Polysomnographic evaluation of obstructive sleep apnea treatment with fixed pressure CPAP determined by formula.

PURPOSE: The use of continuous positive airway pressure (CPAP) is one of the therapeutic modalities for obstructive sleep apnea (OSA). Manual titration polysomnography and the 90th or 95th percentiles of pressure titrated by automatic CPAP (APAP) are the current standard for determining fixed pressure. Pressures programmed at an arbitrary fixed value, or at preset values based on body mass index (BMI) or by predictive formulas, are presented as alternative forms. This study aimed to evaluate the residual apnea-hypopnea index (r-AHI) in polysomnography with CPAP therapy using pressure determined by formula and assess its feasibility to start treatment. METHODS: Patients referred for CPAP therapy were followed up in three outpatient assessments and underwent polysomnography study with pressure CPAP obtained by formula. RESULTS: The study sample consisted of 80 patients, 41 women; age 58.6 ± 11.3 years, BMI 34.1 ± 7.5 kg/m2 and cervical circumference 42.0 ± 4.2 cm. Most patients (74%) had severe OSA and Epworth sleepiness scale (ESS) of 12.0 ± 5.7 points. The calculated average pressure was 7.8 ± 2.1 cmH2O. Polysomnography studies showed an r-AHI of 6.1 ± 5.2 events/h and reduction of 84% from baseline AHI. The r-AHI in the REM-supine was 8.4 ± 9.9 events/h. At 30- and 120-day follow-up assessment, adherence to CPAP was 78% and 75% and the ESS score was 6.9 and 6.1 points, respectively. CONCLUSION: Results suggest that a formula provides an effective initial pressure in the majority of patients (73%). This simplified approach appears to be a viable alternative, with reductions in waiting lists and time from diagnosis to initiation of therapy.

Entamoeba histolytica/Entamoeba dispar infection in chronic hemodialysis patients.

To determine the prevalence of Entamoeba histolytica/E. dispar (Eh/Ed) in chronic hemodialysis (HD) patients, we collected 330 samples of feces from 110 patients, and nine individuals were found to be positive for Eh/Ed. We compared the infected patients with a group of 14 uninfected HD patients. Both groups were analyzed for their signs, symptoms and socio-economic characteristics using questionnaires. Blood tests were also performed in both the groups. Although both groups did not differ statistically with respect to their signs, symptoms and socio-economic conditions, there was a trend toward a greater number of individuals with diarrhea in the Eh/Ed infected group. In conclusion, we suggest that a parasitological examination of the patient's stool to detect the Eh/Ed complex should be included with the routine tests so that those patients with a positive fecal test could be initiated on appropriate anti-Eh/Ed therapy.

Estudo da gravidade dos pacientes vítimas de acidentes de trânsito atendidos pelo hospital de clínicas de Uberlândia de dezembro de 2005 a março de 2006 segundo índices de trauma / Traffic victims and their injuries, as treated in the emergency room of the university hospital of Uberlândia (HCU), from december, 2005 through march, 2006 based on trauma scales

Calculamos os índices Injurity Severity Score (ISS), Revised Trauma Score (RTS) e Escala de Coma de Glasgow (ECG) dos pacientes vítimas de acidentes de trânsito atendidas no Hospital de Clínicas de Uberlândia (HCU) aos sábados dos meses de dezembro de 2005 a março de 2006, além de analisar os dados epidemiológicos referentes ao acidente, aos pacientes e ao atendimento pré e intra-hospitalar (primeiro atendimento). As informações foram obtidas nos prontuários das vítimas. A maioria dos pacientes apresentou lesões na superfície externa do corpo (58; 53,7 por cento), seguida por lesões em extremidades e ossos da pelve (30; 27,8 por cento) e por cabeça e face (15; 13,9 por cento). O sexo masculino foi o mais acometido (53; 58,2 por cento) e os acidentes motociclísticos foram os mais freqüentes (29; 31,9 por cento). Quanto ao ISS, os pacientes em geral apresentaram baixos escores, não excedendo a 16. Todas as vítimas tiveram escores altos na escala de coma de Glasgow, sendo que 60 (65,9 por cento) apresentaram escore igual a 15. Para 17 pacientes (18,7 por cento) foi possível o cálculo do índice RTS. Destes, 15 (88,2 por cento) obtiveram escore final 12. Concluímos que a maioria dos pacientes atendidos no HCU por acidentes de trânsito apresentou trauma leve, sendo que valores RTS e ECG altos correlacionaram-se com escores ISS baixos, indicadores de bom prognóstico e baixo risco de vida, o que em um hospital de atendimento de nível terciário congestiona o serviço e demanda ônus monetário e de pessoal, podendo interferir no bom atendimento de casos de maior complexidade.

The authors applied three different measurement tools to analyze patients, victims of traffic accidents, at the Emergency Room of the Hospital de Clínicas in Uberlândia, Minas Gerais (HCU). The measures used were: the Injury Severity Score (ISS), Revised Trauma Score (RTS) and the Glasgow Coma Scale (GCS). The data, including epidemiological factors, were collected from patients’ charts as they were treated, on Saturdays from December, 2005 through March of the following year. Most of the patients presented superficial lesions or abrasions to the body (58 patients; 53.7 percent), followed by lesions to the extremities and hips (30; 27.8 percent) and head and face injuries (15; 13.9 percent). Most of the injured were male (53; 58.2 percent) and accidents involving motorcycles were very frequent (29; 31.9 percent). Regarding the Injury Severity Score (ISS) patients demonstrated relatively low scores, not exceeding 16. All victims scored high on the Coma Glasgow Scale; of these, 60 (65.9 percent), presented a score of 15. Seventeen patients (18,7 percent) were assessed using the RTS scale. Of these, fifteen (88,2 percent), were given a final score of 12. It was concluded that the majority of the victims of traffic accidents admitted to the HCU Emergency Room during the period of the study demonstrated minimal trauma. High values for RTS and GCS correlated with lower ISS scores, indicating an adequate prognosis and a reduced risk to the patients’ lives. Unfortunately the services and costs involved with their treatment led to a congested situation prejudicial to adequate assistance for more serious cases.

Estudo epidemiológico de queimaduras atendidas nas Unidades de Atendimento Integrado de Uberlândia-MG entre 2000 a 2005 / Epidemiological study of burns attended at the Integrated Assistance Units of Uberlandia-MG between 2000 and 2005

Objetivo: Verificar os aspectos epidemiológicos de queimaduras atendidas nas Unidades de Atendimento Integrado (UAIs) de Uberlândia-MG. Método: O trabalho foi realizado com dados referentes aos casos de queimaduras registrados nas UAIs, no período de 2000 a 2005. Foram analisadas as seguintes variáveis: número de pessoas queimadas, faixa etária, local do corpo acometido e profundidade da lesão. Resultados: Houve 12.707 queimaduras, com pico em 2002, seguido de redução nos dois anos seguintes e um novo aumento em 2005. A UAI Roosevelt foi a que apresentou maior quantidade de casos. Houve prevalência dos acidentes na faixa etária entre 20-39 anos, seguido pela faixa de 0-19 anos. Na faixa pediátrica, houve predomínio entre 1-4 anos. Foi observado um porcentual significativo de casos em que o grau da lesão não foi classificado, totalizando 46%. As lesões de segundo grau foram responsáveis por 33% dos casos classificados. A região ocular correspondeu a 13% das queimaduras. Conclusão: Os centros de atendimento primário e secundário refletem de forma mais fidedigna a prevalência do número de queimados. Observou-se diminuição no número de queimados após a lei que proibiu a venda do álcool líquido e posterior aumento quando a lei foi revogada. Houve a prevalência de queimaduras na faixa etária de 20 aos 39 anos, associadas a casos de acidentes de trabalho. As lesões de segundo grau responderam pela maioria dos casos classificados. A queimadura ocular obteve expressividade quando comparada ao restante do corpo. Os dados desse trabalho foram utilizados para originar o projeto de extensão "Uberlândia não quer se queimar".

Objective: To verify the epidemiologic aspects of burns attended at the Integrated Assistance Units (IAUs) of Uberlandia-MG. Methods: This research was realized with data referring to the cases of burns attended at the IAUs between 2000 to 2005. The number of burns, age, part of the body injured and profundity of burn were analised. Results: There were 12.707 burn incidents, with a peak in 2002, followed by a reduction in the subsequent two years and a new increase in 2005. The Roosevelt neighborhood IAU presented the biggest quantity of cases. There was a prevalence of accidents in the age between 20 and 39 years, followed by the age between 0 and 19 years. In the pediatric range, there was predominance between the age of 1 and 4 years. There is an important percentage of cases where the grade of burns were not classified, around 46%. Second grade burns were responsible for 33% of the classified cases. The ocular region corresponded to 13% of the burns. Conclusion: The centers for primary and secondary care reflect in a more trustworthy way the prevalence of the number of burn victims. A decrease in the number of burn victims was observed after the law that prohibited the sale of the liquid alcohol was passed and then a subsequent increase when the law was revoked. There was the prevalence of burns in the age group from 20 to the 39 years, associated with job accidents. The lesions of second grade answered for most of the classified cases. Ocular burns obtained expressiveness when compared to the remaining of the body. The data of this work was used to originate the extension project "Uberlandia doesn't want to burn itself".