Amilton dos Santos Júnior

Prevalência de dermatoses na rede básica de saúde de Campinas, São Paulo - Brasil

BACKGROUND: Skin lesions are often noted by the individuals bearing them, as well as by their relatives. There is a significant number of patients with skin complaints who search for medical care. OBJECTIVES: To determine the frequency of dermatological complaints and/or findings in users of the primary health care system of the city of Campinas, Brazil. METHODS: Five units were chosen by the Municipal Health Department to participate in this research. All the patients assisted by health professionals of these units were evaluated regarding the presence or absence of dermatological symptoms/ signals in a time period of twenty working days. RESULTS: The acquired data demonstrated that 358 (24.01%) out of 1,491 assisted patients displayed dermatological complaints and/or findings, with a greater prevalence among the younger patients. Of all the users assisted by health professionals who participated in the study and had their records adequately filled out, 9.98% sought the primary care unit primarily because of a dermatological complaint. CONCLUSIONS: These results, in accordance to those of similar surveys carried out in other countries, show the importance of the specialty for the performance of non-dermatologist physicians, pediatricians in particular, and provide elements for the discussion surrounding the curricular reform, concerning the amount of time dedicated to the teaching of dermatology.

Sorologia para sífilis: os médicos estão capacitados a interpretá-la?

Resumo: O ensino da dermatologia e pouco valorizado no curriculo medico, e as doencas sexualmente transmissiveis, em geral, sao apresentadas de forma nao sistematizada. Em estudo sobre o ensino da dermatologia, de 83 medicos que participaram do projeto apenas 10 acertaram uma questao sobre sorologia de lues. Mais pesquisas sobre o ensino das doencas sexualmente transmissiveis sao necessarias no Brasil, e os dermatologistas devem aproveitar a oportunidade, trazida pelas reformas curriculares, para reassumir a responsabilidade do ensino dessas doencas. Palavras-chave: Dermatologia; Doencas sexualmente transmissiveis; Ensino; Eritema multiforme; Sifilis

O que os psiquiatras brasileiros esperam das classificações diagnósticas

OBJETIVO: Realizou-se um levantamento postal anonimo com psiquiatras brasileiros afiliados a Associacao Brasileira de Psiquiatria (ABP) sobre uso, percepcao em termos de utilidade clinica dos sistemas diagnosticos multiaxiais CID-10 e DSM-IV e, ainda, expectativas sobre as proximas revisoes. METODOS: A carta-convite, o questionario padronizado e um envelope selado foram enviados para 1.050 dos 3.062 psiquiatras associados da ABP, selecionados de forma randomizada. Em virtude da taxa relativamente baixa de retorno: 160 respostas (15,2%), nao se pode afirmar que a amostra obtida seja representativa. resultados: Os principais resultados mostraram que, entre os respondentes, a CID-10 e o sistema diagnostico mais utilizado, sobretudo seu eixo clinico. O DSM-IV tambem e amplamente empregado, principalmente os eixos I e II. A principal caracteristica esperada de um sistema classificatorio foi a confiabilidade para comunicacao. As classificacoes sao vistas como instrumentos a ser manejados pelos psiquiatras e, em menor proporcao, por outros membros de equipes multidisciplinares de saude mental. Os atuais sistemas foram considerados confiaveis para o uso transcultural no contexto brasileiro. Em relacao as expectativas quanto aos futuros sistemas, os psiquiatras preferem classificacoes com menos de 100 rubricas diagnosticas e dividem-se entre os que acham que estas devam expressar preferencialmente causa/patogenese dos transtornos mentais e aqueles que esperam que tais categorias, sobretudo, sejam construidas de modo a subsidiar o planejamento terapeutico. CONCLUSOES: Os sistemas diagnosticos desempenham um importante papel na pratica psiquiatrica cotidiana dos psiquiatras respondentes. As opinioes dos psiquiatras brasileiros parecem refletir bem algumas controversias existentes acerca de questoes nosograficas decisivas.

Significados dos episódios maníacos para pacientes com transtorno bipolar em remissão: um estudo qualitativo

Objective To discuss the meanings of the experiences of manic episodes in patients with bipolar disorder (BD). Methods This is a qualitative research, done through semi-structured in-depth interviews in a sample closed by saturation criterion with eight patients with BD in remission. The technical data processing was done through qualitative content analysis of the transcribed interviews and categorization. The results were validated by peer-reviewers from the Laboratory of Clinical-Qualitative Research of the Department of Medical Psychology and Psychiatry, Unicamp consisting of 37 researchers of the method, including, masters, doctoral, postdoctoral and senior researchers. Results Three categories were identified – Ambivalence and shame: to think or not to think about the manic episodes; Organizing personal feelings: remission as a moment of self-consciousness; Maniac episodes: structuring interpersonal relationships versus projections of self-criticism. Conclusion The findings of this research contribute to a greater understanding of manic frames in BD that can assist in the reflections on the doctor-patient relationship, to develop strategies for adherence and the therapeutic and preventive measures of recurrent. Can assist the health team involved in monitoring these cases and also the researchers in investigation of the contribution of these meanings discussed here in the phenomena of adherence to treatment and a better prognosis.

Brazilian university students: predictors of seeking mental health care for a second time

1Among those 2,914 students, 392 (13.5%) sought the service again after completion of their initial treatment, whereas 2,522 (86.5%) had no further contact with the service. It is important to notice that SAPPE has an open-door policy and students are able to receive mental healthcare at the service as many times as they require, throughout the duration of their undergraduate or postgraduate courses. In order to identify predictors of coming back for another period of treatment, we performed multiple logistic regression taking the demographic characteristics and reported complaints that were described in our earlier paper as independent variables. 1 The results from the multiple logistic regression are presented be low in Table 1. Taken together with the findings from our previous study, the results from the multiple logistic regression suggest that there is a student profile that may particularly need support from the campus mental health care ser vice. We reported previously that students who lived in the campus hall of residence were overrepresented among SAPPE’s clients compared with the entire university student body, 1 and now we find that living in the campus halls of residence means that student are almost twice as likely to seek help at SAPPE more than once. Students who apply to live in the limited campus residence facilities at Unicamp are selected on the basis of social and fi nancial criteria. Our findings suggest that the role of SAPPE as a mental healthcare provider is even more important for stu dents in a worse economic situation. Student-clients’ mean age when they first sought help at SAPPE was 23.3 years (standard deviation, SD = 5.1; median: 22 years), 1 and being younger than 20 years of age at first contact

Coronary arterial disease after electroconvulsive therapy: a case report

Objectives Unipolar depression (UPD) is a leading cause of global burden of diseases, particularly among the elderly, whose treatment may be challenging. In such cases, ECT is often recommended due to its safety and efficacy. This report presents a case of a 67-year-old male inpatient that developed a rare cardiac complication during ECT. Methods Clinical case report with patient’s consent and bibliographic review. Results A 67-year-old male inpatient with recurrent severe psychotic depression was hospitalized and ECT was indicated after failure of the pharmacological treatment. A comprehensive clinical pre-evaluation revealed only nonspecific ST-segment changes in electrocardiogram. During the 7th ECT session, it was observed transitory ST-segment depression followed by a discrete increase of plasma troponin I. Severe tri-vessel coronary artery stenosis was found and a percutaneous coronary angioplasty was performed, with satisfactory psychiatric and cardiac outcomes. Conclusions Unipolar depression (UPD) and cardiovascular disease are often coexistent conditions, especially among the elderly. In the current case, myocardial ischemia was detected lately during ECT therapy and its treatment allowed the UPD treatment to be completed adequately.

Levothyroxine, mental confusion and suicide attempt

tion to psychiatric disorders due to organic illnesses, many medical procedures can also cause mental symptoms and lead to suicidal behavior, such as hormone therapy, other drug therapy, endocrine-metabolic responses to major surgery and azygoportal disconnection, among others. A 38-year-old male farm worker, with a background of incomplete elementary education, was admitted to the adult general ward of the Clinical Hospital of the State University of Campinas (Unicamp), diagnosed with myxedematous myopathy, which led to the following clinical sequence: rhabdomyolysis, myoglobinuria and acute renal failure. His clinical treatment had started three years earlier, with a diagnosis of primary hyperthyroidism. He underwent three applications of radioiodine and, after the third one, developed hypothyroidism. Levothyroxine 100 mcg/day was prescribed, but he did not use the medication because he was unable to read and therefore did not understand the prescription. The medical team that provided his outpatient endocrine care was unaware he was not taking the hormone replacement medication. In the ward, because it was assumed he had been in daily use of levothyroxine, his prescription was maintained. Two days after admission, although the renal failure had already been reversed, he woke up confused, disoriented, with psychomotor agitation and impaired judgment of reality, saying that he was being pursued and that people wanted to kill him. When a bed was brought to the corridor by nurses, he considered that it was an ambush. Desperate to flee, he threw himself from the 6 th floor (a drop of eight meters). The fall was partly contained by a protection net. Following this episode, the psychiatric disorder was reversed, after temporary introduction of haloperidol, with no new episodes. He was discharged with a prescription for 50 mcg/day of levothyroxine, without suicidal ideation. The additional diagnostic hypothesis of delirium was made. The iatrogenic levothyroxine poisoning had precipitated or exacerbated the confusion in this previously weakened patient, thereby leading to psychiatric symptoms that resulted in his jumping. Delirium is a syndrome that occurs in approximately 10 to 30% of clinical inpatients. Its features include acute disturbance of the level of awareness and overall impairment of cognitive functions, attention, memory and orientation. There are also frequent abnormal perceptions, delusions, restlessness, agitation and disturbances of sleep and affection. 4 This condition often remains undiagnosed. Physicians need to recognize it, to identify and treat the un derlying causes and to prevent the development of its complications. Besides clinical and psychiatric care for patients with confused and agitated states, several other measures are recommended when aiming to prevent suicide in a general hospital, such as: restriction of access to means of suicide (windows and hazardous balconies); placement of protective nets; training of the care team for early detection of and intervention in any mental disorders; and assessment of suicide risks before hospital discharge.