Mortality due to visceral leishmaniasis in Brazil by municipalities, 2001-2018: a spatial-temporal analysis of estimates from the Global Burden of Disease study.

OBJECTIVES: In the American regions, Brazil accounts for 97% of visceral leishmaniasis (VL) cases, with a case fatality rate of approximately 10%. This study aimed to investigate the VL mortality distribution in Brazil and identify high-priority and high-risk areas for intervention strategies. STUDY DESIGN: This was an ecological study that analysed the spatial-temporal patterns of VL mortality in Brazilian municipalities. METHODS: Age-standardised VL mortality rates from the Global Burden of Disease study from 2001 to 2018 were used. The distribution of mortality in the municipalities was assessed, and subsequently the Local Index of Spatial Autocorrelation (LISA) analysis was conducted to identify contiguous areas with high mortality rates. Scan analysis identified clusters of high spatial-temporal risks. RESULTS: The highest mortality rates and clusters were in municipalities located in the Northeast region and in the states of Tocantins and Roraima (North region), Mato Grosso do Sul (Central-West region), and Minas Gerais (Southeast region). According to LISA, there was an increase in the number of municipalities classified as high priority from the first 3-year period (n = 434) to the last 3-year period (n = 644). The spatio-temporal analysis identified 21 high-risk clusters for VL mortality. CONCLUSION: Areas with a high risk of VL mortality should prioritise preventing transmission, invest in early diagnosis and treatment, and promote the training of healthcare professionals.

Heavy metal contamination in Peru: implications on children's health.

Cerro de Pasco, Peru, has been excessively contaminated with heavy metals due to high mining activities in the region. We investigated the presence of chronic exposure to heavy metals in children living in Cerro de Pasco and its effect on health. Heavy metal concentrations were determined in hair samples collected from 78 children living in a region exposed to an open-pit mine (Paragsha region) and from other 16 children unexposed to mine activities (Carhuamayo region). Children exposed to the mine showed statistically significant higher concentration of aluminum, antimony, arsenic, cadmium, chromium, iron, lead, tin and thallium (p < 0.05) than control children. Hair samples collected from the same children in two occasions (2016 and 2018) showed that the exposure is chronic with higher levels of heavy metals observed in 2018. The concentration of heavy metals was higher in hair tip than in hair root samples. Heavy metals are associated with substantial higher risk of nosebleed (odds ratio, OR = 15.40), chronic colic (OR = 7.30), dermatologic alterations (OR = 6.16), mood alterations (OR = 7.07), presence of white lines on nails (OR = 12.10), reduced visual camp (OR = 3.97) and other symptoms (OR = 5.12). Chronic heavy metal exposure implies various negative consequences on children's health. Preventive measures are crucial to protect children's health.

Exosomes Could Offer New Options to Combat the Long-Term Complications Inflicted by Gestational Diabetes Mellitus.

Gestational diabetes Mellitus (GDM) is a complex clinical condition that promotes pelvic floor myopathy, thus predisposing sufferers to urinary incontinence (UI). GDM usually regresses after birth. Nonetheless, a GDM history is associated with higher risk of subsequently developing type 2 diabetes, cardiovascular diseases (CVD) and UI. Some aspects of the pathophysiology of GDM remain unclear and the associated pathologies (outcomes) are poorly addressed, simultaneously raising public health costs and diminishing women's quality of life. Exosomes are small extracellular vesicles produced and actively secreted by cells as part of their intercellular communication system. Exosomes are heterogenous in their cargo and depending on the cell sources and environment, they can mediate both pathogenetic and therapeutic functions. With the advancement in knowledge of exosomes, new perspectives have emerged to support the mechanistic understanding, prediction/diagnosis and ultimately, treatment of the post-GMD outcomes. Here, we will review recent advances in knowledge of the role of exosomes in GDM and related areas and discuss the possibilities for translating exosomes as therapeutic agents in the GDM clinical setting.

Aprendizagem Baseada em Problemas: Contribuição para Médicos Pediatras / Problem-Based Learning: Contribution to Pediatric Practice

RESUMO Introdução A Aprendizagem Baseada em Problemas (ABP) tem se destacado na educação médica por ser uma proposta fundamentada no construtivismo, com a finalidade de desenvolver a autonomia e o raciocínio crítico do estudante para tomada de decisões. Objetivo Por conta das dificuldades encontradas pelos graduandos e das escassas informações relativas à contribuição da ABP para a prática clínica de médicos pediatras, objetivou-se avaliar a contribuição da ABP para a formação dos médicos pediatras. Metodologia Trata-se de uma série de casos de abordagem descritiva, desenvolvida com médicos pediatras egressos de duas instituições públicas de ensino. A definição da amostra ocorreu de forma intencional, amostragem não probabilística, em que os atributos dos participantes são definidos conforme o objeto de estudo, a fim de selecionar quais os indivíduos são mais adequados para serem incluídos na amostra, a qual é composta por dez médicos pediatras, sendo cinco egressos de cada instituição. Para responderem ao questionário, selecionaram-se médicos especialistas em pediatria. A coleta de dados foi realizada pela pesquisadora principal, por meio de três questões semiestruturadas respondidas via e-mail. As respostas dos entrevistados às questões abertas foram analisadas pelo método de análise reflexão-síntese, que pressupõe a análise e síntese de conteúdo mediadas pela sensibilidade e pela razão. Resultados Os resultados obtidos entre 2003 e 2012 indicaram que 28% dos médicos pediatras apresentavam título de especialista e 72% não o tinham esse título. Os discursos apresentados pelos participantes permitiram identificar que a ABP contribuiu para a formação e atuação dos médicos pediatras em diferentes aspectos, proporcionando a busca de conhecimento, a habilidade para trabalhar em equipe e a facilidade para realizar o manejo clínico de forma interdisciplinar e holística. Porém, os discursos também demonstraram que esse método pode não favorecer o aprofundamento das matérias básicas. Conclusão A ABP contribuiu para a formação e atuação do médico pediatra, porém pode não ter favorecido o aprofundamento das matérias básicas.

ABSTRACT Introduction Problem-Based Learning (PBL) has been highlighted in medical education because it is a proposal based on constructivism, with the purpose of developing students' autonomy and critical thinking for decision-making. Objective In view of the difficulties experienced by undergraduate students and the scarce information regarding the contribution of PBL to the clinical practice of pediatric physicians, we aimed to evaluate the contribution of PBL to the training of pediatricians. Methods This is a series of descriptive cases, developed with pediatricians from two public educational institutions. This study used an intentional, non-probabilistic sampling technique, in which the attributes of the participants are defined according to the object of study, aiming to select which individuals are more suitable to be included in the sample, consisting of ten pediatricians, with five graduated from each institution. Pediatricians were selected to answer the questionnaire. Data collection was performed by the main researcher, through three semi-structured questions answered via e-mail. The interviewees' answers to the open questions were analyzed using the method of reflection-synthesis analysis, which presupposes content analysis and synthesis mediated by sensitivity and reason. Results The results indicated that 28% of the pediatricians had a Board Certification degree, and 72% did not, between the years 2003 and 2012. The participants' discourses allowed us to identify that the PBL contributed to the training and performance of pediatricians in different aspects, providing the search for knowledge; ability to work as a team; and capacity to conduct clinical management in an interdisciplinary and holistic way. However, the discourses also demonstrated that this method might not favor the developing of the basic subjects. Conclusion The PBL contributed to the training and performance of the pediatrician, but it might not have favored the developing of the basic subjects.

Study of mortality from infectious diseases in Brazil from 2005 to 2010: risks involved in handling corpses.

In the wake of disasters, the lack of information on how to handle and dispose of corpses leads the professionals involved in emergency operations to uncertainty about associated risks and safety precautions. The article seeks to establish the risks of the etiologic agents involved in Brazilian mortality due to infectious diseases and identify and discuss the main protection measures for professionals involved in handling of corpses in disaster situations. It involved a survey of deaths by infectious diseases in Brazil between 2005 and 2010, using data from the Mortality Information System. Of the 171,223 deaths analyzed, the pathogens leading to the greatest number of deaths were: HIV, Mycobacterium tuberculosis and Trypanosoma cruzi. 59% belonged to risk class 3 and 40.6% to risk class 2. Eight deaths were caused by risk class 4 pathogens, which represent high risk. The professionals involved in the handling of corpses may be exposed to chronic risks, such as viruses transmitted via blood, gastrointestinal infections and tuberculosis. These findings indicate the importance of investment in the preparation of measures to reduce the risk of infection associated with the handling of corpses.

Study of mortality from infectious diseases in Brazil from 2005 to 2010: risks involved in handling corpses / Estudo da mortalidade no Brasil por doenças infecciosas, de 2005 a 2010: riscos envolvidos no manejo de cadáveres

Abstract In the wake of disasters, the lack of information on how to handle and dispose of corpses leads the professionals involved in emergency operations to uncertainty about associated risks and safety precautions. The article seeks to establish the risks of the etiologic agents involved in Brazilian mortality due to infectious diseases and identify and discuss the main protection measures for professionals involved in handling of corpses in disaster situations. It involved a survey of deaths by infectious diseases in Brazil between 2005 and 2010, using data from the Mortality Information System. Of the 171,223 deaths analyzed, the pathogens leading to the greatest number of deaths were: HIV, Mycobacterium tuberculosis and Trypanosoma cruzi. 59% belonged to risk class 3 and 40.6% to risk class 2. Eight deaths were caused by risk class 4 pathogens, which represent high risk. The professionals involved in the handling of corpses may be exposed to chronic risks, such as viruses transmitted via blood, gastrointestinal infections and tuberculosis. These findings indicate the importance of investment in the preparation of measures to reduce the risk of infection associated with the handling of corpses.

Resumo Após os desastres, a falta de informações claras sobre como gerenciar a disposição dos cadáveres, resultam em incertezas entre os profissionais envolvidos no atendimento emergencial, de quais são os riscos associados e as medidas de segurança no manejo dos corpos. O artigo objetiva determiner o risco dos agentes etiológicos envolvidos na mortalidade brasileira por doenças infecciosas, identificar e discutir as principais medidas de proteção para os profissionais envolvidos no manejo de cadáveres em situações de desastres. Levantamento dos óbitos por doenças infecciosas, no Brasil, de 2005 a 2010, utilizando-se os dados do Sistema de Informações sobre Mortalidade. Dos 171.223 óbitos analisados, os patógenos causadores de maior número de mortes foram: HIV, M. tuberculosis e T cruzi. Dos agentes, 59% pertencem à classe de risco 3 e 40,6% à classe 2. Oito óbitos identificados foram causados por patógenos da classe 4, que representam alto risco. Os profissionais envolvidos no manejo de corpos podem estar expostos aos riscos crônicos, como os vírus transmitidos pelo sangue, infecções gastrointestinais e tuberculose. Estes resultados demonstram a importância no investimento na elaboração de medidas para reduzir o risco de infecção associada ao manejo de cadáveres.

Bacillus anthracis como ameaça terrorista / Bacillus anthracis as terrorist threat

Após 2001, a utilização de patógenos reforçou seu emprego como arma de guerra. Este estudo descritivo tem por objetivo discutir estratégias de contingenciamento em ataque por anthrax, auxiliando no reconhecimento precoce e estabelecimento de medidas de contenção. Profissionais de saúde necessitam reconhecer a infecção, pois em atentados, o elemento-chave é médico e não militar. O anthrax por inalação é a forma de atentado mais provável com 100% de mortalidade, caso não haja tratamento imediato. É altamente resistente; tem período de incubação de um a seis dias; seus sintomas iniciais são similares à influenza; só permite diagnóstico em NB3; a vacina é aquela recomendada para ocupações de risco, de disponibilidade restrita; e requer profilaxia antibiótica longa.

As from 2001, the use of biological agents reinforced the possibility of its consolidation as warfare. This descriptive study aims to discuss the contingency strategies for anthrax attack, seeking early recognition and establishment of containment measures. Health professionals need to recognize the infection since the key-element during an attack is medical rather than military one. Anthrax inhalation is the most likely form of attack with 100% mortality rate, if no immediate treatment is provided. The virus is highly resistant; has an incubation period of one to six days; its early symptoms are similar to influenza's; diagnosis is only allowed in NB3; the vaccine is the one recommended for risk occupations, of restricted availability; and requires long antibiotic prophylaxis.

Espirometria em pré-escolares asmáticos: avaliação da taxa de sucesso / Spirometry in preschools with asthma: evaluate the success rate

Introdução: a asma pode iniciar-se na idade pré-escolar e sua morbidade é elevada. Atualmente, o diagnóstico é centrado apenas no exame clínico, mas a espirometria é um método objetivo realizado rotineiramente em países desenvolvidos. No Brasil, ela é subutilizada e há poucos trabalhos acerca desse tema na literatura nacional. Objetivos: avaliar a taxa de sucesso da espirometria em pré-escolares asmáticos. Metodologia: foirealizado estudo transversal no Laboratório de Função Pulmonar do Hospital das Clínicas da Universidade Federal de Minas Gerais entre o período de 2009 e 2013. Foram coletados dados de 238 espirometrias de pré-escolares e destas foram triadas 64 crianças de três aseis anos, com diagnóstico médico de asma, excluindo-se, assim, os testes de pacientes com outros diagnósticos. As espirometrias foram realizadas com base nos critérios de reprodutibilidade e aceitabilidade preconizados pela American Thoracic Society (ATS). Os critérios de aceitabilidade foram: ausência de artefatos nas curvas, início satisfatórioda inspiração, inspiração máxima antes do início do teste, evidência de esforço máximo, expiração sem hesitação e término adequado (platô no último segundo da curva expiratória forçada). Em todas as curvas o volume de retroextrapolação foi inferior a 5% da CVF. As curvas foram altamente reprodutíveis, com volumes pulmonares não variandomais de 5%. O paciente realizou quantas tentativas fossem necessárias. A taxa de sucesso foi calculada pelo número de espirometrias aceitáveis e reprodutíveis sobre o número de espirometrias não aceitáveis. Resultados: foram avaliadas 64 crianças com diagnóstico de asma, 33 de sexo masculino e 31 de sexo feminino. A taxa de sucesso da espirometriafoi de 64% (IC 95%, 51,0-75,4). A taxa de sucesso estratificada por idade foi de 60 e 56%, respectivamente, para as idades de três e quatro anos; e 85 e 82%, respectivamente, para as idades de cinco e seis anos. Discussão: a taxa de sucesso do estudo foi elevada e aumentou com a idade, o que reforça que a espirometria é um método não invasivo quepoderia ser normatizado nos laboratórios de função pulmonar e contribuiria para o adequado diagnóstico e manejo terapêutico da asma em pré-escolares. Conclusão: a maioria das crianças conseguiu realizar a espirometria. Deve-se ter em vista que foi a primeira vezque as crianças realizaram o teste da espirometria, o que revela a viabilidade de aumentar essa taxa adaptando o laboratório às condições preconizadas pela ATS.

Introduction: The asthma can emerge at the preschool age and it has a high morbidity. For the time being, it?s diagnosis is centered around the clinical exam. However, the spirometry is an objective method performed as a routine in developed countries to asses that diagnosis. In Brazil, this test is underexploited and there are only a few papers about this subject atthe national literature. Objectives: Evaluate the success rate of the spirometry in preschools with asthma. Methodology: A cross-sectional study was conducted at the Pulmonary Function Laboratory of theClinics Hospital, Federal University of Minas Gerais, Brazil, in the period between 2009 and 2013. Data of 238 spirometries were collected and 64 children from 3 to 6 years with medical diagnosis of asma were sorted, excluding, then, the tests of the patients with other pulmonarydiseases. The spirometries were performed based on thecriteria of reproducibility and acceptability recommendedby the American Thoracic Society (ATS). The acceptabilitycriteria were: absence of artefacts at the curves, satisfactorybeginning of inspiration, maximum inspiration prior to the beginning of the test, evidence of maximum effort, expiration without hesitation and adequate finishing (presence of plateau at the last second of the forced expiratory curve). At all the curves, the volume of retro-extrapolationwas lesser than 5% the VFC. The curves were highly reproducible,with pulmonary volumes not variating more than 5%. The patient performed the test as many times as it was needed. The success rate was calculated by the number of acceptable and reproducible spirometries divided bythe number of non-acceptable spirometries. Results: 64 children with the diagnosis of asthma were evalued, 33 males and 31 females. The success rate was 64% (CI 95%, 51,0 ? 75,4). The success rate stratified by age was 60% and 56%, respectively, to the ages of 3 and 4 years old;and 85% e 82%, respectively, to the ages of 5 and 6 years old. Discussion: The study?s success rate was elevated and has increased with age, with reinforces that the spirometry is a non-invasive method that could be normatized at the pulmonary function laboratories, and would contribute to the adequate diagnosis and therapeutic management ofasthma in preschool children. Conclusion: The majority of the children was able to perform the spirometry. It has to be taken into consideration that is the first time those children managed to perform the spirometry test, which indicates feasibility to enhancing that rate by adapting the laboratory to the conditions endorsed by ATS.

[A sociography of elderly victims of family violence in Portugal]. / Estudo sobre pessoas idosas vítimas de violência em Portugal: sociografia da ocorrência.

This article presents data on violence against persons aged 60 years or older and living in Portugal for at least 12 months. The cross-sectional descriptive study collected data with a face-to-face questionnaire applied to victims that had sought assistance at three government institutions and one non-governmental support service for victims. The non-probabilistic sample included 510 victims of violence in family settings. Physical and psychological violence were the most common (87.8% and 69.6%, respectively). Financial violence was reported by 47.5% of the victims, followed by sexual assault (7.5%) and neglect (6.5%). The majority of victims (74.1%) reported more than one type of violence. Victims were mostly women, and mean age was 70.7 years. Most of the perpetrators belonged to the nuclear family, namely spouses or partners, sons/sons-in-law, and daughters/daughters-in-law. However, differences were observed according to victim's gender. The results indicate that violence is not a uniform phenomenon, presenting different configurations.

Medico-legal litigation in Obstetrics: a characterization analysis of a decade in Portugal.

PURPOSE: It was to analyse the most critical areas in Obstetrics and to suggest measures to reduce or avoid the situations most often involved in these disputes. METHODS: Obstetrics cases submitted to the Medico-legal Council since the creation of the National Institute of Legal Medicine and Forensic Sciences in 2001 until 2011 were evaluated. A comprehensive characterization, determination of absolute/relative frequencies, hypothesis of a linear trend over the years and the association between each parameter was done. RESULTS: The analysis has shown no significantly linear trend. The most common reasons for disputes were perinatal asphyxia (50%), traumatic injuries of the newborn (24%), maternal sequelae (19%) and issues related to prenatal diagnosis and/or obstetric ultrasound (5.4%). Perinatal asphyxia showed no significantly linear trend (p=0.58) and was usually related to perinatal deaths or permanent neurologic sequelae in newborn children. Traumatic injuries of the newborn, mostly related to instrumented deliveries, shoulder dystocia or vaginal delivery in breech presentation, has shown a significantly increased linear trend (p<0.001), especially related to instrumented deliveries. The delay/absence of cesarean section was the clinical procedure questioned in a significantly higher number of cases of perinatal asphyxia (68.7%) and of traumatic lesions of the newborn due to instrumented deliveries (20.5%). CONCLUSION: It is important to improve and correct theoretical/practical daily clinical performance in these highlighted areas, in order to reduce or even avoid situations that could end up in medico-legal litigations.

Estudo sobre pessoas idosas vítimas de violência em Portugal: sociografia da ocorrência / A sociography of elderly victims of family violence in Portugal / Estudio sobre las víctimas de la violencia en Portugal: sociografía de la ocurrencia

O presente artigo apresenta dados sobre violência contra pessoas com 60 e mais anos residentes em Portugal há mais de 12 meses. O estudo transversal e descritivo recolheu dados por meio de um questionário aplicado presencialmente a vítimas que recorreram a três entidades governamentais e a uma instituição não-governamental de apoio a vítimas. A amostra não probabilística foi constituída por 510 vítimas de violência em contexto familiar. A violência física e a psicológica foram os tipos mais reportados, afetando 87,8% e 69,6% das pessoas estudadas, seguindo-se a violência financeira (47,5%), sexual (7,5%) e a negligência (6,5%). A maioria (74,1%) dos respondentes indicou mais de um tipo de violência. As vítimas, na maioria mulheres, tinham uma média de idade de 70,7 anos. A maioria dos agressores pertencia à família nuclear, nomeadamente, cônjuges ou companheiros, filhos/enteados e filhas/enteadas. Contudo, observaram-se diferenças no agressor consoante o gênero da vítima. Os resultados indicam que a violência não é um fenômeno uniforme, apresentando-se sob diferentes configurações.

This article presents data on violence against persons aged 60 years or older and living in Portugal for at least 12 months. The cross-sectional descriptive study collected data with a face-to-face questionnaire applied to victims that had sought assistance at three government institutions and one non-governmental support service for victims. The non-probabilistic sample included 510 victims of violence in family settings. Physical and psychological violence were the most common (87.8% and 69.6%, respectively). Financial violence was reported by 47.5% of the victims, followed by sexual assault (7.5%) and neglect (6.5%). The majority of victims (74.1%) reported more than one type of violence. Victims were mostly women, and mean age was 70.7 years. Most of the perpetrators belonged to the nuclear family, namely spouses or partners, sons/sons-in-law, and daughters/daughters-in-law. However, differences were observed according to victim’s gender. The results indicate that violence is not a uniform phenomenon, presenting different configurations.

Este artículo presenta datos sobre la violencia contra las personas de 60 años o más que reside en Portugal desde hace más de 12 meses. Se trata de un estudio descriptivo y transversal que recogió datos a través de un cuestionario respondido presencialmente por las víctimas que recurren a tres entidades de gobierno y una organización no gubernamental. La muestra no probabilística constaba de 510 víctimas de violencia familiar. La violencia física y psicológica fueron los tipos más detectados, afectando a un 87,8% y el 69,6% de los estudiados, seguida por la violencia económica (47,5%), sexual (7,5%) y negligencia (6,5%). La mayoría (74,1%) de los encuestados indica más de un tipo de violencia. Las víctimas, en su mayoría mujeres, tenían una edad media de 70,7 años. La mayoría de los atacantes pertenecían a la familia nuclear, incluidos los cónyuges o parejas, hijos/hijastros e hijas/hijastras. Sin embargo, hubo diferencias en función del sexo de la víctima-abusador. Los resultados indican que la violencia no es un fenómeno uniforme, apareciendo en diferentes configuraciones.

Medico-legal litigation in Obstetrics: a characterization analysis of a decade in Portugal / Litígio médico-legal em Obstetrícia: caracterização de uma década em Portugal

PURPOSE: It was to analyse the most critical areas in Obstetrics and to suggest measures to reduce or avoid the situations most often involved in these disputes. METHODS: Obstetrics cases submitted to the Medico-legal Council since the creation of the National Institute of Legal Medicine and Forensic Sciences in 2001 until 2011 were evaluated. A comprehensive characterization, determination of absolute/relative frequencies, hypothesis of a linear trend over the years and the association between each parameter was done. RESULTS: The analysis has shown no significantly linear trend. The most common reasons for disputes were perinatal asphyxia (50%), traumatic injuries of the newborn (24%), maternal sequelae (19%) and issues related to prenatal diagnosis and/or obstetric ultrasound (5.4%). Perinatal asphyxia showed no significantly linear trend (p=0.58) and was usually related to perinatal deaths or permanent neurologic sequelae in newborn children. Traumatic injuries of the newborn, mostly related to instrumented deliveries, shoulder dystocia or vaginal delivery in breech presentation, has shown a significantly increased linear trend (p<0.001), especially related to instrumented deliveries. The delay/absence of cesarean section was the clinical procedure questioned in a significantly higher number of cases of perinatal asphyxia (68.7%) and of traumatic lesions of the newborn due to instrumented deliveries (20.5%). CONCLUSION: It is important to improve and correct theoretical/practical daily clinical performance in these highlighted areas, in order to reduce or even avoid situations that could end up in medico-legal litigations. .

OBJETIVO: Foi analisar as áreas mais críticas em Obstetrícia e sugerir medidas para reduzir ou evitar as situações mais frequentemente envolvidas nessas disputas. MÉTODOS: Foram avaliados todos os casos relativos à Obstetrícia apresentados ao Conselho Médico-legal desde a criação do Instituto Nacional de Medicina Legal e Ciências Forenses em 2001, até 2011. Foi efetuada uma análise compreensiva, determinação de frequências absolutas/relativas, hipótese de linear trend ao longo dos anos e a associação entre os diversos parâmetros. RESULTADOS: As razões mais comuns para o litígio foram a asfixia perinatal (50%), as lesões traumáticas do recém-nascido (24%), as sequelas maternas (19%) e questões relacionadas com o diagnóstico pré-natal e/ou ecografia obstétrica (5,4%). A asfixia perinatal não teve qualquer tendência linear ao longo dos anos (p=0,58) e esteve geralmente relacionada a mortes perinatais ou sequelas neurológicas permanentes nos recém-nascidos. As lesões traumáticas do recém-nascido, principalmente relacionadas com partos instrumentados, distócia de ombros ou parto vaginal em apresentação pélvica, mostrou uma tendência linear de aumento significativo ao longo dos anos (p<0,001), especialmente relacionada com a instrumentação dos partos. O atraso/ausência de cesariana foi o procedimento clínico questionado num número significativamente maior de casos de asfixia perinatal (68,7%) e de lesões traumáticas do recém-nascido devido a partos instrumentados (20,5%). CONCLUSÃO: É importante melhorar e corrigir o desempenho teórico/prático da clínica diária nas áreas destacadas, a fim de reduzir ou mesmo evitar situações que poderão levar a litígio médico-legal em obstetrícia. .

The impact of tooth avulsion on daily life performance using the Brazilian OIDP index in children and young adults.

INTRODUCTION: The evaluation of orofacial damage is an emerging branch in the forensic sciences, specifically in forensic odontology and medicine. One of the major limitations during the evaluation of forensic orofacial damages is establishing the consolidation date of acquired lesions. The consolidation date is defined as the moment from which orofacial damages are considered irreversible. AIM: To stress the relevance of knowing the consolidation date in children who underwent orofacial trauma, and to enhance forensic expertise on the evaluation of dentomaxillofacial damages. MATERIAL AND METHODS: Ninety-six patients, aged between 11 and 31 years old, treated at the dental clinics of the Federal University of Minas Gerais, Brazil, were selected for forensic orofacial evaluation. All the patients presented at least one traumatically avulsed tooth and a temporary partial denture. RESULTS: The mean age for the traumatic avulsion was 10,3 years old. The mean time for the placement of a prosthesis was 2,9 years after the initial consultation. The mean time for the use of prosthesis was 2,2 years. No significant differences were observed regarding orofacial damage outcomes between patients younger or older than 18 years of age. It was observed that patients using temporary removable partial dentures presented a 3,6-fold greater possibility of developing socially significant sequels if compared with patients using temporary fixed partial dentures. CONCLUSION: Knowing the consolidation date of orofacial damageenables the prediction of the potential development of social sequels in children and adolescents who isaster victim identification (DVI) is an intensive and demanding task involving specialists from various disciplines. The forensic dentist is one of the key persons who underwent traumatic dental avulsion.

Valoração do dano estético nos acórdãos do Tribunal de Justiça de Minas Gerais / Assessment of the aesthetic damage in the jurisprudence of the Court of Justice, Minas Gerais

Introdução: Atualmente no Brasil, o valor da indenização por dano extrapatrimonial (moral) tem sido fixado por arbitramento do juiz. O dano moral não é passível de mensuração econômica e, sendo assim, torna-se necessária a utilização de parâmetros para avaliação do dano. Objetivo: Analisar a frequência do dano estético nas jurisprudências do Tribunal de Justiça de Minas Gerais (TJMG) e identificar o dispositivo legal ou parâmetro que o magistrado empregou para fixar a indenização. Material e Método: Foi realizado levantamento das ações julgadas no TJMG nos acórdãos no período de 2009 a 2012, sendo o cirurgião-dentista processado pelos pacientes. Resultados: Em 76 processos observou-se que somente o método descritivo - análise abstrata - foi utilizado para expor a alteração estética. Em relação à frequência do dano estético nas jurisprudências, dos 35 processos em que houve absolvição dos cirurgiões-dentistas, 94,3% não solicitaram a reparação do dano estético como terceiro gênero. Em relação aos cirurgiões-dentistas condenados, em 63,4% dos 41 processos encontrados não existiu solicitação de dano estético. Em 17,1% dos casos houve solicitação de reparação ao dano estético, enquanto que em 19,5% a solicitação de dano estético foi de forma subentendida. Conclusão: A maioriados julgados analisados não considerou o dano estético como um terceiro gênero e não foi identificado um parâmetro objetivo pelos magistrados para fixar o valor da indenização.

Introduction: Currently, in Brazil, the value of compensation rate for off-balance impairments has been stipulated according to judge's conviction. However, these impairments are not measurable, making necessary the use of specific parameters for assessment and evaluation. Aims: To analyze the frequency of aesthetic damages in the Court of Justice of Minas Gerais. Additionally, to identify the parameters used by the judge in order to stipulate the value of compensation rate. Material and methods: Lawsuits of the Court of Justice of Minas Gerais, dating from 2009 to 2012, in which dentists were suited by patients, were selected for detailed analysis and systematic interpretation. Results: In 76 judgments, only the descriptive method was used to stress the aesthetics damage. In relation to the frequency of these impairments, considering the dentist's acquittal, 94.3%of the 35 judgments did not requested compensation rate for aesthetic damages. On the other hand, considering the dentist's conviction, the compensation rate for aesthetic damages was not requested in 63.4% of 41 judgments. In general, in 17.1% of the judgments the compensation rate for aesthetics impairments was requested, while into 19,5% of these judgments the request was subjective. Conclusion: Most of the analyzed judgmentsdid not consider the aesthetic damage as a third type of compensable impairment. In addition, an objective parameter for the stipulation of compensation rates was not detected into the judgments.

Necessidade de avaliação das lesões dentais em casos de invalidez permanente por acidente / Need for assessment of dental injuries in cases of permanent disability by accident

Objetivo: demonstrar a importância da avaliação das lesões dentais nas perícias de invalidez permanente por acidente, por meio de uma revisão de literatura e de análise de legislação específica. Revisão de litera-tura: o sistema estomatognático, quando equilibrado e controlado pelo sistema nervoso central, é responsável pelo funcionamento harmônico da face durante a res-piração, mastigação, sucção, deglutição e fala. Nesse sistema, os dentes possuem papel fundamental nas fun-ções mastigatória e fonética, e, apesar de serem consi-derados biologicamente como órgãos, a perda dental acidental não está amparada pela atual legislação se-curitária (Circular SUSEP 302/05 e a Resolução CNSP 117/04). Considerações finais: por falta de conheci-mento específico nessa área, há uma incongruência entre a finalidade dos seguros de acidentes pessoais e a reparação de danos odontológicos, especialmente os dentais, de modo que se torna importante a divulgação dessas informações no âmbito odontológico e jurídico, http://dx.doi.org/10.5335/rfo.v18i2.3665para que as normativas legais possam ser alteradas e para que os beneficiários possam usufruir de forma justa e legal dos seus direitos.

A glosa odontológica em uma operadora de grupo de grande porte / Dental services disallowance in a major health plan provider

Objetivo: verificar a frequência de glosa total e dos procedimentos odontológicos realizados pela rede credenciada de uma operadora de plano de saúde. Materiais e método: trata-se de um trabalho observacional transversal no qual foi realizado um levantamento retrospectivo em uma operadora de grupo exclusivamente odontológica no terceiro trimestre de 2012. A análise quantitativa agrupou os procedimentos baseando-se no rol da Agência Nacional de Saúde Suplementar. Os dados coletados foram tabulados e submetidos a análise estatística com intervalos com 95% de confiança e nível de significância de 5%. Resultados: dos 264.758 procedimentos faturados, 21.716 foram glosados; portanto, o percentual global de glosas em relação ao total de procedimentos foi de 8,20%. A maior frequência de glosas foi observada na radiologia (35,93%), seguida pela dentística (24,04%) e pela prevenção (16,70%). Do total de glosas, a endodontia e a prótese tiveram 4,77% e 2,32%, respectivamente. Entretanto, quando se analisou cada grupo do rol individualmente, 24,37% dos procedimentos da prótese e 22,23% dos procedimentos da endodontia foram glosados. Conclusão: a frequência total de glosa na operadora de plano de saúde foi 8,20%. Os procedimentos mais glosados foram de radiologia, dentística e prevenção. Quando se avaliou a frequência de glosa dentro de um mesmo grupo, a prótese e a endodontia foram as especialidades mais glosadas.

Objective: to observe the frequency of full disallowance and dental procedures performed by an accredited network of a Health Plan Provider. Materials and method: cross-sectional observational study in which we performed a retrospective survey in a group provider for dental care only, in the 3rd quarter of 2012. A quantitative analysis pooled the procedures based on the List of the National Supplementary Health Agency. The collected data were tabulated and subjected to statistical analysis with 95% confidence intervals, and significance level of 5%. Results: from the 264,758 procedures billed, 21,716 were disallowed, so the overall percentage of disallowances over the total number of procedures was 8.20%. The higher frequency of disallowances was seen in radiology (35.93%), followed by dentistry (24.04%), and prevention (16.70%). Endodontics and prosthesis were 4.77% and 2.32% respectively, from the total of disallowances. However, when we individually analyzed each group from the List, 24.37% of the prosthesis procedures, and 22.23% of the endodontic procedures were disallowed. Conclusion: the overall frequency of disallowance in the Health Plan Provider was 8.20%. The most disallowed procedures were radiology, dentistry, and prevention. When the frequency of disallowance within the same group was assessed, prosthesis and endodontics were the most disallowed specialties.

Importância do registo nacional de artroplastias na identificação médico-legal / Importance of a national arthroplasty register for identification by medical examiner

Desastres de massa são realidades que sucedem com lamentável frequência. Nestas situações, um dos problemas forenses fundamentais é o da identificação das vítimas. Todos os elementos susceptíveis de puderem contribuir para tal identificação são essenciais e, entre eles, as próteses ortopédicas, que frequentemente permanecem intactas. Estas são basicamente constituídas de polímeros, cerâmicas ou metais. O componente metálico normalmente composto por titânio, cromo, cobalto ou liga de aço resiste após violentos traumatismos ou altas temperaturas. A identificação humana é possível se estabelecer a identidade do implante e este puder ser associado à pessoa na qual foi colocado. O logotipo da prótese reconhece o fabricante e o número de série pode ser confrontado com o processo clínico ou com o registro de próteses como já vem sendo adotado em diversos países. A informação da base de dados deve ter o nome do doente, o modelo do implante e o seu número de série para ser consultado apenas nos casos de identificação forense, respeitando obviamente questões éticas de privacidade. Este artigo realça a importância da criação do registo nacional de próteses.

Mass catastrophes are realities that come to pass with lamentable frequency. In such situations, one of the fundamental forensic problems is in relation to identifying the victims. All the elements that might be capable of contributing towards this identification process are essential, and among these are orthopedic prostheses, which frequently remain intact. These prostheses consist basically of polymers, ceramics or metals. Metal components, which are usually composed of titanium, chromium, cobalt or steel alloys, are resistant to violent trauma or high temperatures. Human identification is possible if the identity of the implant is established and if this can be correlated with the individual in whom it was implanted. The logo on the prosthesis establishes who the manufacturer was and the serial number can be compared with the clinical process or with a prosthesis register, as has been implemented in several countries. The information in the database should include the patient's name, the implant model and its serial number, for consultation only in cases of forensic identification, while obviously respecting ethical issues of privacy. This article highlights the importance of creating a national prosthesis register.

IMPORTANCE OF A NATIONAL ARTHROPLASTY REGISTER FOR IDENTIFICATION BY MEDICAL EXAMINER.

Mass catastrophes are realities that come to pass with lamentable frequency. In such situations, one of the fundamental forensic problems is in relation to identifying the victims. All the elements that might be capable of contributing towards this identification process are essential, and among these are orthopedic prostheses, which frequently remain intact. These prostheses consist basically of polymers, ceramics or metals. Metal components, which are usually composed of titanium, chromium, cobalt or steel alloys, are resistant to violent trauma or high temperatures. Human identification is possible if the identity of the implant is established and if this can be correlated with the individual in whom it was implanted. The logo on the prosthesis establishes who the manufacturer was and the serial number can be compared with the clinical process or with a prosthesis register, as has been implemented in several countries. The information in the database should include the patient's name, the implant model and its serial number, for consultation only in cases of forensic identification, while obviously respecting ethical issues of privacy. This article highlights the importance of creating a national prosthesis register.