Acessos vasculares para Hemodiálise no Ceará-Brasil

Backgroung: the ideal access for hemodialysis is represented by arteriovenous fistulas both as initial access and in use and are determinants of health care parameters for chronic renal patients. Objective: to evaluate vascular access for hemodialysis. Methods: this is a cross-sectional study, with a sample of 2513 individuals on hemodialysis in Ceará. Data were collected on age, sex, time of treatment, underlying disease, initial access and access in use. The data were divided into two groups, the interior of the state and the Metropolitan Region of Fortaleza, in the State of Ceará, and compared using the Student’s Test (p<0.05). Results: the most common age group was between 19 and 64 years (73%). Men prevailed in both regions, 713 (63%) in the countryside and 792 (57%) in the metropolitan area. The most common cause of Chronic Kidney Disease was Hypertension 306 (27%), followed by Disease of undetermined cause 295 (26%) in the countryside; in the metropolitan region, Diabetes Mellitus 356 (26%) was the main cause, followed by Hypertension and Disease of undetermined cause, each with 344 (25%), p=0.001. In the countryside, 9% started treatment for fistula while in the metropolitan area 12%, p=0.011. 79% of patients in the countryside used fistulas and 81% in the metropolitan area, p=0.156. Conclusion: arteriovenous fistulas are more frequent as initial accesses in the metropolitan region than in the interior, but there is an equivalence of fistulas in use in both regions. Catheter is the main initial access route. The evaluation of vascular accesses in Ceará showed that hemodialysis services are able to maintain good parameters of care for patients with chronic kidney disease.Introdução: o acesso ideal para hemodiálise é representado por fístulas arteriovenosas tanto como acesso inicial quanto em uso e são determinantes de parâmetros de atenção à saúde do paciente renal crônico. Objetivo: avaliar os acessos vasculares para hemodiálise. Método: trata-se de estudo transversal, com amostra de 2513 indivíduos em hemodiálise no Ceará. Foram coletados os dados da idade, sexo, tempo de tratamento, doença de base, acesso inicial e acesso em uso. Os dados foram divididos em dois grupos, interior do estado e Região Metropolitana de Fortaleza, no Estado do Ceará e comparados através do Teste de Student (p<0,05). Resultados: a faixa etária mais comum era entre 19 a 64 anos (73%). Os homens prevaleciam nas duas regiões, 713(63%) no interior e 792(57%) na zona metropolitana. A causa mais comum de Doença Renal Crônica era por Hipertensão 306(27%), seguida de Doença de causa indeterminada 295(26%) no interior; já na região metropolitana, Diabetes Melittus 356(26%) era a principal causa, seguida por Hipertensão e Doença de causa indeterminada, cada uma com 344(25%), p=0,001. No interior, 9% iniciaram o tratamento por fístula enquanto na área metropolitana 12%, p=0,011. 79% dos pacientes do interior usavam fístulas e 81% na área metropolitana, p=0,156. Conclusão: as fistulas arteriovenosas são mais frequentes como acessos iniciais na região metropolitana do que no interior mas há uma equivalência de fistulas em uso nas duas regiões. Cateter é a principal via de acesso inicial. A avaliação dos acessos vasculares no Ceará demostrou que os serviços de hemodiálise conseguem manter bons parâmetros de atenção ao portador de doença renal crônica

Haemodialysis access: clinical and epidemiological profile of patients and their vascular access in interior of Brazil.

Background: The analysis of vascular access for hemodialysis is relevant for the quality of life of patient. In this study we investigated the profile of vascular access used for hemodialysis patients in a poor place, interior of Brazil.Objectives: To identify the percentage of vascular access for hemodialysis in this unit conforms to international standards.Methods: We evaluated the reference hemodialysis service in a specific poor place in Brazil. There are 120 patients of both genders who have undergone implant or manufacture of vascular hemodialysis access; there aren´t patients on renal replacement therapy by peritoneal dialysis.Results: Associated diseases were unknown cause, diabetes mellitus and hypertension. 93(77.5) had arteriovenous fistula, with 89 held by the same dialysis and four of them were still maturing. 27 patients on dialysis used central venous catheter. 91 were indigenous and two were made using polytetrafluoroethylene prosthesis (PTFE). Among the 27 patients with central venous catheters, twenty were short-term catheter and 7 were long-term catheter. Among the fistulas for dialysis patients, the highest prevalence was radiocephalic fistula in 60 patients (50%).Among all the fistulas, the left radiocephalic was the most found, in 37 patients (39.8) and right, in 23 patients (24.7). The number of patients that they had only one fistula manufactured corresponded 60 patients (50%). and mean duration of use was 1,74 ±1,64 years, ranging from two months to 9 years.Conclusion: Our Unit of hemodialysis is above the limits established by international norms.Â

Piomiosite tropical: diabetes facilitando o aparecimento de uma doença incomum

Introdução: A piomiosite tropical é uma doença infecciosa que afeta o músculo esquelético, aparecendo como uma inflamação difusa ou um processo mionecrótico rapidamente progressivo. A predisposição desta enfermidade em diabéticos já é referida em vários estudos. A patogênese possivelmente está relacionada a alterações nos neutrófilos e na inversão do padrão de resposta imune que acontece em situações como parasitoses. Staphylococcus aureus é o microorganismo mais comum, representando 90% dos casos de piomiosite tropical. O diagnóstico pode ser tardio porque os pacientes geralmente não buscam cuidados com os primeiros sintomas e, por ser uma doença rara, pode surpreender um médico ainda não familiarizado com esta entidade clínica. Relato de caso: Paciente do sexo masculino com 42 anos de idade com diabetes mellitus, hipotireoidismo, anemia, trombocitopenia e hipoalbuminemia que desenvolveu piomiosite tropical com múltiplos abscessos musculares em quadríceps, sóleo e tibial anterior, tríceps e bíceps braquial e pronador redondo, necessitando de antibioticoterapia prolongada e drenagem cirúrgica. Conclusão: A piomiosite não é uma doença bem conhecida e pode ser fatal se não for diagnosticada precocemente

Vascular Access

Double-lumen catheter in the right jugular vein induces two sub-endothelial abscesses in an unusual place, the transition between the superior vena cava and the right atrium: a case repor

The Analysis Of Psychopathology In Alfred Hitchcock Movies

INTRODUCTION: During the 20th century, psychiatry began to use the cinema as didactic-pedagogical help resource in the study of psychopathology. The Films of Alfred Hitchcock usually present as main themes mental disorders and the psychoanalysis. However, these films were not created with academic goal and it is natural that there are distortions. OBJECTIVES: To evaluate the importance of Hitchcock films as didactic resource in the study of psychopathology, identify possible distortions and seek to justify them on the basis of the historical context. METHODOLOGY: The abstracts of the 53 feature-length films of the director were read and deleted the movies that did not have the mental disorder as a central theme; they were dumb; or those who had only the antisocial personality disorder. It was performed a narrative review. RESULTS: Six films were selected through an intentional sampling. When he speaks of the Heart (1945) shows a picture of amnesia with dissociative fugue. The psychoanalysis is represented in a very superficial. The Indiscreet (1954) describes a voyeuristic disorder and should not be indicated. The Wrong Man (1956) depicts a severe depressive episode with psychotic symptoms. A body that falls (1958) presents the themes of specific phobia of height and the acute stress disorder. Psychosis (1960) represents a framework of dissociative identity disorder, but the scenes of violence may cause a negative view of the mentally ill. Marnie (1964) has as themes the specific phobia and sexual aversion disorder. The psychoanalysis is presented in distorted form and caricature. CONCLUSION: The films directed by Alfred Hitchcock can be useful in the study of psychiatry and should be considered the distortions that can worsen the stigma