Investor Presentaiton

IJMS 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