Conduta cirúrgica na doença inflamatória pélvica (DIP): análise de 19 casos.

Trabalho de Conclusão de Curso - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Departamento de Clínica Cirúrgica, Curso de Medicina, Florianópolis, 198

Accuracy of visual inspection, cytology and colposcopy in the diagnosis of high-grade cervical intraepithelial neoplasia

Introduction: Cervical cancer is still one of the leading causes of cancer and mortality in women, especially in low- and middle-income countries. Normally, the prevention of its occurrence is done through efficient screening and treatment programs for high-grade epithelial lesions, which are pre-malignant lesions. Cheaper diagnostic techniques ensure greater access to women, which can prevent a large number of cancer cases worldwide. Objective: The aim of the study was to evaluate the accuracy of visual inspection either with acetic acid or with Lugol’s iodine, cervical cytology and colposcopy in the diagnosis of cervical intraepithelial neoplasia 2 and 3. Methods: This is a study of diagnostic accuracy. We evaluated 115 women with high-grade squamous intraepithelial lesion confirmed by biopsy, 54 with cervical intraepithelial neoplasia 2 and 61 with cervical intraepithelial neoplasia 3, from January 2016 to December 2018 at the Lower Genital Tract Pathology and Colposcopy Service of the Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. A comparative analysis of the visual inspection, Pap smear and colposcopy diagnostic methods was performed. Results: The average age was 33.1 years (standard deviation=9.83) for cervical intraepithelial neoplasia 2 cases and 35.2 years (standard deviation=7.97) for cervical intraepithelial neoplasia 3. In the cervical intraepithelial neoplasia 2 group, visual inspection tests were positive for high-grade squamous intraepithelial lesion in 98.1% of the cases with acetic acid and 94.4% with Lugol’s iodine. Colposcopy identified a probable high-grade squamous intraepithelial lesion in 94.4% of the cases, while cytology only in 42.6%. In the cervical intraepithelial neoplasia 3 group, the visual inspection tests were positive for high-grade squamous intraepithelial lesion in 91.8% of the cases with acetic acid and 95.1% with Lugol’s iodine. Colposcopy identified a probable high-grade squamous intraepithelial lesion in 93.5% of the cases, while cytology in 65.6%. Conclusion: Visual inspection with acetic acid and Lugol’s iodine, and colposcopy test were more accurate for the diagnosis of cervical intraepithelial neoplasia 2 and 3 than through cytopathology

Effects of acoustic neurostimulation in healthy adults on symptoms of depression, anxiety, stress and sleep quality: a randomized clinical study

Aim: To evaluate the application of an acoustic neurostimulation program with binaural beats and isochronic tones isolated or in association, and its effects on sleep, depression, anxiety, and stress in healthy workers. Methods: A randomized, single-blind, parallel-group clinical trial, using acoustic neurostimulation with binaural beats, isochronic tones, or a combination of these in the 10 Hz range (alpha) performed with daily 20-minute sessions for 21 days. Changes in brainwave patterns were assessed by electroencephalogram (EEG). Psycho-emotional state was assessed with the Depression, Anxiety and Stress Scale 21 Items (DASS-21), and sleep quality with the Pittsburgh Sleep Quality Index (PSQI). In addition, salivary cortisol levels were evaluated as a biomarker of stress. Results: The data revealed distinct patterns of brainwave modulation via brainwave entrainment (BWE) techniques. Binaural beats and isochronic tones, alone and in combination, effectively increased alpha brainwaves in the temporoparietal region. However, when assessing theta brainwave frequencies in the same region, only binaural beats showed a significant effect. Furthermore, in the prefrontal cortex, an elevation in beta waves was exclusively observed with the use of binaural beats. These findings underscore the specificity of BWE techniques on different brainwave frequencies and regions. The study demonstrated marked improvements in several symptoms related to stress, depression, anxiety, assessed by psychometry with DASS-21 and related to sleep quality assessed by the PSQI. Conclusions: These results indicate that 10 Hz acoustic neurostimulation in the alpha range, whether through binaural beats, isochronic tones, or a combination of both, can significantly influence brainwave patterns and intensity. Notably, participants exhibited decrease in symptoms of stress, depression, and anxiety, coupled with improved sleep quality. These data suggest that alpha acoustic neurostimulation holds promise as an effective intervention for bolstering mood, mental health, and overall emotional well-being [Brazilian Clinical Trials Registry (ReBec, ensaiosclinicos.gov.br) identifier: RBR-10yj42dj]

Eficácia e tolerabilidade do tratamento com termocoagulação da neoplasia intraepitelial cervical de alto grau: um estudo de seguimento de 24 meses

Tese (doutorado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Ciências Médicas, Florianópolis, 2021.Introdução: O câncer do colo do útero é ainda uma das principais causas de câncer e de mortalidade em mulheres, sobretudo nos países de baixa e média renda. A prevenção de sua ocorrência, geralmente, é feita por programas eficientes de rastreamento e tratamento das lesões epiteliais de alto grau que são lesões precursoras do câncer. O tratamento dessas lesões é realizado por uma variedade de métodos, tanto ablativos (termocoagulação, crioterapia, eletrocauterização e cauterização química) quanto excisionais (exérese da zona de transformação, conização por bisturi, aparelho de alta frequência ou laser). Os métodos excisionais são mais utilizados por fornecerem material para exame histopatológico, no entanto, são complexos, caros e de difícil acesso em muitas regiões. A termocoagulação é uma alternativa de tratamento barato, simples, de fácil execução e baixo custo. Objetivo: Avaliar a eficácia e tolerabilidade do tratamento com a termocoagulação das lesões intraepiteliais cervicais de alto grau (NIC 2 e 3) num período de 24 meses de seguimento. Método: Foram avaliadas 115 mulheres com neoplasia intraepitelial cervical de alto grau, 54 com NIC 2 e 61 com NIC 3, confirmadas pela biópsia e sem tratamento prévio, no período de janeiro de 2016 a dezembro de 2018 submetidas a termocoagulação, no ambulatório de Patologia Cervical do Hospital das Clínicas de Porto Alegre, Brasil. Resultados: A idade média foi de 33,1 anos (DP=9,8) no grupo NIC 2 e 35,2 anos (DP=7,9) no Grupo de NIC 3. A eficácia do tratamento foi de 90,7% no grupo NIC 2 e 96,6% no Grupo NIC 3. A dor foi o principal sintoma referido no momento do tratamento, ocorrendo mais frequentemente no grupo NIC 3 (49,1%, contra 27,8% no grupo NIC 2). Os efeitos adversos em longo prazo foram diagnosticados em 3 casos (5,6%) de doença inflamatória pélvica no grupo NIC 2 e 3 casos (5,0%) no grupo NIC 3. O percentual de lesão residual foi muito baixo em ambos os grupos, 5 no grupo NIC 2 (9,3%) e 2 no grupo NIC 3 (3,4%). Conclusão: A termocoagulação é um método altamente eficaz no tratamento das lesões precursoras do câncer do colo de útero (NIC 2-3) e com boa tolerabilidade. Essa pesquisa visa encorajar a implantação desse método de tratamento no Brasil.Abstract: Background: Cervical cancer is still one of the main causes of cancer and mortality in women especially in low- and middle-income countries. Usually, the prevention of its occurrence is achieved through efficient screening and treatment programs for high-grade intraepithelial lesions, which are premalignant lesions. These lesions are treated by a variety of methods, such as ablative treatment (thermocoagulation, cryotherapy electrocauterization and Chemical cauterization) and excisional procedure (excision of the transformation zone or conization by electrical methods, high frequency device, laser and cold knife). Excision methods are more frequently used because they provide tissue for histopathological examination. However, they are complex, expensive and difficult to access in many regions. Thermocoagulation is an alternative treatment that is cheap, simple, easy to perform and low cost. Objective: Evaluate the efficacy and tolerability of thermocoagulation treatment of highgrade cervical intraepithelial lesions (CIN 2 and 3) in a 24-month follow up. Method: We evaluated 115 women with high-grade cervical intraepithelial neoplasia, 54 with CIN 2 and 61 with CIN 3, confirmed by biopsy and without previous treatment, from January 2016 to December 2018, undergoing thermocoagulation treatment at the Lower Genital Tract Pathology and Colposcopy Service of the Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. Results: The mean age was 33.1 years (SD=9.8) in CIN 2 and 35.2 years (SD=7.9) for CIN 3 patients. Treatment efficacy was 90.7% in CIN 2 and 96.6.% in CIN 3 cases. Pain was the main symptom reported at the time of treatment, occurring more frequently in the CIN 3 group (49.1% versus 27.8% in the CIN 2 group). As the more important long-term complication, there were 3 cases of pelvic inflammatory disease in CIN 2 (5.6%) and 3 in CIN 3 group (5.0%). The percentage of recurrent lesion was very low in both groups, 5 in CIN 2 group (9.3%) and 2 in CIN 3 group (3.4%) Conclusion: Thermocoagulation is an effective method for treatment of cervical pre-cancer lesions (CIN 2-3) with a low risk of adverse events and complications and has a good tolerability. This research aims to encourage the implementation of this method of treatment in Brazil

Sífilis congênita: relato de caso.

Trabalho de Conclusão de Curso - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Departamento de Pediatria, Curso de Medicina, Florianópolis, 198

Determinação da maturidade pulmonar fetal pela contagem dos corpos lamelares no líquido amniótico

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde. Programa de Pós-Graduação em Ciências Médicas.Objetivo: Avaliar o teste da contagem dos corpos lamelares (CCL) no líquido amniótico, como meio diagnóstico da maturidade pulmonar fetal, comparando-o ao teste da polarização fluorescente TDxFLM

Avaliação da maturidade pulmonar fetal pela contagem dos corpos lamelares no líquido amniótico Evaluation of fetal lung maturity by lamellar bodies counting in amniotic fluid

OBJETIVO: comparar o teste de contagem de corpos lamelares (CCL) no líquido amniótico com o teste da polarização fluorescente (PF) como parâmetro diagnóstico para avaliação da maturidade pulmonar fetal. MÉTODO: estudo transversal, analítico e controlado realizado com 60 gestantes atendidas no período de março de 2002 a dezembro de 2007. Foram colhidas amostras de líquido amniótico e realizados os testes de CCL e PF (TDxFLM II), considerados de referência, e comparados à presença ou ausência da Síndrome do Desconforto Respiratório (SDR). Foram estabelecidos valores de corte para maturidade de 30 mil corpos lamelares/µL para o teste da CCL e 55 mg/g de albumina para o PF. Foram avaliadas as características maternas e perinatais, a evolução neonatal e o desempenho dos testes diagnósticos para predição da maturidade pulmonar fetal. Na análise estatística, foram utilizadas medidas descritivas e calculados os valores referentes à sensibilidade, especificidade, valor preditivo positivo e negativo dos testes, considerando-se significativos valores de p<0,05. RESULTADOS: a idade materna variou entre 15 e 43 anos, com média de 26,6 anos. A idade gestacional variou entre 24,3 e 41,6 semanas, com média de 35,1 semanas. A Síndrome do Desconforto Respiratório foi diagnosticada em 13,3% dos neonatos. As características perinatais, como peso, índice de Apgar, incidência de SDR, foram comparadas aos resultados dos testes de CCL e PF, sendo observada uma correspondência, estatisticamente significativa (p<0,05), entre os grupos de neonatos clinicamente classificados como imaturos e maduros em ambos os testes. Os testes foram concordantes em 68,3% dos casos. Quando se comparou o teste da PF com o teste da CCL, a sensibilidade foi de 100% para ambos, e a especificidade do teste da CCL foi superior (73,1%), quando comparado com o teste de PF (51,9%). O padrão-ouro para determinação da maturidade fetal é a ocorrência da SDR. O valor preditivo positivo do teste da CCL foi superior (36,4%) quando comparado ao teste da PF (24,2%) (p<0,05), sendo que o valor preditivo negativo foi de 100% para ambos os testes. CONCLUSÕES: este estudo demonstrou que o teste da CCL apresenta 100% de sensibilidade e especificidade superior ao teste de referência (PF). Além disso, a CCL é considerada um teste rápido, acessível, barato e factível em nossa realidade, podendo ser utilizado como teste confiável na predição da maturidade pulmonar fetal.<br>PURPOSE: to compare the lamellar body number density (LBND) count in amniotic fluid using the fluorescent polarization (FP) test as a diagnostic parameter for the assessment of fetal pulmonary maturity. METHOD: this was an analytical, controlled cross-sectional study conducted on 60 pregnant women from March 2002 to December 2007. Amniotic fluid specimens were obtained by amniocentesis or at the time of caesarean section, and submitted to the LBND and FP tests (TDxFLM®, Abbott Laboratories), the latter considered to be a reference test, and compared in terms of the presence or absence of respiratory distress syndrome (RDS). Cut-off values for maturity were established at 30,000 lamellar bodies/µL for the LBND test and 55 mg/g albumin for the FP test. Maternal and perinatal characteristics and neonatal evolution were evaluated, and the performance of the diagnostic tests regarding fetal pulmonary maturity was determined. In the statistical analysis, descriptive measures were used and the sensitivity, specificity and positive and predictive values of the tests were determined with the level of significance set at p<0.05. RESULTS: maternal age ranged from 15 to 34 years (mean: 26.6 years) and gestational age ranged from 24.3 to 41.6 weeks (mean: 35.1 weeks). RDS was diagnosed in 35.1% of neonates. Perinatal characteristics such as weight, Apgar score, and RDS incidence were compared to the results of the LBND and FP tests and a significant correspondence (p<0.05) was observed between the groups of neonates clinically classified as mature and immature in both tests. The tests were concordant in 68.3% of the cases. Comparison of the PF and LBND tests revealed 100% specificity for both and a higher specificity for the LBND test (73.1% as opposed to 51.9% for the PF test). The gold standard for the determination of fetal maturity is the occurrence of RDS. The positive predictive value of the LBND test was higher (36.4%) than that of the FP test (24.2%) (p<0.05) and the negative predictive value was 100% for both tests. CONCLUSIONS: the present study demonstrated that the LBND test has 100% sensitivity and higher specificity than the reference test (FP). In addition, the LBND test is considered to be rapid, accessible, inexpensive and feasible for the Brazilian reality, and it can be used as a reliable test for the prediction of fetal pulmonary maturity

Resumos concluídos - Fisioterapia

Resumos concluídos - Fisioterapi

Resumos concluídos - Saúde Coletiva

Resumos concluídos - Saúde Coletiv