Cardiovascular Risk Predictors in Primary Health Care: Reflections on the Adoption of Non-Laboratory Models / Preditores de Risco Cardiovascular na Atenção Primária à Saúde: Reflexões sobre a adoção de modelos não-laboratoriais

This article raises considerations about the use of Cardiovascular Risk (CVR) stratification tools in Primary Health Care (PHC), focusing on the behavior of non-laboratory models as an alternative to laboratory predictions. This reflection is based on empirical research with a cross-sectional and exploratory methodology, focused on the behavior of two scales in an adult population (aged 40 to 74), with comorbidities (Hypertension and/or Diabetes) and without recorded cardiovascular events, in a medium-sized city in Minas Gerais. In the work, titled the "CardioRisk" project, the degree of agreement between CVR stratification performed by the Framingham Global Risk Score, using cholesterol information, and the non-laboratory version of the HEARTS calculator, which uses Body Mass Index instead of serum data, was evaluated. In this paper, the overall results of the research are analyzed, in which, for the constituted sample, a minimal agreement was found between the stratifiers. Recommendations are also presented regarding the management of CVR in the context of PHC, highlighting the importance of a comprehensive assessment of patients at notable risk, such as people with Diabetes.

Este artigo levanta considerações sobre o uso de ferramentas de estratificação do Risco Cardiovascular (RCV) na Atenção Primária à Saúde (APS), com foco no comportamento de modelos não-laboratoriais como alternativa às predições laboratoriais. Reflete-se sobre tal objeto a partir de pesquisa empírica de metodologia transversal e exploratória, voltada para o comportamento de duas escalas em uma população adulta (entre 40 e 74 anos), com comorbidades (Hipertensão e/ou Diabetes) e sem agravos cardiovasculares registrados, em uma cidade de médio porte de Minas Gerais. No trabalho, intitulado projeto "CardioRisco", avaliou-se o grau de concordância entre a estratificação de RCV realizada pelo Escore de Risco Global de Framingham, a partir de informação sobre colesterol, e pela versão não-laboratorial da calculadora HEARTS, que utiliza o Índice de Massa Corporal em substituição ao dado sérico. Neste artigo, analisa-se o resultado geral da pesquisa, no qual, para a amostra constituída, constatou-se uma concordância mínima entre os estratificadores, bem como apresenta-se recomendações em relação ao manejo do RCV no contexto da APS, com destaque para a importância da avaliação integral do paciente de notório risco, como pessoas com Diabetes.

Selective Activity against Amastigote Forms of Trypanosoma cruzi and Leishmania infantum of Diasteriomeric Dicentrine N-oxides.

As part of our continuous research for the discovery of bioactive compounds against Trypanosoma cruzi and Leishmania infantum, the alkaloid (6aS)-dicentrine (1) was oxidized to afford (6aS,6S)- (2) and (6aS,6R)- (3) dicentrine-N-oxides. Evaluation of the cytotoxicity against NCTC cells indicated that 2 and 3 are non-toxic (CC50 > 200 µM) whereas 1 demonstrated CC50 of 52.0 µM. Concerning T. cruzi activity against amastigotes, derivatives 2 and 3 exhibited EC50 values of 9.9 µM (SI > 20.7) and 27.5 µM (SI > 7.3), respectively, but 1 is inactive (EC50 > 100 µM). Otherwise, when tested against L. infantum amastigotes, 1 and 3 exhibited EC50 values of 10.3 µM (SI = 5.0) and 12.7 µM (SI > 15.7), respectively, being 2 inactive (EC50 > 100 µM). Comparing the effects of positive controls benznidazol (EC50 = 6.5 µM and SI > 30.7) and miltefosine (EC50 = 10.2 µM and SI = 15.0), it was observed a selective antiparasitic activity to diastereomers 2 and 3 against T. cruzi and  L. infantum. Considering stereochemical aspects, it was suggested that the configuration of the new stereocenter formed after oxidation of 1 played an important role in the bioactivity against amastigotes of both tested parasites.

Cardiac Sarcoidosis Presenting as Sustained Ventricular Tachycardia.

Introduction: Sarcoidosis has many possible clinical presentations since it can affect any organ, most commonly the lungs. The hallmark of the disease consists of the formation of non-necrotising granulomas. Pathogenesis is thought to rely on the interplay of genetic, environmental and epigenetic factors. This case highlights the importance of a thorough clinical history and physical examination, and the correlation with imaging findings in the diagnostic work-up of the non-ischaemic cardiomyopathy. Case description: A 57-year-old woman was admitted due to the sudden onset of malaise, dizziness, and chest discomfort. Sustained monomorphic ventricular tachycardia was evidenced and the patient rapidly evolved with haemodynamic instability; she underwent successful electrical cardioversion. The electrocardiogram afterwards showed a high-risk electrocardiographic pattern. Invasive coronary angiography excluded obstructive epicardial coronary lesions. Physical examination revealed skin lesions on the lower limbs which raised suspicion for erythema nodosum and therefore a biopsy was performed. Transthoracic echocardiography and cardiac magnetic resonance imaging revealed features consistent with an inflammatory cardiomyopathy, and an implantable cardioverter-defibrillator was placed. The histologic examination of the cutaneous lesions showed a non-necrotising granulomatous inflammatory process. Radionuclide imaging was inconclusive. The patient underwent an endomyocardial biopsy, which confirmed the diagnosis of systemic sarcoidosis with cardiac involvement. Conclusions: Systemic sarcoidosis with cardiac involvement is a challenging diagnosis. The role of imaging techniques such as transthoracic echocardiography, cardiac magnetic resonance imaging and radionuclide imaging is essential in raising suspicion and diagnosing this pathology. Endomyocardial biopsy is the 'gold standard' for its diagnosis; however, it has a low diagnostic yield. LEARNING POINTS: Systemic sarcoidosis with cardiac involvement is a challenging diagnosis as it may present in many different ways.The case presented highlights the importance of a thorough clinical history and physical examination, and the correlation with imaging findings.Imaging techniques such as transthoracic echocardiogram, cardiac magnetic resonance and radionuclide imaging are essential in raising suspicion and diagnosing cardiac sarcoidosis.

Quando eu soltar a minha voz, por favor, entenda: problematizando um dispositivo de psicanálise em extensão / When I let out my voice out, do please understand: considering the implications of a device of psychoanalysis in extension

Este artigo levanta questões sobre uma prática de psicanálise em extensão. Descreve a construção do dispositivo clínico Tá na Roda que visa tornar o grupo um entorno maleável capaz de acolher, conter e – quem sabe – ajudar a metabolizar experiências de sofrimento. A partir de Green, salientamos como a prática clínica em instituições se dá, necessariamente, imersa num entrelaçamento de enquadres e transferências. Na parte final, através da descrição da dinâmica de um atendimento singular nos aproximamos da riqueza e dos desafios característicos deste tipo de trabalho.(AU)

This article raises questions from a psychoanalysis practice in extension. It describes the construction of the clinical device Tá na Roda that aims at making the group a malleable environment ableto welcoming, containing and perhaps helping to metabolize experiences of suffering. After Green, we understand how practice in instiutions is necessarily immersed in an interweaving of transferences and framing up. In the final part, through the description of the dynamics of a series of meetings, we approach the wealth of processes and challenges characteristic of this kind of work.(AU)

Association between blood pressure and angiotensin-converting enzymes activity in prepubertal children ∗.

OBJECTIVES: Angiotensin-converting enzymes' (ACEs) relationship with blood pressure (BP) during childhood has not been clearly established. We aimed to compare ACE and ACE2 activities between BMI groups in a sample of prepubertal children, and to characterize the association between these enzymes' activities and BP. METHODS: Cross-sectional study of 313 children aged 8-9 years old, included in the birth cohort Generation XXI (Portugal). Anthropometric measurements and 24-h ambulatory BP monitoring were performed. ACE and ACE2 activities were quantified by fluorometric methods. RESULTS: Overweight/obese children demonstrated significantly higher ACE and ACE2 activities, when compared to their normal weight counterparts [median (P25-P75), ACE: 39.48 (30.52-48.97) vs. 42.90 (35.62-47.18) vs. 43.38 (33.49-49.89) mU/ml, P for trend = 0.009; ACE2: 10.41 (7.58-15.47) vs. 21.56 (13.34-29.09) vs. 29.00 (22.91-34.32) pM/min per ml, P for trend < 0.001, in normal weight, overweight and obese children, respectively]. In girls, night-time systolic BP (SBP) and diastolic BP (DBP) increased across tertiles of ACE activity ( P < 0.001 and P  = 0.002, respectively). ACE2 activity was associated with higher night-time SBP and DBP in overweight/obese girls ( P  = 0.037 and P  = 0.048, respectively) and night-time DBP in the BMI z-score girl adjusted model ( P  = 0.018). Median ACE2 levels were significantly higher among nondipper girls (16.7 vs. 11.6 pM/min per ml, P  = 0.009). CONCLUSIONS: Our work shows that obesity is associated with activation of the renin-angiotensin-aldosterone system, with significant increase of ACE and ACE2 activities already in childhood. Also, we report sex differences in the association of ACE and ACE2 activities with BP.

Prevalence of Preeclampsia in Brazil: An Integrative Review / Prevalência de pré-eclâmpsia no Brasil: Uma revisão integrativa

Abstract Objective To review literature and estimate the occurrence of preeclampsia and its complications in Brazil. Methods We performed an integrative review of the literature, and included observational studies published until August 2021 on the SciELO and PubMed databases that evaluated preeclampsia among pregnant women in Brazil. Other variables of interests were maternal death, neonatal death, hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome, and eclampsia. Three independent reviewers evaluated all retrieved studies and selected those that met inclusion criteria. A metanalysis of the prevalence of preeclampsia and eclampsia was also performed, to estimate a pooled frequency of those conditions among the studies included. Results We retrieved 304 studies after the initial search; of those, 10 were included in the final analysis, with a total of 52,986 women considered. The pooled prevalence of preeclampsia was of 6.7%, with a total of 2,988 cases reported. The frequency of eclampsia ranged from 1.7% to 6.2%, while the occurrence of HELLP syndrome was underreported. Prematurity associated to hypertensive disorders ranged from 0.5% to 1.72%. Conclusion The frequency of preeclampsia was similar to that reported in other international studies, and it is increasing in Brazil, probably due to the adoption of new diagnostic criteria. The development of a national surveillance network would be essential to understand the problem of hypertensive disorders of pregnancy in Brazil.

Resumo Objetivo Revisar a literatura e estimar a ocorrência de pré-eclâmpsia e suas complicações no Brasil. Métodos Foi realizada uma revisão integrativa da literatura, com a inclusão de estudos observacionais publicados até agosto de 2021, nas bases de dados PubMed e SciELO, que avaliavam pré-eclâmpsia em mulheres brasileiras. Outras variáveis de interesse foram morte materna, morte neonatal, síndrome de hemólise, enzimas hepáticas elevadas e plaquetopenia (hemolysis, elevated liver enzymes, and low platelet count, HELLP, em inglês) e eclâmpsia. Três revisores independentes avaliaram os estudos identificados e selecionaram aqueles que preenchiam os critérios de inclusão. Foi realizada uma meta-análise da prevalência de pré-eclâmpsia e eclâmpsia, para estimar sua frequência acumulada com relação aos estudos incluídos. Resultados Foram identificados 304 estudos, 10 dos quais foram incluídos na análise final, num total de 52.986 mulheres. A frequência acumulada de pré-eclâmpsia foi de 6,7%, com um total de 2.988 casos. A frequência de eclâmpsia variou de 1,7% a 6,2%, ao passo que a ocorrência de síndrome de HELLP foi pouco relatada. A prematuridade associada a hipertensão foi de 0,5% a 1,7%. Conclusão A frequência de pré-eclâmpsia foi similar à de estudos internacionais; no entanto, ao longo dos últimos anos, ela vem aumentando no Brasil, possivelmente como reflexo da adoção de novos critérios diagnósticos. A criação de uma rede nacional de vigilância seria fundamental para entender o problema da hipertensão na gestação no país.

Perfil dos médicos Programa Mais Médicos na Bahia e a utilização da ferramenta do Telessaúde / Profile of Mais Médicos physicians in Bahia and the use of Telehealth / Perfil de los médicos del Programa Más Médicos en Bahía y el uso de la herramienta Telesalud

A vivência no curso de pós-graduação em forma de residência em Planejamento e Gestão no Programa Mais Médicos (PMM) no estado da Bahia possibilitou a construção de um painel, cujos objetivos principais foram retratar o perfil dos médicos que atuam no estado no referido programa e a utilização da ferramenta do Telessaúde. Para construir essa experiência, a metodologia foi baseada em um estudo descritivo, que permitiu uma coleta de dados e o atendimento das metas propostas. Dessa forma, foi possível perceber que os profissionais médicos que atuam no PMM-BA são, em sua maioria, mulheres 764 (52,1%); um total de 703 (47,9%) corresponde aos homens, que declararam possuir registro profissional, sendo 922 (62,8%) no Conselho Regional de Medicina (CRM) e 520 (35,4%) no Registro Médico de Saúde (RMS); 25 (1,7%) não informaram o registro. Quanto ao uso da plataforma Telessaúde, os dados demonstraram que 567 (49,5%) conhecem e possuem cadastro na plataforma, 381 (33,2%) participaram de treinamentos e 446 (38,9%) utilizam a ferramenta. O assunto estudado permitiu propor algumas recomendações, dentre as quais destacam-se: maior investimento em infraestrutura e equipamentos eletrônicos, tais como computadores e acesso à internet, principalmente em localidades mais distantes; treinamento e orientação sobre o uso da plataforma e sua importância para o trabalho na Atenção Básica.

The graduate program residency in Planning and Management within the Mais Médicos Program (PMM) in the state of Bahia, Brazil, allowed us to build a tableau, whose main objective was to outline the profile of physicians working in that program and the use of Telehealth. To build an experience that would allow data collection and fulfillment of the proposed goals, this study adopted a descriptive approach. Thus, results showed that most medical professionals working in the PMM-BA are women 764 (52.1%), while men account for 703 (47.9%) professionals, who declared having a professional register, with 922 (62.8%) on the Regional Council of Medicine (CRM) and 520 (35.4%) on the Medical Health Record (RMS); 25 (1.7%) did not inform a register. Regarding the use of the Telehealth platform, data showed that 567 (49.5%) physicians know and have a subscription on the platform, 381 (33.2%) participated in training and 446 (38.9%) use the tool. These findings allowed for some recommendations, such as greater investment in infrastructure and electronic equipment, like computers and internet access, especially in remote locations; training and advisement on how to use the platform and its importance for Primary Care.

La experiencia en el posgrado en la modalidad de residencia en Planificación y Gestión en el Programa Más Médicos en el estado de Bahía (PMM-BA) permitió construir un panel cuyo objetivo principal fue retratar el perfil de los médicos que actúan en el estado con ese programa y ​​el uso de la herramienta Telesalud. Para construir esta experiencia, la metodología se basó en un estudio descriptivo, que permitió la recolección de datos y el cumplimiento de las metas propuestas. Así, fue posible percibir que el profesional médico que actúa en el PMM-BA es en su mayoría mujeres 764 (52,1%); un total de 703 (47,9%) corresponden a hombres, que declararon tener un historial profesional, con 922 (62,8%) en el Consejo Regional de Medicina (CRM) y 520 (35,4%) en el Registr o Médico de Salud (RMS); 25 (1,7%) no informaron el registro. En cuanto al uso de la plataforma Telesalud, los datos mostraron que 567 (49,5%) conocen y tienen registro en ella, 381 (33,2%) participaron en capacitaciones y 446 (38,9%) utilizan la herramienta. El tema estudiado permitió proponer algunas recomendaciones, entre las que se destacan: mayor inversión en infraestructura y equipos electrónicos, como computadoras y acceso a internet, especialmente en las localidades más alejadas; formación y orientación sobre el uso de la plataforma y su importancia para el trabajo en Atención Primaria.

Prevalence of Preeclampsia in Brazil: An Integrative Review.

OBJECTIVE: To review literature and estimate the occurrence of preeclampsia and its complications in Brazil. METHODS: We performed an integrative review of the literature, and included observational studies published until August 2021 on the SciELO and PubMed databases that evaluated preeclampsia among pregnant women in Brazil. Other variables of interests were maternal death, neonatal death, hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome, and eclampsia. Three independent reviewers evaluated all retrieved studies and selected those that met inclusion criteria. A metanalysis of the prevalence of preeclampsia and eclampsia was also performed, to estimate a pooled frequency of those conditions among the studies included. RESULTS: We retrieved 304 studies after the initial search; of those, 10 were included in the final analysis, with a total of 52,986 women considered. The pooled prevalence of preeclampsia was of 6.7%, with a total of 2,988 cases reported. The frequency of eclampsia ranged from 1.7% to 6.2%, while the occurrence of HELLP syndrome was underreported. Prematurity associated to hypertensive disorders ranged from 0.5% to 1.72%. CONCLUSION: The frequency of preeclampsia was similar to that reported in other international studies, and it is increasing in Brazil, probably due to the adoption of new diagnostic criteria. The development of a national surveillance network would be essential to understand the problem of hypertensive disorders of pregnancy in Brazil.

OBJETIVO: Revisar a literatura e estimar a ocorrência de pré-eclâmpsia e suas complicações no Brasil. MéTODOS: Foi realizada uma revisão integrativa da literatura, com a inclusão de estudos observacionais publicados até agosto de 2021, nas bases de dados PubMed e SciELO, que avaliavam pré-eclâmpsia em mulheres brasileiras. Outras variáveis de interesse foram morte materna, morte neonatal, síndrome de hemólise, enzimas hepáticas elevadas e plaquetopenia (hemolysis, elevated liver enzymes, and low platelet count, HELLP, em inglês) e eclâmpsia. Três revisores independentes avaliaram os estudos identificados e selecionaram aqueles que preenchiam os critérios de inclusão. Foi realizada uma meta-análise da prevalência de pré-eclâmpsia e eclâmpsia, para estimar sua frequência acumulada com relação aos estudos incluídos. RESULTADOS: Foram identificados 304 estudos, 10 dos quais foram incluídos na análise final, num total de 52.986 mulheres. A frequência acumulada de pré-eclâmpsia foi de 6,7%, com um total de 2.988 casos. A frequência de eclâmpsia variou de 1,7% a 6,2%, ao passo que a ocorrência de síndrome de HELLP foi pouco relatada. A prematuridade associada a hipertensão foi de 0,5% a 1,7%. CONCLUSãO: A frequência de pré-eclâmpsia foi similar à de estudos internacionais; no entanto, ao longo dos últimos anos, ela vem aumentando no Brasil, possivelmente como reflexo da adoção de novos critérios diagnósticos. A criação de uma rede nacional de vigilância seria fundamental para entender o problema da hipertensão na gestação no país.

Subbasal corneal nerve damage in patients with bacterial keratitis: in vivo confocal microscopy study / Danos no plexo nervoso subbasal corneano em pacientes com ceratite bacteriana utilizando a microscopia confocal in vivo

ABSTRACT Purpose: To examine subbasal corneal nerve changes in patients with bacterial infectious keratitis using in vivo confocal microscopy. Methods: Thirteen patients (13 eyes) with unilateral bacterial keratitis and 12 healthy controls were prospectively enrolled in the study. In vivo confocal microscopy was performed in all the patients at 2 time points, in the acute phase of infectious keratitis and at 28 ± 0.6 months after resolution of the infection. Results: The subbasal nerve length was 5.15 ± 1.03 mm/mm2 during the acute phase of bacterial keratitis (compared with that of the controls: 19.02 ± 1.78 mm/mm2, p<0.05). Despite the significant corneal nerve regeneration over the interval of 28 months after the resolution of the infection, the nerve density was still significantly reduced as compared with that of the controls (9.73 ± 0.93 mm/mm2, p<0.05). Moreover, in vivo confocal microscopy images showed diffuse high-reflecting areas referring to the scar tissue areas with thin and tortuous nerve branches regenerating toward these areas. Conclusions: A partial corneal nerve regeneration of subbasal nerve plexus during the first 28 months after the acute phase of infectious keratitis was observed. Moreover, the regenerated nerves of the patients remained morphologically altered as compared with those of the healthy controls. These results may be relevant to the clinical follow-up and surgical planning for these patients.

RESUMO Objetivo: Relatar as alterações no plexo nervoso corneano subbasal em pacientes com ceratite infecciosa de origem bacteriana utilizando a microscopia confocal in vivo. Métodos: Treze olhos de 13 pacientes com ceratite bacteriana unilateral e 12 indivíduos saudáveis como grupo controle foram incluídos prospectivamente no estudo. A microscopia confocal in vivo foi realizada em todos os pacientes em 2 momentos: na fase aguda da ceratite infecciosa e após 28 ± 0,6 meses da resolução da infecção. Resultados: A densidade dos nervos no plexo subbasal foi de 5,15 ± 1,03 mm/mm2 na fase aguda da ceratite infecciosa (comparada com o grupo controle: 19,02 ± 1,78 mm/mm2, p<0,05). Apesar de significativa regeneração dos nervos corneanos ao longo de um intervalo de 28 meses após a resolução da infecção, a densidade dos nervos se manteve significativamente reduzida (9,73 ± 0,93 mm/mm2) quando comparada com o grupo controle (19,02 ± 1,78 mm/mm2, p<0,05). Além disso, as imagens obtidas com a microscopia confocal mostraram áreas de hiperreflectividade referente ao tecido corneano cicatricial com ramos de nervos, afinados e tortuosos, se regenerando nessas áreas. Conclusões: Foi observado regeneração parcial dos nervos do plexo corneano subbasal durante os primeiro 28 meses após a resolução da fase aguda da ceratite infecciosa. Além disso, os nervos corneanos regenerados se mantiveram morfologicamente alterados quando comparados ao grupo controle. Esses resultados podem ser relevantes para o acompanhamento clínico e planejamento cirúrgico desses pacientes.

Subbasal corneal nerve damage in patients with bacterial keratitis: in vivo confocal microscopy study.

PURPOSE: To examine subbasal corneal nerve changes in patients with bacterial infectious keratitis using in vivo confocal microscopy. METHODS: Thirteen patients (13 eyes) with unilateral bacterial keratitis and 12 healthy controls were prospectively enrolled in the study. In vivo confocal microscopy was performed in all the patients at 2 time points, in the acute phase of infectious keratitis and at 28 ± 0.6 months after resolution of the infection. RESULTS: The subbasal nerve length was 5.15 ± 1.03 mm/mm2 during the acute phase of bacterial keratitis (compared with that of the controls: 19.02 ± 1.78 mm/mm2, p<0.05). Despite the significant corneal nerve regeneration over the interval of 28 months after the resolution of the infection, the nerve density was still significantly reduced as compared with that of the controls (9.73 ± 0.93 mm/mm2, p<0.05). Moreover, in vivo confocal microscopy images showed diffuse high-reflecting areas referring to the scar tissue areas with thin and tortuous nerve branches regenerating toward these areas. CONCLUSIONS: A partial corneal nerve regeneration of subbasal nerve plexus during the first 28 months after the acute phase of infectious keratitis was observed. Moreover, the regenerated nerves of the patients remained morphologically altered as compared with those of the healthy controls. These results may be relevant to the clinical follow-up and surgical planning for these patients.

A Smartphone App for Individual Xylazine/Ketamine Calculation Decreased Anesthesia-Related Mortality in Mice.

Currently, experimental animals are widely used in biological and medical research. However, the scientific community has raised several bioethical concerns, such as the number of animals required to achieve reproducible and statistically relevant results. These concerns involve aspects related to pain, discomfort, and unwanted animal loss. Retrospectively, we compare two different approaches for anesthesia dosage: a mobile app for dose calculation and a standard dose calculation. A total of 939 C57BL/6J and Swiss mice were analyzed. We collected data on intraoperative and anesthesia-related mortality as described in electronic or physical handwritten records. Our results showed that the mobile app approach significantly reduces anesthetic-related deaths upon using doses of ketamine and xylazine. The results suggest that anesthesia-related mortality can be minimized even more using information technology approaches, helping to solve an old but transversal challenge for researchers working with experimental mice. The mobile app is a free and open code which could be implemented worldwide as an essential requirement for all anesthetic procedures in mice using xylazine and ketamine combination. As an open code app, the Labinsane initiative could also represent the starting point to unify and validate other anesthetic procedures in different species and strains.

Avaliação de anomalias dentárias em terceiros molares através de tomografia computadorizada de feixe cônico / Evaluation of dental anomalies in third molars using cone beam computed tomography

Objetivo: A proposta deste estudo foi determinar a prevalência das anomalias dentárias em terceiros molares. Materiais e métodos: O estudo foi feito de modo transversal e retros-pectivo através da análise das tomografias computadorizadas de feixe cônico (TCFC) de pacientes com os terceiros molares. As anomalias dentárias foram investigadas e registra-das em tabela previamente desenhada para o estudo. Foram registradas outras informações como: sexo e idade. Resultados:151 exames de TCFC foram incluídos na amostra, totali-zando 308 terceiros molares avaliados. Dos 308 terceiros molares avaliados, 105 apresen-taram anomalias (37,7%). A anomalia dentária mais prevalente foi a dilaceração radicular, apresentando 96 casos (34,5%), seguida de 5 casos de microdontia (1,79%), 3 casos de hi-percementose (1,07%) e 1 pérola de esmalte (0,35%). Conclusão: A partir deste estudo foi observado que as anomalias em terceiros molares são comuns. Além disso, a dilaceração foi a anomalia mais prevalente na amostra estudada, sendo importante o cirurgião-dentista utilizar exames de imagem no planejamento de uma extração dentária.

Objective: The purpose of this study was to determine the prevalence of dental anomalies in third molars. Materials and methods: This cross-sectional and retrospective study analyzed the cone-beam computed tomography (CBCT) of patients with third molars. Dental anomalies were investigated and recorded in a table previously designed for the study. Other information such as sex and age were registered. Results: 151 patients were included in the sample, totaling 308 third molars evaluated. Out of 308 teeth, 105 had anomalies (37.7%). The most prevalent dental anomaly was the root tear, 96 cases (34.5%). The second was microdontia, 5 cases (1.79%); hypercementosis, 3 cases (1.07%); and enamel pearl, 1 case (0 .35%). Conclusion:We observed that third molar anomalies are common and that laceration was the most prevalent anomaly in the sample. Thus, dentists need to use imaging tests in planning a tooth extraction.

Health Professionals Who Suffer Intimate Partner Violence: A Descriptive, Multicenter, and Cross-Sectional Study.

OBJECTIVE: The purpose of this study was to know who are the people who assist women, who work as a health professional in the Spanish Public Health System, when they suffer intimate partner violence (IPV). METHODS: A descriptive, cross-sectional, multicenter study was conducted. The participants were female health professionals (N = 794) working within the Spanish Public Health System. The instrument used was Delgado, Aguar, Castellano, and Luna del Castillo's (2006) scale to measure ill-treatment of women. RESULTS: Two hundred seventy women suffered IPV (34%). Of the female health professionals who suffered IPV, 25.9% had spoken with someone about the violence, most commonly talking to trusted people (24.3%), a psychologist (24.3%), health professionals (20%), and others (20%). Married female health professionals living with their current or last partner/husband, residing in an urban area, and with their own salary were least likely to speak about their problem. CONCLUSION: Female health professionals who suffer IPV usually speak about this problem with trusted people instead of consulting a health professional, which may leave the problem in the private sphere. This can be because of victims not wanting to report the violence for fear of their intimate partner or wanting it to remain private. This may deprive the victims of the help they need. For this reason, the health services should establish screening for IPV not only for their patients but also for their workers.

Spectral Doppler and automated software-guided ultrasound assessment of bilateral common carotid intima-media thickness in spondyloarthritis: is there a correlation with clinical findings?

BACKGROUND AND AIM: Limited information is currently available about whether carotid intima-media thickness (IMT) correlates with the degree of disease activity in spondyloarthritis. The objective of this study was to evaluate the correlation between articular and carotid ultrasound data and laboratory and clinical variables in patients with spondyloarthritis. METHODS: Twenty-two patients with spondyloarthritis, recruited consecutively via the spondyloarthritis service of the Universidade Pontifícia Católica de Campinas, São Paulo, Brazil, were assessed using carotid artery ultrasound (radiofrequency quality intima-media thickness, RF-QIMT), joint ultrasound, clinical evaluation, and laboratory tests. RESULTS: Mean (standard deviation, SD) carotid RF-QIMT was 0.643 (0.16) mm. Mean (SD) resistive index (RI) values for the right and left carotid arteries were 0.67 (0.12) and 0.82 (0.38), respectively. Mean (SD) RI values for the right and left sacroiliac joints were 1.10 (0.97) and 0.94 (0.13), respectively. Several significant correlations were detected between ultrasound, clinical, and laboratory variables. Notably, there were correlations between sacroiliac RI and erythrocyte sedimentation rate (p=0.027) and RF-QIMT (p=0.037); between RF-QIMT and Framingham score (p=0.012) and metabolic parameters, including abdominal waist measurement, body mass index (BMI) (p=0.032 to p=0.044). CONCLUSIONS: In patients with spondyloarthritis, RF-QIMT detected atherosclerotic changes in the carotid artery wall, and spectral Doppler detected inflammatory activity in sacroiliac joints. Positive correlations were observed between these ultrasound findings and parameters reflecting patients' metabolic profile and alterations in inflammatory markers.

Prevalence and factors associated with polypharmacy in the older people: 2006-2014.

AIMS AND OBJECTIVES: To analyse the prevalence, risk factors and evolution over time of polypharmacy and self-medication in the older people in Spain from 2006-2014. BACKGROUND: Polypharmacy is a public health problem for older people worldwide which causes different negative effects on their health, increasing health costs and pharmaceutical spending. However, previous studies do not include nationally representative samples and none of them provide updated data. DESIGN: Cross-sectional study with community-dwelling older adults (N = 26,277) who participated in the National Health Survey in Spain in 2006 and 2011/2012 and the European Health Survey in Spain in 2009 and 2014. METHODS: Polypharmacy (defined as use of five or more medications in the last 2 weeks), excessive polypharmacy (defined as use of ten or more medications in the last 2 weeks) and self-medication (defined as use of medications without a prescription) were evaluated. A logistic regression was used for to know the association between polypharmacy and self-medication with the sociodemographic characteristic. RESULTS: The participants were 62% female and 38% male. The mean medication consumption was 2.96 (SD ± 2.11). Prevalence of polypharmacy was present in 21.9%, prevalence of excessive polypharmacy was 0.6%, and prevalence of self-medication was 10.7%. The most commonly used medications were for blood pressure (51.6%), pain (42.8%) and cholesterol (28.2%). Polypharmacy is associated with sex (females), age, being separated/divorced/widowed, lack of education, higher body mass index, being bedridden during the last 2 weeks and self-medication. CONCLUSIONS: The prevalence of polypharmacy and prevalence of self-medication are considerable, and they increased significantly from 2006-2014. RELEVANCE TO CLINICAL PRACTICE: To deal with polypharmacy is a big challenge for nurses. These data suggest to establish innovative clinical strategies in which the health professionals and the patients are involved to improve the personal behaviour with medicines and to reduce the risks and costs of polypharmacy and self-medication.

Vertical transmission of HIV-1 in the metropolitan area of Belo Horizonte, Brazil: 2006-2014 / Transmissão vertical do HIV-1 na área metropolitana de Belo Horizonte, Brasil: 2006-2014

Abstract Objective To revise HIV-1 vertical transmission (VT) rates in the metropolitan area of Belo Horizonte, Brazil, from January of 2006 to December of 2014. Methods Descriptive study of a prospective cohort of HIV-1-infected pregnant women and their children, monitored by the Maternal and Child HIV/Aids Research Group of Research Group at Faculty of Medicine of Universidade Federal de Minas Gerais, Brazil. Results The VT general rate was 1.9% (13/673; confidence interval [CI] 95%: 1.0-3.3). The extensive use of combined highly active antiretroviral therapy (HAART) (89.7%; 583/650) strongly impacted the reduction of VT during this period. Maternal viral load (VL) higher than 1,000 copies/mL showed significant association with VT (OR:6.6; CI 95%:1.3-33.3). Maternal breastfeeding was described in 10 cases in this cohort (1.5%; CI 95%: 0.7-2.7), but it was not associated with VT. Conclusion The present cohort data were coherent with the low VT rate described in other global populations, and it was considerably lower in comparison to the results of the same cohort during the period of 1998-2005, when the VT rate was 6.2%. These data confirm the efficiency of the National Guidelines, and emphasize the importance of adopting the international recommended procedures for prevention of mother-tochild transmission (MTCT) of HIV.

Resumo Objetivo Rever as taxas de transmissão vertical (TV) do HIV-1 na área metropolitana de Belo Horizonte, Brasil, de janeiro de 2006 a dezembro de 2014. Métodos Estudo descritivo de uma coorte prospectiva de gestantes infectadas pelo HIV-1 e seus filhos, monitorados pelo Grupo de Pesquisa em HIV/Aids Materno-Infantil, da Faculdade de Medicina da Universidade Federal de Minas Gerais, Brasil. Resultados A taxa geral de TV foi de 1,9% (13/673; intervalo de confiança [IC] 95%: 1,0-3,3). O uso extensivo de terapia antirretroviral combinada (TARVc) (89,7%; 583/ 650) impactou fortemente a redução de TV durante este período. Carga viral materna superior a 1.000 cópias/mL mostrou associação significante com TV (OR: 6,6; IC 95%:1,3-33,3). A amamentação materna foi descrita em 10 casos nesta coorte (1,5%; IC 95%: 0,7-2,7), mas não foi associada à TV. Conclusão Os dados atuais da coorte foram coerentes com a baixa taxa de TV descrita em outras populações globais, e foi consideravelmentemenor em comparação com os resultados da mesma coorte no período de 1998-2005, quando a taxa de TV foi de 6,2%. Esses dados confirmam a eficiência das Diretrizes Nacionais, e enfatizam a importância de adotar os procedimentos internacionais recomendados para a prevenção da transmissão do HIV da mãe para o filho.

Vertical Transmission of HIV-1 in the Metropolitan Area of Belo Horizonte, Brazil: 2006-2014.

OBJECTIVE: To revise HIV-1 vertical transmission (VT) rates in the metropolitan area of Belo Horizonte, Brazil, from January of 2006 to December of 2014. METHODS: Descriptive study of a prospective cohort of HIV-1-infected pregnant women and their children, monitored by the Maternal and Child HIV/Aids Research Group of Research Group at Faculty of Medicine of Universidade Federal de Minas Gerais, Brazil. RESULTS: The VT general rate was 1.9% (13/673; confidence interval [CI] 95%: 1.0-3.3). The extensive use of combined highly active antiretroviral therapy (HAART) (89.7%; 583/650) strongly impacted the reduction of VT during this period. Maternal viral load (VL) higher than 1,000 copies/mL showed significant association with VT (OR:6.6; CI 95%:1.3-33.3). Maternal breastfeeding was described in 10 cases in this cohort (1.5%; CI 95%: 0.7-2.7), but it was not associated with VT. CONCLUSION: The present cohort data were coherent with the low VT rate described in other global populations, and it was considerably lower in comparison to the results of the same cohort during the period of 1998-2005, when the VT rate was 6.2%. These data confirm the efficiency of the National Guidelines, and emphasize the importance of adopting the international recommended procedures for prevention of mother-to-child transmission (MTCT) of HIV.

OBJETIVO: Rever as taxas de transmissão vertical (TV) do HIV-1 na área metropolitana de Belo Horizonte, Brasil, de janeiro de 2006 a dezembro de 2014. MéTODOS: Estudo descritivo de uma coorte prospectiva de gestantes infectadas pelo HIV-1 e seus filhos, monitorados pelo Grupo de Pesquisa em HIV/Aids Materno-Infantil, da Faculdade de Medicina da Universidade Federal de Minas Gerais, Brasil. RESULTADOS: A taxa geral de TV foi de 1,9% (13/673; intervalo de confiança [IC] 95%: 1,0­3,3). O uso extensivo de terapia antirretroviral combinada (TARVc) (89,7%; 583/650) impactou fortemente a redução de TV durante este período. Carga viral materna superior a 1.000 cópias/mL mostrou associação significante com TV (OR: 6,6; IC 95%:1,3­33,3). A amamentação materna foi descrita em 10 casos nesta coorte (1,5%; IC 95%: 0,7­2,7), mas não foi associada à TV. CONCLUSãO: Os dados atuais da coorte foram coerentes com a baixa taxa de TV descrita em outras populações globais, e foi consideravelmente menor em comparação com os resultados da mesma coorte no período de 1998­2005, quando a taxa de TV foi de 6,2%. Esses dados confirmam a eficiência das Diretrizes Nacionais, e enfatizam a importância de adotar os procedimentos internacionais recomendados para a prevenção da transmissão do HIV da mãe para o filho.

Intimate partner violence among health professionals: distribution by autonomous communities in Spain.

OBJECTIVE To determine the prevalence of intimate partner violence among health care professionals who work in the Spanish National Health System, according to the autonomous communities of Spain. METHOD This was a descriptive cross-sectional multicenter study conducted with male and female health professionals (doctors, nurses, and nursing aides) in the different autonomous communities that are part of the Spanish National Health System. The following instruments were employed: among women, an intimate partner violence screening questionnaire; and among men, a questionnaire that screened for violence in the family environment. RESULTS A total of 1,039 health professionals participated in the study. Of these, 26% had suffered some type of abuse. Among the men, this prevalence was 2.7%, while among the women, it was 33.8%. There were differences in the prevalence of intimate partner violence among different autonomous communities, with the highest percentages in the Canary Islands. In terms of profession, 19.5% of the doctors had been exposed to intimate partner violence, while this percentage was 31% and 48.6% for nurses and nursing professionals, respectively. CONCLUSION The results indicate the presence of intimate partner violence among healthcare personnel in most of the autonomous communities of Spain. The data demonstrate the need to implement action plans, both to support victims and to mitigate the problem.

O pediatra e sua função apostólica: percepções de médicos residentes sobre suas práticas / The pediatrician and his apostolic function: perceptions of resident physicians about their practices / El pediatra y su función apostólica: percepciones de médicos residentes acerca de su práctica

Este estudo é o resultado de um trabalho pedagógico, realizado com médicos residentes em pediatria em um hospital público no Rio de Janeiro. Durante um mês os residentes se encontraram diariamente com um supervisor para uma conversa sobre as suas consultas ambulatoriais. Os sentimentos que esses atendimentos despertavam nos médicos eram trazidos para os encontros. O foco da consulta era a relação médico-paciente e os padrões defensivos dos médicos. O estudo buscou apreender as estratégias subjetivas, utilizadas pelos médicos pediatras em formação para enfrentar a sua prática clínica cotidiana. Oito residentes do primeiro ano de pediatria foram entrevistados com foco nas questões relacionadas à puericultura. Seguiu-se o Método de Explicitação do Discurso Subjacente (MEDS) no campo da pesquisa qualitativa em que as entrevistas são realizadas com uma mescla de perguntas abertas e outras específicas. Observou-se que o zelo apostólico, ou seja, os padrões defensivos dos profissionais, tal como formulado por Michael Balint, se manifesta como uma exigência acentuada sobre as mães, como uma dificuldade de conhecer a dinâmica da família. É possível que esses comportamentos estejam relacionados à excessiva idealização da mãe e da criança, como demonstrou a análise das narrativas. O trabalho direcionado para os conceitos idealizados sobre as mães e as crianças pode ajudar no arrefecimento do zelo apostólico nos profissionais em formação.

This study is the result of a pedagogical work with medical residents in pediatrics at a public hospital in Rio de Janeiro. The doctors met every day during a month with a supervisor to report about their daily practice. During these meetings they talked about the feelings that arouse in the doctors while they were with their patients. The focus of the consultation was directed on the doctor-patient ́s relationship and the defensive patterns doctors may have. The study seeks to learn how subjective strategies used by pediatricians in training are applied in their everyday clinical practice. Eight residents of the first year of Pediatrics were interviewed focusing on issues related to childcare. These interviews were conducted following the Underlying Discourse Unveiling Method (UDUM) in the Field of Qualitative Research in which there are both opens another specific question.It was observed that the apostolic zeal, ie,defensive patterns of professionals, as it was defined by Michael Balint, manifests itself as a strong demand on the mothers, as well as a difficulty in knowing family dynamics. It is possible that these behaviors are related to an excessive idealization of the mother and the child as demonstrated by the analysis of the narratives. The work directed towards the idealized concepts of mothers and infants may be usefin mitigating the apostolic zeal in professionals in training.

Este estudio es el resultado de un trabajo pedagógico con los médicos residentes en pediatría en un hospital público en Rio de Janeiro. Durante un mes los médicos se reunieron todos los días con un supervisor para comentar lo que había surgido en las consultas ambulatorias. En estas reuniones el tema se centró sobre los sentimientos que se despertaban en los ellos durante las mismas. El foco de la consulta estaba dirigido a la relación médico-paciente y los patrones defensivos de los médicos.El estudio examina las estrategias subjetivas utilizadas por los pediatras en formación para poder cumplir con su práctica clínica diaria. Ocho residentes del primer año de pediatría fueron entrevistados centrándose en cuestiones relacionadas con el cuidado de niños. Se ha seguido el Método de Explicación del Discurso Subyacente (MEDS) en el Campo de la Investigación Cualitativa en el cual las entrevistas se llevan a cabo con una mezcla de preguntas abiertas y otras específicas. Se observó que el celo apostólico, es decir, los patrones defensivos de los profesionales, tal como fue formulado por Michael Balint, se manifiesta como una fuerte exigencia con las madres y como una dificultad de conocer la dinámica de la familia. Es posible que estos comportamientos estén relacionados con la idealización excesiva de la madre y del niño, como lo demuestra el análisis de las narrativas. El trabajo dirigido hacia los conceptos idealizados de las madres y de los niños puede ayudar a reducir el celo apostólico en los profesionales en formación.