ABSTRACT Background: unveiling the social representations of breast cancer can bring professionals in the psychological sciences to understand attitudes, behaviors and the influences they exert on patients, family members and specialists. Objective: to determine the structure of the social representations (attitude, information, representational field) of breast cancer in the study subjects. Methods: exploratory, cross-sectional study, of mixed methodology, in the period from May 2014 to December 2015. Applied as techniques: sociodemographic and clinical data form, semi-structured interview, composition, free association. The variables analyzed were: addressability of the attitude towards the diagnosis of breast cancer, addressability of the attitude towards treatments, in the information dimension: knowledge about disease conceptualization, knowledge of symptoms, knowledge about treatments, beliefs about risk factors , opinions on the consequences of breast cancer, opinions on the need to provide knowledge of the disease to patients, relatives. Descriptive statistical analysis of frequencies was performed. The information of the variables in the database of the statistical package SPSS 15.0 for Windows was processed. The results were expressed in absolute and relative frequencies. Results: patients, relatives showed addressability of the negative attitude towards diagnosis and treatment. There was a prevalence of adjusted responses in the explored areas of the information dimension, although with a homogeneous level of depth, in family members. The representative field of breast cancer accounted for mostly models of disease challenge in the study subjects. Conclusions: the subjects of the study in relation to breast cancer showed a negative attitude, there was a predominance of adjusted answers about the pathology information and mostly models of disease challenges.

RESUMEN Fundamento: develar las representaciones sociales del cáncer mamario puede acercar a profesionales de las ciencias psicológicas a comprender actitudes, conductas y las influencias que ejercen en pacientes, familiares y especialistas. Objetivo: determinar la estructura de las representaciones sociales (actitud, información, campo representacional) del cáncer mamario en los sujetos del estudio. Métodos: estudio exploratorio, transversal, de metodología mixta, en el período comprendido entre mayo 2014 a diciembre de 2015. Se aplicaron como técnicas: formulario datos sociodemográficos y clínicos, entrevista semiestructurada, composición, asociación libre. Las variables analizadas fueron: direccionabilidad de la actitud hacia el diagnóstico del cáncer mamario, direccionabilidad de la actitud hacia los tratamientos, en la dimensión información: conocimientos sobre conceptualización de la enfermedad, conocimientos de los síntomas, conocimientos sobre tratamientos, creencias sobre factores de riesgo, opiniones sobre las consecuencias del cáncer mamario, opiniones sobre necesidad de brindar conocimientos de la enfermedad a pacientes, familiares. Se efectuó análisis estadístico descriptivo de frecuencias. Se procesó la información de las variables en la base de datos del paquete estadístico SPSS 15.0 para Windows. Los resultados se expresaron en frecuencias absolutas y relativas. Resultados: pacientes, familiares mostraron direccionabilidad de la actitud negativa hacia el diagnóstico y tratamientos. Prevalencia de respuestas ajustadas en las áreas exploradas de la dimensión información, aunque con nivel de profundidad homogéneo los familiares. El campo representacional del cáncer mamario dio cuenta de modelos mayoritariamente de desafío a la enfermedad en los sujetos del estudio. Conclusiones: cómo se comportaron el conocimiento de la estructura de las representaciones sociales del cáncer mamario en los sujetos del estudio, contribuye al análisis del marco de referencia de la actuación sanitaria, desde un abordaje integral, holístico, por coexistir sentido común y ciencia.

Abstract Objective: Exercise-induced premature ventricular complexes (EiPVCs) are often considered as benign arrhythmias, although they are associated with a high risk of all-cause death in the general healthy population. However, an intermediate pathophysiological process remains unclear, particularly in patients with known cardiovascular disease. The aim of this study was to find an association between EiPVCs, the occurrence of life-threatening ventricular arrhythmias (LACO), and all-cause mortality in patients with cardiovascular disease. Methods: This was an observational study of a cohort of patients with coronary artery disease (CAD) or idiopathic cardiomyopathy (ICM). Stress testing was performed as a part of the routine cardiovascular evaluation. The occurrence of EiPVCs was evaluated during exercise testing (ET). At follow-up, long-term occurrence of LACO was evaluated. A bivariate and multivariate analysis was performed. Results: Out of the total of 1442 patients analysed, 700 (49%) had EiPVCs. During 14 years of following-up after ET, 106 LACO outcomes were observed. Long-term all-cause mortality was 4% (n = 61). A bivariate analysis showed that patients with EiPVCs had an increased risk for LACO (RR = 2.81, 95% CI; 1.9---4.3, P < .001), and for mortality (RR = 2.1, CI95% 1.2---3.4, P < .01). Occurrence of LACO was also associated with a higher mortality risk (RR = 5.7, 95% CI; 3.4---9.4, P < .001). After a post hoc analysis, LACO remained as a highly predictive variable for mortality. Conclusion: Patients with EiPVCs have a high risk of LACO and all-cause mortality. The presence of LACO could be an intermediate stage between EiPVCs and mortality in subjects with cardiovascular disease.

Resumen Objetivo: La extrasistolia ventricular inducida por ejercicio (EVIE) suele considerarse una arritmia benigna, sin embargo, ha sido asociada a mayor mortalidad en población general. Hasta hoy no se ha encontrado el proceso fisiopatológico involucrado, particularmente en pacientes con enfermedad cardiovascular. El objetivo del estudio fue establecer una asociación entre EVIE con la ocurrencia de arritmias ventriculares potencialmente malignas (APM) y letalidad a largo plazo, en sujetos con enfermedad cardiovascular. Método: Estudiamos una cohorte de pacientes con enfermedad coronaria o miocardiopatía dilatada, que realizaron una prueba de ejercicio al inicio del estudio. Inicialmente evaluamos la ocurrencia de EVIE, APM y letalidad a largo plazo y posteriormente se realizó un estudio bivariable y multivariable. Resultados: Se incluyeron 1,442 pacientes de los cuales 700 presentaron EVIE (49%). Durante 14 an˜os de seguimiento, 106 sujetos presentaron APM y la mortalidad total fue de 61 casos (4%). El estudio bivariable mostró que aquellos pacientes con EVIE tuvieron un riesgo de presentar APM de 2.81 (IC95% de 1.9 a 4.3, p < 0.001) y de mortalidad de 2.1 (IC95% de 1.2 a 3.4, p < 0.01). Los individuos con APM tuvieron mayor riesgo de mortalidad (RR= 5.7, IC95% de 3.4 a 9.4, p < 0.001). Después de un análisis multivariable, la APM continuó siendo una variable altamente predictiva de mortalidad. Conclusión: Los pacientes con EVIE tienen un riesgo elevado de presentar APM y de mortalidad a largo plazo. Los resultados sugieren que las APM podrían representar un estado intermedio entre la presencia de EVIE y la mortalidad en pacientes con enfermedad cardiovascular.

OBJETIVOS: Descrever os resultados maternos e neonatais de mulheres grávidas que estavam em tratamento de hemodiálise em um centro de referência no Sudeste brasileiro.MÉTODOS: Estudo retrospectivo e descritivo, com revisão de prontuários de todas as gestações em hemodiálise, acompanhadas no pré-natal especializado da região Sudeste do Brasil.RESULTADOS: Entre as 16 mulheres identificadas, 2 foram excluídas devido à perda de seguimento. Das 14 descritas, a hipertensão foi a causa mais frequente de insuficiência renal crônica (50% dos casos). A maioria (71,4%) realizava tratamento de hemodiálise há mais de um ano e todas elas foram submetidas a 5 ou 6 sessões por semana. Onze mulheres tinham hipertensão crônica, 1 das quais também era diabética, e 6 eram fumantes. Em relação às complicações da gravidez, 1 das mulheres hipertensas desenvolveu hipertensão maligna (com restrição de crescimento fetal e parto prematuro com 29 semanas), 2 tiveram edema pulmonar agudo e 2 apresentaram descolamento prematuro de placenta. O tipo de parto foi cesariana em 9 mulheres (64,3%). Todos os recém-nascidos tiveram Apgar aos cinco minutos maior que 7.CONCLUSÕES: Para melhorar os resultados perinatais e maternos de mulheres em hemodiálise, é importante ter uma abordagem multidisciplinar em centro de referência, um controle rigoroso da uremia, hemoglobina e pressão arterial materna, bem como acompanhar de perto o bem-estar fetal e a morbidade materna. Outra estratégia importante é a orientação adequada para contracepção nessas mulheres.

PURPOSE: To describe maternal and neonatal outcomes in pregnant women undergoing hemodialysis in a referral center in Brazilian Southeast side.METHODS: Retrospective and descriptive study, with chart review of all pregnancies undergoing hemodialysis that were followed-up at an outpatient clinic of high- risk prenatal care in Southeast Brazil.RESULTS: Among the 16 women identified, 2 were excluded due to follow-up loss. In 14 women described, hypertension was the most frequent cause of chronic renal failure (half of cases). The majority (71.4%) had performed hemodialysis treatment for more than one year and all of them underwent 5 to 6 hemodialysis sessions per week. Eleven participants had chronic hypertension, 1 of which was also diabetic, and 6 of them were smokers. Regarding pregnancy complications, 1 of the hypertensive women developed malignant hypertension (with fetal growth restriction and preterm delivery at 29 weeks), 2 had acute pulmonary edema and 2 had abruption placenta. The mode of delivery was cesarean section in 9 women (64.3%). All neonates had Apgar score at five minutes above 7.CONCLUSIONS: To improve perinatal and maternal outcomes of women undergoing hemodialysis, it is important to ensure multidisciplinary approach in referral center, strict control of serum urea, hemoglobin and maternal blood pressure, as well as close monitoring of fetal well-being and maternal morbidities. Another important strategy is suitable guidance for contraception in these women.

BACKGROUND: Fundamentos: As onicomicoses são infecções fúngicas que representam mais de 50% de todas onicopatias e são consideradas por alguns autores a micose superficial de mais difícil tratamento. Poucos estudos foram feitos para investigar a epidemiologia da onicomicose no Brasil. OBJETIVO: Descrever perfil epidemiológico da onicomicose nos consultórios brasileiros de dermatologia. Também observar a etiologia, a freqüência da solicitação do exame micológico e a terapia empregada. MÉTODOS: Foi realizado um estudo descritivo e observacional no período de Maio a Julho de 2010. Participaram 38 dermatologistas de diferentes regiões do Brasil e foram incluídos 7852 pacientes. RESULTADOS: Dos 7852 pacientes, 28.3% apresentaram diagnóstico de onicomicose. Mulheres, maiores de 45 anos, praticantes de esportes, ou com histórico pessoal da doença, apresentaram chance maior de adquirir onicomicose. A doença foi mais frequente nos pés, sendo o hálux, o dedo mais acometido. Nas mãos, o primeiro dedo foi o mais atingido. Exame micológico não foi solicitado para todos os casos. Quando realizado, o fungo mais freqüente foi o Trichophyton rubrum. A lesão clinica mais comum foi a distal-lateral. Os tratamentos tópicos mais prescritos foram amorolfina e ciclopirox olamina, enquanto os sistêmicos foram o fluconazol e a terbinafina. CONCLUSÃO: Este estudo foi de fundamental importância para descrever o comportamento epidemiológico da onicomicose nos consultórios dermatológicos brasileiros e determinar fatores de risco, como gênero, idade, prática de esportes, antecedente pessoal de onicomicose e comorbidades. Esperamos contribuir na melhora da abordagem terapêutica e prevenção desta doença.

BACKGROUND: Onychomycosis is a type of fungal infection that accounts for over 50% of all onycopathies. Some authors consider superficial mycosis the most difficult to be treated. Very few studies have been carried out in order to assess the epidemiology of onychomycosis in Brazil.OBJECTIVE: To describe the epidemiological profile of onychomycosis in Brazilian dermatology offices and to assess the etiology of the disease, how often mycosis exams are requested, and the treatment adopted.METHODS: A descriptive, observational study was carried out between May and July, 2010. Thirty-eight dermatologists from different Brazilian regions participated in the study, and 7,852 patients with any skin diseases who had all of their nails examined were included in the study.RESULTS: Of the 7,852 patients, 28.3% were clinically diagnosed as having onychomycosis. Women over 45 years old who practiced exercises or with a personal history of the disease showed greater likelihood of having onychomycosis. The disease was most seen in the feet, and the majority of cases involved the hallux. On the hands, the index finger was the most affected. Mycosis exams were not requested for all clinically suspected cases. When exams were done, results showed that the most common fungus was Trichophyton rubrum. The most common clinical lesion was distal-lateral. The most prescribed topical treatments were amorolfine and ciclopirox olamine, while systemic treatments included fluconazole and terbinafine.CONCLUSION: This study was important to describe the epidemiological behavior of onychomycosis in Brazilian dermatology offices and to determine important risk factors, such as gender, age, practice of exercises, personal history of the disease, and comorbidities.

OBJETIVOS: Conhecer a prevalência e alguns fatores associados ao baixo peso ao nascer entre gestantes adolescentes. MÉTODOS: Estudo de corte transversal, realizado entre outubro de 1994 a dezembro de 2009, com os partos ocorridos em uma maternidade de Campinas, utilizando informações coletadas em uma Ficha Obstétrica Informatizada. Foram selecionados os casos de partos entre adolescentes e, posteriormente, separados em dois grupos com e sem baixo peso ao nascer. Foram calculados o risco relativo e o intervalo de confiança (IC) de 95% para as variáveis independentes (fatores de risco), e calculou-se o teste do Χ2 para comparação dos resultados perinatais. Assumiu-se nível de significância de 5%. RESULTADOS: No período ocorreram 24.000 partos no Centro de Atenção à Saúde da Mulher (CAISM), com 2.404 em 2.357 adolescentes (10,02%), sendo a frequência de baixo peso ao nascer de 15,1%. A gestação neste grupo foi recorrente em 294 (8,2%). A idade menor que 15 anos, anemia, tabagismo e hipertensão não se associaram ao baixo peso ao nascer. O antecedente de aborto e a associação com lúpus eritematoso sistêmico elevaram o risco de baixo peso ao nascer. A necessidade de cesariana e o Apgar menor que sete também foram mais prevalentes entre as adolescentes com baixo peso ao nascer, e 85% das adolescentes realizaram menos de seis consultas durante o pré-natal. CONCLUSÕES: A prevalência de baixo peso ao nascer é maior entre as adolescentes do que na população geral. Também chamou a atenção o grande número de adolescentes com menos de seis consultas durante o pré-natal. O antecedente de aborto e a presença de lúpus eritematoso sistêmico foram fatores de risco para ocorrência de baixo peso ao nascer em gestantes adolescentes.

PURPOSES: To determine the rate of low birth weight and some of the risk factors associated with this event among adolescents. METHODS: A cross-sectional study conducted between October 1994 and December 2009 at a maternity in Campinas, in Brazil, using information generated from the computerized obstetric form. After selection of adolescents who delivered at this hospital, two groups were created, with and without low birth weight, respectively. Relative risk and 95% confidence interval for all independent variables (risk factors) and the Χ2 test for some perinatal results were performed. The level of significance was set at 5%. RESULTS: During the study period, 24,000 births occurred at CAISM. Of these, 2,404 occurred among 2,357 teenagers (10.02%) and the frequency of low birth weight was 15.1%. Adolescent pregnancy recurred in 294 (8.2%). Age less than 15 years-old, anemia, smoking, and hypertension were not significantly associated with low birth weight. Antecedent of miscarriage and association with systemic lupus erythematosus increased the risk of low birth weight. Cesarean section and an Apgar score below seven were more prevalent among adolescents with low birth weight, and 85% of all adolescents had less than six prenatal visits. CONCLUSIONS: The prevalence of low birth weight is higher among adolescents than among adult women, and there was a large number of adolescents with less than six prenatal visits . The antecedent of miscarriage and the presence of systemic lupus erythematosus were risk factors associated with the occurrence of low birth weight among adolescents.

OBJETIVO: A cirurgia da valva mitral pode ser feita via transatrial ou transeptal. Embora a transatrial seja a preferida, a via transeptal tem sido utilizada mais recentemente e tido um grande valor nas operações com o coração batendo. Mostramos a nossa experiência na cirurgia da valva mitral via transeptal com coração batendo e discutimos seus benefícios e problemas. MÉTODOS: Entre 2000 e 2007, 214 pacientes consecutivos foram operados com o coração batendo. A operação foi feita por via transeptal sem pinçamento da aorta, com o coração batendo e eletrocardiograma normal e em ritmo sinusal. RESULTADOS: A idade média foi de 56,03 ± 13,93 anos (intervalo: 19-86 anos; mediana: 56 anos). Havia 131 (61,2%) pacientes do sexo masculino e 83 (38,8%), do feminino. Foram utilizadas 108 (50,5%) próteses biológicas e 39 (18,2%) mecânicas. Reparo da valva foi feito em 67 (31,3%) pacientes. A estadia hospitalar foi de 17,4 ± 20,0 dias (intervalo: 3-135 dias; mediana: 11 dias). Balão intra-aórtico foi utilizado em 12 (5,6%) pacientes. A mortalidade hospitalar foi de 7,4%. Reoperação para revisão de hemostasia foi necessária em 15 pacientes. CONCLUSÃO: A operação com o coração batendo é uma opção para proteção miocárdica em pacientes submetidos a cirurgia da valva mitral. A técnica é facilitada ao se usar a via transeptal, reduzindo a insuficiência aórtica e melhorando a visualização do aparato mitral.

OBJECTIVE: Mitral valve surgery can be performed through the trans-atrial or the trans-septal approach. Although the trans-atrial is the preferred method, the trans-septal approach has also been used recently and has a particular value in beating-heart mitral valve surgery. Herein we report our experience with beating-heart mitral valve surgery via trans-septal approach, and discuss its advantages and pitfalls. METHODS: Between 2000 and 2007, 214 consecutive patients were operated upon utilizing beating heart technique for mitral valve surgery. The operation was performed via transseptal approach with the aorta unclamped, the heart beating, with normal electrocardiogram and in sinus rhythm. RESULTS: Mean age was 56.03 ± 13.93 years (range: 19-86 years; median: 56 years). There were 131 (61.2%) males and 83 (38.8%) females. Of the prostheses used, 108 (50.5%) were biological, and 39 (18.2%) were mechanical. Mitral repairs were performed in 67 (31.3%) patients. Mean hospital stay was 17.4 ± 20.0 days (range: 3-135 days; median: 11 days). Intra-aortic balloon pump (IABP) utilization was required in 12 (5.6%) of 214 patients. One-month mortality was 7.4%, and re-operation for bleeding was needed in 15 (7%) patients. CONCLUSIONS: Beating-heart mitral valve surgery is an option for myocardial protection in patients undergoing mitral valve surgery. This technique is facilitated by the trans-septal approach due to reduced aortic insufficiency and improved visualization of the mitral apparatus.

El recubrimiento pulpar directo es considerado un procedimiento controversial, debido a que la información concerniente al uso de esta técnica es escasa y ha sido desarrollada sobre la base de razonamientos empíricos y como consecuencia hay desconfianza por parte de los clínicos hacia estos procedimientos conservadores, a pesar de los avances en la práctica del recubrimiento directo. Se han empleado muchos materiales para el recubimiento pulpar directo y se ha aceptado el hidróxido de calcio como el material de elección, debido a su capacidad comprobada para obtener altos porcentajes de éxito. Actualmente se está evaluando la posibilidad de la utilización de los adhesivos dentinarios como recubridores pulpares. Por una parte se ha sugerido su capacidad para la inducción de una cicatrización exitosa, por otro lado se han descrito resultados poco favorables usando la técnica de grabado total seguido del recubrimiento con agentes adhesivos como procedimiento para el recubrimiento pulpar directo.

Direct pulp capping is considered a controversial procedure, due to lack of information concerning use of this technique and it has been developed solely on the basis of empirical reasoning and consequently of this there is mistrust by the professional, toward these conservative procedure, in spite of the advances in the direct capping have been made. Many materials have been used for direct pulp capping but hidrxide calciun has been accept as the best material to be due to its proven capacity to obtain high porcentages of succes. Presently, the possibility of using adhesive bonding as pulp capping is being evaluated. It has been used successfully in the healing induction, on the other hand there have been non-favorable results using the total etch technique followed by capping with dentin bonding agentsas a procedure for direct pulp capping.