Transtorno mental orgânico após meningoencefalite pneumocócica com sintomas semelhantes aos do autismo

Universidade Federal de São Paulo (UNIFESP)Universidade Federal do TocantinsUNIFESPSciEL

Could disulfiram be a new treatment for crack cocaine dependence?: a pilot study

Universidade Federal de São Paulo (UNIFESP)Universidade Federal do TocantinsSecretaria Municipal de Saúde de Palmas Centro de Atenção Psicossocial para Álcool e DrogasUNIFESPSciEL

HELICOBACTER PYLORI INFECTION AND RISK FACTORS IN THE DEVELOPMENT OF GASTRODUODENAL DISEASES IN A POPULATION FROM THE CENTRAL-WEST REGION OF BRAZIL

Resumo: Helicobacter pylori é uma bactéria gram-negativa associada ao desenvolvimento de patologias severas como o adenocarcinoma gástrico. Aproximadamente 50% da população mundial está infectada por este microrganismo. A infecção está associada a fatores socioeconômicos, sociodemográficos e estilo de vida. Em função disso o presente estudo teve o objetivo de avaliar os fatores de risco e patologias gástricas associadas a infecção pela H. pylori. Foram aplicados 117 questionários que contemplavam fatores sociodemográficos, econômicos, sintomatologia e estilo de vida de pacientes submetidos a endoscopia digestiva alta. O diagnóstico foi realizado a partir do exame histopatológico e molecular. A prevalência da infecção foi de 69,2%, sendo 70,4% entre adultos e 79% do sexo feminino. Não foi observada diferença estatística nos níveis educacional, socioeconômico e condições expostas na infância. O hábito de consumir álcool demonstrou significância para a infecção (p=0,049). A sintomatologia mais frequente foi o arroto (p= 0,023). Entre as patologias gástricas, a gastrite foi o desfecho clínico mais encontrado. O conhecimento dos fatores de risco para a infecção bacteriana é de extrema relevância para dar subsídios para implementação de políticas públicas voltadas para a prevenção e erradicação do microrganismo. Palavras-chave: Bactéria. Prevalência. Fatores de risco. Dispepsia.   Abstract: Helicobacter pylori is a gram-negative bacterium associated with the development of severe pathologies such as gastric adenocarcinoma. Approximately 50% of the world population is infected by this microorganism. Infection is associated with socioeconomic, sociodemographic and lifestyle factors. Therefore, the present study had the goal of evaluating the risk factors and gastric pathologies associated with H. pylori infection. A total of 117 questionnaires were used, which included sociodemographic, economic, symptomatology and patient lifestyle factors submitted to upper digestive endoscopy. The diagnosis was done based on histopathological and molecular. The prevalence of infection was 69.2%, being 70.4% among adults and 79% females. No statistical difference was observed in educational, socioeconomic and childhood conditions. The alcohol consumption habit showed significance for the infection (p = 0.049). The most frequent symptomatology was belching (p = 0.023). Among the gastric pathologies, gastritis was the most frequent clinical outcome. The knowledge of the risk factors for bacterial infection is extremely relevant to provide subsidies for the implementation of public policies aimed at the prevention and eradication of the microorganism. Key words: Bacteria. Risk factors. Dyspepsia

O perfil semiológico do paciente portador de hemorragia digestiva alta

OBJETIVO: O seguinte estudo objetivou descrever a semiologia do paciente portador de hemorragia digestiva alta, considerando como determinante na avaliação de potencias focos hemorrágicos. METODOLOGIA: Foram realizadas buscas nas plataformas do SciELO, LILACS, PubMed, Scopus e Google Scholar,utilizando os descritores gastrointestinal bleeding, peptic ulcerous disease e varicose hemorrhage, sendo identificados 35 estudos, dos quais foram incluídos 13 artigos completos. Desses estudos, 5 avaliaram as principais etiologias, 2 o surgimento de novos testes diagnósticos, 2 analisaram os aspectos epidemiológicos e 1 a sintomatologia apresentada pelo acometimento da hemorragia digestiva alta. Observou-se inicialmente a abundâncias de informações conceituais sobre o sangramento, como um transtorno clínico comum, acompanhada de inúmeras manifestações, considerando que o foco hemorrágico pode ocorrer em qualquer porção do trato gastrointestinal. Neste estudo, todas as publicações eleitas apresentaram o quadro semiológico composto por algia abdominal, indícios de choque hipovolêmico e taquicardia, alguns exibiram quedas abruptas da pressão arterial, odinofagia, êmese, náuseas e estado ictérico. Os pacientes implicados, cronicamente, já manifestaram ocorrências prévias, devido ao caráter recidivante torna-se essencial investigar a existência de varizes, fístula aorto-entérica, angiodisplasia e doença ulcerosa. CONCLUSÃO: Elucida-se que a hemorragia digestiva alta representa a principal causa de sangramento do trato gastrointestinal, majoritamente manifesta-se como hematêmese ou melena e cursam com o quadro sintomatológico que auxilia na avaliação da gravidade deste e o embasamento de potenciais focos de sangramento e que contribuam para disseminação de informações e intervenções futuras

Efficacy of Topiramate in the Treatment of Crack Cocaine Dependence: A Double-Blind, Randomized, Placebo-Controlled Trial

Objective: We performed a double-blind, randomized, placebo-controlled trial to assess the efficacy of topiramate in the treatment of crack cocaine dependence. Method: Sixty men who were dependent on cocaine (DSM-IV) (exclusive use of crack cocaine) were selected. The subjects were randomly assigned to either a topiramate group (subjects received 50-200 mg of topiramate per day for 12 weeks) or a control group (subjects received placebo). The initial daily treatment dose was 50 mg, and this dose was increased weekly at increments of 25 to 50 mg, based on the subject's tolerability, to a maximum of 200 mg. All of the subjects also participated in motivational interviews and group therapy. The primary outcome measures were detection of benzoylecgonine in the urine, study retention, frequency of cocaine smoking, amount of cocaine use, and mean amount of money spent on cocaine per week. The study was conducted from February 2013 to February 2014. Results: Twenty-nine subjects in the topiramate group and 29 subjects in the control group completed the study. Longitudinal assessment revealed that retention was not significant (odds ratio [OR] = 1.072, P = .908) between the 2 groups. Negative results from a urine test for benzoylecgonine (a cocaine metabolite), which is a measure of cocaine abstinence, were more frequently obtained from the topiramate group (OR = 8.687, P < .001). Topiramate reduced the quantity of cocaine used (mean reduction = -3.108 g, P < .001), the frequency of cocaine use (mean = -0.784 times per week, P = .005), and the amount of money spent on cocaine (mean [US dollars] = -$25.38, P = .015; this variable did not achieve statistical significance after Bonferroni correction) compared with the placebo during the 12 weeks (or 84 days) of the assessment. However, the differences in reductions between the 2 groups in the quantity of cocaine used, the frequency of cocaine use, and money spent on cocaine over time (time x group interaction) were present only during the first 4 weeks, and none of these variables by 12 weeks. The studied groups did not differ with regard to secondary end points, such as study dropout and the number of subjects who reported side effects. Conclusions: The present findings indicate that topiramate is effective and safe and thus reinforce previous data suggesting that topiramate is a potentially useful treatment for crack cocaine dependence. However, we found that topiramate is only useful as an adjunctive treatment during the first 4 weeks of the treatment. Future studies with larger samples are needed to confirm these results. (C) Copyright 2016 Physicians Postgraduate Press, Inc.Ministry of Science and Technology (MCTI)National Council for Scientific and Technological Development (CNPq)Fed Univ Tocantins, Dept Psychiat, Palmas, BrazilUniv Fed Sao Paulo, Dept Psychiat, Sao Paulo, BrazilPsychosocial Care Ctr Alcohol & Drugs CAPS AD Pal, Palmas, State Of Tocant, BrazilUniv Fed Sao Paulo, Dept Psychiat, LiNC, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Psychiat, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Psychiat, LiNC, Sao Paulo, BrazilCNPq: 14/2013CNPq: 47411/2013-4Web of Scienc