Melhoria da Atenção à Prevenção do Câncer de Colo de Útero e Mama na Unidade Básica de Saúde Vila Princesa, Pelotas/RS

Esse trabalho teve como objetivo principal melhorar a qualidade da assistência à saúde da mulher na área de cobertura da Unidade Básica de Saúde Vila Princesa - Pelotas, no que diz respeito à prevenção dos cânceres de colo de útero e mama. A análise situacional da área de cobertura da unidade demonstrou o número de aproximadamente 1040 usuárias na faixa etária de risco para câncer de colo de útero (entre 25 e 64 anos) e 332 usuárias na faixa etária de risco para câncer de mama (entre 50 e 69 anos). Contudo, através dos registros dos prontuários, foi impossível determinar de forma precisa o número de mulheres em dia com os exames preconizado pelo Ministério da Saúde. A avaliação da estrutura da unidade evidenciou a capacidade que a equipe teria de melhorar os programas voltados à prevenção dos cânceres de colo de útero e mama, sendo este o principal objetivo do projeto. Para isso, a metodologia utilizada foi baseada nas recomendações de protocolos do Ministério da Saúde, através do cadastramento e vinculação das mulheres na faixa etária de risco à unidade, somado ao atendimento qualificado. Após 3 meses de intervenção na comunidade foi verificado o cadastramento de 11,8% e 19,9% das mulheres nos programas de prevenção do câncer de colo de útero e mama, respectivamente. Foram obtidos 100% de registros adequados e 100% de amostras satisfatórias de exame de citopatológico de colo uterino. O projeto de intervenção demonstrou a necessidade de uma grande integração entre todos os membros da equipe para o atingimento de metas, sendo considerado um dos principais benefícios que a intervenção trouxe para a comunidade. Por fim, este trabalho implantou as bases das ações a serem adotadas na equipe de forma que fiquem incorporadas à rotina de atendimento da unidade

Aorto-enteric fistula: a case report

CASE PRESENTATION A 39-year-old patient that had a recent diagnosis of classic Hodgkin Lymphoma with  multiple enlarged retroperitoneal lymph nodes, yet to be staged, was admitted to the hospital with intense back pain and  large volume hematemesis. At first assessment, the patient was medicated, stabilized and submitted to esophagogastroduodenoscopy (EGD), which did not  show active bleeding. After a few hours, the patient had another episode of large volume hematemesis with subsequent hemorrhagic shock. Due to the absence of active bleeding at the  EGD  and to the presence of enlarged and suspicious lymph nodes near the second and third portions of the duodenum, as shown in prior abdominal computed tomography (CT) scan (figure 1a), the gastroenterology staff recommended a CT angiography to investigate the bleeding site. The exam showed retroperitoneal heterogeneous collection with gas bubbles around the aorta and contrast leakage from infrarenal aorta into the third duodenum portion (figures 1b and 1c), findings diagnostic for aorto-duodenal fistula. Then, the patient was sent to the hemodynamics department for endovascular repair, which confirmed active bleeding originated from the infrarenal aorta and was successfully corrected with stent insertion and angioplasty (figures 2a, 2b and 2c). DISCUSSION Aorto-enteric fistula (AEF) consists of a pathologic communication between the aortic lumen and any portion of the gastrointestinal tract². Without prompt intervention, the associated mortality approaches 100%¹. The main clinical signs are abdominal pain and an intermittent herald hemorrhage, resulting from repeated tamponation of the fistula by thrombus formation5. Aorto-enteric fistula may be primary or secondary: primary aorto-enteric fistula (PAEF) occurs in patients with no previous aortic surgery or trauma², as in our case; secondary AEF occurs as a complication of aortic reconstructive surgery, being far more common than primary ones. Both categories, however, are relatively rare, with an incidence of 0.02–0.07% for primary and of 1% for secondary fistulas1,2. PAEF are almost always related to a pre-existing aortic aneurysm². Nevertheless, other less common causes can be encountered, like inflammatory or infectious aortitis, actinic lesions, foreign bodies, and abdominal tumors³. The duodenum, especially its third and fourth portions, is the most common site of fistula, representing 80% of the AEF, involving the third portion in two-thirds of cases 3,4. Early clinical suspicion is essential for a successful outcome5. As our patient had no prior history of surgical intervention nor aortic aneurysm, the bleeding was initially investigated by an EGD, to rule out other causes of upper GI bleeding. However, the absence of active bleeding at the EGD does not rule out an aorto-duodenal fistula 5. Moreover, the length of the endoscope does not allow the visualization of the distal duodenum, where the fistula was located. Owing to its widespread availability, short acquisition time, and high resolution, CT with intravenous contrast has become the first-line modality for imaging evaluation of suspected aortoenteric fistula¹. The signs that strongly suggest a PAEF are the loss of continuity and air bubbles in the aortic wall, which are pathognomonic, and the visualization of the contrast within the GI lumen².  A case report focused on imaging aspects of an aortic-enteric fistula (AEF) in a 39-year-old patient with a recent diagnosis of classic Hodgkin Lymphoma with multiple enlarged retroperitoneal lymph nodes. AEF is a pathologic communication between the aortic lumen and any portion of the gastrointestinal tract. Without prompt intervention, the associated mortality approaches 100%. Early clinical suspicion is essential for a successful outcome and the role of imaging is fundamental to diagnose it. Owing to its widespread availability, short acquisition time, and high resolution, CT with intravenous contrast has become the first-line modality for imaging evaluation of suspected aortic-enteric fistula

Aorto-enteric fistula: a case report

CASE PRESENTATION A 39-year-old patient that had a recent diagnosis of classic Hodgkin Lymphoma with  multiple enlarged retroperitoneal lymph nodes, yet to be staged, was admitted to the hospital with intense back pain and  large volume hematemesis. At first assessment, the patient was medicated, stabilized and submitted to esophagogastroduodenoscopy (EGD), which did not  show active bleeding. After a few hours, the patient had another episode of large volume hematemesis with subsequent hemorrhagic shock. Due to the absence of active bleeding at the  EGD  and to the presence of enlarged and suspicious lymph nodes near the second and third portions of the duodenum, as shown in prior abdominal computed tomography (CT) scan (figure 1a), the gastroenterology staff recommended a CT angiography to investigate the bleeding site. The exam showed retroperitoneal heterogeneous collection with gas bubbles around the aorta and contrast leakage from infrarenal aorta into the third duodenum portion (figures 1b and 1c), findings diagnostic for aorto-duodenal fistula. Then, the patient was sent to the hemodynamics department for endovascular repair, which confirmed active bleeding originated from the infrarenal aorta and was successfully corrected with stent insertion and angioplasty (figures 2a, 2b and 2c). DISCUSSION Aorto-enteric fistula (AEF) consists of a pathologic communication between the aortic lumen and any portion of the gastrointestinal tract². Without prompt intervention, the associated mortality approaches 100%¹. The main clinical signs are abdominal pain and an intermittent herald hemorrhage, resulting from repeated tamponation of the fistula by thrombus formation5. Aorto-enteric fistula may be primary or secondary: primary aorto-enteric fistula (PAEF) occurs in patients with no previous aortic surgery or trauma², as in our case; secondary AEF occurs as a complication of aortic reconstructive surgery, being far more common than primary ones. Both categories, however, are relatively rare, with an incidence of 0.02–0.07% for primary and of 1% for secondary fistulas1,2. PAEF are almost always related to a pre-existing aortic aneurysm². Nevertheless, other less common causes can be encountered, like inflammatory or infectious aortitis, actinic lesions, foreign bodies, and abdominal tumors³. The duodenum, especially its third and fourth portions, is the most common site of fistula, representing 80% of the AEF, involving the third portion in two-thirds of cases 3,4. Early clinical suspicion is essential for a successful outcome5. As our patient had no prior history of surgical intervention nor aortic aneurysm, the bleeding was initially investigated by an EGD, to rule out other causes of upper GI bleeding. However, the absence of active bleeding at the EGD does not rule out an aorto-duodenal fistula 5. Moreover, the length of the endoscope does not allow the visualization of the distal duodenum, where the fistula was located. Owing to its widespread availability, short acquisition time, and high resolution, CT with intravenous contrast has become the first-line modality for imaging evaluation of suspected aortoenteric fistula¹. The signs that strongly suggest a PAEF are the loss of continuity and air bubbles in the aortic wall, which are pathognomonic, and the visualization of the contrast within the GI lumen².

Aorto-enteric fistula: a case report

CASE PRESENTATION A 39-year-old patient that had a recent diagnosis of classic Hodgkin Lymphoma with  multiple enlarged retroperitoneal lymph nodes, yet to be staged, was admitted to the hospital with intense back pain and  large volume hematemesis. At first assessment, the patient was medicated, stabilized and submitted to esophagogastroduodenoscopy (EGD), which did not  show active bleeding. After a few hours, the patient had another episode of large volume hematemesis with subsequent hemorrhagic shock. Due to the absence of active bleeding at the  EGD  and to the presence of enlarged and suspicious lymph nodes near the second and third portions of the duodenum, as shown in prior abdominal computed tomography (CT) scan (figure 1a), the gastroenterology staff recommended a CT angiography to investigate the bleeding site. The exam showed retroperitoneal heterogeneous collection with gas bubbles around the aorta and contrast leakage from infrarenal aorta into the third duodenum portion (figures 1b and 1c), findings diagnostic for aorto-duodenal fistula. Then, the patient was sent to the hemodynamics department for endovascular repair, which confirmed active bleeding originated from the infrarenal aorta and was successfully corrected with stent insertion and angioplasty (figures 2a, 2b and 2c). DISCUSSION Aorto-enteric fistula (AEF) consists of a pathologic communication between the aortic lumen and any portion of the gastrointestinal tract². Without prompt intervention, the associated mortality approaches 100%¹. The main clinical signs are abdominal pain and an intermittent herald hemorrhage, resulting from repeated tamponation of the fistula by thrombus formation5. Aorto-enteric fistula may be primary or secondary: primary aorto-enteric fistula (PAEF) occurs in patients with no previous aortic surgery or trauma², as in our case; secondary AEF occurs as a complication of aortic reconstructive surgery, being far more common than primary ones. Both categories, however, are relatively rare, with an incidence of 0.02–0.07% for primary and of 1% for secondary fistulas1,2. PAEF are almost always related to a pre-existing aortic aneurysm². Nevertheless, other less common causes can be encountered, like inflammatory or infectious aortitis, actinic lesions, foreign bodies, and abdominal tumors³. The duodenum, especially its third and fourth portions, is the most common site of fistula, representing 80% of the AEF, involving the third portion in two-thirds of cases 3,4. Early clinical suspicion is essential for a successful outcome5. As our patient had no prior history of surgical intervention nor aortic aneurysm, the bleeding was initially investigated by an EGD, to rule out other causes of upper GI bleeding. However, the absence of active bleeding at the EGD does not rule out an aorto-duodenal fistula 5. Moreover, the length of the endoscope does not allow the visualization of the distal duodenum, where the fistula was located. Owing to its widespread availability, short acquisition time, and high resolution, CT with intravenous contrast has become the first-line modality for imaging evaluation of suspected aortoenteric fistula¹. The signs that strongly suggest a PAEF are the loss of continuity and air bubbles in the aortic wall, which are pathognomonic, and the visualization of the contrast within the GI lumen².

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements