Aspects of trauma related to violence, accidents and falls before and during the COVID-19 pandemic / Aspectos del trauma relacionados con la violencia, accidentes y caídas antes y durante la pandemia COVID-19

Abstract Introduction: Trauma is the second leading cause of mortality and the sixth leading cause of hospitalization in the country, with violence, accidents, and falls being the most prevalent. However, the country is experiencing reflexes of the COVID-19 pandemic, together with a lack of studies on trauma, as well as on clinical care. Objective: To analyze the clinical and epidemiological characteristics of trauma related to violence, accidents, and falls among the years 2019, 2020, and 2021, considered as before and during the COVID-19 pandemic. Material and Methods: Retrospective cohort study, with adults aged 25-55 years, who suffered trauma related to violence, falls, and other accidents, in the period between March and June of 2019, 2020, and 2021, in the city of São Paulo. Data surveys were carried out using the TABNET system, of the Municipal Health Department. Within this system, the search was carried out through the Information System for the Surveillance of Accidents, of the Coordination of Health Surveillance, in which situations of violence were notified and recorded by the National Information System for Notifiable Diseases. Subsequently, the Information System for Surveillance of Violence and Accidents was accessed, focusing on notifications and records of falls and other accidents. Results: Trauma remained more prevalent for males, with complete primary education, and ethnicity predominantly between white or brown. When analyzing the different types of violence: physical, torture, and sexual, there was a prevalence of higher percentages during the year 2019, the pre-pandemic period of COVID-19, except for psychological/moral violence, which was higher in 2021. It should also be noted that the different mechanisms of violence were significantly more prevalent in 2019, as well as the different causes of violence, falls, and car trauma involving pedestrians, occupants, drivers, and passengers. Outpatient care confirmed the higher trend in the pre-pandemic period; however, emergency hospital care showed a greater number of requests in 2020 and 2021. Conclusión: Trauma from violence, accidents, and falls was higher pre-pandemic compared to the period during the COVID-19 pandemic; as well as the search for health care in hospitals and outpatient clinics. These findings show a possible reduction in trauma reports and lower demand for assistance during the pandemic.

Resumen Introducción: El trauma es la segunda causa de mortalidad y la sexta de hospitalización en el país, siendo la violencia, los accidentes y las caídas las más prevalentes. Sin embargo, el país está experimentando reflejos de una pandemia de COVID-19, junto a una falta de estudios sobre el trauma, así como sobre la atención clínica. Objetivo: Analizar las características clínicas y epidemiológicas del trauma junto a la violencia, accidentes y caídas entre los años 2019, 2020 y 2021, considerados antes y durante la pandemia COVID-19. Materiales y métodos: Estudio de cohorte retrospectivo, con adultos de 25 a 55 años, que sufrieron trauma relacionado con violencia, caídas y otros accidentes, en el período comprendido entre marzo y junio de 2019, 2020 y 2021, en la ciudad de São Paulo. Las encuestas de datos fueron realizadas por el sistema TABNET, por el Departamento Municipal de Salud. Dentro de este sistema, la búsqueda se realizó a través del Sistema de Información para la Vigilancia de Accidentes, de la Coordinación de Vigilancia en Salud, en el cual las situaciones de violencia fueron notificadas y registradas por el Sistema Nacional de Información de Enfermedades Notificables. Posteriormente, se accedió al Sistema de Información de Vigilancia de Violencia y Accidentes, con enfoque en notificaciones y registro de caídas y otros accidentes. Resultados: El trauma siguió siendo más prevalente para los hombres, con educación primaria completa y raza predominantemente entre blancos y morenos. Al analizar los diferentes tipos de violencia: física, tortura y sexual, hubo mayores porcentajes de prevalencia durante el año 2019, período prepandémico de COVID-19, a excepción de la violencia psicológica / moral, que fue mayor en 2021. Nótese que los diferentes mecanismos de violencia fueron significativamente más prevalentes en 2019, así como las diferentes causas de violencia, caídas y traumatismos automovilísticos que involucran a peatones, ocupantes, conductores y pasajeros. La atención ambulatoria confirmó la tendencia de superioridad en el período prepandémico, sin embargo, la atención hospitalaria de emergencia mostró un mayor número de solicitudes en 2020 y 2021. Conclusión: Los traumas de violencia, accidentes y caídas son más prepandémico en comparación con el período durante la pandemia COVID-19; así como la búsqueda de asistencia sanitaria en hospitales y clínicas. Estos hallazgos muestran una posible reducción en los informes de trauma y una menor demanda de asistencia durante la pandemia.

Suicide mortality in the city of São Paulo: epidemiological characteristics and their social factors in a temporal trend between 2000 and 2017. Retrospective study

ABSTRACT BACKGROUND: Suicide is one of the leading causes of death worldwide, accounting for one million deaths annually. Greater understanding of the causal risk factors is needed, especially in large urban centers. OBJECTIVE: To ascertain the epidemiological profile and temporal trend of suicides over two decades and correlate prevalence with social indicators. DESIGN AND SETTING: Descriptive population-based longitudinal retrospective study conducted in the city of São Paulo, Brazil. METHODS: A temporal trend series for suicide mortality in this city was constructed based on data from the Ministry of Health's mortality notification system, covering 2000-2017. It was analyzed using classic demographic variables relating to social factors. RESULTS: Suicide rates were high throughout this period, increasing from 4.6/100,000 inhabitants in the 2000s to 4.9/100,000 in 2017 (mean: 4.7/100,000). The increase in mortality was mainly due to increased male suicide, which went from 6.0/100,000 to the current 8.0/100,000. Other higher coefficients corresponded to social risk factors, such as being a young adult (25-44 years old), being more educated (eight years of schooling) and having white ethnicity (67.2%). Suicide was also twice as likely to occur at home (47.8%). CONCLUSION: High suicide rates were seen over the period 2000-2017, especially among young adults and males. High schooling levels and white ethnicity were risk factors. The home environment is the crucial arena for preventive action. One special aspect of primary prevention is the internet and especially social media, which provides a multitude of information for suicide prevention.

Antibiotic prophylaxis in breast cancer surgery. A randomized controlled trial

Abstract Purpose To assess the effect of antibiotic prophylaxis on surgical site infection (SSI) rates in women undergoing breast cancer surgery in two tertiary hospitals in Brazil. Methods This was a randomized, double-blind, placebo-controlled, parallel-group clinical trial. A total of 124 women without independent risk factors for SSI were randomly assigned to receive either cefazolin (antibiotic group, n = 62) or placebo (control group, n = 62) as preoperative prophylaxis. After surgery, all surgical wounds were examined once a week, for four weeks, according to the Centers for Disease Control and Prevention definitions and classifications for SSI. Results Baseline characteristics were homogeneous between the two groups. Only one patient in the antibiotic group developed SSI, which was classified as superficial incisional. The overall SSI rate was low, with no significant difference between groups. Conclusion Antibiotic prophylaxis had no significant effect on reducing SSI rates in women without independent risk factors for SSI undergoing breast cancer surgery.

Experimental models of scald burns. A scope review

Abstract Purpose: To conduct a scope review of the experimental model described by Walker and Mason, by identifying and analyzing the details of the method. Methods: The authors searched Pubmed-Medline, Cochrane-Bireme and PEDro databases for articles published between January 2016 and December 2018, using the following search queries: burns, burn injuries, models animal, and animal experimentation. All articles whose authors used Walker and Mason's model - with or without changes to the method in Wistar rats - were included in this study. Results: The search identified 45 mentions of Walker and Mason's model; however, after reading each summary, 20 were excluded (of which 5 due to duplicity). The inconsistencies observed after the scope review were: water temperature, length of time of exposure of the experimental model's skin to water, extent of the burnt area, and the description of the thickness/depth of the injury. Conclusions: Reproducibility of a scientific method is the basis to prove the veracity of the observed results. Thus, it is necessary to have a greater number of publications that adopt a reproducible scientific method, for this review found inconsistencies in the description of Walker and Mason's model.

Prevalence of dementia among widowed and non-widowed patients and associated clinical and sociodemographic characteristics / Prevalência, características clínicas e sociodemográficas em pacientes viúvos e não viúvos com demência

Abstract Objective: to verify if the prevalence of dementia differs between widowed and non-widowed elderly persons and between genders, and to analyse if there is an association with sociodemographic and clinical characteristics. Method: a retrospective cross-sectional observational study of patients treated at a Behavioral Neurology outpatient clinic from 1999 to 2009 was carried out, employing anamnesis, physical and neurological examination, the Clinical Dementia Rating Scale (CDR) and the Mini Mental State Examination (MMSE). Sociodemographic (schooling and age) and clinical (age of onset of symptoms and time since onset of symptoms, MMSE and CDR) variables were analyzed. The differences were evaluated by the Mann Whitney test, using a significance value of p<0.05. Results: of 208 patients diagnosed with dementia, 73 (35.1%) were widowed and 135 (64.9%) were non-widowed. Those who were widowed were older than those who were non-widowed (p<0.001) when diagnosed with dementia. This difference in age remained when gender (p<0.001), widowed and widowed women (p<0.001) and widowed and non-widowed men (p<0.001) were compared. The time from onset of symptoms to diagnosis was greater in widowed than in non-widowed men [55.6 (± 86.3) vs. 43.4 (± 44.8) months], although the difference was not statistically significant. Widowed patients with dementia had lower schooling, regardless of gender (p<0.05). Conclusion: the prevalence of dementia differed between widowed and non-widowed individuals, being higher among non-widows. There was an association between widowhood and the clinical and sociodemographic characteristics, with differences between the genders. The loss of a spouse can generate different outcomes among men and women, necessitating measures with a specific focus on prevention and strategies of care in dementia.

Resumo Objetivo: Verificar se a prevalência de demência difere entre viúvos e não viúvos, e analisar se há associação com características sociodemográficas e clínicas, bem como diferenças entre os sexos. Método: Estudo observacional transversal retrospectivo que analisou prontuários de pacientes atendidos em um ambulatório de Neurologia do Comportamento de 1999 a 2009 através de anamnese, exame físico e neurológico, Clinical Dementia Rating Scale (CDR) e Miniexame do Estado Mental (MEEM). Avaliou-se variáveis sociodemográficas (escolaridade e idade) e clínicas (idade e tempo do início dos sintomas, MEEM e CDR). As diferenças foram avaliadas pelo teste de Mann Whitney, admitindo-se p<0,05. Resultados: Dos 208 pacientes com diagnóstico de demência, 73 (35,1%) eram viúvos e 135 (64,9%) não viúvos. Os viúvos eram mais velhos que os não viúvos (p<0,001) quando foram diagnosticados com demência. Essa diferença na idade manteve-se comparando os sexos (p<0,001), mulheres viúvas e não viúvas (p<0,001) e homens viúvos e não viúvos (p<0,001). O tempo do início dos sintomas até o diagnóstico foi maior em homens viúvos quando comparado aos não viúvos [55,6 (±86,3) vs 43,4 (±44,8) meses] mas sem significância estatística. Os viúvos com demência tinham menor escolaridade, independente do sexo (p<0,05). Conclusão: A prevalência de demência diferiu entre viúvos e não viúvos, sendo maior nos não viúvos. Houve associação da viuvez com características clínicas e sociodemográficas com diferença entre os sexos. A perda do cônjuge pode gerar diferentes desfechos entre homens e mulheres, necessitando de medidas com enfoque específico na prevenção e estratégias de cuidado na demência.

Avaliação da acurácia do exame ultrassonográfico em pacientes portadores de hérnia inguinal / Accuracy of the ultrasound examination in patients with inguinal hernia

RESUMO Objetivo: avaliar a acurácia da ultrassonografia no diagnóstico de hérnia inguinal no pré-operatório de pacientes submetidos à herniorrafia inguinal. Métodos: estudo retrospectivo descritivo, analítico, baseado em dados obtidos dos prontuários de pacientes submetidos à herniorrafia inguinal entre janeiro de 2016 e dezembro de 2017 e que realizaram ultrassonografia no período pré-operatório. A amostra foi composta por 232 pacientes e foram comparados os resultados da ultrassonografia com as queixas, exame físico e achados intraoperatórios desses pacientes. Resultados: a ultrassonografia apresentou concordância com a queixa de hérnia inguinal em 52% dos pacientes (p=0,019). Houve discordância entre a porcentagem de pacientes que apresentaram hérnia ao exame físico não confirmada pelo exame ultrassonográfico (28,57%) e a porcentagem de hérnias identificadas somente ao exame complementar (8,93%), com significância estatística (p=0,0291). Quando comparados os resultados ultrassonográficos com achados intraoperatórios, 32,70% dos pacientes que apresentavam hérnia tinham ultrassonografia normal com significância estatística para discordância (p=0,001). Conclusão: a ultrassonografia mostrou-se método não confiável para auxiliar no diagnóstico em casos duvidosos de hérnia inguinal e dispensável quando o diagnóstico era confirmado por queixas típicas e exame físico compatível.

ABSTRACT Objective: to evaluate the accuracy of ultrasonography in the diagnosis of inguinal hernia in the preoperative period of patients submitted to inguinal herniorrhaphy. Methods: we conducted a retrospective, descriptive, analytical study, based on data obtained from the charts of patients submitted to inguinal herniorrhaphy between January 2016 and December 2017 and who underwent ultrasonography in the preoperative period. The sample consisted of 232 patients, and we compared the results of the ultrasonography with the complaints, physical examination and intraoperative findings. Results: ultrasonography was in agreement with inguinal hernia complaint in 52% of patients (p=0.019). There was a disagreement between the percentage of patients who presented a hernia at the physical examination not confirmed by the ultrasound examination (28.57%) and the percentage of hernias identified only by the complementary examination (8.93%), with statistical significance (p=0.0291). When comparing the ultrasound findings with the intraoperative ones, 32.70% of patients presenting with hernia had normal ultrasonography, with statistical significance for discordance (p=0.001). Conclusion: ultrasound was an unreliable method to help diagnosis in dubious cases of inguinal hernia, and dispensable when the diagnosis was confirmed by typical complaints and compatible physical examination.

Correlation between obstructive apnea syndrome and difficult airway in ENT surgery / Correlação entre síndrome da apneia obstrutiva e via aérea difícil na cirurgia otorrinolaringológica

Abstract Introduction: ENT patients with obstructive sleep apnea syndrome have a tendency of collapsing the upper airways in addition to anatomical obstacles. Obstructive sleep apnea syndrome is related to the increased risk of difficult airway and also increased perioperative complications. In order to identify these patients in the preoperative period, the STOP Bang questionnaire has been highlighted because it is summarized and easy to apply. Objectives: Evaluate through the STOP Bang questionnaire whether patients undergoing ENT surgery with a diagnosis of obstructive sleep apnea syndrome have a higher risk of complications, particularly the occurrence of difficult airway. Casuistry and methods: Measurements of anatomical parameters for difficult airway and questionnaire application for clinical prediction of obstructive sleep apnea syndrome were performed in 48 patients with a previous polysomnographic study. Results: The sample detected difficult airway in about 18.7% of patients, all of them with obstructive sleep apnea syndrome. This group had older age, cervical circumference > 40 cm, ASA II and Cormack III/IV. Patients with obstructive sleep apnea syndrome had higher body mass index, cervical circumference, and frequent apnea. In subgroup analysis, the group with severe obstructive sleep apnea syndrome showed a significantly higher SB score compared to patients without this syndrome or with a mild/moderate obstructive sleep apnea syndrome. Conclusions: The STOP Bang questionnaire was not able to predict difficult airway and mild obstructive sleep apnea syndrome, but it identified marked obstructive sleep apnea syndrome. All patients with difficult airway had moderate and marked obstructive sleep apnea syndrome, although this syndrome did not involve difficult airway. The variables Cormack III/IV and BMI greater than 35 kg.m−2 were able to predict difficult airway and obstructive sleep apnea syndrome, respectively.

Resumo Introdução: Os pacientes cirúrgicos otorrinolaringológicos portadores da síndrome da apneia obstrutiva do sono apresentam, além de obstáculos anatômicos, tendência ao colapso das vias aéreas superiores. Síndrome da apneia obstrutiva do sono está relacionada ao maior risco de via aérea difícil e também aumento de complicações perioperatórias. A fim de se identificar esses pacientes no período pré-operatório, tem se destacado o questionário STOP Bang, por ser resumido e de fácil aplicação. Objetivos: Avaliar se pacientes submetidos à cirurgia otorrinolaringológica com diagnóstico de síndrome da apneia obstrutiva do sono pelo questionário STOP Bang apresentariam maior risco de complicações, particularmente ocorrência de via aérea difícil. Casuística e métodos: Feitas medidas de parâmetros anatômicos para via aérea difícil e administrado questionário para predição clínica de síndrome da apneia obstrutiva do sono em 48 pacientes com estudo polissonográfico prévio. Resultados: A amostra detectou via aérea difícil em 18,7% dos pacientes, todos portadores de síndrome da apneia obstrutiva do sono. Esse grupo apresentava maior idade, circunferência cervical > 40 cm, ASA II e Cormack III/IV. Os pacientes com síndrome da apneia obstrutiva do sono apresentaram maior índice de massa corpórea, circunferência cervical e frequência de apneia observada. Na análise de subgrupos, o grupo com síndrome da apneia obstrutiva do sono acentuada mostrou significantemente maior pontuação no SB quando comparado com pacientes sem síndrome da apneia obstrutiva do sono ou com síndrome da apneia obstrutiva do sono leve/moderada. Conclusões: O questionário STOP Bang não foi capaz de predizer via aérea difícil e nem síndrome da apneia obstrutiva do sono leve e moderada, mas identificou síndrome da apneia obstrutiva do sono acentuada. Todos pacientes com via aérea difícil apresentaram síndrome da apneia obstrutiva do sono moderada e acentuada, apesar desta síndrome não implicar em via aérea difícil. As variáveis Cormack III/IV e IMC maior do que 35 Kg.m-2 foram capazes de predizer via aérea difícil e síndrome da apneia obstrutiva do sono respectivamente.

Risk factors associated with complications of acute appendicitis / Fatores de risco associados às complicações de apendicite aguda

ABSTRACT Objective : to identify the main risk factors associated with the development of complications in patients with acute appendicitis. Methods: we conducted a case-control study of 402 patients with acute appendicitis hospitalized in a secondary hospital, divided into two groups: the control group, with 373 patients who progressed without postoperative complications (Group 1) and the study group, with 29 patients who presented complications (Group 2). We evaluated demographic data, signs and symptoms of the disease, imaging tests and hospitalization data. Results: factors associated with complications were fever, radiological and sonographic changes, abrupt positive decompression and diarrhea. Migration of pain, nausea, vomiting and abrupt positive decompression were the findings that were significantly more frequent in both groups (p = 0.05). The duration of signs and symptoms in days in group 2 was significantly higher than in group 1, with a median of three days for the group with complications (p = 0.05). Conclusion: alterations in imaging, fever, diarrhea, positive abrupt decompression, duration of symptoms and lower age are associated with a higher frequency of complications in acute appendicitis, which reinforces the importance of anamnesis, physical examination and indication of complementary exams in the approach of these patients.

RESUMO Objetivo: identificar os principais fatores de risco associados ao desenvolvimento de complicações em pacientes portadores de apendicite aguda. Métodos: estudo caso controle de dados dos prontuários de 402 pacientes internados com apendicite aguda em um hospital de nível secundário, separados em dois grupos: grupo controle, com 373 pacientes que evoluíram sem complicações pós-operatórias (Grupo 1) e grupo estudo, com 29 pacientes que apresentaram complicações (Grupo 2). Foram avaliados dados demográficos, sinais e sintomas da doença, exames de imagem e dados da internação. Resultados: os fatores associados às complicações foram febre, alterações radiológicas e ultrassonográficas, descompressão brusca positiva e diarreia. Migração da dor, náuseas, vômitos e descompressão brusca positiva foram os achados significativamente mais frequentes nos dois grupos (p=0,05). Já a duração dos sinais e sintomas, em dias, no grupo 2 foi significativamente maior que no grupo 1, com mediana de três dias para o grupo com complicações (p=0,05). Conclusão: alterações nos exames de imagem, febre, diarreia, descompressão brusca positiva, tempo de duração de sintomas e menor faixa etária estão associados à maior frequência de complicações na apendicite aguda, o que reforça a importância da anamnese, do exame físico e da indicação de exames complementares na abordagem desses pacientes.

Evaluation of the Prevalence of Maxillary Sinuses Abnormalities through Spiral Computed Tomography (CT)

Abstract Introduction Maxillary sinus disease is common and numerous disorders can affect this anatomical area. Abnormalities can be classified as: non-neoplastic, neoplastic benign, and neoplastic malignant. Objective Evaluate through CT the prevalence of diseases in maxillary sinuses, using the Radiology Department's database of a hospital in São Paulo city. Methods The sample consisted of 762 facial CT scans that we divided into three groups: Group A (12-19 years old); Group B (20-49 years old); Group C (above 50 years old); and male or female. We considered the following pathological processes: I - Mucoperiosteal Thickening; II - Chronic Sinusitis; III - Chronic Odontogenic Sinusitis; IV - Rhinosinusitis; V - Polypoid Lesions; VI - Bone Lesions; VII - Neoplasms; VIII - Antrolith; IX - Foreign Bodies; X - Oroantral Fistula. Results Our study found that 305 exams (40.02%) were normal and 457 exams (59.97%) were abnormal. We found the following disease frequencies: focal mucoperiosteal thickening (21.25%); polypoid lesions (10.76%); chronic sinusitis (7.48%); chronic odontogenic sinusitis (2.29%); neoplasms (2.03%); rhinosinusitis (1.77%); bone lesions, foreign bodies and oroantral fistula in 0.65%; 0.13% and 0.06% respectively. There was no significant difference between male and female, and Groups A, B, or C when relating the frequencies of abnormalities found. There was no significant difference between male and female and the age group for the side of the altered maxillary sinus. Conclusion We observed a high prevalence of sinus maxillary diseases. Mucoperiosteal thickening; acute, chronic, and odontogenic sinusitis; polypoid lesions and neoplasms have high prevalence in maxillary sinuses. Thus, facial CT exam was effective for the evaluation of diseases in maxillary sinuses.

Comparative study of knowledge about oral cancer among undergraduate dental students / Estudo comparativo do conhecimento sobre câncer bucal entre acadêmicos de odontologia

ABSTRACT Objective: To evaluate and compare the knowledge of dental undergraduate students about oral cancer. Methods: The students were divided into two groups according to semester attended in the undergraduate course: Group A, the first semester; and Group B, seventh semester. They were asked to answer a questionnaire about epidemiology, risk factors, clinical aspects, therapeutic solutions and oral self-examination. For statistical analysis, the Fisher's exact test, the Cochran's G test and Kendall's concordance test were used, with significance level set at 0.05. Results: Regarding the prevalent sex, only 8.0% of Group A and 56.0% of Group B judged males as the frequent affected by the disease (p=0.0006). In terms of age, 84.0% of the Group B and 44.0% of the Group A estimated that most cases were diagnosed over 40 years (p=0.0072). Smoking was identified as the major risk factor for 64.0% and 91.6% of Groups A and B, respectively (p=0.0110). On issues related to sex, ethnicity, age, risk factors, self-examination, treatment, professional responsible for treatment and profile of an individual with the disease, the seventh-semester showed significantly higher correct answer percentages than first-semester undergraduates. Conclusion: There was significant correlation between the right and wrong answers given by first and seventh semester students, making necessary a specific approach directed to their lack of knowledge.

RESUMO Objetivo: Avaliar e comparar o conhecimento de acadêmicos de odontologia sobre câncer bucal. Métodos: Os acadêmicos foram divididos em dois grupos, de acordo com o semestre cursado na graduação: Grupo A, primeiro semestre; e Grupo B: sétimo semestre. Eles foram convidados a responderem um questionário referente a epidemiologia, fatores de risco, aspectos clínicos, soluções terapêuticas e autoexame bucal. Para a análise estatística dos resultados, foram utilizados o teste exato de Fisher, o teste G de Cochran e o teste de concordância de Kendall, com nível de significância estabelecido em 0,05. Resultados: Somente 8,0% do Grupo A e 56,0% do Grupo B julgaram o sexo masculino como aquele frequentemente acometido pela lesão (p=0,0006). Em relação à faixa etária, 84,0% do Grupo B e 44,0% do Grupo A estimaram que a maioria dos casos era diagnosticada acima dos 40 anos (p=0,0072). O tabagismo foi apontado como principal fator de risco por 64,0% e 91,6% dos alunos dos Grupos A e B, respectivamente (p=0,0110). Nas questões referentes a sexo, etnia, faixa etária, fatores de risco, autoexame, tratamento, profissional responsável pelo tratamento e perfil de um indivíduo portador da lesão, os alunos do sétimo semestre apresentaram percentagens de respostas corretas significantemente maiores que as dos discentes do primeiro semestre. Conclusão: Houve significativa concordância entre os erros e acertos dos discentes do primeiro e sétimo semestres, sendo necessária uma abordagem específica direcionada à deficiência por eles apresentadas.

Metodologia utilizada na investigação de acidentes de trabalho por empresas envolvidas em litígio trabalhista / Methodology used by companies involved in labor disputes to analyze workplace accidents

Contexto: Dados da Previdência Social demonstraram que 2.135.342 acidentes de trabalho (AT) ocorreram no Brasil de 2010 a 2012. As análises de eventos adversos possibilitam compreender os riscos, solucionar problemas e proteger pessoas, além de contribuir para a diminuição dos custos. Objetivos: Avaliar prospectivamente os métodos utilizados para a análise dos acidentes de trabalho na região de Sorocaba (SP), objetivando verificar se os mesmos seguem as recomendações do Ministério do Trabalho e Emprego (MTE). Métodos: Foram analisadas 62 fichas de investigação de AT requeridas para a realização de laudos médicos periciais no ano de 2013, comparando-as com o Guia de Análise Acidentes de Trabalho do MTE quanto às principais causas de AT. Resultados: Observou-se que a metodologia recomendada pela publicação do MTE não foi utilizada pelas empresas avaliadas, que delegaram ao "ato inseguro" a responsabilidade pela maioria dos AT. Conclusões: O encerramento das análises de AT em fatores imediatos foi observado na maioria das fichas de investigação fornecidas pelas empresas à Justiça Trabalhista.

Context: Social Security data showed that 2,135,342 work accidents (WA) occurred in Brazil from 2010 to 2012. The analysis of adverse event enables understanding of the risks, solution of problem and protection of the people, as well as decrease in costs. Objectives: To evaluate prospectively the methods used for the analysis of work accidents in the municipality of Sorocaba (SP), aiming to verify if they meet the goal of providing correct understanding about the event and its causes. Methods: As required, 62 investigation files of work accidents were analyzed to prepare medical technical reports during 2013, comparing them with the Work Accident Analysis Guide of the Brazilian Ministry of Labor (ML) regarding the main causes of work accidents. Results: It was observed that the recommended methodology of the ML publication was not used by the companies evaluated, which imputed the main cause of work accidents to "unsafe acts" (by workers). Conclusion: The closing of the work accident analysis as "immediate factors" was observed in most of the work accident investigation files analyzed.

The use of a biocompatible cement in endodontic surgery. A randomized clinical trial 1

ABSTRACT PURPOSE: To evaluate the clinical applicability of Pozzolana Biologic Silva cement (PBS(r)) in endodontic surgery. METHODS: Persistent apical periodontitis was diagnosed in 30 teeth of 12 patients by cone-beam computed tomography (CT). All patients had 2 or 4 affected teeth and underwent endodontic surgery with root-end filling. Patients with 2 affected teeth had one tooth (control) treated with mineral trioxide aggregate (MTA-Angelus(r)) as a root-end filling material, and the other tooth treated with PBS (experiment). When the patient had four affected teeth, two of them were treated with MTA and two with PBS. Six months after surgery, all patients were assessed by CT scan. Between-group comparisons of measurements were performed using the Wilcoxon test. RESULTS: Periradicular tissue regeneration was observed in all cases. Significant within-group differences in long axes of the lesion were found in the bucco-palatal direction (PBS group, p=0.0012; MTA group, p=0.024) and coronal-apical direction (PBS group, p=0.0007; MTA group, p=0.0015) between pre- and postoperative measurements. CONCLUSIONS: Pozzolana Biologic Silva cement can be used in the treatment of persistent periradicular lesions. The clinical use of PBS as a root-end filling material may be an alternative to MTA. PBS has additives, which provide enhanced strength.

Fatores biopsicossociais do Eixo II dos Critérios de Diagnóstico para Pesquisa das Desordens Temporomandibulares em indivíduos com disfunção temporomandibular muscular e migrânea / Biopsychosocial factors of Axis II of the Research Diagnostic Criteria for Temporomandibular Disorders in individuals with muscular temporomandibular disorder and migraine

RESUMO JUSTIFICATIVA E OBJETIVOS: Relacionar as variáveis biopsicossociais do Research Diagnostic Criteria for Temporomandibular Disorders com os grupos de pacientes com disfunção temporomandibular, com disfunção temporomandibular e migrânea e grupo controle. MÉTODOS: Estudo do tipo observacional transversal onde foram avaliados 280 pacientes consecutivos, divididos em 3 grupos: grupo I (140 indivíduos controle); grupo II (65 indivíduos com disfunção temporomandibular muscular) e grupo III (75 indivíduos com migrânea e disfunção temporomandibular muscular). Os critérios de exclusão foram indivíduos que apresentaram histórico clínico de processos inflamatórios musculares, espasmos musculares, contraturas e injúria traumática aguda na articulação temporomandibular. RESULTADOS: Os indivíduos do grupo III apresentaram associação com depressão grave (p<0,0001), grau 4 na variável intensidade da dor (p=0,004), sintomas físicos não específicos sem dor intensa (p<0,0001) e sintomas físicos não específicos com dor intensa (p<0,0001). Houve diferença significativa entre os gêneros feminino e masculino no grupo III (Z=2,59; p=0,001), evidenciando maior tempo de dor no gênero feminino. A porcentagem de mulheres no grupo III foi significativamente maior em relação aos homens (p=0,004). CONCLUSÃO: A relação entre as variáveis e os três grupos mostrou maior número de indivíduos acometidos com maior intensidade de sintomas no grupo III. Dessa forma, entende-se que a migrânea é uma condição mórbida frequentemente associada à disfunção temporomandibular, potencializando os sintomas descritos pelos pacientes. Há necessidade de avaliações clínicas multidisciplinares nesses indivíduos para que o tratamento seja otimizado, minimizando a morbidade e diminuindo os custos e o número de consultas prestadas aos pacientes.

ABSTRACT BACKGROUND AND OBJECTIVES: To relate biopsychosocial variables of Research Diagnostic Criteria for Temporomandibular Disorders to groups of patients with temporomandibular disorders, temporomandibular disorders and migraine and a control group. METHODS: This is a cross-sectional observational study where 280 consecutive patients were evaluated and distributed in three groups: group I (140 control individuals); group II (65 individuals with muscle temporomandibular disorders) and group III (75 individuals with migraine and muscle temporomandibular disorders). Exclusion criteria were individuals with clinical history of muscle inflammatory processes, muscle spasms, contractures and acute temporomandibular joint traumatic injury. RESULTS: Group III individuals had association with severe depression (p<0.001), level 4 in pain severity (p=0.004), unspecific physical symptoms without severe pain (p<0.0001) and unspecific symptoms with severe pain (p<0.00001). There has been significant difference between females and males in group III (Z=2.59; p=0.001), with longer pain duration among females. The percentage of females in group III was significantly higher as compared to males (p=0.004). CONCLUSION: The relationship between variables and the three groups has shown a higher number of individuals with more severe symptoms in group III. So, it is understood that migraine is a morbid condition often associated to temporo mandibular disorders, worsening symptoms referred by patients. There is the need for multidisciplinary evaluation of these individuals to optimize treatment and minimize morbidity, costs and the number of medical visits.

A associação fibromialgia e lúpus eritematoso sistêmico altera a apresentação e a gravidade de ambas as doenças? / The association of fibromyalgia and systemic lupus erythematosus change the presentation and severity of both diseases?

Introdução A associação da fibromialgia (FM) e de lúpus eritematoso sistêmico (LES) tem sido investigada com resultados conflitantes em relação ao impacto de uma condição na outra. Objetivos Determinar a frequência de FM em uma amostra de pacientes com LES atendidos no Conjunto Hospitalar de Sorocaba (CHS) e o impacto da FM na atividade do LES e na qualidade de vida, bem como do LES na FM. Material e métodos Estudo descritivo e transversal. Incluíram-se pacientes que preenchem os critérios de classificação para LES e/ou de FM do Colégio Americano de Reumatologia (ACR). A amostra total foi dividida em três grupos: FM/LES (pacientes com associação LES e FM), LES (somente pacientes com LES) e FM (somente pacientes com FM). As seguintes variáveis foram Questionário de Impacto da Fibromialgia (FIQ), Índice de Atividade do Lúpus Eritematoso Sistêmico (Sledai), Índices dos Critérios Diagnósticos de Fibromialgia de 2010 (IGS E IDG) e o SF-36. Resultados A prevalência de pacientes com FM entre os pacientes com LES foi de 12%. O FIQ não apontou diferença entre os grupos e indicou que o LES não interferiu no impacto causado pela FM isoladamente. A presença da FM em pacientes com LES não influenciou a atividade clínica dessa doença. Observou-se um forte impacto da FM na qualidade de vida nos pacientes com LES e não foi observado o contrário. Conclusões A prevalência de FM observada nos pacientes com LES é de 12%. A presença de FM afeta adversamente a qualidade de vida dos pacientes com LES. .

Introduction The association of fibromyalgia (FM) and systemic lupus erythematosus (SLE) has been investigated, with conflicting results regarding the impact of a condition on the other. Objectives To determine the frequency of FM in a sample of patients with SLE treated at the Hospital Complex of Sorocaba (CHS) and the impact of FM in SLE activity and quality of life, as well as of SLE in FM. Materials and Methods Descriptive and correlational study. Patients who met the American College of Rheumatology (ACR) criteria for SLE and/or FM were included. The total sample was divided into three groups: FM/SLE (patients with association of SLE and FM), SLE (SLE patients only) and FM (FM patients only). The following variables were used: Fibromyalgia Impact Questionnaire (FIQ), activity index of SLE (SLEDAI), Indices of Diagnostic Criteria for Fibromyalgia 2010 (SSI end GPI) and SF-36. Results The prevalence of patients with FM among SLE patients was 12%. FIQ showed no difference between groups, indicating that SLE did not affect the impact caused by FM alone. The presence of FM in SLE patients did not influence the clinical activity of this disease. A strong impact of FM on the quality of life in patients with SLE was observed; the opposite was not observed. Conclusions The prevalence of FM observed in SLE patients is 12%. The presence of FM adversely affects the quality of life of patients with SLE. .

Proteínas totais no LCR antes e após radioterapia / CSF protein contents before and after radiotherapy

Com o uso da radioterapia e quimioterapia intratecal associados, passou-se a observar alterações do sistema nervoso central que denotaram lesões neuronais ou vasculares...

Clinical, endoscopic and manometric features of the primary motor disorders of the esophagus / Aspectos clínicos, manométricos e endoscópicos dos distúrbios motores primários do esôfago

BACKGROUND: Significant incidence, diagnostic difficulties, clinical relevance and therapeutic efficacy associated with the small number of publications on the primary esophageal motor disorders, motivated the present study. AIM: To determine the manometric prevalence of these disorders and correlate them to the endoscopic and clinical findings. METHODS: A retrospective study of 2614 patients, being 1529 (58.49%) women and 1085 (41.51%) men. From 299 manometric examinations diagnosed with primary esophageal motor disorder, were sought-clinical data (heartburn, regurgitation, dysphagia, odynophagia, non-cardiac chest pain, pharyngeal globe and extra-esophageal symptoms) and/or endoscopic (hiatal hernia, erosive esophagitis, food waste) that motivated the performance of manometry. RESULTS: Were found 49 cases of achalasia, 73 diffuse spasm, 89 nutcracker esophagus, 82 ineffective esophageal motility, and six lower esophageal sphincter hypertension. In relation to the correlations, it was observed that in 119 patients clinical conditions were associated with dysphagia, found in achalasia more than in other conditions; in relationship between endoscopic findings and clinical conditions there was no statistical significance between data. CONCLUSION: The clinical and endoscopic findings have little value in the characterization of the primary motor disorders of the esophagus, showing even more the need for manometry, particularly in the preoperative period of gastroesophageal reflux disease. .

RACIONAL: A incidência significante, a dificuldade diagnóstica, a relevância clínica e a eficácia terapêutica associada ao pequeno número de publicações sobre os distúrbios motores primários do esôfago, motivou a realização do presente estudo. OBJETIVO: Verificar a prevalência desses distúrbios em manometrias e relacioná-las aos achados endoscópicos e clínicos. MÉTODOS: Estudo retrospectivo de 2614 pacientes sendo 1529 (58,49%) do gênero feminino e 1085 (41,51%) do masculino. A partir de 299 exames manométricos com diagnóstico de distúrbio motor esofagiano primário, procuraram-se os dados clínicos (pirose, regurgitação, disfagia, odinofagia, dor torácica não cardíaca, globo faríngeo e sintomas extra-esofageanos) e/ou endoscópicos (hérnia de hiato, esofagite erosiva, resíduos alimentares) que motivaram a realização da manometria. RESULTADOS: Foram encontrados 49 casos de acalásia, 73 de espasmo difuso, 89 de esôfago em quebra-nozes, 82 de motilidade esofagiana ineficaz, e seis de esfíncter esofagiano inferior hipertensivo. Em relação às correlações, observou-se em 119 pacientes analisados que, na clínica associada às afecções, a disfagia foi mais encontrada na acalásia do que nas outras afecções; na relação entre os achados endoscópicos e as afecções não houve relevância estatística entre os dados. CONCLUSÃO: Os achados clínicos e endoscópicos têm pequeno valor na caracterização das doenças motoras primárias do esôfago, evidenciando ainda mais a necessidade da manometria, particularmente no pré-operatório da doença do refluxo gastroesofágico. .

Impacto da monitoria de Cirurgia Plástica no conhecimento teórico e nas habilidades práticas em estudantes de medicina / Impact of extracurricular activities in Plastic Surgery on the knowledge and practical skills of medical students

Introdução: Avaliar o impacto da monitoria em Cirurgia Plástica da Universidade Federal de São Paulo no conhecimento e nas habilidades práticas em estudantes de Medicina. Métodos: Seis acadêmicos participantes da monitoria e oito acadêmicos não participantes foram selecionados aleatoriamente e avaliados antes e depois do programa, por meio de testes de múltipla escolha e através do instrumento Surgical Skills Assessment (SSA), para avaliação das habilidades práticas. Resultados: O Grupo estudo obteve aumento significativo nas notas de prova teórica, entre o período antes do programa (média 15,8 e desvio padrão de 2,7) e após (média 21,8 e desvio padrão 1,3) (p = 0,02). Resultado semelhante foi encontrado com o instrumento SSA entre o período antes (média 9,8 e desvio padrão 1,4) e após o programa (média de 13,5 e desvio padrão 1,6) (p = 0,02). O grupo controle não obteve mudança significativa nos testes teóricos em agosto de 2010 ( média de 14,0 e desvio padrão 4,1) e junho de 2011 ( média de 13,8 e desvio padrão de 2,6 ) (p = 0,40 ). Resultado semelhante foi encontrado com o instrumento SSA em agosto de 2010 (média de 8,5 e desvio padrão 2,2) e junho de 2011 (média de 9,6 e desvio padrão 1,7) (p = 0,18). Conclusão: Acadêmicos participantes na monitoria de Cirurgia Plástica da Universidade Federal de São Paulo apresentaram melhor conhecimento e melhores habilidades práticas em relação aos não participantes.

Introduction: To assess the impact of extracurricular activities in plastic surgery on the knowledge and practical skills of medical students at the Federal University of São Paulo. Methods: Six students participating in extracurricular activities and eight students who did not participate were randomly selected and evaluated before and after the program by using multiple-choice tests and a Surgical Skills Assessment (SSA) instrument to assess their practical skills. Results: The study group obtained higher scores in the theoretical tests, when the scores before starting the program (average, 15.8; standard deviation, 2.7) were compared with those received after their participation in extracurricular activities (average, 21.8; standard deviation, 1.3) (p = 0.02). Similar results were obtained with the SSA instrument for the period before the start of (average, 9.8; standard deviation, 1.4) and after (average, 13.5; standard deviation, 1.6) (p = 0.02) the program. The control group did not show significant changes in the scores received for theoretical tests when the period from August 2010 (average, 14.0; standard deviation, 4.1) to June 2011 (average, 13.8; standard deviation, 2.6) (p = 0.40) was evaluated. Similar results were obtained with the SSA instrument for the evaluation period between August 2010 (average, 8.5; standard deviation, 2.2) and June 2011 (average, 9.6; standard deviation, 1.7) (p = 0.18). Conclusion: The students participating in extracurricular activities in plastic surgery at the Federal University of São Paulo improved their knowledge and acquired better practical skills compared with students who did not participate.

Frequency and Location of Referred Pain in Patients with Temporomandibular Disorder / Frecuencia y Ubicación del Dolor Referido en Pacientes con Trastornos Temporomandibulares

Based on the survey of records regarding the location and frequency of referred pain in patients with temporomandibular disorder when certain pre-established areas are palpated, we proposed an anatomical-topographical division of the head and neck to allow the standardization and reproducibility of locations of referred pain. Of the 835 charts reviewed, 419 (50.2%) patients had referred pain on palpation of the regions based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and palpation of the cervical regions, as often analyzed by the Cochran Q test. The concordance coefficient of Kendall examined the correlation between regions of referred pain concerning to palpated sites. The new regions were defined preauricular, facial lateral, temporoparietal, posterior head, posterior and lateral cervical, anterior cervical and calvaria. The region palpated that originated more referred pain was corresponding to the masseter muscle followed by the region of the sternocleidomastoid muscle, regardless of the side palpated. On palpation of the regions established by the RDC/TMD, the most frequent area of referred pain was the lateral facial region. On palpation of the neck, were the posterior and lateral cervical regions. The sites that originated more referred pain when palpated were the masseter, temporalis, sternocleidomastoid and trapezius muscles.

Basado en la encuesta de registros relativos a la ubicación y frecuencia de dolor referido en pacientes con trastorno temporomandibular al palpar ciertas áreas preestablecidas, propusimos una division topográfica anatómica de cabeza y cuello para permitir la estandarización y reproducibilidad de los lugares de dolor referido. Al examinar los gráficos de 835 sujetos, 419 un (50,2%) de los pacientes reportaron dolor referido a la palpación de las regiones sobre la base de los Criterios Diagnósticos para la Investigación de Trastornos Temporomandibulares (CDI/TTM) y palpación de la region cervical, con análisis de frecuencia con prueba de Cochran Q. El coeficiente de concordancia de Kendall examinó la correlación entre las regiones de dolor referido en relación a los sitios palpados. Las regiones nuevas fueron definidas como, pre-auricular, facial lateral, temporoparietal, cabeza posterior, posterior y lateral cervical, cervical anterior y bóveda craneal. La región de palpado en la cual se originó el dolor mencionado con mayor frecuencia, corresponde al músculo masetero, seguido por la región del músculo esternocleidomastoideo, independientemente del lado palpado. Durante la palpación de las regiones establecidas por los CDI/TTM, la zona más frecuente de dolor referido fue la región facial lateral. A la palpación del cuello, el dolor referido se reportó en la parte posterior y en las regiones cervicales laterales. Los sitios en los que se originó el mayor dolor referido a la palpación, fueron los músculos maseteros, músculos temporales, esternocleidomastoideo y trapecio.

Health economics and health preference concepts to orthopedics practitioners

The aim of this study was to describe concepts of health economics in order to update and provide the orthopedic practitioner decision making parameters based on preferences. Four basic types of studies of economical evaluation were presented (cost minimization analysis, cost-benefit, cost-effectiveness and cost-utility), as well as the origin, the concept, advantages and disadvantages of using QALY and utility. It was discussed the importance of costs and of SF-6D, an instrument able to get through the utility data from the Medical Outcomes Study 36-item Short Form Health Survey (SF-36). Physicians, especially orthopedic practitioners, are increasingly using technologies which are progressively expensive, thus, they should be able to understand health economics concepts, the importance of utility in clinical decision making process and economic analysis in health.09+.

Tratamento cirúrgico de carcinomas cutâneos pelo Sistema Único de Saúde: análise de custos / Surgical treatment of skin carcinomas in the Brazilian Unified Health System: costs analysis

OBJETIVO: analisar os custos do tratamento cirúrgico de carcinomas cutâneos, realizado em serviço de Cirurgia Plástica de hospital universitário, em pacientes do Sistema Único de Saúde (SUS). MÉTODOS:setenta e um pacientes foram incluídos e registrados seus dados sociodemográficos e da operação. Para análise de custos diretos foi considerado o período de internação do paciente, incluindo custos materiais e humanos. RESULTADOS: o custo material médio por procedimento foi R$.324,70, e o valor médio da taxa de serviço hospitalar, segundo a tabela do SUS, foi R$.193,66. Com isso, obteve-se um custo total médio de R$.518,36 por procedimento. Entretanto, o valor médio repassado pelo SUS ao hospital por procedimento foi R$.429,19. CONCLUSÃO: o tratamento cirúrgico dos carcinomas cutâneos gerou para o hospital, um déficit médio de R$.89,16 reais por procedimento.

OBJECTIVE: To analyze the costs of the surgical treatment of cutaneous carcinomas held in the Plastic Surgery service at a university hospital in patients of the Unified Health System (SUS). METHODS: we included seventy-one patients recorded their demographic and operation data. For analysis of direct costs we considered the period of patient hospitalization, including human and material costs. RESULTS: The average equipment cost per procedure was R$ 324.70, and the mean cost of hospital service, according to the table of SUS, was R$ 193.66. Thus, we obtained an average total cost of R$ 518.36 per procedure. However, the average amount refunded by the SUS per hospital procedure was R$ 429.19. CONCLUSION: Surgical treatment of cutaneous carcinomas generated for the hospital an average deficit of R$ 89.16 per procedure.