Efeito da mudança do estilo de vida em paciente com hipertrigliceridemia grave

Relatamos um caso de hipertrigliceridemia grave em uma mulher de 61 anos, durante uma consulta de rotina no ambulatório de cardiologia, que foi diagnosticada com hipertrigliceridemia grave e resistente ao tratamento medicamentoso prescrito. Ela é aposentada, sedentária, não apresentava hábitos de vida saudáveis e mora sozinha em seu domicílio. Foi encaminhada ao ambulatório de nutrição, e sugerimos um plano terapêutico para mudanças no estilo de vida. A combinação de terapias de estilo de vida foram: atividade física, modificação dietética e inserção na vida social. As recomendações dietéticas seguiram as propostas pela atualização da diretriz brasileira de dislipidemia, com adição do convívio social. Neste caso, foi demonstrado a redução drástica dos níveis séricos de triglicerídeos, com a combinação de terapia de estilo de vida, aliado à melhora de imagem corporal e retorno ao convívio social. Assim, acreditamos que estes adicionais foram cruciais para motivar o seguimento do plano dietético proposto e evitar risco de pancreatite

Preventable infant mortality and quality of health care: maternal perception of the child's illness and treatment

This study used a qualitative methodology to analyze the discourse of mothers from Greater Metropolitan Belo Horizonte, Minas Gerais, Brazil, whose infant children had died from what were considered avoidable causes (diarrhea, malnutrition, and pneumonia), seeking to elucidate the factors associated with utilization of health care services. Identification of the illness by the mother was related to perception of specific alterations in the child's state of health. Analysis of the alterations helped identify the principal characteristics ascribed to each alteration and their relationship to the search for treatment. The authors also studied the mother's assessment of treatment received at health care facilities; 43.0% of the cases involved problems related to the structure of health care services or the attending health care professionals. In 46.0% of the cases, mothers associated the child's death with flaws in the health care service. The study group showed a variety of interpretations of illness, often distinct from the corresponding biomedical concepts. The fact that attending health care personnel overlooked or underrated the mother's perception of the illness and the lack of communications between health care personnel and the child's family had an influence on the child's evolution and subsequent death

Preventable infant mortality and quality of health care: maternal perception of the child's illness and treatment Mortes infantis por causas evitáveis e qualidade dos serviços de saúde: um estudo da percepção materna da doença e do atendimento à criança doente

This study used a qualitative methodology to analyze the discourse of mothers from Greater Metropolitan Belo Horizonte, Minas Gerais, Brazil, whose infant children had died from what were considered avoidable causes (diarrhea, malnutrition, and pneumonia), seeking to elucidate the factors associated with utilization of health care services. Identification of the illness by the mother was related to perception of specific alterations in the child's state of health. Analysis of the alterations helped identify the principal characteristics ascribed to each alteration and their relationship to the search for treatment. The authors also studied the mother's assessment of treatment received at health care facilities; 43.0% of the cases involved problems related to the structure of health care services or the attending health care professionals. In 46.0% of the cases, mothers associated the child's death with flaws in the health care service. The study group showed a variety of interpretations of illness, often distinct from the corresponding biomedical concepts. The fact that attending health care personnel overlooked or underrated the mother's perception of the illness and the lack of communications between health care personnel and the child's family had an influence on the child's evolution and subsequent death.Neste trabalho foi analisado, através de metodologia qualitativa, o discurso de mães moradoras da Região Metropolitana de Belo Horizonte que perderam seus filhos por causas consideradas evitáveis (diarréia, desnutrição e pneumonia), buscando investigar os fatores associados à utilização dos serviços de saúde. Foi observado que a identificação da doença pela mãe está relacionada à percepção de alterações específicas no estado de saúde da criança. A análise de cada alteração permitiu conhecer as principais características atribuídas a cada uma e sua relação com a procura de tratamento. Também foi estudada a avaliação das mães sobre o atendimento recebido nos serviços de saúde, sendo informado em 43,0% dos casos, problemas relacionados à estrutura dos serviços de saúde e ao profissional do serviço de saúde. Em 46,0% dos casos, as mães relacionaram a causa da morte da criança com as falhas do serviço de saúde. Há no grupo estudado um variado conjunto de interpretações de doenças distinto, muitas vezes, dos conceitos biomédicos. O desconhecimento e/ou desvalorização da percepção materna da doença, com ausência de comunicação dos profissionais de saúde com a família da criança doente tiveram influência sobre o óbito

Preventable infant mortality and quality of health care: maternal perception of the child's illness and treatment

This study used a qualitative methodology to analyze the discourse of mothers from Greater Metropolitan Belo Horizonte, Minas Gerais, Brazil, whose infant children had died from what were considered avoidable causes (diarrhea, malnutrition, and pneumonia), seeking to elucidate the factors associated with utilization of health care services. Identification of the illness by the mother was related to perception of specific alterations in the child's state of health. Analysis of the alterations helped identify the principal characteristics ascribed to each alteration and their relationship to the search for treatment. The authors also studied the mother's assessment of treatment received at health care facilities; 43.0% of the cases involved problems related to the structure of health care services or the attending health care professionals. In 46.0% of the cases, mothers associated the child's death with flaws in the health care service. The study group showed a variety of interpretations of illness, often distinct from the corresponding biomedical concepts. The fact that attending health care personnel overlooked or underrated the mother's perception of the illness and the lack of communications between health care personnel and the child's family had an influence on the child's evolution and subsequent death

Frequência de lesões sugestivas de toxoplasmose ocular em uma população rural do Estado do Rio de Janeiro Frequency of lesions suggestive of ocular toxoplasmosis among a rural population in the State of Rio de Janeiro

Para determinar a prevalência da toxoplasmose ocular na população em geral do bairro de Santa Rita de Cássia, Barra Mansa, RJ, foi realizado um estudo seccional no qual 1.071 indivíduos foram submetidos a testes sorológicos (IgG e IgM anti-Toxoplasma) e a exame físico e oftalmológico. O diagnóstico da toxoplasmose ocular presumida foi baseado em critérios clínicos, sorológicos e aspecto da lesão retinocoroidiana. As lesões foram classificadas em três tipos morfológicos: 1. Limites marcados com halo de hiperpigmentação e área de atrofia coriorretiniana central. 2. Halo hipopigmentado e área central hiperpigmentada e 3. Hiperpigmentadas ou hipopigmentadas. A prevalência de lesões cicatrizadas compatíveis com toxoplasmose ocular foi de 3,8% na população em geral e 5,8% entre os indivíduos com sorologia positiva para Toxoplasma gondii (65,9% dos indivíduos analisados), com predominância de: lesões do tipo 1 (41,5%), sexo feminino (68,3%), periféricas (58,5%) e menores que 3 diâmetros de disco (87,8%).<br>To determine the prevalence of ocular toxoplasmosis among the general population of the district of Santa Rita de Cassia, Barra Mansa, State of Rio de Janeiro, a cross-sectional study on 1,071 individuals was performed. These subjects underwent serological tests (anti-Toxoplasma IgG and IgM) and physical and ophthalmological examinations. The diagnosis of presumed ocular toxoplasmosis was based on clinical and serological criteria and the appearance of the retinochoroidal lesion. The lesions were classified into three morphological types: 1. Limits marked with a halo of hyperpigmentation and an area of central chorioretinal atrophy; 2. Hypopigmented halo and hyperpigmented central area; and 3. Hyperpigmented or hypopigmented. The prevalence of healed lesions compatible with ocular toxoplasmosis was 3.8% among the general population and 5.8% among individuals who were seropositive for Toxoplasma gondii (65.9% of the individuals evaluated). Type-1 lesions (41.5%), female sex (68.3%), peripheral lesions (58.5%) and lesions smaller than three disc diameters predominated