RMMG - Revista Médica de Minas Gerais

INTRODUCTION: Hand washing is a simple and essential procedure, which removes dirt, desquamated cells, skin secretions, pollutants and pathogenic microorganisms, being an important hygienic practice, particularly among health care workers.
OBJECTIVE: To evaluate the technique, the moment and the adherence to hand washing in clinical and surgical wards at the Clemente de Faria University Hospital.
METHODS: This was an observational study of health care workers (technical nurses, physicians, residents and medical students) who were active in those units during the period. The information was collected by direct observation, based on a form, from a total of 180 observations during both day and night shifts.
RESULTS: From the observations made, hand washing occurred in 46%, being more frequent at the surgery clinic (60%) than at the medical clinic (39%). The health care workers who presented more adherences were: technical nurses (53%), medical students (32%), physicians (27%) and residents (18%). The majority did not use the right technique and did not wash their hands before and after each procedure.
CONCLUSION: We proved the necessity of implementing strategies that develop more awareness in professionals about this important act for the control of hospital infections.

Keywords Hand washing; Hand washing Methods; Hand washing Standards; Disinfection; Health Personnel; Cross Infection.

This case-control study, nested within a cohort, had the objective of identifying determinants of high morbidity from diarrhea in the first year of life. The newborns were recruited during the first 24 hours of life. Household visits were performed twice weekly during the first year of life to collect data on breastfeeding and diarrhea. Case was a child with > 6 and control was a child with < 5 episodes of diarrhea in the first year of life (N=87 and 515, respectively). Multiple logistic regression was used to eliminate confounding variables. Low birth weight and maternal education were significantly associated with high morbidity for diarrhea. Children whose mother had < 4 years of study had two times (CI 95% = 1.13-3.27) more chance of presenting > 6 episodes of diarrhea in relation to those whose mother had > 5 years (p=0.02). Children born with a birth weight < 2.500 g had two times (CI 95% = 1.20 - 5.70) more chance of higher morbidity from diarrhea in relation to those with a birth weight > 3.500g (p=0.02). In conclusion, low birth weight and maternal education were important factors in the determination of high morbidity for diarrhea in the 1st year of life.

Keywords Diarrhea, Infantile/Epidemiology; Logistic Models; Cohort Studies.

OBJECTIVE: To evaluate the frequency of diabetic foot examination made by doctors of several specialties (chiefly endocrinologists, cardiologists and general practitioners) of their type 2 diabetic patients.
METHODS: We evaluated the conditions of 100 Type 2 diabetic patients from both public and private hospitals in a Brazilian capital - Belo Horizonte, MG - with the help of a questionnaire.
RESULTS: We could observe that the majority of patients (72%) did not get their feet examined. This also includes patients of the endocrinologists (71%), cardiologists (86%) and general practitioners (67%).
CONCLUSION: This study shows the necessity of creating greater incentives for putting knowledge about diabetic patients' foot care into practice and tries to call the doctors' attention to the importance of an early diagnosis. A good foot analysis reduces the incidence of damages to patients and society as a whole.

Keywords Diabetes; Diabetic Foot; Care and Prevention of the Diabetic Foot.

CLL is an indolent neoplasm characterized by the accumulation of B lymphocytes and is the most common leukemia in the western countries.
OBJECTIVE: This paper evaluates the clinical and staging characteristics in patients with chronic lymphocytic leukemia.
METHODS: We analyzed the medical registers of 77 patients that fulfilled diagnostic criteria for CLL from 1992 to 2005.
RESULTS AND CONCLUSIONS: Forty-seven patients (61%) were male and thirty (39%) were female. Median survival was 115 months and the median age at diagnosis was 65 years, ranging from 38 to 91 years. The most common chromosomal abnormality was trisomy 12 (16% of all assessed cases). The modified Rai staging system was the best one for analyzing evolution and survival (p=0,001) showing: in low risk - 21 patients (27,2%); intermediary risk - 36 patients (46,7%) e high risk - 20 patients (25,9%). Median survival was, respectively: 153 months, 65 months and 43 months. Among the variables, none of them showed to be significant in the multivariate analysis. Ten patients (13%) had not been treated until the moment of the study and 67 (87%) were treated with chemotherapy. Patients were treated with chlorambucil, fludarabine, fludarabine plus cyclophosphamide, COP, CHOP or radiotherapy. There was no statistical difference in survival, when the schemes of treatment were compared.

Keywords Chronic Lymphocytic Leukemia; Prognosis; Neoplasm Staging.

INTRODUCTION AND OBJECTIVE: Understanding the patient with multiple complaints requires understanding the trauma, the stress and the autistic withdrawal of the patient. This paper seeks to evaluate the various factors which influence clinical complaints.
METHODOLOGY: Typical clinical cases are presented to aide in the assessment of the poly complainant who has posttraumatic stress disorder (PTSD) and whose care is often difficult to manage because of the diversity and the antagonism of his symptomatology. He is, commonly, the object of invasive complementary exams by medicals specialists in order to eliminate or to establish an organic etiology. The author does not agree with this usual clinical practice because this patient is already traumatized and because this medical procedure can reduce the important affective element present in the specialist's personal relationship with this patient.
RESULTS: To the author, the affective element is the most important therapeutic element of the treatment and the Psychoanalytical Psychotherapy the best one because it emphasizes this element more than the Cognitive and Behavioral Psychotherapy does.
CONCLUSION: In order to improve the understanding and the care of this affective element by the medical specialist, he recommends the Balint Study Group as well as the study of PTSD.

Keywords Multiple complaints. Trauma. Autistic withdrawal. Stress. PTSD.

Cardiac insufficiency (CI) is the most common end of the road for all cardiopathy, constituting an enormous public health problem with grave medical and social repercussions. It is a disease with high morbid-mortality. After diagnosis, 30 to 40% of the patients will be dead within one year. In the last 15 years, considerable progress in the treatment of this disease has been made with the advent of the angiotensin converting enzyme inhibitors, aldosterone antagonists, beta-blockers, heart transplants, cardio defibrillator implants and cardiac resynchronization therapy. However, even with modern therapy, CI is associated with an annual mortality rate of 10%. Research for better treatment constitutes one of the greatest challenges for cardiology.

Keywords Cardiology/tendencies; Cardiopathy/therapies; Cardiopathy/prevention and control; Cardiovascular diagnostic techniques.

The indigenous microbiota associated to the human digestive tract is an extremely complex and unknown ecosystem. Its installation in the newborn and maintenance in the adult are very important for maturation of the host biology and its protection against infection, respectively. However, both can be disturbed by various factors, leading to a reduction of beneficial effects expected from microbiota function under normal conditions. These perturbations can be compensated using probiotics, which are defined as viable microorganisms which, when used in adequate amounts, are beneficial for the host. Lactic acid producing bacteria (Lactobacillus, Bifidobacterium) and yeast (Saccharomyces boulardii) are among the microorganisms most frequently studied and used as probiotics. For some uses, the sum of clinical trials was sufficient to perform meta-analyses that showed a positive effect of probiotic use, such as for prophylaxis of acute diarrhea and antibiotic associated diarrhea (particularly for Clostridium difficile infection), and as a supplement during Helicobacter pylori therapy. More recently, positive effects were also suggested for intestinal inflammatory diseases. However, all the authors agree with the need for more clinical trials and biological assays, particularly in order to understand the mechanisms of the action of probiotics as well as the factors in the digestive ecosystem that can influence this action. Such knowledge must permit an optimization of probiotic use, regulating results, which today are sometimes fluctuant. More recently, positive effects were also suggested for intestinal inflammatory diseases. However, all the authors agree with the need of more clinical trials and biological assays, particularly in order to understand the mechanisms of action of probiotics as well as the factors in the digestive ecosystem that can influence this action. Such knowledge must permit an optimization of probiotic use, regulating results, which today are sometimes fluctuant.

Keywords Indigenous microbiota, probiotic, Lactobacillus, Bifidobacterium, Saccharomyces boulardii, metaanalysis, clinical trial.

General anesthesia is the assembly of several physiological states, including the state of unconsciousness. Gamma-aminobutyric acid receptor, subtype A, has been discovered as an important target of anesthetic drugs, as it contributes for the induction of sedation and unconsciousness. The anesthesiologist should have the knowledge of drugs' effects on the GABAergic neurotransmission system and know how to use the available means to monitor the consciousness of the anesthetized patient. Within this context, the devices that process the electroencephalographic waves have been shown to be very helpful in consciousness monitorization.

Keywords Consciousness; Electroencephalography; Anesthesia General; Monitoring, Intraoperative.

Bezoars result from the swallowing of inorganic or indigestible organic materials that form a mass in the gastrointestinal tract, usually in the stomach. Trichobezoars are formed by swallowed hair. They often are encountered in adolescent girls, especially in patients with depression or mental retardation. The removal of trichobezoars is mandatory because of the risk of potentially life-threatening complications. The authors present a case of a large gastric trichobezoar in a 14-year-old girl. The patient underwent laparotomy, during which a solid mass of hair was totally removed by an anterior gastrotomy. The postoperative period was uneventful. Subsequent psychiatric follow-up was conducted.

Keywords Bezoars; Trichobezoars; Abdominal Pain.

OBJECTIVE: The aim of this study is to present a case report of a patient with Hodgkin's lymphoma preceded by auto-immune hemolytic anemia (AIHA).
DESCRIPTION: This paper reports a case of a 10 year-old patient presenting a typical clinical and laboratory pattern of cold-reactive autoimmune hemolytic anemia. Four years after the diagnosis of AIHA, the patient developed liver and spleen enlargement, fever and weight loss, which was diagnosed as stage II-B Hodgkin's lymphoma. Twenty-three months after chemotherapy, the patient remains in clinical remission for both AHAI and Hodgkin's lymphoma.
COMMENTS: AIHA consists of a group of disorders characterized by the presence of autoantibodies, which cause a shortened red cell life span. Most cases of chronic AHAI are secondary to a severe condition. Consequently these patients require a strict and prolonged follow-up. Our report calls attention to the fact that Hodgkin's lymphoma must be included in the differential diagnosis of chronic AHIA.

Keywords Autoimmune Hemolytic Anemia; Hodgkin's Disease.