ABSTRACT
Introducción: La incidencia de tumores primarios de origen desconocido en pacientes oncológicos es del 0,5 al 7 por ciento en el momento del diagnóstico con una supervivencia a los 3 y 5 años de 11 y 6 por ciento, respectivamente. Objetivo: valorar la utilidad de la técnica PET/CT-FDG (Tomografía por emisión de positrones con 18F-Fluordeoxiglucosa) en el diagnóstico de tumor primario de origen desconocido (TOD). Material y método: Se analizaron retrospectivamente los estudios PET/CT-FDG realizados en pacientes con el diagnóstico de TOD para la búsqueda de tumor primario, con estudios convencionales previos negativos, entre noviembre de 2017 y junio de 2018. El diagnóstico final se estableció mediante confirmación histológica y/o seguimiento clínico/radiológico por 8 meses. Resultados: 42 pacientes fueron estudiados, en 19 estudios PET/CT se evidenciaron focos de captación sugestivos de tumor primario, de los cuales 9 se confirmaron histológicamente como verdaderos positivos y sólo 1 correspondió a un falso positivo. De los 23 pacientes con PET/CT negativos para tumor primario, todos continuaron con diagnóstico de TOD a pesar de las múltiples pruebas diagnósticas. Conclusiones: La técnica PET/CT permitió identificar el 45,2 por ciento de los tumores primarios en la muestra de pacientes, lo que la convierte en una herramienta útil para el diagnóstico en pacientes con metástasis de origen desconocido. Se considera que el PET/CT-FDG debe ser incluido de manera precoz en los algoritmos diagnósticos en Cuba, permitiendo orientar la realización de pruebas complementarias subsiguientes(AU)
Introduction: The incidence of carcinoma of unknown primary origin in oncologic patients is from 0,5 percent to 7 percent at the time of diagnosis with an overall 3-year and 5-year survival of 11 percent and 6 percent, respectively. Objective: To assess the effectiveness of 18 F-FDG-PET/CT (18F-fluorodeoxyglucose posıtron emıssıon tomography) in the diagnosis of carcinoma of unknown primary origin (CUP). Material and Methods: F-FDG-PET/CT studies were conducted in patients with CUP in the search for primary tumor with negative previous conventional studies carried out from November, 2017 to June 2018. The final diagnosis was established by histological confirmation and/or clinical/radiological follow-up during 8 months. Results: A total of 44 patients were studied. There were evidences of suggestive CUP in 19 patients; 9 of them were histologically confirmed as true-positive and only 1 was a false-positive. Of the 23 patients with negative F-FDG-PET/CT studies for primary tumor, all of them continued with the diagnosis of CUP in spite of multiples diagnostic tests. Conclusions: The FDG-PET/CT technique allowed to identify 45,2 percent of the primary tumors in this study, which demonstrates that it is very useful tool for the diagnosis of metastases of unknown origin. It is considered that F-FDG-PET/CT studies should be included earlier in the diagnostic algorithms in Cuba, which will allow to indicate subsequent complementary tests(AU)
Subject(s)
Humans , Neoplasms, Unknown Primary/diagnosis , Positron-Emission Tomography/methodsABSTRACT
Resumo O artigo analisa a tendência crescente da multiplicação de diagnósticos psiquiátricos na infância, que encontra legitimidade no argumento que indica que se as patologias psiquiátricas da infância não forem devidamente tratadas, será altamente provável que, na vida adulta, surjam graves problemas psiquiátricos irreversíveis, assim como problemas associados à criminalidade e à delinquência. Analisa-se o exemplo do transtorno de oposição e desafio, conhecido como TOD, na medida em que, de acordo com o DSM-5, essa patologia supõe um alto risco para o desenvolvimento do transtorno de personalidade antissocial, patologia que apresenta conotações claramente jurídicas e criminológicas. Esses diagnósticos são analisados em perspectiva crítica a partir do conceito foucaultiano de "dispositivo de segurança".
Abstract The article analyzes the growing tendency to multiply psychiatric diagnoses in childhood, which finds legitimacy in the argument that, if childhood psychiatric disorders are not properly treated, it will be highly probable that in adult life there will be serious irreversible psychiatric problems, problems associated with crime and delinquency. The example of oppositional and defiant disorder, known as TOD, is analyzed insofar as, according to DSM-5, this pathology supposes a high risk for the development of antisocial personality disorder, a condition that presents clearly juridical connotations and criminological. These diagnoses are analyzed in a critical perspective from the Foucauldian concept of "safety device".
Subject(s)
Humans , Male , Female , Child , Adolescent , Violence , Child Health , Juvenile Delinquency , Mental Disorders/diagnosis , Mental Disorders/therapy , Attention Deficit and Disruptive Behavior Disorders , Conduct Disorder , Criminal BehaviorABSTRACT
OBJETIVO: descrever a experiência da implementação do Programa Municipal de Controle da Tuberculose (PMCT) no município de Marataízes-ES, Brasil, em 2012. MÉTODOS: relato de experiência sobre as ações de controle da tuberculose no município; realizou-se busca ativa de sintomáticos respiratórios (SR) e casos de abandono do tratamento do ano anterior, incluindo locais de uso comum de drogas, além da capacitação dos profissionais de saúde envolvidos no manejo clínico e cuidado dos doentes e palestras educativas sobre tuberculose nas escolas municipais; a assistência foi realizada também durante finais de semana e feriados. RESULTADOS: foram identificados 98 SR (35 usuários de droga); 27 pacientes foram diagnosticados, notificados e submetidos à terapia diretamente observada (TDO); não houve abandono do tratamento; 25 casos de tuberculose foram encerrados por cura. CONCLUSÃO: a implementação do PMCT mediante uma rede integrada fortaleceu os mecanismos organizacionais de assistência ao portador de tuberculose e aprimorou os indicadores epidemiológicos municipais.
OBJECTIVE: to describe the experience of Municipal Tuberculosis Control Program (MTCP) implementation in the city of Marataízes, State of Espírito Santo, in 2012. METHODS: this is an report the experience of tuberculosis control actions. Respiratory symptomatic (RS) subjects and patients who abandoned treatment in the previous year were actively traced, including in places where drug use is common. Training was provided to healthcare professionals involved in patient clinical management and care. Educational talks on tuberculosis were given in municipal schools. Healthcare was also provided on weekends and holidays. RESULTS: 98 RS were identified (35 drug users); 27 patients were diagnosed, notified and underwent directly observed therapy (DOT); there was no treatment abandonment; 25 tuberculosis cases were cured. CONCLUSION: MTCP implementation through an integrated network strengthened the organizational mechanisms of healthcare to those with tuberculosis and improved municipal epidemiological indicators.
OBJETIVO: describir la experiencia de la implementación del Programa Municipal de Control de Tuberculosis (PMCT) en el municipio de Marataízes-ES, en 2012. MÉTODOS: relato de experiencia sobre las acciones de control de tuberculosis en el municipio. Se realizó una búsqueda activa de personas con síntomas respiratorios (SR) e casos de abandono de tratamiento, durante el último año, incluyendo locales de uso común de drogas, además de la capacitación de profesionales de la salud, envueltos en el manejo clínico y cuidado de los enfermos y de dar conferencias educativas sobre tuberculosis en las escuelas públicas. La asistencia fue también realizada durante finales de semana y feriados. RESULTADOS: se identificaron 98 SR (35 usuarios de drogas); 27 pacientes fueron diagnosticados, notificados y sometidos a terapia por observación directa (TOD); no hubo abandonos, siendo que 25 casos de tuberculosis fueron finalizados con cura. CONCLUSIÓN: la implementación del PMCT por medio de una red integrada fortaleció los mecanismos organizacionales de asistencia al portador de tuberculosis y mejoró los indicadores epidemiológicos municipales.
Subject(s)
Humans , Male , Female , Directly Observed Therapy , Health Information Systems , Health Programs and Plans , Tuberculosis/prevention & controlABSTRACT
A velhice tem várias facetas e preconceitos associados ao que representa. Nosso objetivo é refletir acerca das peculiaridades relacionadas ao fenômeno ser velho e seus impactos no sujeito, destacando o lidar com o desencontro entre o inconsciente atemporal e o corpo envelhecido, chamado de envelhescência. Partimos do pressuposto que os discursos que normatizam o corpo tomam conta da vida simbólico-subjetiva do sujeito, não deixando espaço para a construção de uma narrativa individual.
Old age has facets and preconceptions that are associated with what it represents. Our aim here is to study the peculiarities related to the phenomenon of being old and its impacts on the subject. We focus on how individuals deal with the disparity between the timeless unconscious and the aged body. We assume that the discourses that standardize the body dominate the symbolic subjective life of the subject and leave no room for the construction of an individual narrative.
La vieillesse possède de nombreuses facettes et de préjugés associés à ce qu'elle représente. Notre article porte sur l'étude des particularités liées au phénomène d'être âgé et de ses impacts sur le sujet, en soulignant comment le décalage entre l'inconscient intemporel et le corps âgé, aussi appelé vieillir, est géré. Nous supposons que les discours qui normalisent le corps dominent la vie symbolique subjective du sujet, ne laissant aucun espace pour la construction d'un récit individuel.
La vejez tiene muchos aspectos y prejuicios asociados a lo que representa. Nuestro objetivo es estudiar lo que es peculiar acerca del fenómeno de 'ser viejo' y sus impactos en el sujeto, destacando el manejo del desacuerdo entre el inconsciente atemporal y el cuerpo envejecido, a que se refiere el envejecimiento. Partimos del supuesto de que los discursos que regulan el cuerpo dominan la vida simbólica y subjetiva del sujeto sin dejar espacio para la construcción de una narrativa individual.
Subject(s)
Humans , Aged , Death , Aging/psychology , Human Body , PsychoanalysisABSTRACT
Background & objectives: Microalbuminuria has been described as an early sign of vascular damage in certain high risk goups such as diabetes, hypertension & family history of cardiovascular renal disease. In diabetes mellitus the prognostic value of microalbuminuria as a marker of early nephropathy and increased cardiovascular risk has been well established. The aim of this study is to establish the prevalence of microalbuminuria in nondiabetic essential hypertensive patients and its relation with target organ damage. Material and Methods: 100 non diabetic essential hypertensive patients attending OPD as well as admitted in the tertiary care hospital of Jamnagar were included in this study. They underwent detailed clinical examination. A single early morning urine sample was used to measure microalbuminuria by Micral test strip and urine creatinine was measured to establish albumin creatinine ratio. Results: The age of patients selected for study varied from 35 to 76 years; mean age being 51.5 years. 52% were males and mean duration of hypertension was 3.9 +/- 3.9 yrs. Microalbuminuria was found in 46% of the patients and showed significant association with male gender (p=0.001), age (p<0.05) & target organ damage in any form (p<0.05). Interpretation and conclusion: Measuring urinary albumin excretion (UAE), a simple, low cost and readily available test, can be regarded as a cost effective way to identify nondiabetic essential hypertensives at high risk and can thus help to prevent the development of complications by aggressive treatment to get down to target blood pressure.