Investor Presentaiton

IJMS 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