal, also having a normal de- velopment. The same makes use of anticonvulsant (phenobarbital) and follow up with a neurologist and endocrinologist. Conclusion: The agenesis of the corpus callosum may be associated with genetic syndromes, chromosomal abnormalities or other malformations of the central nervous system and extra central nervous system, which are poor prognostic factors. The estimated patient in the case report does not show abnormalities in their development, presented a sei- zure, now treated with anticonvulsant in their neurological examina- tions did not show any abnormality, however this condition is rare. It is observed that there is a lot of research that might corroborate for greater understanding of this disease. It is understood that these changes occur in 3 out of every 1,000 live births, accounting for 75% of fetal deaths and about 50% of birth defects. 17 Stage in an Institution for Elderly Long Stay: An Experience Report Claudineide Alves Dos Santos; Olga De Jesus Ferreira Sales Introduction: The compulsory training is a tool aimed at the impro- vement of future professionals, aligning theory and practice under the technical supervision and teaching orientation. The stage was developed in an Institution for Elderly Long Stay. The objective of the institution is the accommodating of the elderly who are socially vulnerable prioritizing care biopsychosocial. The Social Psychology understands man as a subject which is designed in respect of its history with that of their society, or at the meeting point of its own history with the history of the world around him. The Experience: The experiment was carried out in Solar do Outono an Institution for Elderly Long Stay of São Luis-Ma, through observation and inter- vention with the institutionalized elderly and non-institutionalized. Observation is a time when the trainee experiences her first contact integration in the institution, which is embraced by the host phase and intervention planning. By acting with institutionalized elderly it was possible to perform the following activities: anamnesis; esta- blishment of therapeutic bond; therapeutic activity with cognitive stimulation; development and implementation of therapeutic acti- vity using music and socializing. The non-institutionalized elderly are community residents who participate in the social group, held weekly in the Institution for Elderly Long Stay. It was possible to work next to them: lectures and application of therapeutic activity working self-esteem and self-worth through a group dynamic te- chnique. One of the aspects observed was the need to think of di- fferent psychological interventions for institutionalized elderly and non-institutionalized. Conclusion: The knowledge acquired in stage required a critical and reflexive posture, free from prejudice and wi- lling to new construction. In this sense, it emphasized that the case of old age requires new adaptation modes, leaving the stereotypical look contributing to the redefinition of the elderly. It is important to highlight that interventions happened from listening in order to rescue the elderly in the construction of its unique history, bringing them the awareness of their own subjectivity. 18 Experiences and Internships inside SUS reality: A Transdisci- plinary Look Andrey Salgado Moraes Filho, Vanessa Sammer, Nathália Rabelo, Raissa Neruza Alves, Guilherme Araújo Rayol Introduction: The Unique Health System (SUS) comes out with an universal, equitable and integrated proposal, confronting a model which was fated to fail a long time ago, an unequal model, verti- calized and raised into an essentially sanative nature. Against such perspective, the VER-SUS (Experience and Internships Inside the SUS Reality) sets up as a device that allows the attendees to experience new challenges of SUS's substantiation and its principles of daily health services. According to that, transdisciplinarity materializes itself as a vital variable during the process, once the interaction between the subjects is important, promoting the dialog and the in- terdependency between different professionals. The Experience: The experience happened during July 16th and 23rd of the current year, being immersed 43 participants and 07 mediators between students and professionals of several fields - Medicine, Psychology, Nursing, Odontology, Speech Therapy, Nutrition and Social Service which enabled the comprehension about the essentiality upon existence of a transdisciplinary team in the process of promoting health. The at- tendees were split in two kinds of groups, Base Nucleus (BN) in order to discuss subjects such as: humanization, constitutional aspects about SUS, clinical cases; and the Living Groups (LG) for visiting. During the immersion time, the participants faced the health ser- vices network operation, problematizing several dimensions of the health/disease process and, mainly, getting your degrees away from the fragmentation of knowledge in disciplinary fields increasingly limited. It was possible to understand the system organization, your policies and programs which implied in the acknowledgement of transdisciplinarity as a needful tool to the multiple care dimensions. Conclusion: The VER-SUS fulfilled a primordial role to the construc- tion of the participants as transformation agents of Unique Health Service reality. The experiences inside the health service improved the understanding about activities which behoove to a transdiscipli- nary team, and the substantiality of its existence in the process of health promotion, establishing a knowledge exchange inside their fields. According to that, it was possible to contrast that SUS count with many services interconnected which provide the full care of the patient. 19 Professionals' Knowledge that are responsible by the Guthrie Test in the city of Araguaína - TO: A Search Realized in some Health Care Units Josué Moura Telles Introduction: The Guthrie test screens for the following rare and se- rious conditions. It's an examen where blood samples are bloated and dried on filter paper. It facilitates the detection of chronic di- seases in children, like sickle cell disease, cystic fibrosis, congenital hypothyroidism and inherited metabolic diseases. In this way, it's possible the prevention of ill-health, reduction of disability and re- duction of mortality in babies with screened conditions. Objectives: To present and analyze the professionals' knowledge that are res- ponsible by the screening blood spot test in Araguaína - TO about this examen and the technique utilized. Methods: It's an exploratory and descriptive study in that was used investigative methods, it had been realized in health care units in the city of Araguaína that make the Guthrie test. It were done semi structured interviews with this professionals. After the collect, the informations were tabulated and analysed like the descriptive statistics. Results: The study was done with 12 professionals in differents health care units, everyone was female with average age of 39 years old. From this total, 80% were nursing technician and 20% nursing auxiliaries. The search shows that only 66,7% from the total of interviewed knows that majority of diseases diagnosed by the bloodspot test are hereditary, although 83,35% don't know these diseases list. It was observed that the- se professionals has an insufficient knowledge about the screening blood spot test, making impossible the right orientation of parents during the realization of examen, for example. Therefore, it's evident that the non-qualification can be represent harm to the attendance of families and to the quality of realization of Guthrie test. Conclu- sion: The analysis of contents reveals that the professionals res- ponsibilities by the Guthrie had poor informations about that. It's necessary that they know basics aspects of Screening Blood Spot test like the diseases screened and about the hereditarian. So that, this screening test be more and more improved like important estrategic of public health. 20 Hyde Prurigo Nodularis: A Case Report Brunna de Sousa Silva; Rafaelly Luz Mendes; Maylla Moura Araújo; Teodoro Bernardes de Lima Neto; Danielly Luz Men- des; Analexia de Arêa Leão Brito Introduction: Hyde described a rare and incurable idiopathic erup- tion, characterized by numerous persistent nodules mainly affecting the extensor surface of the arms and legs of women, calling them- selves Prurigo Nodularis (PN). To clarify the clinical signs, symptoms, diagnosis and therapeutic managements of a rare disease in clinical practice of health professionals. The Case: C. O., 55 years old, male, was admitted to the Dermatology Service in May 2014, complaining of itchy lesions that began in the lower limbs spreading to the upper limbs, dorsal and sacral region, an increase of five years. On physical examination, it was found violaceous papules, coalescing to form plaques with hypochromic central depression, some excoriated in the affected regions. There was a biopsy of abdominal injury, which was evidenced by histopathological, psoriasiform dermatitis excoria- ted with superficial perivascular infiltrate and focal pseudoepithe- liomatous hyperplasia. Started topical treatment with high-potency corticosteroid (halobetasol) and vigorous hydration, with slight im- provement. After thirty days, the patient was referred for photothe- rapy, as it was not possible to perform the treatment with thalidomi- de. The clinical outcome could not be observed, because the patient did not respond to treatment. Conclusion: Hyde Prurigo Nodularis is a rare disease of unknown cause, most common in middle-aged women. There are several treatments cited in the literature, but none proved totally effective. 21 Gastrectomy: Infection Rate in 60 Post-Surgery Patients Alana Vitória Sousa Gonçalves; Lucas Luís Sousa Véras; Mar- celo Emanuel Ericeira da Costa; Ozimo Pereira Gama Filho; Diego Henrique de Carvalho Rodrigues; Danielly de Oliveira Gonçalves Introduction: In the context of hospital infections (HI), the Surgical Area Infection (SAI) has been identified as one of the most important spots of infection, leading to an average increase of 60.0% during hospitalization, in addition to requiring large efforts to prevent them. The surgical area infection is the most important cause of post-sur- gery complications in surgical patients. Center statistics for Disease Control and Prevention (CDC) indicate that 14-16% of hospital infec- tions are attributed to surgical spots infections, fact that is added to significant costs related to health care due to complications of these infections. The SAI is a relevant complication, by contributing to increase mortality and morbidity of post-surgical patients causing physical and emotional damage as work abandone and social life. In addition, increases the cost of treatment significantly, also reflec- ting on a longer hospital stay. Objectives: To analyze patients who underwent gastrectomy who developed surgical site infection in a general hospital in São Luis MA and characterize the profile of pa- tients undergoing gastrectomy, identifying the frequency of surgical site infection in the analyzed sample and the correlation factor risk associated with the patient and the surgical procedure. Methods: A retrospective study through information contained in the medical records of patients undergoing elective gastrectomy from January to December of 2014 in a general hospital in São Luis. This study was not analyzed by the Ethics Committee of the Ceuma University. Results: In 60 cases investigated were found to be the occurrence of surgical site infection in 5 cases (8.3%), which found that 60% were classified as superficial incisional infection; 40% deep incisional and regarding the classification organ/cavity. Conclusion: This study's re- sults offer to hospital infection control professionals a new outlook for the continuing efforts of lower risk index for patients undergoing gastrectomy. 22 Epidemiological Study of Patients Appendectomized in a High Complexity Hospital Alana Vitória Sousa Gonçalves; Lucas Luís Sousa Véras; Ozi- mo Pereira Gama Filho; Danielly de Oliveira Gonçalves; Diego Henrique de Carvalho Rodrigues; Brenda Lima Costa Introduction: Acute appendicitis is the most common surgical emer- gency in our country. Treatment of acute appendicitis is surgery and should be done as soon as the diagnosis is established. Diagnosis and early surgical treatment directly influence the prognosis of this disease. Objectives: To know epidemiological profile, clinical behavior in acute appendicitis and surgical measures in adults undergoing ap- pendectomies. Methods: Retrospective study, cross-sectional, des- criptive and quantitative analysis, analising medical records of 87 patients under appendectomies, assisted in a high complexity public hospital in the state of Maranhão, in the period between July 2014 to January 2015. Results: The numbers on Chart 1 show that in ap- pendectomized patients during the study period, there was a higher prevalence of males (71.1%) compared to females (28.8%), aged 41- 50 years (30 7%) and white (43.5%). Chart 2 in relation to clinical and surgical variables, there was a higher percentage of symptomatic patients in the preoperative time (97.2%), and higher prevalence, on adopted technique, the appendectomy by laparotomy (60%) over the laparoscopic way (39.9%). This chart also shows that the vast majori- ty of patients did not evolve with complications even preoperatively (92.2%) or postoperative (95.8%) and among all kinds of incision, the predominantly found incision was laparoscopy (39.9%) and among the incisions for open appendectomies, the most used was the McBurney. Conclusion: We conclude that during the analyzed period, in a high complexity public hospital of Maranhão, appendectomies were performed more frequently in males and those aged between 41 and 50 years and whites. Within the clinical profile, most of the patients were symptomatic before surgery and no complications be- fore or after surgery. Among the conventional appendectomies, the most commonly used incision was the classical McBurney incision. 23 Elderly Patients with HIV/AIDS: Characteristics of the Epide- mic in the State of Ceará Antonio Joatan de Barros Filho; David de Alencar Correia Maia; Izolda Souza Costa; Jéssica Araújo Vasconcelos Maia; José Osmar Vasconcelos Filho; Sueli de Souza Costa Introduction: In Brazil, the rate of growth of the elderly population follows the global trend, accompanied by socio-cultural change in attitudes to sexuality and aging. The weakness in the elderly, ac- INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info • 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS II COIMAMA S21#12IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS II COIMAMA S22 Abstracts Abstracts companied by some common diseases, complicates the diagnosis of HIV infection, with their symptoms confused with other infections of these. Both the elderly and health professionals tend not to think of AIDS and often neglect the disease in this age group. Objectives: The primary objective of this study was to describe the characteristics of AIDS in the State of Ceará elderly in the last decade. Methods: Conducted a time series study, with data available in the Notifiable Diseases Information System (SINAN) between January 2005 and De- cember 2014. Results: 10,299 new cases were diagnosed, and 1.5% (151) in the elderly, 85.4% with heterosexual behavior and 29.3% married. Most of them, living in Fortaleza (85.6%), aged between 60 and 69 years (86.8%), males (60.9%), brown (61.6%). The proportion of cases man/woman peaked in 2005 (5.5:1) reducing from there, reaching the average value of 0.8: 1 in the period between 2008 and 2011, and increased again, reaching 3, 3:1 in 2014. The groups with less education had higher incidence rates. The high proportion of ig- nored variables reinforces the implication of the research system on the quality of information. Conclusion: AIDS in the elderly grew trend among men aged 60 to 69 years, heterosexual and married in the last decade, which justifies implementation of specific prevention campaigns for this population, aimed at fighting the disease 24 Health-Disease Process: Influence of the green roof used as construction material about temperature and its surroun- dings Antonio Joatan De Barros Filho; Belisa Souza Costa; Sueli De Souza Costa; Daniel Rocha Pereira Introduction: The health-disease process receives direct environ- mental influences and physical conditions to which we are expo- sed. The cities growth creates environmental and socioeconomic impacts directly related to the health-disease process, through the Social Determinants of Health. Conventional buildings raise the hou- ses internal temperature, causing increased power consumption to make a pleasant atmosphere. Also reduce shadows and do not allow absorption of water rain due to soil sealing and may cause floo- ding, bringing numerous diseases such as leptospirosis and dengue. Conventional roofs absorb solar radiation, bringing negative impact on air quality, affecting the public health. The higher temperature, the air acts as a catalyst, and adds atmospheric pollution, making low air quality, generating an increase in respiratory diseases. The green cover roofs are made of engineering system allows the plan- ting of a conventional slab, generating positive impacts on health. Objectives: To conduct comparative analysis of internal and external temperature of roof with a green cover and conventional tile, aimed at saving energy for cooling, less environmental impact, better popu- lation health and environment preservation. Methods: We used two identical brick houses, one next to each other in the northeastern region in hot and humid climate, differing only in terms of coverage: one green roof and one with conventional roof. They had measured their temperature and humidity for 31 days, both externally and in- ternally by temperature sensors. Results: The temperature inside the house with green roof were lower than the house with conventional roof, and were lower than external environment. The temperature inside the house roof conventional were higher than the external environment. Conclusion: The green roof helps to reduce the house internal temperature, reducing energy consumption for cooling en- vironments; improved sound insulation of the building, through the vegetation, which works by absorbing and isolating noise; improves the air around it, to reduce pollution; decreases the possibility of flooding, for better retain rainwater. With these characteristics, pu- blic health advantages to using the green roof on a large scale. 25 Mediastinal Cavernous Hemangiomas: Case Report Layanna Bezerra Maciel Pereira; Rodrigo Torres da Costa; Maria Iracenny Moura Pessoa Lima; Layanne Cavalcante de Moura; Kelwim Madson da Silva; Evandro Magno Firmeza Mendes Introduction: The mediastinal hemangioma are benign vascular tu- mors witch are rarely found in the mediastinum, nevertheless they are the most common type corresponding to approximately 0.5% of all mediastinal tumors. The anterior mediastinal compartment is the most affected and the diagnosis usually occurs in the first four de- cades of life with the peak incidence in the first decade. Cavernous hemangioma is usually diagnosed in people over 35 years old and has equal incidence in men and women. The objective of this study was to describe how to diagnose and treat the tumor. The Case: RFS, 59 years old, male, asymptomatic, referred to the clinic of thoracic surgery after a radiopaque picture was found in the chest radiogra- phy requested on clinical consultation. Patient has denied smoking, previous diseases and use of prescription drugs. Chest radiography showed an image suggestive of a mass tumor in both upper lung lobes. The CT scan showed discrete opacities like "parenchymal fros- ted glass" in a previous follow-up of the upper lobe of the right lung and a massive heterogeneous solid mass lesion with multiple calcifications, lobulated and neoplastic appearance, richly vascula- rized, showing an underling inhomogeneous by means of contrast, located at the left thoracic apex. The pacient underwent resection of mediastinal tumor in his neck extension and pulmonary hilum with full sternotomy and the opening of the left parietal pleura. Histopathological was conclusive for arterio-cavernous hemangioma. Conclusion: This study demonstrates the importance of considering the diagnosis of hemangioma in adult asymptomatic patients with mediastinal tumors because it is an extremely rare benign vascular tumorn of difficult diagnostic by imaging. Surgical excision is the procedure of choice, both for diagnosis and therapy. 26 Cystic Adenomatoid Lung Malformation in Newborn: Case Report Auriane de Sousa Alencar; Juliana Bandeira da Rocha Lima; Gabriela Leal de Carvalho; Stéphannie Fabiane Borges de Oliveira; Alex Jorge Medeiros Silva; Julião José de Alencar Introduction: Congenital abnormality in the lower respiratory tract dichotomy where there is excessive growth of terminal bronchioles, resulting in formation of numerous cysts and alveoli deficiency. It is a rare condition accounting for 25% of lung malformations. Presents 25% mortality rate and good performance in cases in which surgi- cal therapy is applied. The case report below, aims to document successful conduct in the treatment of the pathology and highlight the importance of prenatal diagnosis. The Case: Patient newborn 13 days old, male, born by cesarean section, was referred to Children's Hospital of reference for resection of adenomatous cystic lesion in the right lung detected by ultrasound pregnancy. On examination, it presented algic facies, ruddy, hydrated, anicteric, well perfused and flabby abdomen. Helical chest computerized tomography confirmed solid-cystic expansive formations, characterized by confluent collec- tions of partially characterized walls, lush air-fluid levels in between, occupying almost the entire right hemithorax, with pulmonary remai- ning discreet aerated arranged medially, and contralateral cardiac rejection and superior mediastinum. Thoracotomy was performed in the right hemithorax with transverse incision to the upper lobe level. It continued with separation of horizontal and oblique cracking sec- tion of the right upper lobe bronchus, right upper lobectomy, suture of the bronchial stump, hemostasis review and aerostasis, drainage and closure of the thorax. Histopathology showed that the morpholo- gic features of cystic lesions are compatible with cystic adenomatoid malformation type 1. The patient developed expansion of middle and lower lobes. Conclusion: Prenatal diagnosis coupled with proper treatment planning between obstetricians, neonatologists and pe- diatric surgeons, saves newborns of developing respiratory distress syndrome immediately after birth, which could be fatal. 27 Sacrococcygeal Teratoma: a Case Report Auriane de Sousa Alencar; Juliana Bandeira da Rocha Lima; Gabriella Leal de Carvalho; Stéphannie Fabiane Borges de Oliveira; Alex Jorge Medeiros da Silva; Adriano Pádua Reis Introduction: The germ cell tumors are derived from primordial germ cell and have benign or malignant evolution, it may occur in gonadal or extragonadal location. The most common extragonadal location is the sacrococcygeal region. Teratoma is composed of the different tissues, which vary depending on the organ or location which ori- ginate. The sacrococcygeal teratoma showed an incidence of one case per 35,000 children alive, being more frequent in females in the ratio 2-4: 1. The Case: Male patient, 10-day life, cesarean delivery without complications, pregnancy natural term of Floriano PI was referred to the children's hospital of reference presenting bulging on the right sacrococcygeal region. On physical examination, the patient was acyanotic, anicteric, afebrile, eupneic, hydrated, normal skin color, no palpable lymph nodes, and distended abdomen, pitting, painless to palpation, without masses or visceromegaly. Computeri- zed tomography highlighted lesions of expansive appearance, partly enclosed, with components with adipose attenuation, calcium, liquid and soft tissue, located in the middle intergluteal line underlying the sacrococcygeal region. Blood cell count with mild macrocytosis, rare sedimentary neutrophils and atypical lymphocytes. It was establis- hed surgical dissection treatment with the sacrococcygeal injury in- cision in inverted "V", with resection of the coccyx and preservation of the rectal muscles. Patient progressed well during the postope- rative and was discharged after three days of surgery for outpatient monitoring. Histopathological identified mature teratoma with free margins. Conclusion: The sacrococcygeal region is the most frequent location of teratoma in children. Early diagnosis and treatment are of fundamental importance to prevent their malignancy. Complete surgical resection of the tumor and of the coccyx is the main goal in the definitive treatment of teratoma. 28 Behavioral Aspects of Menopausal Women with Coronary Artery Disease in São Luis, Maranhão Débora Castro Sousa; Luciane Maria Oliveira Brito; Luciana Alencar Fialho Bringel; Marília De Oliveira Bringel; Patrícia Travassos Cutrim; Joyce Pinheiro Leal Costa Introduction: The Cardiovascular diseases are the main cause of death in the world, being the cardiac ischemic diseases - among which the Coronary Artery Disease (CAD) - the most damaging. The formation of atherosclerotic plaque starts with the aggression aga- inst vascular endothelium, due to various risk factors such as dysli- pidemia, hypertension, smoking and obesity. Several studies explain that menopausal women has a high prevalence of CAD, the theories points out that this fact is due to reduction of plasma estrogen le- vels. The literature further states that the risk factors for CAD can be prevented in various ways, especially with regular physical activity and reduction of risk factors such as smoking. Objectives: Analyze the behavioral aspects of women diagnosed with Coronary Artery Di- sease. Methods: Was conducted a case-control study with 72 women (36 cases and 36 controls), between 35 and 65 years old, they were treated at outpatient clinical research in São Luís- MA, from July 2012 to August 2015. It was applied a sociodemographic questionnaire and conducted the analysis of diagnostics tests for CAD. The ethical aspects were respected, under CEP nć 195.357. Results: The variable analysis showed that women with CAD have an increase in physical activity compared to the group of patients without CAD, however, the number of former smokers is more significant in patients with the disease (25% in case group, against 19% in control). The most prevalent comorbidities are hypertension (35%), dyslipidemia (30%) and diabetes (22%). A decrease in sexual activity in patients with CAD was observed. Conclusion: It is evident that diagnosed patients with CAD changed their habits of life, perhaps this is because of the greater medical monitoring and a high concern for health, furthermo- re, the comorbidities associated fall in risk factors for cardiovascular disease, highlighting the need for more effective prevention cam- paigns. However, more studies are needed to assess the relationship between climacteric and menopause with the risk of developing CAD. 29 Sexual Behavior among Deaf People in São Luís - MA Débora Cruz Silva; Letícia Silva Muniz; Dayanne Bevilaqua Neves; Serlyjane Penha Hermano Nunes Introduction: Sexuality is an issue considered taboo in society for a long time, but it is an issue extremely urgent and important. Most information about sexuality are directed to hearing people, leaving deaf people on the sidelines of the information or limiting their access to fragmented and insufficient information for better comprehension about these issues. Objectives: Attach the social and economic reality and access to information on Sexually Transmitted Diseases (STDs), sexuality and contraception by deaf people, identi- fying problems related to them. Methods: This is a descriptive and observational study, formed by 26 students, from two leading insti- tutions in education of deaf people in São Luís/MA. The project was approved by Research Ethics Committees from Federal University of Maranhão (report 509.115). Students answered a structured ques- tionnaire about socio-demographic characteristics, contraception and sexually transmitted diseases prevention with the researcher presence at all-time close to respondent and a LBS (Brazilian Sign Language) interpreter who accompanied them in all applications in order to resolve any doubts appeared during interviews. Results: When asked about the sexual life, 76.5% of deaf interviewed said they have initiated sexual life mainly between 17 and 19 years. Of these, 70.6% also said they have used condoms at first sexual in- tercourse and 80.4% referred to opt for condoms use in all sexual relations. Among contraceptive methods mentioned during the in- terviews, deaf interviewed demonstrated to know and know how to use mainly male condom and contraceptive pill. A discrepancy was noticed between knowing and knowing how to use the methods. They expressed confusion and doubts about the knowledge on STDs, especially in relation to modes of transmission and AIDS prevention. Most deaf people receive instructions about sexuality at school, and they ask the family whenever they have doubts. Conclusion: We noticed that most deaf interviewed still have doubts about sexuality and they mentioned need someone specific to solve these doubts. Intensification on campaigns focused specifically to this group is necessary, using printed material and through the media, as well as in schools. 30 Accessibility to Health Services among Deaf People in São Luís - MA Dayanne Bevilaqua Neves; Letícia Silva Muniz; Débora Cruz Silva; llana Mirian Almeida Felipe; Serlyjane Penha Hermano Nunes Introduction: Hearing loss can be congenital and acquired, this con- dition is defined as impairment in normal perception of sounds, the- reby, the hearing does not have complete functionality in life. Hea- ring impaired people need health services access, not only related to hearing deficiency, but also need to be assisted through preventive measures, both the ones made at population level, in political form or publicity campaigns in media, and at individual level, in consul- tation with health professionals. Objectives: Evaluate accessibility to health services among deaf people as well as their problems and obstacles to receiving service. Methods: Descriptive study with qua- litative approach formed by nine deaf adults, they were interviewed through the Brazilian Sign Language (BSL) - LIBRAS, with help of an interpreter. The project was approved by Research Ethics Committees from Federal University of Maranhão (report 509.115). Volunteers an- swered a semi-structured questionnaire with questions on issues relating to accessibility for deaf people to health services. Analyses were performed based on content analysis technique, thematic mo- dality, which four categories have emerged: communication, auto- nomy, feelings (deaf person perception on health care) and therapy comprehension. Results: Few professionals are able to communicate using BSL (LIBRAS), hindering communication between health profes- sionals and hearing impaired people, compounded by the fact they rarely find interpreters to help them. Lack of interaction between health professionals and deaf people prevent them from establish a relationship, which could make them more secure about service, and further, force them to depend on other people, to help on communi- cation process and understand about their condition, their treatment and procedures that can be performed to their improvement, hinde- ring their autonomy and making them constrained. Conclusion: Most services and health information are inaccessible to deaf people, due to the difficulty on establish an efficient communication process with health professional and the fact that society still sees deaf people as someone unable to make their own decisions about their health and therapy, keeping them dependent on other people. INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS II COIMAMA S23#13IJMS II COIMAMA S24 INTERNATIONAL JOURNAL of MEDICAL STUDENTS Abstracts Abstracts 31 Elementary Teachers Strategy to deal with Students who Suffer from Mental Disturber in School Lourival Vitor de Sousa; Raquilma Lourdes Dantas Dias Pa- rreão; Thaisa Negreiros de Melo; Priscilla Ingrid de Sousa Ferreira; Antoninho Barros Milhomem; Neyrian de Fátima Fernandes Introduction: Studies estimated that until the final of this decade, an incidence of 50% mental health problems worldwide in all age groups and Brazilian epidemiological studies has revealed a prevalence of psychiatric disorders from 10% to 20% in the age group between 05 and 14 years. The school is the local where kids and teenagers spend most part of the day, its environment constitute a privileged vantage point for the observation, discussion and development of strategies to adequacy and effectiveness of learning, emphasizing teachers as protagonist in the early identification of signs and symptoms and mediator of possible treatments. Objectives: Identify strategies of teachers to deal with students who suffering from mental illness. Methods: Descriptive research with qualitative approach. The sam- ple was 54 teachers who work in primary education from 6th to 9th year of municipal schools in Imperatriz-MA. The collection of data took place in April 2015 through a semi-structured questionnaire with objective and open-ended questions about teacher strategies towards mental illness, and participant information. Data were tabu- lated in the Microsoft Excel® Program, 2010 version, data presented in tables to allow a better view, in frequency and percentage. The research was approved by the Ethics Committee under the opinion of number 1.014491 in March 31, 2015. Results: When was questio- ned 32.5% of teachers said to refer the student to the direction and /or pedagogical coordination, 16.25% answered use as a strategy to refer to a psychologist or specialist service, 7.5% pointed talk to the parents or guardians and 11.25% did not answered. It is pos- sible to perceive that one significant amount of teachers does not remain inert in front of mental disorder cases, since studies show the important role of the school to know and assess the potential and realization of possibilities of formal learning when there is the presence of psychiatric disorders. Conclusion: Therefore, it is possi- ble to realize a significant participation of teachers before perception and decision-making strategies to deal with affected students with mental disorders, it may contribute to effective learning and stimu- late the permanence of the student at school. Schools are places where nurses can provide educational support in health, guiding and facilitating the best strategic decision and bridging schools settings with the mental health care network. 32 Knowledge about the Humor Bipolar Disruption by Teachers from Basic Degree Thaisa Negreiros de Lima; Raquilma Lourdes Dantas Dias Parreão; Adna Nascimento Souza; Tayanne Querioz Porcínio; Lais Gomes Silva Guajajara; Maria Neyrian de Fátima Fernan- des Introduction: The Humor Bipolar Disruption (HBD) is a derangement, despite from its distant origin, is still less discussed in the society, and the discussions are less evident when the disease undertaking the teenagers. Being the school a place which the students live most part of their lives, and the teachers as the person who is responsible about teaching and learning tasks beyond following the teenagers intellectual process, they must be aware of the difficulties, which can indicate mental problems, as the HBD. Objectives: To examine the basic degree teachers knowledge from a Maranhão county about bipolar disruption in the adolescence. Methods: Descriptive studies with quantitative approach done in the county schools at Maranhão. The studies were done in a range of 80 teacher. The inclusion criteria were: Be a teacher from 6° basic level to 9° basic level and also work daily with students from this specific group age. The exclusion criteria was: Those teachers which did not complete the question- naire. The data were collected through a questionnaire directly to the teachers. In this questionnaire there were objective questions about the HBD and also data from the participants. The research was approved by the ethic committee, through the number 1.014.491 from March 31st, 2015. The data were putten on a Microsoft Excel Program, version 2010 for statistic analysis and warning. Results: From the surveyed teachers 72,50% has superficial knowledge about the HBD problem. About the TBD seriousness, 67,50% know that this is a serious pathology. Were asked if they - the teachers, have any student with this kind of desease, 48,75% answered they did not know, 33,75% answered that they did not have any, and only 17,50% affirmed they have some students carrier HBD. About the HBD symptoms the major part of the teachers (61,25%) mentioned the turmoil, the physical and mental unease. The attention deficit were also highlited (60%) and restlessness and irritability (60%). Conclu- sion: The teachers knowledge about the HBD disruption is so much on this side of ideal. It is necessary an empowerment to develop the teacher ability to realize the first symptoms as the HBD symptoms. In this manner the nurses could elaborate educational instruments to be executed in the schools offering training about the adolescence mental health to the teachers, fortifying the school link with the county mental health net. 33 Teachers Perception about Humor Bipolar Disruption in Tee- nagers Thaisa Negreiros de Melo; Raquilma Lourdes Dantas Dias Parreão; Adna Nascimento Souza; Tayanne Queiroz Porcínio; Laís Gomes Silva Guajajara; Maria Neyrian de Fátima Fernan- des Introduction: Some studies has lead to the emergence possibility of the humor disruption bipolar in any people from the teenager ages, evidencing a bigger incidence in this age group. So, as a school is a rich scenario to follow the teenager psychosocial development, and the teacher is the major observer, the knowledge about this theme is important to establish the dialogue about humor disruption bipo- lar (HBD) in adolescence in a school range. Objectives: To spot the teachers vision about the (HBD) symptoms in teenagers. Methods: Quantitative survey of descriptive approach, including 80 teachers from junior school, from the 6ć to the 9ć degree, from the cast cou- nty schools in Imperatriz - MA. The data were collected in April 2015 through questionnaire of objective and subjective questions about (HBD) and strategies to face the (HBD), further participants data. The data were putten on Microsoft Excel program, 2010 version, so it can be better visualized and shown in index form. The research was approved by the ethic committee, through the number 1.014.491 from March 31st 2015. Results: From the surveyed participants about the HBD characteristics symptoms, 57,5% marked feel too restless or excessively slow. 56,25% answered they were feeling excessively lively, hearty, elated, excessive happiness. The major part (58,75%) designated contradiction alternatives in HBD adolescence. It is wo- rrying because this characteristic is including in the normal adoles- cence syndrome proposal by Knobell. About the strategy to treat the students which are HBD carrier 36,25% answered that there has to be major understanding, patience, and (or) individual tasks. On the other side adding those who did not answer, they do not know how to deal with, they do not use any differential strategy are the number of 40%. Conclusion: Tlt was evident the necessity to perform educa- tional actions which enable the teachers to observe the students in a holistic manner. They must have the capacity to observe and to tell apart the attitudes and behavior from a normal adolescence apart of pathological behavior, embracing correct attitudes. Intended through this study to collaborate to the raise of the HDB debate in the ado- lescence, aiming to expedite the understanding about the disease. 34 Heterotopic pregnancy: Case study of patient attended at Hospital an Maternity Dom Orione (HMDO) from Araguaína/ TO João Victor Pereira Gomes; Tássylla Caroline Ferreira Pereira; Guilherme Nunes Skripka; Gustavo Luiz Maia Pereira; Gilson Pinto Ribeiro Introduction: Heterotopic pregnancy is a rare condition in which it is ectopic pregnancy simultaneously the intrauterine pregnancy. In the past, topical incidence of ectopic pregnancy was associated with a 1: 30,000. With the advent of assisted reproduction techniques, the frequency of this complication increased to 1: 100-500 pregnan- cies. Ectopic pregnancies may be set in different extra-uterine sites, such as cesarean section scar, abdomen, cervix and other, yet the pole most common nesting in such cases is the tubal, and the lo- cation and that entity developmental stage generate specific clinical signs and symptoms. Early diagnosis is difficult to perform, usually occurring only after the rupture of the ectopic pregnancy, but the diagnosis of this case was conducted after ultrasound examination performed on suspicion of incomplete abortion. The increased inci- dence of this complication, especially in front of pregnancies obtai- ned by in vitro fertilization, associated with the severity of clinical manifestation and the need to generate more information on the subject, encouraged this report is aimed at alerting obstetricians and sonographers. The Case: Patient female, born June 16, 1983, at the time had 30 years, current Araguaína-TO, black color, arrives at Hospital and Maternity Dom Orione (HMDO) with urgent context of treating heterotopic pregnancy on September 11th, 2013, after tubal ectopic pregnancy realization through ultrasound and physical examination (gynecological touch). Patient was admitted referring bleeding for about three days, with enclosed lap and twin pregnancy with topical pregnancy seven weeks and two days another ectopic left horn. The obstetric examination, it was found: fundus (FU): 36; fetal heartbeat (BCF): 140; DU: +; blood pressure (BP): 120/80 mm of mercury (mmHg). The examination of touch gynecological noted that the uterus was in anterior flexed verse (AVF) with a globular aspect and presenting minor bleeding. The patient was indicated to do laparotomy surgery for ectopic pregnancy associated with resec- tion of the left uterine tube. After performing a laparotomy, being held sapingectomia left with no complications in the act, it was initially made to the patient in the postoperative period (PO) zero diet (fasting) for 12 hours, followed by saline solution management 0.9% (1000 mL) intravenously (IV), Metoclopramide Hydrochloride 10mg/2ml intramuscularly (IM). For aftercare were treated dipyrone Sodium 500mg (IV), tenoxicam 20mg (IV) Nalbuphine hydrochloride 10mg/ml (IM), Progesterone 200mg (IV), Cephalothin Sodium (IV) and 5% glucose solution (500 mL). Indwelling catheter through the risco. Paciente surgery PO progressed well, without pain, and blood loss complaint was made, and shall have their regularized diet and making use of dipyrone Sodium 500mg intravenously (IV), Dimethi- cone 40mg (IV) and Bisacodyl 5mg (IV). Removal of urinary catheter 12 hours after surgery. Showed flaccid abdomen, little painful to superficial and deep palpation and present clear and diuresis. The patient is discharged from the hospital on September 14, 2013, as it stood at lucid, afebrile and showed improvements in their clinical condition. The patient returns to HMDO on 09/16/2013 to perform curettage diagnosed with incomplete abortion, and thus admitted. After done the surgery without complications, patient underwent zero diet for six hours after bland diet. There was the administration of dipyrone 500 mg, potassium diclofenac 50mg, 20mg omeprazole, ceftriaxone 1 g IV / IM and metronidazole 5 mg/mL - 100 mL. Patient evolves in good general condition (BEG) without complaints and with a slight vaginal bleeding and was discharged from the HMDO on 09.18.2013. Conclusion: The heterotrophic pregnancy is a rare clinical manifestation and may present a high degree of mortality, since early diagnosis is difficult. Generally, being made only occurred after the rupture of the fallopian tube, and its treatment is surgical thus having a certain risk to patient. So, being an entity that is becoming increasingly common in hospitals and prognosis is directly related to the precocity of treatment, it is necessary to the production of this report to assist in the identification and development of pathology. 35 Satisfaction Evaluation of Pregnant Women for Pre-Natal Care Attended on a Basic Unit Health of São Luís Ana Karolina Carneiro Cutrim; Ariane Braga; Carla Caroline Vieira e Silva; Lorena Arruda; Celma Barros Introduction: Pregnancy is a complex experience with different as- pects of each woman. It is necessary a pre-natal care and quali- fied and humanized puerperal with which integrates all levels of care: promotion, prevention and health care to the mother and the newborn. Objectives: To assess the satisfaction of pregnant women assisted by prenatal in a UBS of Sao Luis, MA. Methods: A descrip- tive and exploratory study with a qualitative approach. The study was carried out in Basic Health Unit Djalma Marques, reference for the care of low-risk pregnant women in Matões-Turu district of Sao Luis, MA. The study included 17 pregnant women between 18 and 38 years. The development of the study was conducted according to the norms of Resolution 466/12 of the National Health Council / Ministry of Health (MOH) and the research project has been submitted and approved by the Research Ethics Committee (CEP) of the University Ceuma with the number CAAE 41820815.9.0000.5084. Results: When asked about the reception in prenatal care, most women reported that they feel welcomed at the Health Unit was possible to detect that this satisfaction described by pregnant women was obtained by general perceptions, taking into account both the way. as the service is performed, the amenities offered by a nearby unit their homes and evaluating the positive and negative aspects. As for the humanization of the professionals involved in prenatal care, inclu- ding in this mode all professionals who have contact with pregnant and who are included in meeting the needs of pregnant women, it can be seen that most of the women interviewed have felt heard by professionals, had the perception that professionals dispenderam attention to their complaints and concerns. Regarding the difficulties faced by pregnant women and the aspects they would like improved, the majority emphasized the lack of infrastructure and basic health unit materials as well as the lack of medicine at the pharmacy. Con- clusion: It was found that the user leading role of the health system has a direct impact on improving the relationship between him and the service. 36 Aortic dissection: Case study of patient attended at Hospital and Maternity Dom Orione (HMDO) from Araguaína / TO João Victor Pereira Gomes; Tássylla Caroline Ferreira Pereira; Vinícius Barbosa Cavalcante de Menezes Introduction: The dissecting aneurysm refers to entry of blood into the arterial wall and its distribution along the length of the blood Ivessel. Aortic dissection is a serious disease requiring prompt diag- nosis and aggressive medical therapy, and if untreated, generates death in 75-90% of the patients, 35% die within the first 15 minutes and 75% resist for a week. Therefore, dissecting aneurysms are clas- sified as the leading cause of death related to aorta. The Case: A 57 years old, bricklayer, former smoker, former alcoholic, colored man born in Carolina - MA, arrives at the Dom Orione Hospital (HMDO), he was transferred from the Araguaína Regional Hospital (HRA). He had been admitted to the local hospital in Carolina 15 days ago complaining of rest dyspnea, lower extremities edema, orthopnea and sternal pain radiated into the right arm. He was attended at HRA, which concluded by the signs and symptoms the following diagnosis: clinical condition compatible with congestive heart fai- lure, diastolic murmur aortic, systolic and mitral, inaudible blood pressure in the right upper extremity and left upper limb of 110 x 50 mmHg during the echocardiography, extensive aortic dissection type A was detected in the thoraco-abdominal direction. The patient is transferred to the HMDO on 05/03/2014. The surgery took place on 05/06/2014, correcting: acute aortic dissection (AAD), by means of aortic valve replacement, revascularization of supra aortic vessels. During the post-operative, the patient presented cardiopulmonary arrest (CPA), fibrillation atrial reversed, acute renal failure reversed, peripheral arterial disease (PAD), and venous insufficiency which was done on 05/21/14 by thrombus in the popliteal vein and significant stenosis next to the common femoral artery generating necrosis of extremities of the toes and edema of the lower members. However, the patient developed significant improvement in overall condition, showing almost complete symptoms remission. Conclusion: There- fore, the AAD is a serious case, which has as a predisposing factor of the hypertension, among others. This report exposes information about an atypical and severe case that reinforces the need to always consider this pathology for its acute and traumatic nature. 37 Scale of Autism Rating in Childhood: Under Nurses Percep- tion Tayanne Queiroz Porcinio; Andressa Arraes Silva; Thaisa Ne- greiros de Melo; Lais Gomes Silva Guajajara; Priscilla Ingrid De Sousa Ferreira; Maria Neyrian de Fátima Fernandes. INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS II COIMAMA S25#14IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS II COIMAMA Abstracts Abstracts Introduction: The infantile autism is a syndrome with high complexi- ty because it involves a compromising variability in motor develop- ment, language, social and cognitive development. To make feasible the assistance to this population, studies point to Childhood Autism Rating Scale (CARS) as a clear and precise instrument for making it the classification and recognition of autism easier, as it provides information on the child's general behaviour and defines the severity of the symptoms presented. Objectives: Analyse the use of CARS in the perception of nurses as a strategy that enables an approach that encourages the active participation of nurses in the care of autistic child. Methods: A descriptive exploratory study with a qualitative approach and developed through action research method. Starring 4 nurses who work in Psychosocial Care Center for Children and Adolescents (CAPSij) at Imperatriz-MA. An individual training was held on CARS and delivered for each nurse a copy of this. They are monitored as they made use of CARS in attendance. The data were collected through a questionnaire with open-ended question about the use of CARS professional practice. Names of writers diagnosed as autistic were used to identify participants. For data analysis, it was applied the Content Analysis of Bardin. The research was approved by the Ethics Committee under opinion number 1.073.622. Results: From speeches, one of the interviewees referred difficulty to analyse and use the scale in child nursing care. However, the other nurses assessed the instrument as a facilitator focused on nursing care for autistic children treated at CAPSij, and left still evident its impor- tance for development of an appropriate and effective treatment plan for each child. None of the nurses reported some disadvantage in scale use as a tool to be used in nursing care plan within the CAPSij. Conclusion: Therefore, action research helped to increase the knowledge of nurses about autism and encouraged the adoption of a more systematic conduct in nursing care dedicated to children with developmental disorder, enabling through the CARS a more detailed attention to the autistic child and your family. 38 "Viva Saúde": report of Medicine students in a Project in University City extension. Josiel Guedes da Silva; Helaine Dias Guimarães; Camila Brito Rodrigues; Bianca Santos Serra; Maria do Desterro Soares Brandão Nascimento Introduction: The project "Attendance chronic disease in the Univer- sity City of the Federal University of Maranhão (UFMA): Viva Saúde", developed by students of the health area of the UFMA, guide itself in the tripod teaching-research-extension, certifying the attendance clinic coming after Itaqui-Bacanga área especially women, having as focus the prevention of the cancer (CA) uterine colon and of breast. Objectives: Narrate experience of the outpatients clinic experience in the context of the project academic extension that comprise action of promotion and prevention health. Methods: It is about one report developed work by academic of Medicine of the 2nd period in pro- ject of extension with the relief professionals health and voluntary academic. Come true Pap smear and physical exam of the mammas for traceable of CA uterine colon and mammas besides treatment clinic service of character generality. The voluntaries realize inside capability in order to refine the scientific knowledge and the technic used in the exams, what favorable the integration of the academic apprenticeship like forms of answer social demand. Results: Noticed an increase in the search of the rendered service in the number voluntaries academic projects. The inhibition of some patients were attended by academics decrease, as proper passed guarantee a ac- ceptance humanized. Academics us remarked major confidence to realize the anamnesis of the exams now that the project it give certainly liberty for this if discover like professional. Besides the scientific related areas of the knowledge. By means of "Viva Saú- de" noticed the importance of the multidisciplinary approach of the treatment since, by means of the voluntaries-patients relationship, provide a vinculum of confidence that permit a line of attention carry on and effective in whom the women realized their exams periodi- cally, as well permit the attendance of the chronic disease prevalent in the community. Conclusion: The project stimulate the correction of knowledge of the graduation, like propose the establishment of one relationship doctor-patients methodical in the respect and in the reciprocity, observing the importance of the integration of the treatment clinic for prevention and health advancement. 39 Pain Intensity Compared with the Types of Thoracic Surgery and High Abdominal Victor Pereira Lima; Marcela Rangel Almeida; Francisco Dimi- tre Rodrigo Pereira Santos; Lívia Maia Pascoal; Pedro Martins Lima Neto Introduction: The high abdominal surgery has become increasingly routine today, highlights are two of the most common: Exploratory Laparotomy and Cholecystectomy. The first is a surgical incision in the abdominal wall used in exploration or therapeutic purposes, sin- ce the second is defined as removal of the gallbladder when it is in the inflammatory process. Pain is one of the most frequent com- plications in the postoperative coming from the trauma of surgery. Objectives: To compare the level of pain in the postoperative period between Exploratory Laparotomy and Cholecystectomy. Methods: Cross-sectional study, quantitative conducted with 30 patients di- vided into two groups: laparotomy and cholecystectomy. Data were collected through questionnaires that assess pain on a scale of o to 10 in patients to the 1st day after surgery. Patient selection was made randomly, the data were analysed by t test through Bioestat 5.0. These data are part of a research project approved by CEP-UFMA seem to 629,315 and everyone involved in the research signed the Informed Consent in accordance with Resolution. 466/2012 of the National Health Council. Results: In the group related to postopera- tive laparotomy notices a higher number of male patients (86.66%) with a mean age of 39.502, parallel to this, in the postoperative group Cholecystectomy have been observed the preponderance of females (80%) and average age of 42.298. In relation to intensity of pain, the values were averaged for 5 Exploratory laparotomy and average 2.6 to cholecystectomy. According to the data collected were reached one standard deviation (SD) of 30.892 p = 0.0093. Conclu- sion: Therefore, that the level of pain is more pronounced in the post-operative exploratory laparotomy over the laparoscopic, it was found by the average 5 intensity pain in cases of patients subjected to laparotomy. With this data it is possible to realize the importance of monitoring by the health team in the postoperative period with the constant development of care to interdisciplinary level, whether medicated or not, aimed at relieving pain especially in patients in the postoperative Laparotomy Exploration. 40 IMCI: Knowledge of Nurses of Primary Care of the City of Imperatriz - MA Victor Pereira Lima; Débora Heissa De Almeida Matos; Adna Nascimento Souza; Giana Gislanne Da Silva De Sousa; Willian Rodrigues Viana Silva; Maria Neyrian De Fátima Fernandes Introduction: The strategy of Integrated Management of Childhood Illness IMCI has developed in order to reduce morbidity and mor- tality in patients aged o to 5 years. Thus, the strategy has been characterized as a simultaneous and integrated approach to child emphasizing the set of the most prevalent diseases in this period. Objectives: Evaluate the knowledge of primary care nurses about the IMCI in Imperatriz - MA. Methods: Study exploratory descriptive with quantitative approach, performed during the second fortnight of June 2013 with nurses working in Family Health Teams Imperatriz- MA. The sample consisted of 35 nurses over 6 months of operation in FHT. The data collected through a multiple choice questionnai- re were analysed by Epi Info® software version 7.0. Participants provided written informed consent and signed, was used according to the resolution nć 466/2012, of the National Health Council. The research was approved by CEP- UFMA below the opinion 515.956. Results: Most of the interviewed were female (89%), with graduation time between 5-8 years (45.71%) and time of work in primary care from 6 months to 4 years (42.86%). The data show that 23 (66%) of nurses were trained by the IMCI strategy, however, (8.57%) of these preferred to use the Municipal Protocol to the strategy. Regarding the knowledge of the IMCI strategy was evident that the sample had the highest success rate in matters related to the Public Target of Strategy (97%) and Pathologies Addressed by the Strategy (94%), the lowest rate of success was to Severe Malnutrition (31%), Dehydration (29%), Contraindications vaccines (23%) and Children Development (6%). Conclusion: The Primary Health Care of Imperatriz -MA, has mostly nurses trained to carry out the nursing care in full to chil- dren based on the IMCI strategy by contrast, it was observed lack of knowledge on the part of nurses assessed on key issues addressed by the IMCI strategy, which brings out the importance of continuing education at the municipal health services. 41 Risk Factors for Hypertension in Academic Nursing from a private University in São Luis - MA Francisca Das Chagas Gaspar Rocha; Yasmin Pascoal Perei- ra Castro; Janice Maria Lopes De Souza; Maíra Damasceno Cunha; Moacira Lopes Carvalho; Camila Aparecida Pinheiro Landim Almeida Introduction: Hypertension is a major public health problems in Bra- zil and worldwide. It is a multi factor disease and the situations that trigger are increasingly present day in con- temporary life, making it extremely important early identify their risk factors. Objectives: to know the risk factors for hypertension in academics Nursing 1st period of a private University of São Luís - MA and identify the socioeconomic profile data of the studied stu- dents; list changeable risk factors and not modifiable for hypertension in the study group and identify co morbidities in the study subjects. Methods: The study was exploratory and descriptive, prospective, transversal and quantitative data analysis. The instrument for data collection was a questionnaire, applied individually, analyzing the lifestyle of these young people, as well as hereditary factors. In compliance with Resolution 466/12 on ethics in research involving human subjects, the research started after the approval of the ethics committee in research at the University CEU- MA with the opinion No. 42836815.2.0000.5084 and formal consent by letter, sent to the coordination of the institution's nursing course, as well as the researcher provided a Term of Informed Consent - TIC, for academics, with the necessary clarification of the research and to receive authorization of same to the questionnaire, as well as for use the information collected only for scientific purposes, ensuring the confidentiality of data, and does not cause any finan- cial or mental harm to participants. 52 students were interviewed. Results: for the age group, the highest percentage was between 20- 25 years (67%), women (81%), single (73%) and white (42%). Refer being alcoholic (58%), eating sporadically alcoholic beve- rage (71%) and deny tobacco use (77%). They state physical exercise (62%), often 3 to 4 times per week (33%). Fast Food ingest weekly (48%), feed 2-3 times a week with vegetables and legumes (46%). They have hypertensive cases in the family (77%), and the father (40%) in most cases. Regarding comorbidities were identified hyper- tension (3.8%), diabetic (1.9%) and obese (5.7%). Conclusion: Our results indicate the presence of changeable risk factors and non-changeable in the study group; Another important point to note is the age group of respondents and the lifestyle of the same. Therefore, these results point to a young population that needs information and awareness of the hypertension syndrome and its complications, and also because it is the scholars who will deal with the commitment of health promotion. 42 Events of Domestic Accidents in Childhood in Responsive- ness Service in São Luis / MA Francisca Das Chagas Gaspar Rocha; Yasmin Pascoal Perei- ra Castro; Janice Maria Lopes De Souza; Maíra Damasceno Cunha; Moacira Lopes Carvalho; Camila Aparecida Pinheiro Landim Almeida Introduction: Accidents in childhood are common and constitute a serious public health problem. They are generally considered inevi- table and unpredictable, but often occur as a consequence of the level of child development, family behavior, instances of facilitating situations and lack of preventive measures. Objectives: To identi- fy the occurrence of domestic accidents involving children, enro- lled in a health facility in Sao Luis-MA from January 2014 to January 2015, characterize the socio demographic aspects of children and caregiver, point out what kind of occurred accidents with the study group and identify the evolution of cases. Methods: The study was a descriptive, retrospective study with quantitative analysis, carried out in an institution of responsiviness. The sample consisted of 574 medical records of children who suffered a domestic accident and were served this institution from January 2014 to January 2015. Data collection was conducted in May 2015 by a format established by the author, pertinent to the purpose of the project. Analysis and discussion of the results obtained during the investigation by the sheet with the following composition: gender, age, type of accident and evolution of the household accident. At the stage of drafting the text was written in dissertation form, as grounded in the knowledge gained from reading and analysis of data in table form for tabulation. It was performed using Excel and clothing tables for better unders- tanding the presentation of data. This study was approved by the Ethics Committee, through the CAAE No. 42836915.1.0000.5084 and the head of emergency care unit in São Luis MA. To the head of the health institution was referred searched an office, data collec- tion being initiated only after approval. Initially, it was sent to the Emergency Department of Health, which served as a research field, a letter requesting authorization from the field to collect data. They followed the ethical principles, in accordance with Resolution No. 466/12 of the National Health Council for research involving human beings. Results: The results were: 64.7% were male and 33.7% were aged 7-11 years old, 51% were with her mother during the occu- rrence of domestic accidents, 34.5% suffered fall, the most affected body region was the upper limbs (31.8%) and 85% were discharged after treatment in the health institution. Conclusion: On above, it is concluded that children are vulnerable to accidents and that most cases accidents occur in their homes, so the home environment can cause bring risks to children, requiring continuous observation of facilitating conditions for this event. 43 VER-SUS Imperatriz: Experiences and Stages in SUS Reality in the Indigenous Community São José (Krikati) in Montes Altos-MA Thyago Leite Ramos; Ronan Lacerda Barbosa; Romullo José Costa Ataídes; Francisco Eduardo Ramos Da Silva; Agamenon Rodrigues Sena Neto; Tiago Albuquerque Fernandes Introduction: The project stages and experiences in the reality of the Unified Health System (VER-SUS) is a tool that allows partici- pants to experience a new learning space within the health facilities and communities, expanding the scope of what health and disease is within each community's reality, interdisciplinary, class struggle, gender movements, minority populations, political reform and other intrinsic aspects of SUS. The Experience: The VER-SUS Imperatriz took place on August, 1st to 10th, 2015 with about 60 participants, in- cluding living and facilitators. During the morning of August 10th, 2015, the VER-SUS Imperatriz team traveled towards São José Village (Krikati) in the Montes Altos city Maranhão, home to about 770 people. The indigenous community enjoys electricity, running water, school and have a health care facility with good physical infras- tructure, equipment and basic pharmacy, mainly with the HIPERDIA program drugs'. The health unit receives two multidisciplinary teams with physicians, nurses, dentists, dental health aides and nursing technicians and indigenous health agents, taking turns every 15 days for services. A Striking feature observed in the relationship between health service provided by professionals and health care offered by the tribe's shaman is tolerance and respect. The health services do not cancel each other, working synergistically to provide welfare to the people who live there inhabitants, so the people started using drugs brought by SUS, however did not abandoned their natural me- dicinal treatments and prayers learned culturally. Conclusion: The VER-SUS Imperatriz showed the importance of knowing the remote communities to urban centers' reality and reflect about the process of health and how the indigenous communities' culture can exert influence on it. The wisdom of these people can be valued and must walk alongside the work of the multidisciplinary team of the unit and vise versa, and this was clearly observed in the São José Village. This mutual respect is synonymous with well-being, tolerance, care and, mainly, of health. S26 INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 II COIMAMA INTERNATIONAL JOURNAL of MEDICAL STUDENTS S27#15IJMS II COIMAMA INTERNATIONAL JOURNAL of MEDICAL STUDENTS Abstracts Abstracts 44 Bioprospecting Species of Vegetable Leaves Himatanthus Drasticus (Janaúba) Gizelli Santos Lourenço Coutinho; Tarciano Nascimento Perei- ra; Luiz Mario da Silva Silveira; Antonio Carlos Romão Borges; Marilene Oliveira da Rocha Borges; Roberto Sigfrido Gallegos Olea Introduction: In Maranhão, the extraction of Himatanthus drasticus (janaúba) has gained importance as an alternative income for the population, but few studies are found in the literature on the lea- ves of this species. Objectives: This study aims to determine the phytochemical composition and metal, as well as evaluating the an- tioxidant and microbiological activity of the hydroalcoholic extract of the leaves of the plant species Himatanthus drasticus. Methods: qualitative tests were performed for detection of secondary metabo- lites and minerals detection was performed through atomic absorp- tion (ICP-OES technique). In relation to the antioxidant activity was used the method in vitro with DPPH and antimicrobial activity were used standard strains (ATCC) of gram-positive bacteria (Staphylococ- cus aureus, Streptococcus agalacicus), gram-negative (Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Proteus mirabi- lis), and yeasts of the genus Candida (C. albicans, C. parapsilosis, C. tropicallis, C. glabrata) by diffusion tests in a solid medium and in an agar diffusion, by determining the Minimum Inhibitory Concentra- tion (MIC). Results: We found in the leaves of Himatanthus drasticus flavonoids, condensed tannins, alkaloids, free steroids, triterpenes, saponins, resins, coumarins and predominance of minerals like cal- cium, potassium, phosphorus and magnesium. The antioxidant ac- tivity showed EC50 of 31.62 mg/mL, and the antimicrobial activity was no inhibition of all tested strains at a MIC 15% by agar dilution technique. Conclusion: These results are preliminary data, about the plant species Himatanthus drasticus, however further studies should be conducted to better clarification on the use of this specie by Maranhão population. 45 Survey of Greater Herbal Medicines Marketing in one drugs- tore of São Luís, Maranhão, Brazil Tarciano Nascimento Pereira; Renatta Belfort de Souza; Nilton Boaes Barbosa; Josefa Cristina da Silva Tavares; Rosália Mo- reira dos Santos; Gizelli Santos Lourenço Coutinho Introduction: Herbal constitute a form of complementary or alternati- ve therapy in the face of health needs. They are presented as an al- ternative to substitute or complement of synthetic drugs. Objectives: This study aimed to carry out the survey of herbal medicines sold in a drugstore in the capital of Maranhão. Methods: It constitutes a survey of the main herbal medicines consumed by the population from September 2014 to March 2015. Results: Being herbal sold in 2297, with higher sales for the months of December (17.3%), March (16.6%) to January (16%). Thus, when stratifying herbal more acqui- red according to the plant drug, it was observed that the Cynara sco- lymus and associations Peumus boldus were the most sought after, representing 54.11%. Then, Peumus boldus (23.9%), Mikania glome- rata (6.75%), Hedera helix (4.8%), Papaver somniferum (2.52%), Cor- dia verbanacea (1.43%), Aesculus hippocastanum (0.74%), Ginkgo bi- loba (0.71%), purple passionflower (0.65%) and others (4.39%) as the best-selling herbal medicines in the pharmaceutical establishment. The most dosage forms were dispensed oral solution (78.5%), syrup (9.14%), capsule (3%), elixirs (2.52%), tablet (2.09%), gum (1.22 %) and others (3.5%). Conclusion: Although the study has taken into consideration only one drugstore, presented important results so that they assess the consumption of herbal for the population of São Luís, indicating a prevalence of sale of herbal medicines for digestive and respiratory disorders. 46 Organization of Primary Care Units' Records in Brazil Renato Albuquerque Heluy; Maria Teresa Soares De Britto E Alves Introduction: The information's recording about the patient is called medical chart. It should consist of identification, medical history, physical examination, definitive diagnosis and treatment. It is es- sential for judicial protection for the health professional, allowing communncation among professionals and support public manage- ment strategies. This study evaluates the registration data, organi- zation and use of medical records in primary care units. Objectives: To check the recording quality in primary care service charts and to estimate the rate of electronic chart's use. Methods: Cross-sectional study that used Access and Quality of Primary Care Improving Pro- gram (PMAQ-AB) data base. Information obtained by interviewing 17.202 teams of heath care units professionals and 4 users of each unit in 2012. This study uses the second module of PMAQS instru- ment called services organization, teamwork process and access of primary care units. It used the program Stata 12.0 to compare pri- mary care units services' quality among Brazil's geographic regions. It was used Chi-squared distribution test to evidence differences in estimated rates. It was considered relevant diferences with p value , 0,05. Results: South region presented the highest rate of eletronic chart implantation, with 30.35%. Of this total, 84.35% had the chart integrated with others attention care points. In Northeast, only 1.33% had eletronic chart implanted. The variable "readable letter", North reagion showed the highest rate, with 82.87%, while South showed the lowest one, with 70.06%. A 9.10% rate at Southeast did not have users' identification (name, age, sex) registered. This rate at North region was 96.94%. Conclusion: It is noticed the small use of eletro- nic charts all over the country. This resource prove itself effective for users data's register and integration among primary care units. Therefore, its use must be encouraged by heath managers. Rates of charts without users' identification are noteworthy, showing charts' filling's bad quality. That point can be improved by adopting a model standard register. Registering with readable letter was a frequent action in every region. 47 Epidemiological profile in Tuberculosis in Altos-Piaui Layanne Cavalcante De Moura; Giovana Brandão Veneziani; Ivo Belarmino Souza Silva; Anelis De Sousa Martins Freitas; Karla Késsia Portela Silva Soares; Joana Elisabeth De Sousa Martins Freitas Introduction: Even with current advances in medicine, tuberculosis (TB) remains a public health problem due to a high prevalence of morbidity and mortality. Objectives: This study has characterized the epidemiological profile of the reported tuberculosis cases in the city of Altos-Piauí between 1998 and 2012. Methods: This was a retrospective, descriptive, quantitative and exploratory cohort study whose data were obtained by the City Health Department having as variables the frequency of occurrence of cases, gender, age, diag- nostic investigation, entry data, clinical presentation and the cases outcome. The data were organized and analyzed using Microsoft Office Excel 2010 spreadsheets. The research was approved by the Ethics Committee of the Faculty Integral Differential under the Proto- col 17968514.2.0000.5211 and authorized by faithful term depositary by the institution where the research took place. Results: During the study period, 215 cases were reported, with an average of 14 per year. It showed a male dominance with 63.26% and cases in the age group of 41-50 years (20%). Among the tests performed to contribute and define the diagnosis of TB, 174 (80.93%) were sputum smear, 155 (72.09%) Chest RX, 19 (8.84%) histopathology, 12 (5.58%) the Mantoux tuberculin skin test and 2 (0.93%) were culture. Regarding how it was presented, 172 (86.05%) cases were initial treatment, 28 (13.02%) relapse treatment, 2 (0.93%) pictured after the abandon- ment. Among the types of TB, the pulmonary positive type presented with 107 (49.76%), negative pulmonary type with 79 cases (36.74%) the lymph node type with 10 (4.65%), followed by 8 cases of pleural type (3.72%). The cure rate was 177 (82.3%) followed by 15 (6.98%) deaths; 13 (6.05%) were transferred to another health service; and there was 7 (3.26%) cases of abandonment. Conclusion: This study was characterized by the trend of lessening cases, predominantly in men between 21-50 years old and were submitted to sputum smear, as well as new cases, pulmonary type and discharged as cured. It is hoped that the results presented serve as an exemple of a basis for greater control of the disease contributing to the identification of risk groups and the Program's weak points with a consequent decrease in the incidence of tuberculosis in Altos - Piaui. 48 Occurrence of viral hepatitis in Maranhão from 2007 to June 2015 Rute Rocha Santos; Lizandra Murielle de Carvalho Moraes; Milla Dantas Martins Rodrigues Xavier; Marcela Bezerra Mar- ques; Natália Maria Marques Brito; Jarbas Moura Moraes Introduction: Viral hepatitis are caused by diferente etiological agents who share the hepatotropism. The prevention of these hepatitis is a major challenge for the countries public health and for the medical and scientific communities. Therefore, hepatitis viruses cause signifi- cant morbidity and mortality in the world, causing acute and chronic liver disease. Objectives: To analyze the occurrence of viral hepatitis in Maranhão from 2007 to June 2015. Methods: This is an epidemio- logical quantitative study prepared from viral hepatitis related data, which was removed from the Notifiable Diseases Information System (SINAN). The data was analyzed according to the etiologic classifica- tion, age, clinical form and sex. The graphs and tables were made in Microsoft Office Excel 2014. Results: This is an epidemiological quan- titative study prepared from viral hepatitis related data, which was removed from the Notifiable Diseases Information System (SINAN). The data was analyzed according to the etiologic classification, age, clinical form and sex. The graphs and tables were made in Microsoft Office Excel 2014. Conclusion: Based on the data, it was noted that the incidence of viral hepatitis between 2007 and June 2015 in Ma- ranhão prevailed in isolation form of hepatitis A, in the age group of 20-39 years, in males. Furthermore, it was observed that the majority of cases were presented in the clinical form of acute hepatitis. 49 Pharmaceutical Care in Accident Prevention with Toxic Plants in the city of São Luís - MA, Brazil Tássio Rômulo Silva Araújo Luz; José Antonio Costa Leite; Daniela Patrícia Brandão Silveira; Maria Cristiane Aranha Brito; José Wilson Carvalho de Mesquita; Denise Fernandes Coutinho Moraes Introduction: Many plants have toxic substances that can cause da- mage to health. According to the National System of Toxic-Pharmaco- logical Information (SINITOX) of FIOCRUZ, 60% of cases of poisoning by toxic plants in Brazil occur in children under 9 years, of which 80% are accidental. Objectives: Evaluate the knowledge of munici- pal school students in São Luís MA about toxic plants, as well as educate about preventive measures to accidents. Methods: This is an experience report of students Phytotherapy Program / UFMA, organized from information on toxic plants obtained during lectu- res to elementary school students from public schools in São Luís - MA on herbal medicine. During the lectures, 10 toxic plants were presented: no one beats me, Castor, Aveloz, Cassava-Brava, Purple Pinion, Nettle, Tinhorão, Crown of Christ, St. George Sword and hat of Napoleon and evaluated the knowledge and ease of obtaining. Because it is teaching-learning experience, there was no need for the formalization of the free and informed consent procedure. Results: During the study, it was observed that 63% of students had easy access to some toxic plants presented, at home, on the street or at school; 92.5% were unaware of the toxicity of at least 3 of the listed toxic plants, the most cited were Me-No-Can, Tinhorão and Castor. The Nettle and hat of Napoleon plants were the best known of the students. No one beats me and Aveloz have ornamental employment , which intensifies the risk of accidents by ingestion or contact with parts of these plants, especially by children. Another factor related to poisoning is the common idea that "If comes from nature does not hurt," excluding the possibility of a plant causing any damage to health, which makes it important demystify this concept. To prevent such accidents educational activities were held, informing about the toxicity of these plants and first aid measures. Conclusion: It was found that the lack of knowledge of toxic plant species, as well as its ease of access are the main factors related to the occurrence of intoxication. In this context, it is believed that the best way to prevent accidents is the spread of knowledge about toxic species in educational programs for the population, contributing to the reduc- tion of accidents with them. 50 Pharmacotherapeutic follow-up in Diabetic and Hypertensive Patient Tássio Rômulo Silva Araújo Luz; José Antonio Costa Leite; Maria Luiza Cruz Introduction: Diabetes is a metabolic disorder characterized by high blood glucose due to insulin deficiency, often associated with its re- sistance. In hypertension, have increased blood pressure, which is a risk factor for cardiovascular disease. As a result, the pharmaceutical care is a essential tool for pharmacotherapeutic follow, especially in diabetic hypertensive patients who require special care involving dose regimen, proper storage of medications and changes in lifes- tyle. Objectives: This study aimed to follow a diabetic and hyperten- sive patient on polytherapy, trying to detect drug-related problems, seeking alternatives that improve their quality of life. Methods: The Monitoring was employed method Dader, which occurred: offering service, first interview, study phase, intervention phase and evalua- tion of results. Results: Male, 58, 178 cm, 80 kg, diabetic for 25 years, and hypertense for 16 years, with joint pain and stomach. In the assessment of vital signs, the only finding was hypertension, due the constant high blood pressure (150/100 mmHg). At the anthro- pometric measurements it was found that the patient has a BMI> 25 (overweight) and high waist circumference (100 cm), increasing risk of metabolic complications. Laboratory tests of glucose profile (glu- cose, HbA1c and postprandial glucose) are changed, even ith the use of drugs. As for habits, the patient reported consuming alcohol on weekends and suspending the medication. The patient used: gliben- clamide, omeprazole, Metformin hydrochloride, Hidrochlorothiazide, Losartan Potassium, Aspirin. Was found drug interactions of clinical importance and it was found that the patient had difficulty to use the medication, featuring non-adherence to treatment. For resolu- tion, there were pharmaceutical interventions, producing a moni- toring diary, a booklet of recommendations, one pharmacotherapy guide and a cabinet medicines indicating a more practical way the correct way to use them. Conclusion: With the pharmacotherapeutic follow-up, the patient was able to improve their quality of life, could solve all your doubts and be guided not only on the use of medici- nes, but also in habits that can be changed. 51 Epidemiological Profile of Schistosomiasis Mansoni in Nor- theast 2010-2015 Marcela Bezerra Marques; Layane Duarte Silva; Thájara Fer- nandes De Sá Guimarães; Augusto César Evelin Rodrigues Introduction: Schistosomiasis is a typical northeastern endemic pa- rasitic disease which remains a serious problem of public health.1 Also known as water belly, schist or snail disease, is characterized in the most severe form, hepatosplenic at enlarged liver and spleen. Diagnosis and treatment are relatively simple, but the eradication of the disease is only possible with preventive measures. Objecti- ves: Raise an epidemiological profile of Schistosomiasis mansoni in the Northeast region 2010 to 2015. Methods: This is a retrospective epidemiological quantitative study compiled from data from the No- tifiable Diseases Information System (SINAN). We analyzed all schis- tosomiasis data regarding age, gender, education and development of the disease in the Northeast region 2010 to 2015. The graphs and tables were made in Microsoft Office Excel 2014. Results: We reported 7298 cases of schistosomiasis in the Northeast, and 3974 (54.5%) male and 3323 (45.5%) in females. Of all cases, the largest num- ber occurred in BA with 3787 cases (51.9%), followed by PE in 1650 (22.6%). The year with the highest occurrence was in 2011, totaling 1526 (20.9%) cases, including the most concentrated in Bahia with 749 (49.1%) cases this year. Most evolved to cure with 3347 patients (45.9%), followed by 185 cases (2.5%) rated as not cure; there were 141 deaths from schistosomiasis, which predominated in the PE (91 cases). The highest frequency occurred in the age group of 20-59 years with 4618 cases (63.3%), followed by people aged less than 20 years with 1625 cases (22.3%). Analyzing the levels of education, 2701 cases were ignored or white and 543 corresponding to illiterate. The highest incidence occurred in people with education level limi- ted to primary education with 2858 cases (39.2%); there was inter- mediate occurrence in people from high school with 863 (11.8%) and lower incidence in those in higher education with 122 cases (1.7%). S28 INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS II COIMAMA S29#16IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS II COIMAMA $30 Abstracts Abstracts Conclusion: Numerous cases of MS in the Northeast have been re- ported, mainly in Bahia and Pernambuco, the latter being the state with the highest number of deaths. The disease is more common in men and in the age group of 20-59 years; and in most cases progress to cure, showing that adequate treatment is effective. In addition, it was noted that the number of cases is inversely proportional to the increase of education. 52 Poison Exogenous Occurrence in Brazil's Northeast 2010-2015 Layane Duarte Silva; Marcela Bezerra Marques; Thájara Fer- nandes De Sá Guimarães; Augusto César Evelin Rodrigues Introduction: Poisoning is the manifestation through signs and symptoms of the harmful effects produced in a living organism as a result of its interaction with some chemical (exogenous). It may be an accident or an assassination attempt or suicide, requiring survei- llance and prevention. They are a public health problem worldwide and to identify the toxic product and the danger involved are criti- cal to effective treatment. Objectives: To analyze the occurrence of Exogenous poisoning (IE) in northeastern Brazil from 2010 to 2015. Methods: This was a retrospective quantitative epidemiological stu- dy prepared from data taken from the Notifiable Diseases Informa- tion System (SINAN). The data analyzed were age, sex, toxic agent, circumstance and course of the disease in the Northeast from 2010 to 2015. The graphs and tables were made in Microsoft Office Excel 2014. Results: There were 98,552 reported cases of IES in the Nor- theast, and 51,107 (51.88%) females and 47,417 (48.12%) in males. Of all cases, the largest number occurred in Pernambuco (PE) to 33,205 (33.69%) cases, followed by Bahia (BA) with 15,973 (16.21%). The hig- hest occurrence was in 2014, totaling 24.389 (24.75%) cases, where the majority focused on PE with 8,394 (34.42%). Most reported by IES were drugs, with 28 782 (29.20%) cases; 14,803 (15.02%) for food and beverages; 8,314 (8.44%) for drug abuse; 5,346 (5.42%) by roden- ticides; 5,202 (5.27) per household products; and 4,648 (4.72%) for agricultural pesticides. Of reported poisonings, 23,049 (23.38%) cases were assumed to suicide attempts; 15,563 (15.79%) referred to as accidental; 10,083 (10.23%) for food intake; 7,853 (7.97%) by habitual use of drugs; and 7,182 (7.29%) for abuse of drugs. Most evolved to cure, with 65,328 (66.28%) achieved cure without sequelae and 1,459 (1.48%) followed for a Cure with sequel. In the same period they were reported 1,266 (1.28%) deaths by IEs. The highest frequency of cases occurred in people in the age group to 20 years with 39,207 (39.78%) cases, followed aged 20-39 years with 38,685 (39.25%). Con- clusion: It was observed that the IES are more frequent in the female population and in people younger than 20 years. Predominated in 2014 with higher incidence of PE. Most IEs were for medicines and largely suicide attempt. Among the cases reported in the Northeast most evolved into healing. The identification and description of the epidemiological characteristics of the cases are of great relevance to the treatment plan and the planning of preventive measures. 53 Percentage of Choledochal Calculations Extraction Success via ERCP in a Public Hospital of Teresina (PI) in 2013 Evellyn Batista da Silva Flizikowski; Jayronn Jailson Santana dos Santos; Bruno Viana Pontes cholangiopancreatography Introduction: Endoscopic retrograde (ERCP) is a procedure involving the esophagus-gastroduodenal en- doscopy with radiological techniques and is used for diagnosis and possible treatment of diseases of the biliary and pancreatic ducts. This technique has safety to 90% in the treatment of disorders of biliary tract and pancreatic but has major complications such as sep- sis. Objectives: This study aims to determine the success rate of the common bile duct calculus extraction via ERCP in the Surgical Clinic of a public hospital in Teresina - Piauí, in 2013. Methods: Study in Surgical Clinic of the Hospital Getúlio Vargas (HGV) in Teresina (PI). For data collection was carried out active surveillance of patients through the operating theater of the hospital record book, using the Keywords: "coledocoplasty", "ERCP" or "endoscopic papillotomy". A universe of twenty-nine were found (29) procedures between the period 01 Jan to 31 December 2013. Then, there was the search of the medical records of patients. Of the 29 recorded procedures, 6 patients were excluded from the study because the records were not found, leaving a sample of 23 patients. The results were analyzed using the Microsoft Excel 2010 program. Results: Of the 23 procedu- res, 60.9% was female patients, 39.1% were male and all with thera- peutic indication. In terms of age, the most discussed age group was between 31 and 40 years, a total of 8 patients. The average hospital stay was 14.4 days. Complication, were found four patients who had post-procedure pancreatitis. In this study, the successful removal of common bile duct stones by ERCP, was achieved in 88% of patients not being achieved in 3 patients (12%). When we analyze a single en- doscopic procedure using only balloon and the basket, which is the case in this series, are success rates of 70-75%. Conclusion: ERCP is a method used for therapeutic purposes and its greatest indication relies on CDL. In 2013, the hospital under study reached a success rate for surgery for ERCP than found in other studies using similar resources available to this institution (basket and the balloon). 54 Socioeconomic Profile of Pregnant Women Assisted in a Basic Health Unit in Maranhão between 2014 and 2015 Núbia Barros de Araújo; Flávia Coelho Mohana Pinheiro; Lívia de Castro Eloi; Samir Henrique Corso; Patrícia Magalhães Coelho; Elane Carvalho de Oliveira Introduction: It is considered the pre-natal a time of physicall and psychological preparation for childbirth and motherhood, therefore, a period of learning by the woman and her family and an opportu- nity for the health team develop education in the process of care. Prenatal consists of a call to the woman during the pregnancy pe- riod, in which "basic care during pregnancy includes the prevention of disease and injury, health promotion and treatment of problems experienced during pregnancy to postpartum". In this context, ex- plains the importance of this study, when the interest of this broke the UNICEUMA PET Health Research Group which researchers parti- cipate in order to meet the population served to qualify the con- sultation and provide feedback to the health facility. Objectives: To describe and analyze the epidemiological profile of pregnant women attended at a Basic Health Unit in Maranhão in the years 2014 and 2015. Methods: We applied 53 questionnaires containing questions about the habits during pregnancy (alcoholism, smoking and drug use), desired type of birth, abortions, pregnancy complications, pre- natal start date, applied vaccines, knowledge of the contraceptive methods and if there was sexual orientation. Data were tabulated by Microsoft Excell 2011 and Bioestat 5.0 programs. Included were all low-risk pregnant women, without exclusion criteria, During the years 2014 and 2015. Results: Regarding habits during pregnancy, 98.1% of pregnant women do not smoke and 92.3% did not ingest alcoholic beverages during pregnancy. There were no reports of drug use. They claimed to be 34.6% in the first pregnancy; 60.7% said they prefer vaginal delivery and 39.3% will opt for cesarean section. 70% of pregnant women reported never having suffered abortion, 24% reported having aborted first time and 6% reported having com- mitted two abortions. As for the beginning of prenatal care, in most cases, the assistance was initiated at 2 and 3 months, with 31.4% and 35.3%, respectively. The most frequent pregnancy complications were anemia (18%), bleeding (6%) and urinary tract infection (2%); however, 68% of the women surveyed said they had not suffered any complication in the period. 72% said they had received sexual orientation (45.7% in school, 11.4% in the family; 14.3% in UBS) and 80.4% knew the contraceptive methods offered by UBS. Conclusion: A good prenatal care ensures the involvement of professionals in the development of a pregnancy without risks being an excellent indica- tor of efficiency of public health policies aimed at reducing morbidity and mortality during this period .The multidisciplinary care and the location of the patient on a broader context of how the health of the citizen is treated by society denotes the need for restructuring in the primary care service for pregnant women. Restructuring that can co- ver this, especially those that are vulnerable conditions represented by the data described above. 55 Antinociceptive Activity Assessment of Hydroalcoholic Ex- tract of Persea Americana Mill Lilaléa Gonçalves França; Emerson Luzas Frazão Sousa; Abner de Oliveira Freire; Vitor Fernandes Rios; João Batista Santos Garcia; Maria do Socorro de Sousa Cartágenes Introduction: The evolution of the human species has always been associated with the use and/ or interest in the development of drugs from natural products, which underscores the importance of traditio- nal knowledge for the evolution of scientific knowledge, particularly the chemical and pharmacological studies, investigating increasing the effectiveness of byproducts, especially those used in folk me- dicine for therapeutic purposes. The popular tradition and the will to get relief from the suffering currently have a significant place in society, either by self-medication or the accredited drug indication. The plant species Persea americana (avocado) presents the popular use indication as hormonal regulator, antifungal, anti-inflammatory and antioxidant, giving the same therapeutic potential. Objectives: To evaluate the antinociceptive activity hidroacoólico extract of Persea americana (EHPA) using the method of writhing induced by acetic acid. Methods: The extract is obtained by maceration (1: 3) using leaves of the sprayed species and 70% ethanol as solvent. After 4 hours fasting, the animals were randomly divided into six groups and treated orally with EHPA (1, 5, or 29.4 mg / kg) or vehicle (sali- ne). After 30 minutes, all animals were induced with 0.8% acetic acid (0.1ml 10g of body weight, intraperitoneally). The manifestation of pain is characterized by abdominal contractions of the animal followed by twisting of the trunk and extension of hind limbs for 20 minutes, this time interval by dividing into four times 5 minutes of observation. The results were expressed as numbers of writhes performed. Results: During the evaluation, the EHPA at a dose of 1 mg/kg which was the better results in the reduction of number of writhings and therefore greater analgesic potency. Doses of 5 and 29.4 mg/kg generated less effective analgesic actions. Conclusion: EHPA reduced the pain signals in mice induced with acetic acid. 56 "Taking Care of Who Cares": Experience Report on Family Caregivers of Institutionalized Psychiatric Patients Daniela Batalha Jardim Ramos Rocha; Lidiane Morais Lima; Bruno Luiz Avelino Cardoso Introduction: The health-disease process suffers direct environmen- tal influences and physical conditions to which we are exposed. With the process of deinstitutionalization, the care of the patients' basic needs, the coordination of their daily activities, medication adminis- tration (and) monitoring health services, became part of the family routine. Family caregivers began to manage the crisis incident, pro- vide them with social support, bear costs and overcome difficulties of these tasks. Influence the management of overhead availability of social support networks, social-sanitary laws, the structure and ade- quacy of mental health services. The Experience: This case involves a patient diagnosed with HIV, about two years, after which the news because of their aggressive behavior pattern was admitted by rela- tives immediately in a psychiatric institution. It is a man of 43 years old, divorced, no children. He decided to quit his job because repor- ted that he could no longer work due to illness. His older brother (S) decided to join him in medical and psychological consultations. As the patient became more dependent emerged the need for a caregi- ver longer present. S. had assumed some responsibilities for patient care, but these intensified when the health status of this worsened. S. interrupted his job, was married and had two children. His routine began to be changed, and leisure subtracted. The high level of stress and anxiety brought on S. sleep disorders and appetite, which led to a considerable increase in weight. Conflict in marriage threatened a marital separation. Conclusion: Driving a empathetic look to the caregiver, offering comprehensive care for its task, considering the primary sources of stress and possible negative interference both in their physical health and emotional, should be given prominence in interventional methods. The recognition of its importance, contribu- tions and the difficulties they face as a decisive step for the deve- lopment of community care practices sensitive to the population's needs, such as implementation of psychoeducational groups, regular home visits and help to develop coping strategies overload. Peritoró-MA Arthur Antunes Silva Castro; Laizza Dos Anjos Vaz; Jeferson Anderson Medeiros; Lívia Camarota Borges; Caubi De Araújo Medeiros; Fernanda De Oliveira Franco Introduction: Cardiopulmonary arrest (CA) is an entity with high ra- tes of mortality, representing an important public health problem. About half of the CA's happen outside the hospital, requiring an effective approach to the situation. Objectives: Analyze the knowled- ge of health professionals of Peritoró-MA about the management of cardiopulmonary arrest. Methods: Data were collected through for- mulated questionnaire with basis in scientific articles about CA, and applied to health-care professionals of Peritoró-MA. Results: Thirty seven healthcare professionals of Peritoró-MA participated answe- ring the questionnaires, including community health agents, nursing technicians and nurses. Of these professionals, 87% had not yet had contact with instructions for basic life support and 35% of the total had already worked on situations of CA. From the data reviewed, it is concluded that the knowledge about the approach and management of out-of-hospital CA by the health-care professionals of Peritoró isn't sufficient, since most reports showed absence of previous contact with training and/or studies about CA. Conclusion: Considering the data obtained, there is a deficiency with regard to skills in handling victims of cardiac arrest. There is a need to deploy methods in the public health system to offer better theoretical-practical training on CA and this is a conduct that should be implemented immediately. 58 Induced Cytotoxicity by Abundant Polysaccharides Fraction Isolated from Babassu Mesocarp Isolda Ribeiro e Silva; Letícia Prince Pereira Pontes; Luce Ma- ria Brandão Torres; Vanessa Fátima de Oliveira; Flávia Raquel Fernandes do Nascimento; Ana Paula Silva de Azevedo dos Santos Introduction: Polysaccharides from natural sources are immune response modifier molecules, activating both innate and adaptive immune system. Attalea speciosa Mart. ex Spreng (Babassu) has an abundant polysaccharides constitution; Babassu has shown immu- nomodulatory activity in biological essays as a potential antitumor immunotherapy adjuvant. Objectives: Evaluate cytotoxic capacity of Polysaccharides Fraction from Babassu mesocarp in Ehrlich tumor cells. Methods: Extraction of total carbohydrates was accomplished by aqueous extraction of mesocarp Babassu powder in water bath at 80° C for 15 minutes, in four cycles, obtaining final ratio of 1:200 (drug: solvent). After centrifugation (2500 rpm, 15 minutes), super- natant was concentrated on rotaevaporator, obtaining a Total Car- bohydrates Extract (TCE). Polysaccharides Fraction (PF) was accom- plished by addition of ethanol (3:1 v/v) to TCE for polysaccharides precipitation. Determination of total carbohydrates was accomplis- hed by chemical qualitative tests and HPAEC/PAD. Quantitative tests for carbohydrates (Dubois method) and proteins (Bradford method) were also performed. Evaluation of cytotoxicity was accomplished by Trypan Blue and MTT methods at 100-1.5μg/mL concentrations. Results: TCE and PF concentrations were 24.24 and 0.274 mg/ml, respectively. Qualitative tests have identified simple and complex carbohydrates in both extracts. Chromatographic profiles have de- termined presence of glucose, fructose and sucrose, and Bradford test has shown 1% of proteins in the extract. Trypan Blue assay has shown that both extracts had cytotoxicity at higher concentrations only (5 and 2.5 μg/ml), at a frequency of 46% and 60% dead cells. FP was evaluated at two different times (2 and 4 hours); results have shown 72% and 21% of cytotoxicity at 100ug/ml concentration. Then, inhibitory concentration (IC50) was determined; the IC50 was 24.30 μg/ml and 69.04 µm/ml at 2 and 4 hours, respectively. Conclusion: According to results, extractive method used could extract polysac- charide, showing the extract has mostly polysaccharides instead of other compounds and the extract has a good cytotoxicity on tumor cells. 59 57 Basic Life Support: Knowledge of Healthcare Professionals of Pharmatherapeutic segment realized in a metabolic syndro- me patient Tatiana Alves Miranda, Isolda Ribeiro e Silva, Maria Luiza INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 II COIMAMA INTERNATIONAL JOURNAL of MEDICAL STUDENTS $31#17IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS II COIMAMA $32 Abstracts Abstracts Cruz Introduction: The pharmaceutical profession has gone through many transformations and dissatisfactions, since apothecary to which the pharmacist was acknowledged and respected by the population, passing by the appearing of the pharmaceutical industry, to which it was responsible of leaving the pharmacist as just a drug seller and no longer as a drug manipulator. Given this dissatisfaction over the world, such as USA and Spain, appear the clinical pharmacy movement which aims to pharmacist-patient approach striving for improvement and patient adherence to treatment. Objectives: The objective was to perform a pharmacotherapeutic follow-up with a patient using several medications in order to understand, analyze and evaluate its therapeutic life and thereby intervene if your drug polytherapy, is affecting wrongly treatment. Methods: The method used for pharmacotherapeutic follow-up was Dader method, which aims to meet the patient's therapy and thus identify problems that may be occurring, and intervene if necessary. Results: The selec- ted patient were female with 59 year-old resident of São Luís city, diagnosed with metabolic syndrome, and uncontrolled diabetes. It makes use of the following medications: simvastatin 40 mg; valsar- tan 320 mg; Glimepiride 4 mg; Metformin 500 mg and Pantropazol 20 mg (used discontinuously). After the analysis of therapy, interactions were found that did not have clinical significance, and these inte- ractions were between simvastatin and Pantropazol and Glimepiride and Metformin, but the biggest problems that had meaning was the improper storage of your medicines and their laboratory tests, making it impossible to know what were the real values of their glycemia and lipids profile. It was asked to interrupt the use of pantoprazole and adopt the practice of exercises for improving joint pain. We prepare a timetable for her to remember to go periodically to the doctor and a folder for her to save and be able to identify where to find their exams. Conclusion: After the pharmacotherapeu- tic follow-up done with the patient and as all the speeches made were very well received, we concluded that the work was of great importance for the patient, and can improve your life. 60 Epidemiological Assessment of Visceral Leishmaniasis in Maranhão among 2010 to 2013 Andressa Oliveira Diniz; Cláudia Tamires Sousa Leite; João Ga- briel Dias Brasiliense Frota; Helena Maria Fonseca De Sousa; Thiago Igor Aranha Introduction: Visceral Leishmaniasis (VL) or kala-azar, is an infectious disease, severe chronic disease, potentially fatal (10%). It is caused by protozoa of the genus Leishmania, belonging to the complex Leis- hmania donovani, transmitted by the bite of female Lutzomyia longi- palpis. A clinical diagnostic is based on the history of fever, anemia, diarrhea, weight loss, asthenia and hepatosplenomegaly. In addition, the health ministry reports the occurrence of 3,100 new cases per year in Brazil, 54% of them in children under 10-years-old. The chan- ges in the world economy contributed to an epidemiological transi- tion process: transfer characteristic morbidity and mortality profiles of rural to urban areas (urbanization of the LV). Therefore, this fact undermines efforts of health agencies for effective control of the disease in different environments. Objectives: To describe the epide- miological profile of patients with visceral leishmaniasis reported in the state of Maranhão, in the period from 2010 to 2013. Methods: A retrospective descriptive study based on the cases reported in Disea- ses Reporting System of Compulsory Notification from 2010 to 2013. The data were organized according to age, sex, race/color, notifica- tion municipality and area of residence. Results: In this period, 1,493 cases of VL were reported, with 354 (23.7%) in 2010, 381 (25.5%) in 2011, 239 (16%) in 2012 and 519 (34.8%) in 2013. Moreover, in terms of age, the most affected age groups are 1-4 years (40.7%), 20-39 years (16.5%), younger than 1 year (13.1%) and 5 9 years (11.4%). Observing gender, 906 cases (60.7%) are male and 587 (39.3%) fema- le. Considering the race/color, the most affected are mixed (72.9%), white (12.7%) and black (9.8%). Furthermore, the cities with most cases are São Luis (7.8%), Imperatriz (6.6%) and Caxias (6.3%). And also the area of residence whose it is concentrated theses cases are urban areas (65.2%). Conclusion: It was evidenced between 2010 and 2011, an increase in the number of cases of VL in Maranhão, which was not detected in 2012. In general, it was identified a predomi- nance of cases in the age group 1-4 years in brown race and male. It was observed that São Luis remains the leader in number of reported cases of VL. However, it is observed that the distribution of cases by municipalities is constant with no significant differences. The same are not factual in relation to the area of residence, where it is obser- ved striking predominance of cases in urban areas. 61 The Practice of Physical Activity in the Improvement of Noci- ceptive Symptoms in Elderly Patients Jessica Da Silva Prates; Thalyta Batista De Sousa; Cintia Moura Carvalho; Evellyn Batista Da Silva Flizikowski; Joycce Huanna De Souza Silva; Joana Elisabeth De Sousa Martins Freitas Introduction: In elderly patients, pain is the most frequent com- plaint. The current trend of the elderly is to present chronic medical conditions, being able to relate to the continuous nature of pain. In primary health care it is vital to measure these aspects, assess needs and monitor progress for a better quality of life. Objectives: To describe the social profile, health perception to the practiced physi- cal activities and how long are made by elderly in an institution on primary health care. Knowing the functional performance of elderly who practice physical activity and evaluate the degree of pain of the elderly. Methods: Research approved by the Research Ethics Committee of the Faculty FACID according to Resolution 466/2012 of the National Health Council, prospective, quantitative approach, a sample of 43 elderly, between August and September 2013, ran- domly chosen, physical activity practitioners in Institution of Pri- mary Care for the Elderly in Teresina-PI. Questionnaires to survey data on age, gender, color, education, health perception, physical activity and practice time; Basic instruments Activity of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) and Geriatric Pain Measurement (GPM). Data analyzed using descriptive statistics, the Student t test and analysis Pearson and Spearman. Results: Of the total elderly, 60-75 years (76.7%), older than 75 years (10%); 95.3% female; black color (46.5%), brown (37.2%), white (16.3%); without studies (20.9%), elementary school (60.5%), secondary education (9.3%), higher education (2.3%); 79.1% had a self-perception of good health and 20.9% to regulate the bad; 58% practiced capoterapia, 23% and 19% dance tai chi chuan; term average physical activity of 47.14 months. To carry out the ADL, IADL in independent and 100% independence in activities such as cooking (95.3%), shopping (95.3%) and travel (95.3%). The score of the Geriatric Pain Meansu- rement (GPM) was quite satisfactory showing that the pain in this population is below grade. Conclusion: The survey confirms the view that the exercise interventions produce significant improvements in algesics symptoms elderly, thus improving the quality of life. Care must physical activity for good health and promoting an active and healthy aging process. 62 Asperger Syndrome Associated With Gilles of La Tourette Syndrome in Pediatric Patients: a Case Report Taynara Luna de Oliveira; Caroline Carvalho de Araújo; Igor Leonardo Vieira Caetano; Larissa Gomes Farias; Jonas Bran- dão Pereira; Elis Raquel da Silva Araújo Introduction: Asperger syndrome is characterized by impairments in social interaction, in limited interests and behaviors. The Gilles de la Tourette syndrome (TS) is presented as simple motor tics, blinks of the eyes and vocal tics. These syndromes are often confused with obsessive compulsive disorder or bipolar disorder. The reason for this work is on display pathologies that are gaining space in psychia- tric clinics and often are difficult to diagnose because they are trea- ted as other psychiatric spectra. The Case: LZF, male, 9 years old, student of the 4th pivotal year. He arrived at the PS with the mother who reported irritability and aggressiveness. Laboratory tests, EEG and MRI skull, all without changes were requested. Reports that at 5 years, presented episodes of irritability, restlessness, repetitive behavior and motor and vocal tics. To 7 years, he received OCD diag- nostic and ST being treated with fluoxetine, with migraine attacks and episodes of irritability, especially at school. The medication was exchanged for Imipramine and then associated with Valproic Acid, without improvement. After a year, another psychiatrist medicated with sertraline but there was worsening irritability and then teamed up Carbamazepine without effect. On examination shows thencaring psychomotor agitation requiring physical restraint. It was diagnosed inacute episode of psychomotor agitation and Bipolar disorder being treated with haloperidol and promethazine, stabilizing the frame. He had a partial response to treatment with risperidone. Other data led to the suspected diagnosis of Autism Spectrum Disorder. His parents reported that L. had difficulty engaging in play with other children and early years, ordered his toys according to size and shape. I had repetitive behaviors, more stereotypically than compulsive; He showed hypersensitivity to noise and difficulty in separating the real from fantasy and to understand and accept rules. Conclusion: After investigation, it is concluded that the patient has Asperger syndro- me, and Tourette's Syndrome. Guidelines were given to parents and the school and the characteristics of the disorder and strategies to better handle your changes. The Risperidone was maintained, with dosage of 1.5 mg / day, and its possible reduction due to improved irritability with behavioral measures, and its possible reduction due to improved irritability with behavioral measures. 63 Conscious Negligence: An analysis of the health related qua- lity of life of medical students in the Federal District of Brazil Isac César Roldão Leite; Tamirys Golenia Dos Passos; Erick Gustavo Da Silva Neres; Ana Beatriz Neri; Rebeca Marques Margoto; Janaína Bianca Barletta Introduction: The graduation of a medical student requires much dedication, focus and determination. The extremely complex curri- culum requires a lot of effort from the student, which can decrea- se their sleep time, leisure time, physical activity, family relations, among other things. The student forgets that these activities are essential for maintaining mental health and usually neglects them. The Experience: One of the major problems the student faces is stress; which is a state of mind that causes damage to the body's homeostasis. This can be related to the new learning methods, the amount of new material and subjects, the direct contact with pa- tients, witnessing death and having to choose their residency. With this dedication to achieve his graduation goals, the student has to adopt a new way of life, having to adapt and even leave aside some daily activities due to the new responsibilities. Due to the extensi- ve workload dedicated to college, they adopt new unhealthy habits such as: little to no physical activity, drugs and/or alcohol use as a method of coping with the anxiety of the career, fast-food based diet, and risky behavior arising from promiscuity, which is intensified by a decrease in modesty and maturity. Even though the student is learning and is aware of the risks that these behaviors bring, he/she faces a dilemma between the knowledge and the need of using these timesaving techniques. Therefore, when we analyzed the medical students of a private university of Brasilia- DF in Brazil, we noticed that the vast majority of theses students practice these behaviors. Conclusion: In conclusion, the students suffer from con- ditions that, in theory, should only be experience in the residency such as: stress, burnout, anxiety, risky behavior, unhealthy eating, among other things. All these behaviors are a strategy to deal with the workload of the career they chose. 64 Comparison of Motor Development of o to 2 years old Chil- dren Ana Carolina Sá Mendonça; Eugênia Aires Pereira; Raissa Neruza Santana Alves; Laise Neves Carvalho; Hilda Thalita Jardim Lobo Introduction: Studies have been showing that the differences in the performance and motor skills between boys and girls have beco- me the target of concerns since the induction of specific activities for each gender can influence motor skills of children. Objectives: To compare the motor development of 0-2 years boys and girls. Methods: An observational, analytical cross-sectional study conduc- ted from April to June 2015, with 72 children attending a basic unit of St. Louis for data collection was used a questionnaire developed by the researchers regarding the aspect sociodemographic and child data and the Denver II test, standardized by the Brazilian popula- tion Drachler (2007). In the bivariate analysis was performed using Pearson's chi square, considering significant p <0.05. This study was based on the Resolution 466/12 of the National Health Council that regulates researches involving human subjects and it was approved by the Research Ethics Committee of UNICEUMA with report number 978 574. Results: The study included 72 children, being 52.8% (38) were female and 47.2% (34) male. In comparison between genders, it was not observed any difference in the global motor development of both (p = 0.63). Conclusion: Given the results, it is suggested studies aiming to identify possible differences in thin motor and thick mo- tor development between the genders from different socio-economic conditions as well as in older age groups. 65 Exclusive Breastfeeding Influence on Motor Development of o to 2 years old Children Ana Carolina Sá Mendonça; Eugênia Aires Pereira; Raissa Neruza Santana Alves; Laise Neves Carvalho; Hilda Thalita. Jardim Lobo Introduction: Breastfeeding is considered a public health issue, and its advantages are recognized around the world. Objectives: To in- vestigate the effect of exclusive breastfeeding in the motor develo- pment of 6 months to 2 years children. Methods: An observational, analytical cross-delineation between April to June 2015, with 56 chil- dren receiving care at a primary care Unit in St. Luis- MA. It used a sociodemographic questionnaire developed by the researchers and the analysis of motor development was used Denver II test, standar- dized to the Brazilian populace by Drachler (2007). This study was approved by the Research and Ethics Committee of UNICEUMA under the report number 978 574. In the bivariate analysis, it was used the Pearson chi square, considering as significant p <0.05. Results: Among the 56 children studied, 57.1% (32) presented thin motor development within normal limits (p = 0.580) and 85.7% (48) thick motor development compatible with the presented age (p = 0.001). Conclusion: In view of the results obtained with this research, it is possible to conclude that exclusive breastfeeding was important for motor development of children, it is essential that more programs to warn pregnant women about the importance of breastfeeding, encouraging breastfeeding and caring for the baby's health regularly. 66 Epidemiological Situation of Zika Virus in Bahia Lorena Natali Cardoso Fernandes Caldas; Larissa Chaves de Carvalho; Mariana Castro Barros Raissa da Silva santos; Geovane Cardoso Fernandes; Consuelo Penha Castro Mar- ques Introduction: Zika virus is an emerging disease, considered as a po- tential public health problem, transmitted through the same Aedes aegypti mosquito, transmitter of dengue also, with high potential for contamination and vector eliminating patent difficulty. The Zica virus has the following symptoms: fever, headache, arthralgia, malai- se, rash on the face, trunk and upper limbs, and severe itching. Knowledge about this disease is still limited and the understanding of the real epidemiological situation is still restricted, with unde- rreporting of cases and only based on clinical diagnoses. One of the great difficulties in diagnosis, due to the lack of commercially available serological tests for detection of antibodies to Zika virus in Brazil. In Bahia, first state to notify the appearance of Zika virus, epidemiological analysis shows an improvement compared to the other regions of Brazil. Objectives: To analyze the incidence of Zika, viruses in Bahia State from January to July 2015. Methods: Epidemio- logical survey, based on data obtained from epidemiological bulletin of the Health Department of the State of Bahia and Datasus in 2015. Results: Zika had its first cases identified in Bahia, in February 2015 were reported 34 518 suspected cases of Zika, in 199 (47.72%) mu- nicipalities, among which are: Salvador (44.16%), Camaçari (15.90%), Jequie (3.63%) and Seguro (3.11%) which concentrate 82.91% of ca- ses. The epidemiological situation is increasing linear trend when as- sessing the distribution according to epidemiological week. In terms INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS II COIMAMA S33#18IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS II COIMAMA S34 Abstracts Abstracts of age, the incidence is highest between 20 and 39 years. The inci- dence of neurological complications associated with Zika virus was 115 cases. Of these, 53 were confirmed as Guillain-Barré syndrome, 24 dropped and 32 are under investigation for classification of neu- rological manifestation and etiology. Among the confirmed, 49 (92%) are potentially related to a history of infection ZIKA and 02 (6.9%) related to dengue, with positive serology). Conclusion: Datasus still does not provide data notified of Zica. Through epidemiological study and knowing that numerous cases were underreported, there is the need for greater monitoring, and more effective and efficient control measures and transmitter vector fight to prevent the spread of this disease as well as reduce the complication rates. 67 Case Report of Tumor Mass Removal in Spinal Cord at Lum- bar Level in Patient of 4 years old Leonardo Silva de Melo; Thalisson Paulo Sousa Madeira; Rayanne Layla Morgado Fonseca; Tárcia Heliny Nojoza Men- donça; Mônica da Cunha Machado Resende; Maria de Jesus Torres Pacheco Introduction: Tumor masses can compress the spinal cord and can be associated with paresis, paresthesias of members, causing brain and local pain, in order to depress the neurological status of the pa- tient, and there may be temporary effects, and perhaps permanent. This paper aims to discuss a case report of a 4 years old admitted patient in the Neurosurgery Ward of the Hospital Universitário Ma- terno Infantil da Universidade Federal do Maranhão - HUMI - UFMA to perform a treatment involving a tumor mass in the spinal cord at lumbar level, at levels of T12 to L2. The Case: Boy, 4 years, residing in São Luis - MA, admitted on 05/25/2015, from the UPA Vinhais. He was taken by his mother to Hospital Universitário Presidente Dutra presenting pelvic pain, paresthesia of the lower limbs and difficulty in walking. After three days in hospital, the Computer Tomography scan found a solid mass with heterogeneous contrast uptake, lobed, measuring about 4.0 x 2.6 x 2,4 cm, located between T11-L2, with apparent epicenter in posterior soft tissue at the spinal canal, but with extension to it, which determines loss of cleavage plane with the marrow, with even paresis of the lower limbs (not wandering and not sitting a month ago), and develops with reduced appetite and loss of sensitivity to evacuation. Physical examination showed acyanosis, anicteric, feverless, normal skin color, without edema, active, reactive to handling and agreed, vesicular murmurs present without adventitious noises, without signs of respiratory distress, RF: 38irpm, RCR, 2T, BNF, at the moment without blowings, periphe- ral pulses present, CF: 110bpm, semi-globular, flaccid and painless abdomen, non palpo Visceromegaly, RHA+, awake, active and re- active to the examination, without equivalent seizure at the time, photoreactiveand isochoricpupils, reducing of the movements in the lower limbs. Conclusion: After mass excision in column, the patient was admitted to the pediatric ICU bed - HUMI on 06/02/2015, being treated with cefazolin, morphine 0.1 mg/kg/day and dexamethasone 0.6mg/kg/day. A priori, the motion picture of the lower limbs of the patient did not get better with surgery, your disability occurred, pro- bably due to the compression of the spinal cord at lumbosacral level, also featuring priapism, in good general condition, accepting food, feverless, active and reactive to examination and eupneic. 68 Progressive Tetraparesis by Arteriovenous Malformation with Cervical Fistula in Patient in São Luís University Hospital Leonardo Silva de Melo; Thalisson Paulo Sousa Madeira; Talyta Garcia da Silva; Héron Máximo da Cunha Gonçalves; Tárcia Heliny Nojoza Mendonça; Maria de Jesus Torres Pache- CO Introduction: Vascular anomalous development of the fetal circu- lation with persistent of primitive arteries and lack of capillaries may cause arteriovenous malformations, and symptoms usually in adulthood, through fistulas. The mortality rate is 10% to 29% after the bleeding. The Case: Female patient, 51, residing in São Luis - MA, admitted in 08/04/2015, reporting loss of muscle strength at first on 07/25/2015, with clinical picture of tetraparesis, tactile sensitivity changed in LLLL/UULL and could not walk. Normal skull tomography on 07/24/2015; Normal Computed Tomography of the Cervical Spine on 07/25/2015 and normal Magnetic Resonance Imaging of Dorsal Column on 07/27/2015; Cerebral angiography, on 08/04/2015, showed the presence of cervical spinal cord arteriovenous malformation with fistulous pattern irrigated preferably by cervical branch arising from the right vertebral artery with a lesser grade participation of thyrocervical trunk. It was noted the presence of small aneurysm in arterial component of AVM possibly from anterior medullar artery. After hospitalization, presented sepsis in urinary focus, urine cultu- re on 08/04/2015 showed Escherichia coli sensible to ciprofloxacin, starting using of cepefepime on 08/07 and subsequent modification to ciprofloxacin on 08/12. On 08/12/2015, patient evaluated alert on the bed, normal colored, hydrated, cardiovascular auscultation in regular pace in two clicks, normophonetic sounds, frequency of 76 heartbeats per minute, large and symmetric peripheral pulses. Res- piratory auscultation with vesicular murmurs without adventitious noises, eupneic. Soft abdomen, painless with presence of hydro-ae- real noises. At neurological examination, photoreactives and isocho- ric pupils, with tetraparesis. Patient featured feverless, diuresis by catheter. It was being awaited treatment of infection and laboratory reassessment to schedule surgery. Conclusion: The progressive tetra- paresis ran from the dilation of the anterior medullar artery, resulting from AVM, compressing the cord at the cervical level causing the clinical picture of progressive tetraparesis. 69 Analysis of characteristics of incidence of hospitalization for injuries due to external causes in the city of Pinheiro-MA, in the period of 2010-2014 Larissa Chaves De Carvalho; Bárbara De Miranda Domingues Tranm; Antonio Joatan De Barros Filho; Mariana Castro Ba- rros; Lorena Natali Cardoso Fernandes Introduction: Among the injuries from external causes (IEC), are: accidents (unintentional) and violence (intentional). As accidental causes, has health problems due to work, to falls, transit, poiso- ning, drowning, among others. Among the violent are aggression and self-harm. These diseases are considered a public health problem because it affects the individual and collective health and requi- res the development of specific policies in order to achieve their prevention and treatment. Since 1998, these diseases are among the largest cause of mortality in the SUS. In Brazil, predominated the mortality rate for unintentional injuries (homicides), followed by transportation accidents. To minimize this problem was created in Brazil in 2001, the National Politic for Reduction of Morbidity and Mortality from Accidents and Violence which brings in your guideli- nes the consolidation and expansion of pre-hospital care, and care aimed at recovery and rehabilitation, and support development of studies and research. Objectives: To analyze the characteristics of the incidence of hospitalizations for injuries from external causes in Pinheiro-MA, in the period of 2010-2014. Methods: Cross-sectional study, with secondary data for the years 2010-2014, from the NHS Information System, DATASUS on the city of Pinheiro-MA. The data was statistically analyzed through the ANOVA and Friedman tests, to analyze the variables. Results: There is a high incidence of hospitali- zations for IEC, the incidence was increasing until 2013 and showed a slight decline in 2014, the age group with the highest incidence of hospitalizations was 20-29 years, the most affected sex was male, with statistical significance p <0.01. The race with the highest in- cidence was mestizo, with strong correlation to injuries, p <0.001. There were also statistical significance between hospitalization rate and mortality rate; between automobile and motorcycle accidents as well as accidents occurring during the provision of surgical services in relation to the total and the sequelae in relation to the total, all with p <0.05. Conclusion: The findings suggest high incidence of hos- pitalizations for ACE, with high rates of traffic accidents and high rate of sequels and accidents resulting from surgical procedures. Thus it is necessary to invest in the prevention of accidents and improving the medical and surgical care of the municipality. 70 Care of injuries from external causes in an emergency de- partment of a large public hospital in São Luis-MA: Experien- ce Report Larissa Chaves De Carvalho; Bárbara De Miranda Domingues Tranm; Vandilson Pinheiro Rodrigues; Maria Aparecida Costa; Judith Rafaelle Oliveira Pinheiro; Consuelo Penha Castro Mar- ques Introduction: Currently, external causes (injuries, falls, agression) are considered a public health problem, and are responsible for the second largest SUS mortality rate in Brazil. To the World Health Orga- nization (WHO) is fundamental as much as possible knowledge and data collection in order to determine its magnitude, consequences and characteristics. However, data from external causes at emergen- cy services are still poorly studied worldwide, and often the emer- gency services are sought for other reasons, not the actual need for emergency care, leading to overcrowding of services. This experien- ce report, search, then bring more information regarding service by external causes injuries in the emergency room of a large public hospital in São Luis-MA. The Experience: In June and July 2015, we held medical care accompaniments in a setor of minor surgery, in a referral hospital in the city of São Luis MA. Most of the patients treated were victims of TBI (traumatic brain injury) low intensity without alarm signs: vomiting, unconsciousness or epistaxis. On exa- mination: air way unobstructed, eupneic, normal skin color, glasgow 15, motor skills, reactive pupils and excoriation. They had the most common causes a fall from height for children and the elderly, and car accidents for adults. As conduct were prescribed suture and an antiseptic dressing, and asked diagnostic test in most cases. We also saw great demand due to foreign body in the oropharynx (as fish bone and chicken bone), skin lesions with knives, diabetic foot and biting dogs. When needed additional tests such as computed tomo- graphy (CT), we observe that in the exam application forms, were fi- lled only the spaces about the name, medical record and exam type, not being specified indications and other patient data. Conclusion: Lack of correct completion of the medical records makes it difficult to chart future research. Many cases could be treated at basic health units and do not require emergency care. Many patients are released early due to overcrowding. The correct sorting of emergency could improve the overcrowding. 71 Stress Management and Social Skills in Health Professionals: an Experience Report about the Work with the Psychiatric Patients Bruno Luiz Avelino Cardoso Introduction: Service for psychiatric patients demand specific social skills for their management. The mental health professional deals directly with different contingencies in the workplace, which requires a keen sense of touch to the nuances and behaviors that are expres- sed by patients and other professionals in the healthy institution. It is known that, according to the new guidelines for the treatment of mental health, the care for psychiatric patients spread to family members and are not restricted to health units. However, the hos- pital-centered model is still connected to sociocultural incentive for its maintenance. Labor issues (work environment, salary, workload) are important factors for the onset of occupational stress and social skills can be an aid factor for the professional in your setting work, because they are the basis for generating positive social interactions. The Experience: It is a retrospective observation process carried out during research on mental health, on the management together with psychiatric patients. The psychiatric environment (institutionalizing) differs notably from non-clinical social context. Although the challen- ges of the psychiatric reform are being implemented, there is still asylums clinical models. It is clear that there have been changes in the process, however there are still objectives to be achieved in relation to the target advocated by Law 10,216. Thus, there is the weekly working hours that can bind to considerable levels of occu- pational stress result of overload. The Social Skills Training (SST) as set strategies in interpersonal relationships can help considerably in the workplace, promoting better interaction professionals performed and healthy organizational climate and behavioral models suitable to psychiatric patients on site. Conclusion: According to authors in SST theme, when professionals have a socially skilled behavior patterns, can contribute on a large scale both for the advancement of organi- zational climate and quality of interpersonal relationships within the company, as to the general public. In this regard, we emphasize the importance of SST for healthcare professionals in order to a satisfac- tory and fruitful work with the institution and users of the services. 72 The Importance of Interdisciplinary Team in Hospital Care to the Mother-And-Child Health: Experience Report at VER-SUS Maranhão Vanessa Samer Siqueira Silva; Tatiane Lopes Ericeira; Brunna Aline Muniz Silva; Jaiza Sousa Penha; Bruno Luiz Avelino Cardoso Introduction: It is understood that the mother-and-child Health, the World Health Organization (WHO), requires all professionals, qua- lification and competence to perform basic care for women and newborns. Therefore, it is essential to search for the quality of the team and the perception of the complementarity of the various work processes, thus overcoming the biomedical rationality. Due to the multiple dimensions that the health needs expressed, including the cultural, social, psychological and biological, this report presents the importance of the interdisciplinary team in assistance to maternal and child health, and aims to discuss teamwork as a strategy coping with the complexity and health needs. The Experience: The experien- ce was obtained during the VER-SUS in one of St. Louis Maternity Hospitals that perform care for pregnant women with normal risk, which is linked to the Unified Health System (SUS, in Portuguese). The home motherhood has a multidisciplinary team committed to interdisciplinary dialogue and the institution's care model is based on the universality and comprehensiveness of the actions, however, there are difficulties regarding the professional staff, as the team is still insufficient when compared to demand. Thus, in order to understand how the humanized care is, we seek to verify the con- ditions, work organization and aspects related to the characteristics of human resources. Including reports of activities, problems related to the physical site conditions, wages and employment contracts. Contrasting that, despite the problems encountered, the team per- formance is from the perspective of the biopsychosocial model in an attempt to fit the Stork Network, the Humanized Birth, and especia- lly in the dynamics of intergroup strategies. Conclusion: This report sought to identify perceptions about the practices of the multidisci- plinary team, as well as the barriers creating a design that is com- mon to the team within the SUS principles, as it is important unders- tand the role of workers as managers of their processes of work. The importance of the experience of academics with SUS reality shows up, a construction tool of a science aimed at humanizing health care team as well as the quality of care, which looks to interdisciplinary response to the health needs in the comprehensive care. 73 Pharmacotherapy Follow-Up on Systemic Arterial Hyperten- sion and Diabetes Mellitus Pacients: Case report Larissa Chaves De Carvalho; Bárbara De Miranda Domingues Tranm; Antonio Joatan De Barros Filho; Mariana Castro Ba- rros; Lorena Natali Cardoso Fernandes Introduction: Polypharmacy is required, and in many cases requires monitoring because of the risks of drug interactions and adverse outcomes associated with medication. For best results with pharma- cotherapy, it has proposed the realization of the following pharma- cotherapeutic pharmaceutically simultaneously medical monitoring. Objectives: Carry out Pharmacotherapeutic Follow-up with a chosen patient to know their health concerns and keep track of your me- dical treatment and, if necessary, propose ways to improve their quality of life. Methods: It held the following pharmacotherapeutic using the procedure described in Dader methodology obeying the following steps: provision of the service; first interview; situational analysis; study phase; the evaluation phase; intervention phase and successive interviews. Results: Male patient, 82 years, the following chart disease: hypertension, type 2 diabetes and glaucoma. It is lactose intolerant and corporal mass index of 26.74, framing in the pre-obese category according to Brazilian Guidelines on Obesity. Du- ring interviews, the patient presented the following average blood pressures: 130/90 mmHg and 130 / 75mmHg. Drug therapy of the INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS II COIMAMA S35#19IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS II COIMAMA S36 Abstracts Abstracts patient is comprised of four drugs: losartan potassium 50 mg, met- formin hydrochloride 850 mg, gliclazide 30mg and timolol maleate 0.5%. Did not match any drug interactions of clinical significance. As for laboratory tests, LDH rate appeared low. To improve it and improve some bad eating habits, a balanced diet was formulated. The glycated hemoglobin showed up very high (10.50%). According to Brazilian Society of Diabetes levels greater than 7% characterize poorly controlled diabetes with high risk of chronic complications. Due to reporting episodes of problems regarding the use of drugs, occurring exchanges between them, we prepared a medication or- ganizer as intervention. Conclusion: The studied patient showed a clinical status stabilized with a few altered levels. He accepted all the pharmacist interventions that have been proposed to improve their quality of life. 74 Voluntary Participation in Blood Donation: The Role of Educa- tion In Health Laís dos Santos Pimentel; Manuela dos Santos Pereira; Leonardo Silva de Melo Aretuza Andrade Ferrante; Claudia Regina de Andrade Arrais Rosa; Antonia Iracilda e Silva Viana Introduction: Encouraged in Brazil since 1940, voluntary blood do- nation is spontaneous when motivated to keep the blood supply without regard to the receiver, and of replacement when it arises to answer the need of a patient, replenishing the inventory. However, the difficulty of blood banks to maintain the blood supply to meet the needs still exists, since there is no substitute for whole blood tissue. This includes to extricate itself from old molds, in which the donor is invited to donate only when a family member need transfu- sion. Objectives: To discuss the role of education in health to sensi- tize volunteering; To analyze the amount of replacement and spon- taneous donations in the 2013-2014 period. Methods: This study has used as methodology the documentary research, which was held in the Hemonucleo of Imperatriz-MA, and was based on the database for donors of 2013 and 2014 years. The collected information refers to the types of donors found: spontaneous (first time and sporadic) and replacement. Later, the data were tabulated and analyzed to enable a comparison between donors' types as well as the relation- ship with the national average and to the literature, linking the need to encourage donations. Results: In 2014, the Brazilian population of donors was 1.8%, whereas there commended by the World Health Organization would be 3% to 5% in order to maintain regular stocks. In 2013, the total of donors among the citizens of Imperatriz was 13303, and in 2014 it was 13510; an unimportant increase of 1,5%. From this sum, 48% are replacement donors in 2013 and 45% in 2014, and in Brazil, in 2012, it was 35,5%. In addition to the importance of increasing the number of spontaneous donors, the data point to the need to sensitize the replacement donor to become a sponta- neous donor. Education in health is essential to attract volunteering, especially with programs that aim to warn about the importance of voluntary donation, ensuring the rise of quality stand, from the collection to the transfusion. Conclusion: It is fundamental the dedi- cation in breaking the difficulties for increasing volunteer in gable to solidify a job with greater excellence, exercising citizenship, gaining membership and loyalty of donors and promoting a link between donor and service. 75 Nutrition Management in Larynx Cancer: Case report Ingrid Roberta De Azevedo Carvalho; Elivânia De Jesus Sodré Rocha; Raidênia Barbosa De Oliveira; Valéria Bogéa Dutra; Marcos Roberto Campos De Macêdo; Alexsandro Ferreira Dos Santos Introduction: The larynx is an organ pyramid-shaped composed of cartilage, muscles and membranes. It is located in the throat area, between the trachea and the base of the tongue. Laryngeal cancer is a tissue neoformation are malignant laryngeal mucosa, which in- vades and destroys other tissues. One of the most frequent to reach the head and neck, accounting for about 25% of malignant tumors that affect this area. Approximately 2/3 of these tumors appear in the glottis and 1/3 involve the supraglottic larynx. The Case: JRM, 74, male, retired, was admitted with complaints of pain, diarrhea, difficulty in feeding and weight loss. He was diagnosed with laryn- geal cancer. The nutrition team reported power via oral rejected. The procedure was carried out for a tracheostomy was observed rejection of enteral nutrition with complaints of pain, discomfort, asthenia, weight loss, secretions, and edema. Result of Subjective Global Assessment: Severely malnourished (SGA C). Physical exami- nation: dehydrated and skin pallor, pale and smooth mucous consu- med muscle tissue (temples, clavicles, shoulder, scapula, quadriceps and gastrocnemius), this edema on the right and left ankle. The patient made use of drugs ranitidine, Plasil, Tramal, dipyrone and captopril. Nutritional diagnosis: moderate malnutrition with loss of fat and muscle, physical capacity and functional diminished. The clinical conditions had unfavorable representing nutritional risk, in- cluding weight loss, caloric intake or lower protein that 75% of the recommendations or moderate or severe malnutrition. Conclusion: The patient presented initially state of moderate malnutrition, wor- sening the overall picture because the patient refused to accept the diet complaining of pain and discomfort. Thus, with caloric intake not reached, attending to severe malnutrition. We noticed the need of a persistent nutritional counseling followed with Peptamen Prebio diet in order to prevent malnutrition, the loss of nitrogen and other nutrients. It can be through the use of a nasogastric tube or even parenteral nutrition since the patient refuses the first option. The patient was shaken, which could be a cause of food refusal VO and have influenced the patient's recovery. Anyway, with the worsening of the picture, his death occurred. 76 The importance of supporting to relatives in the cancer treatment process in a supportive home: an experience re- port from the VER-SUS experiences Raíssa da Silva Santos; Suzanne Marcelle Martins Soares; Mirza Ferreira Lima Barbosa; Brunna Aline Muniz; Lorena Natali Cardoso Fernandes Caldas; Consuelo Penha Castro Marques Introduction: The cancer is one of chronic-degenerative disease that generate more disorders to the sick person and his family. This is justified in important changes in the lifestyle of the patient and his family, since the physical realm to the emotional arising out of discomfort caused by the pain, defacement, dependence, and loss of self-esteem. In this process, the family is appointed as the main source of support and the binomio patient-caregiver is considered an attention unit, so that the cancer must be treated as problem and familiar issue. Considering the relatives's role in this moment, it is essential to provide social support to the binomio patient-caregiver in the intention of settling the difficulties that they are experiencing. The Experience: The Antonio Brunno Foundation - House to Support Cancer Patients it is a nongovernmental, nonprofit organization that welcomes people with cancer and caregivers residing in the country- side of Maranhão state and are undergoing treatment in the capital. The house provides accommodation, food and leisure to residents. Accompanying helps around the tasks of house. During the visit, we found the existence of a strong link between the residents. Adminis- trators have created the institution under the influence of his son Antonio Brunno, who died from cancer. It was found, in conversa- tion with the residents that stay at this home provides a sense of belonging, which helps to reduce the feeling of loss resulting from the disease condition. Leisure activities, group chats and religious practices are, according to residents, important coping resources. Conclusion: The experiences in the house promote the construction of ties after the loss of social references arising from the geographic changes. The sharing of similar experiences approximates people with different life stories and fulfills the supporting function. Thus, helps the relatives to ease the distance of loved ones and the se- paration of the routine activities. In the case of caregiver, the warm welcome and conviviality reduces the feeling of strangeness and increases the feeling of belonging. It appeared from that the foun- dation offers to the residents much more than food and shelter. The foundation constitutes a new family, where affective bonds become motivators in the search of the cure. 77 Teaching of Social Skills in Medicine Course: Contributions to the Doctor-Patient Relationship Bruno Luiz Avelino Cardoso; Duane Henrique Oliveira Alves; Guilherme Cunha Dos Santos Teles; Isac César Roldão Leite; Janaina Bianca Barletta Introduction: The medical care is related to a series of challenging contingencies, among them stand out stress experiences, vulnerabi- lity, grief and loss, in addition to technical and therapeutic manage- ment. The formation of a competent professional should be based on knowledge and clinical reasoning, on practical skill and on doctor- patient relationship. This is directly linked to social skills (SK) that include behavioral components, whether verbal of content, verbal of form (or paralinguistic like verbal fluency) and non-verbal (such as eye contact and gestures), the cognitive-affective components (such as emotions, beliefs and expectations) and physiological. The Experience: In order to improve medical care, FACIPLAC's- Gama / DF medical students, from the third period, participate in a course unit entitled 'Professional Skills, Attitudes and Communication' (Se- miology), where are trained medical history, physical examination and specific SK by a group professors: doctors and psychologists. In the classroom are made reflective activities on interpersonal aspects in the context of health care, role playing of attendance situations in different contexts, film analysis and checklist development. In health scene, as a general hospital and activities with the commu- nity, students put into practice what has been accomplished in the classroom, which, in turn, fed back into the classroom activities, whereas experienced difficulties are discussed and dramatized with behavioral assays, in order to increase the cognitive-behavioral re- pertoire for coping with situations considered stressful. It can be said that a number of teaching strategies are used, such as: modeling in the real scenario, where students learn the behavioral variability according to the practical contingencies; modeling through activities of behavioral essays; modeling by vicarious observation, from movie scenes, classroom representations and conduct of teachers; learning by rules from the instructions received and reading. Conclusion: It is understood that this course provides a psychological and technical preparation for applying a good history guided by professionalism, respect and ethics. It is considered that the acquisition of a skilled social repertoire can encourage better social and professional ad- justment. 78 Medical Education: The importance of the interdisciplinarity in the medical curriculum to form a humanized professional Rebeca Marques Margoto; Ana Beatriz Neri; Tamirys Golenia Dos Passos; Erick Gustavo Da Silva Neres; Isac César Roldão Leite; Janaína Bianca Barletta Introduction: The medicine course has brought throughout the years a kind of education guided in biomedical models of learning and working. Because of this, and the fact that most teachers consist in medical professionals, the culture of communication between me- dicine and other areas of knowledge related to health has been lost over the years. The Experience: With the saturation of the labor mar- ket with dehumanized medical professionals, allied with the need for humanization in medical care, it became necessary to create subjects that brought the interdisciplinarity throughout the medical course, with the focus being in the acceptance and dialogue with other health areas. The interdisciplinarity is based on the premisse that the knowledge is not fragmented and has as its main objective the union of the knowledge obtained in other areas such as psycho- logy and nursing to be used and work together with future medical professionals. The proposal of interdisciplinarity is to provide com- plementarity, interconnections and convergence links and, beyond that, should contemplate learning strategies to enable the student for life in society, aiming the integration. With the globalization era, the teacher is no longer the only holder of the knowledge and a bigger and faster access to knowledge has been provided to the undergraduates. The interdisciplinarity proposes that teachers from other areas work together with the medical students their own spe- cialties, making classes more communicative and interactive, where the learning is done in the triad academic-teacher-academic. Conclu- sion: In this model, it is of vital importance that there is a deepening of the professional formation in order to create the possibility of team work, creating ways to integrate the health care with the users of the public health system (SUS) and the users of the private health system. By doing so, medical professionals combine the cognitive articulation, affection and culture with the patient, making the hand- ling of empathy and the understanding of the health-illness-patient process easier. 79 Postural assessment at primary schools of São Luís-MA Fernando César Vilhena Moreira Lima; Marcus Vinícius Viégas Lima; Hellyne Giselle Reis Madeira Introduction and Objectives: The purpose of this study was to eva- luate the position of students from public and private school system of São Luís-MA. Methods: They were randomly selected from 29 schools and 862 students with an average age of 13.2 years, height 154.90 cm. The photographic record was made at the rear and profile views. The images were digitized and quantified through ALCimagem version 2.1 Ⓡ software, applying the principles of computerized pho- togrammetry. The tabulation of the data and statistical analysis were performed using BioEstat 3.0 program. Results: There was an overall prevalence of 16.24% of the distributed postural changes as follows: 4.2% presented alteration of espondiléia line angle (ALE), 4.5% of the shoulder slope angle (ADO), 5, 1% of the kyphosis angle (ICA) and 4.2% of lordosis angle (ALO). Conclusion: Thus, it emphasizes the importance of regular postural assessments in schools, in order to prevent postural changes that may eventually compromise their quality of life. 80 Importance of Hospital Databases in Epidemiologic Screening of the number of Cancer cases Marcus Vinícius Viégas Lima; Fernando César Vilhena Morei- ra Lima; Jorge Ricardo Fernandes De Araújo; Jorge Ricardo Fernandes De Araújo; Hellyne Giselle Reis Madeira; Mônica Virginia Viégas Lima De Aragão Introduction: The cancer is a major public health problem causing large number of morbidity and mortality worldwide. The investment and the development of actions in improving cancer control through records and reliable data is essential to a proper outlet of manage- ment and care decision. Objectives: To present the epidemiology of cancer patients, belonging to the RHC database of a São Luís county Oncology Center - MA and report the importance of such a database for health care management in this type of center. Methods: Re- trospective study conducted a survey of 2,143 records, between the months of January to July 2015. The variables used in the study were age, gender, origin, staging of disease at diagnosis and treatment. To collect data, we used the SiSRHC software and the descriptive analy- sis, we used the Excel® software for the quantitative variables. For the safety and reliability of data, password access to files, weekly backups of spreadsheets were used in addition to the CPF patient in order to avoid duplication. Results: A total of 2,143 medical records analyzed, 50.3% were female, 55% were of mixed race, 92% were from the state of Maranhão, where 47% were from the capital, the most prevalent type of cancer in sex It is the female breast (25.83%), while the more prevalent in males was the prostate (39.22%). The stage IV was prevalent, accounting for 11% of the sample under the age of 19 years and 21% of the sample aged over 19 years. The most widely used treatment was chemotherapy (22.8% of cases). Conclusion: This study suggested that the Hospital Cancer Registry database plays an important role by being able to generate a set of important information related to cancer and that through this infor- mation, you can perform epidemiological studies to generate actions improved management and care to this population.. 81 Performance of medical students during Blue November in Pinheiro MA: an experience report Thamyres Ferreira Carmo Da Silva; Ana Beatriz Barbosa Lima; Andréia Aline Santana Guida; Michelline Joana Tenorio Al- buquerque Madruga Mesquita; Andréa Suzana Vieira Costa; Livia Mariane Castelo Branco Reis INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS II COIMAMA S37#20IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS II COIMAMA $38 Abstracts Abstracts Introduction: The movement "Blue November" was created in 2012 by the Institute Side by Side for Life, one of the goals of this campaign is to change the paradigms and prejudices regarding the return of man to the doctor and getting screened. The focus of the campaign is the fight against prostate cancer, a pathology that affects much of the male population and is the sixth most common type of cancer in Brazil and the second most common cancer in men after skin tumors. The Experience: The present work it is descriptive study type experience report, carried out during the theoretical and practical teaching of the discipline Fundamentals of Medical Practice of the medical school of the Federal University of Maranhão, Campus Pin- heiro, in the Outpatient Center Pinheiro (CAP) during the campaign November. Assisted clients in this hospital includes users of the Uni- fied Health System, with public ranging from men, women, elderly and children. The developed theoretical and practical activities oc- curred in the morning, and the students were divided into groups, each being responsible for a major issue when it comes to the care and promotion of men's health. Topics covered included prevention of prostate cancer, sexually transmitted diseases, Healthy Eating and toiletries. Each team set up decorated booths, made distribution of personal hygiene kits, condoms and made practical demonstrations on hygiene and about the diseases addressed. In addition to the expository speeches were musical performances, snack and folders distribution. The activities were supervised by the teachers respon- sible for the module and for the outpatient center staff. Conclusion: The realization of the project 'Blue November' by students of the UFMA medicine and faculty of Module I of the Medical Practice Fun- damentals, showed ignorance of the population about human health and disease prevention, in addition to the fear of the population to seek help and information due to the 'taboo', as related to the examination of touch. Thus, there was a positive outcome of the event that had other issues such as sexually transmitted diseases, healthy eating and personal care, with the participation of the entire population, making the exchange between the university and the community, promoting health education and disease prevention. 82 Profile of Prescribed Medications used in a Psychosocial Care Center (CAPS) Mirlley Cristina Ferreira Borges; Suanne Ferreira Marinho; Sally Cristina Moutinho Monteiro; Ilka Kassandra Pereira Belfort; Marcia de Souza Rodrigues Introduction: Currently million people worldwide suffer from social problems related to drug abuse or alcohol and the care of these people is carried out by the Unified Health System (SUS) in Psicos- social- Attention Alcohol and Drug Centers (CAPS-AD) which provide treatment to the abuse and dependence of psychoactive substances. The therapeutic projects vary according to the clinical evaluation of the patient, but mostly psychotropic medications are used. In Brazil, psychotropic medications are frequent causes of drug intoxication, including benzodiazepines, barbiturates, antidepressants and anti- convulsants. Objectives: This way, this study aims to understand the profile of use of prescribed psychiatric drugs and their associations in a CAPS-AD. Methods: The survey was conducted by evaluating the medical records of users in treatment in CAPS-AD in São Luís, State of Maranhão. Data collection was conducted from April to July 2015. The parameters measured were: sex, age, diagnostic impression, an- tidepressants and prescription antipsychotic drug agents and their associations. Results: A total of 110 medical records of users who re- gularly attend the CAPS-AD, and 16% were female and 84% male. The most prevalent age group was between 40-49 years (36%). Among the main diagnostic impressions are the pictures of mental and be- havioral disorders due to use of alcohol (F10), and mental and beha- vioral disorders due to multiple drug use and use of other psychoac- tive substances dependence syndrome (F19.2) the most prevalent (23%). The therapeutic class of drugs most commonly used are anxiolytics anticonvulsant (41%), antidepressants (16%) and anti- psychotics (15%). The most frequently prescribed antidepressant is amitriptyline (29%) and as antipsychotic is risperidone (35%), while the most frequent combination with antidepressant is amitriptyline clonazepam and for the antipsychotic the most frequent association was observed risperidone with diazepam. Conclusion: It was found that the CAPS-AD service acts to seek the articulation of therapeutic projects and the use of psychotropic medications occurs in the vast majority of users of the service. It is necessary, however, to carry out actions to promote the rational use of these drugs, targeting the safety and therapeutic efficacy. 83 Entero Vesical Fistule: Case report Tâmara Aroucha Matos; Sílvio José Moreira Lima; Roseliny de Morais Martins Batista; Tarcísia Bezerra de Alencar; Viviane Oliveira Arruda Carneiro; Vitor Augusto Ribeiro Oliviera Introduction: Entero vesical Fistule, (FEB), also known as vesico- enteric or vesico- colonica are uncommon pathologies resulting from communication between the urinary bladder and intestine, resulting from Diverticulitis (DVC) in 65% of cases when a phlegmon or abs- cess extends or breaks in the bladder wall adjacent causing symp- toms characteristic of pneumature and fecalure considered pathog- nomonic of the disorder. Crohn's disease ranks second causes, followed by inflammatory diseases of the pelvis, colorectal cancer, urinary bladder, uterus, prostate, trauma, radiation, and iatrogenic procedures at the time of reversal of Hartmann. Medical treatment with antibiotics associations, total parenteral nutrition and immuno- modulatory agents have little effect and may have adverse effects such as pancreatitis, hepatitis and nephritis. Currently, the most wi- dely used choice of procedure is a bowel resection of the affected portion and primary anastomosis urinary bladder. The Case: VMP, 61, male, white, married, born in the municipality of Viana -Maranhão searched urologic care with dysuria complaint intense and persistent associated with fecalure and pneumature that began in December 2014. It was held urinary videoendoscopy which showed redness in the internal area of the left side wall and the presence of feces in bladder light. Was carried out is also a Urotomografia who confirmed diagnosis of colic fistula Vésico-, and the patient underwent surgery in January 2015, with dissection and primary suture of the fistu- la with an increase in postoperative complications without getting discharged on the fifth day postoperatively. Conclusion: Although FEV is infrequent and difficult to diagnose the occurrence of pos- sibilities should always be assessed in the case of CVD and other associations so that we can reach an effective and fast treatment, and discard associations with urinary tract infections, which It occurs very frequently. Studies have shown the possibility of a conserva- tive treatment without surgery, only being conducted drug control procedures and radiographic examinations monitoring. Other studies have postulated the use of Octreotide in the treatment of rectal can- cer, getting the disappearance of secondary fistulas probably due to splenic vasoconstriction and reduction of secretions of the gastroin- testinal tract to the bladder caused by the drug. Radiographs and CT scan, barium enema barium and cystoscopy are of great importance for an accurate and safe diagnosis, as well as control assessments. Therefore, a careful medical history and a detailed physical exami- nation are entitled to the importance of early diagnosis of FEV, so preventing further complications since it has a high mortality. 84 Prevalence of Microbiological Agents in Cytological Examina- tion Performed in Basic and Applied Immunology Nucleum Andrey Salgado Moraes Filho; Marcos Antonio Custódio Neto da Silva; Rebeca Costa Castelo Branco; Geusa Felipa de Ba- rros Bezerra; Maria do Desterro Soares Brandão Nascimento Introduction: The normal vaginal flora is composed of a large variety of microorganisms that are modified during normal physiological pro- cess of maturation of the woman. The occurrence of inflammations and/or vaginal infections are a major cause of complaints in women seeking gynecological clinic, and bacterial vaginosis, candidiasis and trichomoniasis represent about 90% of infectious disorders of the female genital tract. The use of cervical-vaginal smear stained by the Papanicolaou method, is a resource used by its practicality, low cost and reap routine ita and is used mainly for cervical cancer research or precursor lesions of cervical cancer, in addition to screening STD agents and observation of bacterial vaginosis or IPV. Objectives: This study aimed to analyze the prevalence of microorganisms related to genital infections in cervical smears collected from January 2009 to December 2012 in Basic and Applied Immunology Nucleum (NIBA) of the Federal University of Maranhão. Methods: We analyzed 845 cytopathology of women attended in Basic and Applied Immunology Nucleum (NIBA) of the Federal University of Maranhão from January 2009 to December 2012. The tests were performed at NIBA by cyto- logic analysis and data obtained from the medical records of chips . Statistical analysis was performed with BioEstat 5.0. This project was approved by the Ethics Committee of University Hospital of the Presidente Dutra in the opinion 001673/201140. Results: Between January 2009 and December 2012 were performed 845 cytological examinations of the cervix. The overall prevalence of microbiological agents was 38.3% (324/845). The prevalence of Gardnerella vaginalis infections, HPV, Trichomonas vaginalis and Candida species were 23% (195/845) 10% (85/845), 3.67% (31/845) and 0.47% (4/845) respec- tively. Conclusion: The prevalence of microbiological agents in this population is significant. The cytological examination is an important diagnostic tool. mothers interviewed, 58 had between 20 and 29 years. About the educational level 50% of respondents have completed high school. About marital status, 38 have stable union. As for household income 47 received a minimum wage. About the number of children 54 of the interviewees had two to three children. As regards the defini- tion of the term childcare 94 unaware of the same; 84 mothers say they have taken their children to childcare consultation, the majority done by the doctor and 55 reported not having knowledge about the actions that are performed on a routine visit. Conclusion: In pri- mary care, child care emerges as a the comprehensive monitoring of child growth and development, turning to aspects of prevention, pro- tection and health promotion, so that the child reaches adulthood without brought unfavorable influences from childhood. Knowing that the majority of respondents are unaware of the importance of child care consultation, it is necessary to implement measures to disseminate and encourage such consultations on UBS. 87 85 Signs and Symptoms of Periodontitis in Pregnant Women Assisted in a Health Basic Unit of São Luis-MA Francisca Laura Ferreira De Sousa; Flávia Fernanda Macêdo Santiago Soares; Laise Neves Carvalho Introduction: Due to physiological changes resulting from pregnancy, such as nutritional deficiencies, high levels of estrogen and pro- gesterone, is very common during this period, gingivitis and tooth mobility. Studies have shown possible risks between oral diseases, especially periodontal disease and pregnancy complications such as premature birth, newborns with low weight and preeclampsia. Expla- nations for these suppositions are based on the fact that periodontal disease is an infectious. Objectives: The aim of this study was to des- cribe the signs and symptoms of periodontitis in pregnant women interviewed by PET- Saúde from CEUMA University. Methods: This is a quantitative, descriptive, observational cross-sectional with 48 preg- nant women, four health units in the city of São Luís, in the period from September 2013 to March 2014. To collect data was used a ques- tionnaire with questions related to socio-demographic and health conditions formulated by the preceptors of Pet- Saúde Redes of Uni- versidade CEUMA. The data collection was conducted by program students, who were previously trained. This study was approved by the Ethics Committee of UNICEUMA search with the notion number 743 094. Results: Among the study participants, 35.4% (17) reported spontaneous gingival bleeding, 30% (15) had bleeding after flossing and 25% (12) reported tooth mobility. Conclusion: It is concluded that periodontal disease also had a high prevalence among pregnant women studied, increasing the importance of health maintenance. 86 Child Health: Perception of Mother for Child Care Consulta- tion Mirla Kalina Silva Dos Santos; Elaine Pereira De Andrade; Nayanna Láyza Oliveira De Sousa; Thais Costa Alves; Sandra Komarsson Carvalho E Cordeiro; Laise Neves Carvalho Introduction: Child care is the medical science that deals with the study of the care of the human being in development, more spe- cifically to the monitoring of child development. According to the Ministério da Saúde, monitoring the growth and development is part of the comprehensive assessment of child health, being a consti- tuent of child care, which involves evaluating the weight, stature, psychomotor development, immunization and complications, nutri- tional status, as well guidelines as the mother/family/caregivers on caring for the child. The childcare can be called nowadays as preventive pediatrics, which analyzes the services provided prenatal consultations, extending through childhood, until the end of adoles- cence, in other words assistance for healthy child able to prevent diseases and allow early intervention to correct deviations of growth and development. Objectives: To describe the perception of mothers on childcare consultation. Methods: A descriptive, observational, cross held at Centro de Saúde Amar in the period from February to July 2015. The study population consisted of 100 mothers of chil- dren attending the Health Basic Unit. For data collection was used questionnaire formulated by the researchers. Results: Among the 100 Tips Nursing Nipple Use of Breastfeeding in Children Assisted in a Health Basic Unit of São Luís Suellen Guimaraes Melo Silva; Manuel Alves De Moura Sobrinho; Laise Neves Carvalho; Tassia Lorena Barros Silva Figueiredo; Francisca Laura Ferreira De Sousa Introduction: The nursing nipples are widely used in many coun- tries and an important cultural habit in our midst. With this, the stimulation of the milk suction can be reduced, leading to lower production of milk with consequent early weanin. Objectives: This study aims to describe the frequency of the use of nursing nipples during breastfeeding in children receiving care at a basic health unit in São Luís MA. Methods: A descriptive, observational, cross-sec- tional, with 50 children aged up to two years, assisted in the Basic Health Unit Djalma Marques, in the period from May to July 2015. For data collection was used a questionnaire formulated by the resear- chers, with identification data and use of artificial suction. The data forms collected by the students of health to work for the education program (PETSAUDE) Universidade CEUMA networks, who were pre- viously trained. Results: Concerning the duration of breastfeeding, all children were breastfed, 24% only up to 3 months, 26% between 4 and 6 months and half of the children, 50% for more than 6 months. About the concomitant use of nursing nipples during the breastfe- eding, of 50 children surveyed, 36% of them made continuous and daily use of that. About the baby bottle feeding associated with breastfeeding, 52% of children used bottles during the same period who were breastfed and 48% of them had never used a bottle until the time of the survey. Conclusion: Knowing the deleterious effects of these habits during the breastfeeding period, become necessary educational measures for mothers and the general public as well as health professionals. INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info • 2015 Vol 3 Suppl 1 II COIMAMA INTERNATIONAL JOURNAL of MEDICAL STUDENTS $39#21IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS XXI COMAPI S40 Abstracts Abstracts Abstracts of Academic Medical Congress of Piaui (COMAPI) 01 A Case Report - Adult-Onset Still's Disease Vanessa Gonçalves Costa; Talita Maria Leal Barros; Haline Meneses Parente; Felipe Soares Oliveira Portela; Ana Luiza De Rezende Almeida; Gabriela Lustosa Said. Introduction: Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disease which occurs in young adults. The etiology of AOSD is still unknown. It is characterized by fever, arthralgia, arthritis initially in large joints, odynophagia, hepatosplenomegaly, skin rash, anemia and lymphadenopathy.The disease is considered a diagnosis of exclusion and the tests are unspecified. Nonsteroidal anti-inflam- matory drugs are usually used first but in some cases glucocorticoids and other drugs are needed. Case presentation: A 25-year-old Brazi- lian man, who presented with arthralgia in his left knee and foot, in October 2012. He was started on anti-inflammatories and analgesics without any improvement. November 2013, He was admitted to a very good hospital in the area with arthralgia in large joints, morning stiffness after periods of prolonged rest, fever, dry cough, odynopha- gia, hoarseness, pyrose, adynamia and weight loss. Laboratory tests revealed Hemoglobin 9,7g/dL, Hematocrit : 31.8 %, leukocytes: 13000 batons 2%, platelets: 449000; 2.5% reticulocytes; negative direct coombs ; normal hemoglobin electrophoresis ; C-reactive pro- tein 384; Ferritin > 2000ng/ml; Iron 12 ng/ml; transferrin 113mg dl hepatitis B and C, HIV and VDRL nonreactive; FAN reagent ; Rheumatoid factor, anti ENA antibodies PANEL, native anti-DNA anti-La, anti-Ro and anti-Sm, anti -RNP nonreactive; negative blood culture and urine culture. Biopsy of the right axillary inguinal lym- ph node revealed non-specific chronic reactive lymphadenitis with no malignancy. Moreover, Echo revealed moderate pulmonary hy- pertension, pericardial effusion and mild tricuspid regurgitation and ejection fraction = 67 % ;Chest CT scan showed signs of pericardial effusion of small volume. Abdominal CT scan showed moderate and homogeneous hepatosplenomegaly. Lung X-ray was normal. It was also performed direct laryngoscopy and there were no abnormalities. After the exclusion of other diseases, the patient was diagnosed with AOSD and he was treated with 40mg prednisone a day, 400mg hydroxychloroquine a day. After three months of treatment, there was improvement in his clinical picture and laboratory findings. Con- clusions: AOSD is a rare entity that requires a great clinical suspicion and it should be considered in patients after excluding a large list of most frequent pathologies. Response to the treatment is satisfactory, with good prognosis. 02 , An Evaluation Of Camellia Sinensis Effects On Antiulcerogenic Activity In Wistar Rats Nunes, A.F.; Júnior, J.R.S.; Silva, A.E.D.; Rodrigues, R.M.M.; Cardoso, A.W.C.; Nunes, P.H.M. Introduction: Ethnobotanical studies prove the existence of a large collection of medical plants whose therapeutic properties are already popularly known. Bioactive compounds such as polyphenols found in Camellia sinensis infusions ("green tea") play an important role in certain pathologies such as: diabetes mellitus, cardiopathies, vi- ral infections, inflammation and degenerative diseases like cancer. Objectives: This study evaluated the antiulcerogenic activity of green tea against acute gastric ulcers induced by ethanol, since this herb is popularly known due to its likely gastroprotective effect. Methods: Twenty one adult specimens of the Rattus norvegicus, Wistar strain, were used. The rats were randomly divided into three groups: 1) Rats treated with distilled water (5mL/kg, control group); 2) Rats treated with green tea (5mL/kg); 3) Rats treated with carbenoxolone (200mg/ Kg, Standard). After 60 minutes of treatment, gastric ulcers were induced by oral administration of 99.5% ethanol (5mL/kg). Thirty minutes later, the rats were euthanized by overdose of Sodium Thio- pental (100 mg/Kg). Then, their stomachs were removed and opened through the lesser curvature to determine the Ulcerative Lesion Area (ULA). In order to express the ULA as a percentage of stomach body area, the Image software was used. The data collected was analyzed by ANOVA, followed by a Tukey Test. The significance level was set at p<0.05. Results: There was no statistically difference in the ALU Mean ± Standard error of the green tea group (27.2 ± 1.93) compared to the control group (22.9 ± 0.98). The ALU's were significantly smaller (p<0.01) between the group treated with carbenoxolone (1.4 ± 0.32) and the control group. Conclusion: Substances found on C. sinesis infusion, popularly known as green tea, such as catechins and fla- vonoids, did not show a protective effect associated with the gastric mucosa of rats exposed to acute ulceration induced by ethanol. 03 Arrhythmogenic Right Ventricular Dysplasia: A Case Report Carlos Eduardo De Carvalho Sousa; Daniel Moura Nunes; Lucas Soares Madeira; Julio Cesar Aires Ferreira Filho. Introduction: Among the diseases with highest risk trigger potentia- lly fatal ventricular arrhythmias is arrhythmogenic right ventricular dysplasia (ARVD), which is a cardiac disorder group of cardiomyo- pathies. The disease is characterized by necrosis of the myocytes with fibrofatty and subsequent replacement by connective tissue. Mainly affects the myocardium of the right ventricle (RV) and more rarely, the left ventricle may also be affected, an additional risk fator. ARVD is a progressive disease and uncertain evolution often respon- sible for sudden cardiac death in young athletes and adults. Case report: The patient is a 39 year old female, married, born and raised in Grand Island-PI survivor rising death on two occasions. Presents medical evidence that relates ventricular tachycardia (VT) at admis- sion, ECG showed sinus rhythm with the presence of Epsilon, negati- ve T wave in V1-V6, QT prolonged, ECHO showed an ejection fraction of 37%, AE and AD with increased dimensions a marked degree, with RV dimensions increased to a marked degree with moderate systolic dysfunction and left ventricular dimensions preserved in ad- missions. Currently makes use of Caverdilol and Amiodarone. In later tests, magnetic resonance of the heart performed with the patient showed significant dilation of the right chambers and aneurysms of the RV free wall, moderate RV systolic dysfunction, myocardial fibrosis of the RV free and compatible signs with arrhythmogenic right ventricular dysplasia. Furthermore, the patient had another major criterion and one minor criterion, respectively, ECG presence of "epsilon waves or QRS duration increased> 100 ms in the right precordial leads (V1- V2)" and presence of "tachycardia sustained ventricular or not, with LBBB pattern". Final thoughts: ARVD is the prevalence and incidence inaccurate due to difficulties and errors in diagnosis. Thus, prospective studies are needed in order to identify their natural history, assess the effectiveness of diagnostic methods and the results of the treatments currently used (antirrítmicas drugs, ablative methods, implantable defibrillator). 04 Artery Stenosis Subclavian Left As A Cause Of Myocardial Ischemia In Patients Of Heart Disease: Case Report Tacianny Eva Araújo Passos; Diana Monte De Carvalho; Lana Mayara Meneses Lustosa Vargas; Thenyson Pereira Leitão; Ana Luiza Silva Ferreira; José Itamar Abreu Costa. Introduction: Heart diseases are a major cause of morbidity and mor- tality in the adult population. Atherosclerosis, heart disease where there is accumulation of lipids and inflammatory cells in artery walls form fatty plaques that clog vessels and create stenoses. The main targets are the aorta and the coronary and cerebral arteries, the main consequences acute myocardial infarction, cerebral ischemia, and aortic aneurysm. This paper aims to present the case of steno- sis of the left subclavian artery as a cause of myocardial ischemia in a patient with coronary artery disease, emphasizing its therapy. Case report: VPS, male, 69 years old, hypertensive, diabetic, under- going coronary artery bypass grafting 8 years ago, was treated at the outpatient clinic of a private hospital in Teresina-Pl, referring chest pain on moderate exertion radiating to members exceeding 1 year. Underwent exercise testing was suggestive of myocardial ischemia. Performed shortly after cardiac catheterization that showed severe lesions in the middle 1/3 of the right coronary artery lesion in left main coronary artery of 50% in the distal third occluded circumflex in the middle 1/3 of saphenous vein graft to the left marginal pervious bridge artery left internal thoracic to left anterior descending (LITA- DA) displayed by the left anterior descending coronary angiography was not possible selective catheterization of the LITA-DA for the left subclavian artery presented with severe lesions in the proximal 1/3. On physical examination good overall condition. Decreased left ra- dial pulse in the law, BP: 140/90 (right arm), physiological breath sounds without adventitious sounds, normal heart sounds, regular rhythm without murmurs in two stages. As a treatment strategy for the patient underwent angioplasty of the left subclavian artery and the day after, angioplasty of the right coronary artery was dischar- ged three days later. After 30 days, the patient was referred to a new exercise test which showed no clinically evolving myocardial ischemia without chest pain. Final thoughts: Atherosclerotic disease is progressive and systemic, so the case presented is of paramount importance for a multiple approach of clinical and interventional treatment is needed. Furthermore, few cases where severe obstruc- tive lesions occur in large arteries (subclavian artery) as a cause of myocardial ischemia and coronary disease. 05 Bilateral Keratoconus Associated With Atopy And The Cons- tant Eye Massage - Case Report Ana Luiza Silva Ferreira; Cicera Dos Santos Moura; Tacianny Eva Araújo Passos; Lana Mayara Meneses Lustosa Vargas; Marlon Marcelo Maciel Sousa; Domingos Augusto Carvalho Mourao. Introduction: Keratoconus, corneal ectasia considered that increases the curvature of the cornea, is a non-inflammatory degenerative pro- cess of the cornea which can cause its irregular astigmatism thinning leading to visual impairment. With still unknown etiology may be related to atopy and other ocular diseases such as keratoconjuncti- vitis, atopic dermatitis of eyelid laxity syndrome, leber's amaurosis, down syndrome and ehler-danlos syndrome. Therefore, there are many doubts as to its etiology, heredity, pathogenesis and bioche- mistry. One of the major etiological factors suggested in the patho- genesis of keratoconus is frequnte scratching eyes. The behavior depends on the severity of the case, but the use of rigid contact len- ses is still the main optical feature used. This report aimed to show a patient with keratoconus, user-gas permeable lenses, diagnosed and monitored by serial clinical examinations topographies and hard contact. Besides showing factors that may have triggered the disease progression and prognostic factors. Case report: Patient rlam, male, 21 years old, diagnosed with bilateral keratoconus 5 years. How to conduct gas-permeable (rgp) rigid lenses were used because the patient did not adapt to the soft contact lens. On first examination of the topography in 2009, the patient had a pattern of astigmatism outside normal limits in both eyes: right eye (od) 50.97 / 53.47 X 25 and left eye (oe) 45.66 48 85 X 110. Upon reaching the eye clinic, the patient complained main complaints: impaired night vision, low visual acuity, excessive sensitivity to light (photophobia) and quite sensitive eyes. In the family there are no cases of keratoconus. From 2011 to 2012, it was observed that the advancing keratoconus in the left eye, because in 2011 the keratometric measurements of the left eye were as follows: 46.56/48.82 X 113. And in 2012 the measures were 47.9750.43 X 112. In 2014, it was observed that the disease continued to advance with the following measures keratometric od 49.1154.83 X 37 and oe 46.92 / 50.46 X 115. From this, the expert suggested it be made a surgical procedure called crosslinking. Final thoughts: The chronicity of the disease and the absence of proper diagnosis and treatment can lead to remodeling of superficial ocular tissue with irreversible eye damage and vision loss. Keratoconus is the leading cause of corneal transplants in brazil and in the world, but are rare cases leading to blindness. The use of contact lenses in patients with keratoconus is considered when the glasses do not provide good vision. Therefore, it is known the importance of regular ophthalmologic monitoring. 06 Bi-Rads Classification: Categotisation Of 71 802 Mammo- grams Alessandra Maria Cerqueira De Sousa; Leonardo De Melo Rodrigues; Brenda Paula Brito Lobão; Mirna Karine De Britto Melo Escórcio; Leonardo Fortes Gomes; Luciana Tolstenko Nogueira. Introduction: Mammography is the imaging method most widely used for the screening and diagnosis of breast cancer. It is con- sidered the gold standard among exam conducted in mastology primarily by its low cost and relative sensitivity. In the evolution of mammography standardization of reports was necessary to fa- cilitate computerization and comparison of results. Systematization called BI-RADS (Breast Imaging Reporting and Data System) was then created by the American College of Radiology. This classification is a tool for mammographic assessment used worldwide establishing risks, predicts the evolution and guides behavior. Objectives: To exa- mine the categorization of mammographic findings, as well as the quantification of mammograms in each of their classes and predict the behaviors of recommendation for each category. Methods: This was an epidemiological, descriptive and quantitative study based on secondary data for the period 2011-2013 collected from the Informa- tion System of Breast Cancer (SISMAMA) concerning mammograms performed in women aged 40-69 years in Piauí. Results: During the reporting period 71 802 mammograms were performed, with 65 360 (91%) aged 40-69 years. Regarding classification, using the criteria of BI-RADS, the BI-RADS category o corresponded to 10.78% of mam- mograms; 59.72% of cases were classified in BI-RADS category 1, the interpretation of which indicates the absence of benign or malignant findings and in 100% of cases the recommendation is adopted to conduct mammogram every two years. Ranked 27.63% of mammo- grams in BI-RADS category 2. The conduit used for category 2 was the same as category 1, since both have the same risk of developing cancer. The BI-RADS categories 3 and 4, it is understood about 1% of cases each. The conduct addressed in the BI-RADS 3 was con- ducting a mammogram after 6 months. The BI-RADS 4 headed for histopathological study, the same indicated for the BI-RADS 5 (0.17% of cases). Only 7 mammograms were classified in BI-RADS 6. Con- clusion: Mammographic evaluation using the BI-RADS classification method allows an adequate standardization of reports, which helps in comparing tests by different radiologists and approaches to be taken against mammographic findings specific, eliminating conflicts between mammographic reports of different professionals, as well as the medical conduct to be followed. 07 Blood Transfusion And Duration Of Mechanical Ventilation Are Associated With In-Hospital Death In Patients With Tbi Admitted To The Intensive Care Unit Ânderson Batista Rodrigues; Marconi Cosme Soares De Oli- veira Filho; Brisa Fideles Gàndara; Irizon Klécio Pereira Rego; Romulo Mello Sampaio; Kelson James Silva De Almeida. Introduction: Traumatic brain injury (TBI) is the leading cause of death in polytrauma patients and generates morbidity especially in the most productive age group. There is no consensus on the clinical and epidemiological variables associated with such morbidity. Simi- larly, the predictive factors for mortality secondary to TBI are not stri- kingly known because of that available studies have methodological limitations. Objective: To identify factors associated with in-hospital mortality in patients with TBI admitted to the Intensive Care Unit (ICU) of the Urgency Hospital of Teresina (HUT). Methodology: This was a descriptive and retrospective study whose sample included patients with TBI admitted to the ICU of HUT during the period from January to December 2011. Patients who were not possible to collect variables for monitoring until hospital discharge were excluded. We defined as variables the epidemiological characteristics associated INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info • 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS XXI COMAPI S41#22IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS XXI COMAPI S42 Abstracts Abstracts with the trauma variables and factors arising from clinical manage- ment in the ICU. Statistical analysis was performed using multivaria- te logistic regression analysis considering in-hospital death, as the dependent variable and the other variables described as indepen- dent. Value of less than 5% "p" is considered to discard null hypothe- sis and confidence interval of 95%. Results: The sample comprised 87 patients with TBI with a mean age of 28.93 ± 12.72 years and male predominance (88.5%). Regarding the severity of the trauma, 64 (73.6%) suffered severe TBI. The rate of in-hospital mortality was 33.33%. In the initial univariate analysis, there was significant corre- lation of in-hospital deaths with the following variables: the reported use of alcohol (p = 0.016), blood transfusion during hospitalization (p = 0.036) and mechanical ventilation (p = 0.002). Conclusion: The- re was a higher frequency of young adult male patients with TBI. We identified high rates of in-hospital mortality. Administration of blood products and the duration of mechanical ventilation were the variables independently correlated with in-hospital mortality after multivariate analysis. 08 Case report: Cushing Syndrome And Its Comorbidities Hudyson Oliveira Rocha; Walber Emanuel Da Cruz Fontes; Renato Barboza Da Silva Neto; Almir José Guimarães Gouvéia; Polyana Sousa Sena Santos; Irene Sousa Da Silva. Introduction: Cushing's syndrome is the result of excessive produc- tion of hormones by the cortical region of the adrenal gland (gluco- corticoids, mineralocorticoids and androgens). Endogenous causes of Cushing's syndrome are rare, with an approximate annual incidence of 10: 1,000,000 people. In most cases, it affects more women than men at a ratio of 8: 1 to Cushing's syndrome (pituitary ACTH-produ- cing tumor), 4: 1 adrenal adenomas and 2: 1 adrenal carcinomas. Cushing's syndrome by ectopic ACTH-dependent secretion of ACTH affects more men than women. ACTH-dependent hypercortisolism affects about 80% of cases of Cushing's syndrome, 85% of these are Cushing's syndrome, and 15% had tumor ectopic ACTH producer. Case report: Patient RCSR, 42, female, enters the hospital with galac- torrhea frame, menstrual irregularity and headache. She denied hy- pertension or other comorbidities. Had a BMI of 22.5 kg/m2 and were absent classic signs of hypercortisolism. Tests performed at the time: PRL = 69 ng/ml, 78 ng/ml and 62 ng/ml. MRI of the hypothalamic-pi- tuitary region revealed pituitary macroadenoma. Bromocriptine was started at a dose of 5 mg/day. In 1992, new tests revealed: PRL = 1.2 ng/ml, TSH = 2.4 µUi/ml, total T4 = 9.0 ng/dl, basal cortisol = 25 μg/dl and cortisol after 1 mg dexamethasone night = 17 µg/dl. Repeated, MRI showed no change in tumor volume. It was then forwarded to surgery. Four months after surgery, the patient was asymptoma- tic, with regular menstrual cycles without use of bromocriptine. The exams: PRL = 8.8 ng/ml, TSH = 2.6 μU/ml, total T4 = 7.5 ng/dl, basal cortisol = 9.5 μg/dl, RM: tumor tissue attached to the right cavernous sinus. New investigation to hypercortisolism demonstrated: cortisol after 1 mg dexamethasone night = 7.3 µg/dl, cortisol after dexa- methasone 0.5 mg of 6 in 6 hours for 48 hours = 8.3 µg/dl, urinary free cortisol = 69,9 μc / 24 and plasma ACTH = 46pg/ml. Immunohis- tochemical study of the tumor was performed in another hospital, 1 year after surgery, showing more than 70% of the cells were positive for ACTH. Conclusion: Despite advances, Cushing's syndrome is still a challenge for endocrinologists, neurosurgeons and radiologists with regard to diagnosis and medical and surgical treatment. 09 Churg Strauss Vasculitis - A Case Report Víctor Manfrinni Magalhães Lima Martins; Talita Maria Leal Barros; Haline Meneses Parente; Ana Luísa De Rezende Al- meida; Felipe Soares Oliveira Portela; Gabriela Lustosa Said. Introduction: Churg Strauss vasculitis (CSV) is also known as eosino- philic granulomatosis with polyangiitis. Diagnosis is mainly clinical which requires the presence of four or more of the six conditions: moderated to severe asthma, Peripheral eosinophilia (>10% or 1,5 x 109/L), mono or polyneuropathy, migratory or transient pulmonary opacities, abnormalities of the paranasal sinuses and extra-vascu- lar eosinophils on biopsy. Although the etiology is not completely defined, it is suggested allergic symptoms or immune mediated. Treatment includes glucocorticoids and in a small number of cases cytotoxic medicines and immunoglobulin is administered. Case pre- sentation: A 61 years old woman was admitted for dermatome hy- poesthesia in lateral right leg, shoulders arthritis, metacarpophalan- geal joints of hands and wrists, metatarsophalangeal and proximal interphalangeal joints of both feet. Furthermore, there was purpura on the back of her feet and palms. She has been suffering from asthma and sinusitis for 14 years using inhaled corticosteroids and due to diabetes using 20U NPH of insulin. Her laboratory test results were as follows: normocytic and normochromic anemia (Hb: 10,2g /dL Ht: 31.9 %), leukocytosis (17000/mm3), eosinophilia (35%) and thrombocytosis (724,000/mm3), high ESR (40mm/h), positive P-anca and negative C-anca. Thereafter, histopathological skin biop- sy was performed and the results were leukocytoclastic vasculitis with mixed inflammatory infiltrate with neutrophils and eosinophils. Tomography scans of paranasal sinuses shows pan- sinusitis with occlusion of the ostium of the right maxillary sinus opacification of the sinus and ethmoid cells. The chest X-ray only revealed marked dorsal kyphosis. In addition, a high dosage of corticosteroids was promptly started. She was found in even better condition at subse- quent follow-up visits. Conclusions: Churg Strauss vasculitis (CSV) is one of the rarest systemic vasculitis, with less than 2,5 people in a million population have being diagnosed each year. Although the diagnosis is fairly difficult, it is always important to be aware of those symptoms as vasculitis, asthama or rhinosinusitis. 10 Clinical And Epidemiological Profile Of Patients With Trauma- tic Brain Injury Admitted To The Intensive Care Unit Of The Professor Zenon Rocha Hospital Of Teresina Ânderson Batista Rodrigues; Gilvan Vilarinho Da Silva Filho; Romulo Mello Sampaio; Brisa Fideles Gândara; Irizon Klecio Pereira Rego; Kelson James Silva De Almeida. Introduction: Traumatic brain injury (TBI) is the major determinant of morbidity and mortality in people with ages between 1 and 44 years old. Severe TBI is associated with a mortality rate of 30% to 70%, and survivors carry severe neurological damage and impairment quality of life. The knowledge of epidemiological characteristics in this pa- tient population is crutial for the development of basic guidelines and prevention programs. Objective: To study the epidemiology cha- racteristics of TBI patients admitted in the Intensive Care Unit (ICU) of the Emergency Hospital of Teresina Professor Zenon Rocha (HUT), Pl during the year of 2011. Methodology: This was a quantitative study, descriptive and retrospective, that studied every patient ad- mitted to the ICU with the diagnosis of TBI in the period from January to December of 2011. The data was collected from medical records and recorded on a standardized form that included epidemiological characteristics and factors related to trauma, age, gender, causal factor TBI, clinical aspects and established treatment. Patients whose medical records were incomplete were excluded from the study. The data was organized through the 2010 Excel Program. The results were presented as average, standard deviation and percentages of the fre- quencies. Results: The predominant age in the sample studied was between 21 and 30 years old (39.1%) and of male gender (88,5%). Most subjects (94.3%) did not have comorbidities and there was no associated systemic trauma (40%). The predominant causative factor was motorcycle accident (75.9%) with severe TBI present in 73.6% patients. The presence of multiple lesions was the most frequent tomographic finding (31.0%) and surgery was the most commonly used therapy (60.9%). Alcohol consumption before the traumatic event was confirmed in 17 patients (19.5%). The rate of in-hospital mortality was 33.33%. Conclusion: Young male are the most frequent subjects involved in accidents leading to TBI. Motorcycle accidents are the most common event. We identified high rates of in-hospital mortality and these patients required a high frequency of surgical management despite the reduced frequency of associated systemic trauma. 11 Clinical Evaluation Of The Quality Of Bisacodyl In Preparation For Colonoscopy Maria Clara Fortes Portela Barbosa; Patrícia Barros Aquino Silva; Antônio Moreira Mendes Filho. Introduction: Colonoscopy is the examination of the large intestine, performed endoscopically, the main indication is the identification of polyps and detecting tumors at an early stage, increasing the chance of cure. To achieve the same prior mechanical cleaning is needed, several drugs can be used as bisacodyl and mannitol. Objective: The aim of this study was to compare the use of two solutions regarding the tolerability, acceptability and effectiveness in bowel preparation for colonoscopy in patients undergoing this exam for several indications. Methods: The study was conducted in a public referral hospital in the state of Piaui. This is a prospective, randomi- zed study with a qualitative approach. The study was conducted in five months. A sample of 54 patients divided into two groups, the first received bisacodyl and mannitol 10 % and the second group, received mannitol 10 % was used. Results: According to the accep- tability of the patient, there is no association between the use of bisacodyl and acceptance of the examination (p = 0.105); regarding tolerability, patients using bisacodyl, had more abdominal cramping (p = 0.012) compared to those who did not use; regarding the qua- lity of the preparation (according to the scale of Boston), the use of bisacodyl on the eve determined not signicant improvement (p. = 0.468). Conclusions: The results were important to highlight that the use of bisacodyl medicine may be waived in some situations, as in our sample, the quality of preparation with or without their use, was not affected. Keywords: Colonoscopy; bisacodyl; mannitol. 12 Collision Tumor: Case Report Antonio José Silva Meneses Filho; Ânderson Batista Rodri- gues; Luis Eduardo De Oliveira Filho; Teresinha Castello Branco Cavalcante; Jerúsia Oliveira Ibiapina; Lina Gomes Dos Santos. Background: Collision tumor is a rare phenomenon characterized by the coexistence of two different tumors on the same organ, forming a single lesion. Although some cases have been well documented in organ sistems like gastrointestinal tract and lungs, few of them were observed on the kidneys. Thus far, fewer than ten cases of re- nal involvement have been reported in the literature. These tumors can occur as a combination of any known histological subtypes and their prognosis is often determined by the high-grade component. In patients with clear cell renal cell carcinoma, collision tumors usually arise from synchronous neoplasms of the collecting duct, colorec- tal, prostate, bladder and non-Hodgkin lymphomas. We report the case of a renal collision tumor composed of a neuroendocrine tumor of the pancreas and a clear cell renal cell carcinoma. Case report: Coming from an emergency service, a 40-year-old male sought an oncology hospital with upper gastrointestinal bleeding. A computer tomography (CT) showed a wide tumor on the left kidney consis- tent with a typical neoplastic process, without spleen and pancreas cleavage planes, besides solid nodules on the right kidney. Blood count, urinalysis, and bone scans were normal. The left kidney and adrenal, pancreas (body-tail), spleen and large intestine segment were removed in an exploratory laparotomy. Histopathological study of the surgical specimen revealed a neuroendocrine carcinoma of the pancreas (24.0 x 18,0cm) with left kidney, spleen and colon invasion and a clear cell carcinoma of the left kidney (3.5 x 2.5cm). In the im- mediate postoperative period, patient developed an intra-abdominal abscess and a pancreatic fistula. A new CT scan showed residual / recurrent lesion on the head pancreas (4.1 x 3.0cm) and liver me- tastasis, what indicated to chemotherapy. Eleven months after the laparotomy, patient had episodes of vomiting and dizziness, and a skull magnetic resonance imaging showed brain nodules suggesting metastasis, and then it was given radiotherapy treatment. Conclu- sion: The simultaneous presentation of two cancers in the same organ characterizes the so-called collision tumor. Tumors formed by the coexistence of a neoplasm of the pancreas in the kidney together a clear cells renal cell carcinoma are rare events, whose prognosis is determined by the highest degree component. 13 Compulsory Admissions Versus Clinical Indications For Hos- pitalization: The Reflex On Assistance Cicera Dos Santos Moura; Ananda Sousa Silva; José Luis Soares; Francisco Carlos De Moura; Daianny Macedo De Sou- sa Rego; Ediwyrton De Freitas Morais Barros. Introduction: It is polemic issue that talks about what happens with patients suffering from mental disorder in Piauí, in view of what the law requires. It is observed overcrowding of the Areolino de Abreu Hospital (HAA) on account of patients referred by the judiciary in safety measure while population who cares hospitalization is under- served due to lack of beds. It is about the impossibility of reconci- ling all these attendances at Areolino de Abreu Hospital, failing to exhaust the service to the community. It can be asserted that the Law 10.216/2001 brought changes and redirected the mental health care model promoting the necessity of respect for the individual with mental disorder. However, the value of a medical expertise that indicates when the patient has conditions of social reinsertion is not being taken account. Such that the the Law of Psychiatric Re- form determines the treatment has the purpose a permanent social reintegration of the patient in its environment, and hospitalization shall be provided only when the resources do not cover intrahospital model show themselves seriously defective or inappropriate, ques- tions had arised to be reflected about the practices currently applied to our current models. Objectives: The study aims to oppose the law 10.21601 to the reality of HAA, regarding the Reduction of Beds Policy that directly affects vacancies for the community. Methods: This is a study of character embodied in the theoretical analysis of the relevant legislative text and document files in the Psychiatric Ins- titution "Areolino de Abreu Hospital", about the number of patients in a safety measure, a survey of the Centers for Psychosocial Care "CAPS (in portuguese)". Results: The HAA has 160 beds, 40 of these being occupied by people with mental disorders in conflict with the law. Of these, 32 were male and 08 were female. The period of hos- pitalization varies from months to indefinite time for justice, many of whom have trouble with the fact that the family no longer want to receive them. Conclusion: It's a hard reality, but that needs to be faced to arise the necessary measures capable to bring benefits to the community. It is suggested as an alternative to judicial the cons- truction of therapeutical shelters equipped with a multidisciplinary team focused on social rehabilitation of these patients. Keywords: Mental Disorder; Compulsory admission; Psychiatric Re- form. 14 Coronary Artery Bypass Grafting Through Services Provided By Public And Private Entities In Piauí Kelwin Madson da Silva; Manuel Pinheiro Barbosa Neto; Lívio Pereira de Macêdo; Rômulo Ferreira Rocha; Edemir Veras de Carvalho Júnior; Luiz Evaldo de Moura Pádua. Introduction: In Brazil, it is estimated that SUS (Sistema Único de Saúde) is responsible for 80% of coronary artery bypass grafting (CABG). Different variables that interfere in success of CABG can be cited: the type of surgery (elective / urgent / emergency), comorbi- dities and clinical status of the patient. PLAMTA (Plano Médico de Assistência e Tratamento) is a health plan subsidized by the govern- ment. Public servants of the State are entitled to receive this service, which covers the patient only for surgeries. If the patient requires consultations diagnostic tests should perform them by SUS, have another health plan or pay for services. In Piauí, the informations are restricted on these services. Objectives: Compare the outcomes of patients undergoing to CABG in reference hospital of Piauí to hos- pital discharge or death by the public and private system. Methods: Retrospective analysis performed by analysis of medical records of patients who underwent to CABG between 2009 and 2013 proceeded with support from the public service and private plans. Age, gender, EuroSCORE and evolution to hospital discharge or death of the pa- tients were recorded. Datas registereds in the frequency range were analyzed by chi-squared test (c2), comparison between groups was used the Mann-Whitney test and the qualitative variables submitted to the Spearman's test (rs), all with p-value <0.05 for significance. The Research Ethics Committee of the São Marcos Hospital appro- ved the process under number 513 488 on 02/11/14. Results: 303 INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info • 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS XXI COMAPI S43#23IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS XXI COMAPI S44 Abstracts Abstracts medical records of patients who underwent to CABG during were analyzed during the study period. From these, 231 patients (76.2%) were operated by the public health system (SUS and PLAMTA). The rest (23.8%), the several private pension plans health. The EuroSCO- RE was homogeneous in both groups (p = 0.85). Of total procedures, 20 had death outcome: 3 emergently, 2 in urgent and 15 elective. Death Outcomes in public systems were 15 (75%) and private it were 5 (25%). The Chi-Squared test (c2) showed no difference between public and private (p = 0.89) systems. The age and gender did not reveal associations (p = 0.39) and (p = 0.68), respectively. Conclu- sion: In reference hospital studied, there was no significant differen- ce between the mortality after CABG in patients operated by public and private health system, framing up the service on the principle of quality and equality of service between them. Keywords: CABG mortality, Public Health System. 15 Distal Epithelioid Sarcoma Luis Eduardo De Oliveira Lima; Antonio José Silva Meneses Filho; Anderson Batista Rodrigues; José Osvaldo Gomes Dos Santos; Marcelo Barbosa Ribeiro; Lina Gomes Dos Santos. Background: Epithelioid sarcoma is an extremely rare subtype of soft tissue sarcoma, showing atypical clinical outcome when compared to other types of sarcomas. May be present in any anatomical region, preferentially affecting end of the upper limbs and rarely the head and neck, predominantly affecting young males, and rarely affect other sites as perineum, penis and vulva. Most of these tumors are presented as a palpable mass in the subcutaneous tissue. The high rate of metastasis to regional lymph nodes cause tumor resection or even amputation the therapeutic procedures adopted in most cases. We report one such rare case of epithelioid sarcoma of soft tissues in the thenar region of the left hand. Case report: Male patient, 11 years, looked for health service due to a large tumor in his left hand, with slow and progressive growth and clearance of sanguinolent se- cretion about 1 year ago. He refers itchy and local pain at night and nocturnal dry cough two weeks ago. He underwent partial surgical resection of the lesion 2 months ago without pathological study, and local recurrence of the injury. The patient underwent incisional biopsy which showed that it was high-grade epithelioid sarcoma. Radiographs of the chest showed multiple pulmonary nodules of varying sizes, not calcified distributed randomly throughout the pul- monary parenchyma bilaterally, and left axillary lymphadenopathy suggestive of metastatic disease. He started chemotherapy with mi- nimal tumor regression. Despite the presence of lung metastases, palliative amputation of his left hand was indicated. The surgical specimen showed extensive vegetating and ulcerated tumor located in the palmar face, thenar region of the right hand measuring 6.0 x 4.5 x 5.0cm, whose histological study showed neoplasm composed of atypical proliferation of epithelioid cells arranged in short bundles and organoid arrangements. The tumor cells were positive for AE1/ AE3, EMA, and CD34, confirming the diagnosis of distal epithelioid sarcoma. Four months after resection of the lesion, the patient keeps no signs of local recurrence of the tumor. Conclusion: Epithelioid sar- coma accounts for a minority of all subtypes of soft tissue sarcoma and displays histological pattern both epithelial and mesenchymal. It has a high rate of local recurrence after resection and has a tendency to metastasize to regional lymph nodes and lungs, which have been reported in about 40 to 50% of cases. The recommended therapeutic approach should be to wide surgical resection with adequate mar- gins, or even amputation may be used in some advanced cases, when there are morphological and immunohistochemical diagnostic confirmation, which occurred in the case reported here. 16 Early Onset Of Schizophrenia Clara Maria Barbosa; Máximo Peixoto Rocha Neto; Adriana Maria Lima Lustosa; Daianny Macedo De Sousa Rego; Raissa Fontenele Belchior Cabral; Krieger Rhelyni De Sousa Olinda. Introduction: Schizophrenia is a psychotic disorder that has preva- lence between 0.5% and 1.5%, with incidence from 0.5 to 5 cases per 10,000 inhabitants. The onset before age 10 or after age 60 is extre- mely rare. The onset before age 17-18 characterizes the early onset schizophrenia and before age 13 the very early onset schizophrenia, and 0.1% to 1% of cases of schizophrenia begins before age 10. The diagnosis is made by the presence and duration of symptoms: delusions, hallucinations, disorganized speech or behavior, negative symptoms (affective flattening, alogia, avolition); associated to social / occupational dysfunction. The objective of this paper is to describe a case of very early onset schizophrenia, extremely rare situation. Case report: Patient 20 year old female with prior learning difficulty, presented the 10-year framework of social withdrawal, disorganized speech, food refusal, unmotivated laughter, hygiene under encou- ragement and mutism associated to walking difficulty. Gradually returned to communicate and ambulate after 5 years and 1 year res- pectively. In 2013, she was admitted for the first time in a psychia- tric hospital, having her second hospitalization in 2014, presenting heteroaggressiveness, impulsiveness, irritability, social withdrawal, disorganized behavior, actions of breaking everything, various delu- sions and cenesthesic and visual hallucinations. After treatment with chlorpromazine, risperidone, promethazine, diazepam, valproic acid, olanzapine, clozapine and clonazepam, suspended or reduced as ne- eded, she showed no aggression, and behavioral improvements and in executive functions. She kept intolerance to frustration, unmo- tivated laughter, euphoria and affective incongruity, delusions and hallucinations. She was discharged after 122 days of hospitalization. Final thoughts: This paper presents a very rare case, the onset of schizophrenia before age 10 very early onset schizophrenia - (0.1 to 1% of cases of schizophrenia). The onset of schizophrenia in chil- dhood is severe, most likely to: poor premorbid adjustment, lower educational performance, structural brain abnormalities, cognitive impairment, relatives with schizophrenia and refractory treatment. 17 Effect of Feed Enriched With Almond Coconut Babassu On Lipid Profile In Experimental Obesity Milena Braga Soares Da Silva; Ana Larisse Gondim Barbosa; Maria Clara Chaves; Mariana Soares Ferreira; Lara Arrais Cha- ves Cronemberger; Maria Do Carmo De Carvalho E Martins. Introduction: Excess body fat, especially abdominal fat, is closely linked to dyslipidemia .Dietary lipids are an important way to affect the lipoprotein metabolism, wherein the polyunsaturated fatty acids may reduce hepatic production of VLDL, the precursor to LDL, and cholesterol influence. Approximately 85 % of almond oil comprises babassu nut saturated fatty acids being lauric main ( 44-46 %), sa- turated fatty acid which is an exception with respect to deleterious effects by being easily oxidized. Objective: To evaluate the effects of consumption of babassu coconut almond on the lipid profile in experimental obesity model. Methods: Obesity was induced by neo- natal administration of monosodium glutamate sodium ( 4 mg/g) in rats, males and females. In three months, groups of 5-7 animals were treated with standard chow (control) or chow plus 10 % of babassu coconut almond (rubs). After 30 days of treatment, blood samples were obtained To determine the serum concentration ( mg /dL) triglyceride, total cholesterol and fractions. Statistical analysis was performed using ANOVA and Tukey test. This study was appro- ved by the Ethics Committee on Animal Use of the University Center UNINOVAFAPI (No. 0002/13). Results: The levels of HDL cholesterol were significantly higher (p < 0.001) in Babaçu (37.74 ± 0.92) com- pared to the control group (27.40 ± 1.66). There was no significant difference between groups with respect to total cholesterol (control 87.6 ± 4.9, 119.6 ± rubs = 25.49) and LDL cholesterol (control = 46.96 ± 5.03; rubs=74,31+25,28). The Babassu (367.2+114.6) group had significantly higher triglycerides (p<0.05) compared to control (66.2 ± 12.97) group. Conclusion: Supplementation with almond babassu in obese animals, the quantity supplied, improved HDL levels. However, also caused large increases in triglycerides. 18 Electrical storm: recurrent ventricular tachycardia in patient with structural heart disease and implantable cardioverter- defibrillator (ICD) in the treatment of pulmonary tuberculosis with rifampicin and isoniazid. Igor Ramon De Melo Batista; Fernando Teixeira De Morais Freire; Carlos Eduardo Batista De Lima. Introduction: Electrical storm is defined as three or more episodes of ventricular tachycardia (VT), ventricular fibrillation (VF) or shock therapy with implantable cardioverter defibrillator (ICD) in 24h. There is no description in the literature of occurrence of severe ventricular arrhythmia associated with the use of rifampicin or isoniazid. Case report: ACCA, male, 64 years old with a congenital heart disease with anomalous origin of the right coronary artery and persistent left superior vena cava with idiopathic ventricular dilatation. 3 years ago underwent implantation of an implantable cardioverter defibrillator (ICD) due to spontaneous VT with hemodynamic instability. In daily use of 400 mg of amiodarone, had no recurrence of arrhythmias. In the past year showed poor general condition with weight loss (weight loss of 62 to 45 kg) and lung nodules. After further investiga- tion, the pacient was diagnosed with pulmonary tuberculosis. In the first 2 months of conventional treatment, he presented weakness and paresthesia in the legs. Amiodarone was suspended due to a possibility of secondary peripheral neuropathy. In the third month of treatment, the therapy for tuberculosis was ajusted to isoniazid and rifampicin in normal doses. The patient developed recurrent episo- des of VT with repeated ICD shock therapies despite antiarrhythmic therapy optimization with amiodarone 800 mg daily in combination or not with venous lidocaine and hidantal, and evolved with periods of improvement and recurrences. In the last week of the treatment for tuberculosis, the pacient presented electrical storm with over 15 TV episodes receiving repeated shock therapy of CDI. We chose to optimize treatment with intravenous amiodarone, propafenone, and suspension of drugs for tuberculosis treatment. In addition, the patient underwent catheter ablation of TV uneventful, though of du- bious success due to different morphologies of ventricular ectopic beats evidenced in the exam. Improved clinically, with no recurren- ces of TV since then. Final considerations: The temporal relationship established by the begin and end of the electrical storm with the du- ration of treatment for tuberculosis suggests a possible arrhythmo- genic activity of this therapy in patients with individual risk factors for ventricular arrhythmias. It is also important to question the role of ablation and the association with propafenone, which are effective therapies in these cases, as possible improvement factors isolated or in combination. 19 Epidemiological Profile Of Patients Diagnosed With Leprosy, In Piaui, 2004 TO 2014 Rayra Gomes Ribeiro; Amanda Tauana Oliveira E Silva; Cibele Carina Souza Silva; Monah Ilka Feitosa Ferreira; Ânderson Batista Rodrigues; Lauro Lourival Lopes Soares Filho. Introduction: Leprosy, a chronic infectious disease caused by Myco- bacterium leprae, primarily affects the skin, but also eyes, peripheral nerves and, incidentally, other organs. Transmitted by saliva droplets of contaminated patient, presenting four different clinical forms. Objectives: To describe and analyze the epidemiological profile of patients with leprosy in Piaui. Methods: A descriptive, retrospective study, quantitative analysis of data from January 2004 to May 2014, in the State of Piaui, of reported cases of leprosy. The epidemiologi- cal survey was done through the Communicable Disease Information System (CDIS). Data were analyzed using Microsoft Excel 2010. Re- sults: 21100 cases have been reported in Piaui in the period analy- zed. Regarding gender, there was a predominance of males (59.4% of cases). As for the operating class, the paucibacillary was diagnosed in 11 816 (56%) cases, Multibacillary in 9251 (43.8%) and was ignored in 33 (0.2%). The smear was positive in 1991 (9.4%) cases, negative in 1878 (8.9%), not held in 4522 (21.4%), ignored in 3226 (15.3%) and not reported in 9483 (44.5%). Regarding clinical form, the Inde- terminate was diagnosed in 4743 (22.5%) cases, Tuberculoid in 3552 (16.8%), borderline in 7402 (35.1%), Lepromatous in 2987 (14 2%), unclassified in 1775 (8.4%), ignored in 6 (0.03%) and not reported in 635 (3%) cases. Regarding the number of lesions, there 927 (4.4%) patients with no lesion 17632 (83.6%) up to 10 lesions, 1612 (7.6%) with 10 to 20 injuries, 238 (1.1%) with 20 to 30 lesions, 84 (0.4%) with 30 to 40 injuries, 149 (0.7%) more than 40 lesions, and 457 (2.2%) patients without such a specification. Regarding the assessment of the physical, 15014 disability (71.2%) cases showed zero degree of disability, 3562 (16.9%) grade 1, 1040 (4.9%) grade II, 1132 (5.4%) not assessed and 352 (1.6%) not reported. Regarding the type of output, healing corresponded to 16 546 (78.4%) cases; transfer to another unit of the same municipality, 284 (1.3%); to another municipality, 540 (2.6%); to another state, 341 (1.6%), and to another country to 15 (0.07%), death accounted for 211 (1%) cases abandonment of treatment, 754 (3.6%), the error of diagnosis, 353 (1.8%), was ignored in 450 (2.1%) and was not notified in 1606 (7.6%). Conclu- sion: After analysis, it was perceived prevalence of leprosy in males, paucibacillary and diforma with low degree of physical disability. In addition, there were errors in filling data and underreporting. 20 Epidemiological Profile Of The Incidence of Aids In Children. In Teresina-Pi Lorayne De Araujo Costa Pereira; Antonio Guilherme Chagas Silva Feitosa; Luiz Euripedes Almondes Santana Lemos; Rienny De Sousa E Silva; Máximo Peixoto Rocha Neto; Cintia Maria De Melo Mendes. Introduction: AIDS is classified as a sexually transmissible disease that has spread widely around the world since the 1980s, affecting all the socioeconomic classes, genders and ages. HIV attacks the im- mune cells of the body, depressing the immune system and making its carriers more susceptible to infections. The vertical transmission is the main route of children infection, hence the importance of con- ducting a safe medical monitoring of pregnants, screening for HIV- infected women and better prevention the transmission to children. Objectives: analyze the incidence of reported cases of AIDS in chil- dren under 5 years of age in Teresina-PI, from 2002 to 2012. Methods: Has been done an analysis of data provided by SINAN concerning to notifications of AIDS in Teresina, in the period from 2002 to 2012. In addition, has been performed a search in the electronic databases Medline and SciELO, gathering articles with full text available, publis- hed between 2009-2013, in English or Portuguese, that documented disease-related characteristics. The following descriptors were used: "AIDS" and "children". Studies focusing on other subjects and studies that included adult or old age were excluded. Results: 93.33% of HIV-children infected cases is due to the category of vertical expo- sure. Between 2002 and 2012 the incidence rate (cases per 100 000 inhabitant) of AIDS in children under five years in Teresina was 3.81, with 3.73 for male population and 3.89 for female population. There was an increase in this rate from 2002 to 2004, declining in 2005 and rising again from 2006 to 2010; 2010 to 2012 fell from 5.08 to 3.32. The years with the highest incidence were 2004 (7.49); 2010 (5.08); and 2011 (5.03). The lowest rates were in 2005 (1.51); 2006 (2.70); 2007 (2.72); and 2008 (2,83). Conclusion: The study illustrates the vertical transmission as largely responsible for the incidence of AIDS in chil- dren. Although declining over the years, the rates illustrate that HIV infection in this age group have to be combated with specialized care to mothers with the virus. Adherence to treatment is relevant in the context, since the current diagnostic methods and the broad spectrum of antiretroviral drugs relate better quality of life. 21 Epidemiological Study of Mortality Due To Ischemic Heart Disease In Piauí Antonio Guilherme Chagas Silva Feitosa; Luiz Euripedes Al- mondes Santana Lemos; Rienny De Sousa E Silva; Lorayne De Araujo Costa Pereira; Máximo Peixoto Rocha Neto; Francisco Das Chagas Araujo Sousa. Introduction: The circulatory system diseases (CSD) are the leading cause of deaths in Piauí. In the state of Piauí, in the period of 2001 to 2011, that is available on Datasus, CSD accounted 31.36% of total deaths, being the ischemic heart diseases (IHD), mainly acute myo- cardial infarction (AMI) and cerebrovascular disease its major com- ponents. However, a reduction in mortality due to these diseases in countries like United States and United Kingdom has been observed, as well as a reduction in IHD in the more developed regions of the country, while these have been rising in the Northeast and North re- gions. Objectives: Describe the epidemiological profile of deaths due to ischemic heart disease in Piauí, predicting most current forecasts using data from 2001 to 2011, and see if the trend toward increased mortality due to IHD can be affirmed in the Northeast of the state. INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 XXI COMAPI INTERNATIONAL JOURNAL of MEDICAL STUDENTS S45#24IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS XXI COMAPI Abstracts Abstracts Methods: It's a cross-sectional, retrospective, descriptive and quan- titative study based on secondary data, accounted and available by Datasus about deaths due to CSD, IHD and their categories, according to CID-10, in Piauí, from 2001 to 2011. Were been considered the variables: age, scholarity, gender, and place of occurrence of death (POD). Results: In the years 2001 and 2011 were accounted for 173 635 deaths in Piauí, of which 31.36% were from CSD and 23.77% of the IHD, being 60.75% in men. The main conditions, according to CID- 10 category, include angina pectoris (0.54%); AMI (90.35%); Recurrent myocardial infarct (0.11%), chronic ischemic heart diseases (5.49%) and Other acute ischemic heart diseases (3.51%). Of the total, 73.21% of the deaths reported occur in people having 60 years or more and 62.14% do not have any or only up to 3 years of schooling. Regar- ding the POD, 47.12% occur in hospitals and 44.51% at home. The Pearson correlation was positive (p = 0.9693) among the variables "year" and "mortality". Improperly filled death certificates are re- cognized limitations. Conclusion: This study revealed, as the deaths for ischemic heart disease: higher prevalence in men, a phenomenon well described; higher mortality for AMI; less prevalence in higher education levels and few differences in the POD. Furthermore, the study confirmed the increasing trend of deaths from IHD observed in the Northeast region, which may be due, among other factors, the increasing improvement in diagnostics, forecasting the maintenance of the situation for the years 2012 to 2014. 22 Epidemiological Study Of Tuberculosis In The City Of Teresina- Pi, In The Period 2007- 2012 Vanessa Gonçalves Costa; Brunna De Sousa Silva; Juliane Brígida Silva Do Nascimento; Raissa Lua Rodrigues Carvalho Araújo; Joycce Huanna De Souza Silva; Augusto César Evelin Rodrigues. Introduction: Tuberculosis (TB) is a infectious, chronic and trans- mitted disease caused by Mycobacterium tuberculosis or Bacillus of Koch (BK), in despite of to be one of the oldest diseases reported, still causes great social impact, and is responsible currently for the largest number of deaths for a single infectious agent around the world. The possibility of the occurrence of coinfection of TB/HIV in- creases the importance of this condition in public health. Objective: To characterize the epidemiology of TB cases registered in the city of Teresina (PI), between 2007 and 2012. Methodology: The present study is an epidemiological, cross-sectional, quantitative and retros- pective. The data were collected from an active search on databases of Sistema de Informação de Agravos de Notificação (SINAN) e Rede Interagencial de Informações para a Saúde (RIPSA). All cases were analyzed according sex, age group, scholarity, treatment outcome, coinfection with HIV and lethality in the period from 2007 to 2012 in Teresina-Pl. Next, the data were tabulated and statistically analyzed through Excel spreadsheet and PrismaⓇ. Results: The number of cases in 2012 decreased by 20% compared to 2007, the year that had the highest number of cases (375), being notified of a total of 1982 cases during the period. TB is most prevalent in young adults (20-39 years) with 732 cases (37%) and in males in the ratio of 2:3. With regard to education, there is a higher frequency in patients of incomplete primary education (1st to 4th incomplete) in all years. The move towards healing and treatment dropout outcome were 50% and 4.7% of cases, respectively, with death the evolution of 2.8% (56 cases) of the notifications. The HIV test was not performed in 390 cases (19.7%). Conclusion: It was found that in Teresina TB is more common in males, in adults aged 20 to 39 years and people with low education. Testing for HIV has oscillated since 2007 and does not cover 100% of TB cases, which is recommended by the Ministry of Health. Information on treatment outcome is poor, because 24.8% are without information. It follows that cure rate in Teresina is well below the goal adopted in Brazil, which is 85%. In contrast, the dropout rate and the lethality remained at acceptable levels during the period. 23 Evaluation By Genogram: Prevention Of Familial Breast Can- cer In Female Relatives Of Women Who Died From Breast Cancer Walber Emanuel Da Cruz Fontes; Almir Jose Guimarães Gou- veia; Vicktor Bruno Pereira Pinto; Carlos Alberto Rosado Da Silva Filho; Renato Barboza Da Silva Neto; Maria Hilda Araújo Ribeiro. Introduction: The familial cancer includes some types of cancer without a well-defined pattern of heritage genetic. The genetics of cancer is an essential component in clinical oncology practice, es- pecially in Brazil, where breast cancer is the leading cause of death in women. Objectives: Evaluate the familial breast cancer, based on family history of women who died from breast cancer, aimed at buil- ding genograms to identify families with hereditary predisposition, which is an aspect of relevance in the early diagnosis of tumors. Methodology: Descriptive and observational study of a sample of convenience from 54 medical records of women who died from breast cancer of Instituto Maranhense de Oncologia Aldenora Bello - IMOAB, in the period from 2000 to 2007 in São Luís - MA. This study was approved by Ethics Committee for Research of the University Hospital of the Federal University of Maranhao. Data were analyzed in Epi Info 2007. Results and Discussion: We investigated 54 medical records of women who died of breast cancer under the age of 60 years and their relatives of first and second degree. Genograms were built and were identified 18 families with case reports of cancer. The average age of patients at diagnosis was 39.55 and at death 41.98 years. The overall survival ranged from 1 to 240 months. It was observed only 1 case of affected relative in 13 families and 2 cases in 3 families. 11 patients had cases in first-degree relatives and 4 of second-degree relatives. 11 patients with a family history were diagnosed under the age of 39 years and 4 were 50 years or more. 10 families had 2 or more cases over two generations, 3 had 2 or more cases in a generation and a reported 3 cases in three generations. 10 families reported that only first-degree relatives were affected, three families reported that only second-degree relatives were affected and one family reported cases in the first and second degree relati- ves Conclusion: It was found that 33.33% of the studied patients had family history of cancer. Of these, more than half were diagnosed aged less than 39 years, suggesting a possible relationship between early age at diagnosis and increased frequency of cases in the fa- mily, which justifies the study of hereditary câncer. 24 Hemophagocytic Lymphohistiocytosis In Child With Visceral Leishmaniasis: Case Report Joana Mayra Teixeira Lima; Sérgio Clementino Benvindo; Lívia Araújo Vale Castelo Branco Torres; Maria Aline Ferreira De Cerqueira; Gildene Alves Da Costa; Catarina Fernandes Pires. Introduction: Hemophagocytic lymphohistiocytosis (HLH) or he- mophagocytic syndrome is a disorder of the mononuclear phagocytic system, characterized by an exacerbated inflammatory response in which activated macrophages exhibit uncontrolled phagocytosis of red blood cells, white blood cells, platelets and precursors. For diag- nosis, the Histiocytosis Society proposed the presence of > 5 out of 8 criteria: fever, splenomegaly, bicytopenia, hypertriglyceridemia and/or hypofibrinogenemia, hemophagocytosis, low or absent NK cell activity, high serum ferritin levels, and elevated soluble CD25 levels. We report a case of HLH secondary to Visceral Leishmaniasis (VL). Case report: Female patient, aged 2 years and 3 months, na- tive of Parnarama-MA, previously treated for pneumonia. Few days after respiratory symptoms, progressed with recrudescence of fever, associated with abdominal distention, lower limb edema, jaundice, hepatosplenomegaly, hyporexia and irritability. She was referred to a specialized center in Teresina-PI, initiating treatment with liposo- mal amphotericin B after confirmation of VL. The child progressed with anasarca, persistent jaundice and visceromegaly. On review of bone marrow slides, hemophagocytosis complexes were visualized. The patient was then transferred to the Children's Hospital for com- plementary diagnostic investigation of HLH. On hospital admission, the child was irritable, presenting with anasarca, jaundice (3+/4+), no alterations in cardiac and pulmonary auscultation, low-grade fe- ver (37.96C). Laboratory tests revealed pancytopenia (Hemoglobin: 7.3g/dL; White Blood Cells: 3560/mL; Platelets: 74.000/mm), hy- pertriglyceridemia (790mg/dl), hyperbilirubinemia (25.45mg/dl), hy- poalbuminemia (1.0g/dl), high serum ferritin levels (>2000ng/mL), ALT (216U/L) and AST (115U/L), Gamma GT (292U/L), PTA without formation of fibrin, negative sorology for cytomegalovirus, hepatitis B, HIV, german measles, measles and toxoplasmosis. The child was managed with pulse therapy (methylprednisolone for three conse- cutive days), obtaining good clinical and laboratory response. Final considerations: The association between HLH and VL is very rare, with approximately 56 cases described in the English literature. We draw atention to the importance of early recognition and success obtained with the institution of pulse therapy, when adoption of the recommended therapeutic regimen (dexamethasone, etoposide and cyclosporine) is impossible. 25 Hospital Morbidity And Mortality In The Elderly In Piauí Brenda Paula Brito Lobão; Leonardo De Melo Rodrigues; Alessandra Maria Cerqueira De Sousa; Mirna Karine De Britto Melo Escórcio; Leonardo Fortes Gomes; Luciana Tolstenko Nogueira. Introduction: The aging population is a reality found in many na- tions, such as Brazil. This growth in the number of seniors and their implications when building a new epidemiological profile of health care are reflected in changes in the structure of hospital care and attention in the demand for medical and social services. Objective: To describe the pattern of hospital mortality in the elderly population in the state of Piaui. Methods: This was a retrospective, and descrip- tive epidemiological study of hospitalizations of elderly patients (60 years or more) in the state of Piauí in the period from 2010 to May 2014. There were analyzed data from the Hospital Information Sys- tem (SIH-SUS) available in DATASUS. Considered the causes of hospi- tal admissions according to the International Classification of Disea- ses (ICD10). Results: There were 207 072 hospital admissions of the elderly over this period, with a slight female predominance (51.5%). The most common causes, the second chapter of the ICD were: car- diovascular diseases (25.11%), respiratory diseases (15.34%) and infectious and parasitic diseases (14.33%). Once specified the cau- se, pneumonia (16 739), heart failure (16,723), intestinal infectious diseases (11,315) and diabetes mellitus (10,697) figure as the most incidents and together account for 26.79% of hospitalizations of el- derly people. 12,282 deaths were recorded, and the hospital morta- lity rate was 5.93%. Neoplasms correspond to the group of diseases with the highest mortality rate (8.89%), followed by diseases of the nervous system (7.80%), respiratory (7.66%) and circulatory (7.04%). Conclusion: The pattern of hospital morbidity and mortality in the el- derly population presents important differences with the equivalent standard for younger adults and their characterization is of funda- mental importance for the development of strategies to improve the effectiveness of hospital care. Keywords: Morbidity, elderly, Hospitalization 26 Hospitalizations Due To External Causes In The State Of Piauí 2008-2013 Mirna Karine De Britto Melo Escórcio; Leonardo De Melo Rodrigues; Brenda Paula Brito Lobão; Alessandra Maria Cer- queira De Sousa; Leonardo Fortes Gomes; Luciana Tolstenko Nogueira. Introduction: External causes conceptualized by the World Health Or- ganization (WHO), like intentional injuries (assaults, homicides, sui- cides, privation or neglect) and unintentional injuries (motor vehicle accidents, drownings, falls, burns, among others) play an prominent among the causes of morbidity and mortality in the country. Such injuries are responsible for a significant portion of the health and social problems, acquiring epidemic character and becoming one of the most serious public health problems in the world. Objective: To describe the morbidity of hospital admissions in the state of Piaui. Methods: This is a retrospective, descriptive and an epidemiological study of hospital admissions due to external causes in Piauí 2008- 2013, based on the data collection (SIH-SUS) Hospital Information System. We considered the external causes of hospital admissions according to the twentieth chapter of the International Classifica- tion of Diseases (ICD10). Results: During the period under review, 89 655 hospital admissions were recorded by external causes. Falls and traffic accidents correspond, respectively, the first (42.01%) and se- cond (26.74%) because in both sexes and in all age groups. The age group 15-39 years is responsible for 65.74% of hospitalizations due to traffic accidents. Motorcyclists are the main victims and represent 64.74%. The males constitute 80.67% of hospitalizations due to tra- ffic accidents. Importantly, the attacks are consistent only 3.52% of admissions. As for the drops, the majority are male (77.06%) and the age distribution extends from 20 to 39 years (33.76%); 73.25% were classified as unspecified falls. The mortality rate (TM) recorded was 2.11%; TM from traffic accidents was 2.86%, while the TM for falls was 1.11%. Conclusion: The profile of hospital mortality from external causes found confirmed falls and traffic accidents as the predomi- nant causes. Given the limited information about falls, difficult to be a better analysis of admissions for such a cause. Motorcyclists young males are the primary victims of accidents. Thus, based on the profile of demand met, such information helps to support the adoption of preventive measures, as well as the appropriateness of hospital services. Keywords: Morbidity, External Causes, Accidents, Falls 27 Incidence of Staphylococcus Aureus In Stethoscopes Of Me- dical Students After Hospital Care Mariélia Barbosa Leal De Freitas; Teresa Maria Barbosa Leal De Freitas, Raíssa Maritan Silva Sousa; Dra Maria Do Rosário Conceição Moura Nunes. Introduction: the stethoscope is a very useful instrument to health care professionals. As it is used directly on the patient, it becomes a potential vector for pathogenic or tolerable micro-organisms. Among the germs carried out by the stethoscope, there is Staphylococcus aureus bacteria, which may cause infections such as: impetigo, folli- culitis, puerperal mastitis, pneumonia, endocarditis and sepsis. The use of an unhygienic stethoscope leads to microbe dissemination and indiscriminate use of antimicrobial agents to treat hospital in- fections. Objectives: To assess the presence of S. aureus in medical student's stethoscopes; To identify bacterias of S. aureus specie and its antibiotics resistance profile. To assess the frequency, stethosco- pe sanitization method and the standard antiseptic chosen by the students. Methods: Quantitative study analyzing 43 samples collec- ted in non-sanitized stethoscopes from medical students. This re- search was approved by Ethics Committee of FACID, according to the resolution 466/2012 of Ministério da Saúde. Participants signed an in- formed consent. Questionnaires regarding to the frequency, method of sanitizing the stethoscope, sharing this instrument and which an- tiseptics are most used were performed. The sample collecting and culture were obtained from stethoscopes, following the assessment of an antibiotics resistance profile through agar diffusion test. The outcomes were analyzed through Origin and Microsoft Excel pro- grams. Results: From 43 samples, 5 suggested presence of S. aureus (12%). Most of the samples with S. aureus (80%) showed resistance to the following antimicrobial agents: Penicillin G, Ampicillin, Strep- tomycin, Tetracycline. Data obtained from the questionnaire are the following: 60% of students sanitize the stethoscope only once a day; 72% share stethoscope; 88% use antiseptic to sanitize the stethos- cope; 96% use alcohol 70% as antiseptic; during sanitizing process, 65% completely disinfect the stethoscope. Conclusion: In the present study, most of the samples did not have S. aureus in its content, however the resistance was analyzed in positive samples. There was prevalence of students that shared and did not sanitize the stethos- cope after hospital care, which increases potential risk of pathogenic germs dissemination and the amount of hospital infections. 28 Incidence of Visceral Leishman's Disease In The State Of Piauí In The Period Of 2008 At 2012 Ananda Sousa Silva; Amanda Moita Carneiro; Flaylson Moura Barros; João Pedro Pinheiro Do Nascimento Vieira; Ânderson Batista Rodrigues; Cíntia Maria De Melo Mendes. Introduction: The visceral leishman's disease or calazar is a chronic infected disease with long periods of fever, weight loss, hepatospe- S46 INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 XXI COMAPI INTERNATIONAL JOURNAL of MEDICAL STUDENTS S47#25IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS XXI COMAPI Abstracts Abstracts nomegaly, recurrent bacterial infection and other symptoms. It is an important zoonosis and if not treated, it has high rate mortality. The protozoon found in Brazil, which causes the disease is the Leishma- nia chagasi and the predominant vector is Lutzomyia longipalpis, also known as birigui or straw mosquito. In urban area, the dog is the main source of infection and in the wild; foxes and marsupials replace it as the source. Piauí was the State with the highest rate of VL incidence of the Northeast Region in 2012. Objectives: The objecti- ve is the LD incidence rate analysis in Piauí during the period of 2008 at 2012, by gender and age. Methods: It is a descriptive study elabo- rated with the information analysis recorded in the Morbid Indicators data bank, which is available on the Department of Health System (DATASUS) of the Health Ministry. The incidence taxes of Leishman's Disease (cases/100.000 habitants) were analyzed on State of Piauí during 2008 until 2012, by gender and age. For the analysis exposi- tion were made graphics and tables on Microsoft Office Excel with the LD incidence rates. Also were made searches in Online Databa- ses: Scielo, Medline and PubMed for article selection between 2008 until 2014. The key words used were: "visceral" and "leishmaniasis". Results: In 2010, Piauí presented the lowest incidence rate (4, 78) of all Northeast States during the analysis period, but, in the following year it presented the highest rate (6, 37) on the period in analysis. The age lower than 1 year was the most committed of both genders and it had the highest rate (48,73) in 2011 and the lowest (27,28) in 2009. The least affected age was between 10 to 19 years for men and 40 to 59 years for women. Conclusion: The State of Piauí was high. incidence taxes of Leishman's disease, specially, for an age below 1 year and to the masculine gender. The vector control through the use of residual insecticides, detection and elimination of reservoirs plus active and passive detection of LD are of fundamental importance for disease control. 29 Intestinal Obstruction By Ovarian Malign Neoplasm: A Diag- nostic Approach Pablo Alberto Nolêto De Freitas; Francisco Mateus Alves De Morais Ferreira; João Paulo Araújo Alves Silva; Amanda Silva De Carli; Luiz Antônio De Alencar; Helder Do Espírito Santo França. Introduction: The ovarian cancer is the most lethal gynecological di- sease. A major cause for this is the asymptomatic evolution in the initials stages (I e II), which causes a late diagnostic in the advanced stages (III e IV). Therefore, the prognostic in this cases are, in ge- neral, negative, which is related a neoplasic dissemination in pelvic and peritoneal structures. Case report: Patient MRS, 47 years old, complains of abdominal pain and constipation. The patient informed that the pains start about twenty days, after flu. Besides, she was affected menorrhagia in the past month and hipomenorrhea in cu- rrent cicle. In the physical examination, she showed an abdominal distension and rigidity and complains of a burning pain in the area. The total abdominal ultrasonography showed a heterogeneous and complex collection in the pelvic area. Without a sure diagnostic, was made an exploratory laparotomy, which detected a multi septated ovarian cyst in the right. In the surgery, was found dissemination in others pelvic and abdominal structures, the cyst and omentum was excised and take to the histopatological exam, what show a peritoneal pseudomixom. The treatments of ovarian neoplasm are basically surgical, which might need of chemotherapy intervention, according the tumor stage. The case report shows rare because the intestinal obstruction causes by the cyst, what can confuses for others obstructions causes, like volvulus, adhesions and intussus- ceptions. However, this case is compatible with recent studies in which the ovarian cancer might be early diagnostic using key signals like abdominal pain and swelling. Despite the report case is about mucinous ovarian carcinoma, associate small lesions restricted to the ovarian, was found peritoneal pseudomixom. The wide heteroge- neity of histological subtypes, allied to clinical aspects and prognos- tics of which one them is a challenge for one clear diagnostic and treatment of ovarian cancer. 30 Invasive Aspergillosis Involving Brain In A Sus Patient: Case Report In A Patient With Diabetes And Leprosy Walber Emanuel Da Cruz Fontes; Almir José Guimarães Gou- veia; Carlos Alberto Rosado Da Silva Filho; Vicktor Bruno Pereira Pinto; João Batista Alvez Segundo; Maria Do Desterro Soares Brandão Nascimento. Introduction: Cerebral Aspergillosis (AC) is a rare disease and poor prognosis even with the use of antifungal agents. This infection of the central nervous system is usually a complication of invasive aspergillosis with blood spread pulmonary focal points mostly in the immunosuppressed. Clinical and laboratory diagnosis of AC is extre- mely complex and has very high mortality, even in cases diagnosed and treated appropriately. Thus, it is salutary an early and accurate diagnosis, given that can save countless lives. Case report: GMP, male, diabetic, leprosy, six months before seeking the health service complaining of headache, started having seizures being transferred to a neurologist who initiated anticonvulsants. After 3 months now presented confusion and was admitted to the Hospital San Marcos. Chest radiography showed pleural thickening with obliteration of the left costo-phrenic sinus; computed tomography (CT) and magnetic resonance imaging (MRI) of the brain showed infarction right cere- bral hemisphere, with luxury hyperemia, for carotid artery thrombo- sis and expansive sphenoid process with cavernous sinus invasion, basic meninges and hydrocephalus. After one month, underwent transsphenoidal biopsy whose pathological result showed inten- se inflammatory process Aspergillus spp. Antifungal (amphotericin B) was used for treatment, but there was worsening of symptoms lowering level of consciousness after intensification of convulsive seizures and vomiting. Submitted to the new neurosurgery, with implantation of subcutaneous Rickmann-Ommaya reservoir with in- traventricular catheter and collected ventricular CSF whose culture was negative. The CT scan showed infarction of the right cerebral hemisphere, catheter into the right lateral ventricle and reduction of hydrocephalus. Taken up antifungal treatment with 5 mg in the reservoir alteranados days. Progressively improved and absence sei- zures using specific. Conclusion: The definitive diagnosis of cerebral aspergillosis should not delay the treatment, which on a reasonable suspicion must be booted. The development of new diagnostic and therapeutic approaches (intraventricular injections of amphotericin B), facilitate to identify which patients are predisposed to diseases associated with aspergillosis. Aspergillosis of the CNS in immuno- compromised patients have a poor prognosis. 31 Investigation of Antiulcerogenic Effect Of The Oil - Resin Co- paifera Multijuga On Chronic Gastric Ulcers Induced By Acetic Acid In Rats Milena Braga Soares Da Silva; James Frederico Rocha Pache- co; Osyanne Timóteo De Sousa; Manoel Dias De Souza Filho, Maria Do Carmo De Carvalho E Martins. Introduction: Gastric ulcer is one of the most common gastrointes- tinal diseases, having a great importance for the costs related to the treatment of its symptoms and complications. The oleoresin of Copaifera multijuga Hayne is widely used in folk medicine as anti -inflammatory, antineoplastic, antiseptic and healing. Objective: To evaluate possible healing action of the oleoresin Copaifera multijuga Hayne in Rattus norvegicus. Methods: Adult male rats were randomly divided into four groups of 5 to 7 animals treated for seven days from the second day after the induction of gastric ulcer by oral adminis- tration, of 1% Tween80 (0.5 ml / 100 g - control) omeprazole 40 mg / kg and oleoresin of Copaifera multijuga Haynes 100 mg / kg (cop100 ) and 200 mg/kg (cop200). The induction of gastric ulcer was per- formed under anesthesia ip with Ketamine 40 mg / kg and xylazine 5 mg/kg by topical application to the stomach serosa of 500 ul 80% acetic acid for 1 minute. At the end of treatment, euthanasia of all animals was performed by administration of an overdose of sodium pentobarbital (100 mg / kg) and their stomachs were removed and opened by the lesser curve to determine the amount of ulcerative lesions (VLU). The lesions were measured considering length, width and depth, whose product is expressed in mm3. Statistical analysis was performed using ANOVA followed by Tukey post-test. This study was approved by the Ethics Committee on Animal experimentation of UFPI (No. 85/2010). Results: No statistically significant differences (p > 0.05) were found in the ulcer lesion volume between groups (control 26.09 ± 3.80; cop100 36.99 ± 7.96; cop200 19.97 ± 7.19; omeprazole 26.69 ± 12.19). The lack of volume reduction of the ul- cers in groups C100 and C200 observed here is discordant with other studies of experimental models using species of the genus Copaife- ra. CONCLUSION: The oil resin Copaifera multijuga Hayne at doses of 100 and 200 mg / kg showed no healing effect in an experimental model of chronic gastric ulcer induced by acetic acid. 32 Juvenile Systemic Lupus Erythematosus: A Study of 31 Cases Vítor Assunção Da Ponte Lopes; Catarina Fernandes Pires; Roberta Oriana Assunção Lopes De Sousa; Suelen Vieira Ri- beiro. Introduction: Juvenile systemic lupus erythematosus is an autoim- mune, with clinical manifestations chronic inflammatory disease. It is rare in childhood, and there is little research in order to investi- gate this disease in Brazil. Objectives: To identify the most common epidemiological, clinical and laboratory characteristics in disease in patients treated at Hospital Infantil Lucídio Portella, Teresina - PI between January 2008 and September 2013. Methodology: This study was descriptive and retrospective. Data were collected from medical records, registered in a file and processed with the SPSS 13.0. Re- sults: 31 charts were analyzed, there was a predominance of females (90.3%) and the majority coming from the interior of Piauí (38.7%). The average age of diagnosis was 126 months (10.5 years) and disea- se duration ranged between 1 and 84 months, with a median of 12 months. The clinical features in descending order of frequency were: fever (90.3%), arthritis (80.6%), malar rash (58.1%) and weight loss (41.9%). Among laboratory abnormalities, pathological casts was the most frequent (67.7%), followed by leukopenia and lymphopenia co- rresponding to approximately 55% and 42% respectively. Antinuclear antibodies was positive in all cases and the main autoantibodies were found anti-DNA (50%) and anti-Sm (27.6%). Conclusion: fever, arthritis, malar rash and pathological casts showed high frequency in the study, followed by leukopenia and lymphopenia. Antinuclear antibodies were positive in all cases and the major autoantibody were found anti-DNA and anti-Sm. The results obtained in this series are for the most part according to the literature studied. 33 Mediastinitis In Patients Undergoing To Coronary Artery Bypass Grafting In A Reference Hospital In Piauí Tiêgo Rodrigues De Oliveira Pires; Caio Bruno De Sousa Ba- rros; Rômulo Ferreira Rocha; Rodrigo Torres Da Costa; Edemir Veras De Carvalho Júnior; Luiz Evaldo De Moura Pádua. Introduction: One of the major risks of Coronary artery bypass graf- ting surgery (CABG) in postoperative period is the mediastinitis. Its prevalence varies between 0.4 and 5%, and it is increased by the presence of pre-existing conditions and other factors such as: obe- sity; diabetes mellitus (DM); CABG using both internal thoracic arte- ries (ITAS); long period of mechanical ventilation; chronic obstructive pulmonary disease (COPD); smoking; long period of preoperative hospitalization; among others. This study aims to establish rela- tionships between factors that may trigger mediastinitis in patients undergoing to CABG. Objectives: Establish relationships between risk factors and mediastinitis in patients undergoing to CABG in reference hospital of Piauí. Methods: Retrospective study from medical records of 303 patients who underwent to CABG between the years 2009 and 2013, obtaining: the number and degree of infection of sternotomy; coronary artery bypass grafting using both internal thoracic arteries (skeletonized without compromising venous drainage by the internal thoracic veins); DM; chronic obstructive pulmonary disease (COPD). The observations were analyzed using the Spearman's correlation test (rs) with p-value <0.05 for significance. The project was approved by the Research Ethics Committee of the São Marcos Hospital (Case No. 513 488 of 02/11/14). Results: The double mammary artery was used in 47.8% of patients. DM and COPD, were recorded in 38.6% and 7.3% of patients, respectively. No correlations with such risk fac- tors were found. Of 303 patients who underwent to CABG during the studied period, only 2 (0.66%) developed mediastinitis. Both were reoperated for cleaning the mediastinum and were discharged in good condition. Superficial sternal infections were observed in 4.6% of patients and were treated with antibiotic therapy, with complete resolution of the condition. It is suggested, on the basis of the- se data, the use of skeletonized double mammary arteries has no negative impact on the development of mediastinitis. Conclusion: Although the literature is emphatic in linking the use of double ITAS, DM and COPD with mediastinitis, it has not been proved in this refe- rence hospital studied. Keywords: Sternotomy, DM, COPD, internal thoracic artery. 34 Morel-Lavellée: A Case Report Luis Eduardo De Oliveira Lima; Antonio José Silva Meneses Filho; Anderson Batista Rodrigues; José Osvaldo Gomes Dos Santos; Marcelo Barbosa Ribeiro; Lina Gomes Dos Santos. Background: Morel-lavellée lesion is a traumatic separation between the skin and the subcutaneous tissue adjacent to fascia causing rup- ture of small blood vessels, resulting in a cavity which can be filled with blood, lymph or fat, sometimes necrotic and/or colonized with infectious agents. Usually, there is a formation of granulation tissue which can be organized in a pseudocapsule, causing the persistence of collections. Lesions can be painful or asymptomatic, most often affecting the lateral thigh, involving the greater trochanter. The diag- nosis is usually based on physical examination, when is possible to observe a greater mobility of the skin, subcutaneous fluctuation and decreased local sensitivity. MRI is the imaging test of choice on the evaluation of these lesions. The treatment is still controversial, but methods of aspiration, injection of sclerosing agents are used, as well as open or closed surgical drainage with debridement in the presence of fat and/or hematoma. Case report: Male patient, 43 years, refers appearance of nodulation on the lateral side of the right thigh for four years. He complains of severe pain in the progressive site, with difficulty in performing his usual activities. He presents a history of trauma in the right hip by a motorcycle accident eight years ago, when it underwent neurosurgery for head trauma. Phy- sical examination and MRI showed that it was a nodular lesion in the subcutaneous tissue of the thigh, indicative of Morel-Lavellée in- jury. Surgical procedure was performed and the macroscopic stu- dy of the specimen showed a nodular tissue formation measuring 13.5 x 8.7 x 3.5cm, whose histological study showed fibrous cyst wall filled by organized hematoma, xanthomatous histiocytes and cholesterol crystals, consistent with the diagnosis of Morel-Lavellée lesion. Conclusion: Morel-lavellée lesion was first described by the French physician Maurice Morel-Lavallée in 1853, affecting the hip and pelvis. It is hardly diagnosed in the first clinical evaluation and it has a high risk of infection, which was not observed in the case reported here. Exams can simulate a malignant neoplasm clinically and radiologically. Having diagnostic suspicion of this injury, the he- matoma should be drained and necrotic material debrided, because this injury may complicate with secondary infection. There are some controversies regarding the recommended definitive therapeutic ap- proach, however, in this case we opted for open surgical drainage, evolving without signs of infection two months after the diagnosis of this rare entity. 35 Mortality Of Diabetes Mellitus: Epidemiological Profile Rienny De Sousa E Silva; Rielly De Sousa E Silva; Lorayne De Araujo Costa Pereira; Antônio Guilherme Chagas Feitosa; Cíntia Maria De Melo Mendes. Introduction: Diabetes Mellitus (DM) is a metabolic disease charac- terized by hyperglycemia resulting from defects in insulin secretion and/or reduction of local tissue response. It can be classified into type I, autoimmune process; and type II, based on the interaction between hormonal resistance and insufficient secretory response. Chronic hyperglycemia favors the emergence of damages: retino- pathy, nephropathy, peripheral neuropathy, cardiovascular disease and dyslipidemia. According to the CDC, it was the 7th leading cause of death in the USA in 2010, however, it may be underreported as a cause of death. Objective: To evaluate the specific mortality rate of DM (SMR) according to age, sex and region of Brazil, between S48 INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS XXI COMAPI S49#26IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS XXI COMAPI $50 Abstracts Abstracts 2007 to 2011. Methodology: It was collected data from the Mortality Information System relating to SMR of DM, defined as number of deaths from DM/100000 inhabitants. It was delimited in 2007 until 2011, because this is the last year with available information, and was analyzed the differences between the brazilian regions and sex of the patient. Besides articles of bases CDC and MEDLINE published between 2013-2014, in English, documenting the DM. Keywords used: diabetes mellitus, diagnosis. Studies that addressed other topics and date before 2013 were excluded. Results: Northeast region posses- sed the largest SMR of DM, with higher values in females (female/ male, from 2007 to 2011, respectively: 28.3/22.0, 29.5/23.6, 30.2/24.1, 31.7/25.7, 32.9/27.1). In descending order by regions in 2007, it has: northeast (28.8 with the state of PE in 1st place. In other years, PB took 1st.), south (25.9 RS), southeast (25.8 RJ), midwest (19.1 - MS. In 2011, MT took 1st), north (13.9 TO). This order remained constant, varying only the value of SMR, which showed an upward trend. In 2011, there was a rate of 36.6 in the northeast; 30.6, south; 28.6, southeast; 22.6, midwest and 21.8, north. The highest values , regarding age, were observed in patients 60 years or older, with a mean of 204.9 (2007); 212.1 (2008); 212.8 (2009); 213.4 (2010) and 223.8 (2011). Piauí remained at 6th of the northeast states. Con- clusion: DM has emerged as a public health problem of great mag- nitude. Thus, it is necessary to adopt more effective measures of population education regarding the prevention of acute and chronic complications, to improve the quality of life of patients and reduce the burden of the health system. 36 Ollier Disease: Case Report Dionline Borges Paulo; Bruna Rodrigues Barbosa; Luís Ricar- do Da Luz Borges; Jerúsia Ibiapina Oliveira; Lina Gomes Dos Santos; Marcelo Barbosa Ribeiro. Introduction: Enchondromatosis or Ollier disease (OD) is defined by the presence of multiple enchondromas and characterized by an asymmetric distribution of cartilage lesions, which may exhibit wide variability in size, number, location, evolution, age of onset and diag- nosis. The estimated prevalence of OD is 1/100 000 and affects long tubular bones, particularly the tibia, femur, and / or fibula, flat bo- nes, especially the pelvis, may also be affected, causing deformities and shortening of bone tissue affected. In some instances, bone may be shortening the only clinical sign of disease. Are called Maffucci syndrome when associated with multiple cutaneous hemangiomas and intracranial gliomas. We present a case of Ollier disease, which sought medical assistance due to a condition of bone fracture. Case report: Female, 29 years, born and resident in Teresina-Pl, with a history of bowing of the femur and tibia from childhood. Sought medical attention because of subtrochanteric fracture of left femur, which was confirmed by radiographic examination. The patient was then referred for surgical treatment, curettage of the lesion, fracture reduction and fixation using metal plate was performed. The study of bone tissue histopathology revealed benign chondroid neoplasm composed of clusters of mature chondrocytes and without atypia, arranged in pairs trabeculae immersed amid abundant cartilage ma- trix, confirming that it was enchondroma. Final thoughts: The diag- nosis of Ollier disease is based on clinical and radiological findings. There are no different to that entity biochemical or genetic markers. Most cases are sporadic, but families with several affected members have been reported as a study involving 29 families with multiple exostoses, has suggested the presence of gene mutations related to members of the family of tumor suppressor genes EXT1 (44%), EXT2 (28%) and EXT3 (28%). 37 Post Streptococcal Glomerulonephritis Progressing With Growing: A Rare Outcome Dandara Coelho Cavalcante; Pedro Henrique Piauilino Ben- vindo Ferreira; Ricardo Lira Araújo; Vítor Assunção Da Ponte Lopes; Roberta Oriana Assunção Lopes De Sousa. Introduction: Acute post-streptococcal glomerulonephritis should be seen as a late sequel of a kidney infection by specific strains of beta hemolytic streptococci group A (Streptococcus pyogenes). The strains called "nephritogenic" may be present in pharyngitis or streptococcal pyodermitis, such as a nonbullous impetigo and erysipelas. The ty- pical presentation is of sudden onset of macroscopic hematuria, oli- guria, edema and elevated levels of blood pressure. Half of the cases occur with altered renal function, with possible moderate retention of nitrogenous compounds. However, it is estimated that only 1% of cases evolve rapidly progressive. Case report: Female, eight years old, with a history that two months ago had purulent lesions in the right foot and knee. After six weeks she evolves with headache, macroscopic hematuria, besides edema of the lower members and abdominal. Laboratory tests: urea: 164, creatinine: 12,1; proteinuria: 68.6 mg/kg/24h, creatinine clearance: 6.9; ASO: 1600. Admitted in the intensive care unit for hemodialysis. It was performed renal biopsy that evidenced acute diffuse endocapillary glomerulonephritis with epithelial crescents in 100% of glomeruli represented, then it was initiated immunosuppressive therapy with pulse of cyclophospha- mide plus corticosteroids. She was discharged from hospital after 113 days, remaining with peritoneal dialysis, three times a week until the present day. Conclusion: The relevance of the case consists in the fact of reporting a rare and severe outcome of a relatively common disease. Therefore, it is necessary that professionals are always attentive to indications for renal biopsy, and thus establish the appropriate treatment early. 38 Prevention Of Blindness In Patients With Temporal Arteritis: A Window Of Opportunity Jéssica Barbosa Cronemberger; Luíza Sá E Rêgo Tupinambá; Giovanna Peressin Da Paz; Paloma Almeida Santana; Nara Lí- via Rezende Soares; Raíssa Maria Sampaio Neves Fernandes. Introduction: Temporal arteritis is a systemic vasculitis of large and medium-sized vessels that affects cranial arteries originating from the aortic arch, typically the temporal artery. There is a higher preva- lence in women over 50 years. Severe headache, visual disturbances, jaw claudication, polymyalgia rheumatica and constitutional symp- toms are the most characteristic clinical manifestations. The diagno- sis is based on the classification criteria of the American College of Rheumatology 1990 include 1- Onset after age 50; 2-Recent or new headache; 3- Abnormalities of the temporal artery; 4-ESR> 50 mm / 1st hour; 5- Compatible artery biopsy. Positivity in 3 of the 5 criteria confirms the diagnosis. Glucocorticoid in high doses usually produ- ces dramatic response to therapy, but immunosuppressants may be required. This report is an alert to the suddenness of visual impair- ment in patients with temporal arteritis. Case report: ELCB, female, 83 years, referred intense frontal headache, not measured fever and dysuria during 15 days. Investigations: ESR = 100mm / 1st hour; CRP = 60 mg/L; urinalysis = 32 pus cells / field; Urine culture: positive for E. coli; tomography was normal. After treatment with norfloxa- cin, the patient reported improvement of dysuria, with persistent fever and headache. She reported appearance of mist in the visual field with normal ophthalmologic evaluation. The day after the seem ophthalmological, the visual deficit worsened, evidencing anterior ischemic optic neuritis. Diagnosed with temporal arteritis, hospitali- zation and emergency pulse therapy with methylprednisolone 1 g / day for 3 days were indicated. She was discharged in good general condition without fever or headache, with some visual impairment, using prednisone 50 mg / day until the stabilization of the visual framework and normalization of inflammatory markers, followed by gradual dose reduction. After seven months of onset, was in stable condition without steroids and without visual deterioration. The fo- llowing month, she developed pain in the scapular and pelvic girdles and ESR = 110mm / 1st compatible with polymyalgia rheumatica waists. Prescribed prednisone 20 mg / day with remission. Currently taking prednisone 5 mg / day, with normal inflammatory markers, no complaints. Conclusion: Early recognition of visual impairment and prompt institution of therapy in patients with temporal arteritis can result in blindness prevention and better overall prognosis of this condition. 39 Profile Of Patients Undergoing To Coronary Artery Bypass Grafting In A Reference Hospital In Piauí Caio Bruno De Sousa Barros; Tiêgo Rodrigues De Oliveira Pires; Lívio Pereira De Macêdo; Manuel Pinheiro Barbosa Neto; Edemir Veras De Carvalho Júnior; Luiz Evaldo De Moura Pádua. Introduction: Alternative treatments for coronary artery disease are widely procedures used in the world. However, on critical analysis of several recent studies and meta-analyzes, surgery Coronary artery bypass grafting (CABG), according to current guidelines, has better results in the medium and long term, allowing for remission of an- gina symptoms, as well as providing a increase in life expectan- cy of patients. In Piauí, information is scarce on the perioperative characteristics associated with CABG. The objective of this research was to establish the profile of patients undergoing to CABG at São Marcos Hospital in Teresina-Pl. Objectives: Describe the profile of patients undergoing to CABG in reference hospital of Piauí. Methods: Retrospective study performed by the medical records of patients who underwent to CABG between 2009 and 2013, by analyzing: age, gender, preoperative comorbidities, clinical status, type of surgery, calculated EuroSCORE, and evolution to hospital discharge or death. Observations presented as frequencies were analyzed by chi-squa- red test (c2) and the qualitative nature variables submitted to the Spearman's correlation (rs) with p-value <0.05 for significance. The project was approved by the Research Ethics Committee of the São Marcos Hospital (Case No. 513 488 of 02/11/14). Results: 303 CABG procedures were performed in the period, registering a mortality of 6.6%, they are not associated with the genders (p = 0.78). The me- dium risk estimated by EuroSCORE of patients with death outcome was 9.84%. The variables correlated with death were: Diabetes Melli- tus (DM) (p=0.01), Chronic Obstructive Pulmonary Disease (COPD) (p = 0.01) and EuroSCORE (p <0.01). The comorbidities that were not associated with mortality in this study were: Hypertension (HBP) (p = 0.33), unstable angina (p = 0.13), Acute Myocardial Infarction (AMI) (p = 0.68), Cerebrovascular Accident (CVA) prior (p = 0.72), extra-cardiac atherosclerotic vascular disease (p = 0.08) and ejection fraction (EF) (p = 0.18). Although Unstable Angina, extra-cardiac athe- rosclerotic vascular disease and EF comorbidities have not reached statistical significance, that may have negatively influenced in the death outcome due low p-values. Conclusion: DM and COPD were the comorbidities that more contributed to death outcome. The EuroSCO- RE was associated predictively with death among patients. Keywords: CABG mortality, COPD, DM 40 Psychosis Secondary To Clinical Conditions Clara Maria Barbosa; Máximo Peixoto Rocha Neto; Ana Keline De Moura; Ilana De Meneses Silva; Marciano Reis Felinto; Krieger Rhelyni De Sousa Olinda. Introduction: Psychosis Secondary to Clinical Conditions is charac- terized by hallucinations or delusions due to the direct physiologi- cal effects of a general medical condition, not explained by another mental disorder or in the course of a delirium. There are few relevant epidemiological data of this condition, since they are directly rela- ted to organic pathology. Also, it is suggested that the syndrome is underdiagnosed in the area of general health care. The objective of this paper is to describe a case of psychosis secondary to a medical condition, whose therapeutic approach should be differentiated from the other psychotic patients. Case report: Patient 15 year old male presented bullous itchy rash all over the body; high fever and un- controllable vomiting after five days; severe headache two days later, prompting him to seek emergency department. On physical examina- tion, the patient was in good general condition, tachypnea, hypoac- tive, pallid, with pruritic erythematous lesions throughout the body. On the 2nd day of hospitalization, he developed decreased level of consciousness, weak response to verbal stimuli and lethargy. Hy- dration, symptomatic treatment, ceftriaxone, acyclovir, mannitol and dexamethasone were administered. On the 6th day of hospitaliza- tion, still no improvement, a urinary catheter of relief was instituted due to urinary retention. On the 7th, the patient had psychomotor agitation and lethargy, adding chlorpromazine to the prescription. In the 8th, chlorpromazine is suspended and haloperidol is introduced. On the 9th, the patient is discharged from the ICU and is sent to the infirmary, when presented with mental confusion, psychomotor agitation, high volume of voice, echolalia, reverb thought, shaped lesions crust over the body, photophobia and insomnia. On neuro- logical examination, the patient had ataxia. He evolved with little improvement and drowsiness. On the 12th day of hospitalization, he was discharged for guidance Neurologist, reducing the haloperidol only for nighttime dose. After 5 days, there was remission of psycho- tic symptoms. Diagnostic hypothesis: complicated with encephalitis and psychiatric manifestations varicella. Final thoughts: This paper presents a case of psychosis secondary to medical conditions, which usually manifests acutely and has different organic etiologies. Thus, it is crucial to discriminate organic etiology to have adequate thera- peutic approach and improved prognosis. 41 Report Of Paraurethral Cyst On Girl: Is The Surgical Excision A Secure Option? Humberto Ferreira De Castro Filho; Daniel Santos Rocha So- bral Filho; Flávia Vanessa Carvalho Sousa Esteves; João Paulo Araújo Alves Silva; Helder Damásio Da Silva; Eulalio Damázio Da Silva Junior. Introduction: Para(peri)urethral cyst in women is rare, mainly in newborns and infants. The paraurethral cysts in female newborns does not have an elucidated etiology, it may have an origin from mother's hormonal factors or embryogenic. These cysts can be as- ymptomatic, obstructive or yet show discharge of secretions with fetid odor. In the literature, there is not a consensus in the treatment of this cyst, varying from observation, incision, marsupialization or an aspiration with needle. It will be reported a case of paraurethral cyst, in an infant, surgically treated with cyst excision. Case report: Female patient, 12 months old, with paraurethral cystic lesion, iden- tified 2 months ago, and effort to urinate. USG of the urinary tract showed no signs of infravesical obstruction and discarded associated anomalies. Due to the absence of obstruction, has been proposed topical use of estrogen in vaginal cream for 3 months, observing important reduction of cystic mass kept for 3 months post treatment. Later, the patient showed, besides the cystic lesion, discharge of fetid odor, in lower volume, from the paraurethral cyst, partially responsive to topical estrogen and without inflammatory or infec- tious signals. To the 2 years and 3 months old, due to the lesion persistence and the fetid odor discharge, was performed a surgical excision of the paraurethral cystic lesion by vaginal approach aiming the complete excision of the secretive paraurethral gland, instead of a simple aspiration or incision. After the vesical catheterization with a Foley catheter, was performed a U-shaped incision in the anterior vaginal wall and dissection of the cyst being careful to not damage the urethra e and does not move toward the urinary sphincter. The paraurethral cyst was isolated and completely excised, with discre- te lesion of the distal urethra, which was easily reconstructed. The patient showed a temporary urinary urge incontinence, returning to the use of diapers for 2 months after the surgery, recovering, spontaneously, the continence and without recurrence of the cystic lesion. Final considerations: The treatment of the paraurethral cyst is not well defined and most reports indicate spontaneous resolution of cystic lesions. In this report, it was demonstrated that, despite the small anatomical structures due to the age of the patient, the complete excision of a recurrent glandular paraurethral lesion, with fetid discharge, even in small child, it's a secure option and with an excellent surgical result. 42 Scapular Chondrosarcoma: Case Report Ânderson Batista Rodrigues; Antonio José Silva Meneses Fil- ho; Luis Eduardo De Oliveira Filho; Jerúsia Oliveira Ibiapina; José Osvaldo Gomes Dos Santos; Lina Gomes Dos Santos. Background: Chondrosarcomas are malignant neoplasms which ex- hibit a pure chondroid differentiation and show a vast variation in the histological and clinical aspects. They account for 20% of primary bone tumors and usually affect over-50-year-old people. They offen occur in the long bones, so the incidence of scapular chondrosar- coma is rare. In general, it is a slow-growing tumor, but it can lead to metastasis. If we preserve the safety margins, surgical treatment shows us good survival rates. We present the case of a conventio- INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS XXI COMAPI $51#27IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS XXI COMAPI $52 Abstracts Abstracts nal scapular chondrosarcoma in an young patient. Case report: A 30-year-old male presented to a care service with pain and functional limitation on the left shoulder girdle. Physical examination showed a wide and mobile tumor, which was irregular and painful when it was pressed on the left scapular area. Patient reported a prior resection of chondroid lesions on the same location in June 2005. A Computer Tomography (CT) showed an osteolytic lesion with soft tissue component affecting all the left scapula. The biopsy of the bone lesion diagnosed a malignant tumor consistent with well-diffe- rentiated chondrosarcoma, whose resection margins were neoplasm free. So, it was indicated an internal total scapulectomy with a par- tial claviclectomy and grand dorsalis shred. Histological study of the surgical specimen showed a lobulated and bright intraosseous sca- pular lesion, measuring 18.0 X 11.0 x 7.0cm with cortical rupture and invasion of soft tissues, what confirmed the diagnosis of a conven- tional chondrosarcoma. Conclusion: The histopathological chondroid neoplasms diagnosis is challenging, whereas histological features of benign and malignant neoplasms are overlapped. However, the co- rrelation between clinical, radiological and histopathological findings allow an accurate diagnosis in most cases, particularly when there is an unusual topography involvement, as we seen in this case. 43 Sensory Manifestations In Patients With Devic's Disease: Report Of Two Cases Rozangela Dos Santos Veloso; Carlos Fernando Rodrigues Batista; Luiz Euripedes Almondes Santana Lemos; Gregory Ramon Bandeira Da Silva; Raimundo Nonato Campos Sousa. Introduction: Devic's disease has inflammatory and demyelinating nature. It is characterized by optic neuritis and myelitis. Typically manifests as unilateral or bilateral loss of visual acuity, severe pa- raplegia or tetraplegia with sphincter dysfunction and impairment of well defined sensory level, pain and spasms of the trunk and extremities. The prevalence among all other demyelinating diseases of the central nervous system (CNS) is only 1.5%. It is more common in women, with peak incidence ranging from 35 to 45 years. Affec- ted patients have an IgG autoantibody (NMO-IgG auto) targeting the protein Aquaporin Channel 4. CASE REPORTS: 1) Patient 39, female, white, lives in Teresina. 15 months ago She noticed severe reduction of visual acuity in the right eye. 4 months ago she developed pa- raesthesia and reduced tactile sensitivity in the left arm that exten- ded to other areas of the body. Subsequently, there were transient reduction in visual acuity in the left eye. Associately, She started incontinence and constipation. On examination, we found changes in the optic nerve, slight reduction of strength in the left limbs and painful and sensory sensitivities and presence of Lhermitte's sign. Magnetic resonance imaging (MRI) of the cervical spine were re- quested, which showed hyperintensity on T2 in the central portion of the cord with mieloedema extending from C2 to C5 and, among other tests, serum antibody to aquaporin-4, with positive results. 2) Patient 19, female, white, resides in Parnaíba. 8 months ago, She started low back pain. She evolved with urinary retention and difficulty in walking. She refers episode of diffuse muscle spasms. In recent months started throbbing bitemporal headache, bilateral retro-orbital pain, blurred vision, muscle strength and reduced tactile sensitivity in the lower limbs. In the current survey, there is grade 5 muscle strength and reduced tactile sensitivity in the lower limbs. She can not stand. Among other tests, MRI of spine which showed hyperintense T2 signal in the central portion of the spinal cord in vir- tually its entire length were required, and measurement of antibody to aquaporin-4, with positive results. Final thoughts: The Neuromye- litis Optica is an autoimmune disorder of the central nervous system rare. The dosage autoantibody increased to 4 aquaporina- became important diagnostic criteria. 44 Severe Adverse Drug Reaction After Ending Of Dual Therapy For Hepatitis C: A Rare Occurrence Luíza Sá E Rêgo Tupinambá; André Freitas Nunes; Lorena Araújo Luz; Matheus Filipe Oliveira Azevedo; Vítor Assunção Da Ponte Lopes; Conceição De Maria Sá E Rêgo Vasconcelos. Introduction: The classical treament for hepatitis C involves peg in- terferon alfa and ribavirin. The use of these drugs may be involved with the occurrence of systemic, psychiatric, hematologic, and skin adverse reactions, like rash. The acute rash, morbilliform or scarla- tiniform, that is usually urticarial and sometimes accompanied by itching, may be associated with general symptoms, such as fever, arthralgia and headache. The clinical develops suddenly, starting at variable time. This report has the objective of describing a dual therapy-related adverse drug reactions and to alert health care pro- fessionals to monitor the occurrence of adverse reactions even after the end of treatment. CASE REPORTS: Female patient with genotype 3 hepatitis C virus has undergone dual therapy with interferon and ribavirin for 24 weeks. During the treatment, adverse effects, such as anorexia, asthenia, depression, anemia and leukopenia, occurred, but were solved without discontinuation of the treatment. One day after the conclusion of the dual therapy, she presented itching and erythematous lesions on the scalp progressing to neck, trunk and limbs. Therefore, an acute generalized scarlatiniform erythema oc- curred. She denies the use of other medications or substances that could justify the rash. At first, utilized sunflower oil, petrolatum so- dium, fexofenadine and clobetasol propionate cream. With 1 week of treatment and no remission of symptoms, initiated prednisone 20 mg/day orally. Laboratory tests (07/03): hemoglobin: 10.2 g / dl; hematocrit: 31.2%; leukocytes: 4,900 / mm with eosinophilia of 29%; platelets: 150,000 mm ALT: 47 Histopathology consis- tent with drug eruption. Her symptoms in two weeks disappeared without sequelae. Final thoughts: This case describes the occurrence of serious adverse drug-related reaction to hepatitis C dual therapy, occurring after the end of treatment. This is an unusual condition, since the peak incidence of these reactions occurs in the first two weeks after the start of the drug. Then, it is necessary for physicians to remain vigilant to possible adverse reactions even after the end of treatment. 45 Study About The Occurrence of Dengue Hemorrhagic Fever (DHF) In Teresina, In The Period of 2007-2012 Augusto César Evelin Rodrigues; José James Lima Da Silva Segundo; Joycce Huanna De Souza Silva. Introduction: Dengue is one of the most important diseases in Brazil. A clinical manifestation of it that deserves attention is the Dengue Hemorrhagic Fever (DHF), which has a high mortality rate. Divided into 4 grades, DHF is diagnosed clinical and laboratory assessment, and presents signs of hemorrhage, as well as the usual symptoms of dengue. Objectives: To evaluate the occurrence of DHF cases in Teresina during 2007-2012 by sex, age, grade, school, time of year, area, mortality and lethality. Identify major complications and evo- lutions. Methods: Epidemiological study of secondary quantitative data taken from the Notifiable Diseases Information System (SINAN). All data according to gender, age, grade, race, education, time of year, area, mortality, and lethality were analyzed. Data were grou- ped into Microsoft Excel spreadsheets and displayed in graphs and tables. Results: We found 109 reported cases of DHF in the period. 67% of them were female. 45% of those aged 20-60 years and 28% at 5-9 years with lower participation in other age groups. 57.8% oc- curred in DHF grade II and others, altogether reached 34%. 38.5% of the patients analyzed were illiterate or had only incomplete 1st to 4th grade and 11% had completed higher education. It was noticed that 89.9% of cases occurred in the period from March to July, and that 60% of cases were recorded in 2007. 97.3% of cases occurred in urban areas. Patients with DHF represent from o to 2% of the total cases of dengue. 89% were cured and 9.2% died. Conclusion: Preva- lence in females due to higher predisposition, and aged 5-9 years on low immunogenicity. The higher the degree study, more prevention and education. 90% of cases occurred in the period from March to July, coinciding with the rainy season in Teresina, setting a seasonal disease. There was a predominance of cases in 2007, which can be explained by the introduction of DENV 2 virus in Teresina, which has great potential for developing DHF. It was noted that the number of cases has increased in recent years due to greater chance of develo- ping this clinical form, because most of the population have already had at least one dengue infection. It is essentially an urban disease, where there is greater circulation of the virus and the mosquito. It was also observed, highly lethal. 9% of the patients died. 46 Study Of The Occurrence of Cases Of Meningitis In Teresina-Pi In The Period 2007-2012 Joycce Huanna De Sousa Silva; Brunna De Sousa Silva; Maylla Moura Araújo; Felipe Gomes Da Silva; Talisia Farias Castro; Augusto César Evelin Rodrigues. Introduction: Meningitis is an inflammation of the meninges, which may originate through the bloodstream or as a result of other in- fections, being a reportable disease. It is a serious and endemic disease that can affect individuals of any age and is caused by va- rious infectious agents. Objectives: To analyze the occurrence of ca- ses of meningitis in Teresina 2007-2012; identify the distribution of cases by age group (FE) and sex; raise the mortality and mortality of meningitis and to investigate the main etiological agents of the di- sease. Methodology: The present study is an epidemiological, cross- sectional, quantitative and retrospective. The data were collected from an active search in the databases of the Information System for Notifiable Diseases (SINAN) and Interagency Network of Health Infor- mation (RIPSA). We analyzed all cases according to sex, EF, etiology, mortality and lethality in the period from 2007 to 2012 in Teresina-Pl. The following data were tabulated through the Excel spreadsheet and PrismaⓇ. Results: Of the 1701 reported cases, 196 (11.52%) occurred in 2007, 384 (22.57%) in 2008, 502 (29.51%) in 2009, 243 (14.28%) in 2010, 213 (12.52%) in 2011 and 163 (9.58%) in 2012 cases were predominant in males, with 58% in 2008, 59% 2009, 61% in 2010, 55% in 2011 and 60% in 2012 and an equal number of cases in the years 2007, 2007, 2010, 2011 and 2012, the FE greater number of cases was 20-39 years and in 2008 and 2009 was 5-9 years. According to the etiology, 83 (4.87%) cases were ignored / white, 1 (0.05%) type meningococcemia, 11 patients (0.64%) meningococcal 5 (0.29%) tuberculosis, 163 (9.58%) Bacterial, 442 (25.98%) unspecified, 935 (54.96%) Viral, 33 (1.94%) of Other etiologies, 2 (0.11%) Haemophilus influenzae and 24 (1.41%) for pneumococcal. Of the total cases, 1586 were cured, 73 and 37 appeared for death as unknown. The mortality rate in the study period was 4.3%. Conclusion: The high incidence of cases in the period occurred in males, in EF 20-39 years and as a cause viral meningitis, which had in 2009 a larger number of cases. This same trend was obtained in relation to the etiology of the cases, with regard to bacterial meningitis, pneumococcal and unspecified. The mortality rate is still considered high and low lethality throug- hout the study period, with a materially stable from 2007 to 2010 and declining proportion in other years. 47 Subungual Epidermoid Carcinoma: A Case Report Amanda Tauana Oliveira E Silva; Rayra Gomes Ribeiro; Antô- nio José Silva Meneses Filho; Ana Lúcia Nascimento Araújo; Lauro Lopes Lourival Filho; Sabas Carlos Vieira. Introduction: Tumors of nail bed are rare and are associated with chronic inflammation secondary to trauma, infection or exposure to ultraviolet radiation. Squamous cell carcinoma is the most common tumor of the nail bed. Onychomycosis can be the presenting symp- tom, as well as a predisposing factor in patients with occupational risk. The early detection of these tumors offers the best chance of preserving the maximum hand function. Treatment modalities in- clude chemotherapy, Mohs surgery, and amputation. Case report: Patient, 50, male, no history of hypertension, diabetes or smoking. Sought the dermatology service in June 2014 for a lesion on the first finger of the right hand four years ago. Reported having conduc- ted several topical treatments without success. Clinical examination showed a granulomatous subungual bleeding lesion in the proximal third. In the axilla there were no suspicious lymph nodes. A biopsy of the tumor, which showed the presence of carcinoma metatypical. The chest radiograph was normal. Was performed held excision of the nail matrix and bed with biopsy freezing margins. We opted for the shortening of the phalanx and flap in VY pulp to preserve half the length of the distal phalanx and the distal interphalangeal joint of the thumb. Immunohistochemical study revealed invasive squa- mous cell carcinoma G2, HSM-3415-pan-keratin positive, p63 positive and negative epithelial glycoprotein. No adjuvant treatment was in- dicated. Patient had an uneventful recovery and two months after surgical treatment lies in tracking. Conclusion: The presence of an expanding lesion in the subungual region that does not respond to medical therapy should draw attention to the diagnosis of malignant lesion, avoiding delays in diagnosis as in the present, in which case four years have passed since the beginning of symptoms to establis- hing the correct diagnosis. 48 Surgical Correction Of Ectopic Penis And Ectopic Scrotum Associated With Bilateral Orchidopexy Daniel Santos Rocha Sobral Filho; Luis Gustavo Pinto; Lucas Arrais Chaves Nascimento; Francisco Alves Vieira De Sá Júnior; Helder Damásio Da Silva; Eulálio Damazio Da Silva Júnior. Purpose: Various congenital genital anomalies affecting males. Among them, cryptorchidism is the most common. The bilateral cryptorchidism constitutes one third of cases of anomalies. Others diseases are the ectopic penis and ectopic scrotum, although being rare. Ectopic penis is more reported in penoscrotal transposition ca- ses. The case that will be reported has clinical importance by the rarity of the association between ectopic penis, ectopic scrotum and bilateral cryptorchidism. Case report: Male patient, 10 years, with ectopic penis and ectopic scrotum located in the perineal region, without penoscrotal transposition and with bilateral cryptorchidism. He presented associated skeletal deformity of pubic shaft type with ankylosis of the knees, and no association with abnormalities of the urinary tract. MRI demonstrated cryptorchid and atrophied testes. The left testicle was located near the base of the penis and the right at inguinal canal. Previously, the child had undergone a left orchidopexy. It was unsuccessfully due to the ectopic location of the scrotum. The surgery was initiated by right inguinal incision, aiming to mobilize the right testicle which, however, was only possible to the anatomical position of the scrotum, and not to its real ectopic position. The procedure continued with surgical correction of ectopic penis and ectopic scrotum, which was initiated by an inverted Y inci- sion. It was complemented inferiorly to separate penis from scrotum. Then, penis was mobilized from perineum to its anatomical position. A flap was mobilized from perineal scrotal skin to setup a scrotum adjacent and inferior to the penis and to form the median raphe and the two hemiscrotums. After flap mobilization, the orchidopexy was initiated by right testicle positioning on right hemiscrotum and was continued by left testicle disposal on left hemiscrotums. The penis was sutured to the skin of pubic region. The scrotal flap with the testes positioned was fixed in its anatomical position. At least, a postectomy was performed and the perineal skin was sutured, which was free of tension due to non-removal of scrotum-perineal skin excess. Final considerations: Ectopic penis and ectopic scrotum associated with bilateral cryptorchidism are rare congenital anoma- lies and have few reports in the literature. The penis and scrotum positioning surgical correction was essential to treat cryptorchidism and to promote a gain in patient self-image. 49 Syndrome of Twin-Twin Transfusion: Case Repost Eduardo França Do Vale Chaves Filho; Anielle Memória Da Silva; Diego Ricardo Guimarães Rodrigues; Flávia Cristina Araújo Siqueira; Cintia Maria De Melo Mendes. Introduction: The syndrome of twin-twin transfusion (TTTS) occurs in up to 30% of monochorionic twin pregnancies diamnióticas. It is characterized by the unbalanced flow of blood of a fetus (donor) to another (recipient) through placental vascular anastomoses. Severe forms of the disease invariably show the anidrâmnio sequence (fe- tus donor) polyhydramnios (receiver fetus), with or without modifi- cation dopplervelocimetric fetoplacental, hydrops in the recipient or death of one or both fetuses. Case report: Female 32 years G6P4A0, monochorionic diamniotic twin pregnancy at 24 weeks gestation with late Doppler sonographic diagnosis of TTTS, due to incomplete realization of prenatal care. Performed a procedure to amniodrena- gem as a palliative measure, evolving into premature birth of two male children on the third day of hospitalization. The birth weights of the newborns were 1,180 and 480 grams (g) send to the fetus of INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 XXI COMAPI INTERNATIONAL JOURNAL of MEDICAL STUDENTS S53#28IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS XXI COMAPI $54 Abstracts Abstracts less weight (fetal donor) was death in the neonatal ICU. Patient had no complications during puerperium. Discussion: Considering the ca- ses with two live fetuses at the time of diagnosis, the risk of death of at least one of them in the expectant management is 70-100%. On these occasions, neurological damage occurs in 25-35% of survivors, resulting in hemodynamic disturbances and/or prematurity. Mana- gement options for patients with TTTS include serial amniodrenagem the septostomy and ablation of placental vessels with laser (AVPL). The first two are aimed at reducing polyhydramnios and prolong gestation, whereas the latter aims to inactivate the anastomoses that favor the development of the disease. Despite evidence in the medical literature about the best results obtained with vascular abla- tion, most centers for fetal therapy in our country still uses the palliative options amniodrenagem septostomy and following up on these patients because AVPL is available only in large centers where all necessary equipment is available. Final thoughts: We can see the need for the training of medical professionals to perform the correct and early ultrasound diagnosis, and investments in fetal medicine centers in Piauí for the treatment of TTTS using the ablation of pla- cental vessels with laser. Keywords: fetofetal transfusion, pregnancy, arteriovenous anastomo- sis. 50 Systemic Sclerosis: Case Report In Man Daniella Dias Silva Sá; Denyse Dias Silva Sá; Jayranne Mara Santana Dos Santos; Flávia Brandão Miranda. Introduction: Systemic sclerosis or scleroderma is a disorder of the connective system of unknown etiology, chronic and progressive evolution. It has higher prevalence in women aged 30-50 years old and higher incidence in Afro-descendants. The diffuse cutaneous form is characterized by thickening of the skin (scleroderma) and demage of multiple internal organs, particularly the lungs, gastroin- testinal tract, heart and kidneys. Case report: 51 years old patient, male, with known systemic sclerosis and chronic alcoholic, was admitted to the medical service in the countryside of the state of Piauí with respiratory failure, unstable blood pressure and oxygen saturation ranging between 46-94%. The patient was referred to a tertiary care with isochoric pupils, no spontaneous verbal respon- se and in mechanical ventilation, in need for vasoactive drugs and sedoanalgesia. The patient had hypothermia, tachydyspnea and leu- kocytosis, showing sepsis of pulmonary origin. On physical examina- tion, evidenced fibrosis and cutaneous hyperpigmentation, micros- tomia, sharp nose, skin thickening on the fingers of both hands that affects proximal metacarpal-phalanx region and sclerodactyly, scars and ulcers on the fingertips. Computed tomography of the chest evidenced areas of reticular infiltration and ground-glass opacities, fusiform opacities located along the left oblique fissure, suggestive of encysted pleural collections, tiny punctate calcifications along the bilateral pleural surfaces, multiple nodule calcifications, some with the aspect of eggshell and scarring fibrosis in the lung apices. Labo- ratory tests showed urea 230 mg/dL, creatinine: 6.5 mg/dL, sodium: 142.8 mmol/L, potassium: 4.58 mmol/L, lactate: 5.3 mg/dL and pH 7.1. Thus, it was necessary to start hemodialysis. Antibiotic therapy and vitamins replacement were also added to the treatment. After 12 days of hospitalization and several hemodialysis sessions, re- nal excretion decreased and there was clinical improvement in the patient, who was conscious, oriented, in spontaneous ventilation, phasic and eupneic. 51 Takayasu Arteritis: Rare Vasculitis In Childhood Analia Pires; Catarina Fernandes Pires; Roberta Oriana As- sunção Lopes De Sousa; Karla Karoline Queiroz De Carvalho; Vítor Assunção Da Ponte Lopes; Dandara Coelho Cavalcante. Introduction: Takayasu arteritis (TA) is a chronic vasculitis involving the aorta and its main branches. Transmural granulomatous inflam- mation occurs it can cause stenosis, occlusion, dilatation and / or aneurysm formation in the arteries involved. It mainly affects women in the reproductive phase. The clinical picture of TA includes a sys- temic inflammatory phase, associated with fever and constitutional symptoms, a phase of vascular inflammation, and a final late phase of ischemia. Case report: TRS, 8 years, was admitted with complaints of evening low fever, chest pain, skin patches for 2 months. Sought medical care in Picos-PI, which was performed chest radiograph showing widening of the mediastinum, and symptomatic prescribed propanolol, with clinical improvement. After 15 days, purpuric skin lesions descendants appeared, starting in the region of the right thigh, progressing to the foot in both lower limbs, and the appea- rance of painful ischemic injury in the fourth left toe. Referred to Hospital Infantil Lucídio Portela (HILP) for diagnostic investigation. Physical examination: pale + / 4+, facies of pain. Presence of necroti- zing ischemic lesion in the distal phalanx of left fourth toe. Presence of necrotizing ischemic lesion in the distal phalanx of left fourth toe. Cardiac auscultation: heart sounds very loud, regular rhythm in 2 stroke, systolic murmur pancardiac 2 + 4 +, presence of splitting of the second sound. Blood pressure from members: MSD 212X74, 119X79 MSE, MIE 84×52, 80x40 MED. Radial pulse and right popliteal wider than the left, upper limb pulses wider than the lower limbs. Abdomen was normotensive without visceral and no palpable mas- ses. Tests: VHS 55, PCR 24 mg/L, ASLO 800 IU/mL, hemoglobin 10.4 g/dL, Hto 31%, Leukocyte 11200 S54 B3 L43, platelets 399,000, Ur 28, Cr 0.6, AST 26 IU/mL, ALT 24 IU/ml, FAN nonreactive, with normal renal US doppler. Resonance angiography showing concentric narrowing of the thoracic aorta, the left subclavian artery and sac- cular dilatation in the descending thoracic aorta. Initiated therapy with propranolol 40 mg / day, captopril 37.5 mg/day, aspirin 100 mg/day, methylprednisolone pulse therapy combined with 30 mg / kg/day and cyclophosphamide 1 g / m², with clinical improvement. Final thoughts: Due to the rarity of the disease and its progression in the severity, it is necessary for early identification of clinical mani- festations, so that appropriate therapy can be instituted and serious sequelae are minimized. 52 Thanatophoric Dysplasia: Importance Of Prenatal Care Brenda Maria Coelho Modesto Amorim; Diego Ricardo Gui- marães Rodrigues; Renata Brito Aguiar De Araújo; Clarice De Sá Pires Carvalho, Isadora Fortes Portela Barbosa; Cintia Maria De Melo Mendes. Introduction: The thanatophoric dysplasia is a congenital chon- drodysplasia, autosomal dominant, whose main characteristic is the bone deformation with shortening of the limbs, thoracic atro- phy with abdomen bell-shaped, plus relative macrocephaly, hy- drocephaly and severe polyhydramnios. The term thanatophoric is derived from the Greek "thanatophoros", meaning dead childbirth, since most patients are stillborn or survive a few hours or days. Its approximate incidence in the population is from 1/35000 to 1/50000. The sonographic diagnosis is possible from 14 weeks of pregnancy and the prognosis is invariably reserved. Case report: Newborn (NB) male, third pregnancy of 34 years old patient who did not perform prenatal care. In gestational age of 38 weeks held an abdominal ultrasound that revealed polyhydramnios. There were sonar audible fetal heartbeat Patient referred to a discrete discharge vaginal, and denied earlier losses. The patient came to perform cesarean partu- rition. RN presented Apgar 2 in the first minute and four in the fifth minute. At birth showed depressed neurologic functions, with apparent death, cyanosis, palpable ictus below the left costal arch. Required resuscitation at the birthing room. She underwent positive pressure ventilation and intubation tracheal. Unsuccessfully, she died. At autopsy appropriated nutritional status was observed for gestational age. weight of 2,645 grams, 37 cm skull-foot length, head circumference of 37 cm, shortened rib cage, neck conformation and reduced size, short and curved legs. Final thoughts: Prenatal care includes prevention, the promotion of health and treatment of problems that occur during the period gestational and postpartum, and its main objective is the host of pregnant women from the be- ginning of pregnancy until the end end ensuring the birth of a healthy child. Fetal ultrasound is a noninvasive method to diagnose numerous skeletal dysplasias, including thanatophoric.The diagnosis of dysplasia thanatophoric can be performed both at the prenatal and perinatal period. When the diagnosis is made during pregnancy, there is a way to prevent potential pregnancy complications and provide life support for neonates, besides assisting in differential diagnosis and provide genetic counseling to the family. 53 The Importance Of Anaminesis In A Possible Etiology Drug Bullous Pemphigoid Case Report Renata Brito Aguiar De Araujo; Diego Ricardo Guimarães Rodrigues; Clarice De Sá Pires Carvalho; Isadora Fortes Por- tela Barbosa; Luara Lis Barbosa Boson; Cintia Maria De Melo Mendes. Introduction: Bullous pemphigoid is a vesicular-bullous autoimmune disease that focuses mainly in elderly people, a serious disease with a mortality rate ranging from 10 to 20%., Manifests as large, tense blisters that rupture leaving eroded áreas,. primarily located in areas of flexion.. In the elderly may be accompanied by itching in up to 45% of the cases. May occur in a localized or generalized form, with or without concomitant rash. It has been reported the appearan- ce of the disease after exposure to ultraviolet radiation, radiation therapy, or use of certain drugs, being a disease that has a good response to immunosuppressive treatment. Case report: MSCS, 69, female, widow, housewife, residing in Timon-MA. She reports that for the past two months emerged persistent pruritic urticarial plaques on the scalp and after about two weeks, progressed to blistering and painful lesions, with approximately 0.5 mm in greatest diameter, filled with clear liquid, which easily popped.. For 10 days, the bu- bbles began to spread to the arms, trunk and legs simultaneously. There was an increase in the diameter and the amount of bubbles, reaching 4 cm. On physical examination showed emaciated, afebrile and eupneic hypertensive (blood pressure 160/80 mm Hg); it was also observed the presence of several tense bullae on an erythema- tous base on the chest and abdomen, and some containing liquid and hemorrhagic injuries suffered no deformity by applying a force on them.. The patient was hospitalized in use of dapsone and symp- tomatic and reported improvement of symptoms described above. Personal history of depression and hypertension for 30 years, with the use of several medications, including enalapril. Final thoughts: Bullous pemphigoid in 4-8% of cases can be triggered by drugs such as the angiotensin-converting enzyme inhibitors (ACEI), and among them stands the Enalapril, which the patient is taking. Since it is also an autoimmune disease, and the patient is depressed, we empha- size the importance of anaminesis for a diagnosis and appropriate conduct, as possible triggers medicines should be replaced. Despite the bullous pemphigoid not be as dangerous as pemphigus, it can persist for a long time, and so the differential diagnosis of this disea- se is critical to its treatment. 54 The Perception Of The Image Of The Medical Profession And Their Meanings In Search Websites Lucas Alexandre Gonçalves Do Nascimento Gomes; Felipe Santana Rodrigues; Gustavo Barcelar Fontenele Araújo; Mar- ny Ryann Rapôso Ferreira; Vanessa Gonçalves Costa; Fábio Solon Tajra. Introduction: To grasp the image meaning, we need to analyze its symbols and its strong associations. These symbols, signals and associations search can be applied to medicine. Some images and symbols that connote and denote physician can be seized from just one simple search on the web. Goal: Analyze the doctor representa- tion on the image found on search websites. Identify symbols and signals that are associated to this job on these websites. Method: The study consists in an exploratory and a descriptive method with a qualitative and a quantitative focusing. Pictures were searched on 5 different sites by keywords like "medico", "médica" and "profes- sional medico". These pictures were collected along uninterrupted 30 days and we developed 4 boxes, namely: A) Box 1 has the registra- tion of all results from this research, categories: Box 2, box 3 and box 4; B) Box 2, pictures that contain human elements present, catego- ries: loveliness, religiosity, leadership, teamwork, distance between doctor and patient, the profession overall and controversies; C) Box 3, Pictures applied to profession overall category from Box 2, sub- categories: Consultation/prescription, procedure, clinical procedure with auscultation focusing, overcharge, computerization working, professional profile, among outros; and,D) Box 4, pictures that has been necessary the analysis of the non-human element, category: stethoscope, personal protective equipment, symbol, medical place, health registration, among others. Results: Pictures were analyzed in a number of 2187, divided into 4 boxes: Box 1 (100%; n=2187); box 2 (79,39%; n=1736); box 3 (49,56%; n=1084) and, box 4 (51,62%;n=1129). On Box 2, highlighted: professional overall (62,44%; n=1084), tea- mwork (11,12%;n=193) e loveliness (9,39%; n=163). On box 3, showed: consultation/ prescription (39,67%; n=430), professional profile(19,28%; n=209) and procedure(15,13%; n=164). On box 4, stood out: stethoscope(49,15%; n=555), health registration (17,09%;n=193) and personal protective equipment(11,69%; n=132). Conclusion: we can conclude that the doctor is essentially to its profession overall, doctoring or doing surgery or examining. When it isn't, it is linked to elements that refer to its working, almost being reduced to one stethoscope or another working equipment. Keywords: medical profession, picture, image and symbol 55 Therapeutic Difficulty And Psychosocial Factors In Tourette Syndrome Patient Janine Lemos De Melo Lôbo Jôfili Lopes; Camilla Aniele Areia Ferreira; Aarão Andrade Napoleão Lima; Jose Carvalho Feitosa Neto; Larissa Clementino Leite De Sá Carvalho; Kelson James Da Silva Almeida. Introduction: Tourette Syndrome (TS) is a genetic disorder with neu- ropsychiatric background. Clinical manifestations include motor, vo- cal and sensitive tics that start before the patient is 18 years old. TS occurs in a range from 1% to 2.9% in some social groups. It affects men 3 to 4 times more than women. TS compromises social and psychological development of the patientsand it is usually related to behavior and emotional issues, which causes a huge impact on the life of the patients and their relatives. Common associated issues are obsessive-compulsive disorder and attention hyperactivity disorder. Case report: A 19-year-old male patient started motor tics that lasted 3 or 4 months when he was 14 years old. The situation occurred other times and had the same duration. The patient shows the same behavior during many functional and physiologic activities and pre- sents complex vocal tics (palillia). Obsessive-compulsive sypmtoms are also presented. He has a peculiar behavior since he was 4 years old and is aggressive with his siblings. Besides, it is hard for him to concentrate and conclude tasks, which justify low academic perfor- mance. Treatment started with sertraline 50mg (selective serotonin reuptake inhibitor) and continued with atipic antipsychotics, triciclic antidepressants, neuroleptics and benzodiazepines. Final considera- tions: Although TS is an old syndrome, its etiology and treatment are not well established. However, some drugs control the symptoms, which improves patients' lives, especially social aspects. We need more research to clarify all those obscure aspects of the syndrome, as well as we need it to be discussed more in the scientific and non- scientific society. When biological, genetic and behavior aspects are clearer, diagnose and treatment will be more precise, which allows more favorable prognosis, when compared to the current one. 56 Treatment of Lupus Erythematosus In Patients Followed Up At University Hospital Of Reference In The State Of Piauí André Freitas Nunes; Luíza Sá E Rêgo Tupinambá; Érica Patrí- cia Chaves; Vítor Assunção Da Ponte Lopes; Roberta Oriana Assunção Lopes De Sousa; Catarina Fernandes Pires. Introduction: Systemic lupus erythematosus (SLE) is a chronic in- flammatory disease of autoimmune nature, characterized by the presence of autoantibodies and systemic involvement of various organs. Children and adolescents are about 15 to 20% of all ca- ses. Treatment of SLE depends on the extent and severity of the disease. Objective: Knowing the drug therapy used at the time of diagnosis, by 31 patients enrolled in a public service of reference in pediatric rheumatology in the state of Piaui. MATERIAL AND Methods: Retrospective analysis of data from 31 patients at Children's Hospi- tal Lucídio Portella (CHLP), Teresina, PI, with SLE, followed up from January 2008 to September 2013. The variables used were processed INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info • 2015 Vol 3 Suppl 1 XXI COMAPI INTERNATIONAL JOURNAL of MEDICAL STUDENTS $55#29IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS XXI COMAPI $56 Abstracts Abstracts by SPSS 13.0 software. Results: Patients were predominantly female (90.3%), with an average age of diagnosis of 10.5 years. Regarding the symptoms present in the diagnostic criteria and in descending order, 90.3% had fever, 80.6% arthritis, 25% convulsion and 22.6% pericarditis. The most common laboratory abnormality was a patho- logical cylindruria (67.7%). According to these changes, therapy was instituted. The use of oral corticosteroids was 96.8% and their as- sociation with antimalarial occurred in 51.6% of patients. The set of corticosteroids, azathioprine or methotrexate and antimalarial use occurred in 12 children. A simple pulse therapy was used by 38.7% and 32.3% of patients received combination. No patient used immunobiological. Conclusion: Treatment of Systemic Lupus Erythe- matosus must be individualized for each patient and depend on the location and severity of these affections. Oral corticosteroid drug therapy was the most used. 57 Trichotillomania And Trichophagia Associated With Depres- sion Máximo Peixoto Rocha Neto; Clara Maria Barbosa; Antonio Guilherme Chagas Silva Feitosa; Luiz Euripedes Almondes Santana Lemos; Lorayne De Araujo Costa Pereira; Krieger Rhelyni De Sousa Olinda. Introduction: Trichotillomania (TTM) is characterized by recurrent hair pulling behavior associated with satisfaction or relief after re- moving them. The disorder is not accounted for by another mental disorder and is not due to general medical conditions causing su- ffering, social and occupational impairment. Studies show the scalp as the most frequently affected region and that the average age for the start of the frame is approximately 13 years and is associated with greater depression and generalized anxiety. Surveys report that 20.6% of patients with TTM after the act of plucking hair started oral behaviors such as running the hair between his lips, plucking the root or eat the strand of hair or part it, what is called trichophagia. Case report: A 30 years old, female, started 16 years ago presenting social isolation, anxiety and an uncontrollable urge to pull the hairs. After extracting them, she ate only the hair bulb feeling relief and sa- tisfaction. Realized the act as irrational, but when she tried to resist the urge she had discomfort characterized by intense anxiety and autonomic symptoms. The urge became frequent and there was no apparent motivation to feel it or realize it. Since 2005, she has been showing worsening morning symptoms, however denies nail biting, tics or gastric complications. Notes that she have already used some strategies to ease the symptoms, how to occupy your hands with some activity and use of headscarves, but was not successful. Was diagnosed with trichotillomania associated with depression. Started treatment with fluoxetine 20 mg / day; Carbolythium 600 mg / day and 1 mg Alprazolam / day. In her first return shet reports clinical improvement with a decrease in the intensity of the impulse and got back to work. Showed slight tremors of the extremities in the first week, that had already improved, and visible increase in capillary volume. However in the second return, the patient had a worsening adopting Fluoxetine 40 mg/day; Carbolythium maintained Rispe- ridone 2 mg/day and 2 mg Clonazepam at night. She is currently stable with improvement of the symptoms. Final remarks: Different theories point the need to understand the etiology of the Tricolo- mania behavior as multifactorial. Nevertheless, additional research needs to be conducted to evaluate the relative efficacy of pharma- cological and behavioral treatments, in addition to their association. 58 Use Of Intra-Aortic Balloon Pump (IABP) In Patient With Car- diogenic Shock Francisco Alves Vieira De Sá Júnior; Francisca Jessyane Dos Santos Sá; Daniel Santos Rocha Sobral Filho; Alice Ribeiro Feitosa Da Silva; Filipe Aquino Costa; Luiz Otávio De Góes. Introduction: Cardiac assist devices are widely used to treat cardioge- nic shock which, in most cases, is the result of myocardial infarction, cardiac dysrhythmia and acute myocarditis. One of these devices is the intra-aortic balloon pump (IABP), which increases coronary blood flow, providing better blood irrigation, cardiac muscle contraction and cerebral blood flow. The purpose of this report is to describe the clinical logistics, presenting the significance of the IABP in con- trolling cardiogenic shock and supporting optimization of medicinal therapy for congestive heart failure (CHF). Case report: A.G.H.O. is a 65-year-old woman previously diagnosed with hypertension, type 2 diabetes, dysrhythmia and history of heart disease (decompensated CHF caused by dilated cardiomyopathy and mitral insufficiency). She presented episodes of respiratory difficulty (dyspnea) when under exertion and reaching paroxysmal nocturnal dyspnea later at rest. She developed decompensated heart failure characterised by car- diogenic shock followed by renal failure owing to perfusion deficit. Vasoactives were administered in order to try to normalise pressure and contractility. With the prediction of better results and due to the evolution of the patient's condition, which was still serious, it was opted for the placement of IABP, which through the process of counterpulsation, suffers inflations in diastolic periods, redirecting the blood flow to the coronary arteries. Access to the instalation of the IABP occurred by the right femoral artery, not being reported any complications. The patient showed improvement in metabolic acid-base balance and CVP (Central Venous Pressure). With the wea- ning from medications (dobutamine and norepinephrine) the opti- mization of the drugs for CHF, the close monitoring of vascular and renal functions, the improved levels of consciousness and signs of clinical metabolic and hemodynamic stability, it was decided for the removal of the IABP on the tenth day. After the weaning from IABP, the patient maintained metabolic and hemodynamic stability. Final considerations: The IABP is a rather effective circulatory support in treating cardiovascular disorders, especially in cardiogenic shock, as it contributes decisively in the reversal of severe hypotension of the blood flow. This report confirms the importance of the IABP in medical practice. 59 Bipolar Affective Disorder Associated With Mental Retarda- tion And Bizarre Behavior Máximo Peixoto Rocha Neto; Clara Maria Barbosa; José Lucas Talles Ferreira Luz; Anna Alzira Macau Furtado Ferreira, Luiz Euripedes Mondes Santana Lemos; Krieger Rhelyni De Sousa Olinda. Introduction: Bipolar Affective Disorder (BAD) is a disease related to mood or affect and it is characterized by mood disorders, with depressive and manic episodes throughout life. The TAB may be as- sociated with other disorders such as mental retardation in which there is a global impairment of cognitive, language and motor skills and social behavior. However the presence of bizarre behavior was unusual in this disorder, complicating the diagnosis and treatment. Case report: A 23 years old female with a history of a retarded psychomotor development started to show symptoms at age 15 been aggressive, impulsive and restless. Had strange behaviors like going to school with wet uniform and use several bags at once (all of them full of pamphlets, spoiled food, garbage and many condoms). Moreover when she chose an outfit, pulls out all the clothes closet throwing them on the floor. Referring insomnia waking up around midnight to wash her hair and at four in the morning to clean the house. Started performing overspending, stealing and present pro- miscuous behavior. In family parties, ate compulsively, primitively and created friction with family. Looked for the ambulatory of Areo- lino Abreu hospital where she was diagnosed with bipolar affective disorder associated with Mild Mental Retardation with the presence of Bizarre Behavior, which in the case of an unusual presentation to TAB difficult and slowed the appropriate clinical conduct. At the first consultation was restless, with increased volume of speech, irritable mood, impulsive, decreased need for sleep, childish behavior and lack of sense of social standards being treated with Valproic Acid, Clonazepam and Quetiapine. During treatment showed instability of the frame with periods of improvement of the sleep patterns and mood interspersed with refusing medication and running away from home.She is currently medicated and stable. Final remarks: The presence of Bizarre Behavior associated with TAB despite unusual should be considered since it helps in establishing the early diag- nosis that leads improvement in the evolution of the framework besides a gain in quality of life of the patient. Abstracts of International Congress for Medical Students and Young Health Professionals (MEDICALIS) 01 02 Soft And Hard Tissue Reconstruction Of Oral And Maxillofacial Structures. The Way We Do. Assoc. Prof. Horatiu Rotaru, MD PhD Non-Alcoholic Fatty Liver Disease In Clinical Practice: Today And Tomorrow Assist. Professor Ludovico Abenavoli MD PhD 03 Targeted Therapies In Oncology And Hematology Prof. Spiro Mihaylov Konstantinov MD PhD 04 Telocytes: Current knowledges And Perspectives Assist. Prof. Dragos Cretoiu MD PhD 05 06 07 08 09 The Battle For Life: Legal And Ethical Aspects Of Organ Dona- tion And Transplantation Assist. Prof. Maria Aluas MD PhD A Positive View Of Dying Tim Patten MD PhD, Katy Daniels MD PhD, Anthony Clarke MD PhD, Valerie Rowe MD PhD and Mr. Robert Rowe Thoracic Trauma Zul Mirza MD PhD Metabolic Alterations And Their Association With The External And Internal Exposome Assist. Prof. Makris Konstantionos MD PhD Correctional Medicine: International Challenges and Trends in 21 Century John May MD PhD INTERNATIONAL JOURNAL of MEDICAL STUDENTS 16th Medicalis www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS S57#30IJMS MMSS 2015 $58 INTERNATIONAL JOURNAL of MEDICAL STUDENTS Abstracts Abstracts Abstracts of Malaysian Medical Student Summit (MMSS) Major postpartum haemorrhage secondary to acute comple- 01 te uterine inversion, a case report. CS Chean 1, Peter Liao, S Shaman, S S Poon', A Soltan 2 1 Faculty of medicine, University of Liverpool, 2 Liverpool Women's Hospital Introduction & Objectives: Obstetric haemorrhage is one of the lea- ding causes of maternal death in developed and developing cou- ntries. Acute uterine inversion is a rare obstetric emergency, esti- mated to occur in 1 of 3500 to 5000 deliveries. Patient/Method: A 35-year-old lady (G2P2) was admitted for induction of labour at 41+3 weeks as per local protocol for the management of postdates preg- nancies. She gave a history of previous postpartum haemorrhage (PPH) following her first pregnancy elsewhere. The plan was active management of third stage with routine precautions (e.g. IV access, blood sample for group and save etc.) to be taken in case recurrent PPH. In theatre, the uterine inversion was corrected manually with no difficulty immediately as the patient was anaesthetised. However, she continued to suffer major (atonic) PPH and the urine started to become blood stained raising concerns about DIC. Results & Dis- cussions: The switching off of volatile anaesthetics and insertion of Bakri Balloon was successful in controlling this patient's major PPH. On day 2 post-operatively, she seemed to have recovered relatively quickly and the Bakri Balloon was removed. The uterus was well contracted with minimal lochia and the patient was discharged home on day 3 postnatal with a healthy baby. Conclusion: Acute uterine inversion is a rare but severe condition and all staff should be aware of PROMPT (Practical Obstetric Multi-Professional Training) and the management of PPH as described in the RCOG green-top guideline No. 52 as delay in treatment is associated with high mortality and morbidity. 02 Clinical Audit on Diagnostic & Treatment Recommendation of Dry Eyes in St. Paul's Eye Unit Liverpool CS Chean, M Aswin ', S S Poon', A Sajjad 1 1 Faculty of Medicine, University of Liverpool, 2 St. Paul's Eye Unit, Royal Liverpool and Broadgreen Univer- sity Objective: Clinical audit of diagnosis and treatment methodologies of dry eyes in St. Paul's eye unit compared to the standard recommen- dations of Dry Eyes Workshop (DEWS) report 2007. Methods: Data are collected from 18 dry eye patients for a total period of 3 months. Pa- tient demographics are analysed and the diagnostic methodologies used in St. Paul's Eye Unit were reviewed. The severity of dry eye of every patient in this audit is then graded according to the standard. Their respective treatment provided in St. Paul's are then compa- red against the standard treatment recommendations. Results: The mean age of patients (N-18) is 70.5 (SD=12.63) whereas all patients in this audit are female. Patients are then divided into subgroups of Primary Sjogren's syndrome dry eye, Secondary Sjogren's syndrome dry eye and nonSjogren's syndrome dry eye. Most patients (55.6%) suffer from Grade 3 severity dry eyes. One-third (33.3%) of patients have adequate treatment which correlates with their dry eye severity grading. Discussion: The standard diagnostic protocol recommended by DEWS report should be followed. Most practitioners in St. Paul Eye Unit appear to be more conservative in their treatment of dry eye patients of varying severity. However, the standard guideline noted that treatment recommendations can be modified by practitioners on the basis of their clinical experience and individual patient pro- file. Conclusion: The standard guidelines of dry eye diagnosis and management is of considerable clinical utility and it is advised to be used by practitioners based on each individual patient profile and clinical experience for the best interests of the patients. 03 Clostridium Perfringens Enterotoxin (CPE) in Clostridium Perfringens Gastroenteritis: A review of recent evidence Goh JE, Lee LH Jeffrey Cheah School of Medicine and Health Sciences, Mo- nash University Malaysia. Introduction: Clostridium Perfringens is referred as a worldwide pathogenic microorganism in nature as well as in humans. Its as- sociated type A food-poisoning has been classified among the most widespread foodborne gastroenteritis diseases in the developed countries globally. Objective: To review existing and novel aspects of C. Perfringens, its toxin Clostridium Perfringens Enterotoxin (CPE) and its associated type A foodborne illness. Methodology: Pubmed, Science Direct and Elsevier were systematically searched using "Clostridium Perfringens", "Clostridium Perfringens Enterotoxin" and "Clostridium Perfringens type A Gastroenteritis" as keywords. Fifty articles published in the past 10 years were selected to be reviewed on prevalence and sources of infection; identification of bacteria and its toxin CPE; treatment and public health measures to curb this issue and CPE as potential medical application. Results: Substantial experimental and epidemiologic studies have provided rigid eviden- ce on the role plays by CPE as the major virulence factor responsible for the pathogenesis of C. Perfringens type A gastroenteritis. Signi- ficant advancement on the knowledge available on C. Perfringens and its associated gastroenteritis has been made. Discussion: Public health measures in preventing further outbreak cases from happe- ning are especially important and much attention is given towards effective disinfection routines and proper food handling practices which aid in removing the presence of any bacteria. Conclusion: Many challenges remain for researchers, including the physiology, genetics and mechanism of action of different cpe positive strains and the reassessment of the current diagnostic tools to more ex- plicit methods in identifying C. Perfringens type A food-poisoning outbreak. Besides that, there is a need for more in-depth views on the sources and reservoirs of C. Perfringens cpe-positive strains for better control of this organism in foods. 04 The role of group II mGluRs in synaptic transmission and plasticity at the CA2 region of the hippocampus Jonathan Lee Chuo Min Introduction: Group II metabotropic glutamate receptors (mGluR) have been known to depress neuronal transmission via inhibition of neurotransmitter release at glutamatergic synapses. They can also mediate long term depression in several regions of the brain in- cluding the lateral amygdala and striatum. However, their roles in the hippocampus, particularly the cornu ammonis 2 (CA2) region is largely unclear. Objectives & Methods: We have used electrophysio- logical techniques on wildtype and mGluR2 deficient rats in com- bination with group II mGluR modulating drugs to tease apart the physiological functions of group II mGluRs on the temporo ammonic pathway input synapse to the CA2. Results & Discussions: Using DCG-IV (group II mGluR agonist), we have identified that activation of group II mGluRs leads to depression of synaptic transmission in the TAP-CA2 synapse in a dose-dependent manner. Washout of DCG-IV resulted in LTD which indicates that group II mGluRs can mediate LTD in the same region. Using LY541850 (mGluR2 agonist, mGluR3 anta- gonist) on wildtype rats, DCG-IV on mGluR2 deficient rats, we have further evidence that activation of mGluR 2/3 alone can induce signi- ficant depression of synaptic response as well as induce LTD. Using these drugs in combination, we have also established that mGluR2 and mGluR3 may have synergistic effects on one another, potentia- ting depression and lowering the threshold for LTD induction. Con- clusion: These results suggest important roles of group II mGluRs as regulators of CA2 activity which may have significant implications in explaining the mechanism behind the clinically beneficial (eg. neu- roprotective/anxiolytic) effects of group II mGluR modulation. These results will also help tease apart the physiological role of the CA2 in the construction of episodic memory in the hippocampus. 05 Pain, itch and quality of life after Herpes zoster: A web-based prospective study Albert JM van Wijck', Yueting Kew² 1 Pain Clinic, Department of Anesthesiology, UMC Utrecht, The Netherlands 2 Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia Introduction: Pain and itch are the most common complication in herpes zoster (HZ) patients and are difficult to treat. However, long- term impact on quality of life (QOL) is not known. Aim: To measu- re the incidence of pain and itch after HZ and the impact on QOL. Methods: We performed an observational prospective study in pa- tients above 50 years with HZ. Participants were recruited by internet and by general practitioners within 7 days after onset of the rash. Follow-up was web-based for pain, itch and quality of life at 2 weeks an 1, 3, 6 and 12 months. There were no restrictions in treatment. Significant pain or itch was defined as a score. 30 on a 100 mm VAS. Results: A web-based prospective study was feasible in the 50+ po- pulation. We enrolled 661 patients with a follow-up of at least one month. Mean age was 65 years (range 50-96). Presence of PHN redu- ced Quality of Life to a large degree. Results are displayed in figure 1 and 2. Conclusion: Although the risk of long lasting severe PHN is low, the burden of disease is high. 06 The Frequency of Neuropathic Pain In Low Back Pain Patients Attending A Tertiary Spine Clinic Cheng Yin Tan, Yueting Kew', Sue Sien Thang', Leong Hooi Tan', Yvonne Khaii Khoo', Chong Jing Ng', Jun Ni Lim', Jia Hui Ng', Chris Yin Wei Chan², Mun Keong Kwan², Khean Jin Goh¹ 1 Division of Neurology, Department of Medicine 2 Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia Aim: Chronic back pain may have a combination of both nociceptive and neuropathic pain components. The objective of the study is to evaluate the neuropathic pain component in a group of outpatients with low back pain Methods: The painDETECT neuropathic pain scree- ning questionnaire was used to identify pain mechanisms in a cohort of patients seen at the Spine Clinic, University of Malaya Medical Centre, Kuala Lumpur. Pain mechanisms were classified as nocicep- tive, unclear and neuropathic and were correlated with demographic factors, associated diseases, underlying diagnosis for low back pain as well as pain severity (numerical rating scale), disability (Roland Morris Disability Questionnaire) and anxiety/depression (Hospital Anxiety and Depression Scale). Results: Of the 210 patients recruited, 26 (12.4%) had neuropathic pain, 45 (21.4%) were unclear and 139 (66.2%) were likely nociceptive pain. Subjects with neuropathic pain were more often women, more likely to have leg pain and to have the pain radiate below the knee. There were no differences between ethnic groups, associated diseases, underlying cause or duration of back pain. Patients with neuropathic pain had significantly more se- vere average (6.8 vs. 4.7, P<0.001) and highest (8.4 vs. 5.6, P<0.001) pain score over the last 4 weeks. They also had higher RMDQ scores (16.4 vs. 10.0, P<0.001) and more of them had anxiety (42.3% vs. 12.2%; P<0.001). Conclusions: The frequency of neuropathic pain was 12.4%. Low back pain with neuropathic pain component was more severe and was associated with greater disability and more anxiety in patients. 07 How does educational theory influence the teaching of clini- cal skills Y W Liao University of Liverpool, Liverpool Introduction: From palpating to auscultating, doctors use these clini- cal skills in everyday practice to help diagnose patients. Hence, there is no surprise that the teaching of clinical skills is a fundamental pillar of every medical school. Objective: The objective of a con- temporary medical education aims to produce medical professionals with multiple competencies, one of which is clinical skills. This paper aims to deconstruct the concept of teaching clinical skills and seeks to discuss the types of theories used to teach clinical skills. By re- viewing the fundamentals and history of each theory, this paper will then seek to uncover the education theories used in clinical skills sessions and understand the implications and effects of each theory. Methods: A literature search was performed using online database (Pubmed and Scopus). To refine the search and ensure consistency, a specific set of inclusion and exclusion criteria was agreed on and applied for both databases. Results: A total of 20 papers were se- lected. Discussion: Four key education theories was examined and related to the teaching of clinical skills. These 4 theories are the curriculum theory, behaviourism, cognitivism, and constructivism. Every theory was related to the teaching of clinical skills and its effectiveness is then judged and evaluated. Conclusion: Education theories are not mutually exclusive and can be integrated into a clinical skills session more than one at a time. However, the choice of which theory to be integrated is highly dependent on the specific clinical skill being taught and its perceived effectiveness during the session. 08 Self-Management of Gestational Diabetes Mellitus Y W Liao University of Liverpool, Liverpool Introduction: The prevalence of Gestational Diabetes Mellitus (GDM) has been on the rise globally with studies stating that up to 14% of pregnancies are complicated due to diabetes and 3%-5% of that number is GDM. Hence, it is no surprise that GDM has become a particularly important topic of research within the specialty of obs- tetrics and gynecology. Objective: This paper seeks to investigate the feasibility of self-management of GDM by reviewing various papers recommending different self-management techniques, the effective- ness of self-managing GDM and if the patient is placed in any harm by choosing to selfmanage GDM. Methods: A literature search was performed using online database (Pubmed and Scopus). A specific set of inclusion and exclusion criteria was applied to both databases. Only RCTs and systematic reviews were included. Results: 20 papers were selected. As the prevalence of GDM may differ according to ethnicity, the 20 papers originated from various countries to ensure a diverse sample size was taken into account. Discussion: A few areas were considered to determine the feasibility of self-management of GDM. 1) 2) Patient adherence to self-monitoring of blood glucose. Evi- dence shows that proper pharmacological intervention time is not significantly affected if blood glucose is recorded daily or less frequently. Effectiveness of nutritional management 3) - Studies have shown that proper diet management is effective in mana- ging and even preventing GDM. Self-management techniques in an ambulatory setting - Va- rious studies have recommended different ways to control GDM in an ambulatory setting. Conclusion: Based on current evidence, it is possible to self-manage GDM in an ambulatory setting with proper support from the health care team. This is especially important as GDM will last for the dura- tion of the pregnancy hence self management is needed to ensure proper blood glucose levels are maintained. 09 Effect of music tempo on blood pressure, heart rate and respiratory rate among medical students in Melaka Manipal Medical College: A single blinded randomised controlled trial Aiman A, Amalina N, Malkit S, Salman B, Ikram K Introduction: Music plays a complex role in human beings causing diverse physiological changes, including both neurological and car- dio-respiratory aspects. Studies have shown that different music tempos have contrasting effect on the vitals. Objectives: The aim INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS MMSS 2015 $59#31IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS MMSS 2015 s60 Abstracts Abstracts was to evaluate the effect of two types of music tempos on blood pressure, heart rate and respiratory rate among young adults in a medical college setting. Methods: The study was a single- blinded randomized controlled trial with sample size of 40 medical students, divided into two groups. Students were asked to listen to the songs for 7 minutes depending on which group they belonged: either fast tempo songs >120BPM or slow tempo 52-108BPM. Blood pressure, heart rate and respiratory rate were measured pre and post interven- tion. Results: After listening to slow tempo songs, there were signifi- cant reductions in mean systolic blood pressure (P-value = 0.01) and mean diastolic blood pressure (P-value <0.01). However, there were no difference in mean systolic and diastolic blood pressure for fast tempo songs (P-value=0.07) and (P-value = 0.23) respectively. As for the heart rate, changes were insignificant (P-value>0.05 for both). Per contra, the only significant difference for respiratory rate was for the fast tempo songs (P-value<0.01) Discussion: The results showed that slow tempo songs causes reduction in systolic and diastolic blood pressure. This is further supported by a study conducted by Siritun- ga et al that demonstrates reduction in mean systolic and diastolic blood pressure of subjects after listening to classical Indian music. Conclusion: In conclusion, slow tempo music can be used in bringing down blood pressure of patients or subjects where applicable. 10 Influence of Body Mass Index on Visual Reaction Time. A Cross-sectional Analytical Study. Ngo Choon Wei Melaka Manipal Medical College Introduction: Visual system faces the daunting task of rapidly pro- cessing an enormous range of information in everyday perception; identifying items, determine layouts and guide action to them. Humans need an effective visual system for everyday exploration and interaction, more so in medical personnel, whereby visual re- action is vital for every case management. Objective: To determine the relationship between Body Mass Index (BMI) and Visual Reac- tion Time (VRT) in medical students. Methodology: Cross-sectional analytical study was done at Melaka Manipal Medical College bet- ween October-November 2014. We included 112 students without medical conditions including neurological disorders, cardiovascular disorders and diabetes. Subjects were asked to complete a standard questionnaire before having their height measured using calibrated measuring tape in Frankfort plane, and their weight measured using electronic weighing balance. Body Mass Index (BMI) was calculated using Quatelet Index, and categorized using Asian BMI. Visual Reac- tion time was recorded using validated Human Benchmark program. Results: Significant difference was seen in different groups in BMI, namely underweight, normal and overweight, with respect to visual reaction time. The other variables such as gender, ethnicity, caffeine consumption, fatigue level, exercise and handedness are not signi- ficantly associated with VRT. Discussion: BMI was found to be linked with the nerve conduction velocity, small fiber neuropathy, alteration of nerve inhibition capacity and causing abnormalities in myelination due to high levels of adipokines. Extreme BMI especially underweight persons experience a dysregulation in the hormone secretion could result in cognitive disorders. Conclusion: Underweight individuals have been shown to have prolonged median visual reaction time as compared to their normal and overweight BMI counterparts. Further study on this is needed as BMI may not correlate well with the body fat composition of subjects, for which we propose further study to use waist-hip ratio instead. 11 Effects of energy drinks on the Peak Expiratory Flow Rate (PEFR) among medical students of different races in Malay- sia: A Randomized Controlled Trial Adamlebbe Dulkifly, Nishalini Chandrasekaran, Hafez Amir Samia, Rowena Lau, Yong Yung Sze Melaka Manipal Medical College Introduction: Energy drinks are commercially available drinks contai- ning natural ingredients promoted by the manufacturers to improve performance, concentration, endurance and alertness. Several stu- dies have proven that energy drinks have a significant effect on car- diovascular and cerebrovascular system. However, minimal studies have been done to study the effect of energy drink onrespiratory sys- tem (RS). One of the method to assess RS is peak expiratory flow rate (PEFR). Objective: In this study, we aim to determine the effect of ener- gy drink on PEFR in healthy young adults. Methods: We performed a randomized, single-blinded study on a group of 40 young adults (20 males and 20 females). Participants were handed out questionnaires andthe drinks in an unlabeled styrofoamcup(355ml). Their initial pul- se rates were counted for 60 seconds immediately after consuming the drink. After 30 minutes, their level of alertness were tested, peak flow rate and pulse rate were measured. Results: Consumption of the energy drink led to an increase in PEFR (p<0.05) compared to the placebo group. There was no significant difference in the mean of the immediate pulse between the two groups (p>0.05). However, there was a significant increase in the pulse rate after 30 minutes of consuming the energy drink (p<0.05). Additionally, there was an increase in perception of energy level after consumption of both drinks (p<0.05); which was more significant in those who consumed the energy drink compared to the placebo (p<0.05). Conclusions: An increase in the Peak Expiratory Flow Rate (PEFR), pulse rate and per- ception of energy level was noted in young healthy individuals after consuming the energy drink. 12 Parental Bonding And Self Esteem Among Melaka Manipal Medical College Students Ong Jia Wen, Siti Nurr Syafeena Binti Rais, Nur Hanisah Bin- ti Abdul Halim, Nurmardhati Abyan Binti Mad Shah, Nurul Azleen Binti Abdul Aziz Melaka Manipal Medical College Introduction: The quality of the parent-child relationship has been argued to have a significant impact on the competence, resilience, and well-being of all individuals. Objective: This cross-sectional study was conducted to study the relationship between parental bonding and self-esteem among medical students in Melaka Manipal Medical College. Methods: The sample comprised of 168 respondents from Batch 28 and Batch 29 MBBS students. The data was obtained by using Parental Bonding Instruments by Gordon Parker, Hilary Tupling and L.B. Brown and Rosenberg's Self-esteem Scale by Dr Rosenberg. Results: it is found that there is a significant relationship between parental bonding for both mother (p=0.00014) and father (p=0.00254) with self-esteem. Parents who are acceptance, approving, respon- sive and nurturing shows elevated perception of self-worth and competence among the students. In contrast, students subjected to less accepting parental practices (disapproving, unresponsive and uninterested) show low self-confidence, poor selfperception, and low self-esteem. Based on Parental Bonding Instrument, there are 4 types of parental styles namely affectionate constraint parenting (high care and high protection), affectionless control parenting (low care and high protection), optimal parenting (high care and low pro- tection) and neglectful parenting (low care and low protection). Opti- mal parenting has shown a strong association with high self-esteem among the students. Conclusion: Parents should be optimum in their parenting, ie. High care but low protection so that their children will have higher self-esteem. In medical profession, high self-esteem leads to better performance and interpersonal success which has been regarded as the utmost important quality as it enhances parti- cipation in social welfare and healthcare management. 13 The Anxiolytic Effects of Lavender Scent Among Medical Stu- dents: A Randomized Controlled Trial Ong Li Wen, Muhammad Haziq, Muhammad Farid, Nantha Ku- mar Melaka Manipal Medical College Introduction: Lavender(Lavandula angustifolia) is often recommen- ded for stress relief and believed to possess anxiolytic effects. Objectives: To assess the efficacy of lavender in reducing anxiety among medical students. Methods: A single-blinded randomized- controlled trial was conducted among Melaka Manipal Medical Co- llege students.40 participants were stratified into female and male groups, and randomly assigned to intervention and control groups. Intervention group were asked to enter an enclosed darkroom diffu- sed with lavender scent by using ceramic candle warmer with its upper compartment filled with lavender oil, while control group were asked to enter another room with same setting except that lavender oil has been replaced by plain water.Anxiety was induced by providing visual and auditory stimuli in video form.20-item State Trait Anxiety Inventory(STAI-20) questionnaire was used to measure anxiety level.Pre and post-intervention heart rate and blood pressure were noted. The raw data collected was processed using Microsoft Excel 2003, analysed using Epi Info7 for Windows(7.1.3) and GraphPad software.Results were recorded as frequencies, means,standard deviation, and P values.A P value of,0.05 is significant. Results: STAI- 20 Score shows significant reduction in intervention group compared to the control group with P value of 0.011.Other results of change in systolic blood pressure, diastolic blood pressure and heart rate show no significant association between intervention and control group with P value <0.05. Discussion: STAI-20 Score with P value 0.011 indi- cates lavender significantly reduce anxiety among participants. Our result is consistent with study done by Kutlu et al 2008. However, our result shows no significant effect of lavender on blood pressure and heart rate. Conclusion: Our study shows significant effect of lavender scent on reducing anxiety among medical students. In further stu- dies, we recommend a larger sample size and the use of other form of anxiety induced stimulus. 14 Ability of Noggin gene therapy to reduce heterotopic ossifica- tion in Fibrodysplasia Ossificans Progressiva patients Prrinisha Kanabathy I.M. Sechenov First Moscow State Medical University Introduction: Fibrodysplasia Ossificans Progressiva (FOP) is an extre- mely rare disease. Mutation of an autosomal dominant allele in the gene, known as Activin A Receptor type 1 (ACVR1) causes the disease. The mutation causes fibrous tissue to be ossified spontaneously or when damaged. Inappropriate signaling by the mutated gene causes Bone Morphogenic Protein 4(BMP-4) to stimulate fibroproliferation of the mesenchymal stem cells, and provokes endochondral bone in- duction.This results in replacement of muscle and connective tissues into bones. The approach of Noggin gene therapy as a treatment helps to control heterotropic ossification by regulating the activity of BMP-4 in tissue. Objective: To develop an effective gene therapy that could inhibit BMP-4 induced heterotropic ossification. Methods: BMP- 4 induced heterotopic ossification was used as model to test the ability of the BMP-4 antagonist, Noggin, to block de novo bone forma- tion, either by local or systemic delivery. It duplicates the stages of FOP heterotopic ossification similar in human. Since Noggin acts loca- lly, a Noggin mutein, hNOGDeltaB2, was engineered. It was shown to circulate systemically, and its ability to block heterotopic ossification was tested in mouse model with the use of adenovirus-mediated somatic cell gene transfer. Results: BMP-4 induced mouse model de- veloped heterotopic ossification. Local delivery of wild Noggin inhi- bited heterotopic ossification, but in systemic administration it was ineffective. Systemic delivery of adenovirus encoding hNOGDeltaB2 resulted in systemic levels that persisted approximately more than two weeks, which was sufficient enough to block BMP-4 induced he- terotopic ossification. Conclusion: Delivery of Noggin mutien through gene therapy successfully inhibited the BMP-4 induced heterotropic ossification in mouse model.This is due to its mechanism, where Noggin is involved in controlling the process of ossification by regu- lating the concentrations of BMP-4 concentration in tissue through negative feedback mechanism. 15 An audit of compliance for the investigation of newly detec- ted M-proteins and the management of Monoclonal Gammo- pathy of Undetermined Significance Sugeeta Sukumar University of Manchester Introduction: Monoclonal gammopathy of undetermined significance (MGUS) is a benign cloncal cell disorder with a potential become malignant and requires monitoring depending on stratified risk. Aim: A clinical audit was carried out to assess two areas: firstly, iden- tifying if patients are being appropriately referred and if a MGUS scoring system could be applied to improve referrals and predict malignancy; second part involves assessing the investigation and management of MGUS within the haematology department according to the risk stratified for each patient. Methods: 204 patients with newly detected monoclonal proteins were identified over a 6 month period between July and December of 2015 using online databases called Quadramed and Evolve and analysed. Results Audit identi- fied 19.4% of probable high risk patients were not referred and the scoring system developed had a high predictive value in this small sample group. A new system has been implemented in the immu- nology department to prevent under diagnosis of patients. However, further education of MGUS risk stratification needs to be considered within primary care. Majority of guidelines are being complied with but there is a poor compliance in performing urine electrophoresis and computed tomography (CT) scans. With regard to management, 8 high risk patients have been discharged as they were deemed to be borderline scenarios and 6 low risk patients remain under follow up due to concomitant haematological conditions. Frequency of fo- llow up needs to be standardized and carried out more frequently every 3-4 months which could be achieved using the telephone clinic service available. 16 Prevalence and Characteristics of Depressive Symptoms in University Students in Melaka, Malaysia: A Cross-sectional Study Tan Jin Rong, Chan Ya Tze, Khoo Veejie, Laviniya Naidu, Mu- hammad Rafik Faculty of Medicine, Melaka Manipal Medical College Introduction: Depression is an emerging health problem, with an es- timated 350 million people affected worldwide. Objectives: Our study aims to determine the prevalence and evaluate the characteristics of depressive symptoms among medical, law and pre-university. We perform an exploratory analysis to survey the relationships of depressive symptoms with several risk factors like gender, scholar- ship, housing and medical problems. Methods: An analytical cross sectional study was conducted on medical, law and pre-university students of two private institutions in Melaka, Malaysia, between September and October 2014. A total of 376 students participated in this study (MBBS= 142, Law= 129, Pre-U-105). They completed selfad- ministered questionnaires which included socio-demographic ques- tions and the Beck Depression Inventory (BDI) survey. Each item in the BDI can be further divided into 3 clusters: affective, cognitive and somatic. Statistical analysis was performed using post-hoc test for multiple comparisons and multiple logistic regression. Results: There were 162 (43.1%) students with depressive symptoms (BDI>9). Law students were found to be more depressed with the highest mean BDI score (11.7±8.7) compared to MBBS (8.4±8.1) and pre-university students (8.9±6.8). Affective, cognitive and somatic clusters were sig- nificantly higher among law students. For exploratory analysis of risk factors, law students and those staying in hostel were significantly more likely to develop depressive symptoms. Discussion: This is the first cross sectional study that directly evaluates the characteristics of depressive symptoms by applying clusters in Malaysia. Law stu- dents are more depressed might be due to law students' frequent fear of failure in an atmosphere of intensive competition, teaching method and emotionally abusive in law students. Students living in hostel alone are more likely to develop depression, this can be due to the loneliness they may be experiencing, as they have than been reported to be less happy, less satisfied and more pessimistic. Conclusion: There is high prevalence of depressive symptoms among law, medical and pre-university students. If detected early, students with depressive symptoms may be successfully managed with beha- vioral therapy, emotional support and interpersonal psychotherapy. 17 Randomized Controlled Trial Study: The Effect of Exercise On Reaction Time Tan Jo Lynn, Ting Teck Hing, NazrulShahabudin, Nabila Aiz- zuddin, Saranya Kathirvel Community Medicine INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 MMSS 2015 INTERNATIONAL JOURNAL of MEDICAL STUDENTS S61#32IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS MMSS 2015 S62 Abstracts Abstracts Introduction: Reaction time (RT) is the elapsed time between the presentation of a sensory stimulus and the subsequent behavioural response. Physical exercise has been shown to develop or maintain mental & physical fitness and overall health. The objective of this experimental study is to assess the effect of short term exercise on reaction time among MMMC students. Methodology: This is a single-blinded RCT conducted on medical students from Melaka Ma- nipal Medical College (MMMC) over an 8 week period. Using block randomization, 60 participants aged 18-28 were randomized into 2 experimental groups who performed exercise of different intensities, and a control group. Prior to the intervention (exercise), each partici- pant completed a self-administered structured questionnaire. Blood pressure, heart rates, memory, reaction time were measured before and after intervention. Collected data was processed in Microsoft Excel, and analyzed using Epi-info 7 and SPSS. Descriptive statistics and ANOVA were calculated. Results: There was a significant differen- ce of Systolic Blood Pressure and Pulse Rate between intervention groups (p<0.05). Changes in Reaction time, Diastolic BP and Memory were not significant (p>0.05). Participant perception was measured using EFI scoring. Higher Total EFI and subscale scores indicate more positive mood states, while higher Physical Exhaustion scores indi- cate greater physical exhaustion. We found a significant difference in positive engagement and revitalisation (p<0.05), but no significance differences in tranquillity and physical exhaustion, (p>0.05). Conclu- sions: Aerobic exercise of different intensities produces no improve- ments in reaction time. However exercise improves mood. Exercise could help create a more enthusiastic, happy society. Exercise also helps in keeping the body refreshed and energetic, promoting a stress-free environment. 18 Glycemic control among adult patients attending follow up in specialist clinics, University of Malaya Medical Center and the guideline adherence in their management Tan Yin Zhien University of Malaya Introduction: The prevalence of diabetes mellitus has been on the rise in Malaysia. The Clinical Practice Guideline (CPG) for manage- ment of diabetes mellitus was updated to the latest version in 2009, but the guideline adherence in managing diabetes mellitus remained unknown. Objectives: To look into the co-morbidities, diabetic medi- cations, glucose control, pill burden of the patients living with diabe- tes mellitus, the percentage of guideline adherence in terms of blood pressure control and prescription of statin among diabetic patients. Methods: A cross-sectional study was conducted at the medical cli- nics of University of Malaya Medical Center, randomly recruiting 456 diabetic patients who has follow-up in the clinics in November and December 2014. Patients' demographic, co-morbidities and clinical information were gathered mainly via interview, while patients' medication and blood investigation results were retrieved from the medical records of the patients. Results: Dyslipidemia and hyperten- sion are the common comorbidities associated with diabetes me- llitus (80.3% 77.6%). The drug combination with most number of patient is biguanide with insulin (21.7%). Glucose control among the respondents are poor generally, with only 23.5% and 27.6% of the patients achieving target HbA1c and fasting plasma glucose levels respectively. Conducting a logistic regression using poorly controlled HbA1c as dependent variable, variables that significantly contribu- te to the model are employment, triglyceride level, fasting plasma glucose and type of anti-diabetic treatment (p<0.05). Blood pressure control is poor among the diabetics. Guideline adherence is good in the aspect of prescription of angiotensin converting enzyme inhibitor (ACEI), angiotensinreceptor blocker (ARB) and statins for hypertensi- ve and dyslipidemia patients among the diabetic respondents. 46.3% of the patients are taking 6 to 11 pills daily (including aspirin and medication for diabetes, hypertension, dyslipidemia), with medica- tion for other conditions not included. Conclusion: The glycemic and blood pressure control among the patients being followed-up in the medical clinics in UMMC remained poor. The guideline adherence in terms of prescription of ACEIS, ARBS and statins are good generally. More recommendations from the guidelines should be studied to obtain an overall picture of guideline adherence in managing dia- betes mellitus. 19 Perioperative Management of Patients with Cardiac Implan- table Electronic Devices Tharsini Sarvanandan University of Manchester Introduction: Worldwide, several million people have received a car- diac implantable electronic device (CIED) as treatment for their arr- hythmias. Although the introduction of these devices has completely transformed the treatment of patients who have cardiac conduction problems, it has made the management of these patients periope- ratively more complex due to the presence of the device itself. Aim: This review aims to look at the basics of CIEDS, specifically, the va- rious types and their function as well as current opinion and guidan- ce on managing patients with these devices perioperatively. It also takes into consideration the potential complications that may arise and any interference these devices may be susceptible to in this cri- tical period. Methods: A search was conducted through electronic da- tabases including PubMed, EMBASE and Ovid. Keywords used in this search were 'pacemakers' OR 'implantable cardioverter-defibrillator' OR 'ICD' AND 'anaesthesia' OR 'perioperative'. The list of the search results was reviewed to determine the relevance to the topic at hand by screening the title and abstract of the papers. Results: In order to increase the probability of a good outcome, a thorough preoperative assessment as well as vigilant monitoring throughout this period is vital. Appropriate measures to ensure patient safety including repro- gramming the device should be considered. Conclusion: The preope- rative assessment is an opportunity to elicit information from the pa- tient regarding their overall health and the function of their device so that the right preparations can be made if intraoperative problems are anticipated. During surgery, continuous monitoring is essential and equipment for resuscitation must always be readily available. Postoperatively, device function should be evaluated again. 20 Factors Associated with Differences in Haemoglobin Levels in Community-Dwelling Older Individuals in the Klang Valley Yew SY', Bee PC², Tan MP3,4 1 Fourth Year Medical Student, 2 Division of Haematology, 3 Division of Geriatric Medicine, 4 Ageing and Age-Associated Disorders Research Group, De- partment of Medicine, Faculty of Medicine, University of Malaya Introduction: Anaemia is a significant independent contributor to morbidity, mortality and frailty in elderly patients, and can lead to cardiovascular and neurological events. It has a great impact on the quality of life. The objective of the study was to determine the fac- tors associated with differences in haemoglobin level among the community-dwelling elderly in Klang Valley. Methods: Participants in this cross-sectional study were recruited from community-dwe- lling elderly (65 years and above) in Klang Valley during health awareness events. Anemia was defined according to World Health Organization (WHO) criteria as a hemoglobin (Hb) level of less than 13.0g/dL in men, and less than 12.0g/dL in women. Results: A total of 137 sampled residents met the criteria for data completeness and were retained for analysis. Mean age was 71.6 + 5.9 years. Using WHO criteria, 9.5% of the participants were anaemic. Factors asso- ciated with differences in haemoglobin levels statistically (p<0.05) were educational level of primary level or less (p=0.003) and age > 70 years (p=0.007). Hemoglobin level correlated significantly with weight(r=0.406, p<0.001), height(r=0.335, p<0.001) and BMI(r=0.242, p=0.006), but negatively with age(r=-0.231, p=0.007). Conclusion: Lower educational level, age, lower body weight and BMI and lower height are associated with lower haemoglobin levels among commu- nity dwelling older residents in the Klang Valley. An understanding of risk factors associated with anaemia will help direct efforts to reduce the burden of anaemia in our population. Abstracts of 11th Warsaw Internation Medical Congress (WIMC) Dentistry Case Report 01 Elongated Styloid Process Syndrome Eagle's Syndrome - Presentation Of Two Cases Jacek Michał Nowak, Marcin Piotr Szerszeń Medical University of Warsaw / Department of Oral Surgery Background: Eagle syndrome or syndrome of prolonged styloid process of the temporal bone is a rare syndrome, which cause is an extended styloid process and often concomitant an ossification stylohyoid ligaments. Patient typically reports to a doctor because of sudden severe pain in his ear, throat, floor of mouth the oral side of the neck and jaw angle around the lodge tonsil. This pain occurs when you open your mouth, turn the head or swallow. Addi- tional symptoms which are coexisting may be drooling, dysphagia, odynophagia, trismus, body sensation something in the throat. Pain symptoms occur suddenly and last from a few seconds to several minutes. Case: 56 year old man being treated for a pain and swelling on the left side of the face on heighti second and third molar. The patient is treated with immunosuppressants because of a kidney transplant. In a clinical study inflammation around the tooth 37, which was removed in the pocket of antibiotics and inflammation of the tooth 38, which had to be removed on the next visit. Despite per- formed surgeries, the patient is complaining of a pain and a trismus. The study revealed CBCT exacerbation of inflammation left temporo- mandibular joint and extended the styloid process syndrome. A 65 year woman before the transplant. In a clinical study need to revise the endodontic treatment of teeth 31, 34, or their extraction. In the photo OPG noted considerable length styloid process extending on the right to the angle of the mandible, and the left side to the middle branch of the mandible. After the additional interview, the patient is given signs in the front triangle of the neck. Conclusions: Eagle syndrome is a rare syndrome that poses diagnostic problems due to the very characteristic symptoms, which include sore throat, odynophagia, headaches, foreign body sensation in the throat. In order to make the diagnosis should be performed CT, which shows elongated styloid process and is rise in the diagnosis. 02 Erythema Exsudativum Multiforme - Methods of Treatment In The Dental Office Based On The Description of Patient Admitted To The Department of Periodontology And Oral Mucosa Disease Anna Haładyj Department of Periodontology and Oral Mucosa Disease, Medical University of Warsaw Background: Erythema multiforme is an acute disease of the skin and mucous membranes, recurrent in 25% of cases, mostly obser- ved in men. Characterized by erythematous-edematous changes, forming concentric figures, blisters and bloody ulcerations on lips. The disease is caused mainly by infectious agents, states of altered immune reactivity and certain medications. Case: 23-year-old patient was referred by an internist to the Department of Periodontology and Oral Mucosa Disease because of the presence of painful ulcers on angles of the mouth, buccal mucosa, upper and lower lips and erosions on the hard palate. He was already taking Heviran due to changes on the skin on the back of the hand, Telfast and Groprinosin prescribed by the internist. In dental office, compresses with 0,1% Laticort were applied to the inflammatory changed places, patient was instructed to take vitamin C, calcium and to continue the an- tihistamine and antiviral therapy. On subsequent visits, wraps with 0.25% Corhydron were continued, regression of pain and healing of the changes were observed, which eventually disappeared after 3 weeks. The patient came back to the Department after 5 months due to recurrence of the disease. Erosions showed again on the mucosa of lips, cheeks and palate. The patient has already received Telfast. Calcium, Tantum Verde and vitamin C were prescribed. Next three visits showed healing of changes on the mucosa, compresses with 0.25% Corhydron were sustained. The patient did not showed up again. Conclusions: In the dental office, in order to reduce the pain in the patient with erythema multiforme, corticosteroid solutions are being used to spray the oral mucosa. Systemic treatment is carried out with antihistamines, antiviral and sealing vascular endothelium drugs. Dentists should pay attention to the patient's medical history and try to determine a possible causative factor which elimination is the basis of the therapy of erythematous-edematous changes. 03 Pharmacological - Prostethic Treatment Of A Patient Pre- senting Dentureinduced Stomatitis Complicated By Fungal Infection Case Report Magdalena Walczak, Anna Walawska, Kamila Wróbel-Bednarz Medical University of Warsaw Background: Denture induced stomatitis (DIS) complicated by fungal infections is a common problem observed in patients with complete prosthetic restorations. This is usually related to many factors, in- cluding patients' physical conditions as well as special conditions prevailing in the oral cavity under the upper denture base. Specific microclimate often promotes fungal infections, especially Candida albicans infection can be observed. Patients then complain about a number of ailments, such as: pain, burning sensation, bleeding and serious problems with eating and talking. Case: This paper presents a case of treatment of the patient diagnosed with DISComplicated by fungal infections. The problem was indirectly caused by self-repair of the damaged upper complete denture. As a result of prosthetic and pharmacologic treatment, a significant improvement of patient's clinical condition was observed. Conclusions: Proper oral hygiene instructions and immediate implementation of suitabletreatment are essential and lead to recuperation from fungal infections. Patient's motivation, meticulous oral hygiene routine and regular follow-up visits are extremely important for patients with complete prosthetic dentures. These contribute to increase the time-of-life of this type of restorations in the oral cavity as well as reduce the risk of further complications including denture induced stomatitis. 04 Asymptomatic Sialolithiasis In The Duct of Submandibular Gland Case Report Michał Oszwałdowski, dr Paweł Nieckula, dr Bartłomiej Iwańczyk, dr Igor Kresa Students' Scientific Group, Department of Dental Surgery, Medical University of Warsaw Background: The paired submandibular glands are major salivary glands and produce 75% of saliva. Properties and components de- fine proper functions of saliva. However, under some circumstan- ces nonorganic part of it may form a salivary calculus. Presence of concretion sialolithiasis is the most common salivary gland disease, which occurs typically between the fourth and sixth decade of life. The state is characterized by the obstruction of a salivary gland or its excretory duct. The usual symptoms are pain and swe- lling of the affected gland, but the patient's case proves that such condition may remain asymptomatic, despite the fact that the size of salivary calculus in his submandibular gland duct was found to be substantial. Case: A 23-year-old male was referred to the Dental Surgery Department of the Medical University of Warsaw with the complaint of painless, egzofitic formation localized on the floor of the mouth, noticed by him few days before the appointment. Clinical examination revealed solid and yellowish mass under mucosa in the left Wharton's duct indicating sialolithiasis. Calculus was clinically filling the entire lumen of the duct. There were no obvious sings of INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS 11th WIMC 563#33IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS 11th WIMC S64 Abstracts Abstracts inflammation of the submandibular gland. A CBCT procedure was performed and it confirmed the presence of radiopaque object at the above-mentioned location. The treatment consisted of a surgical sto- ne removal, performed under local anesthesia. Conclusions: On the basis of the case described, it can be concluded that a considerable salivary stone in the duct of submandibular gland may cause no symptoms for the patient, thereby the dentist is likely to be unaware of its presence. As a result it may lead to a misinterpretation of RTG image taken during everyday dental practices. 05 Surgical Removal Of Inverted Impacted Maxillary Premolar: Case Report Paulina Sosnowska Department of Dental Surgery, Medical University of Warsaw Background: The eruption process is a very complex phenomenon in which multiple factors act synchronously to achieve a normal tooth position. However the process might be altered by genetic, molecu- lar, cellular or tissue causes. An impacted tooth is prevented from its normal path of eruption in the dental arch due to lack of space in the arch or obstruction in the eruptive pathway of the tooth. The teeth most commonly impacted are the mandibular third permanent mo- lar, maxillary permanent canine and occasionally the premolars. This impaction can be horizontal, vertical, mesioangular, distoangular or inverted of which inversion is very rare. Inversion is defined as "the malposition of a tooth in which the tooth has reversed and is posi- tioned upside down". In most cases inverted teeth have been found to be erupted into nasal cavity or found in maxillary sinus. Inversion of the premolar is very rare with few cases reported in the literature. Case: 46-year-old patient has been referred to the Department of Dental Surgery, Medical University of Warsaw. The panoramic radio- graph revealed abnormal position of right maxillary second premolar. Tooth was rotated 180 degrees to the horizontal axis. In clinical exa- mination the tip of the root was visible in the oral cavity. The patient reported prior attempt of removing the tooth by the dentist who considered it as residual root fragment. The patient was qualified for surgical removal of the 15 tooth. Under local anaesthesia, the tooth was removed as a whole, as well as adjacent cyst. Distally in the re- sultant osseous defect, the undamaged Schneiderian membrane was visible. Two pieces of absorbable haemostatic gelatin sponge was applied and the wound was sutured. Conclusions: This is a rare case of inverted impaction of the premolar. Some of the etiological factors that may result in an inverted impaction are systemic conditions like nutritional or endocrine disorders, previous trauma or stimulation to the affected site during tooth growth, abnormal location of tooth bud during initiation or follicular tooth sac inflammation. Systemic conditions or trauma that could result in inversion of a tooth was not reported by the patient. The most probable reason for the condition in this case is abnormal location of the tooth bud, but as the patient had never been diagnosed by radiograph, the condition was not treated at an early stage. This shows the importance of radiological examination before every treatment. 06 Non-Surgical Management Of A Large Periapical Lesion (Case Report) Yuriy Riznyk, Yaryna Havryshkevych, Mateusz Wykretowicz Danylo Halytsky Lviv National Medical University Therapeutic Dentistry Department Background: Endodontic treatment failure is usually characterised by the presence of post-treatment apical periodontitis. Apical periodon- titis is an inflammatory disorder of periradicular tissues caused by the etiological agents of endodontic origin. Persistent apical perio- dontitis can occur when a root canal treatment of apical periodontitis has: inadequate antimicrobial control, inappropriate access cavity design, missed canals, inadequate instrumentation, debridement and leaking temporary or permanent restorations. Based on current approaches all inflammatory periapical lesions should be initially treated with conservative nonsurgical procedures. However, treating a tooth with periapical radiolucency of a considerable size is always a question of success. The objective of our present case report was INTERNATIONAL JOURNAL of MEDICAL STUDENTS to evaluate the periapical pathology of posterior teeth clinically and radiographically, and to treat these teeth using the orthograde way and avoid traumatic surgical exploration. Case: A 21-year-old male patient with a non-contributory medical history was presented to our department with complaints on persistent acute pain in the UR6, increasing on biting. After the evaluation of main complaints, the clinical testing and radiographic analysis were performed. The pe- riradicular lesion in the area of teeth UR6-UR8 was revealed. The diagnosis: symptomatic apical periodontitis of UR6, asymptomatic apical periodontitis of UR7, UR8. The endodontic treatments of UR6 and UR8 were carried out in single visit method. The endodontic re- treatment of UR7 was carried out in two sessions, with crown-down instrumentation, irrigation with 6% sodium hypochlorite, 17% EDTA, 2% chlorhexidine and intracanal medication with calcium hydroxide paste. After 14 days, the root canals were filled with gutta-percha and AH-plus sealer by the lateral condensation technique and MTA. In a year the clinical and radiographic examination revealed almost a complete repair. Conclusions: Understanding the causes of endodon- tic treatment failure is of primary importance for a proper manage- ment of this condition. Teeth with a post-treatment apical periodon- titis can be managed by either nonsurgical endodontic retreatment or periradicular surgery. This case shows the capacity of the body to heal when the etiological factors are removed by a nonsurgical endodontic retreatment. An appropriate treatment of the infected ca- nals allowed a complete repair of these large radiolucent periapical lesions without any surgical intervention. Internal Case Report 07 Rapidly Progressive Glomerulonephritis Associated With Sys- temic Lupus Erythematosus: A Case Report Jastrzębska K, Gozdowska J, Perkowska-Ptasińska A, Durlik M. Departments of Transplantation Medicine and Nephrology, Medical University of Warsaw, Poland Background: Lupus nephritis is a frequent manifestation of a mul- tisystem autoimmune disease-systemic lupus erythematosus (SLE) and an important cause of both acute renal injury and end stage renal disease. Renal involvement is observed in approximately 60% of patients with SLE. Case: We report the case of crescentic glomeru- lonephritis in a previously healthy 21-year-old man who experienced a nasal injury in February 2011. Within a brief period the patient with insidious symptoms such as mild edema of lower limbs and face developed such clinical features as fever, nausea, vomiting, headache, loin pain, hematuria, oliguria, and hypertension. Based on the clinical history, laboratory test of renal function and ultra- sonography, acute kidney injury (AKI) was diagnosed and treated symptomatically. Rapidly worsening renal function became an im- portant determinant of renal failure therefore initially treatment was changed to hemodialysis therapy. Conducted immunological tests demonstrated elevated levels of antinuclear antibodies (ANA) and antibodies to dsDNA as well as low complement (C3 and C4) levels. The diagnosis of rapidly progressive glomerulonephritis (RPGN) in the background of diffuse mesangial proliferative glomerulonephritis with crescent formation was confirmed by the presence of patholo- gical features in renal biopsy. In addition to hemodialysis, treatment with steroid (methylprednisolone) and immunosuppressive agents (cyclophosphamide) was applied. The therapy resulted in clinical and histological improvement. After two months of treatment, there was recovery of renal function and the patient became dialysis in- dependent. Maintenance therapy (low doses of steroids and myco- phenolate mophetil) has been continued for about 4 years. Serum creatinine level is about 1.2 mg/dL, without proteinuria. Conclusions: Crescentic glomerulonephritis in the course of SLE is associated with unfavorable prognosis therefore must be treated promptly to pre- vent irreversible kidney injury. This case illustrates the potential of long-term high-dose immunotherapy in the treatment of RPGN in the course of SLE. Therapy the RPGN among patient with SLE can be challenging, considering the lack of current treatment guidelines and www.ijms.info • 2015 Vol 3 Suppl 1 published research. 08 49-Year-Old Patient With Nephrolithiasis, Haematuria, High Level Of Creatinine And Sepsis-Are You Sure It Is Acute Kid- ney Failure? Karolina Borowska, Katarzyna Ożga Jagiellonian University Medical College Background: Acute kidney failure (AKI) is a very complex condition, which symptoms depend on cause of this disorder. Regardless of a cause we can observe general malaise, loss of appetite, nausea, vomiting and eventually oliguria or even anuria. Renal function exa- cerbates rapidly. There are a lot of causes of AKI, we can divide into three groups: prerenal, intrinsic and postrenal. Possible reasons of AKI are haemorrhage, tumour or systemic autoimmune disease. The complications such as hypertension, anaemia and infections may occur. Case: The patient, a 49-year-old man was admitted to the Department of Allergy and Immunology of JUMC with oliguria and fever. He was previously treated because of Staphylococcus sepsis. Nephrolithiasis and infection were considered as a cause of AKI. Pa- tient had fever (38,50C) and his blood pressure was elevated to 140/90 mmHg. The physical examination disclosed basal crackles. The chest X-ray confirmed pulmonary oedema. The laboratory tests showed significant elevation of kidney function markers (cretinine- 560μmol/L, urine-17,3mmol/L), hypoalbuminaemia, anaemia and high level of acute-phase proteins-CRP-179,5 mg/L. Furthermore, haematuria was observed. Haemodialysis treatment was essential. Urine culture revealed presence of Klebsiella pneumoniae, so the appropriate, targeted antibiotic was administered intravenously. The result of immunological test for presence of anti-glomerular base- ment membrane (anti-GBM) antibodies was positive, while tests for ANCA and ANA were negative. All symptoms and test results indica- ted on Anti-GMB disease. Methylprednisolone was introduced. The patient was transferred to Intensive Care Unit to perform plasma- pheresis therapy. Kidney biopsy confirmed advanced glomerulopathy with signs of glomeruli basement membranes inflammatory changes regression. Then the patient received first intravenous pulse of cyclo- phosphamide. Although general condition of the patient significantly improved, he still required haemodialysis. After 42 days of hospita- lization he was discharged and advised to return to check-up and next cyclophosphamide dosage in two weeks. Conclusions: AKI can be caused by many different diseases or iatrogenic actions. Although systemic vasculitis are not so common disturbances, they should be taken into consideration in the differential diagnosis of kidney fai- lure. This case proves that rare diseases exist not only in textbooks but they are around us. 09 Incidental Tumor-Related Left Ventricular Hypertrophy Coe- xisting With Sarcoidosis Piotr Sypień, Martyna Zaleska Warsaw Medical University, Department of Cardiology and Hypertension, Central Clinical Hospital of the Ministry of Interior, Warsaw Background: Cardiac tumors are uncommon group of disorders, es- timated in population as 0,0017-0,33% [1]. Most of them are metas- tasis, only 5% are primary. Usually they are benign, most frequently we find myxomas(50%), fibromas (6,9%) and sarcomas (6,4%). They are generally localized in left heart. They present with non-specific symptoms. During diagnostic process transthoracic echocardiogra- phy (TTE) plays an important role. Once a patient comes in with suspicion of cardiac tumor, echocardiography does not fully define diagnosis, cardiac magnetic resonance (CMR) may be of some help. Case: We present a case of 70-years old patient suffering from paro- xysmal atrial fibrillation, hypertension and goitre, who was admitted with suspicion of cardiac hypertrophy due to lung cancer. Follow up with TTE brought unspecific wall hypertrophy of about 40 mm localized in posterior wall and CMR brought unspecific oval mass sized 63x41 mm localised in back wall. Mediastinoscopy with biopsy of lymphoid nodes done as a part of lung cancer follow up gave an unexpected diagnosis of sarcoidosis. Due to supposing diagnosis www.ijms.info • 2015 Vol 3 Suppl 1 open by the biopsy, CMR of heart was performed. Final diagnosis of oval mass sized 63 x 41 mm suspection of fibroma or rhabdomyoma was done. Conclusions: Cardiac tumors are uncommon and most frequent they are metastatic. Even though in a patient with suspec- ted lung cancer, oval mass in the heart may end up as coexists lung sarcoidosis and fibroma. 10 Tacrolimus-Associated Central Pontine Myelinolysis After Liver Transplantation Artur Kośnik Liver and Internal Medicine Unit of Medical University of Warsaw, Warsaw, Poland Background: Central pontine myelinolysis (CMP) is a detrimental neurologic complication after liver transplantation, representing a source of early mortality. The etiology of CMP is unclear, although a marked variation of perioperative serum sodium remains the main risk factor. The last studies indicate the role of immunosuppressants on its development and emphasise the neurotoxicity of calcineuri- ne inhibitors, mainly tacrolimus. We present the first Polish case of tacrolimus-associated central pontine myelinolysis after orthotopic liver transplantation. Case: A 46-year-old man who underwent or- thotopic liver transplantation (OLT) developed dysarthria followed by disorders of consciousness and dysphagia. Magnetic resonance imaging (MRI) findings confirmed the diagnosis of central pontine myelinolysis (CMP). Since no perioperative disorders of fluid and electrolyte balance was observed, the hypothesis of tacrolimus neu- rotoxicity was established. The immunosuppression regimen was modified by switching from tacrolimus to everolimus. The patient experienced significant neurologic recovery. Regression of MRI ab- normalities was observed four months later. Conclusions: Tacrolimus may precipitate central pontine myelinolysis and its cessation from immunosuppressive therapy in early post-operative course may have benefits for patients who present with devastating neurological symptoms. In the setting of central pontine myelinolysis everolimus (and other mTOR inhibitors) should be considered as safe and effec- tive immunosuppressants. 11 Cold-Induced Angina And St-Segment Depressions In 22 Years Old Female With Pericardial Effusion. Coronary Artery Spasm And Raynaud's Phenomenon As Systemic Vasospasm Disorder Sylwia Gajda Medical University of Warsaw Background: Typical angina pain lasting more than 20 minutes and ST segment changes on ECG are not always due to atherosclero- sis.If the patient is young with no risk factors for coronary artery disease (CAD), the diagnosis is more challenging.Pericarditis and myocarditis can mimic myocardial infarction.Coronary artery spasm (CAS) and cardiac syndrome X should be considered too. What makes the diagnoses more difficult, is that they may overlap, which can lead to a variety of clinical presentations. Case: A 22-year-old fema- le presented with 4 episodes of crushing chest pain while running in cold weather.The patient also complained of fatigue and palpi- tations whenever walking up stairs during previous 2 months.She has never smoked, BMI = 18.4, blood pressure = 90/60 and a normal cholesterol level. Last winter she started to suffer from Raynaud's phenomenon and had cold intolerance for years. In the past she had blood tests positive for ANA, low platelet count and a decrease in C3 complement.She was scheduled for a treadmill stress test, but befo- re the test she got a Raynaud's attack, chest pain and an ECG tracing showing ST-segment depressions up to 2 mm in lateral and inferior leads. Blood tests, including cardiac enzymes, were normal.She was sent home with cardiac syndrome X as a possible diagnosis. The next day she had similar angina pain at rest along with ECG changes and was admitted to the hospital. During hospitalisation she complained of similar symptoms. Each time cardiac enzymes were negative.Echo- cardiography showed 4 mm of fluid in pericardial sac.Myocarditis and CAS were suspected and she was treated with diltiazem and ibuprophen.After 4 days she was discharged, however 3 days later INTERNATIONAL JOURNAL of MEDICAL STUDENTS 11th WIMC S65#34IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS 11th WIMC s66 Abstracts Abstracts she had severe chest pain, ST-segment depressions and was admit- ted again.MRI showed fluid in the pericardial sac with a maximum of 8 mm at the base, After 9 days she was discharged with a diagnosis of pericaridial effusion and CAS. Conclusions: Anginal pain and ST- segment changes are not always due to CAD. The possibility of CAS should be taken into account, especially when the patient is a wo- man with history of chest pain triggered by cold exposure, smoking, stress or some drugs. This young female presented with symptoms typical for coronary artery occlusion, which were caused by CAS.To- gether with Raynaud's phenomenon and a suspicion of glaucoma it can reflect a systemic vasospasm disorder.The prognosis for variant angina is good, although it can lead to myocardial infarction, serious arrhythmias and even death. 12 A Case Report Of 60 -Year-Old Man With Depression And Hypertension Diagnosed With Pheochromocytoma Kinga Brodzińska, Beata Rak Students' Scientific Group, Chair and Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Poland Background: Pheochromocytoma is an adrenal gland tumor, origi- nating in the chromaffin cells, which produces catecholamines. Characteristic for this tumor is the "rule of tens" (10% bilateral, 10% extraadrenal, 10% malignant). The classical triad of clinical symptoms consists of palpitations, headaches and excesive swea- ting. Other symptoms include: hypertension, anxiety, pallor, nausea, weakness. However, it can be asymptomatic. Because of unspecific symptoms the diagnosis of this rare neuroendocrine tumor can be missed or delayed. The differential diagnosis should consider: essen- tial hypertension, anxiety attack, hyperthyroidism, hypogonadism, hypoglycemia, renal artery stenosis, intracranial lesion, autonomic epilepsy, carcinoid syndrome, use of cocaine or amphetamine. The final diagnosis is based on biochemical testing of plasma or urine metanephrines and imaging studies (CT, MRI, 123 MIBG, scan, PET). There is a need to exclude causes of falsely elevation of metane- phrines like: withdrawal of lewodopa, symphaticomimetics, alfa/ beta blockers and tricyclic antidepressants. Case: This study reports the case of a 60- year- old man with a history of depression and stable hypertension who was admitted to the hospital because of a tumor (35 x 30mm) in the left adrenal gland found incidentally on abdominal ultrasound examination. The patient complained only of profuse sweating on exertion. There was no abnormalities on physi- cal examination. He has been treated for depression for 7 years with clomipramine (Anafranil) and mianserin (Lerivon); for hypertension with losartan (Cozaar) and doksazosin (Doxar). The work up revealed elevated level of urine metanephines and noradrenaline. As post surgery urine metanephrines normalized, but norepinephrine was still elevated it may suggest that elevation of norepinephrine is due to drugs influence. It should be however established as it may aslo suggest not complete excision of a tumor or extradrenal tumor (me- tastases/paraganglioma). To confirm the drug influence hypothesis antidepressives should be withdrawn but it is not possible because of patients condition. Conclusions: This case report suggest, that pheochromocytoma is not always easy to diagnose. False positive and negative results do occur. The interpretation of laboratory data needs to be done together with clinical picture, imaging studies and concurrent treatment. 13 Magnetic Resonance Enterography For Assessment of Intens- tinal Graft-Versus- Host Disease Weronika Jaremek, lek. spec. radiolog Joanna Podgórska, lek. Piotr Kacprzyk II Zakład Radiologii Klinicznej Centralny Szpital Kliniczny Warszawskiego Uniwersytetu Medycznego Klinika Chorób Wewnętrznych Hematologii i Onkologii Centralny Szpital Kliniczny Warszawskiego Uniwersytetu Medycznego Background: Graft-versus-host disease (GVHD) occurs as a main, se- vere and frequent complication after allogenic bone marrow trans- plantation (alloPBSCT). The process of GVHD develops when donor alive T lymphocytes cells damage recipient target organs, especially skin, liver, digestive tract and bone marrow. After SCT about 50% of patients suffer from clinically relevant GVHD what more 10-year survival rate is no more than 5% in acute GVHD. Currently the as- sessment of intestinal GVHD is mainly based on clinical symptoms and endoscopic examination of the upper and lower gastrointes- tinal tract together with multiple biopsies. Magnetic resonans en- terography (MRE) is a standard method for evaluation various in- testinal pathologies in Inflammatory Bowel Diseases particularly in Leśniowski-Crohn disease. MRE is really sensitive to identify active inflammation, wall thickening, stenosis, mural stratification, ascites and others. Thereupon it could be also good method in grading of gastrointestinal graft-versus-host disease GI GVHD after alloPBSCT. Case: 45 year men, GI GVHD after alloPBSCT owing to MCL (mantle cell lymphoma). Patient underwent MRE. The MRE findings showed inflammation changes of all small intestine with submucosal oede- ma and mesentery changes. Conclusions: Magnetic resonance ente- rography is new opportunity and really well alternative method for assessing clinical severity of GI GVHD. MRE precisely shows localiza- tions and types of pathological changes. What else, patients may have to undergo repeated MRE because it is non-invasive method due to that long control of disease or relapsing detection is relatively simple. In case of that It could be also really useful method for GVHD patients. 14 Papillary Thyroid Carcinoma, Primary Hyperparathyroidism And Idiopathic Hyperandrogenism In 35-Year-Old Obese Fe- male Patient Case Report Marta Muszel, Kamil Wocial Medical University of Warsaw, Department of Internal Medi- cine and Endocrinology, Students' Scientific Group "Endocri- nus" Background: Papillary thyroid carcinoma (PTC) is the most prevalent of all thyroid carcinomas. It is characterized by rather slow growth with lymphatic spreads, distant metastases occur rarely. Some studies suggest that there is a connection between prevalence of Hashimoto's thyroiditis and PTC. Primary hyperparathyroidism can appear as a part of multiple endocrine neoplasia (MEN) syndrome. Its occurrence in patients with PTC is rare. Case: 35-year-old obese woman with Hashimoto thyroiditis, hypertension was admitted to hospital due to hirsutism that was gradually escalating since pu- berty, she reported regular menstruations. On physical examination patient presented: • • second degree obesity (BMI- 36,3)- patient reported that she gained circa 30kg over 7 years hirsutism 10/36 points on Ferriman-Gallwey score features of acanthosis nigricans (AN) around neck and axi- llas features of acne on face and chest DHEAS, testosterone and 17(OH)-P serum concentrations were nor- mal. TV ultrasound revealed no ovary abnormalities. Diagnosis of idiopathic hyperandrogenism has been established on basis of these results along with regular menstruations. Oral glucose tolerance test indicated impaired fasting glycaemia. Basic laboratory tests revealed elevated serum ionized calcium level. Further tests indicated increa- sed plasma parathormone concentration and urinary calcium ex- cretion. Laboratory results suggested primary hyperparathyroidism. Bone densitometry result was within normal range. MIBI parathyroid scintigraphy demonstrated no signs of increased gathering of the marker, however it might have been due to Hashimoto's thyroiditis and levothyroxine treatment. Further diagnostic procedure excluded MEN1 and MEN2a. Thyroid ultrasound (US) performed 1 year prior to patient's admission showed hypoechoic nodule (8mm size). Present thyroid US demonstrated 3 nodules, one of them was non homo- geneously hypoechoic with microcalcifications present. Fine-needle aspiration biopsy indicated PTC. Surgical consultation was planned to schedule strumectomy and parathyroidectomy. Conclusions: In case of described patient three diseases- idiopathic hyperandrogenism, primary hyperparathyroidism and papillary thyroid carcinoma have occurred independently. Patients with nodular HT should be carefully monitored, because of possible connection between nodular HT and papillary thyroid carcinoma. Radical strumectomy and parathyroi- dectomy is the first choice treatment in case of described patient. 15 When gynecology meets pneumonology a rare cause of multiple pulmonary nodules Magdalena Chojnowska, Marta Maskey-Warzechowska MD, PhD, Renata Rubinsztajn MD, PhD Students' Scientific Group "Alveolus", Department Internal Medicine, Pneumonology and Allergology, Medical University of Warsaw Background: Multiple contrast enhanced nodular lesions in the lungs indicate a malignancy, however benign diseases should also be con- sidered. We present a 57-year old woman with a rare pulmonological manifestation of a common benign gynecological disorder. Case: A 57-year old woman with a history of hysterectomy due to uterine leiomyoma 15 years ago, was hospitalized due to multiple pulmo- nary nodules in both lungs. The lesions were revealed in a routinely performed chest radiogram. The patient had no symptoms, no ab- normalities were found on physical examination. Computed tomo- graphy of the chest revealed multiple, bilateral, well-defined, nodu- lar lesions which varied in size and showed contrast enhancement. A malignant disseminated neoplasm was suspected, but numerous imaging studies and cancer markers within the normal range failed to confirm this suspicion. 18 FDG PET-CT was negative. The patient underwent open lung biopsy; histopathological examination showed altered muscular cells and low grade stromal sarcoma was diag- nosed. However, the attending oncologist, taking into consideration the lack of the primary focus and the very good general state of the patient despite an interval of few months between the initial and final diagnosis decided to consult the histopathological specimens in two independent oncological centers: benign metastasizing leiomyo- matosis was diagnosed. The patient is under observation since 2012, she remains asymptomatic. In 2015 a new single nodular lesion was detected in the left lung, the appearance of the remaining nodules is stable. Conclusions: Bilateral multiple lung nodules with contrast enhancement in CT are typically associated with pulmonary metas- tases. However, differential diagnosis should also include benign le- sions. BML should be suspected especially in asymptomatic middle- aged women with a history of uterine leiomyoma, who present with pulmonary nodules. 16 A Fever Of Unknown Origin As A Sign Of Neoplastic Process In The Body. Case Report. Katarzyna Ożga, Karolina Borowska Jagiellonian University Medical College Background: Neoplastic process in the body, especially neoplasia of the lymphoid system, sometimes creates diagnostic difficulties. Lymphomas, including Hodgkin lymphoma, can be associated with paraneoplastic syndromes, which do not lead to appropriate diag- nosis. Hodgkin lymphoma is the most common neoplasm in young adults, but because of non-specific symptoms it's often detected in advanced stage. Case: The patient is a 29 year-old male who presen- ted fever episodes up to 39 °C, which repeatedly recurred during last 10 months. The medical history revealed ulcerative colitis treated with mesalazine. The fever episodes began in January 2014, when the patient presented to his family doctor. Firstly he was suspected to suffer from some infection but the treatment was unsuccessful. Apart from fever the patient complained of hematochezia. In October 2014 he was admitted to the Department of Allergy and Immunology JUMC where the diagnostic procedure was extended. On physical examination no abnormalities were detected. Laboratory tests revea- led elevated LDH level (720.0 U/L) and CRP level (on admission: 14.3 mg/L, during hospitalization: 29.8 mg/L), in immunology test PANCA antibodies were found, although they are often present in ulcerative colitis patients. During hospitalization several episodes of fever up to 39.2 °C occurred. In thorax computed tomography nodular densi- ties with air spaces in lungs were detected accompanied by interlo- bular septal thickening. Bronchoscopy disclosed reddened bronchial mucosa, but all cultures including tuberculosis were negative. The abdominal ultrasound showed hepatomegaly and mild splenome- galy. Abdominal and pelvis radiology scans confirmed hepatomegaly and uncovered enlarged paraaortic and internal iliac lymph nodes. Lymphadenopathy was also found in the hepatic hilum area. Colo- noscopy did not reveal any abnormalities. Because of abdominal and pelvic lymphadenopathy the patient was referred for a lymph node biopsy. Histopathological examination of the samples revealed Hodgkin lymphoma. Conclusions: Hodgkin lymphoma can have a lot of symptoms, but the most common is lymphadenopathy, which occurs in 95% of cases. Usually, there is painless lymphadenopathy in cervical and supraclavicular region, but isolated subdiaphragmatic lymphadenopathy is rare. That's why in those cases finding the ap- propriate diagnosis is long and difficult. 17 Budd-Chiari Syndrome Connected To Mutation Of Jak 2 - A Case Report Anna Skoczek Medical University of Warsaw, Radiology Department Background: Hepatic veins occlusion, also known as the Budd-Chiari syndrome is one of the causes of liver failure Two maior forms of the disease can be distinguished: a primary form with thrombosis of the hepatic veins and a secondary form, due to compression of the veins by adjacent structures. All forms can lead to serious hemodynamic consequences and severe liver damage from inten- se centrilobular congestion, with ischemia, pressure necrosis and loss of parenchymal cells in the center of the liver lobule. Hepatic vein thrombosis is most commonly associated with myeloprolife- rative syndromes, hypercoagulable states and cancer. Diagnose is confirmed by CT with angiography and ultrasonography. Treatment includes administration of anticoagulants, angioplasty of the occu- pied veins and liver transplantation. Case: A 31-year old woman was admitted to hospital because of Budd-Chiari syndrome with suspi- cion of essential thrombocythaemia (present mutation V617F of JAK- 2) and thrombosis of hepatic portal system. The patient presented ascites and peripheral edemas with signs of hepatic insufficiency. Angio-CT showed presence of fluid in both pleural cavities and pe- ricardial sac, advanced ascites, slightly enlarged liver with large 1st segment and uneven density, indicating perfusion abnormalities. The study showed occlusion of all hepatic veins, with exception of a small vein from the 1st segment, compression of vena cava sup. by the liver at the level of diaphragm and thrombosis of portal vein, v. mesenterica sup. and v. lienalis. Spleen and other organs of abdomi- nal cavity were unaltered. During hospitalization, through paracen- tesis 21 of fluid was obtained, the patient was also consulted by a hematologist. A gastroscopic banding of varices was performed. The edemas subsided through optimal diuretic treatment. Due to throm- bosis of portal vein system, which contraindicates hepatic trans- plantation, the patient was qualified for conservative treatment with anticoagulants. The patient was discharged from the hospital in good condition for further hematologic diagnostic. Conclusions: The Budd- Chiari syndrome caused by thrombocythaemia with JAK-2 mutation is a rare disease, often asymptomatic. In this case it was present with the whole classic clinical and imaging manifestation and also with coexisting thrombosis of portal vein's system, which makes this case unusual and interesting from didactic point of view. 18 Multiple Endocrine Neoplasia Type 1- Cancer Predisposition Syndrome Associated With Cerebral Palsy. A Case Report Radosław Pietrzak, Anna Pasierb Students Scientific Group Endocrinus, Department of Endo- crinology and Internal Medicine, Medical University of War- saw Background: Multiple endocrine neoplasia type 1 (MEN1) is a syn- drome of endocrine and non-endocrine tumors involving the pa- rathyroids, anterior pituitary and enteropancreatic neuroendocrine tissues, and is inherited in an autosomal dominant. Estimates of the prevalence of MEN1 is 1 per 30 000 in general population. Tumors can be benign or malignant and they can grow synchronous or metachro- INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS 11th WIMC 567#35IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS 11th WIMC s68 Abstracts Abstracts nous. Manifestation of the disease is related to the affected organ and can include mass effects from tumor size, hormone secretion and malignancy. Diagnosis is mostly accidental. Case: The present study reports a case of MEN 1 associated with juvenile cerebral palsy. A 37-year-old male patient with MEN1 has exhibited major clinical manifestation of MEN 1, such as prolactinoma, hyperparathyroidism and insulinoma. 16 years ago he was successfully operated, and prolactinoma tumor and two enlarged parathyroid glands were re- moved. There were no signs of malignancy in the removed material. Since then patient has been under pharmacological treatment with Bromergon due to prolactinoma and Diazoxide due to insulinoma. Patient has not expressed any complications of cerebral palsy such as physical disability or mental retardation. The patient stays under the surveillance of the Department. In July 2014 he was admitted to the Department of Endocrinology and Internal Medicine in Warsaw due to a loss of consciousness. Considering the patient's whole cli- nical picture, it seems that the fainting might have been caused by hypoglycemia in course of viral gastroenteritis. Since then, episodes of loss of consciousness have not occurred. In physical examination, there were no signs of arrhythmia, recent neurological symptoms or hypoglycemia episodes. Morning prolactin level was at 15,75 ng/ ml. Abdominal ultrasound showed no new lesions in the pancreas in comparison to ultrasound 2 years ago. Laboratory tests showed an increased calcium and parathormone level, even though the patient had no signs of hypercalcemia. In parathyroid ultrasound a lesion (which seems to be enlarged lower right parathyroid) was present. Further treatment recommendations for the patient included a sur- gery and more tests. Conclusions: Described clinical case shows an extremely rare example of MEN 1 associated with previous childhood disease. MEN 1 is a promising model to understand endocrine and other tumors. To the best of our knowledge, there have not been any report of MEN 1 associated with cerebral palsy 19 Fabry Disease In Patient With Previous Wrong Diagnosis Olga Chrząstek Medical University of Warsaw Background: Fabry disease (angiokeratoma corporis diffusum) is an X-linked recessive disease. It happens due to a defect of alpha- galactosidase resulting in the accumulation of globotriaosylceramide (Gb3) in a lysosomes in variety of cell types. Kidneys, heart and cen- tral nervous system are often affected. Clinical consequences include progressive renal and cardiac dysfunction. Peripheral neuropathy, chronic burning pain felt in hands and feet as well as episodic pain- ful crises and angiokeratoma are described. The condition affects males, however females, who have been described as carriers of the defective gene may exhibit a wide spectrum of symptoms. In Euro- pe the enzyme replacement therapy (ERT) was introduced in 2001. Case: A 49-years old man was admitted to hospital in April 2003 for diagnosis of chronic kidney failure etiology. After many diagnostic examinations, the etiology wasn't found. In anamnesis: from child- hood the patient reported chronic burning pain of hands and feet as well as episodic painful sensations related to temperature change. Because of that the patient had regularly taken various analgetic drugs. The patient's mother presented Osler-Weber-Rendu syndrome and hypertension. At the age of 12, Osler-Weber-Rendu syndrome was histopathologically confirmed in our patient. Since that time, the patient was under the supervision of a rheumatologist, later a hematologist. At the age of 24, because of atrial fibrillation (AF) car- dioversion was performed. Multifocal vascular damage of cerebrum and cerebellum after stroke in November 2002 was presented. Also hypertension was diagnosed. Finally, end stage renal disease was diagnosed in our patient (2006). After 3 years of renal replacement therapy, a-galactosidase A (GLA) activity in leukocytes and plasma has been tested. A decreased level of the enzyme confirmed Fabry disease. That enabled to begin enzyme replacement therapy for his 9-years old daughter who had painful sensations in her hands. In 2007 our patient received renal graft. Conclusions: The aim of this case presentation is to highlight the problem of wrong diagnosis in the past and the consequences arising from it. Atypical symptoms reported by the patient should attract our attention. Also rare di- seases should be taken into consideration especially when causal treatment is available. 20 Torsades De Pointes And A Brain Tumour In A Patient Presen- ting With Seizures Monika Madrova 1; Adam Lukac; Lukas Mach 1,2 1 Masaryk University, Brno, Czech Republic; 2 International Clinical Research Centre, St. Anne's University Hospital Brno, Czech Republic Background: Seizures have been previously described to occur in association with heart rhythm disturbances, but possible underlying pathophysiological links have not been clearly elucidated, and yet prompt identification and treatment of cardiac arrhythmias could reduce morbidity in some patients presenting with new onset of seizures. We report on a patient in whom seizure activity resolved after treatment of a cardiac arrhythmia. Case: A 45-year-old lady was brought to emergency department (ED) after 2 witnessed sei- zure episodes. Her medical history was significant for hypertension treated with bisoprolol, lacidipine, amiloride, and hydrochlorothiazi- de. She had not previously experienced any seizures. Shortly after ED admission another seizure associated with loss of conscious- ness, clonic spams, and urine incontinence occurred. The patient was administered diazepam and urgent computed tomography of brain was performed. This showed hyperdense extra-axial tumour (39x29x25mm) located on apex of the right temporal bone pyramid without perifocal oedema or expansion. Blood tests revealed se- vere hypokalaemia (2.5 mmol/l), and repeated 12-lead ECG recor- dings were significant for QT interval prolongation, and polytopic ventricular ectopic beats. Two more seizure episodes occurred, and at this time 12-lead ECG during the seizure was obtained. Torsades de pointes polymorphic ventricular tachycardia was present throug- hout the seizure episode. Urgent correction of low serum potassium was commenced, and magnesium sulphate was administered. The seizure symptoms subsided with spontaneous conversion to sinus rhythm. No further seizures developed after electrolyte balance res- titution. The patient was discharged from hospital on day 5 from admission, and outpatient neurosurgical consultation was requested Conclusions: Two possible explanations for seizure activity coincided in this patient, intracranial mass, and polymorphic ventricular tachy- cardia. Given the lack of perifocal oedema and brain parenchyma invasion the tumour appeared to be a less likely explanation. Also, the resolution of symptoms after sinus rhythm restoration supported the notion that the arrhythmia was the causative factor. This case highlights the importance of extensive cardiovascular monitoring and full clinical work-up including brain imaging of patients with new onset of seizures. 21 Dystonia: A Problematic Diagnosis Adam Gałczyński, Elżbieta Julia Borys, Katarzyna Stefania Ochyra Jagiellonian University/Medical College Background: Dystonia is a movement disorder that causes sustained muscle contractions, repetitive twisting movements and abnormal postures of the face, neck, trunk, arms or legs. It results from si- multaneous contraction of agonist and antagonist muscles. It can be caused be a genetic disorder or acquired structural lesions, but it can also be induced by drug use, especially by antipsychotics; an estima- ted 1-4% of patients treated with second generation antipsychotics may be affected by this illness. Dystonia is the second most popular (32%) manifestation of a psychogenic movement disorder. Diagnosis is problematic, particularly in cases where many risk factors coexist, but it is crucial for proper treatment and affects the prognosis. Case: A 31-year-old female patient diagnosed with paranoid schizophrenia, with a 12-year history of psychiatric hospitalizations, developed a movement disorder in the course of her treatment. In 2009, she presented to the psychiatric hospital with involuntary head and ex- tremity movements. Due to the use of risperidone, a second genera- tion antipsychotic, a tardive dyskinesia was suspected. Neurological consultation and testing ruled out an organic cause of symptoms. In the course of the following years, the symptoms reappeared in a different form and the diagnosis had to be re-evaluated. In 2011, the patient presented with painful torticollis and twisting arm mo- vements. The symptoms fluctuated and depended on the patient's present emotional state rather than on used drugs. Torsion dystonia and Huntington Disease were ruled out by genetic testing. Neuroi- maging and an EMG of the sternocleidomastoid muscle showed no evidence of a possible organic cause of symptoms. Gait impairment, abasia and astasis contributed to the final diagnosis of dissociative motor disorder in the course of schizophrenia. Conclusions: Patients with psychogenic movement disorders have debilitating symptoms that can lead to long-term disability and seriously affect their quality of life. They require structured and multidisciplinary treatment sup- ported by neurological and psychiatric follow-up. The final diagnosis should be made not only through the exclusion of organic cause, but also with an in-depth analysis of the onset, precipitating factors and presentation of the movement disorder. The patient's acceptance of the psychogenic origin of symptoms is fundamental for the positive outcome of treatment. 22 Hirsutism With Hair-An Syndrome And Features Of Acanthosis Nigricans In 21-Year-Old Female Patient Kamil Wocial, Marta Muszel, Mikołaj Radziszewski Medical University of Warsaw, Department of Internal Medi- cine and Endocrinology, Students' Scientific Group "Endocri- nus" Background: HAIR-AN syndrome is characterized by hyperandroge- nism (HA- elevated concentration of androgens in serum with clini- cal manifestations, such as hirsutism, acne, androgenic alopecia), insulin resistance (IR) and features of acanthosis nigricans (AN- skin condition characterized by areas of dark, velvety discoloration in body folds and creases). It is perceived to appear clinically in ado- lescent women, however, it is diagnosed in adulthood as well. It occurs in 5-10% of women with hyperandrogenism. Case: A 21-year- old woman was admitted to the hospital due to incrementally esca- lating chin and cheeks hair, oligomenorrhoea. She notified fatigue, muscle pain, increased blood pressure's values and weight gain about 30 kilograms over the last three years. She did not report galactorrhoea, blurred vision, drowsiness, sweating and sexual dys- function. On physical examination she presented third degree obe- sity, abdominal skin stretch marks, features of AN around neck. In case of observed hirsutism the patient achieved Ferriman-Gallwey score of 29 points. Differential diagnosis included: hyperprolactine- mia, acromegaly, thyroid disturbances, Cushing's syndrome, ovary and adrenal tumors, non-classical adrenal hyperplasia. Computed tomography scan was performed and no lesions in adrenal glands were found. Results of ambulatory conducted transvaginal ultraso- nography (TV US) showed no abnormalities in ovaries, but diagnostic value of this TV US is questionable. Laboratory studies indicated in- creased concentrations of serum testosterone and insulin, decreased steroid hormones binding globulin level, hypercholesterolemia. Ho- meostasis model assessment insulin resistance (HOMA IR) equaled 16,54. Levels of pituitary hormones, thyroid parameters, cortisol and 17-hydroxyprogesteron were within normal ranges. HAIR-AN was es- tablished as a final diagnosis. Treatment was aimed at decreasing insulin resistance (metformine) and body mass (diet and exercise), performing bariatric surgery has been proposed to take under consi- deration. Conclusions: Hyperandrogenism, AN may be manifestations of malignancies and endocrine disorders such as hypercortisolemia or prolactinemia, so thorough diagnostic procedure is necessary in all cases. Properly performed diagnostic process of hirsutism and AN is necessary in order to find optimal treatment for the patient. 23 Exacerbation of Multiple Sclerosis Induced By Reverse Takot- subo Cardiomyopathy Paulina Głowacka, Maria Gąska, Paulina Karolczak, Dorota Ochijewicz Medical University of Warsaw, 1st Department of Cardiology Background: Takotsubo cardiomyopathy (TTC) is characterized by transient myocardial contractility impairment without significant changes in coronary artery. Clinical presentation of TTC mimics acute coronary syndrome. A rare variant of TTC is reverse TTC in which the basal segments of the left ventricle are akinetic. Case: 43-year-old woman with history of multiple sclerosis (MS) was admitted to the emergency department with dyspnoea, chest pain and the left upper limb numbness. These symptoms were induced by psychical stress. Tnl (2,439ng/ml), CKMBmass (9,3ng/ml) and NTproBNP (5918pg/ml) were elevated. Electrocardiography demonstrated ST segment eleva- tion in V1, V2 leads and ST segment depression in II, III, aVF, V4-V5 leads. The QTc interval was prolonged to 478ms. There weren't signi- ficant changes in coronary arteries. The echocardiography revealed akinesis of basal segments, hypokinesis of middle segments of the left ventricle. The ejection fraction (EF) was 34%. During hospitali- zation we observed improvement of left ventricle function. After 10 days EF increased to 58%. Because of vomiting and nausea compu- ter tomography and lumbar puncture were performed. Patient was consulted by neurologist who excluded recurrence of MS. Patient was also consulted by psychologist. After 7 days hospitalization pa- tient was discharged in general good condition and ACE inhibitors, B-blokers, eplerenone and IPP therapy. Nevertheless two weeks la- ter she was admitted to the hospital with an exacerbation of MS. Conclusions: TTC occurs most often as a response to severe mental or physical stress. As shown in the described case it can also be a trigger aggravating chronic disease. Mental stress in our patient caused symptoms of TTC. After recovery recurrence of MS was ob- served. In the literature one can find cases of neurogenic acute left ventricular failure accompanied by MS. In this case, symptoms of TTC occurred at first and when they resolved the exacerbation of MS was observed. 24 Sarcoidosis An Enemy Hard To Defeat Magdalena Cichocka', Mikołaj Radziszewski', Elżbieta Grabc- zak², MD, PhD 1 Students' Scientific Group "Alveolus", Department of Inter- nal Diseases, Pulmonology and Allergology, Medical Universi- ty of Warsaw 2 Department of Internal Diseases, Pulmonology and Allergo- logy, Medical University of Warsaw Background: Sarcoidosis is a multisystem inflammatory disease of unknown etiology characterized by the presence of non-caseating granulomas. It mainly affects lungs, but may have any extrathora- cic localization. Exclusion of tuberculosis, fungal infection and neo- plastic diseases is mandatory for the diagnosis. Case: A 44-year old man with a history of 18 year-lasting sarcoidosis was admitted to the hospital due to cervical lymphadenopathy and hoarseness for 3 months. The past medical history included hypertension, allergic asthma, third-stage of renal failure, Pott's disease, cataract surgery. He underwent glucocorticoid and methotrexate treatment for sarcoi- dosis and antituberculous therapy for spine tuberculosis. On admis- sion patient was in a good general condition. The enlarged cervical, submandibular and axillar lymph nodes were palpable. A computed tomography scan revealed nodules and mass-like opacities in midd- le parts of the lungs. Laboratory tests showed hypereosinophilia, hipoalbuminaemia, hypergammaglobulinaemia with all antibody classes increase, hypercalcaemia, hypercalciuria. The cancer antigen 19-9 level was increased with no evidence of neoplastic disease. The sputum samples were obtained and bronchoscopy with bronchoal- veolar lavage (BAL), transbronchial needle aspiration of mediastinal lymph nodes and cervical lymph node biopsy were performed. En- doscopy revealed larynx inflammation and congested bronchial mu- cosa. Direct smear and culture of BAL fluid for acid fast bacilli were negative, but sputum samples were thrice positive for Mycobacte- rium abscessus. Candida albicans and Streptococcus species were also detected. The lymph node histopathological examination revea- led non-caseating granulomas. The antimycobacterial treatment was implemented first despite suspected progression of sarcoidosis. Con- clusions: Sarcoidosis treatment should be considered carefully and the complex diagnostic process has to be implemented for exclusion INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info • 2015 Vol 3 Suppl 1 11th WIMC INTERNATIONAL JOURNAL of MEDICAL STUDENTS $69#36IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS 11th WIMC $70 Abstracts Abstracts of other diseases. The clinical features such as lymphadenopathy may accompany conditions like sarcoidosis-lymphoma syndrome or tuberculosis. The first-line treatment includes glucocorticoid therapy which modulates immunological response and may predispose to the reactivation of the latent infections or acquirement of new ones. The complex assessment is mandatory to differentiate the treatment complications from coexisting conditions and disease progression, before proper therapy implementation. 25 A Case Of Fever With A Twist Ritwick Mondal Department of Medicine Background: Fever is one of the commonest symptoms; clinicians come across both in outpatient and inpatient on a daily basis. This is quite often treated with the broad spectrum antibiotics without even an attempt to get to a diagnosis. It is true that one of the very causes is infection and the fever often responds to antibiotics. However we should not forget the basis of medicine i.e. History taking and clinical examination. Case: A 65 years old lady who lives alone with no co- Morbidity started having fever for two weeks prior to her admission. The fever was between 100-103F.This settled only with Paracetamol therapy. Fever was in association with chill, rigor, and mild cough with mucoid expectoration. There was no other systemic symptom. No urinary, Bowel syndrome, No pain anywhere. At the time she extremely weak so much so that she could not even walk up to the toilet. She was treated with three courses of oral and IV antibiotic. outside with no benefit. Physical examination showed an alert and conscious lady with no evidence of meningism, ear discharge, or any focal neurological sign. Chest examination revealed few inspiratory crepitations over Right base. Respiratory rate was 24/min.Sp02 was 97%. Her pulse rate was 80/min, when her temperature was 100.80F. Other systemic examination was normal. On specific questioning the patient admitted to have several parrots as pets for sometimes.Pro- visional diagnosis of psittacosis was made. All antibiotics were stop- ped. She was started on Doxicycline. She started feeling better with in appropriately 12 hrs. Fever settled with in 24hrs. Patient started to mobilize the next day. She became almost normal except her weak- ness which was significantly less than before. She was discharged on Doxicycline to be taken for 3 weeks. Conclusions: Psittacosis is acquired on contact with birds (Parrots, pigeons, chickens), which may or may not be ill. Psittacosis in human is caused by the bacte- ria Chlamydia Psittaci. The onset is usually rapid, with fever, Chills, myalgia, Dry cough and headache. Signs include high temperature and pulse dissociation. Psittacosis is indistinguishable from other bacterial or viral pneumonias by radiography. The organism is rarely isolated from cultures. The diagnosis is usually made serologically; antibodies appear during the second week and can be demonstrated by the complement fixation or immunofluoroscence. 26 Miliary Sarcoidosis Case Report And Review Of Literature Nina Miązek, Irmina Michałek, Piotr Zapała Department of Dermatology, Medical University of Warsaw Background: Sarcoidosis is a multisystemic noncaseating granuloma- tous disorder with peak incidence between 25 and 40 years. The ori- gin of sarcoidosis remains unclear. One fourth of patients have spe- cific and non-specific skin manifestations. Miliary sarcoidosis [MS] is one of clinical skin variable with no systemic involvement and rela- tively benign course. Macular, papular or nodular lesions in MS are mostly multiple and affect face, occipital region, extensor surfaces of the extremities and the trunk. We report the case of a patient with MS previously misdiagnosed as acne. Case: A 28-year-old Caucasian woman presented to the Dermatology Department with micropapu- lar skin lesions on submalar and perioral region, relapsing from six months. Inflammatory changes were burning and pruritic. No syste- mic symptoms or other abnormalities in general examination were observed. Clinical signs originally suggested acne, which was treated with first generation topical retinoid and tetracycline with poor effec- tiveness achieved. Uneffective therapy suggested misdiagnosis. A. punch biopsy was performed and revealed noncaseating granulomas with epithelial cells and lymphocytes. Chest x-ray showed no abnor- malities. The results of complete blood count, metabolic panel and the Mendel-Mantoux test were within normal limits. Clinical manifes- tation and histological picture allowed us to establish final diagnosis of MS. Initially, the patient was treated with oral corticosteroids (30) mg daily; 0,5mg/kg), with further therapy extension with chloroquine diphosphate (250mg daily) showing almost complete remission of skin lesions. To prevent complications from long-term treatment with systemic steroids and chloroquine, potassium chloride and omepra- zole were implemented. Conclusions: Skin changes in MS are often nonspecific, which remains a clinical challenge. In the diagnosis of sarcoidosis, distinction its skin variant from systemic involvement seems crucial, thus appropriate diagnostic panel is recommended. Solid response to steroids, observed in our clinic confirms literature data and supports its use in MS especially in combined therapy. 27 Unrecognized Congenital Coronary Artery Anomaly Resulting In The Need For Transcatheter Heart Valve Procedure Maria Różańska, Martyna Zaleska Centralny Szpital Kliniczny MSW Warszawa, Klinika Kardiolo- gii Zachowawczej i Nadciśnienia tętniczego Background: The treatment of chronic functional mitral regurgitation (MR) include: medical therapy for heart failure(HF) or left ventricular systolic dysfunction (LVSD), cardiac resynchronization therapy(CRT) in selected patients, and possibly mitral valve surgery or heart trans- plantation. Transcatheter heart valve (THV) procedures may also be considered, especially in patients who are not referred for surgery, like those with severe LVSD. Case: We present a case of a male patient, age 38, who originally underwent a cardiothoracic surgery in 1999: closure of patent ductus arteriosus and aortic valve repla- cement due to HF. Procedure was complicated by massive infero- lateral myocardial infarction. It resulted in post operational iatroge- nic congestive heart failure with left ventricle ejection fraction(LVEF) of 20%. In following years patient required implantable cardioverter defibrillator, and later cardiac resynchronization therapy(CRT) im- plantations. Also in the following years patient required numerous hospitalizations, both diagnostic and due to exacerbations of chronic heart failure. Almost all the times there were different complications of diagnostic procedures in example hematoma of some sort, resul- ting in extended hospitalizations. Between February 2012 and June 2012 patient suffered from several viral infections. His clinical status severely deteriorated. Between February 2012 and December 2013 his LVEF gradually lowered from 40% to 22% and MR progressed. In January 2014 "Heart Team" met to discuss options for MR treatment. During discussion possibility of circumflex artery anomaly and con- sequent improper cardioplegia during 1999 operation was raised up. So in march 2014 computed tomography was performed and showed congenital circumflex artery anomaly (separate origin from right co- ronary artery). Eventual patient was considered high risk for redo operation. Propose possibilities were: MitraClip and THV in the mi- tral position. Conclusions: Although the incidence of abnormal aortic origin of the coronary arteries is low, this case illustrates that its recognition is crucial to appropriate management of cardioplegia and avoidance of severe complications, including severe HF. The optimal treatment of chronic functional MR is still a matter of controversy and should be discussed by the Heart Team. The constantly evolving percutaneous treatment techniques may be an alternative for pa- tients with contraindications for open heart surgery. 28 latrogenic Life-Threating Condition In A Patient With Multiple Rare Disorders Martyna Zaleska Warsaw Medical University, Department of Cardiology and Hypertension, Central Clinical Hospital of the Ministry of Interior, Warsaw Background: Background: Andersen-Tawil syndrome (ATS) is a rare inherited disorder, characterized by periodic paralysis, long QT, ven- tricular arrhythmias and skeletal developmental abnormalities. Case: We report a case of 52 year old female with history of congenital long QT-syndrome (LQTS) who was admitted to our Department due to electrical storm caused by endocarditis. In the past patient un- derwent implantable cardioverter defibrillator (ICD) in secondary pre- vention of cardiac arrest procedure. During current hospitalization smear from the tip of ventricular electrode proved bacterial cause of electrical storm and blood cultures showed 4 bacterial species (none the same as the tip of the electrode). After a course of antibiotics due to mitral regurgitation she was referred for cardiac surgery. Tri- cuspid valve repair was also performed. The patient had biological mitral prosthesis (Perimount 29 mm) and tricuspid annulus (Edwards MC3 30mm) implanted. Post operational period was uneventful. She was admitted again 26 days after discharge due to chronic heart failure (CHF) exacerbation. Additionally tests showed acute renal and hepatic failure, severely reduced left ventricular ejection fraction, left crus deep vein thrombosis. During hospitalization patient re- quired bridging vitamin K antagonists (VKA) with, which resulted in heparin induced thrombocytopenia. Fondaparinux was required for further inhospital antithrombotic treatment. Due to low potassium level she underwent 3 cardiac arrests calmed with defibrillation. De- tailed medical history revealed potential cause of CHF exacerbation, multiorgan failure and deep vein thrombosis - primary care physi- cian withdrawn oral steroids and VKA most likely due to liable INR results. It resulted in exacerbation of vasculitis with antyPR3-ANCA antibodies and left crus deep vein thrombosis. Aggressive treatment in the cardiac intensive care unit was introduced and from the 4th day of stay we observed gradual improvement of both clinical outco- mes and laboratory data. Due to characteristic dysmorphic futures (low-set ears, small mandible, hypertelorism) suspicion of ATS was raised up. It was confirmed with genetic tests. On the 25th day she was discharged in good condition. After 6 months patient's clinical status is stable. She stays fully functional with NYHA class II. Conclusions: To sum up the fact, that patient has one rare disorder should not exclude him from further diagnostic process and very detailed, even if sometimes challenging, outpatient care. 29 Improving Of Myocardial Function After Lvad Therapy In Pa- tient With Idiopathic Cardiomyopathy Aleksandra Brutkiewicz Institute of Cardiology, Warsaw Background: Vetricular Assist Device (VAD) is a mechanical cardiac support used in the treatment of refractory to pharmacological the- rapy heart failure. In Poland it is usually used as a bridge to heart transplantation. In small amount of cases, usually acute myocarditis, post-partum cardiomyopathy or post-cardiotomy shock, VAD serves as a bridge to recovery. The successful explantation of VAD in other cases of cardiomyopathy is incidental. Case: A 30-year old women was admitted to Cardiac Intensive Care Unit with acute heart failure. She presented with severe dyspnea, lasting for 3 weeks, which ini- tially was recognized as respiratory tract infection. Moreover, hypo- tonia, tachycardia and oliguria were observed. Blood tests revealed CRP 1.81 mg/dl, WBC 18.3*103/μl, NT-proBNP 6106 pg/ml, troponine- negative. Chest X-ray showed congestion with no signs of pneu- monia. In echocardiography generalized hypokinesis was described (LVEF-10%), with enlarged left ventricle (LVEDD 6,5 cm). As inotropic support and further IABP did not result in improving of clinical sta- tus, the decision of left ventricle assist device (LVAD) implantation in category bridge-to-transplant was made. Myocardial biopsy showed no specific changes except from focal fibrosis. Myocardium contrac- tility recovered partially during LVAD therapy and LVEF raised to 40%. LVAD was explanted in 63rd day of therapy. Patient was followed up for the next 8 months. She remained stable in NYHA class II and was suspended on the heart transplant waiting list. Magnetic resonan- ce revealed moderate enlargement of both ventricles with reduced contractility (LVEF 47%, RVEF 41%) and small areas of intramyocardial fibrosis/necrosis indicating other than ischemic etiology of cardiom- yopathy. onclusions: Although the inflammatory factor could not be excluded, clinical data suggest idiopathic cardiomyopathy as a bac- kground of heart failure in the patient described. The adequate assessment of potential reversibility of severe cardiac dysfunction is always a challenge, especially in patient with cardiomyopathy of unknown etiology and first presentation of the disease. LVAD the- rapy could win the time to final decision in this particular group of patients. 30 Hedinger's Syndrome In Patient Treated With Peptide Recep- tor Radionuclide Therapy Mikołaj Radziszewski Students' Scientific Group "ENDOCRINUS", Department of Internal Medicine and Endocrinology, Medical University of Warsaw Background: Neuroendocrine neoplasms (NENS) are very rare tumors and can arise almost everywhere in the body. In metastatic functio- nal tumors of small intestine, symptoms are caused by the release of vasoactive substances, especially serotonin. That is called carcinoid syndrome (CS). Carcinoid heart disease (CHD) Hedinger's syndro- me develops in 40-50% of patients with the CS. Serotonin leads to tricuspid and pulmonary valves' fibrosis and their dysfunction. It is of great importance for the clinical stage and prognosis. Cu- rrently, the gold standard for the diagnosis of CHD is transthoracic echocardiography. Case: A 56-year old man was admitted to the Cli- nic of Endocrinology and Internal Medicine due to sudden face and chest flushing appearing for 3 years, with diarrhea, discomfort in the abdomen, accompanied by weakness lasting for a few months. On physical examination the patient presented facial redness, jaun- dice, teleangiectasis, hepatomegaly and symptoms of heart failure (NYHA II) with systolic murmur in the Erb's point. Abdominal ultra- sound showed multiply lesions in the liver. During the diagnostic laparoscopy, tumor biopsy was performed. Histopathological findings presented well-differentiated NEN (WHO Classification 2010: G1) with positive chromogranin A (CgA) and synaptophysin stains. Laboratory studies indicated increased blood levels of CgA, lactate dehydroge- nase, gamma-glutamylotranspeptydase and bilirubin's fractions. The concentration of 5-hydroxyindoloacetic acid in 24-hour urine collec- tion was also elevated. Echocardiography visualized advanced tri- cuspid valve's regurgitation and compound failure of the pulmonary valve. In imaging studies (abdomen computed tomography scans, Gallium-68-DOTA-TATE Positron Emission Tomography/Computed To- mography, colonoscopy) were no signs of the NEN primary origin. Diagnosis of well-differentiated neuroendocrine neoplasm G1 with unknown primary origin and carcinoid syndrome led to qualification to treatment with long-acting somatostatin analogues and peptide receptor radionuclide therapy. CHD had been diagnosed and respec- tive treatment was implemented. Patient did not agree on surgery treatment of valve replacement. Conclusions: The signs of CS appear relatively late, most frequently after metastases to the liver. It is im- portant to find out the origin of the NEN. However, in the presented case the point is to treat the disease in progress, as CHD is the most common cause of death in patients with the CS. 31 Veno-Occlusive Disease Of The Liver After Liver Transplanta- tion: Case Report Maciej Janik Medical University of Warsaw, Students' Scientific group in the Liver and Internal Medicine Unit Background: Veno-Occlusive Disease (VOD) of the liver is mainly des- cribed after chemo-irradiation therapy during hematopoietic stem cell transplantation (SCT) and has been rarely reported after liver transplantation (LT). The pathology of the VOD includes a fibrous na- rrowing of small hepatic venules. VOD is characterized by painful he- patomegaly, ascites and jaundice. Moreover, elevated serum alkaline phosphatase and bilirubin levels are the most typical indicators of VOD. Calcineurin inhibitor tacrolimus (TAC) is nowadays the primary immunosuppressive agent in the therapy after LT. However, among the numerous adverse effects of this drug, thrombotic microangio- pathy (TMA) is quite rare but severe complication. Case: A 60-year- old Caucasian women underwent LT in October 2014 for liver cirrhosis caused by primary biliary cirrhosis (PBC), which was complicated by hepatocellular carcinoma (HCC). The postoperative course was une- ventful, immunosuppressive regimen included TAC, mycophenolan INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 11th WIMC INTERNATIONAL JOURNAL of MEDICAL STUDENTS S71#37IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS 11th WIMC Abstracts Abstracts 11th WIMC mofetil (MMF), and prednisone; serum level of TAC was within the reference limits. The patient was discharged home in good condi- tion. 5 weeks after LT the patient was admitted to the hospital due to abdominal pain and diarrhea from 7 days. Hepatomegaly and ascites were found during physical examination. Lab tests showed increased serum level of liver enzymes and renal failure. The ab- dominal angio-CT scan revealed significant hepatic perfusion defect without any sign of liver vessels pathology. Moreover, there were no typical symptoms for any common complications after LT, therefore the VOD was suspected. Then, treatment strategy was changed: TAC was stopped, MMF dose was decreased due to leukopenia and a novel drug mammalian target of rapamycine inhibitor everolimus was introduced. Unfortunately, liver biopsy was not performed due to advanced ascites. The modification of the immunosuppressive regimen caused disappearing of the pathological symptoms, and ab- dominal CT-scan revealed significant improvement of the liver paren- chyma. Great outcomes confirmed VOD as a diagnosis of the disease. Conclusions: Discontinuation of TAC and introducing the novel immu- nosuppressive agent caused complete recovery in described patient. Rare complications should be included into differential diagnosis in liver transplant recipients, especially when symptoms are not typical for common complication, therefore appropriate treatment strategy can be use and better outcomes can be gain. Pediatric Case Report 32 Ectopic Thoracic Kidney In A Child Aleksandra Księżopolska Medical University of Warsaw/Department of Pediatrics and Nephrology Background: Renal ectopia is one of the most common congenital abnormalities. It occurs in 1/1000 newborns and is found in 1/20 000 autopsies. Most often, ectopic kidney is placed in the minor pelvis or medially upward. There is a tendency to appear more frequently in males and at the left side of the body. Thoracic location of kidney is extremely rare only about 5% of all renal ectopias. These patients don't present any pathological signs for a long time and defect is usually discovered accidentally during routine check-up, diagnosis of dyspnea or suspicious mass in lungs. Case: We present the case of a 1,5-month-old boy, who was referred to Department of Pedia- tric Nephrology to diagnose the long-lasting newborns jaundice and suspicion of left kidney agenesis. Physical examination was normal, except jaundice. In laboratory tests function of the kidneys and uri- nalysis were normal, too. The ultrasound of abdomen and thorax revealed the ectopic left kidney located upwardly, in the thoracic cavity. X-ray of the chest revealed left kidney above the diaphragm. Renal scintigraphy (DMSA scan) confirmed ectopic thoracic kidney. Voiding cystourethrography (VCUG) excluded vesicoureteral reflux. The patient was in good general condition and didn't show any concomitant abnormalities. Conclusions: In the event of suspicion of the renal agenesis on ultrasonography, ectopic kidney should be included in differential diagnosis. Ectopic kidney can be placed in pelvis or thoracic cavity. A complete urological evaluation in patient with ectopic kidney is necessary to exclude concomitant urological anomalies. 33 Lower Limb Replantation Strategy After Traumatic Avulsion Augustina Grigaitė, Justina Linauskaitė Lithuanian University of Health Sciences Background: 9 year old boy was admitted to Emergency Room due to traumatic amputation of his left leg. He experienced avulsion trauma after attempting to jump over tractor's cardan joint, his leg got stuck into it and was forcibly detached from the rest of the body. Lower part of the leg below the knee joint was completely avulsed from the rest of the body. Case: It was decided to replant the detached limb to salvage the knee joint which, if successful, would assure better outcomes for boy's future mobility. Replantation was needed to ensure revascularization of the knee joint. 14 days after the re- S72 INTERNATIONAL JOURNAL of MEDICAL STUDENTS plantation, necrosis of the feet occurred, as expected, because of the severity of the trauma. Fortunately, knee joint revascularized and remained viable. Leg amputation inferior to the knee joint was performed by a plastic and reconstructive surgeon in assistance with orthopedic surgeon. Skin flap was used to form the stump. 2 months after the surgery leg stump healed completely, no necrosis or infec- tion occurred. 6 months following the surgery, leg prosthesis was fitted. A year after the trauma boy is able to walk without crutches using calf prosthesis. Conclusions: Limb avulsion traumas are one of the most severe ones. Leg amputation is a life changing condition, especially for children. In this case the preservation of quality of life through regained function is crucial. The goal of replantation was to salvage the knee joint which is extremely important for leg mobility. Replantation allowed viability of the knee joint, which showed good outcomes after applying the prosthesis. 34 Isolated Cerebellitis As A Rare Manifestation Of Perinatal Hiv Infection Case Report Bartłomiej Piotr Gaweł, Joanna Kacperczyk Student Scientific Club of Paediatric Anesthesiology and In- tensive Care, Medical University of Warsaw Background: Clinical manifestation of HIV infection in children differs from that in adults. Most common involvement of CNS in perinatally infected children is encephalopathy. Isolated cerebellar involvement is rare and can have various aetiology. Most frequently it is asso- ciated with lymphoma, less frequently with infections (toxoplas- mosis, JC virus, CMV) and cerebrovascular disorders. Opportunistic infections in children have a more fulminant course due to lack of prior immunity. Case: 3 years old male patient was admitted to the hospital for diagnosis of walking impairment. Patient had undergo- ne an episode of cerebellitis previous year which responded well to therapy. Death of 1,5 years old brother due to hydrocephaly of unknown origin. Cerebellitis was diagnosed yet in spite of treatment patient developed disruption of consciousness and respiratory fai- lure and thereafter was intubated. He was transferred to another hospitals' ICU in a critical state for further diagnosis of suspected severe hereditary or metabolic disorder. Despite further treatment and widest possible diagnostics no cause was found and patient state worsened quickly. He had developed cardiovascular instability and impaction due to rise of intracranial pressure. Next day patient went into cardiac arrest and due to previous DNR instruction patient was not resuscitated. Only post-mortem HIV infection was identified as a cause of death. Conclusions: Perinatal HIV infection is rare in developed countries so it is uncommon for paediatricians to consi- der it in differential diagnosis. Moreover, HIV infection has different symptoms in adult population than in children. When added these two factors contribute to the failure of administering right treatment and death of the patient. HIV should be considered in every child with lymphadenopathy, fever of unknown origin, recurrent or oppor- tunistic infections. 35 A De Novo Unbalanced Chromosomal Rearrangment Invol- ving X And Y Chromosome In A Patient With Ambigous Geni- talia - Clinical Findings And Cytogenetic Analyses Małgorzata Dera, Aleksandra Pietrzyk, Zofia Litwińska Pomeranian Medical University/Unit of cytogenetics Background: Due to the coexisting submicroscopic chromosomal re- arrangements it is very difficult to determine the primary cause of the sex differentiation disorders which occurs in the patient. Case: A male neonate with ambigous genitalia was born at 38 gestational weeks (birth weight: 2570g, Apgar score 7/8/9) to young, healthy, unrelated parents with no family history of congenital anomalies, intellectual disability or miscarriage. Intrauterine hypotrophy and neonatal hypoglicemia were remarkable in his medical history. Upon physical examination penoscrotal hypospadias was noted with testicles palpable in scotum. No dysmorphic features, congenital defetcs and were found. High resolution karyotype of peripheral blood lymphocytes revealed partial deletion of long arm of chromo- some Y and was determined as 46, XY, del(Y)(q11.23). FISH analysis www.ijms.info • 2015 Vol 3 Suppl 1 showed mosaic for 45,X in 30% of analysed nuclei. Microdeletions Y molecular test was showed presence of investigated sequences of short arm of chromosome Y, including SRY but none of those located on long arm, such as AZFa, AZFb, AZFC. Further array CGH analysis delineated chromosome Y deletion to be 34.92 Mb of size but also showed undetected previously deletion in Xp22.33 (1.12 Mb) with concurrent 20 Mb duplication in Xp22.33- Xp.22.11. Conclusions: Si- milar chromosome X aberrations has been described as pathogenic and have been reported in females with dysmorphic features and ID. In so complex abnormalities phenotype- genotype correlation is extremely difficult to perform. 36 12 Years Old Girl With Hiv-Related Thrombocytopenia Agnieszka Cieniewicz Students' Scientific Group, Department of Children's Infec- tious Diseases, Medical University of Warsaw Background: Over the past 30 years the number of children infected with human immunodeficiency virus (HIV) has increased dramati- cally. Haematological abnormalities of varying severity may be the manifestation of this infection. They are believed to occur as a con- sequence of changes in the microenvironment of bone marrow and due to deficiency of growth factors. Thrombocytopenia is found in 40% of patients with HIV infection during the course of the disease. I present a case of a girl with HIV associated thrombocytopenia, misdiagnosed as idiopathic thrombocytopenic purpura. Case: Since 8th month of life the girl has been hospitalised several times due to recurrent fever, episodes of haemoptysis, bacterial infections of upper respiratory tract, laryngitis, candidiasis, erythematous papular rash and petechiae. She had a history of easily bruising in areas of accidental trauma. At the age of 5 she was admitted to Department of Haematology. Physical examination revealed hepatomegaly and lymphadenopathy. Dental caries was also observed. The lowest pla- telet count observed in laboratory tests was 3×10^9/L. Bone marrow aspiration showed an abundance of megakaryocytes. Other haema- tological investigations were normal. She was diagnosed with idio- pathic thrombocytopenic purpura. Treatment with IVIG was started but low platelets count persisted. An improvement was observed after introducing steroids but platelets count decreased on any at- tempt of reducing the dose. After a year of unsuccessful treatment, on further questioning the girl's father admitted he had been HIV po- sitive for several years. This prompted the decision of performing HIV test, which was positive (her mother also turned out to be infected). At the age of 6, the girl was diagnosed with vertical HIV infection in stadium B2 with thrombocytopenia. After initiating antiretroviral the- rapy platelet count increased. Currently the patient is aged 12 and is successfully treated. Conclusions: Thrombocytopenia can be the presenting feature of HIV infection in childhood. Therefore HIV should be considered in differential diagnosis in paediatrics in all cases of unexplained thrombocytopenia or any other cytopenia. 37 Urinary Retention And Tumor In The Pelvis Severe Suspi- cions And An Unexpected Solution Aleksandra Rurarz, Bartosz Siewert Students' Scientific Association of the Clinical Department of Paediatrics, Medical Centre for Postgraduate Education at the Bielanski Hospital, Warsaw Background: Urinary retention is a medical emergency which may result from a vast number of medical conditions. The most obvious cause is the obstruction of urine flow resulting from urinary tract pathology or oppression by adjacent organs or as a result of the ongoing processes in the abdomen, especially in the pelvis. Case: A girl at the age of 13 years 7 months was admitted to the Hospital Emergency Department due to urinary retention. 6 days before the admission she reported abdominal pain in the lower abdomen but she did not have fever and reported no voiding symptoms. In the PHC clinic she was initially diagnosed with cystitis but general urine analysis did not confirm this diagnosis. Symptoms intensified and three days before the admission the first episode of urinary reten- tion occured. The girl was consulted in the Emergency Department www.ijms.info . 2015 Vol 3 Suppl 1 where the bladder catheterization was performed, yielding 1200 ml of urine. The diagnosis of cystitis was upheld and Furaginum and No-spa were commissioned. Initially, an improvement was observed but during the day of admission difficulties in urinating reappeared despite strong urgency. On clinical examination the bladder was pal- pable 3 cm above the symphysis pubis. General examination and urine culture led to the exclusion of urinary tract infection. After catheterization, 13000ml of urine was obtained. In the differential diagnosis urolithiasis and proliferative processes were considered. The executed abdominal ultrasonography revealed enlarged uterus and vagina with fluid collections. The consulting gynecologist confir- med vaginal atresia. The girl underwent the intervention of hymen incision during which free flow of hemolized blood in the amount of approx. 700ml was received. After surgery, the girl was in a good condition and the symptoms disappeared. Conclusions: In the course of history taking and physical examination, medical doctors should avoid duplicating earlier diagnoses and their own differential diag- nosis should be carried out every time. A very careful examination of each patient, regardless of age, which includes consideration of the urogenital organs is crucial as well. Otherwise, medical doctors may cause a delay in the right diagnosis. Such examination should obviously take place in conditions of comfort for the patient and preserving their right to privacy. 38 Infective Endocarditis Complicated With Embolism Of The Middle Cerebral Artery In 10-Month-Old Girl - Case Report Agnieszka Pskit Students' Scientific Association at Department of Pediatric and Pediatric Cardiology, Medical University of Warsaw Background: Infective endocarditis (IE) is a non-uniform disease with various signs and symptoms. Valvular heart disease is a high-risk factor increasing incidence of IE. The diagnosis, according to Duke criteria, is based on the positive blood culture and an echocardio- gram with evidence of endocardial involvement. The disease may re- sult in complications like emboli, neurological events and valve des- truction. Case: 2-month-old girl with an aortic stenosis was admitted to hospital in order to continue the diagnosis and qualification for an interventional treatment. During hospitalization echocardiogra- phy showed pressure gradient through the aortic valve (PG) up to 73mmHg, mean 43mmHg. The patient was qualified for balloon aortic valvuloplasty. Immediately after the procedure echocardiogram re- vealed that PG decreased to a maximum of 22mmHg, mean 12mmHg and mild aortic insufficiency (IAO). At the age of 3.5 months the pa- tient was admitted to the local hospital due to pneumonia. When she was 4 months old echocardiography showed a slight increase of IAo up to modrete, which was considered as a typical sign after baloon valvuloplasty during folow up. In the age of 9 months, she was refe- red to the local hospital due to the sudden restriction of mobility and muscle weakness in the left lower extremity. The angio-CT revealed an ischemic stroke in the course of embolisation of the right middle cerebral artery. In echocardiography further increase of IAo was diag- nosed, even that infective endocarditis was not diagnosed. During a planned visit in cardiological unit at 10 months, a girl was diagnosed with severe IAO with an image of the oscillating intracardiac vegeta- tions on both cusps of the aortic valve. Blood cultures were positive for Staphylococcus epidermidis. Infective endocarditis was diagno- sed and treated according to the guidelines. Conclusions: Patients with aortic valve disease are at increased risk of developing infective endocarditis than general population. Therefore in such cases it is essential to remember during follow-up visits to pay attention to the details from the interview and test results that may suggest this disease. One of the earliest symptoms of infective endocarditis may be ischemic stroke due to artery embolism caused by the torn piece of valvular vegetation. 39 Side Effects Not Only Statistics Bartosz Siewert, Aleksandra Rurarz Paediatric Clinic, Bielański Hospital, Warsaw Background: Every medical intervention, especially connected with INTERNATIONAL JOURNAL of MEDICAL STUDENTS S73#38IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS 11th WIMC $74 Abstracts Abstracts ordering medicaments or other therapeutical products, may cause side effects. They are all listed in 'The Characteristic of a Medical Pro- duct' with ascribed frequency of occurrence. It is essential to remem- ber to be thoroughly acquainted with such a document before using a medical product. Case: A 13 year-old girl was admitted to hospital because of blurred vision and uncontrolled head movements to the back which had been preceded by gastroenteritis for two days. In the beginning a neuroinfection was considered, but after a thorough anamnesis it turned out that the patient was treated with Torecan. That led us to believe that the patients' symptoms were the side effects of the administered thiethylperazine and therefore treatment with Akineton (biperiden) was initiated. Our hypothesis was con- firmed as the treatment yielded very good results. On the second day of hospitalization dyskinesis reappeared, so the patient was administered one more dose of Akineton. Shortly after the initiation of treatment all symptoms disappeared, but the patient complai- ned about hallucinations which lasted for several hours. Observed side effects of both medications were described in 'Characteristic of Medical Product' as rare occurences. Conclusions: In the discussed case, side effects of medication used to stop diarrhea occurred. Such a procedure is not compatible with current guidelines concerning gastroenteritis treatment, but parents administered it without con- sulting a doctor. On the other hand, medication which was used to stop dyskinesis was administered properly but side effects of that drug also occurred. Every drug administration should be preceded by ensuring that benefits outweigh the potential side effects for the patient, which, despite being described as rare, can always occur. We should also pay special attention to educate patients (and their parents) about appropriate administration of drugs. 40 Acute Lymphoblastic Leukemia: Diagnostic Difficulties, Complications During Treatment And Patient's Death Due To Listeria Monocytogenes Infection Katarzyna Adamczewska Poznan University of Medical Sciences/ Pediatric Oncology and Hematology Background: ALL is the most common childhood cancer, which early recognition and proper treatment may turn problematic. This work is to highlight difficulties during making diagnosis of ALL, the ones connected with side effects of chemotherapy and atypical onset of opportunistic infections. Case: 15-year old boy was referred to Pedia- tric Oncology and Hematology Clinic with initial diagnosis of NHL with complaint of severe epistaxis, emesis and musculoskeletal pains. On clinical examination: lymphadenopathy, tachycardia. Chest X-ray and CT showed widened mediastinum, suggesting mediastinal mass and pleural effusion. Blood tests revealed leukocytosis, thrombo- cytopenia and hyperuricemia. Due to bone marrow myelogram and immunologic examination T-cell acute lymphoblastic leukemia was diagnosed. Patient was treated according to ALL IC BFM 2009 for IR risk group. On account of impaired coagulation, genetic examination was carried out with a result of factor V Leiden and heterozygo- tic C667T and A1298C mutations of MTHFR detection. Corticosteroid therapy resulted in insulin resistance. During diabetic diet sudden increase in bilirubin level occured with normal hepatic enzymes level at the same time. The suspicion of Gilbert's syndrome was confirmed. CT evaluating remission of mediastinal mass (Protocol la) revealed invasive pneumomycosis (Aspergillus fumigatus), despite lack of any clinical symptoms. Intensive treatment was immediately administered. After finishing Protocol II the rise in CRP was obser- ved with decreased number of WBC at the same time. Patient was feverish and complained of nonspecific abdominal pain and dysuria. USG detected fluid in right iliac fossa. 3 hours later boy's neurological state dramatically worsened (anisocoria, neck stiffness). CT reveled acute hydrocephalus which needed immediate drainage. Listeria mo- nocytogenes was isolated from CSF. Despite intensive antibiotic the- rapy, infection caused boy's death. Conclusions: Mediastinal mass, suggesting NHL, may occur during ALL, especially T-cell. During ALL treatment it must be remembered that multiple complications may cause deviation and delay in chemotherapy. Immunocompromised patients may be affected by opportunistic pathogens which results in life-threatening infection. Fluid in right iliac fossa is characteristic for listeriosis in ALL patients. 41 Burkitt Lymphoma In Untypical Localization Karol Ratajczak Students' Scientific Group, Department of Pediatric Otolaryn- gology, Medical University of Warsaw Background: Burkitt lymphoma is a malignant tumor of the lympha- tic system, arisen from B lymphocytes found in the germinal center. There are three clinical variants: the endemic variant, the sporadic type and immunodeficiency-associated type. The second and third type can be found all over the world, the endemic variant is associa- ted with EBV and most commonly occurs in children living in malaria endemic regions of the world. Burkitt's tumor usually develop in mandible, but may also concern intestines, nervous system, kidney, ovaries, or other organs. Case: A 6-year-old boy was admitted to the Department of Pediatric Otolaryngology due to sleep apnea and speech disorders ongoing for three days. A physical examination showed enlarged cervical nodes on the right side of the neck and enlarged right palatine tonsil. Other groups of lymph nodes were not palpable, organomegaly was not found. CT of the head and neck revealed abnormal mass in the site of right palatine tonsil. The size of the lesion was 39x37x33mm and it was almost closing the na- sopharynx. The mass also completely obstructed oropharynx and laryngopharynx. The lesion was removed under general anesthe- sia. Subsequently adenoidectomy was performed. Histopathological test of the mass revealed Burkitt lymphoma stage 2. Chemotherapy treatment was applied. Conclusions: Malignant tumors are uncom- mon in children, but they should be always considered in differential diagnosis, especially in case of one-sided sudden enlargement of palatine tonsil. The presented case demonstrates that Burkitt lym- phoma may develop in untypical localization and can be associated with unspecific symptoms leading to life-threatening consequences. 42 Recurrent Diaphragmatic Hernia In 2-Year-Old Male Patient - Case Report Natalia Bajorek, Matthew Olesiak, Wojciech Rogula, Miłosz Saryusz-Romiszewski, Dominika Korzeniowska Jagiellonian University Collegium Medicum/ Department of Pediatric Surgery Background: The authors present a 2-year-old male patient after a repair of a congenital diaphragmatic hernia who was admitted to the hospital with suspicion of bowel obstruction. Imaging studies showed a subsequent pathology classified as a recurrent diaphrag- matic hernia to be the most probable finding. Case: The patient presented to the hospital with the complaints of vomiting and no passage of stool for the prior three days. The patient underwent a left sided thoracoscopy for a congenital diaphragmatic hernia on day 2-post partum. The herniated bowel loops were reduced into the abdominal cavity. The diaphragmatic defect was repaired with interrupted non-absorbable sutures under considerably moderate tension. Until now, he suffered from recurrent episodes of bronchitis. Physical examination showed a distended abdomen with tenderness on palpation. X-ray scans were diagnostic for bowel obstruction and the suspicion of recurrent diaphragmatic hernia was raised. The pa- tient was qualified for laparotomy. Intra-operatively, the omentum and transverse colon strangulated with defects in the diaphragm was visualized. Segmental resection of necrotic bowel with anas- tomosis and diaphragm repair was performed. Pneumothorax with pleural empyema in left pleural cavity was cured with drainage. The postoperative period was complicated by the suspicion of sepsis. The patient was successfully treated and discharged home in good clinical condition. Conclusions: Recurrent diaphragmatic hernia may present as a life threatening complication 2 years after initial suc- cessful repair. 43 Salmonella Infection After Travelling To Tropics - Two Cases Report Joanna Ulan Students' Scientific Group, Department of Children's Infec- tious Diseases, Medical University of Warsaw Background: The number of children who travel internationally is increasing. Children face most of the same health risks as adults but consequences can be more serious. Diarrhoea is one of the most common diseases experienced by children who travel, especially to the developing countries. Case: Case 1: A 2-years old boy, who returned from Tanzania after a tourist stay, was admitted to the hospital because of fever. For few previous days he had been in worse condition, with decreased appetite and loose stools (2 per day). At admission the boy was febrile, apathetic and dehydrated. Lab tests showed normal leukocyte count, slightly elevated CRP level, hyponatremia and hypokalaemia. Test for mala- ria was negative. Supportive therapy with intravenous rehydration, antipyretics, natrium and kalium substitution was used. Fever per- sisted, vomits and diarrhoea occured. CRP level increased. Denga, rota- and adenoviral infection were excluded. Antimicrobial therapy with trimethoprim-sulfamethoxazole was administered and rapid cli- nical improvement was observed. Salmonella type B was cultured from stool sample. Case 2: A 2-years old girl was admitted to the hospital, after coming back from a 6-weeks stay in Thailand, with a day history of fever, one episode of vomiting and 2 loose stools. At admission she was in me- dium general condition, dehydrated. Physical examination revealed pharyngitis with no other abnormalities. Lab tests showed slightly elevated CRP level; leukocyte count and blood smear, electrolytes and glucose levels, urinalysis were normal. Intravenous rehydration and cefuroxime were used. General condition improved, the girl did not vomit and passed normal stools, but fever persisted. In the 3rd day of hospitalization lab tests revealed elevated procalcitonin level. Blood and stool were obtained for culture and antibiotic therapy was changed for ceftriaxone. Meningitis, malaria and denga were excluded. Stool culture was positive for Salmonella typhimurium, a strain resistant to third-generation cephalosporins and trimetho- prim-sulfamethoxazole, was cultured. The result of antibiogram was known, when clinical improvement was achieved with normalization of temperature, therefore antimicrobial therapy was not changed. Conclusions: Parents travelling with children to the developing coun- tries should realize health risks. Infection acquired abroad can cause serious morbidity and, additionally, may result in spread of less com- mon bacterial strains, including drug resistant ones. 44 Dysgerminoma In 9-Year Old Female - A Case Report Agnieszka Basiukajć Poznan University of Medical Sciences Background: Ovarian germ cell tumors are derived from primordial germ cells of the ovary. These neoplasms comprise approximately 20 percent of ovarian neoplasms overall, but account for only about 5 percent of all malignant ovarian neoplasms. Ovarian germ cell tu- mors arise primarily in young women between 10 and 30 years of age and represent 70 percent of ovarian neoplasms in this age group. Typical manifestation is abdominal pain and abdominal enlargement, precocious puberty and abnormal vaginal bleeding. The aim of the study is to present a case of dysgerminoma in 9-year old female. Case: A 9-year old female was admitted to Pediatric Oncology and Hematology Department with a suspicion of an abdominal tumor. She presented with a history of progressive abdominal enlargement for three weeks and non-specific abdominal pain for two years. Physical examination revealed distended abdomen and a large palpable mass in the mesogastric area. Abdominal ultrasonography and computed tomography showed a large heterogeneous mass 20x13x15cm and presence of fluid in peritoneum. Ovaries and uterus were not vi- sualized. Laboratory tests revealed elevated levels of lactate dehy- drogenase, alpha-fetoprotein and ẞ-human chorionic gonadotropin. Thus the ovarian germ cell tumor was suspected. The unilateral sal- pingo-oophorectomy was performed. Serum levels of tumor markers normalized after the surgery. The diagnosis of dysgerminoma was confirmed by histopathological examination. Cytological investiga- tion of peritoneal fluid revealed the presence of tumor cells. Further examinations showed enlarged mediastinal and retroperitoneal lym- ph nodes. The gynecological referral appeared normal however the ultrasound examination did not visualize the contralateral ovary. The patient was observed for gonadal dysgenesis although the karyotype investigation did not reveal any disorders. According to the protocole TGM-95, the patient was qualified for VIP (iphosphamide, etoposide, cisplatin) chemotherapy. Conclusions: The rarity of pediatric ovarian malignancies contributes to a low index of suspicion. In case of ab- dominal mass in female patients ovarian tumors should be taken into consideration at any age. 45 Liver Abscess In Amebiasis. A Case Report M. Fikri Safian, Bamdad Tavakolnia Medical University of Warsaw Background: Infection by Entamoeba histolytica occurs sporadically in non-endemic areas and it can present with extraintestinal mani- festations of which the most common is liver abscess. Case: In this case report the clinical course and treatment of a patient with liver abscess caused by Entamoeba histolytica admitted to our Clinic is presented and discussed. A 23 year-old man was referred from Infec- tious Diseases Hospital with suspicion of liver abscess by Entamoeba histolytica. CT and ultrasound examination were performed showing 120x80 mm abscess localized in right lobe of the liver. Patient was managed with percutaneous drainage under control of ultrasound. Pus obtained during the procedure was sent to bacteriological tests and histopathology investigations. An X-ray fistulography was per- formed 5 days later showing decrease in cyst size to 87x62 mm. The patient received antibiotic treatment with Ciprofloxacin and Metronidazole. Serological tests confirmed infection by Entamoeba histolytica. Bacteriological tests were negative. The patient was discharged in good condition and referred to Tropical and Parasitic Disease Ward for further pharmacological treatment. Conclusions: A differential diagnosis for liver abscess should take into account amoebic infection even though it is does not occur commonly in non-endemic areas. Standard treatment for Entamoeba histolytica abscess is chemotherapy. In cases where the size of an abscess exceeds 5 centimeters the drain placement is a treatment of choice accompanied by antibiotic therapy. 46 A Rare Case Report Of Xanthogranulomatous Osteomyelitis Of Right Tibia Dr. Mazharuddin Ali Khan, Dr.Chinnala Srujan Kumar, Dr. Da- vuluri Harish Kumar NTR University of Health Sciences/ Department of Orthopae- dics Background: Xanthogranulomatous osteomyelitis is a type of chro- nic inflammatory process which is rare bone infection and is diagno- sed histologically by fomy histiocytes, spindle cells and occasional osteoclastic gaint cells composition of immune cell aggregation Gross and radiological examination can mimic malignancy with variable densities, and differentiation should be confirmed by histopathologi- cal evaluation. Pathogenesis may be due to cell mediated immunity of delayed hypersensitivity type. Case: We describe the case of a 25-year-old female presenting with pain in left leg which aggrevated on walking and relieved by rest. Tenderness in left leg were detected following examination. Mild leukocytosis, elevated alkaline phospha- tase, and increased erythrocyte sedimentation rate with negative C-reactive protein (CRP) were revealed. X-ray imaging showed focal thickening of cortex in the mid shaft of tibia with no nidus. Com- puted tomography (CT) scan revealed lesions involving medulla and cortex, periosteal reaction with soft tissue component, and bone marrow infiltration in right humerus and left fibula. Magnetic reso- nance imaging (MRI) showed abnormal signal in medulla, of the left tibia associated with and diffuse hypersignal areas of soft tissue and cortical surface irregularity were demonstrated. Confirmation I was made by histological examination as xanthogranulomatous os- teomyelitis. Conclusions: This case is primarily presented due to its rarity and is the eighth case of Xanthogranulomatous osteomyelitis which is being reported in the literature to the best of our knowled- ge. The importance lies in the differential diagnoses of Xanthogra- nulomatous osteomyelitis which resembles tumour either benign or malignant based on gross and radiological examination and found INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS 11th WIMC S75#39IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS 11th WIMC Abstracts Abstracts that Xanthogranulomatous osteomyelitis can present with variable densities such as osteolytic, sclerotic (as in our case) and mixed densities radiologically. Histopathological examination plays a vital role in diagnosis of Xanthogranulomatous osteomyelitis and hence helps in appropriate treatment plan of the case. 47 Valve-In-Valve Transcatheter Aortic Valve Implantation Via Common Carotid Artery Anna Wancerz, Mateusz Wondołkowski, Dominika Puchta, Wiktoria Ciechowska, Zenon Huczek, Janusz Kochman, Ro- muald Cichoń, Radosław Wilimski Students' Scientific Group by the Department of Cardiac Sur- gery at the 1st Department of Cardiology, Medical University of Warsaw Background: Transcatheter Aortic Valve Implantation (TAVI) is an al- ternative procedure to aortic valve replacement (AVR) in high-risk patients with severe aortic stenosis (AS). This innovative technique had primarily involved delivering the valve using the transfemoral approach however the alternative: direct aortic, trans-apical, sub- clavian and carotid approaches have emerged over time. Case: A 74-year-old female with prosthetic aortic valve stenosis (aortic valve area: 0.45 cm2, mean gradient: 37 mmHg) and many comorbidities such as thoraco-abdominal aneurysm, hypertension, chronic kidney disease and recently diagnosed early-stage operable colorectal can- cer was admitted to the Department of Cardiac Surgery at the 1st De- partment of Cardiology, Medical University of Warsaw due to severe functional status deterioration in the past 4 months with chest pain and dyspnea (from NYHA class I to III). The patient was previously treated for aortic stenosis with AVR combined with coronary artery bypass grafting (CABG) and reductive ascending aortoplasty. Due to the previously stated factors the Heart Team decided to perform a valve in valve TAVI procedure. Transcarotid access was chosen as the best alternative. Second prosthetic aortic valve Evolut R 23 mm, was carefully placed and deployed within the previously im- planted surgical prosthesis. Control angiography revealed good po- sitioning and no aortic regurgitation. The patient's brain function was monitored using cerebral oxymetry and transcranial Doppler ultrasonography. Clinical and radiological examination did not reveal any pathological changes in the central nervous system during and after the procedure. Other complications did not occur. The patient was discharged in the seventh post-operative day in good clinical condition. Conclusions: Considering known patient selection criteria: advanced age, generalized atherosclerotic disease, porcelain aorta, or previous cardiac surgery and the connection between etiology and risk factors it is wise to search alternative approaches for this patients cohort. Transcarotid approach offers straight delivery route and short distance from access site to annulus level, which results in excellent control during frame flaring with no need to reposition. Probability of cerebral ischemia requires rigorous monitoring of cere- bral perfusion. The chosen access enabled valve-in-valve placement improving valvular function and further surgical treatment of the patient's comorbidities. 48 Arm Graft Thrombosis After Endovascular Treatment of Pa- tient With Abdominal Aortic Aneurysm Marcin Kowalik, Agata Frączek, Magda Grodzieńska, Alek- sandra Grzelka, Anna Drelich-Zbroja, Małgorzata Szczerbo- Trojanowska Uniwersytet Medyczny w Lublinie Background: The implantation of stent grafts is an established te- chnique for the treatment of patients with abdominal aortic aneu- rysms. Unfortunately, this method entails the possibility of compli- cations. Complications after endovascular surgery can be divided into primary (up to 30 days after surgery) and secondary (over 30 days), due to the time elapsed since surgery. The most common complication of endovascular techniques is the so-called „endo- leak" to the aneurysm, which can lead to further expansion of the aneurysm, and consequently to its rupture. Other complications of endovascular treatment are narrowing of the arm of a stentgraft as a result of leg fracture caused by the meandering course of the iliac arteries, migration and thrombosis of the arm. Stentgraft arm thrombosis can lead to a dangerous narrowing of the prosthesis and, consequently, to the symptoms of chronic or acute ischemia of the lower limbs. An important role is played by periodic check- ups of patients after endovascular surgery, which serve the rapid detection of possible complications, both primary and secondary. "Golden standard" for monitoring patients after implantation of the stent graft is now computed tomography. Case: This paper discusses the case of a patient with abdominal aortic aneurysm, endovascu- lary treated using a stent graft, technically completed with success. Control angiography ending surgery, revealed normal patency of the graft and ruled out the presence of complications. The patient was then subjected to a routine check-up at 6 months after surgery. The patient control ultrasound after 6 months, detected left bundle graft thrombosis, which was confirmed by computed tomography. Con- clusions: Endovascular treatment of patients with abdominal aortic aneurysms is not without complications. One of them is thrombosis of the stent graft's arm. Ultrasound examination clearly allows the detection of such complications, without the need for Computerised tomography, which exposes the patient to radiation and nephrotoxic contrast agent administration. Accurate and systematic observation of patients after endovascular implantation of a stent graft allows immediate detection of complications. 49 Varicella -Zoster Virus Infection Of The Central Nervous Sys- tem In 28-Year-Old Man After Orthotopic Liver Transplanta- tion Due To Hbv Cirrhosis Marta Poręcka, Emil Bik, Radosław Pietrzak, Igor Ilasz Students Scientific Group, Department of General, Transplant and Liver Surgery, Medical University of Warsaw Background: Varicella, also known as "chicken pox", is a very com- mon and usually benign disease in the early stages of youth caused by varicella-zoster virus (VZV). Approximately 95% of the popula- tion becomes immune to chicken pox during their childhood due to vaccination or acquired immunity. Varicella is rare among adults, however, some factors may increase the risk of the disease,such as immunosuppression. The aim of this study is to describe the clini- cal presentation and outcome of patient suffering from meningitis and encephalitis caused by VZV reactivation after orthotopic liver transplantation (OLTX). Case: A 28-year-old man suffering from liver cirrhosis due to HBV was admitted to the Department for elective OLTX. After a 9-hour surgery patient was transported to Intensive Care Unit where he recovered full consciousness. First laboratory tests showed no abnormalities. Four days after OLTX patient started to complain about visual deficiency, which was followed by lost of consciousness and seizure. Meningeal signs did not occurred. After computed tomography of the head and neurological consultation, posterior reversible encephalopathy syndrome was diagnosed and the doctor recommended a modified scheme of immunosuppres- sion. Blood and cerebrospinal fluid (CSF) cultures did demonstrate neither bacterial nor fungal growth. Eight days after OLTX exploratory laparotomy with peritoneal lavage was performed due to suspicion of intraabdominal infection (leak of turbid fluid, high serum levels of proinflammatory agents: C-reactive protein 131,1 mg/L and pro- calcytonin 2,59 ng/ml). Unfortunately, patient's condition did not change. Two weeks after the transplantation magnetic resonance was taken and CSF was collected for viral testing. Polymerase chain reaction (PCR) was positive for VZV. This diagnosis finally allowed the application of antiviral therapy-3x 500 mg of Acyclovir. Patient in stable neurological state with a very good function of the transplant liver was transferred to Warsaw Hospital for Infectious Diseases for further treatment. Subsequently he was treated at neurological ward and intensively rehabilitated in order to make a full recovery. Con- clusions: Neuroinfections after solid organs transplanation are rather rare, however, any inexplicable conscious disturbances should arou- se suspicion of central nervous system infection and CSF in this particular group of patients shall be examined not only for bacteria and fungi, but also for viruses. 50 Gastrointestinal Bleeding In Patient With Suspicion of Neu- roendocrine Neoplasm In Ileum: A Case Report Magdalena Czerwińska Student Research of General Surgery and Transplantology "Kindley", Medical University of Warsaw Background: Neuroendocrine neoplasms (NENS) are rare and gene- rally slow-growing. They secrete various peptides and neuroami- nes. The annual incidence of NENS is approximately 40-50 cases per million. 70% of them are gastroenteropancreatic neuroendocri- ne tumors (GEP-NET), which usually investigated in small intestine. They account for 1%-2% of all gastrointestinal malignancies. The incidence of GEP-NET has increased, during the last 30 years. Its hor- monal activity may be associated with clinical symptoms, although the majority of NENS show no secretive activity in the early stage of the disease (85 %), resulting in delayed diagnosis. About 11% of cases of GEP-NET are recognized during surgical intervention per- formed because of obstruction or gastrointestinal bleeding. Case: 63 year-old female patient was admitted to the Department of General Surgery and Transplantology for right-sided hemicolectomy, becau- se of the diagnosis of polyp in distal part of ileum. Woman was in generally good health condition, without any specific symptoms. Physical examination showed soft abdomen, with no tenderness. Per rectum examination also resulted in no pathology. Patient history showed periodic lower gastrointestinal hemorrhage since 6 months, what triggered colonoscopy-submitted ileum polyp. There was no histopathological verification because of submucosal localization of the polyp. CT scan showed a focal change with diameter about 15mm, localized in the distal part of ileum about 4cm from Bauhin's valve. It was not extended beyond the external bowel outline. Adi- pose tissues in vicinity of the tumor was unchanged. In addition, round 12mm-in-diameter lesion was found above the Bauhin's valve, which was suspected of being metastasis to lymphatic node. Elective right-sided hemicolectomy was performed. Patient recovered well and was discharged on the seven postoperative day. Histopatho- logy report revealed well-differentiated neuroendocrine carcinoma of ileum, pT2N1. Patient was referred to oncological consultation to qualification for chemotherapy. Conclusions: Surgery, if feasible, is the only curative therapy of NENS. NENS are usually hormonally non- active, what results in non-symptomatic grown. Moreover, they are small-sized and dismissed in most radiological examination. There is a need to paying attention to the diagnostic possibility of NENS, to provide earlier diagnosis and more effective treatment. one of the reasons for BIH is stenosis of the brain venous sinuses. Contrast MR Venography of brain sinuses should be a part of the rou- tine BIH diagnosis. The present case is most likely the first in Poland in which transverse sinus stenting was effective. 52 Intracranial Pneumatocele Caused By Basal Cell Carcinoma Urszula Knych Department of Neurosurgery at Second Faculty of Medicine, Medical Uniwersity of Warsaw Background: Basal-cell carcinoma is a slow growing skin cancer that can infiltrate surrounding tissues. It is most commonly located in head and neck region and is usually excised before it can progress to cause serious damage. This case report presents a patient with se- verely neglected basal-cell carcinoma which infiltrated the cranium so deeply that it caused pneumatocele. Case: A 76 year old female patient was admitted to an emergency room after fall-induced head injury. The patient was conscious, confused but with good verbal contact, and dehydrated. There was an ulcerative, bleeding, suppu- rated, feculent lesion measuring 81 mm diameter on patient's left frontal area, which she claimed has been growing for more that 10 years. She denied having any other health problems and taking any medications. A CT brain scan showed a 30,4 mm width bone defect of the left frontal bone, and air collection, mostly surrounding the left frontal lobe. A smear was taken from the lesion and bacteriological culture have shown the growth of Proteus vulgaris. The patient was admitted to neurosurgical ward. Physical examination did not reveal any neurological deficits. After plastic surgeon's consult, the patient was qualified for surgery. During the surgery an external lesion was excised, but after extension of craniectomy caused by the bone des- truction, it turned out that the lesion was infiltrating the ceiling of the orbital cavity. This infiltration was not excised. The dura mater and the brain tissue were also infiltrated and therefore the excision was made to the margin of the visible lesion. The duroplasty was performed using a graft made from fascia late of the left thigh. The deficit of skin and bone was covered with rotated left temporal ar- tery pedunculated skin flap, and the deficit from this flap was cove- red with a skin graft from the left thigh. Intracranial smear showed infection with Morganella morganii, therefore therapy with cefotaxi- me was applied. The histopathology from the skin lesion revealed basal-cell carcinoma. Conclusions: Basal cell carcinoma of the head is rarely causing severe damage to the underlying tissues, but if ne- glected and growing for many years, it can cause intracranial lesions. Therefore it is crucial to order a CT scan before performing a surgery. 51 Gbenign Intracranial Hypertension Due To The Transverse Sinus Stenosis. Case Report Bartosz Sieradzki 53 Warsaw Medical University / Department of Neurosurgery Background: The aim of this study is to present a rare case of benign intracranial hypertension (BIH) caused by stenosis of the transver- se sinus. BIH is a neurological disorder that is characterized by an increased intracranial pressure in the absence of a tumor. The most important neurological symptom is papilloedema, which can lead to progressive optic nerve atrophy and blindness. Case: A 40-year-old overweight woman who had been treated with hormones because of menstrual disorders, has been admitted to Neurosurgery Department due to recurrent headaches for the past two years, and papilloedema detected on the ophthalmic examination. On admission, neurological examination was negative except for an exaggerated tendon reflexes on the left side and the presence of a Babinski sign. MRI revealed partially empty sella with no brain focal lesions. Veno-MR showed partial stenosis of the right transverse sinus, which has been confir- med by angiography. In the first stage of the treatment the patient underwent endovascular balloon angioplasty of the transverse sinus. Follow-upMR and ophthalmic examinationshowed persistent trans- verse sinus stenosis and papilloedema. Two month later, patient un- derwent stenting of the right transverse sinus by Leo + 5. 5 x35mm (stent), and further balloon sinuplasty by Eclipse 6x9mm without any complications. Four days after the second procedure, follow-up ophthalmic examination revealed partial papilloedema regression. Patient's headaches resolved and the improvement persists over a two-month follow-up. Conclusions: It should be remembered that Surgical Outcome Of A Primary Angle-Closure Glaucoma Treatment Case Report Katarzyna Wojewoda, Agnieszka Dłużniewska, Monika Pilec- ka Students' Scientific Association on the Ophthalmology De- partment of Medical University of Lublin Background: A primary angle-closure glaucoma (PACG) is a condition determined by the anatomy of the eye. Patients with an abnorma- lly narrow drainage angle are predisposed to develop symptoms of an acute angle-closure glaucoma (AACG). Another risk factors are: thinner ciliary bodies, thinner iris, thicker lens, especially situated anteriorly, shallower anterior chambers, smaller eyeballs and cor- nea, shorter axial length of the eyeball. Physiological, age-dependent thickening of lens results in further anterior chamber crowding. Di- latation of the iris causes pathological iris-lens apposition leading to a pupillary block. The aqueous flow is obstructed or blocked. The rising pressure in the posterior chamber pushes the iris forward that results in further narrowing and finally closure of the drainage angle and subsequent increase of the intraocular pressure (IOP). Case: In 2012 53-year-old woman was referred to an ophthalmologist due to a visual acuity (VA) decrease in the right eye (RE). Examination re- vealed VA RE = 0,25 C.C. + 1,75 DSph and VA in the left eye (LE) = 1,0 C.C. + 2,0 DSph. RE IOP was elevated 34 mmHg, LE IOP = 19 mmHg. The patient was given acetazolamid and ẞ-blocker. The gonioscopy revealed the iridocorneal angle in RE as grade 1, with a hooked angle, in LE - grade 2. The patient was diagnosed with RE PACG. RE $76 INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS 11th WIMC S77#40IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS 11th WIMC Abstracts Abstracts was treated with fakotrabeculectomy and LE with laser iryidotomy. Post-operative VA RE = 0,4 stenop., VA LE = 0,5 stenop., RE IOP = 26 mmHg and LE IOP = 24 mmHg. A month later the 20-gauge vitrectomy with a re-enactment of the anterior chamber of RE was performed. VA RE = 0,6 stenop., RE IOP = 15 mmHg. LE IOP increased to 44 mmHg. LE gonioplasty was performed in 2013. In 2014 RE adhesions lysis and another re-enactment of the anterior chamber was performed. The final results were: VA RE = 0,4 c.c. 2,75 DSph, VA LE = 1,0 C.C. + 2,0 DSph, RE IOP = 15 mmHg and LE IOP = 25 mmHg. Conclusions: The final result of the treatment was a success in terms of surgical proce- dures' effectiveness, but it was a failure for the patient. The depth of the anterior chamber after procedures performed on a small eyeball with AACG is impossible to predict, so we cannot anticipate the eye's refraction. Due to an unfeasible to correct discrepancy between the eyes, the visual acuity cannot be improved and the patient's quality of life is not significantly increased. 54 Hypersensitivity Vasculitis In A Patient With Surgically Trea- ted Coronary Artery Disease Mateusz Wondołkowski, Anna Wancerz, Dominika Puchta, Wiktoria Ciechowska, Anna Słowikowska, Adam Arendarczyk, Romuald Cichoń, Radosław Wilimski Students' Scientific Group by the Department of Cardiac Sur- gery at the 1st Department of Cardiology, Medical University of Warsaw Background: Hypersensitivity vasculitis (HV) contains a heteroge- neous group of vasculitides associated with type III hypersensiti- ve response to drugs, infectious agents, and other antigens. It is characterized by immune complex deposition in capillaries followed by inflammatory response and fibrous necrosis. It may occur as a result of pharmacological therapy in many medical specialties. Case: A 48-year-old male with a history of myocardial infarctions, arterial hypertension and type II diabetes was admitted to the Department of Cardiac Surgery at the 1st Department of Cardiology, Medical Uni- versity of Warsaw for surgical treatment of coronary artery disease. The patient underwent off-pump coronary artery bypass grafting (OPCAB). The postoperative period was uneventful. The patient was discharged in the 6th post-operative day in good clinical condition with a prescription for the following: acetylsalicylic acid, atorvas- tatin, nebivolol, valsartan, metformin and torasemide. On the 13th postoperative day the patient was once again admitted to the de- partment due to the onset of bright red, well-demarcated palpable petechiae, macules and papules localized on his upper and lower extremities which put forward the suspicion of sepsis. The concen- tration of lesions was highest nearby the surgical wound after saphe- nectomy using multiple incisions with small skin bridges - tunneling on the patient's medial region of the left leg. The patient's general practitioner had prescribed Sulodexide (a mixture of heparin and dermatan sulphate) as a prevention of diabetic nephropathy. Based on extensive laboratory studies, which excluded thrombocytopenia (PLT 484 x103/uL) and significant elevation of biochemical markers of systemic inflammation (CRP 32,2mg/L, WBC 11,88K/uL) HV was suspected. The patient was referred to the Department of Dermato- logy where drug induced HV was confirmed most probably triggered by Sulodexide. Conclusions: The treatment of patients with many comorbidities frequently requires the administration of a number of different drugs. Pharmacological polytherapy creates a higher risk of suffering of sides affects. Meticulous clinical examination and doctor- patient cooperation is crucial for efficient patient medical treatment. We must not forget to treat the patient holistically and keep in mind the inseparability of all medical fields. 55 Esophageal Metastases Of Hepatocellular Carcinoma After Liver Transplantation Radosław Pietrzak, Igor Ilasz, Marta Poręcka, Emil Bik Students Scientific Group, Department of General, Transplant and Liver Surgery, Medical University of Warsaw Background: Hepatocellular carcinoma (HCC) is the most common primary liver cancer. It develops as a complication of liver cirrhosis due to viral hepatitis or alcoholic disease. When surgical resection of HCC is impossible, but the tumor meets the Milan criteria, indicated treatment is orthotopic liver transplantation (OLTX). HCC recurrence within 5 years after OLTX is reported in approximately 20% of cases. Metastases to the esophagus occur in far less than in 1% of patients and unfortunately most of them are diagnosed during autopsy. Case: : A 66-year-old male with unresectable HCC and liver cirrhosis (HBV and alcoholic liver disease) was admitted to the Department 15th November 2012 for elective OLTX. Whole procedure and hospital stay were uneventful. Patient was discharged with good function of liver transplant. In less than 2 years after OLTX, patient was admitted to the Department due to dysphagia, there were no additional symp- toms from the liver. A gastroscopy has revealed a 3 cm exophytic mass in the lower part of the esophagus occluding half of its lumen. Sample of the lesion was collected for further investigation. Histo- pathological examination confirmed HCC metastasis. Afterwards, the patient was admitted to the department for further treatment and the stenosis was nullified by esophageal prosthesis. Later on, in September 2014 gastroscopy revealed that protesis migrated to the stomach, so it was replaced with a new one. Migration occurred again and 3 months later the prosthesis was not substituted but re- moved due to hemorrhage from the tumor. It was put back in January 2015. Despite the metastasis of HCC in esophagus imaging didn't show any additional neoplastic changes. The patient still stays under surveillance of the Department. Conclusions: Any case of dysphagia after OLTX due to HCC shall arouse suspicion of metastatic process. Although, HCC metastases to esophagus after OLTX are extremely rare, an endoscopic examination should be immediately performed. 56 Reduced Level Of Pain After Labour As The Case Of Latent Diseases Magda Niedźwiedzka, Piotr Baranek Students' Scientific Group of Department of General, Trans- plant and Liver Surgery, Medical University of Warsaw Background: Surgical emergencies in the purperium are not often, that along with the abdominal symptom, which may be thought to be related to the pregnancy, and rarely convincing signs in contrast to the symptoms, may lead to delay in a diagnosis by inexperien- ced surgeon. What is more, Any of the common surgical emer- gencies could occur during puerperium, such as, acute appendicitis and symptomatic cholelithiasis. Moreover there are some of them that appear more often during puerperium, for example intestinal obstruction. Inadequate treatment of all of them could lead to the life-threatening complications. Case: 35-year old female was admit- ted to Department of General, Transplant and Liver Surgery in order to diagnose the origin of acute abdominal pain lasting two days and located in right iliac fossa with suspected appendicitis. The patient has been performed a Cesarean section three weeks before. USG examination revealed actute inflammation: turgid appendix covered with much fibrous tissue and thickened wall to 1 cm of diameter. Primary treatment showed no recovery thus patient was qualified to operation. Explorative laparoscopy has been performed along with classic appendectomy, removing gangrenous appendix. The level of pain experienced by the patient turned out to be inadequate with the symptoms. According to the literature, the threshold of pain after labour decreases due to the action of beta-endorphins. There- fore, other diseases' pain symptoms may remain reduced or latent. Conclusions: Fluctuation in the level of the pain tolerance caused by the exudation of the beta-endorphins may interrupt patient's per- ception. With the limited number of safely usable antibiotics during breastfeeding, the assessment of the condition fo the patient and the treatment could be relevantly straitened. Extensive examinations and medical imaging are necessary to establish proper diagnosis in order to conduct the most appropriate treatment. 57 Is Endoscopic Cystogastrostomy A Safe Method Of Treatment Post-Traumatic Pancreatic Pseudocysts? Emilia Kowalczyk, Wojciech Korcz Students' Scientific Group, General, Gastroenterological and Oncological Surgery, Medical University of Warsaw Background: According to the American Association for the Surgery of Trauma injuries are the third cause leading to formation pancreatic pseudocysts and represent 3-8% of them. For decades, the gold stan- dard for dealing with post-traumatic pancreatic pseudocysts is their surgical drainage. It is believed increasingly that surgery as a method of choice should be used only in rare cases, for cysts with a very large diameter or the suspicion of neoplasm. Over the last decade the importance of endoscopic treatment has increased. Endoscopic treatment of traumatic pancreatic collection is safe and effective and can be considered a first-choice alternative to surgical treatment Case: A 34-year-old patient with suspiction of post-traumatic pan- creatic pseudocyst detected in USG was admitted to our hospital. On admission she was in a good condition without any symptoms. A physical examination revealed distended abdomen with a palpable, painless mass in the epigastrium. Computer tomography showed a huge, well encysted fluid collection of distal body and tail, with segmental wall thickened to 7mm, hypodense pancreatic pseudo- cyst of about 106 × 122 × 95 mm in size. All blood investigations were normal except serum lipase (73U/L) and fibrinogen (742 mg/ dl). She was performed a gastroscopy which showed compression of the stomach. Based on all data she was qualified to endoscopic cystogastrostomy. While the endoscope was removing, it suddenly rotated and changed the initial location with the result that inte- rrupted the stomach wall. That is why it was decided to convert procedure to laparotomy. After opening the abdomen there were a large amount of air and cloudy fluid from the cyst. Sutured site of perforation and intestinal-pancreatic anastomosis was performed. After the operation, the patient was given parenteral nutrition, cour- se of empiric antibiotic and recoverd well without complications. She was discharged on the 16th postoperative day. The patient was free of symptoms and signs although a control USG showed a residual cyst durig a 6-month follow-up. Conclusions: The preferred method of treatment pancreatic pseudocysts is their endoscopic drainage (the success rate: 91-94%), but we must keep in mind that the final decision should be made individually and takes into consideration both the resort experience and patient preferences, so as to minimi- ze the risk of complications. 58 The Role of EndoVAC Therapy In Pancreatico-Gastric Anasto- mosis Insufficiency. The Novel Approach Krzysztof Szmyt, Adam Bobkiewicz Department of General, Endocrinological and Gastroente- rological Oncology Surgery, Poznan University of Medical Sciences, Poznan, Poland Background: Pancreatic leakage after pancreaticoduodenectomy is associated with a high morbidity and mortality. Different techniques have been investigated to improve a safety of anastomosis after pancreatic surgery. Negative pressure wound therapy (NPWT) is a well-established treatment based on a device called vacuum-assis- ted closure (VAC) system. Endoscopic vaccum-assisted wound closu- re system (EndoVAC) therapy has been proven to be an important alternative in patients with upper and lower intestinal leakage not responding standard endoscopic and/or surgical treatment proce- dures. Case: A 72-year-old patient was admitted to the Department of General, Endocrinological and Gastroenterological Oncology Sur- gery because of diagnosed tumor in the head of the pancreas. A CT scan revealed a tumor in the head of the pancreas (14x11x10cm). Pancreatoduodenectomy (Whipple procedure) was performed. In- traoperative histopathological examination diagnosed a neuroen- docrine tumor of the pancreas. At 6 day after primary surgery a pancreatico-gastric anastomosis insufficiency was diagnosed. The patient was re-operated twice, at 7 and 15 day after the primary sur- gery. Because of deterioration of patient's general condition, patient was qualified for EndoVAC therapy at 20 day following the primary surgery. Continuous negative pressure of 100 mmHg was set up. At 6 day following initiated EndoVAC therapy, the check-up with endos- copy was performed. The size of the anastomotic fistula significantly decreased and there was no indication for further NPWT. Patient was discharged from hospital at 21 day after the NPWT was implemen- ted with any signs of pancreatico-gastric anastomotic dehiscence. Conclusions: EndoVAC provides perfect wound drainage, closure of the various kind of defect and promotes tissue granulation. This therapy may significantly improve a morbidity and mortality. Moreo- ver, EndoVAC may be usefulness in the multidisciplinary approach - from upper gastrointestinal to rectal surgery complications. Further extensive, large-cohort studies need to be performed to establish application and effectiveness of EndoVAC, before routine widespread use can be recommended. 59 Ophthalmic Dirofilariasis Radina Kirkova Medical University of Sofia Background: Dirofilariasis is a parasitic disease of domestic and wild animals, that occasionally infects humans. The genus Dirofilaria be- longs to the family Onchocercidae and subfamily Dirofilariine of the order Spirurida. Dirofilaria infects different mammals it replicates in animal's body and it could be find in the form of microfilariae (immature stage). Microfilariae are transmitted to humans through biological vectors, such as certain species of mosquitoes (Anopheles, Aedes, Culex). The human is not an appropriate host. The parasite is found in subcutaneous tissue and mucous membranes. The in- volvement of eye may be periorbital, subconjunctival and intrao- cular. Case: We describe a case of subconjunctival dirofilariasis in 64-year-old female patient, hospitalized in the Clinic of Ophthalmo- logy, University Hospital "Tsaritsa Joanna" (Sofia, Bulgaria). The pa- tient presented with redness, irritation, feeling for "movement" and intermittent local pain in the left eye. Her complaints dated from 3 months. Ophthalmic examination revealed a thin white live worm under the chaemotic and injected bulbar conjunctiva. The parasite was removed surgically under local anaesthesia. It was long 130 mm. The worm was identified as Dirofilaria repens in The Center of Pa- rasitology, Sofia, Bulgaria. Conclusions: Ocular dirofilariasis, caused by Dirofilaria repens is very rare for European countries, except the Meditarranean countries. In the literature, the biggest part of the described cases, are from Asia and Africa. The prevention is very important and consists of controlling mosquitoes and animals, that have microfilaria (treating with antihelmintics). 60 Can Glaucoma Treatment Result In Hypotony Maculopathy? - Case Study Anna Kozioł, Katarzyna Wojewoda, Karolina Kątska, Jan Os- trowski, Kinga Caban Medical University of Lublin/Department of Diagnositc and Microsurgery of Glaucoma Background: Glaucoma is a group of eye disorders characterized by progressive optic nerve damage and visual filed loss usually asso- ciated with increased intraocular pressure (IOP). Globally, it affects around 60 million people (2012 data) and remains second leading cause of blindness. Primary open-angle glaucoma is the most com- mon form of glaucoma, tends to develop slowly and usually without any symptoms until significant vision loss has occurred. Despite the fact that pathogenesis of glaucoma is not fully understood, the level of IOP is related to ganglion cell deaths. IOP is the most important and only modifiable risk for this disease, its reduction benefits in preventing the development and slowing the disease's progression. When pharmacological treatment do not achieve desired results, incisional surgery or laser are indicated. Trabeculectomy, which is a highly successful time-tested surgery, remains is the gold standard for glaucoma surgical treatment. Case: In 2004, 54 year old male patient pharmacologically treated for LE(left eye) open - angle glaucoma was admitted to Glaucoma Clinic due to high IOP. Examination showed BCVA LE 0,5 and BCVA RE (right eye) 0,25. Tonometry revealed both RE and LE ocular hypertension - 28 mmHg and 60 mmHg, respectively. After gonioskopy, the diagnosis of RE open angle glaucoma was established and patient was referred to LE trabeculectomy. In 2009 he was admitted again, due to RE ocular hypertension. RE trabeculectomy and LE filtration bleb revision were performed. Despite of adjunctive treatment (beta - blocker, alpha - mimetic and carbonic anhydrase inhibitor), LE IOP remains high and decision about another bleb revision was made. Post operative follow up revealed BCVA LE diminution to 0,1 and LE IOP 4 mmHg. Hypotony maculopathy was diagnosed and managed by adding com- $78 INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS 11th WIMC $79#41IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS 11th WIMC s80 Abstracts Abstracts pression sutures. Conclusions: The goal of glaucoma treatment is to preserve irreversible loss of vision. Because of glaucoma chronic progression, therapeutic options need to be adjusted periodically. Although trabeculectomy is highly effective in advanced glaucoma treatment, its efficacy is unpredictable. Both too high and too low postoperative IOP may require interventions to restore the flow of aqueous in the filtration bleb. Hypotony maculopathy can be a vision -threatened complication of glaucoma filtration surgery. In this case direct suturing of the bleb was a preferable form of treatment and resulted in IOP normalization. 61 Temporomandibular Joint Function Before And After Unilate- ral Masticatory Muscles Excision During Oncological Salvage Surgery Piotr Janik Students' Research Group Associated with Head and Neck Cancer Department, Cancer Center, M. Sklodowska-Curie Institute, Warsaw Background: The change in stress distribution and function of tem- poromandibular joint (TMJ) leads to remodeling of articular tissues. It could result in temporomandibular disorders (TMD) but also can result in improvement of TMJ function. We present case of the pa- tient with TMJ function impairment due to the neoplastic infiltration that improved after oncological salvage surgery. Case: 60 year-old male with recurrent oral squamous cell carcinoma (SCC), metastases to the cervical lymph nodes (T4N2Mo) treated with radiotherapy one year ago developed local recurrence. Masticatory muscles infiltration caused significant trismus. The surgical procedure included partial maxillectomy, resection of the coronoid process of the mandible, buccal mucosa, masseter muscle, pterygoid muscles, upper and lower gum, and the floor of the mouth on the left side with all suprahyoid muscles. Tracheotomy was performed. Resected tissues were reconstructed with anterolateral thigh microsurgical flap. Body and ramus of the mandible was not infiltrated. TMJ function was analyzed using JMA Zebris System® before, 9 days and 3 months after surgery. Conclusions: This case shows improvement of TMJ mo- bility after unilateral excision of all masticatory muscles. Functio- nal analysis of TMJ is useful in objective assessment of masticatory function before and after treatment. Further observation is needed to assess delayed effects of surgery. 62 Improper Therapy Of The Simple Subgaleal Hematoma Can Induce A Very Serious Neurosurgical Problem Karolina Twardowska, Marcin Zarzycki Department of Neurosurgery at Second Faculty of Medicine, Medical University of Warsaw Background: A subgaleal hematoma is a collection of blood in the potential space between the skull's periosteum and the scalp's galea aponeurotica. It occurs infrequently. This could be a big problem in the elderly patients who take antiplatelet therapy. An extensive sub- galeal hematoma rarely occurs several days after minor head trau- ma, but very rare complication of this type of hematoma is subgaleal empyema formation. Case: A 46 year-old man developed a subgaleal hematoma as a result of a head injury caused by a hit of a dull object. When a mass started to develop over the scalp the patient presented to his GP, but the doctor didn't apply any treatment. After few weeks when the patient observed an aggravation of symptoms (headache and swelling of the subcutaneous tissue), he consulted a surgeon, who recommended to contact with physiotherapist. Also a sample of purulent content was taken for examination and the patient was treated with antibiotics. The therapy did not work and the patient developed a huge soft-tissue empyema measured 20cm diameter located in the parietal region, with many ulcers on the skin. After consultation with a neurosurgeon the patient was sent to the neurosurgery department of the local hospital. Computed tomogra- phy (CT) showed a significant thickening of the subcutaneous soft- tissue lesions of the head with the suspicious of the empyema in the epidural space. During surgery the empyema and damaged parts of parietal bone were removed, and the dura mater was cleaned. For the reconstruction of the damaged skin in the operative region was used a pedicle skin flap which was supplied with the occipital artery and additional free skin graft from the right tight. Conclusions: In this case we observe improper recovery of the subgaleal hematoma. This could be more often problem in the elderly patients who take antiplatelet therapy because the trauma in this group of patients has a different nature. Neglect or inappropriate treatment of the subga- leal hematoma could cause the subgaleal empyema. The lack of the decision to drain the hematoma or empyema can provoke the very serious skin and bone complications. 63 Should Mechanical Circulatory Support Be Considered As First Choice Surgical Treatment Of Terminal Heart Failure? Case Of 35 Years Old Female With Cardiomyopathy Agnieszka Jasińska, Piotr Gajewski Medical University of Warsaw Background: Ventricular assist devices (VAD) are the base of mecha- nical circulatory support. They are surgically implanted directly into heart ventricule, commonly to the left ventricule (LVAD) but also can support both ventricules (BIVAD). HeartWare VAD (HVAD) is now fre- quently used as a heart failure therapy. It provides continuous flow and due to literature can support heart for more than 5 years. Case: 35 years old female, who suffers from hypertrophic cardiomyopathy (HCM), which occurred after viral-induced lower respiratory tract in- fection and consequent myocarditis when she was 8 y/o. HCM was complicated by obstruction in the outflow area and paroxysmal atrial fibrillation. Since January 2014 patient was eligible for HTX. However, operation had to be cancelled, because of coincidence of patient's menstruation. In autumn 2014 patient's heart failure has aggravated (from NYHA III to IV), she was admitted to the Dept of Cardiosurgery and Transplantology of Institute of Cardiology. On admission patient presented deterioration of heart failure. Because of cardiogenic shock, positive inotropic agents were necessary and an intra-aortic balloon pump (IABP) was implanted. Patient's LVEF was 20% and RV contractility remained correct on cardiac echo (TTE), so a decision of long-term left ventricular assistance was made in Feb 2015. Implan- tation was executed without complications. Postoperative therapy contained haemodynamic stabilization with levosimendan, diuresis stimulation (furosemide), antibioticotherapy (piperacilin/tazobac- tam). On POD 11 patient was reffered to Cardiosurgery department. During next week, patient's cardiovascular efficency has deteriora- ted, peripheral oedema and anuria occurred. Because of cardiac tam- ponade suspicion, reoperation was necessary. Although pericardial effusion was not detected, heart failure had exacerbated and RV contractility decreased. To treat life threatening cardiac insufficiency, another mechanical support- extracorporeal membrane oxygenation (ECMO) was implanted. Since the implantation took place in the end of third week of Feb, patient stays in the postanesthesia care unit. Conclusions: Although HTX is still regarded as the "gold standard" treatment for end-stage heart failure, VAD should be considered as an alternative, but comparable method. Our case shows that VAD is suitable for patient so far considered candidat to HTX and may be a bridge to HTX, to recovery, to another bridge, but also a destination therapy. INTERNATIONAL JOURNAL of MEDICAL STUDENTS 11th WIMC www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS S81