Correlations between childhood maltreatment, anxiety and depressive symptoms, and risk behaviors in adolescent schoolchildren.

OBJECTIVE: Childhood maltreatment is extremely harmful to health, especially in relation to development of the psychiatric disorders throughout life. The objective of this study was to describe the prevalence and types of maltreatment in a sample of adolescent schoolchildren and to investigate associations between maltreatment types and anxiety and depressive symptoms, sociodemographic variables, and risk behaviors. The study also identified which variables were the greatest predictors of anxiety and depressive symptoms. METHODS: We conducted a cross-sectional study with a sample of 654 school students aged 11 to 17 years. We collected sociodemographic data and administered the Revised Child Anxiety and Depression Scale (RCADS-47) to measure anxiety and depressive symptoms as well as the Childhood Trauma Questionnaire (CTQ) to evaluate maltreatment and adverse experiences such as abuse and negligence during childhood and adolescence. Statistical analyses were conducted to estimate correlations between sociodemographic data, anxiety, depression, and types of maltreatment. A regression analysis was also conducted to identify maltreatment types that predict psychological symptoms. RESULTS: Emotional abuse and emotional neglect were the most prevalent types of maltreatment. Statistically, emotional abuse was the maltreatment type most strongly correlated with depression and anxiety and tended to co-occur with other types of maltreatment. Additionally, emotional and sexual abuse were the greatest predictors of anxiety and depression in adolescents. CONCLUSION: The above results reinforce the findings of previous studies in terms of understanding the effects of maltreatment. They identify emotional abuse as the main predictor of depressive and anxiety symptoms.

Correlations between childhood maltreatment, anxiety and depressive symptoms, and risk behaviors in adolescent schoolchildren

Abstract Objective Childhood maltreatment is extremely harmful to health, especially in relation to development of the psychiatric disorders throughout life. The objective of this study was to describe the prevalence and types of maltreatment in a sample of adolescent schoolchildren and to investigate associations between maltreatment types and anxiety and depressive symptoms, sociodemographic variables, and risk behaviors. The study also identified which variables were the greatest predictors of anxiety and depressive symptoms. Methods We conducted a cross-sectional study with a sample of 654 school students aged 11 to 17 years. We collected sociodemographic data and administered the Revised Child Anxiety and Depression Scale (RCADS-47) to measure anxiety and depressive symptoms as well as the Childhood Trauma Questionnaire (CTQ) to evaluate maltreatment and adverse experiences such as abuse and negligence during childhood and adolescence. Statistical analyses were conducted to estimate correlations between sociodemographic data, anxiety, depression, and types of maltreatment. A regression analysis was also conducted to identify maltreatment types that predict psychological symptoms. Results Emotional abuse and emotional neglect were the most prevalent types of maltreatment. Statistically, emotional abuse was the maltreatment type most strongly correlated with depression and anxiety and tended to co-occur with other types of maltreatment. Additionally, emotional and sexual abuse were the greatest predictors of anxiety and depression in adolescents. Conclusion The above results reinforce the findings of previous studies in terms of understanding the effects of maltreatment. They identify emotional abuse as the main predictor of depressive and anxiety symptoms.

Life satisfaction mediates the association between childhood maltreatment and depressive symptoms: a study in a sample of Brazilian adolescents.

OBJECTIVE: To evaluate the interrelationships between childhood maltreatment, life satisfaction (LS), and depressive symptoms, and to investigate LS as a mediating factor in the association between childhood maltreatment and depressive symptoms. METHODS: The sample consisted of 342 adolescents, aged 11 to 17 years (mean = 13.3, SD = 1.52 years), recruited from a public school in Salvador, Brazil. Participants filled out instruments for the collection of sociodemographic data and evaluation of childhood maltreatment, LS, and depressive symptoms. Structural equation modeling (SEM) was used to evaluate the mediating effect of LS. RESULTS: We detected significant negative correlations between childhood maltreatment and LS and between LS and depressive symptoms. We observed a significant positive correlation between childhood maltreatment and depressive symptoms. LS partially mediated the association between childhood maltreatment and depressive symptoms, mitigating the impact of maltreatment. CONCLUSION: LS played an important mediating role in the association between childhood maltreatment and depressive symptoms. Longitudinal studies are recommended to fully elucidate these associations, reinforcing the need for attention and care of this vulnerable population.

Opções farmacológicas para ceratite por micobactérias não-tuberculosas: uma revisão integrativa / Pharmacological options for nontuberculous mycobacterial keratitis: an integrative review"

Introdução: as ceratites são infecções da córnea, que acontecem pós-trauma, cirúrgico ou não, ou em indivíduos imunossuprimidos e que podem ter como agente etiológico micobactérias não-tuberculosas (MNTs). O diagnóstico das ceratites por MNTs é feito pelos aspectos clínicos em associação à identificação do patógeno. Não existe um consenso na literatura com relação ao tratamento farmacológico. Objetivos: o objetivo primário é identificar as opções terapêuticas farmacológicas para ceratites por MNTs e, o secundário, descrever os aspectos clínicos dessa infecção. Metodologia: um total de 214 artigos foram encontrados através da pesquisa nas fontes CAPES, LILACS, PUBMED e Biblioteca Cochrane, utilizando-se as combinações de palavras chave: "ceratite" e "micobactérias não-tuberculosas, destes, após o uso dos critérios de exclusão, 4 artigos foram selecionados. Resultados: partindose das 4 publicações selecionadas foram reunidos 5 casos clínicos, todos com história de trauma corneano, cirúrgico ou não. Os 5 pacientes foram submetidos à técnica diagnóstica não-invasiva e em todos foi identificada MNT. Os tratamentos farmacológicos foram feitos com antimicrobianos das classes das quinolonas, aminoglicosídeos e macrolídeos. Em um dos casos foi usado um corticoide e em dois foi feita associação com anti-inflamatório não-esteroide. Conclusão: o tratamento farmacológico da ceratite por MNTs é de longo prazo, e, neste estudo, variou de 3 semanas a 6 meses. Os quimioterápicos usados são os aminoglicosídeos, macrolídeos e quinolonas e, em alguns casos, a combinação destes. O uso de anti-inflamatórios não-esteroidais e esteroidais não é consensual. Quanto aos aspectos clínicos, observam-se características comuns a outras ceratites infecciosas

Disentangling the mental health impact of childhood abuse and neglect: A replication and extension study in a Brazilian sample of high-risk youth.

Childhood maltreatment is a key predictor of mental health problems across the life span. Yet, how maltreatment types independently and jointly influence the risk for psychiatric problems remains unclear. The aim of the study was two-fold: first, to replicate recent findings regarding the impact of maltreatment types on youth psychiatric symptoms, based on a Brazilian sample of high-risk adolescents (n = 347; age range = 11-17 yrs), and second, to extend existing findings by examining whether this relationship is mediated by bullying victimization and/or perpetration. Measures included self-report ratings of childhood maltreatment and peer victimization, as well as multi-informant reports of internalizing and externalizing symptoms. Consistent with prior research, we found that: (i) maltreatment types often co-occurred; (ii) there was a linear association between number of maltreatment types experienced and symptom severity (i.e. cumulative effect); and (iii) emotional abuse emerged as the most consistent independent predictor of poor mental health across domains, raters, and gender. Additionally, this study extends previous findings by showing that the influence of maltreatment on psychiatric outcomes is partially mediated by peer victimization, but not by bullying perpetration. In conclusion, these findings expand our understanding of the heterogeneity in individual responses to maltreatment as well as highlighting emotional abuse as an important predictor of poor mental health.

Avaliação de nova técnica não cirúrgica para tratamento de deficiência de papila em área estética: estudo clínico randomizado controlado / New evaluation technique non-surgical for papilla deficiency treatment in cosmetic area: randomized controlled trial

A ausência ou perda da papila interdental cria deficiência estética, problemas fonéticos, impactação alimentar e gera muita expectativa ao paciente. Até o momento, o tratamento da ausência ou perda da papila interdental tem sido mal sucedido e não há estudos que indiquem que a regeneração da papila é um resultado previsível. O objetivo deste estudo foi avaliar a efetividade da injeção de gel de ácido hialurônico de origem não animal na redução ou eliminação da deficiência de papila entre dentes naturais comparativamente ao tratamento por meio de enxerto de tecido conjuntivo subepitelial. Foram avaliados neste estudo 20 sítios de 6 pacientes de ambos os sexos, com idade variável de 29 a 62 anos, apresentando deficiência de papila entre dentes naturais, na região anterior superior, em pelo menos dois dentes. Os 20 sítios tratados foram aleatoriamente divididos em dois grupos, de acordo com o tratamento para correção da deficiência de papila por meio de enxerto de tecido conjuntivo subepitelial (grupo controle) ou por meio de injeção de gel de ácido hialurônico (grupo teste). Um examinador único, calibrado, avaliou a distância da ponta da papila ao ponto de contato com auxílio de sonda periodontal milimetrada antes e aos 1, 3 e 6 meses após o tratamento. Além disso, foram investigados, nos sítios tratados, as medidas de profundidade de sondagem, nível de inserção, índice de sangramento do sulco, índice de placa, distância do ponto de contato à crista óssea alveolar, distância da ponta da papila à crista óssea alveolar e largura da papila. Os resultados demonstraram que aos 6 meses de pósoperatório o percentual de mudança na altura da papila foi maior no grupo teste (14,94% ± 21,35%) do que no grupo controle (-1,39% ± 31,46%), entretanto sem diferenças significantes entre os grupos (p> 0.05). Não houve variação estatisticamente significante na largura da papila antes e aos 4 meses após o tratamento nos grupos teste (p= 0.09) e controle (p= 0.16), assim como não houve variação significativa na distância entre a ponta da papila e a crista óssea alveolar. Houve melhora significativa do Índice de Estética Rosa (IER) observado aos 6 meses de acompanhamento em comparação com a condição inicial no grupo teste (p= 0.0078; Wilcoxon), enquanto que não houve mudança significativa no IER observado no grupo controle aos 6 meses de acompanhamento (p= 0.35). Os resultados obtidos permitiram concluir que o tratamento da deficiência de papila por meio de injeção de gel de ácido hialurônico promove melhora da deficiência de papila, similar aos resultados obtidos com o tratamento por meio de enxerto de tecido conjuntivo subepitelial, porém com melhora estética significativa relacionada especialmente às características de cor e textura do tecido relativamente aos tecidos moles adjacentes.(AU)

The absence or loss of interdental papilla creates an esthetic deficiency, phonetic problems and food impaction and generates a lot of expectation for the patient. Until now, the treatment for absence or loss of interdental papilla is unsuccessful e and there are no researches that show that the papilla regeneration is a predictable outcome. The aim of this study was to evaluate the effectivity of a non-animal originated hyaluronic acid injection in the reduction or elimination of papilla deficiency between natural teeth in comparison to a sub epithelial connective tissue graft treatment. The analysis was made on 20 sites in 6 patients, both genders, 29 - 62 years, showing deficiency in the papilla between natural teeth in the upper anterior region in at least two teeth. The 20 sites treated were randomly divided into two groups, according to the treatment by subepithelial connective tissue graft (control group) or by hyaluronic acid injection (test group). A single calibrated examiner evaluated the distance between the tip of the papilla to the contact point using a graduated periodontal probe before the treatment and 1, 3 and 6 months after it. Besides, it were investigated probing pocket depth, clinical attachment level, gingival bleeding index, plaque index, distance from papilla to alveolar crest, distance from contact point to alveolar crest and width of the papilla. The results showed that 6 months after the procedure, the percentage of change in the papilla level was higher in the test group (14,94% ± 21,35%) than in the control group (-1,39% ± 31,46%), though not statistically significant (p>0.05). There was no significant difference variation in the width of the papilla before and 4 months after the treatment in test group (p=0.09) and control group (p=0.16), and there was no significant difference variation in the distance between the tip of the papilla and the alveolar bone crest. There was significant improvement of the Pink Esthetic Score (PES) after 6 months in comparison to the initial condition in test group (p=0.0078; Wilcoxon), while there was no significant difference in the PES in control group 6 months after treatment (p=0.35). The results allow to conclude that the treatment for of the papilla deficiency using hyaluronic acid injection promotes improvement, similar to the results of the sub epithelial connective tissue graft treatment, but with significant esthetic improvement related specially to the color and texture characteristics of the adjacent soft tissues.(AU)

Transcultural Adaptation of GRID Hamilton Rating Scale For Depression (GRID-HAMD) to Brazilian Portuguese and Evaluation of the Impact of Training Upon Inter-Rater Reliability.

UNLABELLED: GRID-HAMD is a semi-structured interview guide developed to overcome flaws in HAM-D, and has been incorporated into an increasing number of studies. OBJECTIVES: Carry out the transcultural adaptation of GRID-HAMD into the Brazilian Portuguese language, evaluate the inter-rater reliability of this instrument and the training impact upon this measure, and verify the raters' opinions of said instrument. METHODS: The transcultural adaptation was conducted by appropriate methodology. The measurement of inter-rater reliability was done by way of videos that were evaluated by 85 professionals before and after training for the use of this instrument. RESULTS: The intraclass correlation coefficient (ICC) remained between 0.76 and 0.90 for GRID-HAMD-21 and between 0.72 and 0.91 for GRID-HAMD-17. The training did not have an impact on the ICC, except for a few groups of participants with a lower level of experience. Most of the participants showed high acceptance of GRID-HAMD, when compared to other versions of HAM-D. CONCLUSION: The scale presented adequate inter-rater reliability even before training began. Training did not have an impact on this measure, except for a few groups with less experience. GRID-HAMD received favorable opinions from most of the participants.

Tratamento de recessões gengivais utilizando enxerto de tecido conjuntivo através da técnica do túnel / Tunnel technique for gingival recession treatment with subepithelial connective tissue graft

O tratamento de recessões gengivais com enxerto de tecido conjuntivo subepitelial proporciona cicatrização adequada e resultados de cobertura radicular previsíveis. Neste artigo, um caso clínico é apresentado descrevendo um procedimento cirúrgico periodontal para a cobertura de recessões gengivais múltiplas adjacentes. A técnica do túnel, que utiliza enxerto de tecido conjuntivo subepitelial, é uma técnica cirúrgica que se baseia na construção de um túnel abaixo do tecido gengival, por meio de uma incisão sulcular além da linha mucogengival sem levantar a papila. Um enxerto de tecido conjuntivo da área doadora palatina foi introduzido através desse túnel, cobrindo as recessões gengivais adjacentes. A técnica de sutura utilizada permitiu que o enxerto deslizasse através do túnel sob os tecidos gengivais, garantindo a estabilização do enxerto sobre as recessões. O paciente foi acompanhado até a completa cicatrização e os resultados clínicos no pós-operatório foram favoráveis, mostrando ganho de espessura gengival e aumento da faixa de tecido ceratinizado, cobertura radicular, além da eliminação do sintoma de hiperestesia dentinária, relatado pelo paciente

The treatment of gingival recessions with subepithelial connective tissue graft provides adequate healing and predictable root coverage results. This paper, a clinical case is presented describing a surgical eriodontal procedure for the coverage of multiple adjacent gingival recessions. The tunnel subepithelial connective tissue graft is a surgical technique based on the construction of a tunnel under the gingival tissue by means of a sulcular incision beyond the mucogingival line without raising the papillae. A connective tissue graft from palatal donor area was introduced through this tunnel, covering the adjacent gingival recessions. The suture technique used allows the graft slide through the tunnel under the gingival tissues, ensuring the stabilization of the graft over recessions. The patient was followed until complete healing was achieved and clinical results ostoperatively are favorable with improvement in gingival thickness and increased keratinized tissue width, root coverage in addition to the elimination of dentin hypersensitivity symptoms reported by patient.

99mTc-thymine scintigraphy may be a promising method in the diagnosis of breast cancer.

OBJECTIVE: Mammography has been established as the gold standard for the detection of breast cancer, and imaging techniques such as ultrasonography, magnetic resonance imaging, scintigraphy and positron emission tomography may be useful to improve its sensitivity and specificity. The objective of this study with breast scintigraphy was to evaluate the uptake of 99mTc-thymine in mammary lesions. METHODS: A total of 45 patients were included in this study. Thirty-three patients (73%) were subjected to surgery or percutaneous biopsy, providing histopathological data. The other 12 patients who remained under surveillance received clinical examinations and biannual mammography with a normal follow-up of at least three years, the data from which were used for comparison with the scintimammography results. RESULTS: The majority of patients (64.4%) had clinically impalpable lesions with a mammogram diagnosis of microcalcifications, impalpable nodules, or focal asymmetry. Of the studied lesions, 87% were smaller or equal to 20 mm in diameter, and 22% had malignant histopathological findings. Scintigraphy with 99mTc-thymine had a sensitivity of 70%, a specificity of 85.7%, positive and negative predictive values of 58.3% and 90.9%, respectively, and an accuracy of 82.2%. CONCLUSIONS: The results of this study are consistent with those previously reported by other authors. The good specificity and high negative predictive value of this technique and the absence of uptake in the heart indicate that it may be a promising complementary method in clinical practice and that it may contribute to reducing unnecessary benign biopsies.

Nutritional supplementation with L-arginine prevents pelvic radiation-induced changes in morphology, density, and regulating factors of blood vessels in the wall of rat bladder.

PURPOSE: To determine whether L-arginine has protective effects against radiation-induced alterations in the morphology and regulatory factors of vesical blood vessels in rats. METHODS: Male rats aged 3-4 months were divided into groups of 10 animals each: (a) controls, consisting of non-treated animals; (b) radiated-only rats; and (c) radiated rats receiving L-arginine supplementation. Radiation was in one session of 10 Gy and was aimed at the pelvic-abdominal region. L-arginine was administered once a day (0.65 g/kg body weight), starting 7 days before radiation and continuing until killing on the 16th day after radiation. The density, relative area, and wall thickness of blood vessels were measured in the vesical lamina propria using histological methods, and the expression of vascular endothelial growth factor (VEGF) and fibroblast growth factors (FGF) in the bladder wall was assessed by RT-PCR. RESULTS: Compared with controls, radiation alone decreased the density and relative area of blood vessels by 32 % (p < 0.01) and 25 % (p < 0.05), respectively, and reduced the arterial wall thickness by 42 % (p < 0.004). VEGF and FGF mRNA levels after radiation were diminished by 67 % (p < 0.002) and 56 % (p < 0.04), respectively. The radiated animals supplemented with L-arginine were not significantly different from controls. CONCLUSIONS: Pelvic radiation leads to significant vesical modifications, as in the morphology of blood vessels and in VEGF and FGF expression. All these changes, however, were prevented by L-arginine treatment. These results emphasize, therefore, the potential use of this amino acid as a radioprotective drug.

99mTc-thymine scintigraphy may be a promising method in the diagnosis of breast cancer

OBJECTIVE: Mammography has been established as the gold standard for the detection of breast cancer, and imaging techniques such as ultrasonography, magnetic resonance imaging, scintigraphy and positron emission tomography may be useful to improve its sensitivity and specificity. The objective of this study with breast scintigraphy was to evaluate the uptake of 99mTc-thymine in mammary lesions. METHODS: A total of 45 patients were included in this study. Thirty-three patients (73%) were subjected to surgery or percutaneous biopsy, providing histopathological data. The other 12 patients who remained under surveillance received clinical examinations and biannual mammography with a normal follow-up of at least three years, the data from which were used for comparison with the scintimammography results. RESULTS: The majority of patients (64.4%) had clinically impalpable lesions with a mammogram diagnosis of microcalcifications, impalpable nodules, or focal asymmetry. Of the studied lesions, 87% were smaller or equal to 20 mm in diameter, and 22% had malignant histopathological findings. Scintigraphy with 99mTc-thymine had a sensitivity of 70%, a specificity of 85.7%, positive and negative predictive values of 58.3% and 90.9%, respectively, and an accuracy of 82.2%. CONCLUSIONS: The results of this study are consistent with those previously reported by other authors. The good specificity and high negative predictive value of this technique and the absence of uptake in the heart indicate that it may be a promising complementary method in clinical practice and that it may contribute to reducing unnecessary benign biopsies.

Caracterização das condições de saúde de um grupo de idosos pertencente a um plano de saúde / Elderly's health insurance: health condition's characterization

Uma operadora de planos de saúde vem desenvolvendo há três anos ações de promoção de saúde com um grupo de idosos a ela vinculado, moradores no município de São Paulo, SP. Esta pesquisa foi realizada com este grupo de idosos com o objetivo de aprofundar o conhecimento sobre suas condições de saúde e morbidade. Mediante os dados coletados se pretendem posteriormente reestruturar os serviços da operadora, a fim de melhor atender às particularidades e demandas deste segmento etário. Trata-se de estudo exploratório transversal com 124 idosos, cujos dados foram coletados por equipe interdisciplinar composta por enfermeiros, médicos e assistentes sociais, em atendimentos individuais previamente agendados pelos idosos participantes, durante os meses de fevereiro a setembro de 2010. Dos instrumentos utilizados pela equipe e cujos resultados serão descritos abaixo, tem-se: questionário sociodemográfico e de avaliação de morbidade, teste de marcha e equilíbrio e avaliação da capacidade funcional. Os resultados desta pesquisa mostraram que a maioria dos idosos que compõe o grupo são mulheres, porém os homens que dela participam são mais velhos e mais doentes. O grupo é composto, em sua maioria, por aposentados, casados e com elevado grau de instrução. Apesar de todos terem uma ou mais doenças crônicas, associadas entre si ou com outros fatores de risco à saúde, este fato parece não interferir significativamente na avaliação da qualidade de vida que possuem.

Avaliação clínica e microscópica do fenótipo periodontal dos pacientes atendidos na Faculdade de Odontologia de Bauru, Universidade de São Paulo / Clinical and microscopic evaluation of periodontal phenotype of patients attending at School of Dentistry at Bauru, University of São Paulo

A definição clara de doença periodontal é fundamental para se estabelecer critérios de risco ao desenvolvimento de outras condições sistêmicas e definir fenótipos biológicos que representem os eventos microbiológicos, moleculares e imunológicos subjacentes à manifestação clínica da doença. O objetivo deste estudo foi avaliar a prevalência dos diferentes fenótipos biológicos dentre os pacientes atendidos na Faculdade de Odontologia de Bauru-USP, correlacionando os achados clínicos às condições sistêmicas dos pacientes e aos achados microscópicos. Foram incluídos na amostra dados do prontuário clínico de 313 pacientes de ambos os sexos, com idade entre 12 e 76 anos. Após a coleta dos dados relativos à identificação, história médica e odontológica e parâmetros periodontais (profundidade de sondagem P.S.; recessão - REC ou hiperplasia HP; nível de inserção clínica NIC; índice de sangramento à sondagem SS e índice de placa IPl), a amostra foi dividida em cinco grupos: IBG-S (Interface Biofilme Gengiva - Saúde)- SS <10% e P.S. 3mm (n=24); IBG-G (Gengivite)- SS≥10% e P.S.≤3mm (n=39); IBG-LP/SL (Lesão Profunda- Sangramento Leve)- SS< 10% e 1 sítio ou mais P.S.≥4 mm (n=47); IBG-LP/SM (Lesão Profunda -Sangramento Moderado)- 10%-49% de SS e 1 sítio ou mais com P.S.≥4 mm (n=131); IBG-LP/SS (Lesão Profunda -Sangramento severo)- SS≥50% dos sítios e 1 sítio ou mais com P.S.≥4 mm (n=72). Foram obtidas biópsias de tecido mole de 25 pacientes dos diferentes grupos para análise em microscopia ótica convencional por dois examinadores experientes, desconhecedores da identificação dos pacientes. Os resultados demonstraram maior prevalência de IBG-LP/SM (41,85%) e menor prevalência de IBG-S (7,65%). A idade média foi de 42,93 ± 14,48 anos, sem diferenças entre os grupos (p=0.42; Kruskal-Wallis), com prevalência de mulheres (63,8%). A avaliação pelo teste Chi-quadrado demonstrou que IBG-LP/SL, IBG- LP/SM e IBG-LP/SS apresentaram maior número de fumantes do que IBG-S...

A clear definition of periodontal disease is essential to establish criteria of risk of developing other systemic conditions, as well as to determine biological phenotypes that represent the microbiological, molecular and immunological features underlying clinical manifestation of the disease. The aim of this study was to evaluate the prevalence of different biological phenotypes among patients attended at School of Dentistry at Bauru-USP, correlating the clinical findings with systemic conditions and microscopic findings. It was included in the sample data collected from dental file records of 313 patients, both genders, age ranged 12-76 years. After collection of data related to the identification, medical and dental history and periodontal parameters (probing depth PD; recession REC or marginal hyperplasia HP; clinical attachment level CAL; bleeding on probing BOP; plaque índex IPl), sample was divided into Five groups: BGI-H (Health)- BOP <10% and PD≤ 3mm (n=24); BGI-G (Gingivitis)- BOP≥10% and PD≤3mm (n=39); BGI-DL/LB (Deep lesion/low bleeding)- SS<10% and 1 or more sites PD≥4 mm (n=47); BGI-DP/MB (Deep lesion/moderate bleeding)- 10%-49% BOP and 1 or more sites PD≥4 mm (n=131); BGI-DL/SB (Deep lesion/severe bleeding)- BOP 50% and 1 ore more sites PD≥4 mm (n=72). Soft tissue excisional biopsies were removed from 25 patients of all groups for analysis in optical microscopy by two expertise blinded examiners. The results showed more prevalence of BGI-DP/MB (41.85%) and lesser prevalence of BGI-H (7.65%). Mean age was 42.93±14.48 years, without significant differences among groups (p=0.42; Kruskal-Wallis), and prevalence of women (63.8%). Evaluation by Chi-squared test showed that BGI-DL/LB, BGI-DL/MB and BGI-DL/SB presented more smokers than BGI-H and BGI-G (p=0.015), without significant differences in diabetes and cardiovascular diseases (p>0.05). The risk of patients with BOP> 10% present CVD was significantly higher...

Avaliação da dureza de diferentes metais utilizados na confecção de pinos pré-fabricados / Assessment of different metal hardness used in the manufacture of pre-fabricated posts

Diversos tipos de materiais metálicos vêm sendo pesquisados nos últimos anos, indicados para a confecção de pinos pré-fabricados, com o objetivo de serem utilizados como retentores intrarradiculares visando à restauração estética e funcional. Pode-se afirmar que, apesar de algum ganho na utilização de materiais não metálicos para a confecção de pinos intrarradiculares, o metal ainda representa uma alternativa altamente confiável, especialmente porque o desempenho clínico dos retentores metálicos tem se mostrado excelente. O presente estudo teve como finalidade avaliar a dureza Vickers de três diferentes metais (Titânio C. P., Liga de Titânio/Vanádio/Alumínio e Liga de Aço Inoxidável), que podem ser utilizados para este fim. Os resultados obtidos demonstraram significativas diferenças entre os três materiais testados.

A combined regenerative approach for the treatment of aggressive periodontitis: long-term follow-up of a familial case.

This article reports the longitudinal follow-up of a familial case of aggressive periodontitis treated by a combined regenerative approach that consisted of root conditioning, bone grafting, and membrane positioning. Treatment resulted in attachment level gain, reduction of probing depth, absence of bleeding on probing, and complete bone filling of the defect. The short-term results obtained after surgery were maintained after 6 years, suggesting that the combined regenerative approach is able to completely arrest the disease with long-term stability.

Profilaxia antimicrobiana pré-operatória: avaliação dos critérios empregados por cirurgiões-dentistas na cidade de Salvador-Ba / Prior surgical antibiotic prophylaxis: evaluation of criterions used by dentists, in Salvador-Ba

A prescrição de antimicrobianos é necessária quando da realização de inúmeros procedimentos odontológicos. No entanto, o uso indiscriminado destes medicamentos pode trazer conseqüencias negativas, com risco para a saúde do paciente e a geração de microorganismos resistentes. Existe uma grande variação de protocolos recomendados, mas pouca base científica para as recomendações. O modo de tratar as infecções é frequentemente empírico, gerando muitas vezes prescrições inadequadas. O objetivo deste estudo foi avaliar os critérios utilizados por uma amostra de cirurgiões-dentistas, da cidade de Salvador-BA, quanto à prescrição de antimicrobianos de forma profilática, antes da intervenção cirúrgica, e determinar quais as drogas mais empregadas e sob qual regime terapêutico. Para isso, foram aplicados questionários a profissionais que atuam nas áreas de clínica geral, cirurgia e traumatologia bucomaxilofacial, endodontia e periodontia. No total foram avaliados 103 questionários. Os resultados revelaram que a amoxicilina é o antimicrobiano de primeira escolha para a maioria dos profissionais e que apenas 33 por cento dos entrevistados empregam corretamente o protocolo de profilaxia antibiótica pré-operatória, segundo a American Heart Association (AHA)

Perfil assistencial do Ambulatório de Fisioterapia no Câncer de Cabeça e Pescoço, Unidade I - Instituto Nacional de Câncer (INCA) / Supportive profile of Physical Therapy Treatment on Head and Neck Cancer Patients at Brazilian National Cancer Institute (INCA)

Objetivo: identificar o perfil assistencial do Ambulatório de Fisioterapia no câncer de cabeça e pescoço, do Instituto Nacional de Câncer, demonstrando o número de atendimentos realizados, as características dos atendimentos e as principais repercussões funcionais apresentadas pelos pacientes. Pacientes e Método: análise quantitativa e qualitativa dos atendimentos fisioterapêuticos realizados no período de 01/02/2007 a 31/05/2007. Resultados: foram disponibilizadas 839 vagas, sendo realizados 643 atendimentos e ocorreram 196 faltas. Dos atendimentos realizados, 17% foram consultas de primeira vez. A principal repercussão funcional identificada foi a disfunção do nervo acessório (29,5%), seguida das desordens da articulação têmporo-mandibular (ATM) (27,6%) e distúrbios respiratórios (12,3%). Dor foi identificada em 42,3% dos atendimentos, sendo analgesia respons??vel por 23% dos procedimentos realizados. Vinte e três por cento dos atendimentos comportaram três ou mais procedimentos, evidenciando múltiplas disfunções em um mesmo paciente. Discussão: As repercussões funcionais secundárias ao câncer de cabeça e pescoço e/ou seus tratamentos são importantes e bastante freqüentes. As desordens do ombro e da ATM, assim como os distúrbios respiratórios, foram as complicações mais rotineiramente observadas. A dor está presente em um percentual significativo dos pacientes que necessitam de Fisioterapia. A abordagem integral visa a prevenção de complicações previsíveis, assim como a reabilitação das complicações instaladas e o manejo das seqüelas inevitáveis.

Objective: to identify the supportive profile of physical therapy appointments at Brazilian National Cancer Institute (INCA), looking for patients` main demands and their dysfunctional characteristics. Materials and methods: the physiotherapeutic consultations for head and neck cancer patients performed between 02/01/2007 and 05/31/2007 were retrospectively analyzed in their quantitative and qualitative aspects. Results: sixty hundred and forty-three appointments were reviewed including 17% of first time patients. The main dysfunctions identified were on the accessory nerve (29.5%), followed by temporomandibular joint (TMJ) (27.6%) and breathing disorders (12.3%). Pain was a complain present in 42.3% of these cases, and analgesia was responsible for 23% of the total procedures performed. In 23% of realized consults, 3 or more procedures were necessary representing multiple dysfunctions on each patient. Discussion: secondary dysfunctions caused by head and neck cancer and/or its indicated treatment are important and quite frequent. Shoulder and TMJ dysfunctions as well as breathing disorders were the most frequent complications observed. Pain was seen in a significant number of patients under physiotherapy. Patients total care has the intention of preventing known complications, and allowing early rehabilitation and sequels management of installed dysfunctions.

Compreendendo a natureza das políticas do Estado capitalista / Understanding the nature of capitalist state policies

Este artigo tem duas dimensões de análise: uma busca compreender o sentido e a finalidade da política concebida e executada pelo Estado capitalista;a outra investiga a sua natureza, se pública ou estatal. Com isso, tem-se como propósito construir bases conceituais e metodológicas que ajudem a entender um pouco melhor as razões dos sucessos ou fracassos das políticas ditas públicas, particularmente em contextos de países periféricos. Essa construção para o entendimento passa por compreender que o resultado está associado muito mais à forma de gestão da demanda social - administração política - do que à precisão do cálculo previamente estabelecido.

This article has two analytical dimensions: the first deals with the meaning and purpose of the policies designed and implemented by the capitalist state; the second investigates their nature, whether public or state. Therefore, the article intends to build a conceptual and methodological framework that will help to better understand about the reasons of the success or failure of the so-called public policies, especially in the context of the peripheral countries. This involves understanding that the outcome is associated much more to the way social demands are managed - political administration - that to the precision of previously established calculations.

Fluvoxamina no transtorno depressivo maior: um estudo multicêntrico aberto / Fluvoxamine in the treatment of major depressive disorder: an open multicentric study

OBJETIVO: Este trabalho estudou a eficácia e a tolerabilidade da fluvoxamina no tratamento, de forma aberta, sem comparação com placebo ou outros agentes, por 6 semanas, de pacientes com o diagnóstico de transtorno depressivo maior (TDM). Constitui-se em objetivo secundário do estudo avaliar os efeitos da fluvoxamina sobre o sono dos pacientes. MÉTODOS: Foram incluídos 104 pacientes, maiores de 18 anos, com o diagnóstico de TDM, de acordo com os critérios do Manual Diagnóstico e Estatístico de Transtornos Mentais, 4ª edição (DSM-IV), e com escores, na Escala de Hamilton para Depressão, versão de 17 itens (HAM-D 17), de 17 pontos ou mais. Avaliou-se a eficácia da fluvoxamina por meio das Escalas HAM-D 17 e da CGI (Impressão Clínica Global). A análise dos itens 4, 5 e 6 da HAM-D 17 foi utilizada para a avaliação do sono dos pacientes. Avaliaram-se a segurança e a tolerabilidade da fluvoxamina ao longo das 6 semanas, registrando-se quaisquer eventos adversos. A fluvoxamina foi inicialmente ministrada em doses de 50 ou 100 mg/dia, podendo haver aumentos progressivos até 300 mg/dia. RESULTADOS: Dos 104 pacientes incluídos, 81 (78 por cento) concluíram o estudo. Obtiveram resposta favorável (diminuição de 50 por cento ou mais na HAM-D 17) 69 por cento dos pacientes, e a taxa de remissão (HAM-D 17 < 7) foi de 52 por cento. A análise da CGI indicou ter havido melhora significante (p < 0,001) em relação aos escores de base. A análise específica dos itens relativos ao sono, na HAM-D 17, revelou melhora significativa já na segunda visita, mantendo-se ao longo das 6 semanas. Os eventos adversos foram os esperados para inibidores seletivos de recaptação da serotonina, predominando as queixas gastrointestinais, em sua maioria transitórias e de pequena intensidade. CONCLUSÃO: O estudo vem confirmar a eficácia e a tolerabilidade da fluvoxamina no tratamento do transtorno depressivo maior, assim como sua eficácia no tratamento das alterações do sono encontradas...

OBJECTIVE: This research studied the efficacy and tolerability of fluvoxamine in the treatment of major depressive disorder (MDD), during 6 weeks, in an open trial, without placebo or active comparator. A secondary objective was the evaluation of the effects of fluvoxamine on the sleep of the pacients. METHODS: 104 patients were inicially included, with the diagnosis of MDD in accordance to the criteria of the Diagnostic and Statistical Manual for Mental Disorders, 4th edition (DSM-IV). Patients should have scores > 17 in the Hamilton Depression Scale for Depression 17 itens (HAM-D 17). The efficacy of fluvoxamine was studied through the HAM-D 17 and CGI (Clinical Global Impression). The analysis of the HAM-D 17 itens 4, 5, and 6 was used for the evaluation of the quality of sleep of the patients. Security and tolerability of fluvoxamine was assessed throughout the six weeks, being registered any adverse event. Fluvoxamine was inicially administered at the doses of 50 or 100 mg/day; the doses could be progressively increased until 300 mg/day. RESULTS: From the 104 included patients, 81 (78 percent) concluded the study. Sixty nine percent (69 percent) of the patients obtained favorable response (defined as 50 percent improvement in the HAM-D 17) and the remission rate (HAM-D 17 < 7) was 52 percent. The specific analysis of CGI showed significant improvement (p < 0.001) comparing to the baseline scores. The speficic analysis of the sleep itens of the HAM-D 17 showed significant improvement from the 2nd week; the improvement was sustained until the end of the 6 weeks study. The adverse events were those expected for the serotonin selective reuptake inhibitors (SSRI), predominantly gastrointestinal complaints, transitory and of low intensity in most of the cases. CONCLUSION: This study confirms the efficacy and tolerability of fluvoxamine in the treatment of MDD, and also its efficacy in the treatment of sleep disturbs among depressed patients. The...

Hypercoagulability markers in young asymptomatic heterozygous carriers of factor V Leiden (G1691A) or prothrombin (G20210A) variant.

BACKGROUND: Mutations in factor V (factor V Leiden-G1691A) and prothrombin (G20210A) genes are important risk factors for thrombophilia due to their high incidence in patients with thromboembolic events, especially among the young. However, it is not clear if levels of hypercoagulability markers are significantly altered in asymptomatic young carriers of factor V Leiden or prothrombin G20210A. METHODS: Hemostatic status of 32 asymptomatic young individuals carrying these mutations and of 18 normal control individuals was investigated through the determination of plasma thrombomodulin (TM), prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT) and D-dimer. RESULTS: No significant differences were observed in these hemostatic markers when comparing groups of individuals carrying mutations and the control group. CONCLUSION: Analysis of these results leads to the conclusion that the presence of these mutations, in the absence of acquired risk factors, does not constantly predispose these young carriers to a state of hypercoagulability.