Eu mudo, nós mudamos? Perspectivas sobre o trabalho dos Agentes Comunitários de Saúde / I change, do we change? Perspectives on the work of Community Health Agents

Este artigo visa analisar o processo de trabalho e as perspectivas de mudanças, a fim de proporcionar reflexões sobre a prática cotidiana de 62 Agentes Comunitários de Saúde da cidade de Campo Bom, no Rio Grande do Sul, Brasil. Os dados obtidos foram coletados através de entrevistas individuais e questionários autopreenchidos, e a análise dos conteúdos foi feita a partir da construção do Discurso do Sujeito Coletivo. A maioria dos trabalhadores relata que haveria algo a ser modificado no seu processo de trabalho. Dentre os aspectos a serem modificados e/ou melhorados estão: burocratização do trabalho, reorganização das marcações de consulta, respeito, união das equipes, maior participação dos profissionais de saúde (médicos e enfermeiros) nas visitas domiciliares, equipes incompletas, automatização do processo de trabalho, grande número de famílias cadastradas, reconhecimento, ausência e/ou sucateamento de materiais básicos de trabalho

Falem bem ou falem mal, mas falem de mim: relação entre trabalho e qualidade de vida do agente Comunitário de Saúde / Any publicity is good publicity: rlationship between work and quality of life of the Community Health Agent

Este estudo objetivou estabelecer a relação entre o processo de trabalho e a qualidade de vida do grupo de agentes comunitários de saúde do município de Campo Bom, no Vale dos Sinos na região metropolitana de Porto Alegre. Se configurou do tipo descritivo exploratório, transversal, de abordagem quantitativa. Participaram desta pesquisa 62 Agentes Comunitários de Saúde, com faixa etária entre 23 e 61 anos, sendo 58 (93,5%) mulheres e 4 (6,5%) de homens. Os participantes responderam um questionário sobre dados sociodemográficos, socioeconômicos e de trabalho, e ao questionário WHOQOL-BREF. A execução desta pesquisa pôde confirmar estatisticamente o impacto do processo de trabalho nos diferentes domínios da qualidade de vida.

Quem somos nós? A identidade não tão secreta dos agentes comunitários de saúde / Who are we? The not-so-secret identity of community health agents

Este artigo teve como objetivo analisar o entendimento de 62 Agentes Comunitários de Saúde da cidade de Campo Bom, no Rio Grande do Sul (Brasil), sobre as definições estabelecidas por eles acerca de sua identidade, proporcionando uma reflexão referente às práticas do cotidiano do trabalho. As entrevistas individuais e questionários auto preenchidos foram analisadas pelo seu conteúdo a partir da construção do Discurso do Sujeito Coletivo. As percepções apontam para a autodefinição do agente como um trabalhador que possui escuta qualificada; elo entre a equipe e a comunidade; múltiplas ações, que muitas vezes vão além do estabelecido legalmente; realizações pessoais condicionadas ao "sucesso" profissional; trabalho sob a lógica da educação em saúde. Esta pesquisa demonstrou que, por vezes, é o próprio trabalhador que se coloca na condição de "super-herói", o que nos faz pensar o quanto os processos de trabalho devem ser amplamente e continuamente discutidos.

Compulsión glucídica en mujeres adultas y su relación con el consumo de psicofármacos / Carbohydrate compulsion in adult women and its relationship with psychotropic drug

En la mujer adulta declina la función ovárica y la producción de estrógenos, con sintomatología física y psíquica, alteración en la regulación del apetito y tendencia a la ingesta de hidratos de carbono. Los psicofármacos empleados para el manejo del estado anímico podrían provocar efectos secundarios, como modificación de la ingesta y peso corporal y efectos neuroendocrinos como regulación de la serotonina, entre otros. Objetivos: Identificar la asociación entre el consumo de psicofármacos y la compulsión glucídica en mujeres adultas. Materiales y Método: Se realizó un estudio analítico de corte transversal sobre 114 mujeres mayores de 40 años que asistieron al consultorio de climaterio del Hospital General de Agudos “Bernandino Rivadavia”. Se analizaron variables biológicas, antropométricas, conducta alimentaria y consumo de psicofármacos, recabadas mediante encuestas estructuradas, voluntarias y anónimas, y mediciones antropométricas. Para el análisis estadístico se utilizó SPSS 15.0, calculando medidas de tendencia central,comparación de medias y Odds Ratio (OR) con intervalo de confianza (IC) del 95%, test chi cuadrado (x2) y correlación de Pearson con nivel de significación p< 0,05. Resultados: El 67,5% de la muestra presentó sobrepeso u obesidad y el 48,2% circunferencia de cintura (CC) aumentada. El 69,3% refirió compulsión glucídica, siendo los panificados y el chocolate los alimentos de mayor elección en estos episodios. No se observó significación estadística entre las mujeres que consumían psicofármacos para mejorar la calidad de vida, y la presencia de compulsión o estado nutricional alterado. Conclusión: Las mujeres que consumieron psicofármacos no presentaron diferencias en la prevalencia de compulsión glucídica o el estado nutricional alterado...

Absence of hypoalbuminemia despite massive proteinuria in focal segmental glomerulosclerosis secondary to hyperfiltration.

We observed that some patients do not develop hypoalbuminemia despite the presence of massive proteinuria. To investigate whether the absence or presence of hypoalbuminemia could be a marker in the distinction between idiopathic focal segmental glomerulosclerosis (FSG) and FSG secondary to hyperfiltration, we reviewed all our patients with biopsy-proven FSG and persistent nephrotic-range proteinuria (>3.5 g/24 h). Patients who met these conditions were then separated into those with hypoalbuminemia (serum albumin level <3 g/dL; group I; n = 19) and those with normoalbuminemia (>3.5 g/24 h; group II; n = 18). All group I patients had nephrotic edema in contrast with the absence of edema in all group II patients. Serum cholesterol and triglyceride levels were significantly greater in group I. All group I patients had been diagnosed with idiopathic FSG. The diagnoses of group II patients were FSG secondary to massive obesity in eight patients (44%), vesicoureteral reflux in five patients (27%), and renal mass reduction in three patients (16%); only two patients (11%) in this group had idiopathic FSG. The case histories of 19 other patients with nephrotic-range proteinuria associated with hyperfiltering disorders (reflux nephropathy, massive obesity, renal mass reduction), but without renal biopsy, were also reviewed; despite massive proteinuria (5.8 +/- 3.1 g/24 h), serum albumin and total protein levels were always within normal values. In conclusion, patients with FSG secondary to hyperfiltration do not develop hypoalbuminemia or the other characteristic complications of nephrotic syndrome, despite the presence of massive proteinuria values.

Association of thin basement membrane nephropathy with hypercalciuria, hyperuricosuria and nephrolithiasis.

BACKGROUND: Familial persistent microhematuria with normal renal function is the most common presentation of thin basement membrane nephropathy (TBMN). Gross hematuria episodes and loin pain attacks are other manifestations of the disease. On the other hand, it has been shown that hypercalciuria (HC) and hyperuricosuria (HU) can produce both gross or microscopic non-glomerular hematuria, in addition to their role in renal stone formation. METHODS: We studied the prevalence of HC, HU and nephrolithiasis in a group of 27 biopsy-proven TBMN as well as in 19 non-biopsied first-degree relatives with persistent microhematuria and 25 first-degree relatives without microhematuria. A group of 27 patients with IgA nephropathy (IgAN) and persistent microhematuria, and another group of 20 healthy subjects without known renal diseases were selected as control groups. RESULTS: Ten (37%) patients with TBMN and 8 (42%) relatives with microhematuria showed HC and/or HU at presentation; relatives without microhematuria, IgAN patients and normal controls showed a significantly lower prevalence of HC and HU. The prevalence of previous nephrolithiasis among TBMN patients (25%) was significantly higher than in IgAN patients (3%; P < 0.05). Family history of nephrolithiasis was recorded in 14 (51%) of the 27 TBMN families, in contrast with 2 of 27 (7%) with IgAN and 1 of 20 (5%) in normal controls (P < 0.05). The prevalence of nephrolithiasis, gross hematuria bouts and loin pain episodes among TBMN patients and microhematuric relatives showing HC and/or HU at presentation (44%, 44% and 27%, respectively) were significantly higher than those of TBMN patients and microhematuric relatives with normal calcium and uric acid urinary excretions (10%, 7% and 3%, respectively; P < 0.05). At the end of follow-up (8.8+/-4.1 years in TBMN patients and 9.1+/-4.2 years in relatives with microhematuria), all the cases maintained normal renal function. CONCLUSIONS: We found a high prevalence of HC, HU, and nephrolithiasis among TBMN patients and relatives with microhematuria. Our study also shows a significant relationship between the presence of HC and/or HU and the prevalence of nephrolithiasis, gross hematuria bouts and loin pain episodes.

Miastenia Gravis en el Hospital Santo Tomás 1990-1997 / Myasthenia gravis in Santo Tomás Hospital 1990-1997

Myasthenia Gravis is an infrequent disease. Diagnosis and treatment must be done early to avoid high morbidity that can compromise patients lives. Nine cases were identified during the eight year 1990-1997 at the Santo Tomas Hospital of Panama city but one had to be excluded because he refused treatment. Most of the patients (7/8) had symptoms for more than 3 months. The diagnosis of Myasthenia Gravis requires a high index of suspicion and the clinical impressión must be confirmed by various diagnostic studies that include the edrophonium test, the repetitive stimulation test, the therapeutic test with pyridostigmine, the determination of acetylcholine anti-receptor antibodies and a CT Scan of the thorax. Medical treatment consists mainly of anticholinesterase agents and surgical treatment consists of thymectomy by means of an extended transternal ablation. Operative results were excellent, seven out of eight improved

[Myasthenia gravis in Santo Tomás Hospital 1990-1997]. / Miastenia Gravis en el Hospital Santo Tomás 1990-1997.

Myasthenia Gravis is an infrequent disease. Diagnosis and treatment must be done early to avoid high morbidity that can compromise patients lives. Nine cases were identified during the eight year 1990-1997 at the Santo Tomas Hospital of Panama city but one had to be excluded because he refused treatment. Most of the patients (7/8) had symptoms for more than 3 months. The diagnosis of Myasthenia Gravis requires a high index of suspicion and the clinical impressión must be confirmed by various diagnostic studies that include the edrophonium test, the repetitive stimulation test, the therapeutic test with pyridostigmine, the determination of acetylcholine anti-receptor antibodies and a CT Scan of the thorax. Medical treatment consists mainly of anticholinesterase agents and surgical treatment consists of thymectomy by means of an extended transternal ablation. Operative results were excellent, seven out of eight improved.

Trichomonas en un empiema pleural / Trichomonas in pleural empyema

Trichomonas sp. was found in a patient with empyema and chronic obstructive pulmonary disease. This is a uncommon finding. A wet mount of pleural fluid is recommended to be observed by light microscopy

Trauma cardíaco penetrante / Penetrating cardiac trauma

The author reviewed the clinical records of 40 patients with the diagnosis of penetrating cardiac trauma operated on in a period of 38 months in order to confirm the prognostic value of trauma indexes: Physiologic Index, Revised Trauma Scale and Index of Penetrating Cardiac Trauma. Thirty-eight patients were men and two were women with an average age of 26.8 years. Thirty-one patients suffered knife wounds and nine were wounded by bullets. The 15 unstable patients (systolic Blood Pressure 80 mmHg after infusion of crystalloid solutions) were submitted to thoracotomy. The 25 stable patients underwent the performance of a pericardial (subxiphoid) window for diagnosis, followed by sternotomy if the result was positive. There were 5 deaths all of which occurred in the operating room due to exsanguination. In all these cases Revised Trauma Scale was less than 3 and the Physiologic Index was grade III in four and grade II in one patient. Our results indicate that the Revised Trauma Scale and the Physiologic Index are good prognostic indicators of survival and that patients with Physiologic Index grade I and II have good probabilities for survival if they are operated on promptly

Subxiphoid pericardial window in the diagnosis of penetrating cardiac trauma.

During a 15-month period, a subxiphoid pericardial window was performed as a diagnostic method to rule out cardiac injury in 76 patients with penetrating wounds near the heart. Patients with an obvious diagnosis of cardiac tamponade or patients in severe shock were excluded. Seventy-four patients were male, and 2 were female. The average age was 26.7 years. The procedure was done under general anesthesia in every case. There were no false-positive or false-negative results. There were no deaths, and the morbidity rate was 1.3%. In 16 patients (21%), the procedure identified hemopericardium. In our hands, the subxiphoid pericardial window has proved to be a rapid, precise, and safe method for the diagnosis of wounds of the heart. Until a less invasive procedure proves more precise, we recommend it as the standard diagnostic approach for cardiac injuries in patients in stable condition.

[Subxiphoid drainage of pericardial effusions]. / Drenaje subxifoides de efusiones pericárdicas.

Subxiphoid drainage of chronic or persistent effusion was done on five patients (three women and two men) in a twelve-month period. The average age was 30 years. All patients had symptoms and two had a diagnosis of cardiac tamponade. Every patient had an echocardiogram. Subxiphoid drainage was done by creating a pericardial window. Three patients were done with local and two under general anesthesia. There was no morbidity or mortality, associated with the procedure. Two of the effusions were idiopathic and one each was purulent, uremic or metastatic. The patients were followed for an average of 6.5 months and all remained asymptomatic and without evidence of recurrent pericardial effusion. This procedure is effective in the treatment of persistent pericardial effusions. It is an easy and fast operation with low morbidity and mortality, which allows it to be used in patients who are high surgical risks.

Drenaje subxifoides de efusiones pericárdicas / Subxiphoid drainage of pericardial effusions

Subxiphoid drainage of chronic or persistent effusion was done on five patients (three women and two men) in a twelve-month period. The average age was 30 years. All patients had symptoms and two had a diagnosis of cardiac tamponade. Every patient had an echocardiogram. Subxiphoid drainage was done by creating a pericardial window. Three patients were done with local and two under general anesthesia. There was no morbidity or mortality, associated with the procedure. Two of the effusions were idiopathic and one each was purulent, uremic or metastatic. The patients were followed for an average of 6.5 months and all remained asymptomatic and without evidence of recurrent pericardial effusion. This procedure is effective in the treatment of persistent pericardial effusions. It is an easy and fast operation with low morbidity and mortality, which allows it to be used in patients who are high surgical risks