Investor Presentaiton

IJMS 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