Jornal de Prática Geral

The first 1,000 days, from conception to the end of the second year after birth, are crucial for the future of any human being. They are crucial for health, for the development of diseases, for learning. In this process, epigenetics and precocious sensory development are the principal routes. Several organizations throughout the globe have highlighted the importance of these 1,000 days. The “1,000 Days” initiative was born in 2010 with the backing of the U.S. Government, the Government of Ireland and several nonprofit organizations, and drove greater action and investment to improve nutrition for women and young children throughout the world. This and similar initiatives aim to improve nutrition in developing and in industrialized countries, where problems are different, but the first 1,000 days are equally crucial; these initiatives are highlighted in the text.

Studies of the early phase of psychosis reveal that culturally relevant beliefs and practices are related to attitudes toward these symptoms and to help-seeking behaviors. Therefore, a systematic and comprehensive literature review will help to develop more culturally sensitive clinical approaches to serving patients and their family members and lay a foundation for conducting culturally relevant research. Our primary aim was to provide a review of cultural factors of patients with a duration of fewer than 5 years of illness (early psychosis), from Chinese backgrounds around the world. Five themes were identified related to culturally relevant beliefs and practices and help-seeking behaviors among patients with early psychosis and their families: These themes included expressed emotions, caregivers’ experience, help-seeking pathways, quality of life, and duration of untreated psychosis. Directions for future research and clinical practice were presented.

Total thyroidectomy is not routinely performed for indications other than malignancy until the last quarter of the twentieth century. Despite significant advancement in surgical techniques of total thyroidectomy developed by Theodore Kocher and William Halsted, significant risks including damage to the recurrent laryngeal nerve, hematoma, and thyroid storm are still important considerations when weighing against surgical benefits. Currently the use of neural integrity monitor (NIM) electromyogram (EMG) tracheal tube has become increasingly popular among surgeons to reduce risks of damage to the recurrent laryngeal nerves. The purpose of this case report is to discuss anesthetic management in a 48-year-old female patient undergoing total thyroidectomy using a NIM endotracheal tube (Medtronic Xomed, Jacksonville, Florida).

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States [1]. COPD is a complex disease for which the cause and cure remain elusive. Conventional treatments for COPD have traditionally included medication and surgery. However, these conventional therapies have limitations and have been insufficient to reliably cease disease progression or improve the patient’s quality of life in a meaningful way [2]. Complementary therapies, such as yoga, mindfulness, and tai chi, have emerged that may show promising innovations for improving COPD patient care; however, there is a paucity of studies to demonstrate clinical efficacy. Initial research on complementary therapies has revealed hope that these innovative approaches may help alleviate symptoms, improve quality of life, and reduce depression and anxiety in people with COPD [3]. While there is a growing body of research surrounding complementary therapies for COPD, the weight of the evidence remains limited.

Objectives Malignant pleural mesothelioma (MPM) remains an incurable and with very poor outcome cancer. The median survival is 12 months with first line therapy; a median survival of 24 months at best when treated with multimodal approach (both neoadjuvant chemotherapy and surgery with or without radiation therapy or postoperative chemotherapy). Identifying a possible prognostic marker would seem imperative. Several studies, all with limited numbers of patients, have tried to find a possible valid and reliable prognostic marker. Univariate and multivariate analyses had been performed, yet the majority of the findings remain invalidated in other MPM populations. It has been recently shown that a reduction in serum sodium could have negative effects on hospitalization length, quality of life and prognosis in cancer patients. Materials and methods We therefore performed a retrospective single institute analysis to assess and possibly confirm the prognostic role of hyponatremia in MPM. Results The OS and the PFS in the hyponatremia group are inferior to the patients who had normal serum sodium level throughout the treatment. None of our patients presented with hyponatremia, but having sodium serum level <130 at some point during chemotherapy was a strong indicator of short PFS and a negative prognostic factor. The findings were similar in first and second line setting. Conclusion Further prospective, well designed trial, are warranted to better explore the impact of sodium correction on the PFS and OS of cancer patients and MPM.

Context: Breast cancer is the most common non-skin cancer and second deadliest cancer in women. Mammography, an X-ray of the breast, serves as the primary diagnostic tool for breast cancer detection as it reduces the risk of death through early detection and treatment of the disease. The medical community, however, has not agreed on how frequently such screenings should be performed [1]. Various organizations have produced different guidelines regarding the suggested frequency of routine mammograms. For example, the United States Preventive Services Task Force (USPST) endorses biennial mammography screenings for females ages 50-74, whereas the American Cancer Society (ACS) advocates annual mammography screenings for women beginning at age 40. It is this review’s hypothesis that annual mammography is proving to be statistically more beneficial than biennial screening in the reduction of breast cancer mortality rate. Methods: Full text articles from the U.S. National Institute of Health’s Public Medicine’s archives (PubMed) were reviewed in order to compare annual versus biennial mammographic screenings and the diagnostic advantages, detriments and mortality rates of each interval. Results: The majority of articles agree that women between the ages of 40-49 years undergoing biennial screenings are more likely to be diagnosed with late stage disease than women diagnosed during annual screenings. The results for women 50 years and older are less conclusive. While some studies of the over-50 group delineate no difference in the incidence of late-stage disease using either the biennial or annual intervals, the majority of findings suggest the annual interval is more effective than the biennial screening in detecting early stage cancer. Conclusion: Overall, women partaking in annual mammography screening experience decreased false positive “recall” rates. In addition, earlier diagnoses through annual screenings help detect smaller tumors providing a more hopeful prognosis. While these findings support the importance of annual mammography screenings for women 40 years and older, studies indicate that annual screenings only minimally improve estimated breast cancer survival rates for women aged 50-74 years compared to biennial screening.

We present a unique case of a sixty two year old woman with symmetric lipomatosis of the lower back, similar to cup C female breast. Lipoma is the most common type of soft tissue mesenchymal tumor, commonly found in the upper back, neck, shoulders and abdomen, and rarely in the face, hands or feet. When lipomatosis is symmetrical it is often termed Multiple Symmetrical Lipomatosis (MSL), also known as Madelung disease, a rare syndrome of unknown etiology. Our patient was referred with large symmetrical subcutaneous masses in her lower back similar to cup C female breast. Prior to her surgery, the patient was referred to ultrasonography of the lower back which demonstrated two large subcutaneous lesions with an average size of 12.5 × 3 × 14 cm. Lesions were excised under general anesthesia, with the left lipoma weighing 535 gr’, and the right 425 gr’, and sent for pathological examination. Surgical drains were removed two days after the procedure, and the patient was discharged. Pathology confirmed our clinical diagnosis, and 18 months after the procedure-the surgical wounds healed to the patient’s satisfaction. We believe that although this disease remains rare, the deferential diagnosis between simple lipoma, MSL and obesity may contribute to current underdiagnoses of MSL. It is important to accurately diagnose MSL as it may be related to systemic comorbidities. Plastic surgeons should bear in mind that clinical presentation may vary, as for our patient, and must be familiar with this disease and its management.

Connective tissue disease (CTD) and sickle cell disease (SCD) are diverse group of disorders; however, both of these diseases are characterized by underlying chronic inflammation. CTD is perceived to have a higher incidence and to affect the disease severity in SCD. Objectives: We seek to describe prevalence of autoimmunity and CTD and itsimpact on SCD disease severity as this is not well described in the literature. Methods: We retrospectively reviewed the medical records of 722 patients with SCD, seen over an 11 year period followed at a tertiary care hospital in London, UK. During the last 2 years of the study, number of hospitalizations and length of hospital stay were compared in patients with SCD with and without CTD. Results: In the study cohort, hemoglobin SS was the most common genotype (n = 451; 62%) and 411 (57%) were female. Twenty-three patients (3.1% had documented evidence of CTD, with rheumatoid arthritis (n = 14; 2%) and systemic lupus erythematosus (n = 2; 0.3%) being the most common. Antinuclear antibody was present in 108 (15%) of the patients and anti-smooth muscle antibody was present in 60 (8%). The mean number of hospitalizations (1.9 ± 2.7 vs. 1.5 ± 2.7) and mean length of hospital stay (6 days ± 4.1 vs. 7 days ± 11.4) were not different between those with or without autoimmunity and/or CTD. Avascular necrosis was the most common non-CTD musculoskeletal complication, affecting 72 (10%) patients. Conclusion: Our study suggests that positive autoimmune serology and CTD were more common in SCD compared to non-SCD population of similar ethnic background; however, presence of CTD does not appear to affect the SCD severity. The high frequency of CTD and overlapping of clinical symptoms suggest a need for diagnostic vigilance in diagnosing CTD in patients with SCD.

Under the revised Medical Service Law, in-depth investigations of unpredictable deaths in health facilities must be undertaken. To illustrate our suggested procedure for investigating the sudden death of inpatients, and to emphasize the importance of postmortem examinations, we discuss an unusual forensic autopsy case. An 82-year-old Japanese woman with a 17-year history of type 2 diabetes and angina pectoris suddenly died after the injection of a water-soluble, nonionic contrast medium called iso-hexol (Omnipaque). The forensic autopsy and postmortem blood examination revealed an elevated serum level of tryptase (242 μg/L), a normal serum level of IgE (64 IU/mL) and 5076 μg/mL of iso-hexol, but no morphological evidence suggesting injury or disease. Therefore, the cause of death was confirmed as a fatal anaphylactoid reaction caused by the injected contrast medium. Although severely adverse reactions from nonionic contrast media are rare, patients should be observed carefully after administration of such compounds. This case also illustrates the importance of determining the correct cause of sudden death by performing an autopsy and subsequent analytical examinations. The possibility of anaphylactic/anaphylactoid reaction should be considered in all cases of sudden unexpected deaths in hospitals or clinics.

The prevalence of hypertension increased dramatically during the last several decades in China. The Chinese government has launched a national comprehensive hypertension management program in primary care, which includes hypertension detection, measurement, treatment and follow-up. The awareness, treatment and control rates of hypertension in China have improved in recent years, which is possibly attributable to the program to some extent. However, policy makers are facing many issues regarding hypertension management. This study pointed out two major issues. The first one was the low hypertension management rate. The other one was the hypertension management process itself-there were significant gaps between standards of care and medical practice. Possible barriers to effective delivery of hypertensive care were elaborated which may help improve hypertension management in primary care in China.

Dengue infection may cause neurological complications ranging from encephalitis to radiculitis and result in disability and morbidity. We here present a case of Polyradiculomyelopathy with bilateral optic neuritis secondary to Dengue infection that showed minimal improvement despite timely steroids and plasma exchange.

Climbing as a young sport is growing fast. The fastest growing part of the sport is due to indoor walls for training attracting youngsters. With hard training from young ages it is vital to be able to pinpoint training regimes to avoid injuries in athletes. This reviews purpose is to search the literature to investigate what group of climbers are most prone to injury and which injuries are the most common. Method: A semi structured literature search was conducted in PubMed on September 11 2013. Result: The search gave 1244 titles. All titles were carefully searched for the possible finding of descriptions of climbing related chronic injuries. This led to the reading of 96 and then to a final inclusion of 44 papers. We found descriptions of 45 chronic injuries the 17 papers. Discussion: Due to methodological differences, lack of reporting strategies and not using control groups in the included papers it is not possible to conclude on which groups of climbers are more prone to injuries or to which state the injuries are most prevalent amongst climbers.

Purpose: Describing a case of an atypical ocular perforation by a daily use object, the treatment performed and the outcome after treatment. METHOD: Case report by reviewing medical data. Case Report: A twenty-five female that had an atypical penetrating ocular trauma evolving to a symptomatic peripheralvitreous traction, that was successful treated by pars plana 23 gauge vitrectomy. Conclusion: Penetrating ocular trauma is an important cause of monocular blindness. Prompt diagnoses and treatment, are essential for the best possible prognoses.

A cross-sectional descriptive study was conducted among participants who attended to outpatient department Number 2 Defence Services General Hospital. The objective is to describe understanding of prescription from health care providers to patients. The study recruited participants by using simple random sampling and pre-tested questionnaire from August to September 2014. The participants were age between 17 and 77 years and the mean age was 47.27 (SD 11.67) years. Among 194 participants, 99 (51%) were male and 95 (49%) were female. The participants who came to hospital for themselves (93.3%), for husband/wife (2.1%), for their children (1%) and for parent (3.6%). The participants who went to the specialist doctors (59.3%) and medical officer (25.8%) and the remainders (14.9%) did not know which doctors treated to them. Although the participants (87.6%) could answer their diagnosis, 12.4% of participants could not answer it. The time given for explanation of prescription was between 1 and 20 minutes and the mean time was 5.5 (SD 4.26) minutes. While 68% of the participants could answer at least one pill of the prescribed drugs, 32 % of participants could not answer it. Furthermore, the participants (87.6%) knew well about dosing frequency of pills that they took. But 4.6% of participants knew about dosing frequency of one or more pills and the remainders (7.7%) did not know about it. Most of the prescribers (74.7%) did not explain adverse reaction of pills; only 25.3% of prescribers explained it. There was association between patients’ understanding of medical prescription and age group and gender. Despite the doctors and nursing staffs prescribing clearly and giving more time for explanation of prescription, some of the participants do not know it. Thus, the prescribers should ask how to take the pills after the patients had received the pills and explain well about the adverse reaction of the pills.