Investor Presentaiton

IJMS 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