RESUMO
BACKGROUND: Chagas disease is a serious public health issue in South and Central America due to its high prevalence, morbidity, and mortality. The esophageal form of the disease leads to achalasia and consequent megaesophagus. In advanced or recurrent cases of megaesophagus, there is no consensus for which of three established techniques-the Serra-Dória procedure, subtotal esophagectomy, or Modified Thal cardioplasty-is best. Very few studies have investigated the average efficacy and long-term outcomes of the Thal procedure. The present study sought to bridge this gap. METHODS: The Modified Thal procedure was performed in 29 patients at Hospital Universitário de Brasília between 1998 and 2008. All underwent clinical and nutritional evaluation, upper gastrointestinal endoscopy (UDE) with chromoscopy, esophageal manometry, and 24-h pH monitoring. RESULTS: Overall, 86 % experienced resolution of all symptoms after surgery. Most patients were classified as Visick grade I, II, or III. The average body mass index was 22.7 kg/m(2). UDE showed normal mucosa in 76 % of patients, and 11 % had unstained areas on chromoscopy. Esophageal manometry demonstrated incomplete lower esophageal sphincter (LES) relaxation in 50 % of patients, complete LES relaxation in 21 %, and no LES relaxation in 29 %. All showed complete relaxation of the upper esophageal sphincter. On 24-h pH monitoring, reflux was pathological in 50 % of patients. CONCLUSIONS: Overall, the modified Thal procedure improved symptoms-namely, dysphagia to liquids with resulting weight loss and malnutrition-in patients with megaesophagus. No correlations were found between clinical complaints, endoscopic findings, and degree of manometric abnormality in these patients.
Assuntos
Cárdia/cirurgia , Doença de Chagas/complicações , Acalasia Esofágica/etiologia , Acalasia Esofágica/cirurgia , Esofagectomia/métodos , Adulto , Idoso , Anastomose Cirúrgica/métodos , Brasil , Doença de Chagas/diagnóstico , Estudos Transversais , Acalasia Esofágica/fisiopatologia , Junção Esofagogástrica/cirurgia , Esofagoscopia/métodos , Feminino , Seguimentos , Hospitais Universitários , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do TratamentoRESUMO
Este estudo consiste em um relato de experiência derivada do PET-Saúde, implantado na UnB e inserido na realidade da comunidade do Paranoá-DF, durante o período 2009-2010. Entre as atividades desenvolvidas, estão: a elaboração de instrumento de dados estruturado em moldes da Medicina da Família; a criação de um portfólio eletrônico; a realização de oficinas de capacitação; entre outras. Dos resultados obtidos, foi possível verificar uma mudança na postura acadêmica, formando futuros profissionais mais críticos, reflexivos, empáticos e preocupados efetivamente com a Atenção Primária à Saúde.
This study is composed of a report of experience derived from PET-Health, established in UNB and inserted into the reality of community Paranoá-DF, during the period 2009-2010. Among the activities are: development of an instrument of data structured in a manner of Family Medicine; the creation of an electronic portfolio, the holding of training workshops, among others. From the acquired results, it was observed a change in academic attitude, making future professionals more critical, thoughtful, empathetic and really concerned with the Primary Health Care.
RESUMO
Health-related popular articles are easily found among media sources. With the increasing popularity of the internet, medical information - full of misconceptions - has become easily available to the lay people. The ability to recognize misconceptions may require good biomedical knowledge. In this sense, we decided to use articles from the internet as part of a formal exam to evaluate students' learning of Clinical and Applied Biochemistry (CAB). This test, known as the True-or-False (T-or-F) exam, is made up of statements found online that are judged by freshmen medical and nutrition students taking Basic Biochemistry. In the last four teaching-semesters, students' acceptance and responses to T-or-F exam on CAB were evaluated through questionnaires (using a 0-4 Likert scale). Results from 258 students revealed that 71, 87, and 94% of them believed, respectively, that the exam was (i) difficult, (ii) of good quality, and (iii) that using media-questions is relevant for evaluating the learning of CAB. Moreover, the average grade in the T-of-F exam was 5.85 (out of 10). This low average is probably because students are not familiarized with this sort of examination that does not emphasize on memorizations of biochemical pathways and processes - it instead evaluates mostly the comprehension and application of knowledge, levels 2 and 3 in Bloom's scale. Such conclusion was possible by analyzing 192 questions in four exams - 67% were at levels 2, 3 or above. This kind of media-based exam could be well applied to several other disciplines in health sciences.