Trabalho de Conclusão de Curso - TCC

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Análise clínica-epidemiológica dos pacientes com acidente vascular encefálico isquêmico sob as diretrizes de atendimento no Hospital e Pronto Socorro Municipal Mário Pinotti
(Centro Universitário do Estado do Pará, 2022-11-10) Soares, Gabriel dos Santos; Góes, Nicole Garcia dos Santos; Andrade, Selma Parente Sousa; Siqueira, Cláudia Regina Dias; http://lattes.cnpq.br/6013946222269824; http://lattes.cnpq.br/4429392453942556; Sefer, Celina Cláudia Israel; http://lattes.cnpq.br/0218316102057635; Souza, Aline Cristine Passos; http://lattes.cnpq.br/5404002728453981
Cerebrovascular Accident (CVA), also popularly known as "stroke", can be classified as ischemic CVA (iCVA) or hemorrhagic CVA (hCVA). An ischemic stroke is the rapidly evolving neurological deficit caused by a focal brain injury resulting from reduced arterial blood flow (ischemia), followed by infarction, impairing the adequate supply of oxygen and nutrients to the brain tissue. On a global scale, stroke is the second leading cause of death, and, in Brazil, the fourth, with ischemic stroke being the most frequent subtype. Thus, the rapid recognition of symptoms and factors that influence prognosis are extremely important in preventing irreversible brain damage. This study aims to carry out a clinical-epidemiological analysis of patients with suspected or confirmed diagnosis of stroke at the Hospital Pronto Socorro Municipal Mário Pinotti, a reference in urgencies and emergencies in Belém-PA and compare with the goals established by the Brazilian Society of Cerebrovascular Diseases on Treatment of Ischemic Stroke. Data from medical records from the Rede Bem Estar program from July 2018 to December 2021 were used. The data were represented in Microsoft Excel tables and analyzed by the Biostat 5.5 program. Results: Men were more affected by stroke (54.3%), the age group with the highest prevalence was 61 to 80 years (52.7%). Most patients came from Belém and the metropolitan area (74.9%), followed by the interior of the state (24.6%) and from outside the state (0.5%). The time of medical care after admission was up to 2 hours in 77% of the cases and 15.9% were seen within 2 to 5 hours of time after arriving at the hospital. As for the imaging exam, about 16.2% of the sample took more than 30 minutes and 5.4% did not. The main risk factors seen were SAH (84.3%), DM (43.2%) and history of previous stroke (22.4%). Most patients had hemiparesis or hemiplegia (77.8%), language alterations (66.2%), alterations in the level of consciousness (52.4%) and labial rhyme deviation (27.3%). The therapeutic mainstay of stroke in HPSM was based on symptomatic, antiplatelet agents and statin. It was concluded that a series of factors are interconnected to achieve the best times of care, diagnosis and therapy, resulting in benefits for neurofunctionality in patients with ischemic stroke. Thus, meeting the goals recommended by national and international guidelines is essential to increasingly seek excellence in care.
Avaliação do conhecimento dos graduandos de medicina de uma instituição de ensino particular acerca da conduta do paciente com AVE no serviço de urgência
(Centro Universitário do Estado do Pará, 2019) Sabóia, Cícero Alyson Dantas; Cunha, Karen Elita Marinho; Sefer, Celina Cláudia Israel; http://lattes.cnpq.br/0218316102057635
The stroke is the second leading cause of death worldwide and the leading cause of death in the adult population in Brazil. It usually affects people over 55 years of age and is one of the leading causes of disability in the world. Data from the Ministry of Health reveal that, in 2015, there were 100,520 deaths related to the AVE, constituting 7.95% of the total deaths in the country. Stroke is a clinical emergency and a short delay in your treatment may have important clinical implications. Therefore, it is necessary that the doctors have control over the matter and know how to conduct a patient with a stroke in the emergency department. Objective: To evaluate the knowledge of the medical students of a private higher education institution regarding the conduct of the patient with stroke in the emergency department. Methodology: A cross-sectional, descriptive study using a quantitative questionnaire analysis with 109 medical students from Centro Universitário do Estado do Pará (CESUPA), distributed in the fourth, eighth and eleventh semesters. The analytical statistic was used to evaluate the results through the G-tests and Chi-square Adherence for univariate tables and G-tests and Chi-square Independence for bivariate tables. Results: A total of 109 questionnaires were analyzed, being 36 of the fourth, 40 of the eighth and 33 of the 11th semester. There was a predominance of females (56%) and the age group of 22 to 23 years (32.1%). Students of the 11th semester (72.7%) were the ones who felt more secure to attend stroke victims in the emergency room. In addition, 99.1% of students consider it important to master the subject. The superiority of the 11th semester was noted in the following items: most common cause of stroke (87.9% of correct answers); signs and symptoms suggestive of stroke, except in the item "aphasia", in which eighth-semester students (95%) obtained more correct scores than the eleventh (78.8%); definition of onset of symptoms if patient wakes or is found with symptoms of stroke (69.7%); maximum time from onset of symptoms to thrombolysis (63.6%); blood pressure (BP), which indicates the use of anti-hypertensives in patients suffering from stroke (72.7%); and in all items of assertions of true or false. It is noteworthy that, in these assertions, a satisfactory result of the students of the 11th semester was observed in relation to the others. A relevant fact was the accuracy of 100% of these students about the information that the computed tomography (CT) of the skull can be normal up to 24 hours of the AVE. In addition, there is a partial evolution regarding the conduct in the case of suspected stroke, since there was evolution only in the items "CT of the skull or cerebral nuclear magnetic resonance (NMR)" and "Thrombolysis if ischemic stroke". There was no evolution in the items "acetylsalicylic acid (AAS)", "Measurement and control of blood glucose" and "electrocardiogram (ECG)". Conclusion: It is concluded that there is an evolution in the knowledge of medical graduates of CESUPA about the conduct of the patient victim of stroke in the urgency with the advancement of the semesters, but there are still gaps in theoretical and practical medical training on the subject proposed by the institution.
Tendência da mortalidade por acidente vascular encefálico na população brasileira entre 2009 a 2018
(Centro Universitário do Estado do Pará, 2021) Yamada, Aline Rejanne Michiko da Conceição; Quaresma, Heron Correa; Rodrigues, Cybelle Cristina Pereira; http://lattes.cnpq.br/9540610661271303
Introduction: The morbidity and mortality of Brazilian individuals exposed to stroke is a public health problem and has numerous socio-spatial repercussions. Thus, it is important to know the stroke mortality rate in the Brazilian population, in order to promote public health policies. Objective: To analyze the occurrence of stroke mortality in the Brazilian population between 2009 and 2018. Methodology: Data were collected (age, sex, education, marital status, race / color, ICD-10 classification, place of occurrence) of 1,003. 862 national cases of death due to stroke that occurred between the period of 2009 to 2018, present in the SUS Mortality Information System (SIM-SUS), collected from the Informatics Department of the Unified Health System (DATASUS). Results: The mortality rate varied from 52.3 to 47.9 deaths / 100 thousand inhabitants in the period from 2009 to 2018. The South region was responsible for the highest mortality among the period studied, with a coefficient of 58.9 deaths per 100 thousand inhabitants, however, it presented the greatest percentage reduction after standardization, with a percentage of 13.8%. The North region was responsible for the lowest mortality rate in the period, with a value of 34.4 deaths per 100 thousand inhabitants, however it was the only region that presented an increase of 22.3% of deaths between the studied period. There is an approximate frequency of mortality between men and women for the total population, with a predominance, in absolute numbers, in males (505,552 - male; 498,183 - female). There was an increase in death from stroke in proportion to the increase in age in all Brazilian regions. There is an inverse relationship between mortality and the increase in education in all Brazilian regions, ranging from 219,586 cases in individuals with no education to 32,590 cases in individuals with 11 or more years of study. There is a predominance of deaths from stroke in white individuals (50.5%, n = 507,380 cases) followed by brown individuals (34.7%, n = 347,951 cases). 77.8% (n = 780,602) of the cases had an outcome in public or private hospitals. The occurrence of death from stroke predominated in married people (36.1%, n = 362,816). There is a higher notification of stroke not specified as hemorrhagic or ischemic (41%, n = 411,651). Conclusion: There was a decrease in the mortality coefficient, with the South region having the highest coefficient, but the largest reduction in events and the North region, the smallest, despite being the only region that showed an increase in the number of cases. The gender variable did not show significant differences in the number of deaths, although the male gender stands out, however, the variables age, race and study time revealed a predominance in the number of deaths in the elderly, white race and individuals with shorter study time. Given these findings, it is necessary to carry out more actions to promote programs such as Hiperdia and greater participation of health professionals who are part of the Family Health Strategy to avoid health problems in the at-risk population that may lead to a stroke event.

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