Factors associated with time-to-treatment initiation of breast cancer. / Fatores associados ao tempo para submissão ao primeiro tratamento do câncer de mama.

The present retrospective study investigated factors associated with time-to-treatment initiation of breast cancer of a cohort of 12,100 cases of health facilities qualified for high complexity in oncology within the scope of the Brazilian Public Health System (SUS) of Rio de Janeiro between 2013 and 2019. Multivariate logistic regression was used to estimate odds ratios and 95% confidence intervals. Of all cases, 82.1% were submitted to the first treatment >60 days. Patients without previous diagnosis history, higher education and in stages III and IV were less likely to have their first treatment >60 days, while treatment at a health facility outside the capital showed a higher probability. Patients with a previous diagnosis history, aged ≥50, non-white race/skin color and in stage I were more likely to be submitted to their first treatment >60 days, while subjects with higher education, treated in a health facility outside the capital and in stage IV showed a lower probability. To summarize, sociodemographic, clinical and health facility-related factors are associated with time-to-treatment initiation of breast cancer.

Este estudo retrospectivo investigou fatores associados ao tempo para submissão ao primeiro tratamento do câncer de mama entre 12.100 casos assistidos em estabelecimentos de saúde habilitados para a alta complexidade em oncologia no âmbito do SUS localizados no Rio de Janeiro entre 2013 e 2019. Regressão logística multivariada estimou razões de chances e intervalos de 95% de confiança. Foram submetidos ao primeiro tratamento em tempo >60 dias 82,1% dos casos. Entre aqueles sem histórico de diagnóstico anterior, alta escolaridade e estadiamento III e IV exibiram menor probabilidade de submissão ao primeiro tratamento em tempo >60 dias, enquanto tratamento em estabelecimento de saúde não localizado na capital exibiu probabilidade maior. Entre aqueles com histórico de diagnóstico anterior, idade ≥50 anos, raça/cor da pele não branca e estadiamento I exibiram maior probabilidade de submissão ao primeiro tratamento em tempo >60 dias, enquanto alta escolaridade, tratamento em estabelecimento de saúde não localizado na capital e estadiamento IV exibiram probabilidade menor. Em suma, fatores sociodemográficos, clínicos e relacionados ao estabelecimento de saúde estão associados ao tempo para submissão ao primeiro tratamento do câncer de mama.

Fatores associados ao tempo para submissão ao primeiro tratamento do câncer de mama / Factors associated with time-to-treatment initiation of breast cancer

Resumo Este estudo retrospectivo investigou fatores associados ao tempo para submissão ao primeiro tratamento do câncer de mama entre 12.100 casos assistidos em estabelecimentos de saúde habilitados para a alta complexidade em oncologia no âmbito do SUS localizados no Rio de Janeiro entre 2013 e 2019. Regressão logística multivariada estimou razões de chances e intervalos de 95% de confiança. Foram submetidos ao primeiro tratamento em tempo >60 dias 82,1% dos casos. Entre aqueles sem histórico de diagnóstico anterior, alta escolaridade e estadiamento III e IV exibiram menor probabilidade de submissão ao primeiro tratamento em tempo >60 dias, enquanto tratamento em estabelecimento de saúde não localizado na capital exibiu probabilidade maior. Entre aqueles com histórico de diagnóstico anterior, idade ≥50 anos, raça/cor da pele não branca e estadiamento I exibiram maior probabilidade de submissão ao primeiro tratamento em tempo >60 dias, enquanto alta escolaridade, tratamento em estabelecimento de saúde não localizado na capital e estadiamento IV exibiram probabilidade menor. Em suma, fatores sociodemográficos, clínicos e relacionados ao estabelecimento de saúde estão associados ao tempo para submissão ao primeiro tratamento do câncer de mama.

Abstract The present retrospective study investigated factors associated with time-to-treatment initiation of breast cancer of a cohort of 12,100 cases of health facilities qualified for high complexity in oncology within the scope of the Brazilian Public Health System (SUS) of Rio de Janeiro between 2013 and 2019. Multivariate logistic regression was used to estimate odds ratios and 95% confidence intervals. Of all cases, 82.1% were submitted to the first treatment >60 days. Patients without previous diagnosis history, higher education and in stages III and IV were less likely to have their first treatment >60 days, while treatment at a health facility outside the capital showed a higher probability. Patients with a previous diagnosis history, aged ≥50, non-white race/skin color and in stage I were more likely to be submitted to their first treatment >60 days, while subjects with higher education, treated in a health facility outside the capital and in stage IV showed a lower probability. To summarize, sociodemographic, clinical and health facility-related factors are associated with time-to-treatment initiation of breast cancer.

Mechanical and morphological responses of osteoblast-like cells to two-photon polymerized microgrooved surfaces.

Microgrooved surfaces are recognized as an important strategy of tissue engineering to promote the alignment of bone cells. In this work, we have investigated the mechanical and morphological aspects of osteoblasts cells after interaction with different micro-structured polymeric surfaces. Femtosecond laser writing technique was used for the construction of circular and parallel microgrooved patterns in biocompatible polymeric surfaces based on pentaerythritol triacrylate. Additionally, we have studied the influence of the biocompatible TiO2 nanocrystals (NCs) related to the cell behavior, when incorporated to the photoresin. The atomic force microscopy technique was used to investigate the biomechanical reaction of the human osteoblast-like MG-63 cells for the different microgroove. It was demonstrated that osteoblasts grown on circular microgrooved surfaces exhibited significantly larger Young's modulus compared to cells sown on flat films. Furthermore, we could observe that TiO2 NCs improved the circular microgrooves effects, resulting in more populated sites, 34% more elongated cells, and increasing the cell stiffness by almost 160%. These results can guide the design and construction of effective scaffold surfaces with circular microgrooves for tissue engineering and bone regeneration.

Insulin resistance increases as days on feed advance in feedlot Bos indicus beef cattle offered a high-concentrate finishing diet.

This experiment evaluated the effects of advancing days on feed (DOF) on insulin resistance (IR) of finishing Bos indicus bulls offered a high-concentrate diet. On day 0, 100 Bos indicus Nellore bulls were housed in 12 feedlot pens (8 or 9 bulls/pen) for a 108-d feeding period, in a manner that all pens had an equivalent BW at the beginning of the finishing period. Bulls received the same diets throughout the 108-d feeding period. Diets were corn-based (38% starch) and were offered in amounts to ensure ad libitum intake. Individual shrunk BW was obtained on days 0 and 108 after 16 h of feed and water withdrawal, whereas unshrunk BW was recorded on days 19 and 60 for average daily gain (ADG) calculation. From days 0 to 108, feed intake and feed efficiency (FE) were calculated from each pen. Blood samples were collected on days 0, 60, and 108 to assess serum concentrations of haptoglobin, cortisol, glucose, and non-esterified fatty acids (NEFA), and insulin. Glucose, NEFA, and insulin concentrations were used to determine revised quantitative insulin sensitivity check index (RQUICKI), so that lower RQUICKI values indicate a greater IR of the herd. Pen was used as the experimental unit. Overall, DMI increased as DOF also increased (R2 = 0.71), being greater from days 19 to 60 and 60 to 108 vs. 0 to 19 (P < 0.0001), but did not differ between days 19 to 60 and 60 to 108 (P = 0.79). Conversely, ADG and FE linearly decreased as DOF increased from days 0 to 108 (P < 0.0001; R2 = 0.68 and 0.79, respectively). Log-transformed RQUICKI decreased as DOF increased up to 108 (P < 0.0001; r = -0.61). Similarly, serum concentrations of haptoglobin and cortisol increased as RQUICKI increased (P < 0.0001; r = 0.43 and 0.67, respectively). In summary, insulin resistance, per RQUICKI, increased and performance reduced in feedlot bulls with the advance of days on feed. Moreover, inflammatory markers were also positively associated with insulin resistance, suggesting that inflammation might be involved with the incidence of insulin resistance.

This experiment was designed to evaluate the effects of feeding a high-starch during the feedlot phase (108 d) on performance, inflammatory markers, and insulin resistance of Bos indicus bulls. As feeding period increased, performance of the animals was reduced, whereas inflammatory markers were positively correlated with days on feed. Moreover, insulin resistance state also worsened as days on feeding increased, indicating that offering a high-starch diet for an extended period of time might lead to chronic inflammation and the occurrence of insulin resistance, which, in turn, could help us to explain the often observed decrease on performance of animals in the later stages of the feedlot phase.

Effects of sexual orientation-based bullying on feelings of loneliness and sleeping difficulty among Brazilian middle school students

Abstract Objective: To investigate the extent to which sexual orientation-based bullying relates to self-reported feelings of loneliness and sleeping difficulty among Brazilian middle school students. Method: This is a cross-sectional study using data from the 2015 PeNSE (Pesquisa Nacional de Saúde do Escolar), a survey designed to monitor the health of children and adolescents enrolled in the ninth grade in public and private Brazilian schools. Multiple linear regressions stratified by sex were used on a sample of 101,646 students, considering as reference students who had not experienced bullying, as well as students who had experienced other causes of bullying; a significance level of p < 0.05 was accepted. Results: When the reference group was composed of students who had not experienced bullying, the associations between sexual orientation-based bullying and feelings of loneliness and between sexual orientation-based bullying and sleeping difficulty were positive (p < 0.05) for both male and female students, with magnitudes about twice as large as those found among those who reported having experienced other cause s of bullying. However, when the reference group was composed of students who had experienced other causes of bullying, only the association between sexual orientation-based bullying and feelings of loneliness was positive (p < 0.05) for both male and female students. Conclusion: This study highlights that sexual orientation-based bullying is a predictor of feelings of loneliness.

Effects of sexual orientation-based bullying on feelings of loneliness and sleeping difficulty among Brazilian middle school students.

OBJECTIVE: To investigate the extent to which sexual orientation-based bullying relates to self-reported feelings of loneliness and sleeping difficulty among Brazilian middle school students. METHOD: This is a cross-sectional study using data from the 2015 PeNSE (Pesquisa Nacional de Saúde do Escolar), a survey designed to monitor the health of children and adolescents enrolled in the ninth grade in public and private Brazilian schools. Multiple linear regressions stratified by sex were used on a sample of 101,646 students, considering as reference students who had not experienced bullying, as well as students who had experienced other causes of bullying; a significance level of p<0.05 was accepted. RESULTS: When the reference group was composed of students who had not experienced bullying, the associations between sexual orientation-based bullying and feelings of loneliness and between sexual orientation-based bullying and sleeping difficulty were positive (p<0.05) for both male and female students, with magnitudes about twice as large as those found among those who reported having experienced other cause s of bullying. However, when the reference group was composed of students who had experienced other causes of bullying, only the association between sexual orientation-based bullying and feelings of loneliness was positive (p<0.05) for both male and female students. CONCLUSION: This study highlights that sexual orientation-based bullying is a predictor of feelings of loneliness.

Prevalência de discriminação percebida por orientação sexual nos serviços de saúde do Brasil: Pesquisa Nacional de Saúde, 2013 / Prevalence of discrimination perceived by sexual orientation in Brazilian health services: National Health Survey, 2013

Resumo Introdução A associação entre discriminação por orientação sexual e desfechos negativos em saúde é cada vez mais estabelecida na literatura. Entretanto, poucos estudos exploram a discriminação por orientação sexual nos serviços de saúde em amostras representativas da população geral. Objetivo Estimar a prevalência de discriminação percebida por orientação sexual nos serviços de saúde do Brasil. Método Este estudo transversal utilizou dados da Pesquisa Nacional de Saúde 2013. A prevalência de discriminação percebida por orientação sexual nos serviços de saúde foi estimada de forma global, e sua associação com características sociodemográficas e de uso de serviços de saúde foi investigada por meio de regressão de Poisson com variância robusta que calculou razões de prevalências. Resultados A prevalência global do fenômeno sob investigação foi igual a 0,18%. Embora estatisticamente significativa, a magnitude das associações observadas foi tão pequena, que nenhuma das características sociodemográficas e de uso de serviços de saúde investigadas pareceu ser capaz de, pragmaticamente, influenciar o risco de uma pessoa sofrer discriminação por orientação sexual nos serviços de saúde do Brasil. Conclusão O estudo reforça a importância de instaurar ações de promoção do respeito à diversidade sexual nos serviços de saúde do Brasil.

Abstract Background The association between discrimination based on sexual orientation and adverse health outcomes is increasingly observed in the literature. However, few studies explore discrimination based on sexual orientation in health services in representative samples of the overall population. Objective To estimate the prevalence of discrimination perceived by sexual orientation in Brazilian health servicesl. Method This cross-sectional study used data from the 2013 National Health Survey. The prevalence of discrimination perceived by sexual orientation in health services was globally estimated and its association with sociodemographic characteristics and those regarding health services was investigated using Poisson regression producing robust variance that calculated prevalence ratios. Results The global prevalence of the phenomenon investigated was equal to 0.18%. Although statistically significant, the magnitude of the observed associations was so small that none of the sociodemographic characteristics and the use of health services investigated seemed to be able to pragmatically influence the risk of a person being discrimined due to his/her sexual orientation in Brazilian health servicesl. Conclusion The study stresses the importance of establishing actions to promote respect for sexual diversity in Brazilian health services.

Effect of the zero-tolerance drinking and driving law on mortality due to road traffic accidents according to the type of victim, sex, and age in Rio de Janeiro, Brazil: An interrupted time series study.

Objective: The objective of this study was to estimate the effect of the Brazilian zero-tolerance drinking and driving law on mortality rates due to road traffic accidents according to the type of victim, sex, and age. Methods: An interrupted time series design was used to compare yearly mortality rates due to road traffic accidents in Rio de Janeiro, Brazil, before and after the zero-tolerance drinking and driving law came into effect on June 19, 2008. Yearly mortality rates were compared according to the type of victim: pedestrian, cyclist, motorcyclist, and vehicle occupant. We used the Prais-Winsten procedure of autoregression in the analysis of time series; the outcome of this analysis was the annual percentage change in the rates. Overall and stratified analyses were conducted to investigate whether the zero-tolerance drinking and driving law may have had a distributional effect on mortality rates due to road traffic accidents depending on sex and age group; a significance level of P < .01 was accepted. Results: From 1999 to 2016, there were 15,629 deaths due to road traffic accidents in Rio de Janeiro. The effect of the zero-tolerance drinking and driving law on overall mortality rates due to road traffic accidents in Rio de Janeiro was not statistically significant. However, among cyclists and motorcyclists aged ≥60 years and among pedestrians of both sexes and aged ≥20 years, the effect of the zero-tolerance drinking and driving law was to decrease mortality due to road traffic accidents at a yearly rate. Conclusion: There is evidence of reduced mortality rates due to road traffic accidents among cyclists and motorcyclists aged ≥60 years and among pedestrians of both sexes aged ≥20 years in the second major Brazilian capital 9 years after the zero-tolerance drinking and driving law was adopted.

Immunoglobulin G4-related disease of the maxillofacial region: a rare case / Enfermedad relacionada con inmunoglobulina G4 en el área maxilofacial: un caso raro

IgG4-related disease is a systemic, multifocal, immune-mediated disorder that can affect multiple organs and may present as a tumor, with rare cases described in the maxillofacial region. A female patient, 53 years old, presenting tumor-like mass in the right mandibular region. Magnetic resonance imaging suggested well circumscribed nodular lesion adjacent to the branch / body of the mandible, extending posteriorly to the masseter muscle. During the surgical procedure of excision, a lesion was observed adhering to the right masseter muscle, but it was possible to remove it completely. Histopathological and immunehistochemical analysis suggested diagnosis of IgG4-related disease, furthermore, IgG4 serum count was increased. Actually, the patient continues on periodical followups in our service and by other specialties. Can be concluded that precise diagnosis of this pathology depends on many factors, being challenging and the treatment involves multidisciplinary evaluation due to the possibility of involvement of several other organs.

La enfermedad relacionada con IgG4 es una condición sistémica, multifocal, mediada por una alteración de la respuesta inmune que puede afectar diferentes órganos o puede presentarse como un tumor, raramente descrito en el área maxilofacial. Se describe el caso de una paciente de sexo femenino de 53 años de edad, presentando una masa tumoral en el ángulo mandibular derecho. La resonancia magnética sugirió un área nodular bien delimitada adyacente al cuerpo mandibular y extendida posteriormente hasta el musculo masetero. Durante la escisión quirúrgica, la lesión se presentaba adherida al musculo de forma lateral siendo posible el retiro total de la lesión. El estudio histopatológico e inmunohistoquimico determinó el diagnóstico de enfermedad relacionada con IgG4 presentando un conteo de igG4 aumentado. Actualmente, la paciente continua con seguimiento por la especialidad. Se puede concluir que el diagnóstico preciso de esta patología depende de algunos factores; el tratamiento debe ser multidsciplinario debido a la inclusión de diferentes órganos en la enfermedad.

Pre-operative templating for knee arthroplasty shows low accuracy with standard X-rays.

OBJECTIVES: The purpose of this study was to evaluate the accuracy and reliability of pre-operative templating in predicting the size of femoral and tibial components and the effect of coronal deformity on templating accuracy. METHODS: This was a retrospective study of 39 pre-operative templates prepared by three different surgeons with different levels of training. The accuracy and reliability measures were evaluated by alpha and kappa coefficients of agreement. The analysis of the effect of coronal deformity on the accuracy of the template was measured by the Spearman's correlation test. RESULTS: Templating was accurate for the femoral component in 28.21% of anterposterior (AP) radiographs and 35.90% of lateral radiographs. Kappa coefficients were respectively 0.111 (95% confidence interval [95%CI]: -0.19 to 0.241) and 0.200 (95%CI: -0.010 to 0.401), indicating poor agreement. Templating accuracy for the tibial component were, respectively, 37.61% and 47.01% for AP and lateral views. Kappa coefficients were 0.186 (95%CI: -0.070 to 0.379) for the AP view and 0.315 (95%CI: -0.199 to 0.431) for the lateral view, showing poor and slight agreement respectively. Considering a margin of error of ±1 sizes, the agreement level improved for all components, particularly for tibia, where agreement levels become very good. The inter-observer agreement was fair for all components, except for the lateral view of the femoral component, whose agreement was good. The Spearman correlation test showed no correlation between accuracy of templating and coronal deformity. CONCLUSION: Pre-operative templating is an unreliable and inaccurate tool. There is no relation between coronal deformity and accuracy of templating.

Applications of digital subtraction angiography in the management of penetrating injuries of the maxillofacial region: A case report.

This report presents a clinical case of trauma due to assault with a knife, and describes the importance of using the correct imaging modality in cases of facial penetrating trauma involving the superficial and deep anatomical planes. Penetrating wounds in the maxillofacial region are rare and poorly reported, but can result in serious complications that are difficult to resolve and may compromise the patient's quality of life, especially when large blood vessels or other vital structures are involved. Thus, it is essential to determine the extent of the affected blood vessels and the proximity of the retained object to the anatomical structures. In this case, digital subtraction angiography was the imaging modality chosen. The use of appropriate imaging examinations allows a proper map of the surgical field, reducing the chances of vascular damage during the surgical procedure.

Prevalência de imunidade à hepatite B entre profissionais de enfermagem atuantes em hemodiálise / Prevalencia de inmunidad a la hepatitis B entre enfermería profesional activa en la hemodiálisis / Prevalence of immunity to hepatitis B among professional nursing active in hemodialysis

Objective: to evaluate the prevalence of immunity to hepatitis B among nurses active on hemodialysis. Methods: Cross-sectional study was conducted with 63 professionals from a hemodialysis private service and 29 public service ones that answered a questionnaire containing information on demographics, labor, adoption of biosecurity measures in hemodialysis and related to vaccination, immunity and occupational exposure and non-occupational at Hepatitis B vírus. Results: Among the professionals from the private service, the prevalence of immunity to hepatitis B was 93.7% and among the professionals in the public service, the prevalence was 86.2%; in both services were not found statistically significant differences when characteristics related to demographics, laboral and occupational and non-occupational exposure to hepatitis B were considered. Conclusion: Possibly these high prevalences were due to complete immunization schedule against hepatitis B found in over 80% of study participants.

Objetivo: avaliar a prevalência de imunidade à hepatite B entre profissionais de enfermagem atuantes em hemodiálise. Métodos: Estudo seccional desenvolvido com 63 profissionais de um serviço privado de hemodiálise e 29 de um serviço público que responderam um questionário contendo informações demográficas, trabalhistas, sobre adoção de medidas de biossegurança em hemodiálise e relativas à vacinação, imunidade e exposição ocupacional e não ocupacional ao vírus da hepatite B. Resultados: Entre os profissionais do serviço privado, a prevalência de imunidade à hepatite B foi de 93,7% e, entre os profissionais do serviço público, a prevalência foi de 86,2%; em ambos serviços diferenças estatisticamente significativas não foram encontradas quando características demográficas, trabalhistas e de exposição ocupacional e não ocupacional ao vírus da hepatite B foram consideradas. Conclusão: Possivelmente essas elevadas prevalências se deviam ao esquema vacinal completo contra a hepatite B encontrado em mais de 80% dos profissionais de enfermagem participantes do estudo.

Objetivo: evaluar la prevalencia de inmunidad a la hepatitis B entre los profesionales de enfermería que trabajan en hemodiálisis. Métodos: Estudio transversal con 63 profesionales de servicio privado y 29 de servicio público que respondieron un cuestionario que contiene información demográfica, laboral, sobre la adopción de medidas de bioseguridad en hemodiálises, relacionados con la vacunación, la inmunidad, la exposición ocupacional y no ocupacional al virus de la hepatitis B. Resultados: Entre los profesionales del servicio privado, la prevalencia de la inmunidad a la hepatitis B fue 93,7% y entre los profesionales del público, la prevalencia fue de 86,2%; en ambos no se encontraron diferencias estadísticamente significativas cuando se consideraron los datos demográficos, laboral, exposición ocupacional y no ocupacional a la hepatitis B. Conclusión: Posiblemente estas elevadas prevalencias se debieron a el completo esquema de vacunación contra la hepatitis B que se encontró en más del 80% de los participantes del estudio.

Avaliação da concordância entre modelos ortodônticos digitais e de gesso com e sem apinhamento / Evaluation of the agreement between digital and orthodontic models with and without crowding

O objetivo deste estudo foi avaliar o grau de concordância entre modelos ortodônticos digitais e modelos ortodônticos de gesso com e sem apinhamento. A amostra foi composta por 116 modelos de gesso, sendo 50% com apinhamento e os outros 50% sem apinhamento. Todos eles foram escaneados através do aparelho Optical 3D (Open Technologies, Itália) gerando modelos digitais. Foram realizadas medidas do diâmetro mesiodistal (DMD) dos dentes e da soma de segmentos dos arcos dentários. Nos modelos físicos as medições foram feitas com paquímetro digital, já nos digitais foram feitas a partir do programa MeshLab, versão 1.3.4 BETA. A concordância entre os modelos ortodônticos digitais e de gesso foi avaliada pelo método de Bland-Altman e a hipótese de o viés ser ou não igual a zero foi verificada pelo teste t de Student para amostras emparelhadas. Foi adotado o nível de significância estatística de 5% e nível de significância clínica ≥ 0,5mm para DMD e ≥ 1,5mm para soma de segmento de arco. Apesar de existirem algumas diferenças estatisticamente significantes entre as medições realizadas nos modelos de gesso e os digitais com e sem apinhamento, as discrepâncias foram consideradas clinicamente não significantes para ambos. Conclui-se que as medições obtidas a partir de modelos digitais com ou sem apinhamento, gerados através do aparelho Optical 3D scanner (Open Technologies, Itália) e programa MeshLab®, são concordantes com as realizadas manualmente em modelos de gesso. Modelos 9 digitais podem ser uma alternativa clinicamente confiável para modelos de gesso na prática ortodôntica.(AU)

The objective of this study was to evaluate the degree of agreement between digital orthodontic models and orthodontic models of plaster with and without crowding. The sample consisted of 116 gypsum models, 50% with crowding and the other 50% with no crowding. All of them were scanned through the Optical 3D device (Open Technologies, Italy) generating digital models. Measurements were made of the mesiodistal diameter of the teeth and the sum of segments of the dental arches. In the physical models the measurements were made with digital caliper, already in the digital ones were made from the program MeshLab, version 1.3.4 BETA. The agreement between the digital orthodontic and plaster models was evaluated by the Bland-Altman method and the hypothesis that the bias was equal to zero was verified by Student's t test for paired samples. The level of statistical significance was set at 5% and clinical significance level ≥ 0.5mm for DMD and ≥ 1.5mm for sum of arc segment. Although there were some statistically significant differences between the measurements performed in the plaster models and the digital ones with and without crowding, the discrepancies were considered clinically not significant for both. It is concluded that the measurements obtained from digital models with or without crowding, generated by the Optical 3D scanner (Open Technologies, Italy) and 11 MeshLab® program, are in agreement with those performed manually in plaster models. Digital models may be a clinically reliable alternative for plaster models in orthodontic practice.(AU)

Estudo da prevalência das uveítes em hospital oftalmológico terciário em Teresina, Piauí, Brasil / Study of the prevalence of uveitis in a tertiary ophthalmology hospital in Teresina, Piauí, Brazil

RESUMO Objetivo: analisar a prevalência das uveítes em pacientes atendidos em um serviço oftalmológico terciário em Teresina, Piauí. Métodos: estudo retrospectivo baseado em prontuários de pacientes atendidos nesse serviço. Foram descritos: gênero, faixa etária, procedência, doença de base, diagnóstico anatômico, aspecto clínico e tempo de evolução. Resultados: foram incluídos 403 prontuários constatando-se que a cada 1000 pacientes atendidos neste serviço, 3,2 tinham uveíte.A idade média dos pacientes foi de 42 anos, tanto o gênero feminino (50,6%) quanto o gênero masculino (49,4%) foram acometidos similarmente, com 61,5% dos pacientes provenientes da capital. A doença de base mais frequente foi a toxoplasmose, seguida das uveítes idiopáticas apenas com manifestações oculares. Quanto à classificação anatômica, 49,6% foram posteriores e 3,5% foram intermediárias. Em relação ao aspecto clínico, 64% foram granulomatosas, 24,8% não-granulomatosas e 11,2% não foram classificáveis. Segundo a evolução clínica, 41,4% foram agudas, seguidas de 30,8% crônicas, 14,4% recorrentes e em 13,4% os pacientes não foi feito o acompanhamento. Conclusão: pudemos constatar que para cada 1000 pacientes atendidos neste serviço 3,2 tinham uveíte, apresentando-se a toxoplasmose como importante fonte de uveíte neste serviço.

ABSTRACT Objective: To analyze the prevalence of uveitis in patients treated at a tertiary ophthalmic service in Teresina, Piauí State, Brazil. Methods: This was a retrospective study based on medical records of patients treated at this service. Sex, age, origin, underlying diseases, anatomical diagnosis, clinical aspects and progression time were described. Results: 403 records were included, noting that 3.2 out of every 1,000 patients treated at the service had uveitis.The average age of patients was 42 years old, with both sexes (50.6% females and 49.4% males) affected similarly, and with 61.5% coming from the state capital, Teresina. The most common underlying disease was toxoplasmosis, followed by idiopathic uveitis with ocular manifestations only. As to the anatomical classification, 49.6% of them were posterior and only 3.5% were intermediate. Regarding the clinical aspects, 64% were granulomatous, 24.8% non-granulomatous, and 11.2% were not classifiable. According to the clinical progression, 41.4% were acute, followed by 30.8% chronic, 14.4% recurrent cases, and 13.4% of patients did not return for medical care. Conclusion: we found that for every 1,000 patients treated at the service, 3.2 had uveitis, with toxoplasmosis itself found to be an important source of uveitis.

Postoperative complications after dental extraction in liver pretransplant patients.

OBJECTIVES: The liver pretransplant phase requires the interaction of -multidisciplinary teams for optimal patient outcomes, including dental -professionals. In this study, we sought to estimate the prevalence of complications related to dental extraction in liver transplant candidates. MATERIAL AND METHODS: This study is a case series of patients eligible for liver transplants referred for dental treatment between 2012 and 2014. Eligible patients for this study underwent at least one tooth extraction, had a complete blood count at the time of the procedure, and were candidates for liver transplantation. RESULTS: Forty-three patients, 12 women (28%) and 31 men (72%), with an -average age of 50.9 ± 11.4 years, had received a total of 116 dental extractions. The prevalence of postoperative complications was 1.7% including two bleeding episodes in the same patient. Seven patients presented a platelet count below 50 × 10³/µL and received platelet transfusions preoperatively. CONCLUSIONS: Postoperative complications following dental extractions in liver transplant candidates are unusual. CLINICAL RELEVANCE: Low postoperative complications prevalence indicates that dental surgical procedures may be safety performed in patients eligible for liver transplantation after careful -preoperative evaluation.

Importância das emoções na aprendizagem: uma abordagem neuropsicopedagógica / Importance of emotions in learning: a neuropsycopedagogical approach

O artigo procura abordar a importância das emoções na aprendizagem escolar, tendo em atenção que a missão da escola atual não deve ser focada somente no desenvolvimento intelectual das crianças e dos jovens, mas deve, igualmente, responsabilizar-se pelo seu desenvolvimento social e emocional. Independentemente de as neurociências demonstrarem, atualmente, que as emoções têm impacto fulcral na aprendizagem, muitos professores e responsáveis educacionais revelam, ainda, alguma insegurança em incorporarem o trabalho sobre as emoções na sala de aula. Ao longo do texto são exploradas questões sobre as relações entre a emoção e a cognição em termos neurofuncionais, quando ambas as funções se incorporam na aprendizagem, levantando várias reflexões sobre o processo ensino-aprendizagem e sobre as interações emocionais entre professores e alunos. Finalmente, algumas estratégias pedagógicas para os professores são avançadas e discutidas.

The article seeks to address the importance of emotions in school learning, bearing in mind that the current school's mission should not focus only on the intellectual development of children and young people, but should also be responsible for their social and emotional development. Regardless of today neurosciences show that emotions have a key impact on learning, many teachers and educational officials, still reveal some uncertainty in incorporating work on emotions in the classroom. Throughout the text are explored questions about the relationship between emotion and cognition in neurofunctional terms when both functions are incorporated in learning, raising various reflections on the teaching-learning process and on the emotional interactions between teachers and students. Finally, some teaching strategies for teachers are advanced and discussed.

Pneumatosis intestinalis and volvulus: a rare association / Pneumatose intestinal e volvo: uma associação rara

Pneumatosis intestinalis (PI) is a rare condition, especially when associated with volvulus; it is often misdiagnosed and inappropriately treated. We present the case of a 27 year-old woman suffering from an acute abdomen. An abdominal tomography was performed revealing Pneumatosis intestinalis. Once in the operating theatre sigmoid volvulus was diagnosed and Hartmann surgery performed. Histology showed intestinal ischemia. During the hospital stay, evolution was favourable. The authors present this case and a brief theoretical review, due to its rarity and clinical interest.

A pneumatose intestinal (PI) é uma condição pouco frequente, sendo ainda mais rara em associação com volvo; sendo muitas vezes mal diagnosticada e tratada inapropriadamente. Apresentamos o caso de uma mulher de 27 anos com um quadro de abdómen agudo. Realizou TAC abdominal que demonstrou pneumatose intestinal. Intra-operatoriamente foi diagnosticado volvo da sigmoideia e optado por cirurgia de Hartmann. O resultado anatomo-patológico da peça foi compatível com isquémia intestinal. Durante o internamento hospital, a doente evoluiu favoravelmente. Os autores apresentam este caso e uma breve revisão teórica, pela sua raridade e interesse clínico.

Perfil do consumo de álcool de usuários de uma unidade de Atenção Primária à Saúde / Profile of users of alcohol consumption of Primary Health Unit

Objetivo Descrever o perfil de consumo de álcool de usuários adultos de uma unidade de Atenção Primária à Saúde, segundo características sociodemográficas. Métodos Inquérito domiciliar desenvolvido com usuários de uma unidade de Atenção Primária à Saúde na cidade do Rio de Janeiro, Brasil. Em 2010, amostra de 301 indivíduos respondeu a um instrumento de coleta que continha o Alcohol Use Disorders Identification Test e variáveis de caracterização sociodemográfica. Análises univariadas com distribuição de frequências simples e bivariadas com diferenças avaliadas pelo teste X2 e pelo teste exato de Fisher foram conduzidas, considerando-se um nível de significância de 0,05. Resultados O consumo de álcool de pessoas do sexo masculino, jovens, de baixa escolaridade, não casadas, empregadas e sem religião mostrou-se mais perigoso para a saúde. Conclusão Ações preventivas em saúde voltadas para o controle do consumo abusivo de álcool devem estar dirigidas para os grupos mais vulneráveis. É importante enfatizar ações de promoção à saúde de forma a evitar a iniciação e a manutenção de consumo perigoso de álcool, bem como sua evolução para casos de dependência. .

Objective To describe the profile of adult users of alcohol consumption of a unit of Primary Health Care, according to sociodemographic characteristics. Methods Household survey developed with users of a unit of primary health care in the city of Rio de Janeiro, Brazil. In 2010, sample of 301 individuals responded to a collection instrument containing the Alcohol Use Disorders Identification Test and sociodemographic variables. Univariate analyzes with simple frequency distribution and bivariate with differences evaluated by X2 test and Fisher’s exact test were conducted considering a 0.05 significance level. Results The consumption of alcohol males, young and poorly educated, unmarried, employed and no religion was more dangerous to health. Conclusion Preventive health actions focused on the control of alcohol consumption should be facing these vulnerable groups. It is important to emphasize health promotion actions to prevent the initiation and maintenance of a hazardous alcohol consumption and its evolution for dependency cases. .

[Acute respiratory distress syndrome: case series, two years at an intensive care unit]. / Síndrome de Dificuldade Respiratória Aguda: Casuística de Dois Anos numa Unidade de Cuidados Intensivos.

INTRODUCTION: Acute Respiratory Distress Syndrome has a significant incidence and mortality at Intensive Care Units. Therefore, more studies are necessary in order to develop new effective therapeutic strategies. The authors have proposed themselves to characterize Acute Respiratory Distress Syndrome patients admitted to an Intensive Care Unit for 2 years. MATERIAL AND METHODS: This was an observational retrospective study of the patients filling the Acute Respiratory Distress Syndrome criteria from the American-European Consensus Conference on ARDS, being excluded those non invasively ventilated. Demographic data, Acute Respiratory Distress Syndrome etiology, comorbidities, Gravity Indices, PaO2/FiO2, ventilator modalities and programmation, pulmonary compliance, days of invasive mechanical ventilation, corticosteroids use, rescue therapies, complications, days at Intensive Care Unit and obits were searched for and were submitted to statistic description and analysis. RESULTS: A 40 patients sample was obtained, with a median age of 72.5 years (interquartile range = 22) and a female:male ratio of ≈1:1.86. Fifty five percent of the Acute Respiratory Distress Syndrome cases had pulmonary etiology. The mean minimal PaO2/FiO2 was 88 mmHg (CI 95%: 78.5-97.6). The mean maximal applied PEEP was 12.4 cmH2O (Standard Deviation 4.12) and the mean maximal used tidal volume was 8.2 mL/ Kg ideal body weight (CI 95%: 7.7-8.6). The median invasive mechanical ventilation days was 10. Forty seven and one half percent of the patients had been administered corticosteroids and 52.5% had been submitted to recruitment maneuvers. The most frequent complication was Ventilator Associated Pneumonia (20%). The median Intensive Care Unit stay was 10.7 days (interquartile range 10.85). The fatality rate was 60%. The probability of the favorable outcome 'non-death in Intensive Care Unit' was 4.4x superior for patients who were administered corticosteroids and 11x superior for patients < 65 years old. DISCUSSION AND CONCLUSIONS: Acute Respiratory Distress Syndrome is associated with long hospitalization and significant mortality. New prospective studies will be necessary to endorse the potential benefit of steroid therapy and to identify the subgroups of patients that warrant its use.

Introdução: A Síndrome de Dificuldade Respiratória Aguda apresenta incidência e mortalidade significativas em Cuidados Intensivos, justificando estudos adicionais, nomeadamente para definição de novas abordagens terapêuticas. Os autores propuseram-se caracterizaros casos duma Unidade de Cuidados Intensivos em dois anos.Material e Métodos: Procedeu-se a um estudo observacional retrospectivo dos casos admitidos numa Unidade de Cuidados Intensivos, cumprindo os critérios diagnósticos da American-European Consensus Conference on ARDS, tendo sido excluídos os não ventilados invasivamente. Pesquisados e submetidos a tratamento estatístico: dados demográficos, etiologia do Síndrome de Dificuldade Respiratória Aguda, comorbilidades, Índices de Gravidade, PaO2/FiO2, modalidades e parâmetros ventilatórios, compliance pulmonar, dias de ventilação mecânica invasiva, corticoterapia, terapêuticas de resgate, complicações, duração do internamento, óbitos.Resultados: Obtiveram-se 40 doentes, com uma mediana de 72,5 anos (amplitude interquartil 22) e um ratio feminino:masculino ≈1:1,86. Cinquenta e cinco por cento dos Síndrome de Dificuldade Respiratória Aguda tiveram etiologia pulmonar. A média do PaO2/ FiO2 mínimo foi 88mm Hg (IC 95%: 78,5-97,6). A média da PEEP máxima aplicada foi 12,4 cmH2O (Desvio Padrão 4,12) e a médiado Volume Corrente máximo utilizado foi 8,2 mL/Kg peso ideal (IC 95%: 7,7-8,6). A mediana dos dias de ventilação mecânica invasiva foi 10. Em 47,5% dos doentes foram administrados corticóides. Em 52,5% foi executado recrutamento alveolar. A complicação mais frequente foi a Pneumonia Associada a Ventilação (20%). A mediana da duração do internamento foi 10,7 dias (amplitude interquartil10,85). Faleceram 60% dos doentes. A probabilidade de outcome favorável 'não óbito na Unidade de Cuidados Intensivos' foi 4,4x superior nos doentes sob corticoterapia e 11x superior nos doentes com idade < 65 anos.Discussão e Conclusões: A Síndrome de Dificuldade Respiratória Aguda associa-se a internamentos prolongados e significativa mortalidade. Novos estudos prospectivos serão necessários para confirmar o benefício dos corticóides, bem como identificar o/(s) subgrupo/(s) de doentes que mais justificam a sua utilização.