Maria Mônica Freitas Ribeiro

Insuficiência renal aguda secundária a acidentes ofídicos botrópico e crotálico. Análise de 63 casos

Sessenta e tres pacientes com insuficiencia renal aguda secundaria a acidente ofidico foram tratados no CTI do Hospital das Clinicas da UFMG. Em 32 pacientes (51%) o acidente foi produzido por serpentes do genero Bothrops (grupo bio-tropico) e em 32 pacientes (49%) pela cascavel sul-americana (grupo crotalico). As principais complicacoes apresentadas pelos pacientes foram a uremia (100% dos casos), hiperpotassemia (89% dos casos), anemia (78% dos casos), infeccao urinaria (37% dos casos), hiper-hidratacao (17% dos casos), parada cardiaca (14% dos casos) e edema agudo dos pulmoes (11% dos casos). Cinco pacientes do grupo crotalico (16%) tiveram insuficiencia respiratoria aguda atribuida a acao neurotoxica do veneno, quatro dos quais se recuperaram completamente. Sete pacientes do grupo botropico (22%) tiveram necrose cortical renal diagnosticada em cinco atraves da biopsia renal e em dois na necropsia. Quarenta e cinco pacientes (71%) foram tratados com dialise peritoneal e a hemodialise foi necessaria em dois pacientes, um dos quais havia sido submetido a dialise peritoneal. Em 17 pacientes (27%) o tratamento foi conservador. Cinquenta e cinco pacientes receberam alta hospitalar, quatro dos quais com insuficiencia renal cronica secundaria a necrose cortical renal e oito (13%) faleceram. Os obitos foram atribuidos a edema pulmonar agudo em quatro pacientes, a estado de choque em dois pacientes e a coma e infeccao respiratoria apos parada cardiaca em dois pacientes.Sessenta e tres pacientes com insuficiencia renal aguda secundaria a acidente ofidico foram tratados no CTI do Hospital das Clinicas da UFMG. Em 32 pacientes (51%) o acidente foi produzido por serpentes do genero Bothrops (grupo bio-tropico) e em 32 pacientes (49%) pela cascavel sul-americana (grupo crotalico). As principais complicacoes apresentadas pelos pacientes foram a uremia (100% dos casos), hiperpotassemia (89% dos casos), anemia (78% dos casos), infeccao urinaria (37% dos casos), hiper-hidratacao (17% dos casos), parada cardiaca (14% dos casos) e edema agudo dos pulmoes (11% dos casos). Cinco pacientes do grupo crotalico (16%) tiveram insuficiencia respiratoria aguda atribuida a acao neurotoxica do veneno, quatro dos quais se recuperaram completamente. Sete pacientes do grupo botropico (22%) tiveram necrose cortical renal diagnosticada em cinco atraves da biopsia renal e em dois na necropsia. Quarenta e cinco pacientes (71%) foram tratados com dialise peritoneal e a hemodialise foi necessaria em dois pacientes, um dos quais havia sido submetido a dialise peritoneal. Em 17 pacientes (27%) o tratamento foi conservador. Cinquenta e cinco pacientes receberam alta hospitalar, quatro dos quais com insuficiencia renal cronica secundaria a necrose cortical renal e oito (13%) faleceram. Os obitos foram atribuidos a edema pulmonar agudo em quatro pacientes, a estado de choque em dois pacientes e a coma e infeccao respiratoria apos parada cardiaca em dois pacientes.

Brazilian medical students’ attitudes towards patient-centered care

Background: The doctor-patient relationship is essencial to medical care (Engel 1980; Balint 1984), however, medical schools focus mainly on biomedical subjects and don’t give the necessary attention to communication skills, humanistic attitudes, and professional values (Haidet et al. 2001, 2002). Methods: Attitudes of medical students towards the doctor-patient relationship have been examined and the Patient-Practitioner Orientation Scale (PPOS) has been used to measure students’ and practitioners’ patient-centered beliefs, first in USA (Haidet et al. 2002), and then in several other countries (Choi & Moon 2005; Tsimtsiou et al. 2005; Shankar et al. 2006). This study aimed to examine the attitudes of Brazilian medical students towards the doctor-patient relationship by using the PPOS. The scale was translated into Portuguese and was administered to approximately 800 students in their first, fifth, seventh, ninth, tenth and twelfth semesters of medical school along with a socio-demographic questionnaire. Results: A total of 738 students (>90%) completed data collection. For the entire cohort, female gender (p < 0.000), later semester in medical school (p < 0.000), primary-care specialty choice (p < 0.02) and lower familial income (p < 0.03) were significantly associated with more patient-centered attitudes. Sharing sub-scores, measuring beliefs about power and information between physician and patient, were significantly more patient-centered for twelfth semester male students than for first semester males (p < 0.000), but not for female students. Caring sub-scores, which measure beliefs about attending to patients emotions and lifestyle, did not change with the years of school. In general, Caring scores were considerably higher than Sharing scores. Total PPOS scores in Brazil are comparable to those found among medical students in the United States, however they are considerably higher than PPOS total scores in Nepal, Greece, and Korea. Conclusions: Communication skills and patient care needs to be critically examined by Brazilian teachers and students aiming to change attitudes toward the doctor-patient relationship to be more patient-centered attitudes.

Rabdomióilise secundária a acidente ofídico crotálico (Crotalus durissus terrificus)

This paper reports two cases of rhabdomyolysis following Crotalus durissus terrificus snake bite. The diagnosis of rhabdomyolysis was based upon the presence of severe muscle pain and increased blood levels of CPK, GOT and LDH. In case 2 it was confirmed by the detection of myoglobinemia through serum Immunoelectrophoresis carried out against anti-human myoglobin serum and by a muscle biopsy. This patient- also developed acute renal failure following the snake bite. This complication was attributed to the nephrotoxic and he-molytic venom actions and to the arterial hypotension presented by the patient. The possibility that in this case rhabdomyolysis was also involved in the pathogenesis of acute renal failure can not be ruled out. The patient also presented hypocalcemia, hyperuricemia and hyperphosphatemia during the oligoanuric phase of acute renal failure which are laboratory findings associated with rhabdomyolysis.

Cross-cultural validation of the Patient–Practitioner Orientation Scale (PPOS)

OBJECTIVES Translate, adapt and validate the Patient-Practitioner Orientation Scale (PPOS) for use in Brazil. METHODS The PPOS was translated to Portuguese using a modified Delphi technique. The final version was applied to 360 participants. Reliability (test-retest and internal consistency) and construct validity (explanatory and confirmatory factor analysis) were assessed. RESULTS Only two items did not reach pre-established criteria agreement in Delphi technique. In pre-testing, seven items were modified. Internal consistency (Cronbachs alpha=0.605) and test-retest reliability (intraclass correlation coefficient=0.670) were adequate. In explanatory factor analysis, one item did not achieve a loading factor, one item was considered factorially complex and two items were inconsistent with a priori factors. Confirmatory factor analysis provided an acceptable adjustment for the observed variables (χ(2)/df=2.33; GFI=0.91; AGFI=0.89; CFI=0.84; NFI=0.75; NNFI=0.81; RMSEA=0.062 (p=0.016) and SRMR=0.065). CONCLUSIONS The Brazilian version PPOS (B-PPOS) showed acceptable validity and adequate reliability. PRACTICE IMPLICATIONS The use of the B-PPOS in national and cross-cultural studies may contribute to the evaluation and monitoring of the attitudes of doctors, medical students and patients toward their professional relationships in research and practice.

Teaching of leprosy: current challenges

In the context of declining leprosy endemicity worldwide, keeping the interest in knowledge and expertise in leprosy alive has been a matter of concern. Approaching the problem only in primary care, without the proper integration with other levels of care in the health system fails to account for the complexity of the disease. Training professionals to work at different levels of health care is a current challenge. The objective of this review was to look for experiences related to the teaching of leprosy both in undergraduate courses in the field of health sciences and in training programs for professionals who work in patient care. We highlight the role of the dermatologist in the management of control programs, diagnosis and treatment of the disease, as well as in the continuous education of other health professionals.

Itinerários terapêuticos de sujeitos com sintomas anoréxicos e bulímicos

The scope of this study is to identify and contextualize aspects of the therapeutic itineraries of patients treated at a university medical clinic specialized in nervous anorexia and bulimia. For this purpose, an attempt was made to reconstitute the succession of events triggered in 20 respondents and their families with the classification of anorexia and bulimia as “health problems.” The narratives were analyzed in order to link the individual experiences and the social context of their occurrence (organization of health services, characteristics of treatment and medical knowledge and characteristics of contemporary subjectivity), in light of the theoretical studies of Public Health and Psychoanalysis. Data analysis revealed that these itineraries arise from connections and disconnections between two distinct approaches: one that organizes the management of patients and the other governing the conduct of health institutions and families. If the latter presuppose a quest for health, this is not what primarily concerns the individuals in question. Their refusal to moderate their own eating disorders is notable on their itineraries, and indicates the functionality of those practices. Such practices play a part in the reconstruction of their self-images.

A composição do curriculum vitae entre estudantes de medicina e seus condicionantes

This research investigates the choices of the formative activities performed by medical students and their motives, in order to understand the reasons behind these choices in the institutional context in which they occur and in the broader social context of modern capitalist societies, where new standards of self-achievement have developed, according to A. Ehrenbergs research. Therefore, we not only listened to medical students, but also studied the prevailing values and practices adopted in the medical school investigated. Furthermore, other procedures mentioned by the interviewees were analyzed, including the selection criteria for medical residency. Data were collected through semi-structured interviews with twelve medical students. Additionally, 156 of 160 fourth year medical students answered a survey about extracurricular activities. The data analysis was based on similar surveys and studies on current changes in the patterns of individual behavior in society.

Desenvolvendo habilidades para um atendimento clínico humanizado: relato de uma experiência na disciplina de Semiologia Médica

The article presents free expression with encouragement for creativity as a method for learning communications skills and reflecting on the physician-patient relationship in the course on Clinical Skills. The development of group projects by students encourages reflection and creativity on their experience in the outpatient clinics and allows exercising teamwork.