Seroprevalence of hepatitis B, hepatitis C, and human immunodeficiency virus in hemophilia A patients: A descriptive study

Background: Hemophilia A (Factor VIII deficiency) is a X-linked coagulopathy that affects approximately 1/10,000 male live births. In the past, the treatment of hemophilia A consisted of cryoprecipitated plasma and purified factor preparations. As a result, they experienced unusually high incidence of hepatitis and human immunodeficiency virus (HIV) seroconversion. Aims and Objectives: The aims of this study were to find out the seroprevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV infection, among hemophiliacs attending a tertiary care center in Kerala, southern India. Materials and Methods: A cross-sectional study was conducted on hemophilia A patients who attended the departments of medicine and paediatrics. Demographic details and treatment history were obtained by questionnaire. Enzyme-linked immunosorbent assay was used to detect HBV surface antigen, HCV antibodies, and HIV. The statistical data analysis was performed using SPSS software version. Results: Out of 90 hemophilia A patients who underwent testing for the seroprevalence of transfusion-transmitted viral infections, one (1.1%) patient tested positive for HIV, two (2.2%) for HCV, and one (1.1%) for HBV. Among patients with hemophilia A, the prevalence of transfusion-transmitted infection was 4.4%. Patients with HIV- and HCV-positive tests belonged to the severe hemophilia A group. Moreover, the HBV-positive patient belonged to moderate hemophilia A. Conclusion: The present paradigm of management of hemophilia A patients is with plasma-derived or recombinant Factor VIII concentrates, cryoprecipitates, and fresh frozen plasma. Due to the risk, however remote, of transfusion-transmitted viral infections, all hemophiliacs should receive the hepatitis B vaccine and undergo routine testing for HIV, HCV, and HBV viruses.

Wide Excision of a Desmoid Tumor of the Anterior Abdominal Wall with Subsequent Reconstruction.

Desmoid tumors are benign tumors of mesenchymal origin with a complex course of the disease, due to absence of a capsule, infiltrative growth, heterogeneous structure and shape, the true extent of which is difficult to assess before surgery. Despite its benign nature, the recurrence rate reaches 25-50% of cases, and surgical treatment is often accompanied by a number of difficulties with a decrease in the quality of life of patients. In the presented clinical case, a wide excision of desmoid tumor was performed, followed by reconstruction, which ensured a good postoperative result while preserving oncological principles.

Clinico-cytomorphological features and thyroid function tests of different thyroid lesions – A hospital-based cross-sectional study

Background: Thyroid gland is an endocrine organ. The non-neoplastic and neoplastic conditions affecting the gland can manifest as the swelling of the gland with thyroid dysfunction. Based on cytology, the diseases can be categorized into non-neoplastic, benign neoplastic, and malignant neoplastic conditions and according to hormone status, the lesions of thyroid can be categorized in hypothyroid, euthyroid, or hyperthyroid condition. Aims and Objectives: Our study was done to find out the various cytomorphological spectrum of thyroid diseases and to record their common clinical presentation along with hormonal status in a tertiary care hospital in Northern Odisha. Materials and Methods: A total of 220 cases of thyroid disorder were taken for analysis over a period of 2 years. Patients demographic data, brief clinical features, finding on FNAC (cytomorphology), and thyroid function status were analyzed with appropriate statistical method. Results: The predominant age group affected was 21–40 years and total female to male patient ratio was 5.5:1. Most common presentations were heat intolerance (22.27%), cold intolerance (28.63%), and tachycardia (27.72%) apart from thyroid enlargement. Most common non-neoplastic lesion were multinodular and colloid goiter constituting 38.18% of total cases and most common neoplastic lesion was papillary carcinoma constituting 14.55% of total cases. Thyroid function test showed predominantly euthyroid states for all conditions. Conclusion: As the rest part of India, this part of Odisha also showed that thyroid disorders are more common in females and the most affected age group is 21–40 years. Multinodular and colloid goiter are the most common thyroid lesions. Most of the cases present with euthyroid state.

Change in Disease Dynamics and Health Care Utilisation in Children during COVID 19 in a Tertiary Care Hospital of Eastern India

This retrospective, observational study was conducted by collecting data from medical records during COVID 19 pandemic from March 2020 till August 2020. This was compared with the data of 2019 during similar months. The impact of COVID 19 on use of preventive and curative paediatric health care service units like outpatient department, casualty, intensive care and immunization clinic were assessed. Data from 2019 to 2020 were compared using standard parametric and nonparametric tests. There was a significant decline in routine OPD (68%) attendance during the COVID 19 period as compared to pre-COVID period. Paediatric ward admissions and PICU admissions were decreased by 55% and 42% respectively. We also observed a significant 43% decline in the number of children attending immunization clinic in the year 2020. The fear of COVID 19 pandemic and the measures taken to control the pandemic has affected the health seeking behaviour of patients. This evaluation of trends in healthcare use may help in planning the delivery of healthcare service delivery in future.

Geriatric Depression and Its Association with Geriatric Malnutrition: A Cross-Sectional Study in Hubballi, North Karnataka

Background: The world's elderly population is increasing rapidly. According to the 2011 census elderly population contributes to 7.4% of the total population. Both physical and mental disorders are prevalent among the elderly. Symptoms of depression in older people are often overlooked and untreated. Depression leads to loss of appetite, diminution of food intake, and weight loss consequently leading to malnutrition. Methodology: A community-based cross-sectional study was conducted among the geriatric population of urban field practice area using a predesigned, semi-structured questionnaire. Geriatric Depression was assessed using Geriatric Depression Scale and Nutritional Status using the Mini Nutritional Assessment Scale. House to house survey of the Geriatric population was conducted after obtaining written consent. Results: Out of 260 participants, 51.5% of the population were males, 49.2% of the population belonged to 60-69 years age group and 16.9% of them were more than 80 years of age. The prevalence of geriatric depression was 68.5 %,). The majority (64%) of the elderly population were at risk of malnutrition. Depression scores were negatively correlated with nutritional scores. Conclusion: The prevalence of depression and malnutrition was considerably high among the elderly population. Malnutrition among the elderly is a significant determinant of malnutrition.

Prevalence of Violence against Health Care Personnel in a Tertiary Care Centre, Hubballi, India

Background: The sudden outburst of events in different parts of country like Dhule, Dharwad, Chennai and Jaipur led to the need of conducting a survey about violence against health care personnel. Health care personnel are at high risk of being victims of verbal and physical violence, its effect on them and their views on causes for sudden increase in such events. Methodology: A semi-structured questionnaire regarding their experience with violence against health care personnel was prepared. Data was collected for two months 朚ay and June 2017. Sample size of 200 was calculated which included doctors, nursing staff and group D workers from KIMS Hubballi and analysed using SPSS version 21. Results: 99.5% were aware of increasing violent events.76% of them have experienced violence of which, Verbal abuse- 92.10% being the highest form, emotional abuse -17.76% and physical violence 6.58%. The common place of violence was the emergency department -62.09% during daily working hours. 92.10% have reported that patient attenders caused violence. Conclusion: Verbal and emotional abuse against health care workers has significantly amplified which is deteriorating physician patient relationship. Violence against health care personnel is a serious issue that needs to be dealt with more safety measures at the hospital.

Covid Vaccine Side Effects and Covid Infection after Vaccination- A Cross Sectional Study in Hubballi, Karnataka

Introduction: Vaccination against Covid-19 has become the promising strategy in controlling rise in Covid cases. Covishield and Covaxin were the two vaccines initially available in India which have been administered to all those >18years of age. These vaccines exhibit a spectrum of side effects, which may affect vaccination rates. The study was conducted to estimate the frequency of side effects of Covid vaccines in India and their relationship with co-morbidities and prior Covid-19 infection. Methodology: A cross sectional questionnaire-based online survey was conducted for duration of one month among 1800 participants who had received at least one dose of Covid vaccine at KIMS Hospital, Hubballi, Karnataka, selected using systematic random sampling and information about vaccination, comorbidities and covid infection after vaccination was collected. Results: The most common side effects were fever, headache and generalised body ache. The prevalence of infection after complete vaccination with Covishield (4.45%) was higher than Covaxin (1.08%) and difference was statistically significant. The prevalence of side effects and Covid-19 infection after vaccination did not vary with co-morbidities. Conclusion: The side effects reported were not serious and the prevalence was similar in both the vaccines. The prevalence of infection still remains high after vaccination; hence Covid Appropriate Behaviour should be continued.

Family Environment and Its Effect on Self Esteem and Adjustment Behaviour among School Children: A Cross Sectional Study from Hubli Taluka, Dharwad, Karnataka

Background: Family environment plays a significant role in socio-emotional and educational adjustment in adolescents. In the present scenario, parents are in hurry to improve their standard of living and they have no time to engage in child-bearing activities. Low self-esteem is creating mental and psycho-social problems such as poor academic achievement, inadequate adjustments among the siblings and peers, impaired social functioning, suicide, and substance abuse among adolescents. Methodology: A School-based cross-sectional study was conducted among adolescents of Hubli taluka. Information was collected by a self-administered questionnaire with components for Systematic assessment of family environment (SAFE), Self-esteem scale, and Adjustment inventory for school students (AISS). Results: Among 600 adolescents, 85.6% of adolescents had Normal self-esteem, 95%of families were competent, however only 1-7% of the students had an excellent adjustment. Emotional and social adjustment was better compared to Educational adjustment. Adjustment behavior and family environment had a positive association. There was a significant difference in the adjustment scores among low self-esteem and normal self-esteem (p<0.001) and also among discordant and competent families. Conclusion: The adjustment behavior depends on a better family environment and normal self-esteem. The Family environment has a positive effect on self-esteem as well as adjustment behavior. School mental health services should be initiated.

Rotational alignment of the tibial component in total knee arthroplasty:a narrative review / 中华外科杂志

Component malrotation is one of the major causes of failure in total knee arthroplasty.Based on previous researches,Insall line has excessive external rotation tendency.Although Akagi line is the most recognized anatomical axis at present,it still has a certain tendency of internal rotation.The tibial posterior condylar axis is not suitable for symmetrical component and yet the Curve-on-Curve technique is not suitable for anatomic component.In addition,reference to any fixed anatomical markers cannot ensure the rotation consistency of tibiofemoral component in extension position.Although range of motion technique is beneficial to tibiofemoral rotation synchronization,its clinical effect seems to be unstable.Nevertheless,Patients can obtain good postoperative results with all major techniques.Before the recognized "gold standard" is defined,orthopedic surgeons can determine the rotation alignment of tibial component according to their most accustomed surgical method.With a deeper understanding of knee anatomy,biomechanics and kinematics,digital assistive technology may be expected to become a breakthrough in the tibial rotational alignment.

Early introduction of exercise prevents insulin resistance in postnatal overfed rats

Early childhood obesity increases the risk of developing metabolic diseases. We examined the early introduction of exercise in small-litter obese-induced rats (SL) on glucose metabolism in the epididymal adipose tissue (AT) and soleus muscle (SM). On day 3 post-birth, pups were divided into groups of ten or three (SL). On day 22, rats were split into sedentary (S and SLS) and exercise (E and SLE) groups. The rats swam three times/week carrying a load for 30 min. In the first week, they swam without a load; in the 2nd week, they carried a load equivalent to 2% of their body weight; from the 3rd week to the final week, they carried a 5% body load. At 85 days of age, an insulin tolerance test was performed in some rats. At 90 days of age, rats were killed, and blood was harvested for plasma glucose, cholesterol, and triacylglycerol measurements. Mesenteric, epididymal, retroperitoneal, and brown adipose tissues were removed and weighed. SM and AT were incubated in the Krebs-Ringer bicarbonate buffer, 5.5 mM glucose for 1 h with or without 10 mU/mL insulin. Comparison between the groups was performed by 3-way ANOVA followed by the Tukey post-hoc test. Sedentary, overfed rats had greater body mass, more visceral fat, lower lactate production, and insulin resistance. Early introduction of exercise reduced plasma cholesterol and contained the deposition of white adipose tissue and insulin resistance. In conclusion, the early introduction of exercise prevents the effects of obesity on glucose metabolism in adulthood in this rat model.

Effects of teriparatide on bone formation in rats with experimentally induced premaxillary expansion

ABSTRACT Objective: This study aimed to evaluate the effects of systemic teriparatide on sutural bone formation after premaxillary suture expansion in rats. Material and Methods: Twenty Wistar male rats (8-10 weeks old) were randomly divided into two groups, namely, control (C, n=10) and teriparatide (T, n=10). An expansion force was applied to the maxillary incisors using helical spring for a seven-day expansion period, for both groups. On the eighth day, the rats were kept for a seven-day consolidation period, and then 60 µg/kg teriparatide (once a day) was administered to group T subcutaneously for seven days. Then, all the rats were sacrificed, and histological sections were stained with hemotoxylin-eosin for examination. Anti-osteonectin, anti-osteocalcin, anti-Vascular endothelial growth factor (VEGF) and anti-transforming growth factor beta (TGF-β) were evaluated by immunohistochemical analysis in the midpalatal suture area. Results: Histologically, the newly formed bone tissue was observed to be larger in group T than in group C. The number of immunoreactive osteoblasts for osteonectin, osteocalcin and VEGF antibodies was significantly higher in group T than in group C (p = 0.0001). The TGF-β antibody showed a mild reaction in group T, but did not reach significance in comparison with group C (p ˃ 0.05). Conclusion: Systemic teriparatide application following the premaxillary expansion of the suture area may stimulate bone formation and add to the consolidation of the expansion in rats by regulating osteonectin, osteocalcin and VEGF.

RESUMO Objetivo: O presente estudo teve como objetivo avaliar os efeitos do uso sistêmico da teriparatida na formação óssea sutural após a expansão da pré-maxila em ratos. Material e Métodos: Vinte ratos machos da raça Wistar (com oito a dez semanas de vida) foram divididos aleatoriamente em dois grupos: controle (C, n=10) e teriparatida (T, n=10). Uma força de expansão foi aplicada aos incisivos superiores, usando uma mola helicoidal, por um período de expansão de sete dias em ambos os grupos. No oitavo dia, os ratos iniciaram um período de sete dias de consolidação, nos quais 60 µg/kg de teriparatida foram administrados (uma vez ao dia), por via subcutânea, para o grupo T. Posteriormente, todos os ratos foram sacrificados e cortes histológicos corados com hemotolixina-eosina foram examinados. Por meio de análise imuno-histoquímica da região da sutura palatina mediana, avaliou-se a presença de anti-ostenectina, anti-osteocalcina, anti-fator de crescimento endotelial vascular (VEGF) e anti- fator transformador de crescimento (TGF-β). Resultados: Histologicamente, observou-se que o tecido ósseo recém-formado foi maior no grupo T do que no grupo C. O número de osteoblastos imunorreativos para anticorpos de osteonectina, osteocalcina e VEGF foi significativamente maior no grupo T do que no grupo C (p = 0,0001). O anticorpo TGF-β mostrou uma pequena reação no grupo T; porém, sem diferença significativa para o grupo C (p ˃ 0,05). Conclusão: O uso sistêmico de teriparatida após a expansão da sutura na região da pré-maxila pode estimular a formação óssea e melhorar a consolidação da expansão em ratos, por meio da regulação de osteonectina, osteocalcina e VEGF.

Electrocardiographic changes in patients with dilated cardiomyopathy

Introduction: Cardiomyopathy is the disease of the heart muscle, which causes deterioration of myocardial functioning. A study was conducted to find electrocardiographic findings in dilated cardiomyopathy. Materials and methods: This was a hospital-based study, conducted in the department of General Medicine, GSL Medical College. Informed written consent was taken from each patient or his/her attendant prior to including in the study. Patients with dilated cardiomyopathy, both gender, all ages. Heart failure based on Framingham criteria, ECHO criteria – LV ejection fraction less than 45%, with left ventricular or biventricular dilatation, with global hypo-contractility were included in the study. ECG and 2 D Echo have been performed on the patients. Framingham criteria were used for the diagnosis of heart failure. Descriptive statistics were presented in the form of mean ± standard deviation and percentages. Results: Total 102 patients were included in the study, with a mean age of 56.3 ±12.5 years, the male-female ratio was 1.9. Tachycardia was 61%, left axis deviation was present 34.3% and right axis deviation in 8.8%. Left ventricular end-diastolic and systolic diameters were elevated in most of the patients. Conclusion: With these findings, it can be concluded severe LV systolic dysfunction is very common among dilated cardiomyopathy patients.

A Novel Technique for Fixation of Non-union Unicondylar Hoffa’s Fracture: A Case Report

@#Hoffa fractures are rare and difficult fractures to manage. Hoffa fracture involves a coronal plane fracture of posterior femoral condyle. Non-union in Hoffa fracture is further difficult to manage. The surgical management for such nonunion includes open reduction with recon/LCP plate or screw fixation with bone grafting. The problem with plates is the difficulty in contouring the plates according to the shape of posterior femoral condyles. We describe a new technique with 2 L shaped neutralisation plates placed in a circular fashion. This technique provides a more rigid construct and gives better holding strength of screws in Hoffa fragment. This enhances union and mobilisation can be started early.

A study to assess the socio-epidemiological profile of sickle cell disease among affected tribal population

Background: Sickle cell disease (SCD) is more than a century old disease, but we still do not have an affordable cure for it. Although studies show that the prevalence of the disease is high in tribal areas, awareness and mainstreaming of management of SCD in the Primary Health Cares are still not formalized in the system. Our study aims to provide practical insights for imparting quality services and ensure that the provisions reach at the doors of patients. Objectives: The objectives of the study were to study the epidemiological profile and clinical patterns of SCD among affected tribal population. Materials and Methods: The study was conducted at a tribal area named Sakwar. By applying suitable formula, the sample size was calculated to be 197. After obtaining informed consent, one to one interview method was used for data collection regarding health status, previous diagnosis, complication, etc. Body mass index of the patients was calculated using standard formula. SPSS version 22 was used for statistical analysis. Results: Majority of the subjects were females (62.44%) belonging to Hindu religion 145 (73.60%) and scheduled tribes (67.01%). The study subjects were predominantly students belonging to lower socioeconomic status. About 67% of patients were having sickle cell trait while 33% had SCD. Among complications 50% had painful crisis, 36% had gallbladder stone, 15.58% had jaundice, and 5.08% study subjects had avascular necrosis. About 18.7% of study subjects had to receive blood transfusion for their disease. About 18.27% of study subjects were underweight. Majority of the study subjects were taking treatment from private practitioner while government hospitals were preferred for inpatient care and blood transfusion. We found SCD occurrence was significantly associated with female sex and consanguineous marriage. Receiving treatment from private practitioners was significantly associated with occurrence of complication among the study subjects. Conclusion: The study found that the disease and its complication were significantly more among female sex. Occurrence of complication was more common among people taking treatment from general practitioner.

Diverse aminoglycoside phosphotransferase types conferring aminoglycoside resistance in Enterobacteriaceae: A single-centre study from Northeast India

The present study investigates the molecular basis of aph-mediated aminoglycoside resistance and their transmission dynamics in a tertiary care hospital of Northeast India. Two hundred forty one isolates (230 Escherichia coli and 11 Klebsiella pneumoniae) were collected and screened for aminoglycoside resistance genes. Various aph types were amplified using polymerase chain reaction (PCR) assay. Plasmid incompatibilty, horizontal transferability and ERIC-PCR based typing were carried out for all the positive isolates. Among them, 67 isolates showed the presence of aph gene. Aph (3“)-IIIa and aph (3')-Via were predominant and horizontally transferable. All the plasmids were of incompatibility I1 group. Twenty-eight different haplotypes of E. coli were found harbouring aph gene types. This study was able to identify diverse aph types in a single centre and their corresponding phenotypic trait.

Epidemiological profile of pediatric pilgrim patients coming to Shri Mata Vaishno Devi Yatra in Jammu

Background: Shri Mata Vaishno Devi Shrine is visited by lakhs of devotees from India and abroad every year and the number is swelling every year. Since the inception of Shri Mata Vaishno Devi Shrine Board (1986), the number of pilgrims visiting the temple has increased from 13.96 lakhs in the year 1981–1986 to 78 lakhs in 2017 and is possible only due to very efficient and pilgrim-oriented management of Shrine Board. Objectives: The objectives of this study were to study the epidemiological profile of pediatric pilgrim patients coming to Community Health Centre (CHC), Katra, and thereby suggest precautions which should be taken by the pilgrims. Materials and Methods: The present cross-sectional study was conducted over a period of 1 year from August 2017 to July 2018, in the Pediatrics Section at CHC, Katra, District Reasi, Director Health Services Jammu, Jammu and Kashmir, India. All pilgrims up to the age of 18 years with any type of recent ailments were included in this study. The detailed sociodemographic details present history and past history were taken and complete physical examination was done. The patients were categorized on the basis of diagnosis and managed as per the protocol. If necessary, patients were referred to higher center for further evaluation and management. Results: Of total 14,400 children who came to pediatrics outpatient department of CHC, Katra, 435 were pilgrims from all over India and abroad. Majority 144 (33%) pediatric pilgrim patients were from Uttar Pradesh followed by 98 (22.5%) from Delhi. Birth to 3-year group was the most common group suffering from ailments followed by 3 years to 6 years group. The most common complaints with which these children presented were related to gastrointestinal system and respiratory system. Less common complaints included allergic rash, insect bites, injuries due to fall, abnormal body movements, and monkey bites. Conclusion: Children up to 6 years are more prone for illnesses, particularly those <3 years old.

Sub-inhibitory concentration of ertapenem induces overexpression of regulator of antibiotic resistance A in Escherichia coli

AcrAB-TolC is a tripartite efflux pump system constitutively expressed which functions as an intrinsic-resistant mechanism found to be responsible for conferring resistance towards dyes, detergents and different compounds including various classes of antibiotics. One global regulator belonging to AraC-type regulator family, regulator of antibiotic resistance A (RarA) up-regulates the expression of AcrAB-TolC encoded in Klebsiella pneumoniae, Enterobacter sp. 638, Serratia proteamaculans 568 and Enterobacter cloacae resulting in multidrug-resistant phenotypes. The present work was initiated to find out the transcriptional response of RarA in clinical isolates of Escherichia coli against concentration gradient carbapenem stress. A total of 22 clinical isolates of E. coli and expression level of regulators were analysed via quantitative real-time polymerase chain reaction with and without carbapenem stress. As a result, a strong correlation between the expressional levels of RarA in AcrAB overexpressed isolates of E. coli and elevated expression was observed when exposed under concentration gradient ertapenem stress. The clones containing pRar showed reduction in the zone of inhibition towards carbapenem, indicating the active participation of RarA in AcrAB overexpressed isolates of E. coli conferring resistance towards carbapenems.

Transcriptional response of AcrEF-TolC against fluoroquinolone and carbapenem in Escherichia coli of clinical origin

Introduction: Efflux pump systems constitute a major means of intrinsic resistance in Escherichia coli. AcrEF-TolC pump is known to exhibit higher expression level in quinolone resistant isolates. However, the transcriptional response of this pump is yet to be known when exposed to quinolone and other group of antibiotics. Objective: The present study analyses the transcriptional response of AcrEF-TolC in the presence of quinolones and carbapenems. Methodology: A total of 167 non-duplicate clinical isolates from Silchar medical college and Hospital, Silchar, India were included in this study. Of which 27 were devoid of any carbapenemase activity and among them 13 isolates showed overexpression of AcrE and AcrF gene. Transcriptional response of AcrE was directly proportional to increasing concentration of levofloxacin and ofloxacin. However, the response of AcrE and AcrF was inconsistent with carbapenems. Result: The study isolates showed susceptibility towards amikacin (68.4%), gentamicin (59.6%), cefepime (52.7%) and pipercillin/tazobactam (48.3%). The present investigation highlights that apart from qnr genes and mutational changes in gyr region, AcrEF-TolC plays a major role in fluoroquinolone resistance in this part of the world. Conclusion: Upregulation of AcrE in the presence of levofloxacin and ofloxacin warrants further investigation to establish their active role in efflux of this drug.

Avaliação da produtividade, dos custos e da satisfação dos usuários do setor odontológico de um hospital militar / Evaluation of productivity, costs and users' satisfaction of the dental service from a military hospital

Introduction: the evaluation of health services can be considered as a manner to promote the continuous improvement of attention, providing the user with a service of better quality. Being the Hospital of Military Police of Santa Maria (HBM/SM) a public service offered to the corporation, it should also be evaluated, so that measures can institute to its expansion. Objective: to analyze the service provided and the public's satisfaction attended by the HBM/ SM. Methods: three hundred and seventy monthly production maps were evaluated from 2010 to 2016 in order to verify the dental procedures performed and the patients treated. The satisfaction surveys answered by users were also appraised. The monthly expenses were determined by adding: salaries, dental material, emergency expenses, depreciation and estimated fixed costs. The working hours for dentists were calculated annually according to the working arrangements of each professional. Results: the total cost was R$ 6.866.119,03 being performed 103.075 dental procedures, resulting in an average cost of R$ 66,61 per procedure. The monthly average of dental procedures (preventive and curative) was 1.207,74 ± 328,49. Dependents represent 48.03% of the users and the military staff, 44.87%. The vast majority of users considered the dental service excellent or good in relation to the different aspects evaluated. The average number of procedures/hour exceeded SUS goal (3 procedures/hour) to achieve maximum economic efficiency in 5 of the 7 years evaluated. Conclusion: even being more economically advantageous to maintain a proper dental care center for the corporation's members and their dependents, economic measures can be adopted, such as renegotiation of outsourcing contracts, direct contracting of professional or implementation of the Temporary Military Health Program.

Introdução: sendo o Setor Odontológico do Hospital da Brigada Militar de Santa Maria um serviço público oferecido para corporação, este deve ser avaliado para que se instituam medidas de ampliação. Objetivo: analisar o serviço prestado e a satisfação do público atendido pelo referido setor. Metodologia: foram avaliados 370 mapas mensais de produção de 2010 a 2016, nos quais constam os procedimentos odontológicos realizados e os pacientes atendidos, e as pesquisas de satisfação respondidas pelos usuários. Os gastos mensais foram determinados somando-se salários, material odontológico, despesas emergenciais, depreciação e custos fixos estimados. As horas de trabalho dos dentistas foram calculadas de acordo com o regime de trabalho de cada um. Resultados: o custo total foi de R$ 6.866.119,03, sendo realizados 103.075 procedimentos odontológicos, resultando num custo médio por procedimento de R$ 66,61. A média mensal de procedimentos odontológicos foi de 1.207,74 ± 328,49. A grande maioria dos usuários considerou o serviço ótimo ou bom em relação aos diferentes aspectos avaliados. A média de procedimentos/hora superou a meta do SUS, de 3 procedimentos/hora para atingir máxima economicidade, em 5 dos 7 anos avaliados. Conclusão: mesmo sendo mais vantajoso economicamente manter um centro de atendimento odontológico próprio para os integrantes da corporação, pode-se propor medidas de economicidade a serem adotadas, como renegociação dos contratos terceirizados, contratação direta dos profissionais ou implementação do Programa de Militares Estaduais de Saúde Temporários.

Effect of wet-laboratory training on resident performed manual small-incision cataract surgery

Purpose: The aim of this study was to study the effect of wet-laboratory training on the surgical outcome of resident performed manual small-incision cataract surgery (MSICS). Methods: We conducted a retrospective, comparative observational study on resident performed MSICS in our institute. We collected data of 464 patients of which Group A had 232 cases performed by residents without prior wet-laboratory training and Group B had 232 resident performed cases after adequate skill training in the wet laboratory. The demographics, type of cataract, intraoperative, postoperative complications, and immediate visual outcome were compared between the two groups. Results: The age, sex, and type of cataract were similar in both groups of residents. The frequency of intraoperative complications was higher in Group A (23.7%) than in Group B (15.08%) (P = 0.019). The occurrence of posterior capsule (PC) rupture and vitreous loss showed a statistically significant difference, with Group A showing a high rate of 14.3% PC rent and vitreous loss while only 6.9% (P = 0.01) had this complication in Group B. The postoperative visual outcome also was better in Group B than in Group A, with 62.06% of patients in Group B, having a postoperative day 1 vision of better than 6/18 as compared to only 38.36% in Group A. Conclusion: The wet-laboratory training is an effective method of improving the skills of the ophthalmology residents in MSICS. The reduction of complications will improve the quality of surgery and improve the postoperative visual outcome.