Estratégias pedagógicas de ensino de diagnóstico por imagem nas escolas médicas brasileiras: uma revisão sistemática / Pedagogical strategies for teaching diagnostic imaging in Brazilian medical schools: a systematic review

RESUMO Introdução: A competência dos profissionais de saúde em radiologia não apenas desempenha um papel fundamental no controle de custos, mas também na prevenção de erros médicos decorrentes da inexperiência durante a prática clínica. Objetivo: Este estudo realiza uma revisão sistemática com o objetivo de investigar as estratégias pedagógicas empregadas no ensino de diagnóstico por imagem nas instituições médicas brasileiras, bem como analisar o nível de conhecimento adquirido pelos estudantes de Medicina ao longo de sua graduação. Método: A revisão sistemática da literatura seguiu as diretrizes do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) e abrangeu as bases de dados PubMed, LILACS/BVS, Scopus, Web of Science, Embase e ScienceDirect. A busca visou identificar artigos que abordassem metodologias e estratégias de disseminação do conhecimento em imagiologia médica. A avaliação do nível de evidência foi conduzida utilizando a abordagem GRADE. Resultado: Dos 152 artigos inicialmente identificados, 13 foram selecionados após a remoção de duplicatas e análise de títulos e resumos. Durante a leitura completa, excluíram-se oito artigos por causa de metodologias inadequadas ou desalinhamento com os objetivos da pesquisa. Os estudos elegíveis envolveram 461 alunos de Medicina em 49 instituições brasileiras, principalmente privadas, caracterizadas por um sistema híbrido de ensino e uma ênfase particular em módulos de radiologia médica. Salas de aula foram destacadas como os principais ambientes de ensino. No contexto do ensino de diagnóstico por imagens, muitos alunos ainda enfrentam dificuldades na avaliação de exames, independentemente do período letivo. O estudo aponta para a falta de uniformidade nos benefícios das políticas governamentais, resultando em segregação regional e financeira no acesso ao ensino. Conclusão: A despadronização do ensino contribui para uma formação deficiente em radiologia, deixando os profissionais despreparados para a interpretação adequada de exames. Diante da escassez de estudos e das disparidades identificadas, torna-se imperativo estabelecer parâmetros mínimos para os currículos em radiologia médica, proporcionando uma base estruturada para as instituições de ensino nacionais e visando à melhoria da qualidade do ensino e da formação profissional.

ABSTRACT Introduction: The competence of healthcare professionals in radiology not only plays a fundamental role in cost control but also in preventing medical errors resulting from inexperience during clinical practice. Objective: This study conducts a systematic review aiming to investigate the pedagogical strategies employed in teaching imaging diagnostics at Brazilian medical institutions, as well as to analyze the level of knowledge acquired by medical students throughout their education. Method: The systematic literature review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and covered the databases PubMed, LILACS/BVS, Scopus, Web of Science, Embase, and ScienceDirect. The search aimed to identify articles that addressed methodologies and strategies for disseminating knowledge in medical imaging. The evaluation of the level of evidence was conducted using the GRADE approach. Results: Of the 152 articles initially identified, 13 were selected after the removal of duplicates and analysis of titles and abstracts. During the full reading, eight articles were excluded due to inadequate methodologies or misalignment with the research objectives. The eligible studies involved 461 medical students across 49 Brazilian institutions, primarily private, characterized by a hybrid teaching system and a particular emphasis on medical radiology modules. Classrooms were highlighted as the main teaching environments. In the context of teaching imaging diagnostics, many students still face difficulties in evaluating exams, regardless of the academic term. The study points to the lack of uniformity in the benefits of government policies, resulting in regional and financial segregation in access to education. Conclusion: The lack of standardization in education contributes to inadequate training in radiology, leaving professionals unprepared for the proper interpretation of exams. Given the scarcity of studies and the identified disparities, it becomes imperative to establish minimum standards for medical radiology curricula, providing a structured foundation for national educational institutions and aiming to improve the quality of education and professional training.

Development of endometrial cancer after long-term usage of the levonorgestrel-releasing intrauterine system.

A 52-year-old long-term user of the levonorgestrel-releasing intrauterine system (LNG-IUS) presented with vaginal bleeding. Endometrial biopsy was performed and revealed endometrioid adenocarcinoma. The patient had a laparoscopic hysterectomy and bilateral salpingo-oophorectomy. Endometrial cancer is rare in women with LNG-IUS as only seven cases have been published in the literature. Although scientific evidence shows LNG-IUS has a protective effect on the endometrium from developing cancer, our report highlights the importance of clinicians to be vigilant in cases of women with LNG-IUS who develop intermittent vaginal bleeding.

Aspectos sistêmicos e odontológicos de portadores de paralisia cerebral

A paralisia Cerebral (PC) pode ser considerada um grupo de desordens do desenvolvimento do movimento e da postura, e é atribuída a distúrbios não progressivos que ocorreram no cérebro durante o período fetal e no bebê, resultando em dificuldades nas habilidades funcionais. Estes déficits funcionais, via de regra, provocam repercussões na qualidade da saúde bucal e na qualidade de vida destes pacientes. O presente artigo realiza uma revisão de literatura sobre os aspectos sistêmicos e odontológicos de indivíduos portadores de paralisia cerebral, enfatizando aspectos conceituais, epidemiológicos e clínicos, com a finalidade de transmitir conhecimento aos profissionais da saúde e com isso tentar melhorar atenção à saúde geral nesse grupo populacional. Entretanto concluiu-se que não basta transmitir conhecimento faz-se necessário também a implementação de políticas públicas que contemplem a promoção, prevenção e melhoria dos serviços especializados para esses pacientes, conjuntamente com ações interprofissionais da saúde que contribuam para a integralidade da assistência e aprimoramento dos serviços.

The influence of chemiotherapic agents and their accessories on oral manifestations of acute lymphoid leukemic children

Aim: To evaluate the influence of chemotherapy agents and their accessories on oral manifestations of children who have acute lymphoid leukemia. Material and Methods: After the stipulated period for the research, the total sample reached was of 68children. Nevertheless, only 46 children had continued for the second period. Children from 2 to 12 years of age who had been diagnosed with ALL ­ and would be submitted to treatment at Ophir Loyola Hospital, in Belém, State of Pará ­ had been included in the research. The first evaluation has been held before the chemotherapy treatment and had offered anamnesis and clinical exams. The second evaluation has been held in 10 to 15 days after the beginning of chemotherapy treatment and has offered a new clinical exam and annotations of the drugs which had been utilized during the chemotherapy. Results: From the drugs given at Ophir Loyola Hospital, it has been observed that 14 to 24mg (83%), vincristine 0,6mg to 1 g (80%), ARA-C 20mg to 1600mg (74%), cardioxane13mg to 340mg (65%), methotrexate 12mg to 2400mg (63%), cyclophosphamide 104mg to 1540mg (59%), asparaginase 50UI to 9600UI (57%) andmesna 75mg to 510mg (54%) have been used the most. No drug has presented statistic at 5% levelin Fisher exact test, when crossing with the presence of the main mouth manifestations: mucositis, xerostomia, toothache,and dysphagia. Conclusions: In the face of the results, it can be concluded that there has been no influence of the chemotherapy agents and their accessories in the oral manifestations of acute lymphoid leukemic children; nevertheless, these patients may present any kind of lesion on the mouth cavity during or after the beginning of chemotherapy. The dental surgeon needs to recognize the oral manifestations and intervene on the buccal health of the ALL patients, contributing and helping with his/her treatment.

Pediatric cancer: epidemiologic profile of attended children in a reference center in the state of Para

Aim: To describe the epidemiological findings of children diagnosed with cancer in a referral center. Material and Methods: Daily at Ophir Loyola Hospital visits were made - Belém / PA, in clinical pediatric oncology sector, from December 2013 to June 2014. The sample comprised 46 children 2-12 years, diagnosed with cancer, which was already or would begin anticancer treatment. A questionnaire containing questions about family, socioeconomic and environmental aspects was applied.. Results: The most frequent neoplasia LLA was followed by nephroblastoma, neuroblastoma, Hodgkin lymphoma, and osteosarcoma. The genre most affected by childhood cancer was male. The age group with the predominant prevalence were children aged 8-12 years. By observing the religious belief that it was possible to detect most practiced Catholicism. The practice of sports is not part of the daily lives of these children. The origin of these families had dominated for deriving from the state. As the rating distribution of households according to the Economic Classification Criterion Brazil, the two classes were most frequently C2 and D. Conclusions: We sought, in this article, to demonstrate the epidemiological profile of children seen at a referral center in the state of Para. Research like this, identifying population groups at highest risk or with more unfavorable prognosis, provide health authorities and researchers in the area of cancer with an important instrument in the definition of health necessary for proper control and prevention of the disease.

The caries experience and dentistry following evaluation of children submitted to antineoplastic therapy

Aim: To evaluate the caries experience and the dentistry following of children submitted to antineoplastic therapy of a reference Hospital to this type of treatment in Para state, Brazil. Material and Methods: The sample consisted of 46 children. It was included children in the ages of 2 to 12 years diagnosed with cancer that would be submitted to chemotherapy treatment. The evaluation was performed before the chemotherapy treatment and consisted of anamnesis and oral clinical examination. In order to decrease the interexaminer diagnosis variability and increase the data surveys confidentiality, a previous training and calibration was performed before the beginning of the examination. Results: There was a higher prevalence of childish cancer among male gender children. The age group more affected was between 8 to 12 years. There was a bigger percentage of patients that didn't go to the dentist before the chemotherapy treatment. The children caries experience was evaluated by the CPO-D and medium Ceo-d indexes, obtaining respectively the values of 4,75 and 0,47. Conclusions: The initial caries experience was high comparing to the international and Brazil average. Most of researched children didn't have a previous dentistry care before the beginning of antineoplastic therapy.

Oral Manifestations and Salivary pH Changes in Children undergoing Antineoplastic Therapy

Objective: To identify the oral manifestations and salivary pH before and after chemotherapy in pediatric patients. Material and Methods: The sample consisted of 46 children. It was included children from 2 to 12 years, diagnosed with Acute Lymphoblastic Leukemia (ALL) and they would be subjected to chemotherapy. The first evaluation was performed before chemotherapy and consisted of anamnesis, oral clinical examination and saliva collection to measure the pH. The second evaluation was performed among 10 to 15 days after the start of chemotherapy treatment and consisted of new saliva collection and clinical examination. Results: The results showed that the gender most affected by childhood cancer was male. The predominant age group were children aged 8-12 years. The most frequent oral manifestations were mucositis (35%), xerostomia (26%), toothache and dysphagia (22%). There was also a significant reduction in salivary pH after chemotherapy, p <0.0001, indicating that the average pre and post chemotherapy are different (Δ = 10.6) with statistical significance at the 5% level. Conclusion: Patients with ALL can present any lesion in the oral cavity during or after the start of chemotherapy and undergo changes in the amount of salivary pH. The dentist needs and know the oral manifestations and intervene in the oral health of patients with ALL, contributing and assisting in their treatment.

Analysis of the relation of intrauterine digital sucking with the permanence of the habit in the post birth child

AIM: This research aims to investigate the development of this habit's appearance, which may be observed even at the intrauterine stage and which also persists for a long time. MATERIAL AND METHODS: 25 gestations that presented children practicing intrauterine digital sucking habits were followed-up. The initial analysis was accomplished through routine ultrasound examination, using pregnant women between the 4th and 8th gestation months who visited João de Barros Barreto University Hospital. Detecting this habit, every quarter an afterbirth accessory was carried out,over a 1 year period, in order to observe the habit's persistence. This phase was developed in the Dental Office of the Brasil Sorridente Program. Statistical analysis were carried out regarding the obtained outcomes using the described statistics and inferential methods, and the Chi-square test with 5% significance level was applied. RESULTS: This research observed that 72% of babies were male gender and 28% female gender, 68% of babies persisted with the digital sucking habit 1 month afterbirth, 72% until the second month, 56% until the fifth month and 48% until one year old. Assessing the habit's post natal persistence according to gender, the binominal test was applied which was significant (p=0.0186). It was concluded that the number of male babies with digital sucking habit was above the female gender (p=0.0455), the habit's persistence was reduced by 50% when compared with the first month, however, the p=0.2474 indicates that the reduction was not significant. CONCLUSION: Our outcomes cannot be generalized; however they can be used as a base for future research in this area.

Conhecimento dos cirurgiões dentistas diante Urgência/Emergência Médica / Knowledge of Dental Surgeons in Emergency/Medical Emergency

Situações de urgências e emergências médicas podem acontecer a qualquer momento no consultório odontológico e com qualquer indivíduo. O objetivo deste estudo foi avaliar o nível de conhecimento dos cirurgiões-dentistas (CDs) do município de Belém do Pará, quanto às situações de urgência e emergência em consultório odontológico. O estudo foi do tipo exploratório descritivo, com delineamento transversal e abordagem quantitativa. Foi aplicado um questionário a 362 CDs, a fim de caracterizar o perfil profissional (sexo, tempo de formado, se clínico geral ou especialista), ocorrência de situação de urgência/emergência, qual a ocorrência mais comum na prática clínica, como esta era conduzida, como atuar frente emergências/ urgência em casos de síncope vasovagal, crise hipertensiva, medicação em caso de choque anafilático e episódio de convulsão. Amostra era composta por 102 homens, 147 mulheres e 121 respondentes não informaram o sexo. Houve um predomínio de respondentes com 1 a 5 anos de formados; 50.5% possuíam título de Especialista e 49.5% eram Clínicos Gerais. Dos 125 (33.8%) CDs que experienciaram situações de urgência/emergência, a hipoglicemia foi a mais comum (48,8%). É perceptível uma lacuna na formação dos CDs quanto ao diagnóstico diferencial e forma de abordagem quando da ocorrência de uma urgência/emergência médica em consultório odontológico... (AU)

Emergency situations and medical emergencies can happen at any time in the dental office and to any individual. The aim of this study was to evaluate the level of knowledge of dentists ( CDs ) in Belém do Pará , as for emergencies and emergency dental office . The study was exploratory and descriptive , cross-sectional design and quantitative approach . A questionnaire was applied to 362 CDs in order to characterize the professional profile ( sex, year of graduation , whether general practitioner or specialist ) , occurrence of urgency / emergency , which is the most common occurrence in clinical practice , as it was conducted as act against emergencies / urgent in cases of vasovagal syncope, hypertensive crisis medication in case of anaphylactic shock and convulsion . Sample consisted of 102 men , 147 women and 121 respondents did not report sex . There was a predominance of respondents with 1-5 years of graduates ; 50.5 % had a Specialist and 49.5 % were GPs . Of 125 (33.8 % ) who experienced situations CDs urgent / emergency , hypoglycaemia was the most common ( 48.8 % ). Noticeable is a gap in the training of CDs on the differential diagnosis and how to approach in the event of an emergency / medical emergency in the dental office... (AU)

Reimplante dentário na dentição decídua: uma alternativa de sucesso – relato de caso / Tooth replantation in primary dentition: a successful choice - case report

A literatura ‚ muito controversa ao descrever os reimplantes de dentes decíduos.  um procedimento desencorajado pela maioria por poder causar danos ao sucessor permanente. O presente trabalho apresenta e discute relatos de sucesso de reimplantes na dentição decídua, bem como aborda sua técnica, suas indicações, contraindicações e possíveis sequelas. Frentes diversas condutas em relação … avulso de um dente decíduo, observa-se que são necessários mais estudos para que se possa obter êxito em um número maior de casos

Literature is very controversial while describing the replantation of primary teeth. This procedure is commonly discouraged due to the possibility of causing damage to its permanent successor. This article presents and discusses reports of successful replantation in primary dentition, and also discusses the technique, its indications and contraindications as well as possible sequels. Considering the different approaches after a deciduous tooth avulsion, it was observed that further researches are required to ensure successful procedures

Cochliomyia homnivorax em estágio avançado na cavidade oral / Cochliomyia Homnivorax in an advanced stage in the oral cavity

Miíase caracteriza-se pela invasão de tecidos do corpo ou cavidade de animais vivos por larva. É mais frequentemente observada em países subdesenvolvidos e tropicais, mas existem casos descritos em todo o mundo. O tratamento convencional consiste na remoção mecânica das larvas, uma a uma, consistindo em ato dolorido, constrangedor e repugnante, tanto para o profissional quanto para o paciente. Apesar de não ser considerada rara, observa-se pouco conhecimento do profissional de odontologia para o diagnóstico e tratamento de tal patologia.Por este motivo, esse trabalho relata um caso de miíase oral, em estágio avançado, acometendo um paciente de nove anos de idade, tratado em clínica médico-odontológica. O diagnóstico foi baseado na presença visual de larvas Cochliomyia homnivorax, díptero da família Calliphoridae, que estavam entre o segundo e terceiro estágio de desenvolvimento. Fatores predisponentes como falta de informação, desnutrição, má higiene oral, preexistência de lesões bucais e halitose severa têm influência decisiva no surgimento e progressão de miíase bucal. Realizou-se, também, uma breve revisão de literatura, na qual foi discutido sobre esta patologia, sobre a importância do diagnóstico clínico precoce, sua etiologia, possíveis associações com outras patologias e diferentes tipos de tratamento.

Myiasis is characterized by the invasion of body or cavity tissues of live animals by larva. It is most frequently observed in underdeveloped and tropical countries, but there are cases described worldwide. Conventional treatment consists of mechanical removal of the larvae, one by one, which is a painful, embarrassing and repugnant process, both for the professional and patient. Although it is not considered rare, it has been observed that the dental professional has little knowledge for the diagnosis and treatment of this pathology. For this reason, this study reports a case of oral myiasis at an advanced stage, which affected a nine-year-old patient, treated at a medical-dental clinic. Diagnosis was based on the visual presence of Cochliomyia homnivorax larvae, diptera of the Calliphoridae family, which were between the second and third stages of development. Predisposing factors, such as the lack of information, malnutrition, poor oral hygiene, preexistence of oral lesions and severe halitosis have a decisive influence in the appearance and progression of oral myiasis. A brief literature review was also conducted, in which this pathology was discussed, including the importance of early clinical diagnosis, its etiology, possible associations with other pathologies, and different types of treatment.

Alterações do esmalte dentário e o início do processo eruptivo em bebês nascidos prematuros/baixo peso / Dentary enamel defects and the begining of the eruptive process in pretermo children with low weight

OBJETIVOS: Investigar a relação entre as alterações estruturais do esmalte dentário e o padrão do início do período eruptivo dental, frente à prematuridade e ao baixo peso dos bebês ao nascimento. MATERIAIS E MÉTODOS: foram utilizados 50 bebês com idade gestacional correspondente a 35 semanas ou menos, com peso inferior ou igual a 2.500 gramas, na faixa etária de 5 a 36 meses, nascidos na Fundação Santa Casa de Misericórdia do Pará. Foi avaliada a presença de defeitos de esmalte e o início da erupção dentária através do exame clinico realizado na própria residência e por um único examinador. RESULTADOS: os defeitos de esmalte foram observados em 38% dos bebês examinados, sendo prevalente a opacidade branca/creme com maior incidência na maxila; há relação inversa entre peso ao nascimento/idade gestacional e a presença de alterações estruturais no esmalte dentário. O início do processo eruptivo ocorreu aos nove meses de idade (50%). Não houve diferença significativa entre os gêneros masculino e feminino, no que se refere à presença de defeitos de esmalte e ao início da erupção dentária. CONCLUSÃO: Os bebês de peso baixo tendem a apresentar maior número de defeitos de esmalte e há relação inversa entre a idade gestacional/grupo de baixo peso e o atraso no processo eruptivo.

OBJECTIVES: to investigate the relation enters the structural alterations of the dental enamel and the standard of the beginning of the dental eruptivo period, front to the prematurity and the low weight of the babies to the birth. MATERIALS AND METHODS: the 35 weeks had been used 50 babies with corresponding gestacional age or less, with inferior or equal weight the 2500 gram, in the etária band of 5 the 36 months, that had been bom in the Foundation Saint Casa de Misericórdia of Pará. It was evaluated the presence of enamel defects and the beginning of the dental eruption through the carried through clinic examination in the proper residence and for an only examiner. RESULTS: the enamel defects had been observed in 38% of the examined babies, being more prevalent the opacity branca/creme with bigger incidence in the jaw; an inverse relation between weight to the gestacional nascimento/idade and the presence of structural alterations in the dental enamel was established. The beginning of the eruptivo process occurred to the 9 months of age (50%). It did not have significant difference between the sorts masculine and feminine in that if it relates to the presence of defects of enamel and to the beginning of the dental eruption. CONCLUSION: The babies of low weight tend to present greater number of enamel defects and to the measure that the weight increases the number of babies with defects diminishes. Inverse relation was observed enters the age gestacional/group of low weight and the delay in the eruptiv processo.

Análise de percepções e ações de cuidados bucais realizados por equipes de enfermagem em unidades de tratamento intensivo / Perceptions and actions of oral care performed by nursing teams in intensive care units

OBJETIVOS: Buscando estabelecer um perfil da percepção e realização dos cuidados em saúde bucal prestados a pacientes internados em unidades de tratamento intensivo por equipes de enfermagem, realizou-se um estudo com entrevistas orientadas por um questionário. MÉTODOS: A população de estudo foi constituída de profissionais de enfermagem divididos em três categorias de formação: enfermeiros, técnicos de enfermagem e auxiliares de enfermagem que atuam em instituições hospitalares públicas e particulares prestando serviços em unidades de tratamento intensivo na cidade de Belém - PA. RESULTADOS: A pesquisa desenvolvida neste trabalho retornou com resultados, os quais sugerem que os cuidados de higiene bucal realizados nos pacientes hospitalizados em unidades de terapia intensiva são escassos e inadequados, sendo necessárias modificações nos cuidados dispensados atualmente, especialmente no ambiente nosocômial da equipe de atenção ao paciente. CONCLUSÃO: A presença de cirurgião dentista, a difusão dos conhecimentos de odontologia preventiva e o uso de recursos específicos de higiene bucal são medidas sugeridas como tentativas de solucionar as dificuldades apresentadas na manutenção da saúde bucal e no tratamento das doenças bucais, que afetam a saúde geral dos pacientes hospitalizados. A atuação interdisciplinar no atendimento a estes indivíduos é defendida visando à obtenção de uma melhor qualidade de vida prevenindo ou minimizando patologias orais presentes.

OBJECTIVES: A study was carried out, by means of a questionnaire for guided interviews seeking to establish a profile of perceptions and oral care given by ICU nursing team to patients in intensive care units. METHODS: The target population consisted of nursing practitioners divided in three education categories: nurses, nursing technicians and auxiliary nurses working at public and private hospital institutions providing for intensive care unit patients in Belem-PA. Dentistry experience has developed in this field reporting scientific findings and practical applications on prevention and reestablishment of the oral health in question. RESULTS: This survey disclosed results suggesting that oral hygiene care given to intensive care units patients is insufficient and inadequate requiring changes be made in the care now provided in the nosocomial environment by the nursing team. CONCLUSION: Presence of a dentist, knowledge of preventive dentistry, dissemination and use of oral hygiene specific resources are means suggested in an attempt to resolve difficulties found in oral health maintenance and treatment of oral diseases that affect the general health of hospitalized individuals. Interdisciplinary action for these individuals is advocated to achieve a better quality of life by preventing or minimizing oral pathologies.

Perceptions and actions of oral care performed by nursing teams in intensive care units. / Análise de percepções e ações de cuidados bucais realizados por equipes de enfermagem em unidades de tratamento intensivo.

OBJECTIVES: A study was carried out, by means of a questionnaire for guided interviews seeking to establish a profile of perceptions and oral care given by ICU nursing team to patients in intensive care units. METHODS: The target population consisted of nursing practitioners divided in three education categories: nurses, nursing technicians and auxiliary nurses working at public and private hospital institutions providing for intensive care unit patients in Belem-PA. Dentistry experience has developed in this field reporting scientific findings and practical applications on prevention and reestablishment of the oral health in question. RESULTS: This survey disclosed results suggesting that oral hygiene care given to intensive care units patients is insufficient and inadequate requiring changes be made in the care now provided in the nosocomial environment by the nursing team. CONCLUSION: Presence of a dentist, knowledge of preventive dentistry, dissemination and use of oral hygiene specific resources are means suggested in an attempt to resolve difficulties found in oral health maintenance and treatment of oral diseases that affect the general health of hospitalized individuals. Interdisciplinary action for these individuals is advocated to achieve a better quality of life by preventing or minimizing oral pathologies.

Primary hyperparathyroidism in pregnancy presenting as intractable hyperemesis complicating psychogenic anorexia: a case report.

BACKGROUND: Primary hyperparathyroidism is a rare complication of pregnancy. Its peak incidence is in the perimenopausal period. CASE: A 31-year-old woman was admitted at 8 weeks of pregnancy with intractable hyperemesis and fatigue. After parathyroidectomy, at 18 weeks' gestation, she remained asymptomatic. Biochemistry gradually normalized, and her body mass index returned to the levels found prior to her eating disorder manifestation. In our review there were no maternal complications in 32 of 43 (74%) cases. There were 10 cases (21%) of fetal complications identified. CONCLUSION: Postponing treatment increases the risk of preeclampsia, preterm labor and fetal parathyroid impairment, while early surgical treatment decreases the fetal complication rate 4-fold.

Percepção das gestantes sobre a atenção odontológica precoce nos bebês / Pregnant womenÆs awareness related to their babiesÆ early oral health care

Objetivos: Obter maiores informações sobre o conhecimento materno em relação aos cuidados bucais do bebê. Métodos: Aplicou-se um questionário a 40 gestantes do Serviço Materno Infantil da Universidade Estadual do Pará. Resultados: Foram analisados na forma de freqüência e percentagem, tendo sido possível estabelecer que a faixa etária das gestantes variou de 15 até 40 anos; 67% das gestantes responderam que os bebês ficarão com elas durante o dia, 28% com as avós e 5% com outros. Em relação à prática de higiene oral, 92% das gestantes irão praticar algum tipo de higiene bucal em seu futuro bebê, embora 48% delas jamais haviam recebido qualquer tipo de orientação quanto à necessidade de higienizar a boca do bebê. Das entrevistadas, 92% acreditam que o atendimento odontológico realizado em bebês previne problemas futuros; destas 57% levarão seus filhos pela primeira vez ao consultório dentário antes de completarem 1 ano. Conclusão: Após a análise dos dados obtidos foi possível constatar que existe a necessidade da implementação de ações práticas voltadas para a interação entre médico ginecologista, médicos pediatras e odontopediatras, para que seja instituído no atendimento a gestante um programa educativo, levando mais informações, para que ocorra a conscientização das mães sobre a saúde bucal de seus filhos, desde ainda bebês.

Investigación de alteraciones del esmalte dentario e inicio del proceso eruptivo en bebés nacidos prematuros y con bajo peso / Investigation on dental enamel alterations and eruption time in premature and low-weight newborn babies

La condición de prematuro ha sido relacionada con la aparición de defectos en el esmalte y alteraciones en el patrón de erupción dentaria. El niño nacido antes de término puede presentar problemas en el período neonatal, que suelen repercutir en el desarrollo general y en los procesos bucales. Se seleccionaron 50 bebés con una edad entre 5 y 36 meses, un tiempo gestacional de 36 semanas o menos y un peso inferior o igual a 2.500 kg. Se evaluaron presencia de defectos en el esmalte y en el inicio de la erupción dentaria. En el 38 por ciento de los niños examinados se observó defectos en el esmalte, el prevalente fue la opacidad blanca/crema con mayor incidencia en el maxilar inferior. Se estableció la relación inversa entre el peso de nacimiento/edad gestacional y la presencia de alteraciones estructurales en el esmalte dentario. En la mayoría de los bebés el inicio del proceso eruptivo ocurrió a los 9 meses de edad (50 por ciento); cuanto menor fue el peso de nacimiento y la edad gestacional, más tardiamente ocurría la erupción. Cuando fueron utilizadas las edades corregidas de los bebés, la edad media de erupción de los incisivos centreales inferior fue de 6.58 meses. No hubo diferencias significativas en defectos en el esmalte y el inicio de la erupción dentaria entre los géneros masculino y femenino.(AU)

Over one thousand patients with early stage endometriosis treated with the Helica Thermal Coagulator (HELICA): safety aspects.

STUDY OBJECTIVE: To assess the safety of the Helica Thermal Coagulator in the laparoscopic treatment of early stage endometriosis. DESIGN: Retrospective, observational. SETTINGS: The Princess Royal University Hospital, The Sloane and Chelsfield Park Hospitals, Kent, UK. PATIENTS: One thousand and sixty patients with early stage endometriosis. RESULTS: All patients were treated laparoscopically with the Helica Thermal Coagulator; a new laparoscopic device that combines electrical energy with helium for the treatment of endometriosis. No major bladder, ureteric or bowel injuries occurred. The only complication was a perforated vagina from the cutting probe during dissection of the cul-de-sac in a patient with a vaginal endometriotic nodule. CONCLUSION: The Helica Thermal Coagulator is a safe device for the laparoscopic treatment of endometriosis.

Investigación de alteraciones del esmalte dentario e inicio del proceso eruptivo en bebés nacidos prematuros y con bajo peso / Investigation on dental enamel alterations and eruption time in premature and low-weight newborn babies

La condición de prematuro ha sido relacionada con la aparición de defectos en el esmalte y alteraciones en el patrón de erupción dentaria. El niño nacido antes de término puede presentar problemas en el período neonatal, que suelen repercutir en el desarrollo general y en los procesos bucales. Se seleccionaron 50 bebés con una edad entre 5 y 36 meses, un tiempo gestacional de 36 semanas o menos y un peso inferior o igual a 2.500 kg. Se evaluaron presencia de defectos en el esmalte y en el inicio de la erupción dentaria. En el 38 por ciento de los niños examinados se observó defectos en el esmalte, el prevalente fue la opacidad blanca/crema con mayor incidencia en el maxilar inferior. Se estableció la relación inversa entre el peso de nacimiento/edad gestacional y la presencia de alteraciones estructurales en el esmalte dentario. En la mayoría de los bebés el inicio del proceso eruptivo ocurrió a los 9 meses de edad (50 por ciento); cuanto menor fue el peso de nacimiento y la edad gestacional, más tardiamente ocurría la erupción. Cuando fueron utilizadas las edades corregidas de los bebés, la edad media de erupción de los incisivos centreales inferior fue de 6.58 meses. No hubo diferencias significativas en defectos en el esmalte y el inicio de la erupción dentaria entre los géneros masculino y femenino.