Trabalho de Conclusão de Curso - TCC
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Item Perfil epidemiológico dos nascimentos no Brasil a partir das declarações de nascidos-vivos entre 2006 e 2015(Centro Universitário do Estado do Pará, 2019) Paula, Fillipe Augusto Moura de; Damasceno, Ana Cláudia Alves; http://lattes.cnpq.br/6202464010989232Introduction: Birth and birth are transformative events in the lives of women and babies, and most often, they are not at risk. Brazil went from a high-fertility regime to a low-fertility and long-term internal and external regime to improve the quality of care for the newborn and to reduce maternal and infant mortality. Objective: To analyze the socio-epidemiological profile of births in Brazil from the birth-to-child report by Sinasc in DATASUS, corresponding to the period from January 2006 to December 2015. Results: About 29.2 million live births were born between 2006 and 2015. The year of 2015 registered the highest rate and year of 2010 the lowest. As for seasonality, the March-April-May quarter had the highest rates, with 26.8% of total births and the lowest October-November-December quarter (23.6%). There was an increase in the proportion of births of mothers aged 30 years or older, from 24.53% to 32.79%, and a reduction in the proportion of those aged less than 20 years, from 24.48% to 18.14%. There was an increase in the birth rate where mothers performed prenatal care with 7 or more consultations, from 54.54% to 66.49%. About 2% of the births were of multiple gestation, with maintenance of this percentage in the period. The incidence of low birth weight in the period was 2.45 million births. Cesarean section was the type of delivery in 52.07% of births, with an increase of 10.46 percentage points of this way of delivery in the period. 2.6 million premature infants (8.95% of the total live births) were born, with a rate increase from 6.61% to 10.83% in the period evaluated. Apgar score higher than 7 (good vitality) occurred in 82.27% of the total live births, and 93.39% presented the same score in the 5th minute of life. The incidence of births with an Apgar score lower than 8 in the first minute was higher in preterm (32.82%) compared to the term and post term (15.8% and 19.9%, respectively). Conclusion: The Live Birth Information System (Sinasc) is a good and timely source of information about births in Brazil. It is possible to trace the profile of births, having as a basic document the Declaration of Live Birth (DNV). The results obtained are very important for the knowledge of many variables that may help in the future the construction of strategies aimed at improving the Brazilian Health system.Item Perfil epidemiológico das pacientes com lesões precursoras e câncer do colo de útero atendidas em um Centro de Especialidades Médicas(Centro Universitário do Estado do Pará, 2019) Silva, Giovanna Gomes e; Furtado, Lidia Lacerda; Campos, Ana Carla Araujo; http://lattes.cnpq.br/4066530269438763Introduction: Carcinoma of the uterine cervix is the fourth most incident cancer in women in Brazil, in 2018, was expected 16.340 new cases of carcinoma of the uterine cervix in Brazil. At the region North, including Pará State, this cancer is the most incident at the female population, just behind non-melanoma skin cancer, where were diagnosed 820 new cases in 2016. The profile of women that develop this kind of cancer, stand out early age at first sexual intercourse, multiplicity of partners, history of sexually transmitted infections, use of the oral contraceptives, multiparity, early pregnancy and tabagism. Objectives: To describe epidemiological profile of patients with uterine cervix cancer treated at a specialized medical center. Methods: A descriptive and retrospective study was performed. Data were collected from medical records of patients diagnosed with uterine cervix cancer or precursor lesions from 2015 to 2018, sociodemographic information and main characteristics that are considered as risk factors for the development of the disease were collected. Results: The average age of the patients was 41,5 years, most were divorced, illiterate, multiparous, the first sexual intercourse occurred between 8 and 24 years and had altered cytopathological exams and colposcopy. Conclusion: The data analyzed allowed to characterize the epidemiological profile of patients with carcinoma of the uterine cervix and its precursor lesions in the population studied. These data have relevance in the implementation of public actions for patients with similar profiles, so that screening and early diagnosis can be performed.Item Análise do aprendizado de anatomia humana em um curso de medicina com Aprendizagem Baseada em Problemas (ABP)(Centro Universitário do Estado do Pará, 2019) Marques, Igor Gabriel; Cunha, Victor Menezes da; Penha, Nelson Elias Abrahão da; Oliveira, Wellington Pinheiro de; http://lattes.cnpq.br/4902455106917702; http://lattes.cnpq.br/5207645183090927Objective: This paper aims to analyze the perception of learnig in human anatomy of the medical student along the PBL method in differents cycles of the course (basics and clinics). Method: This is an analytical and descriptive cross-sectional study wich have analyzed data obtained through a questionnaire, with directs responses using the Likert scale, applied to CESUPA’s students of the fifth and eighth semesters of the medical course, between november 2018 and march 2019. Results: When the answers was decomposed individually for questions per class, it was verified independence through the G-test. There were statistical significance for the questions 7 “Are you sure that the anatomical study developed through the active methodology, up to this moment of the course, was enough to complete the thematic modules?” (p = 0,0007), being the alternative B the most checked by the two classes and 8 ”Do you believe that the knowledge learned unitl here will be usefull for the practice at your profession as a general physician?” (p = 0.036), being the alternative A, the most checked by the two classes, then, the alternative B. The remaining questions were not statistically significant (p<0.05). Conclusion: The medical studens who learn anatomy through the PBL at CESUPA feel safe about the support of this subject in their way as a general practitioner and has a good degree of agreement that the learning developed in anatomy, was sufficient for the conclusion of each thematic module.Item Análise do impacto de vacinação contra a meningite meningocócica “C” no munícipio de Belém-PA no período de 2014 a 2018(Centro Universitário do Estado do Pará, 2019) Sousa, Israel Laune; Farah, Rached Rached; Magno, Ismaelino Mauro Nunes; http://lattes.cnpq.br/3841081216551678Introduction: Meningitis is an infectious disease characterized by inflammation of the meninges. It has several causal factors, whether infectious or not. Among the infectious causes, the main ones are of viral and bacterial etiology. Intracerebral cysts or tumors, medications, and inflammatory diseases may also trigger the inflammatory process. Objective: To evaluate the impact of the Meningococcal C Conjugated Vaccine (MenC) and the incidence of meningococcal disease in the city of Belém-PA and the number of hospitalizations for meningitis in children from 0 to 1 year old from 2014 to 2018. Methodology. This is a time series ecological study, which used records of hospitalizations for any cause and for a disease that is suspected of meningitis through data provided by the SUS Hospital Information System from 2014 to 2018. Result: In the study period (2014 to 2018), a total of 621,110 hospitalizations were registered in the municipality of Belém-PA, for general causes. Already due to infection meningococcal infections and viral meningitis were registered 242 hospitalizations from January 2014 to December 2018. In the age group from 0 to 1 year old, in the same period, were recorded 2323 hospitalizations. Regarding meningitis vaccination coverage, it was observed that the percentage of Conjugated Meningococcal - C vaccination coverage in the municipality of Belém remained with a slight variation in 2015, whereas in 2015 there were 216 new cases and a drop in 2017 and 2018. Discussion: Comparing the hospitalization rate in the post-vaccination periods, there was an increase of 13 more hospitalizations in 2018 for the 0 to 1 year age group. The results show an increase in the hospitalization rate due to meningococcal disease, even after the introduction of the meningococcal vaccine. Conclusion: the study identified a drop in vaccination coverage in the city of Belém do Pará, which is below the established target of 95.00% in the period studied meningococcal disease.Item Avaliação clínica da gravidade em pacientes portadores de Doença Pulmonar Obstrutiva Crônica (DPOC) atendidos no CEMEC – CESUPA(Centro Universitário do Estado do Pará, 2019-11-20) Ayres, Layse Melo Menici; Navarro, Stéphanie de Windson Cruz; Pinheiro, Marilia de Fátima Silva; http://lattes.cnpq.br/2037104893893669; Monteiro, José Tadeu Colares; http://lattes.cnpq.br/7627103187307808; Santos, Roberta Kahwage; http://lattes.cnpq.br/2527080199033009Introduction: Chronic Obstructive Pulmonary Disease - COPD is a common, preventable and irreversible condition, defined as a syndrome characterized by chronic airflow limitation, evolving with destruction of the pulmonary parenchyma. Smoking is the main cause and respiratory signs and symptoms characterize it. The FEV1 / FVC ratio < 0.7 after bronchodilator administration is used for diagnosis and is classified by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in ABCD for clinical severity and 1234 for degree of obstruction. Objectives: General: To evaluate the severity of COPD in patients followed at CEMEC. Specifics: 1) Classify patients according to severity in groups A, B, C and D. 2) Characterize the relationship of severity with the variables gender, age, BMI, smoking load, oximetry and medications in use of the patients studied. 3) Characterize the relationship of variables with the mMRC scales and exacerbating profile. 4) Compare FEV1 among patients classified by symptomatology. 5) Compare the spirometric profile of exacerbating and non-exacerbating patients. Methodology: The medical records were searched through ICD J44 in CEMEC where 25 of them fit the delimited profile and their variables were collected and analyzed. Results: A higher prevalence was found in groups C and D (66.66%), aged 55 to 78 years, with the highest mean BMI in group B (30.9 kg / m2) and most females (12). / 21). Post-bronchodilator FEV1 was found to be higher in less symptomatic patients (59.4 ± 24.1). 61.11% of the patients had a smoking load > 20 packs / year, most of them also exacerbating (13/21). Regarding the therapy applied to the GOLD ABCD groups (n = 17), it was found that 12 were on monotherapy, five in combination and only one had no scheme. Conclusion: A significant number of patients who did not really fit the ICD J44 were observed; Of the 25 patients, only 21 had sufficient data for ABCD classification, among them, most were in groups C and D. The female gender was more prevalent, as well as the patients with the highest smoking load; Among the most symptomatic, there was a higher obstructive degree, and it was possible to trace the severity profile of these patients treated at the service.Item Relação de polimorfismos genéticos específicos como fatores de risco para o desenvolvimento de Malformações Arteriovenosas (MAVs) cerebrais: uma revisão sistemática(Centro Universitário do Estado do Pará, 2019) Santos, Leonardo Magalhães; Farias, Valter Fernando Rodrigues; Paschoal Júnior, Fernando Mendes; Paschoal, Eric Homero Albuquerque; http://lattes.cnpq.br/1593548343125421; http://lattes.cnpq.br/0171195401629428Arteriovenous Malformations (AVMs) of the brain are vascular lesions that shunt arterial blood directly into a low-resistance system of draining veins without an intervening normal capillary bed. Among the main clinical manifestations (which contribute greatly to the cases of death of this pathology), hemorrhage and seizures are prominent. The pathophysiology of this condition is still poorly understood, but the role of proinflammatory cytokines and genes responsible for these cytokines and cerebral angiogenesis in this process is recognized. The present work aimed to identify the relationship of specific genetic polymorphisms as risk factors for the development of Cerebral Arteriovenous Malformations (AVMs). A systematic review of the literature was performed, using the PRISMA Statement as the research protocol, in the MedLine databse. The terms / descriptors in Health Sciences, in the English language, included in the research of the title were: genetic polymorphism, arteriovenous malformation, single nucleotide polymorphism, genetic linkage, brain arteriovenous malformation, hemorrhage, seizures and headache. Case-control studies were included in this study, where, in the research methodology, the genetic tests used to identify the polymorphism and the presence of AVM in image examination were established. The extraction of articles was done by two authors independently. In all, 208 articles were found, of which only 11 fulfilled the inclusion criteria of this research. The most affected age group was in the range between 35 and 40 years. AVMs, in general, presented with a mean size of 3 to 6 cm. Of the analyzed polymorphisms, all had a direct relationship between having the polymorphism and being an MAV (each with its statistical frequency). And, of the more present clinical manifestations, the hemorrhage was highlighted. It is concluded that more studies should be listed to highlight the role of genetic polymorphisms in this process, in order to improve the therapeutic arsenal to lead this pathology and the prognosis of patients.Item Análise da dose de levotiroxina nos diversos tipos de hipotireoidismo atendidos no ambulatório de tireoide do Centro de Especialidades Médicas do CESUPA (CEMEC)(Centro Universitário do Estado do Pará, 2019) Silva, Lucas Ivanilson Guedes Henriques; Valente, Ana Augusta Motta Oliveira; Neves, Dilma Costa de Oliveira; http://lattes.cnpq.br/7230812534416350; http://lattes.cnpq.br/0439088319200326Introduction: Hypothyroidism is an endocrinopathy with a prevalence of 0.3% to 4.6% in the population, and its treatment is hormone replacement with levothyroxine (LT4) at an initial dose of 1.6 to 1.8 mcg / kg / day, however, it is known that the type of hypothyroidism may influence the amount of LT4 to be administered to the patient. Objectives: To analyze the dose of levothyroxine (LT4) used in the various types of hypothyroidism. Material and Method: It was a cross-sectional, descriptive and quantitative study based on the data collection of medical records of patients with hypothyroidism, attended, in the period from 2015 to 2018, in the Thyroid Ambulatory of the Center of Medical Specialties of CESUPA (CEMEC). The variables analyzed were age, sex, weight, type of hypothyroidism, levothyroxine dose, TSH and free T4 value recorded at the last visit, symptoms, comorbidities and use of other medications. Results: 187 medical records of patients with hypothyroidism were analyzed, with a predominance of women (97.9%) between 21-44 years of age. The most prevalent cause of hypothyroidism was total thyroidectomy and the highest mean levothyroxine dose was in this group. Among men, the postoperative period was predominant in adult patients (2). In most patients, there was no record of cardiovascular and gastrointestinal related comorbidities that could affect LT4 dose. There was also no significant statistical difference (p = 0.5428) between the use of other drugs and the absence of comorbidities and the age groups of the patients. Disabsortive disease was the comorbidity found that altered LT-4 replacement by age range. The highest mean doses of levothyroxine were recorded in patients with total thyroidectomy hypothyroidism. No significant statistical difference was observed between the averages and medians of the levothyroxine doses and the age ranges of the patients. The medications that may change the dose of LT4 most encountered were calcium, metformin and estrogens. The most controlled patients (within the TSH target) were those with an autoimmune cause. Conclusion: No type influence of hypothyroidism was observed on the dose of levothyroxine.Item Aspectos clínicos e histopatológicos do lúpus eritematoso cutâneo registrados em serviço de referência do estado do Pará no período de 2010 a 2017(Centro Universitário do Estado do Pará, 2019) Lima, Luis Felipe Silva; Gouvêa, Rebecca Ribeiro; Bittencourt, Maraya de Jesus Semblano; Amin, Gabriela Athayde; http://lattes.cnpq.br/8604283847300465; http://lattes.cnpq.br/6566823528602319INTRODUCTION: Systemic Lupus erythematosus (SLE) is an autoimmune and multifactorial disease characterized by a chronic inflammatory process resulting from changes in immune regulation due to the production of autoantibodies against various cellular constituents. The skin is one of the target organs most affected by the disease, and genetic, hormonal and environmental factors interact and interfere with the development of skin disease. The cutaneous manifestations can be divided into specific and nonspecific, according to their clinical and histological characteristics, and the specific ones can be found in the skin in three ways: chronic (CCLE) ; Subacute (SCLE) and Acute (ACLE). It presents genetic, autoimmune, hormonal and environmental factors as pathogenic substrates, and its clinical and laboratory characteristics help the diagnosis, which can be confirmed by histopathological study. OBJECTIVES: This study aims to elucidate the histopathological changes that occur in the LECC and its subtypes, correlating the disorders analyzed in the slides with the clinical manifestations presented by the patient. MATERIAL AND METHODS: This was a cross-sectional, retrospective and descriptive study conducted at the dermatology service of the Federal University of Pará through the analysis of medical records in which the disease was histologically confirmed. RESULTS: We analyzed epidemiological and clinical data from a group of 55 patients with Cutaneous lupus erythematosus (CLE) . The average age at disease onset was 42 years. There was a predominance of females (80% of cases). 64% of the cases affected the face, and 51% were disseminated or generalized in the skin (with lesions also below the neck). There was a predominance of erythema and peeling (87% and 47% of cases), followed by atrophy (42%). The most affected phototype was IV in 61.8% of cases. 33% of the cases were CCLE, followed by ACLE in 13 patients (24%) and SCLE in four patients (7%). The most frequent dermatological lesion was erythema (87%), followed by scaling, infiltration and atrophy. 29% of patients had positive antinuclear factor. In the epidermis it was observed that all cases presented vacuolar alteration, 64% of patients presented basal thickening and 58% atrophy. In the dermis, all patients presented lymphocytes in the infiltrate and 87% presented mucin in the connective interstices. CONCLUSION: Understanding the changes that appear at the microscopic level is of paramount importance for understanding the course of the disease and, thus, enabling the elaboration of an appropriate therapeutic approach. The medical professional plays a fundamental role in the management of patients with Cutaneous lupus erythematosus, and their duty is to understand all its universality for a satisfactory clinical follow-up and the prevention of possible injuries. Although not a common disease, its chronicity leads to the accumulation of cases in clinical outpatient clinics. In addition, although progress is good in most cases, delayed initiation of treatment can lead to disfiguring scars.Item Aspectos epidemiológicos dos óbitos de crianças por afogamento nas regiões brasileiras(Centro Universitário do Estado do Pará, 2019) Rezende, Maíra dos Santos da Mata; Gonçalves, Vívian Danielle Bastos da Silva; Neves, Dilma Costa de Oliveira; http://lattes.cnpq.br/7230812534416350Introduction: Drowning is the leading cause of unintentional death in children, among external causes, and the one that has the greatest family, social and economic impact. It is a public health problem, in which prevention is the main tool. Objectives: Describing the epidemiological profile of children from 0 to 11 years old who were victims of drowning and accidental submersion that evolved to death in the Brazilian regions and capitals from 2010 to 2017. Methodology: Ecological study whose data were collected from the Mortality Information System (SIM) provided by the IT Department of the Unified Health System (Datasus). The study variables were: age, sex, race/color, year of death (2010 to 2017), place of death, region of occurrence and the primary cause of death classified in ICD-10, with alpha numeric code W65 to W74. The variables were grouped by Brazilian Regions. Results: Drowning as the primary cause of death in children in Brazil represented 19.3% (6,296) of all deaths from external causes, with the highest proportion (32.8%) observed in the Northern Region. The highest proportion of drowning deaths occurred in the state capitals was observed in the Midwest Region (25.1%), followed by the North Region (19.3%). It was observed that deaths from drowning children tend to increase in the Midwest and South regions and to decrease in the North, Northeast and Southeast regions. The predominant age group of deaths was between 0 and 2 years of age (2,405), mainly in the North, Midwest, South and Southeast. In the Northeast, there was superiority in the age group from 6 to 11 years (919), with the highest absolute number of drowning deaths in children. There was a predominance in males (4,337) in all Brazilian regions, with higher occurrence in the Northeast. Brown race/color was predominant in all regions except the Southern region. The mortality rate was higher in children aged from 0 to 2 years (163) in all regions. The main day of the week for all regions was Sunday, with a predominance of afternoon time. As for the place of occurrence, excluding the unspecified place of occurrence (615), the drowning of children in natural waters (422) stood out in all regions, followed by residence, for the North and Northeast regions and pool in the Center regions. West, South and Southeast. In the North and Northeast regions, the most frequent age range in natural waters is from 6 to 11 years and in residence from 0 to 2 years. While in the South, Southeast and Midwest, the occurrence of drowning in natural waters predominated, with the most frequent age range between 6 and 11 years, followed by swimming pool, aged between 0 and 2 years. Conclusion: We emphasize the importance of the results obtained for the creation of drowning prevention strategies in children, contributing to the improvement of the quality of life of families and society as a whole.Item Epidemiologia das internações por transtornos mentais e comportamentais no Brasil(Centro Universitário do Estado do Pará, 2019) Melo, Maria Fernanda Marques; Camacho, Thais Feitosa; Del Nero, Luciana Brandão Carreira; http://lattes.cnpq.br/5056614008350803Introduction: Mental disorders have high prevalence rates in the population and represent a significant demand for health services. Because chronic diseases are highly prevalent in the world, mental disorders contribute to early morbidity, disability, and mortality. It is estimated that 25% of the general population has one or more mental disorders throughout their lives. In Brazil, the National Mental Health Policy has been carried out through a model of mental health care advocated in the principles of Brazilian psychiatric reform. Objective: To analyze the epidemiological profile of hospitalizations due to mental and behavioral disorders in Brazil from 2008 to 2017. Method: The study is epidemiologic, ecological, quantitative and descriptive, based on secondary data related to hospital admissions due to Mental and Behavioral Disorders available at SIH / DATASUS. Results: In the analyzed period there were 2.583.073 million for mental and behavioral disorders, corresponding to 2.30% of total hospitalizations, there was a gradual decrease in the percentage of hospitalizations over the 10 years. Schizophrenia, schizotypal and delusional disorders presented the highest percentage (38.99%) among morbidities, there was a decrease in hospitalizations due to alcohol use (18.98% to 16.79%) and an increase in hospitalizations due to mood disorders (16.24% to 22.25%) and disorders due to the use of other psychoactive substances (14.53% to 18.54%). The largest number of hospitalizations is concentrated in the Southeast region (1,069,849) and the highest percentage in the South region (3.8%). The age group of 30 to 39 years (25.75%), male (64.03%), and white / race (41.4%) were the most prevalent. We observed a progressive increase in the mortality rate (0.55%) and a reduction in the average length of stay (45.4 days to 31.8 days). Conclusion: The present study demonstrated the gradual decrease in the percentage of hospitalizations due to mental and behavioral disorders in Brazil during the analyzed period and was an auxiliary tool in the formulation of strategies and public policies in the area of mental health.Item Impacto clínico e prognóstico das modificações no sistema TNM do American Joint Committee For Cancer oitava edição em pacientes com câncer de mama(Centro Universitário do Estado do Pará, 2019) Bohne, Mariana Rocha; Khayat, Yasmin de Farias; Pereira, Cynthia Mara Brito Lins; Khayat, André Salim; http://lattes.cnpq.br/6305099258051586; http://lattes.cnpq.br/3186657130674078Introduction: Breast cancer is in fifth place as the cause of cancer death in the world population. In Brazil, this neoplasm is a first in the female public, without considering non-melanoma skin cancer. However, with the objective of conducting early research on the biological causes of breast cancer, there was a great reduction in mortality rates and greater survival in patients with metastatic disease. The American Joint Committee on Cancer (AJCC) is a state cancer system that enables disease progression. The AJCC instituted its history form based on anatomical information of the primary tumor ("T"), regional lymph nodes ("N") and metastases ("M"). Biological factors, tumor grade, estrogen receptor (ER) positivity, HER2 and progesterone receptor (PR), were included in the eighth edition of the manual, implemented in 2018. Aim: This work aimed to analyze the impact generated by the update of the TNM / AJCC staging system (eighth edition) and to elucidate the importance of including the biological factors and other modifications of the new system for a better medical approach. Method: A retrospective, analytical, cross-sectional, and documentary study of a qualitative approach in which patients with breast cancer were submitted to Ophir Loyola Hospital in 2018, having undergone the cancer staging of the TNM of the American Joint Committee on Cancer (AJCC) seventh edition, so that it could be reclassified according to the prognostic status of the eighth edition of this manual. Socio-demographic data, hormonal and reproductive histories, risk factors related to cancer, anatomopathological characteristics, biological factors and molecular subtype of the tumors were considered. Conclusion: Changes in the stage of the breast cancer patients evaluated after the reclassification with the eighth edition of the TNM / AJCC system were found, so that there was a positive impact of this system on the prognostic targeting, generating a better therapeutic selection.Item Avaliação do uso de hidroclorotiazida em pacientes com carcinoma basocelular atendidos em ambulatório de dermatologia(Centro Universitário do Estado do Pará, 2019-11-20) Rodrigues, Pedro Henrique Pantoja Souza; Franco, Rodrigo Carneiro; Amin, Gabriela Athayde; Carneiro, Francisca Regina Oliveira; http://lattes.cnpq.br/1387234135281918; http://lattes.cnpq.br/8604283847300465; Bittencourt, Maraya de Jesus Semblano; http://lattes.cnpq.br/6566823528602319; Lima, Caren dos Santos; http://lattes.cnpq.br/6225022147519510Introduction: According to the National Cancer Institute (INCA), nonmelanoma skin cancer represents 30% of all malignant neoplasm in Brazil. These tumors have low lethality but high morbidity, so recognition of risk factors and early diagnosis are determinant for prognosis. Basal cell carcinoma arises from non-keratinized cells from the basal layer of the epidermis and represents 76% of all non-melanoma skin cancer (CPNM). In Brazil, approximately 165,580 new cases of this neoplasm were estimated, with tendency to increase this rate for the next years. It is locally invasive, usually nonagressive and destructive of skin, despite its low metastatic potential, being more common among the elderly, white populations and male. Its main clinical presentation is a papule ou nodule with a pearly aspect, often with typical telangectasy located mainly in the head and neck region. Some studies have related hydrochlorothiazide, one of the main antihypertensive drugs used in Brazil, as a potential risk factor for the development of Basal Cell Carcinoma (CBC). This led the National Health Surveillance Agency (ANVISA) to release a note informing about the increased risk of nonmelanoma skin cancer with the use of the drug and recommending that physicians report this risk to patients, as well to guide patients for regular self-examination of the skin looking for new lesions. Current studies, however, are recent and conflicts about this association. Objective: Evaluate the relationship between hydrochlorothiazide use and the risk of developing basal cell carcinoma. Materials and Methods: A population-based case-control study was conducted, collecting cases (histopathological CBC confirmations) of the Pathology Laboratory of the Dermatology Service of the Center for Medical Specialties of the University Center of Pará (CESUPA). Controls were matched 3:1 by age and sex. Data was obtained from medical record or interview. Analytical statistics were used to evaluate the results of the categorical variables of the sample through the G and Chi-squared tests adherence and independence. Odds Ratio was calculated using Logistic Regression, with a 95% confidence interval. Results: We obtained 36 cases of BCC and 108 controls. The use of hydrochlorothiazide increased the risk of developing basal cell carcinoma (Odds Ratio 2.53 and 95% CI 1.04 - 6.14). There seems to be a cumulative dose relationship, evidenced by Odds ratio 2.80 and 95% CI 1.01 - 7.77 for doses greater than or equal to 27,000mg, corresponding to 3 years or more of use, which is not observed at doses lower than this. Conclusion: The use of hydrochlorothiazide increase the risk of developing basal cell carcinoma.Item 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/0218316102057635The 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.Item Sintomas da síndrome da apneia obstrutiva do sono em mulheres gestantes do Centro de Especialidades Médicas do CESUPA(Centro Universitário do Estado do Pará, 2019-11-18) Guedes, Danielle Veloso Marinho; Nascimento, Raíssa Andrade do; Nunes, Leonardo Mendes Acatauassú; Luz, Marília Gabriela Queiroz da; http://lattes.cnpq.br/7318301499873546; http://lattes.cnpq.br/3512764081076675; Força, Mariana Tótola; http://lattes.cnpq.br/4000323182108455; Neves, Dilma Costa de Oliveira; http://lattes.cnpq.br/7230812534416350Context: Obstructive Sleep Apnea Syndrome (OSAS), main sleep-disordered breathing, is currently considered a public health problem, due to its cardiovascular and metabolic complications. Pregnancy is associated with anatomical, mechanical and hormonal changes that modify sleep quality and patterns, which may exacerbate or increase the chances for pregnant women to develop obstructive sleep apnea syndrome. Purpose: Assess the prevalence of symptoms of obstructive sleep apnea syndrome in pregnant women attended at Prenatal Care Ambulatory of Medical Specialties Center of Cesupa between October 2018 and March 2019. Method: Cross-sectional observational study was conducted by analyzing the filling of questionnaire and scales by 50 patients attended at Prenatal Care Ambulatory of Medical Specialties Center of Cesupa between October 2018 and March 2019, and in a second phase, by data collection from respective medical records. Results: The most denounced symptom (78%) by the participants was tiredness during the day. 48.9% of the patients reported excessive daytime sleepiness and 40%, snoring. No significant correlation was found between excessive daytime sleepiness and snoring. The most prevalent age group was 21 to 25 years, while 50% of pregnant women were nulliparous and 40% were in the third trimester. There was no relationship between symptoms presented and alteration of body mass index or systemic blood pressure. Conclusion: There was a significant presence of symptoms of obstructive sleep apnea syndrome in the pregnant women evaluated, however, not of the most specific ones. It is possible that by factors such as modest sample size and cross-sectionality of study the results may not have reflected the importance of an improved analysis of this syndrome in pregnancy, given its underdiagnosis and harmful consequences, both for the mother and for the fetus.Item Principais aspectos clínicos e radiológicos pulmonares em pacientes portadores de artrite reumatóide em um Centro de Especialidades Médicas em Belém-PA(Centro Universitário do Estado do Pará, 2019) Castro, Erick Garcia; Fernandes, Marina Assis da Escóssia; Monteiro, José Tadeu Colares; Ohashi, Claudia Barros; http://lattes.cnpq.br/0889116450004563; http://lattes.cnpq.br/7627103187307808Objective: To analyze the main repercussions pulmonary, clinical and radiological, in patients diagnosed with rheumatoid arthritis who are being monitored by the Center for Medical Specialties of the Pará State University Center (CEMEC-CESUPA), and from there serve as a source for secondary studies. Methods: The study is cross-sectional, descriptive and observational with quantitative and qualitative descriptive and analytical approach, with data collection in the medical records of patients treated at the Center of Medical Specialties of the University Center of the State of Pará (CESUPA), in the period between january 2014 to december 2018. Results: 156 patients with rheumatoid arthritis were analyzed. The age group and the most affected sex were, respectively, patients older than 60 years and female. Regarding smoking, 53.8% non-smokers, 37.2% former smokers and 9% smokers. Regarding the performance or not of laboratory tests, it was found that 56.4% of the patients performed PPD, 83.3% of the DAS 28 was calculated and 99.4% of the rheumatoid factor. Among the pulmonary symptoms present in 40 patients (24.5%), the most common was dyspnea, followed by chest pain and cough. Regarding the imaging exams, it was concluded that 85.3% had documented in the medical records the description of chest radiography or computed tomography or magnetic resonance, among them, 30.8% presented alteration in the exam. The main documented radiological alteration was the acinar pattern present in 75.0% of patients with alteration, followed by interstitial pattern (66.7%), pulmonary nodule (27.1), pleural pattern (10.4%) and others. Conclusion: It is necessary to perform the analysis of all patients with rheumatoid arthritis, with special attention to pulmonary repercussions due to the significant appearance of clinical and / or radiological alterations in these patients.Item Perfil epidemiológico dos pacientes com síndrome vertiginosa atendidos no ambulatório de otorrinolaringologia do Centro de Especialidades Médicas do Cesupa (CEMEC) de 2015 a 2017(Centro Universitário do Estado do Pará, 2019) Santos, Erik Matheus de Oliveira; Rocha, Iago Henriques Leite; Nunes, Leonardo Mendes Acatauassú; Penha, Nelson Elias Abrahão da; http://lattes.cnpq.br/5207645183090927; http://lattes.cnpq.br/3512764081076675Introduction: Vertigo is a disabling symptom, with direct repercussions on the patient´s life, and has a significant prevalence. especially with the advancing age. Objective: To determine the epidemiological profile of patients with vertigo attended at the Otorhinolaryngology outpatient clinic of the CESUPA Medical Specialties Center (CEMEC). Method: This is a cross-sectional and descriptive study, based on the review of medical records of patients with vertigo attended at the Otorhinolaryngology outpatient clinic of the Center of Medical Specialties of CESUPA (CEMEC), between 2015 and 2017. The data analyzed included: age, gender, race, marital status, type of vertigo, previous treatment, presence of other clinical manifestations and etiological diagnosis of vertigo syndrome. Results: Females were the most prevalent with 91.4% of the individuals, and the age range between 61 and 70 years represented the highest prevalence with 41.4% of the total. As for comorbidities, 52.9% of the individuals did not present comorbidities and 47.1% had comorbidities, 46.1% had systemic arterial hypertension and 40.4% had dyslipidemia. When assessing the clinical manifestations, the most prevalent were imbalance, tinnitus and headache. No cases of paresis, diplopia and dysarthria were observed. Regarding the type of vertigo, 94% presented vertigo of peripheral origin and 6% of central origin. Of the individuals with central vertigo, 50% had vestibular migraine, 25% cerebrovascular accident or brainstem and 25% undetermined. In relation to the diagnosis of peripheral vertigo, 45.4% of the individuals presented benign paroxysmal positional vertigo (BPPV), 6.1% of the individuals presented Ménière's disease, 6.1% bacterial labyrinthitis and 42.4% undetermined. Regarding drug treatment for vertigo, 51.4% of patients used drugs as therapy once at time, 7% used dimenhydrate, 4.2% of the subjects used betahistine, 41.8% flunarizine and 7% other treatments. There was no significant difference between the factors evaluated about the treatment (p value> 0.05). Conclusion: Vertigo is a more common pathology in females and associated with advancing age, which requires careful clinical investigation. It may have an important impact on the quality of life and need pharmacological therapy. The most prevalent causes are those with peripheral etiology and benign paroxysmal positional vertigo (BPPV), which is the most common.Item Correlação entre o autodiagnóstico de alergia alimentar e a presença de IGE específica(Centro Universitário do Estado do Pará, 2019) Eismann, Fernanda Carolina Pereira; Venturim, Vitória Destro; Barreto, Bruno Acatauassú Paes; http://lattes.cnpq.br/4741205865293040OBJECTIVES: To evaluate the relationship between self-diagnosis of food al-lergy and the presence of specific IgE for said food; METHODS: A semi-struc-tured questionnaire was administered to 100 volunteers, followed by a Prick Test for ten pre-established foods. The study was conducted in individuals between the ages of 18 and 75, of both sexes, where all signed the Term of Free and Informed Consent prior to the beginning of the research. Statistical analysis of the data was done through the Biostat 5.0 program. RESULTS: Of the 100 inter-viewees, 63% reported having some type of allergy. Among the population of self-referenced allergic individuals, 55.5% answered that their allergies were of food etiology. Of the 35 pre-test food allergy self-diagnoses, only ten tested pos-itive for Prick Test. Four new diagnoses of food allergy were performed in the study population. CONCLUSION: We conclude that the wrong self-diagnoses are a reality in the world population. The diversity of food-related pathologies, the number of concomitant adverse reactions in various diseases and the mediatic appeal of fad diets can influence many of these cases. It is fundamental the role of the physician in establishing the diagnostic resolution to the patient to avoid unnecessary restrictive diets and the propagation of overdiagnosis.Item Ocorrência da sarcopenia e suas principais complicações em idosos obesos(Centro Universitário do Estado do Pará, 2019) Reis, Fernanda de Carvalho; Tadaiewsky, Zbyeth da Silva; Maués, Cristiane Ribeiro; Cavallero, Mônica Ribeiro Maués; http://lattes.cnpq.br/0584956998438639Introduction: The world population is aging. It is estimated that in Brazil, in the last 60 years, there has been an increase of more than 15 million elderly individuals. The Ministry of Health accepts that in the elderly, defined as 60 years or older, there is an increase in the prevalence of chronic and disabling diseases, such as obesity and sarcopenia. The latter is defined by the gradual loss of skeletal muscle mass which results in a reduction in both muscle endurance and muscle strength.Objective: To identify the prevalence of sarcopenia among obese elderly who are followed up at the Obesity Outpatient Clinic of CESUPA Medical Center (CEMEC).Methodology: The study analyzed 14 patients who were enrolled at the CEMEC Obesity Outpatient Clinic. Data collection was performed in 2 steps. In the first, data on age, gender, previous diagnoses and occurrence of falls were collected in a specific research form. Then, the participants were submitted to anthropometric measurements, body composition evaluation and functional performance tests. Bioimpedance, Grip Hand Strength Test, Timed up and go and Gait Speed were used. The 2018 European Criteria (EWGSOP2) were used as a reference for the diagnosis of sarcopenia.Results: It was observed that none of the analyzed sample had a diagnosis for sarcopenia, however, two patients had lower palmar grip strength, which was classified as probable sarcopenia.Conclusion: This study concluded that although results were negative to confirm the diagnosis of sarcopenia in the sample, relevant changes in body composition and physical performance were perceived, thus contributing in the future to the establishment of a condition with sarcopenia and its complications.Item Perfil clínico e epidemiológico na primeira consulta de pacientes matriculados em ambulatório de obesidade infantil(Centro Universitário do Estado do Pará, 2019) Meira, Breno Figueiredo; Mergulhao, Thalita Martins; Silva, Silvana Cristina Rodrigues da; Rocha, Mônica Souza Filho Moura; http://lattes.cnpq.br/1302412321438738; http://lattes.cnpq.br/6484463061528812INTRODUCTION: Obesity among children and adolescents is increasing, becoming a worldwide epidemic. Several factors are related in its genesis, including genetic, sedentary lifestyle, screen-based lifestyle, tablets and video games lifestyles, and unhealthy diet. In this context, the study that reveals the clinical and epidemiological profile of patients in the first consultation evaluation of the Childhood Obesity Outpatient Clinic of a Medical School of the city of Belém is enriching. OBJECTIVE: To evaluate the clinical and epidemiology of patients enrolled in the childhood obesity outpatient clinic. METHODOLOGY: A descriptive, transversal study with information extraction through an elaborated questionnaire applied in the first consultation file of the medical records. RESULTS: Sixty-one medical records registered at CEMEC's Childhood Obesity Outpatient Clinic were evaluated. It was identified 62.3% male and 37.7% female. The age groups found were schoolchildren and adolescents, with 47.5% and 52.5% respectively. Physical activity was not reported by 68.9% of patients. Most patients reported screen time greater than 2 hours daily. There is no significant difference in patients who underwent exclusive breastfeeding up to 6 months, and those who did not. A large proportion of patients had severe obesity (52.5%), especially boys, while 39.3% had obesity and 8.2% were overweight. The most declared monthly household income was 1 to 2 minimum wages. Among the parent's education there was a significant proportion for the complete high school of mothers (39.3%) and fathers (19.7). The presence of a family history of obesity was more frequently reported (72.1%). There was a significant proportion of patients with blood pressure below the 90th percentile (70.5%). CONCLUSION: it is necessary to know the epidemiological profile of childhood obesity, so that health professionals can update themselves with the current scenario, and take knowledge of childhood obesity, to better prevent, diagnosticate and treat, above all, doctors who work in childcare.Item Avaliação da morfologia e função tireoidiana nos pacientes acromegálicos atendidos no Centro de Especialidades Médicas do CESUPA (CEMEC)(Centro Universitário do Estado do Pará, 2019) Ribeiro, Bruna Dias da Costa; Rodrigues, Silvana da Silva; Bastos, Fabíola de Arruda; Caldato, Milena Coelho Fernandes; http://lattes.cnpq.br/9477878606835309; http://lattes.cnpq.br/9386935778704228Introduction: Acromegaly is a chronic and multisystemic desease, has an insidious onset, and is debilitating. Results from hypersecretion of Growth Hormone and Insulin Growth Factor. The mortality rate is up to 3.5 times larger than the unaffected population due to mainly associated comorbidities and the late character of its diagnosis. Among the proved associations, it’s important to give attention to thyroid functional modifications and it’s morphology, due to evolution of these modifications until the appearance of thyroid neoplasms. Objective: Evaluate thyroid morphology and thyroid functional disorders in acromegalic patients attended at the “Centro de Especialidades Médicas (CEMEC) – CESUPA”, on the Pituitary and Adrenal abulatory. Methodology: Epidemiological, cross-sectional and retrospective study. Data were collected from the acromegalics patient’s medical records, enrolled at the Pituitary and Adrenal abulatory, at CEMEC until June 2019, with a total of 59 patients. Results: Most of the acromegalic patients treated at CEMEC presented pituitary macroadenoma (83.1%) in the initial evaluation. Among the altered laboratory results of TSH (first evaluation 17 and last evaluation 7), the majority presented values below normal in both the first (n = 15) and the last evaluation (n = 6). Thyroxine altered values were also analyzed (first evaluation n=10 and last evaluation n=8), and there was a higher occurrence of results below normality in the first evaluation (n = 7) and equality between values below and above normality in the final evaluation, however without statistically significant results (p = 0.9849). Evaluating the presence of thyroid nodules with gender and time of disease, there was no statistically significant difference (respectively p = 0.9426 and p = 0.4115), however, the relation was significant when related to age group, with a higher frequency between 70 and 79 years. years old (* p = 0.0435). Furthermore, it was evidenced that there was no statistically significant relation between the IGF-1 LSN values and the occurrence of thyroid nodules in the first and final evaluations (respectively p = 0.5834 and p = 0.9514). There was also no statistically significant relationship when analyzing mean GH values and nodule occurrence at the first and last assessment (p = 0.7197 and 0.6831).Conclusion: In the thyroid ultrasonography, most of the nodules found in the first and final evaluation had the following characteristics: localization in the right, single, hypoechoic sludge, with solid content and regular contours. The characteristics found weren’t suggestive of malignancy. Although acromegaly treatment control is unrelated to the occurrence of nodules, it is extremely important to follow up these possible modifications to improve the life expectancy of these patients and the early detection of potentially malignant lesions.