Papers by Salomão Kahwage Neto
Revista Eletrônica Acervo Saúde, Apr 23, 2020
Objetivo: Detalhar o caso de uma paciente que evoluiu com mielinólise extrapontina secundária à h... more Objetivo: Detalhar o caso de uma paciente que evoluiu com mielinólise extrapontina secundária à hipernatremia. Detalhamento do caso: Paciente adulta iniciou quadro de cefaleia unilateral, fraqueza muscular e engasgos constantes progressivos. Após episódio de broncoaspiração de grande quantidade, necessitou intubação orotraqueal. No âmbito hospitalar, detectado sódio sérico de 180 mEq/L na entrada, que foi corrigido ao longo de 7 dias até sua normalização. O quadro clínico de tetraparesia inicial foi melhorado na medida em que os níveis de sódio normalizavam e uma ressonância magnética de controle mostrou regressão total das lesões. Atualmente, em acompanhamento no regime ambulatorial com poucas sequelas após o ocorrido. Considerações Finais: As síndromes de desmielinização osmótica podem ter apresentações variadas de acordo com o local acometido no encéfalo. Não é possível prever o desfecho, podendo ser totalmente favorável ou catastrófico. Necessitam maior atenção as correções de distúrbios hidroeletrolíticos, pois a prevenção ainda se configura na melhor alternativa para estes pacientes.
Revista Brasileira de Educação Médica, Dec 1, 2017
Introduction: Despite technological advances, anamnesis and physical examination remain the most ... more Introduction: Despite technological advances, anamnesis and physical examination remain the most important and effective diagnostic tools in a clinical case. However, many students complete their medical degree lacking these essential skills. The unstandardized character of the physical examination is considered one of the major hurdles in the teaching-learning of this practice. Objective: To evaluate the clinical skills of medical students and the applicability of a simplified physical examination guide for the improvement of these skills. Methods: This was an analytical and quantitative-approach study, which compared before-and-after information among general medicine student interns from January to February 2014. The students were trained with the simplified guide for a 3-week period. The students had their clinical examination evaluated in 13 items: vital signs, oral cavity examination, ophthalmoscopy, otoscopy, thyroid examination, cardiovascular, pulmonary, abdominal examination, lymph nodes, anthropometric measurements, ankle-brachial index (ABI), neurological examination, examination of the breast (female patients) or testicles (male patients). The result of each part of the examination was classified into three categories: complete assessment, partial assessment and absent assessment. Results: A total of 31 students participated. Significant improvement was found in almost all items in relation to the complete evaluation after training with the guide: cardiovascular system (3.23% versus 74.19%, before and after training, respectively, p < 0.01), pulmonary system (22.58% versus 90.32%, p < 0.01), abdomen (22.58% versus 74.19%, p = 0.01), vital signs (16.13% versus 100%, p < 0.01), palpation of lymph nodes (6.45% versus 77.42%, p < 0.01), neurological examination (0% versus 22.58%, p = 0.02), thyroid palpation (0% versus 61.29%, p < 0.01), examination of oral cavity (6.45% versus 67.74%, p < 0.01), anthropometric measurements (0% versus 45.16%, p < 0.01), breast examination (0% versus 36.84%, p = 0.02), ophthalmoscopy (0% versus 32.26%, p < 0.01), otoscopy (0% versus 64.52%, p < 0.01); evaluation of the ankle-brachial index (0% versus 83.87%, p < 0.01), examination of the testicles (0% versus 8.33%, p = 1.0). A 280.7% increase was also observed in the students' median score after training (1.92 versus 7.31 points, P < 0.001). There was no significant correlation between student performance and time on the medical course (R2 = 0.1242; P = 0.0515). Conclusions: There is a large deficit in teaching clinical skills during undergraduate medical courses. As an effective solution, a simplified sequential clinical examination guide can serve as training for medical students.
Rev Para Med, Mar 1, 2001
Revista Paraense De Medicina, Sep 1, 2007
Obesity Surgery, 2002
Background: Wernicke-Korsakof f syndrome and peripheral neuropathy are very uncommon in bariatric... more Background: Wernicke-Korsakof f syndrome and peripheral neuropathy are very uncommon in bariatric surgical practice. The literature indicates that these complications tend to strike patients receiving unbalanced diets or undergoing rapid weight-loss. Methods: In a retrospective analysis of the initial experience of a bariatric team in the city of Belem, Pará, in northern Brazil, 5 cases were diagnosed in the first year, 4 of them following gastric bypass and the last one after therapy with an intragastric balloon. Results: All episodes followed periods of severe vomiting, which certainly interfered with intake of food as well as of routine vitamin supplements, resulting in severe polyneuropathy and other neurologic manifestions, mostly damaging motility of lower limbs. Therapy consisted of pharmacologic doses of vitamin B 1 along with restoration of adequate diet and multivitamin prescriptions. Physical therapy was employed to prevent atrophy and accelerate normalization of muscle strength. All patients responded to this program after variable intervals without significant sequelae. Conclusions: Thiamine-related neurologic derangements were a cause for much concern and prolonged morbidity in this series, but responded to vitamin B 1 replenishment. A high degree of clinical suspicion in bariatric patients and urgent therapeutic intervention whenever postoperative vomiting persists for several days, especially during the first 2-3 months after operation, are the safest approach to these uncommon episodes. It is speculated whether peculiarities in the regional diet of this area in Brazil could have influenced the high incidence of the neurologic aberrations.
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Papers by Salomão Kahwage Neto