Melhoria da Atenção à Saúde dos Usuários com HAS e/ou DM do Centro de Saúde de São José do Norte, RS

Ao longo dos últimos trinta anos, houve uma mudança do perfil de morbimortalidade da população brasileira com predomínio das doenças crônicas não transmissíveis. Grande impacto econômico ocorre notadamente nos serviços de saúde, como consequência dos crescentes custos do tratamento da doença e, sobretudo, das complicações, como as doenças cardiovasculares e a diálise por insuficiência renal. A atenção primária à saúde é responsável pela atenção aos problemas mais comuns na comunidade e tem papel primordial nas ações de controle da hipertensão arterial, da diabetes mellitus e das doenças cardiovasculares. Suas ações vão desde a promoção à saúde e prevenção de riscos até rastreamentos, manejo específico e prevenção de suas complicações. O projeto de intervenção realizado no Centro de Saúde de São José do Norte objetivou ampliar e qualificar a atenção à saúde de hipertensos e diabéticos. Para tanto, foi necessário um trabalho em equipe, com ênfase na escuta e no exame clínico, além da realização de exames complementares, do monitoramento contínuo, da promoção de saúde e da melhora nos registros. Os cadernos de atenção básica nortearam as condutas neste processo. A intervenção foi realizada nos meses de agosto a novembro, totalizando doze semanas, e o cadastramento dos usuários portadores de HAS foi crescente: 3,3% (58 Usuários) no primeiro mês; 9,4% (156 Usuários) no segundo mês e 12,5% (207 Usuários) no terceiro. Da mesma forma, 24 usuários com DM foram cadastrados no mês 1 (5,9%), 59 cadastrados no mês 2 (14,4%), e no terceiro mês foram 80 (19,5%). A intervenção conseguiu realizar exame clínico completo, orientações sobre atividade física, alimentação, cessação do tabagismo e higiene bucal em 100% dos cadastrados. A estratificação do risco cardiovascular foi realizada em quase 80% dos usuários com HAS e 90% dos usuários com DM, o que acompanhou o resultado sobre exames complementares em dia de acordo com o protocolo. Como a população de abrangência é grande, para atingir uma cobertura de 100% seria necessário maior tempo de acompanhamento, ou ampliação da ESF, com mapeamento e divisão do território. Apesar de não alcançar a totalidade da população, a intervenção conseguiu proporcionar um atendimento mais qualificado a essa população

Protocolos de regulação ambulatorial : dermatologia

Telemedicin

PLECT or PPLECT? Granulomatous pyoderma gangrenosum in the differential diagnosis of the verrucous syndrome

Pyoderma gangrenosum (PG) is an uncommon neutrophilic dermatosis, with variable clinical features, nonspecific histopathology and multifactorial pathogenesis, posing a challenging diagnosis for the dermatologist. Pyoderma gangrenosum is a diagnosis of exclusion and should be included in the differential diagnoses of the verrucous syndrome. We report a granulomatous variant affecting the face

Usefulness of dermoscopy in the evaluation of patch test reactions

Background: Despite being widely used in different areas of dermatology, there have been fewstudies evaluating the benefit of dermoscopy in the interpretation of patch tests, especially inweak and doubtful reactions.Objectives: To evaluate the role of dermoscopy in the interpretation of patch tests and describethe main findings of the reactions.Method: Prospective study, carried out in dermatology reference centers in southern Brazil,which evaluated the final results of patch tests analyzed with the aid of dermoscopy.Results: 77 patients and 160 reactions were included. The most prevalent substances werenickel sulphate (23.8%), kathon CG (9.4%), and perfume mix (8.8%). The main dermoscopicfindings were reaction area greater than half of the chamber site (90%), homogeneous erythema(86.9%), vesicles (30%), crusts (21.3%), perifollicular erythema (35%), pore reaction (19.4%) andpustules (8.8%). Dermoscopy was found to facilitate the definition of erythema in reactions onblack skin and when due to substances with deposition of pigment. Of the 64 weak or doubtfulreactions, 36 (56.25%) showed a change in the final result after dermoscopy evaluation; of the 36doubtful reactions, 33 (91.6%) showed a change in the final result after dermoscopy evaluation(p < 0.001).Study limitations: The probable limitation of the study is its sample size. Though certain sig-nificance levels have been reached, other possible relationships may not have been observed.Conclusion: Dermoscopy improves significantly the interpretation of patch tests, especially inweak and doubtful reactions

PLECT or PPLECT? Granulomatous pyoderma gangrenosum in the differential diagnosis of the verrucous syndrome

Pyoderma gangrenosum (PG) is an uncommon neutrophilic dermatosis, with variable clinical features, nonspecific histopathology and multifactorial pathogenesis, posing a challenging diagnosis for the dermatologist. Pyoderma gangrenosum is a diagnosis of exclusion and should be included in the differential diagnoses of the verrucous syndrome. We report a granulomatous variant affecting the face

A case of late-onset oligomeganephronia

A 33-year old caucasian man was investigated for pain in the right flank, proteinuria, hemathuria and an elevated serum creatinine level. He also presented an abnormal ultrasonography, which revealed asymmetric kidneys. Through renal biopsy, the diagnosis of oligomeganephronia (OMN) was confirmed. OMN is a very rare form of renal hypoplasia, and late-onset in adulthood is even rarer. In the pediatric population, OMN leads to end-stage-renal-failure(ESRF) in a few years. This is the sixth case related in the literature of a late-onset OMN who have not yet developed ESRF

Sensitizing agents found in children and adolescents with recalcitrant atopic dermatitis : a cross-sectional study with a pediatric battery

Background Atopic dermatitis is the most common inflammatory skin disease in childhood and has an important impact on quality of life, especially severe cases or those that are recalcitrant to treatments. Sensitization to allergens with the potential for allergic contact dermatitis is a factor associated with cases of recalcitrant atopic dermatitis. Understanding the relationship between atopic dermatitis, allergens, and allergic contact dermatitis is essential. In Brazil, there are no studies on sensitization to allergens found in patch tests with pediatric batteries in patients with atopic dermatitis. Objectives To verify the main sensitizing agents, the prevalence of allergic contact dermatitis and the epidemiological and clinical profile of children and adolescents with atopic dermatitis. Methods Cross-sectional, prospective study in patients between 4 and 18 years of age, with recalcitrant atopic dermatitis, treated at the Sanitary Dermatology Outpatient Clinic (RS). All patients underwent patch tests with a battery of pediatric allergens. Results The prevalence of sensitization and allergic contact dermatitis in the evaluated patients was 37.07% (20/54) and 27.7% (15/54), respectively. The most frequent allergens were: nickel sulfate (16.7%), disperse blue (5.6%), and fragrance mix I (5.6%). Nickel was associated with the female sex (p = 0.019). Study limitations Sample size and selection, absence of a control group. Conclusions A proportion of patients with recalcitrant atopic dermatitis may be sensitized to different allergens and may even have developed allergic contact dermatitis. Recognizing this context is important in the prevention strategy and management of the disease