Vivências de trabalho precoce de adolescentes em medida socioeducativa / Experience of child labor of adolescents complying with a social-educational measure / Vivencias de trabajo infantil de adolescentes en medidas socioeducativas

Este artigo tem como objetivo analisar a vivência de trabalho precoce de adolescentes e jovens em cumprimento de medida socioeducativa, no estado da Paraíba. Os instrumentos utilizados foram um Questionário Mosquito Diagnóstico e uma Entrevista Semiestruturada. A análise foi realizada com o software Iramuteq, (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires), através da Análise Hierárquica Descendente, que gerou seis classes: significado do trabalho; infância e escola; condições objetivas de vida; trabalho, drogas e ato infracional; consequências do trabalho infantil; e trabalho infantojuvenil. A perspectiva teórica utilizada foi a psicologia histórico-cultural e os dados discutidos a partir do conceito de vivência. Conclui-se que as vivências e situações sociais de desenvolvimento foram caracterizadas pelo trabalho precoce que oportunizou o envolvimento com atos infracionais e as instituições responsáveis pela garantia de direitos em vez de garantir a proteção social, criminalizaram por meio de medidas socioeducativas.(AU)

This article aims to analyze the experience of child labor of adolescents and youngsters that are complying a social-educational measure, in the State of Paraíba. The instruments utilized were a Questionnaire Mosquito Diagnóstico and a Semi-Structured Interview. The analysis was performed by using the Iramuteq software (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires), by using Descending Hierarchical Analysis, which generated six classes: meaning of labor; childhood and school; objective conditions of life; labor, drugs, and act of infraction; consequences of child labor; and child labor. The theoretical perspective used was historical-cultural psychology and the data were discussed from the concept of experience. It was concluded that the experiences and social situations of development were characterized by child labor, which enabled the involvement with acts of infraction; and the institutions responsible for guaranteeing rights, instead of guaranteeing social protection, criminalized by using social-educational measures.(AU)

Este artículo tiene como objetivo analizar la vivencia precoz de adolescentes y jóvenes que cumplen medidas socioeducativas en el estado de Paraíba (Brasil). Los instrumentos utilizados fueron un Cuestionario Mosquito Diagnóstico y una entrevista semiestructurada. El análisis se realizó con el software Iramuteq (Interface de R pour les Multidimensionnelles Analyzes de Textes et de Questionnaires), mediante análisis jerárquico descendente, que generó seis clases: Significado del trabajo; Infancia y escuela; Condiciones objetivas de vida; Trabajo, drogas y acto de infracción; Consecuencias del trabajo infantil; y Trabajo infantojuvenil. La perspectiva teórica que se utilizó fue la psicología histórico-cultural, y los datos se discutieron desde el concepto de vivencia. Se concluye que las vivencias y situaciones sociales de desarrollo se caracterizaron por trabajo infantil que permitió la participación en infracciones y que las instituciones responsables de garantizar los derechos en lugar de la protección social los criminalizaron mediante medidas socioeducativas.(AU)

Implications of anatomical variation of the sphenoid sinus for orthognathic surgery: a case report in cone beam computed tomography / Implicações da variação anatômica do seio esfenoidal para cirurgia ortognática: um relato de caso em tomografia computadorizada de feixe cônico

ABSTRACT The Sphenoid Sinus is considered the paranasal sinus with more variation to the degree of pneumatization. Thus, this work aimed report to the first case on the interference of this anatomical variation for orthognathic surgery. A 18- year-old woman, with isolated cleft palate repaired, was submitted to orthognathic surgery to correct the maxillomandibular skeletal discrepancy. The cone beam computed tomography (CBCT) exam performed for preoperative planning showed a great extension for the adjacent structures, with proximity to the posterior wall of the maxillary sinus and pterygomaxillary fissure bilaterally. The postoperative CBCT image evidenced the compromise of the sinus floor due to the factors related to the transoperative period. This case, along with literature review, highlighted the importance of identifying sphenoid sinus variation in CBCT exams prior to orthognathic surgery, in order to avoid serious complications for the patient, such as sinus infections; hemorrhages; mucocele formation or intracranial involvement.

RESUMO O Seio Esfenoidal é considerado o seio paranasal com maior variação quanto ao grau de pneumatização. Assim, este trabalho objetivou relatar o primeiro caso sobre a interferência dessa variação anatômica para a cirurgia ortognática. Mulher,18 anos, com fissura de palato isolada reparada, foi submetida à cirurgia ortognática para correção da discrepância esquelética maxilomandibular. O exame de tomografia computadorizada de feixe cônico (TCFC), realizado para planejamento pré-operatório, mostrou grande extensão para as estruturas adjacentes, e com proximidade da parede posterior do seio maxilar e fissura pterigomaxilar bilateralmente. A imagem de TCFC pós-operatória evidenciou o comprometimento do assoalho do seio devido aos fatores relacionados ao transoperatório. Este caso, juntamente com a revisão da literatura, destacou a importância de identificar a variação do seio esfenoidal nos exames de TCFC prévios à cirurgia ortognática, a fim de evitar complicações graves para o paciente, tais como sinusite, hemorragias, formação de mucoceles ou, até mesmo, envolvimento intracraniano.

Use of Chlorhexidine Bioadhesive Gel to Reduce Infection and Discomfort in Alveolar Bone Graft Wound: A Randomized Pilot Study

ABSTRACT: The objective of this study was to analyze the inflammation index, edema, bacterial plaque presence and postoperative discomfort, with the use of chlorhexidine gel. This is a randomized double-blinded pilot study, with 21 unilateral cleft lip and palate individuals, randomized into 2 groups: Test Group (TG), with 7 individuals who used 0.2 % chlorhexidine bioadhesive gel in the surgical wound after the bone graft; and Control Group (CG) with 14 individuals who used a placebo gel as the same way. The gel was applied on the surgical wound suture after alveolar bone graft. The evaluation criteria of the gel application effectiveness were the visual analogue scale (VAS) for pain control and/or discomfor t and clinical evaluation of inflammatory condition and/or wound infection. The study showed promising results for postoperativel y use of the chlorhexidine gel, although there was no statistically significant difference between the groups.

RESUMEN: El objetivo de este estudio fue analizar el índice de inflamación, edema, presencia de placa bacteriana y molestias postoperatorias, con el uso del gel de clorhexidina. Se trata de un estudio piloto aleatorizado, doble ciego, con 21 individuos con fisura labial y palatina unilateral, aleatorizados en 2 grupos: Grupo Test (GT), con 7 individuos que utilizaron gel bioadhesivo de clorhexidina al 0,2 % en la herida quirúrgica posterior al injerto óseo; y Grupo Control (GC) con 14 individuos que usaron un gel placebo de la misma forma. El gel se aplicó sobre la sutura de la herida quirúrgica después del injerto óseo alveolar. Los criterios de evaluación de la efectividad de la aplicación del gel fueron la escala analógica visual (EVA) para el control del dolor y/o malestar y la evaluación clínica del estado inflamatorio y/o infección de la herida. El estudio mostró resultados positivos para el uso posoperatorio del gel de clorhexidina, aunque no hubo diferencias estadísticamente significativas entre los grupos.

Evaluation of the Nasopharyngeal Cannula Use After Orthognathic Surgery: Permeability of the Nasal Airways and Discomfort of the Patient With Cleft Lip and Palate.

It is believed that the use of the nasopharyngeal cannula can maintain the patent upper airway in the immediate post-operative period of orthognathic surgery. The present study is a randomized clinical trial with the objective of evaluating the difference in the use of the nasopharyngeal cannula in the post-operative period of orthognathic surgery with respect to permeability and discomfort. The sample was composed of 26 individuals with repaired cleft lip and palate randomly distributed in 2 groups with and without nasopharyngeal cannula. The evaluation was composed by Visual Analogue Scale (VAS), test with Altman mirror in 4 pre-operative periods, 6, 24, 30 hours after the operation. Rhinomanometry was also performed, a flow- pressure technique in 2 distinct moments, 6 and 24 hours after surgery. As a result, greater discomfort, greater obstruction as well as a reduction in the area of bilateral minimum nasal cross-section (ASTM) and increased resistance in the group with nasopharyngeal cannula are observed. In the intra-group comparison with the lowest ASTM values, the test group showed a significant difference between the first and the second moments (P = 0.001). It can be concluded that the nasopharyngeal cannula contributes to increase discomfort, worsens airway permeability by decreasing ASTM and increasing nasal resistance. Regarding the length of stay of the nasopharyngeal cannula, it can be said that from 6 hours onwards it does not contribute to the reduction of discomfort, airway permeability and assist in hemostasis.

Postoperative Orthognathic Surgery Edema Assessment With and Without Manual Lymphatic Drainage.

OBJECTIVE: To evaluate the effects of manual lymphatic drainage (MLD) on facial edema and pain in patients who underwent orthognathic surgery from patient and professional perspectives and clinical measures. METHODS: It is a randomized double-blind clinical trial, where 30 patients who underwent bimaxillary orthognathic surgery were divided into 2 groups (treatment and placebo). One group (treatment) received MLD from 2nd postoperative day, besides cryotherapy and postoperative medications. The other group (placebo) received cryotherapy, medications, and manual superficial sliding movements as placebo. For edema evaluation, facial measurements with tape and photographs were used. To evaluate patients' perception, visual analog scale for pain and edema was used. In statistical analysis, quantitative data were analyzed using Student t test for normally distributed variables and Mann-Whitney test for non-normal to find differences between groups; 5% significance level was adopted. RESULTS: No difference was found between groups in the amount of maximum developed edema (P = 0.290) nor on what day the edema peak occurred (P = 0.091). However, it was found that treatment group showed faster and greater regression of swelling compared with placebo (P < 0.001). Manual lymphatic drainage was not effective in relieving pain in these patients and nor in edema perception (P = 0.784 and P = 0.946, respectively). CONCLUSION: Manual lymphatic drainage was effective in reducing facial measurements in orthognathic surgery postoperatory. When considering patient's pain and swelling perception, no difference was found between groups.

Cerebellar Transcranial Direct Current Stimulation (ctDCS) Impairs Balance Control in Healthy Individuals.

The cerebellum plays an important role in the planning, initiation and stability of movements, as well as in postural control and balance. Modulation of neural regions underlying balance control may be a potential alternative to treat balance impairments in cerebellar patients. Transcranial direct current stimulation (tDCS) is a noninvasive and safe tool capable to modulate cerebellar activity. We aim to investigate the effects of cerebellar tDCS (ctDCS) on postural balance in healthy individuals. Fifteen healthy and right-handed subjects were submitted to three sessions of ctDCS (anodal, cathodal and sham), separated by at least 48 h. In each session, tests of static (right and left Athlete Single Leg tests) and dynamic balance (Limits of Stability test) were performed using the Biodex Balance System before and immediately after the ctDCS. The results revealed that cathodal ctDCS impaired static balance of healthy individuals, reflected in higher scores on overall stability index when compared to baseline for right (p = 0.034) and left (p = 0.01) Athlete Single Leg test. In addition, we found significant impairment for left Athlete Single Leg test in comparison to sham stimulation (p = 0.04). As far as we know, this is the first study that points changes on balance control after ctDCS in healthy individuals. This finding raises insights to further investigation about cerebellar modulation for neurological patients.

Comparação da anatomia transversal de mandíbula de indivíduos classe III com e sem fissura labiopalatina por meio de tomografia de feixe cônico / Comparison of transverse dimension of class III mandible with and without cleft lip and palate using conical beam tomography

A relação entre a anatomia mandibular e a ocorrência de fratura indesejada de mandíbula na osteotomia sagital é alvo de estudos. A literatura mostra a existência de diferentes conformações anatômicas da mandíbula, porém não há estudos nessa área direcionados a indivíduos com fissura labiopalatina. Também não há na literatura estudos que mostrem as diferenças morfológicas da mandíbula relacionadas a secção transversal entre primeiro e segundo molar e sua relação com implicações na cirurgia ortognática. O objetivo do presente estudo foi avaliar a morfologia da região entre primeiro e segundo molar inferior e classificar a prevalência dos tipos mandibulares dentro de cada grupo. Foram realizadas análises e medições das reformatações das tomografias da região de molares, bilateralmente, de indivíduos Classe III, com fissura labiopalatina unilateral (Grupo FLP) submetidos à cirurgia ortognática para recuo mandibular no Hospital de Reabilitação de Anomalias Craniofaciais e de indivíduos Classe III, sem fissura (Grupo Controle) do banco de dados do Departamento de Cirurgia e Estomatologia da Faculdade de Odontologia de Bauru. Foram realizadas duas medidas lineares e uma medida angular. As hemimandíbulas foram classificadas segundo a profundidade da fossa mandibular em: Tipo a - 0 e 1mm; Tipo b - 1,1 e 2mm; Tipo c - 2,1 e 3mm; Tipo d - maior que 3,1mm. Foram analisadas 200 hemimandíbulas no Grupo FLP e 100 no Grupo Controle. Os resultados mostraram que não houve diferença entre os grupos quanto a classificação das mandíbulas segunda a profundidade da fossa, sendo o grupo b o mais prevalente, mas houve diferença em relação a angulação e a altura da mandíbula. Também foi notada uma relação entre a altura da mandíbula e a sua angulação em ambos os grupos. Assim, pode ser observada a grande variação morfológica dessa região, tanto para o grupo com fissura labiopalatina, quanto para o grupo controle. (AU)

The relationship between a mandibular anatomy and an occurrence of an undesirable jaw fracture in a sagittal osteotomy is the subject of the studies. The literature shows an existence of different anatomical conformations of the mandible, but there are no studies on the area directed to individuals with cleft lip and palate. There are not in the literature, studies that show a prevalence of mandibular types and the relation of these anatomical variations with orthognathic surgery implications. The objective of the present study was evaluate the morphology of the region between the first and second lower molars and analyze the prevalence of mandibular types within each sample group. Analyzes and measurements of the CT scans were performed bilaterally on Class III patients with unilateral cleft lip and palate (CLP Group) submitted to orthognathic surgery for mandibular retreatment at the Hospital for Rehabilitation of Craniofacial Anomalies and Class III individuals, without Fissure (Control Group) of the database of the Department of Stomatology of the Faculty of Dentistry of Bauru. Two linear measurements and one angular measurement were performed. The half of mandibles were classified according to the depth of the mandibular fossa in: Type a - 0 and 1mm; Type b - 1.1 and 2mm; Type c - 2.1 and 3 mm; Type d - greater than 3.1mm. Two hundred half of mandibles were analyzed in the CLP Group and 100 in the Control Group. The results showed that there was no difference between the groups regarding the classification of the mandibles according to the depth of the fossa, being group b the most prevalent, but there was difference in relation to the angulation and the height of the mandible. It was also noted a relationship between the height of the mandible and its angulation in both groups. Thus, the great anatomical variation of this region can be observed, both for the group with fissure and for the group without fissure. (AU)

General anesthesia for dental care management of a patient with epidermolysis bullosa: 24-month follow-up.

Epidermolysis bullosa comprises a group of uncommon skin-related diseases, characterized by the formation of blisters on mucocutaneous regions occurring spontaneously, following a trauma, exposure to heat, or as a result of minimal mechanical trauma. The dental treatment of the patient with epidermolysis bullosa raises many questions and discussions, due to the difficulty of carrying out the procedures. This report aimed to detail the clinical considerations of the treatment under general anesthesia of a patient with epidermolysis bullosa. The extraction of all deciduous teeth under general anesthesia was recommended based on the clinical and radiographic examinations. At 24-month follow-up, the patient had great improvement in oral hygiene without new caries lesions. The patient has been followed-up at every month for caries lesion prevention and permanent tooth development. The treatment under general anesthesia provided the ideal safe conditions and was beneficial for the patient.

Catechol-O-methyltransferase genetic variant associated with the risk of Alzheimer's disease in a Brazilian population.

The aim of the present study was to examine the association between polymorphism in the catechol-O-methyltransferase(COMT) gene and Alzheimer's disease (AD) in a Brazilian population. The case-control method was used to study the association between AD and genetic variants of COMT. Six tag single-nucleotide polymorphisms(SNPs) in the COMT gene were genotyped by RT-PCR. Our findings showed that the 6 tag SNPs analyzed in this study were not associated with AD at the allele and genotype levels in comparison with the control group. No statistical difference was found between groups with and without behavioral and psychological symptoms of dementia (BPSD). Our results do not support the hypothesis that the polymorphisms of the COMT gene may be associated with susceptibility to AD with and without BPSD.

The role of genetic variation of BDNF gene in antidepressant-induced mania in bipolar disorder.

The occurrence of mania during antidepressant treatment is a key issue in the clinical management of bipolar disorder (BD). Brain-derived neurotrophic factor (BDNF) has been implicated in the pathogenesis of mood disorders. Moreover, antidepressants increase the expression of BDNF and its overactivity may be involved in the mechanism of development of the manic state. The aim of the present study was to test the influence of BDNF gene alterations in antidepressant-induced mania in bipolar patients. A case-control study was performed to analyse genotype and allele frequencies for the BDNF polymorphisms between two groups [37 patients with antidepressant-induced mania (AIM+) and 55 patients without antidepressant-induced mania (AIM-)]. No significant differences were found between AIM+ and AIM- groups. Our results did not support the BDNF gene link to antidepressant-induced mania, like a previous study with a smaller sample has already suggested.

Complicações extralaríngeas das cirurgias por laringoscopia direta de suspensão / Extra-laryngeal complications of suspension laryngoscopy

Apesar do uso rotineiro da laringoscopia de suspensão (LS) na microcirurgia de laringe, poucos são os estudos na literatura que tratam das complicações deste procedimento. OBJETIVO: Avaliar as complicações extralaríngeas após a laringoscopia de suspensão e relacioná-las com o tempo de cirurgia. MATERIAL E MÉTODO: Trinta e sete procedimentos consecutivos foram analisados prospectivamente enfocando as lesões relacionadas à LS. A pesquisa incluiu análise pré e pós-operatória dos pacientes quanto aos critérios estudados. RESULTADO: O tempo cirúrgico foi menor de trinta minutos em quatorze casos, entre trinta e sessenta minutos em dezesseis casos e maior de uma hora em sete casos. Vinte e sete apresentaram lesão relacionada à LS, sendo mais comuns as lesões da mucosa oral. Lesão temporária dos nervos foi encontrada em cinco casos, e trauma dentário em um caso. Houve relação estatística entre o tempo de cirurgia e o índice de lesões de mucosa oral menores de 1 centímetro, confirmando que procedimentos mais longos apresentam maior risco para esta complicação. CONCLUSÃO: Esses achados demonstram que a LS não é um procedimento inócuo, produzindo complicações freqüentes. Ainda que não representem grande morbidade aos pacientes, tais danos são evitáveis desde que técnicas mais apuradas sejam utilizadas.

Although suspension laryngoscopy is routinely used in laryngeal surgery, there are only few studies on the complications of this procedure. AIM: to evaluate the complications outside the larynx following suspension laryngoscopy and analyze their relation with surgery duration. MATERIALS AND METHODS: Thirty-seven procedures were prospectively analyzed for intervention-related complications. The study included patient preoperative and postoperative assessment, focusing on dental, mucosal and nerve status (hypoglossal and lingual nerves). RESULTS: Most procedures (27/37) were associated to some kind of complication, and mucosal injuries were the most common; temporary nerve lesions were observed in five cases and dental injuries in one case. Statistic significance was found between surgery duration and mucosal injury (lesions smaller than 1 centimeter), showing that longer procedure pose higher risks for these complications. CONCLUSION: These findings suggest that suspension laryngoscopy is frequently associated with complications outside the larynx. Although these injuries represent a low risk of significant morbidity, they can be avoided if more accurate techniques are used.

Extra-laryngeal complications of suspension laryngoscopy.

UNLABELLED: Although suspension laryngoscopy is routinely used in laryngeal surgery, there are only few studies on the complications of this procedure. AIM: to evaluate the complications outside the larynx following suspension laryngoscopy and analyze their relation with surgery duration. MATERIALS AND METHODS: Thirty-seven procedures were prospectively analyzed for intervention-related complications. The study included patient preoperative and postoperative assessment, focusing on dental, mucosal and nerve status (hypoglossal and lingual nerves). RESULTS: Most procedures (27/37) were associated to some kind of complication, and mucosal injuries were the most common; temporary nerve lesions were observed in five cases and dental injuries in one case. Statistic significance was found between surgery duration and mucosal injury (lesions smaller than 1 centimeter), showing that longer procedure pose higher risks for these complications. CONCLUSION: These findings suggest that suspension laryngoscopy is frequently associated with complications outside the larynx. Although these injuries represent a low risk of significant morbidity, they can be avoided if more accurate techniques are used.

Discriminação de preços no saneamento: um estudo de caso da Região dos Lagos no Rio de Janeiro / Price discrimination in sanitation services: a case study of a beach resort in the state of Rio de Janeiro, Brazil

Este artigo apresenta um estudo de caso de uma decisão regulatória no setor de saneamento na Região dos Lagos do Rio de Janeiro, que mostra como a política de discriminação de preços introduzida pela privatização não pôde ser mantida por erros de implementação da política e inadequação da compreensão de suas implicações, tanto pelo regulador como pelos consumidores. Conclui-se que a manutenção da regra de discriminação de preços teria poupado recursos públicos.