Prevalência de maloclusão em dentição decídua nos alunos do ensino pré-escolar do concelho de porto de mós (portugal) / Prevalence of malocclusion in deciduous dentition in preschool students in the municipality of Porto de Mós (Portugal) / Prevalencia de maloclusión en dentición temporal en preescolares del municipio de Porto de Mós (Portugal)

Introdução:A maloclusão é considerada a segunda doença oral mais comum em crianças e jovens adultos. É importante saber identificar estas alterações de forma a permitir um adequado desenvolvimento da oclusão.O diagnóstico de um desenvolvimento anormal na dentição decídua é relevante para a prevenção e quando necessáriouma intervenção precoce. Objetivo:O objetivo deste estudo transversal foi avaliar a prevalênciade maloclusão em crianças com dentição decídua e relacionar com diferentes parâmetros.Metodologia:Observaram-se 300 crianças de ambos os sexos, com idades compreendidas entre os 3 e os 6 anos. A recolha de dados foi realizada a partir do exame clínico comkits de observação(espelho bucal básico descartável,sonda descartável, babador,luvas e sacos descartáveis), sob luz natural e na cadeira escolar, no Agrupamento de Escolas de Porto de Mós, Distrito Sanitário de Leiria. Analisaram-se as seguintes características: Tipo de arco de Baume, espaços primatas, diastemas, apinhamento, relação distal dos segundos molares decíduos, relação canina, sobremordida e sobressaliência, mordida anterior e posterior.Resultados:A prevalência de maloclusão registradafoi de 67,7%, verificando-se ser mais baixa aos seis anos, sem apresentar diferenças significativas em ambos os sexos. A sobressaliência foi a maloclusão mais prevalente (42,7%) nas crianças observadas, seguida da mordida aberta anterior (23,3%). Registrou-seumaelevada prevalência de maloclusão nas crianças com arco de Baume tipo II, sem diastemas ou espaços primatas, com apinhamento, degrau distal, classe II canina ou desvio da linha média para a direita.Conclusões:Verificou-se existir uma elevada prevalência de maloclusão nas crianças do agrupamento de escolas do Concelhode Porto de Mós, estando relacionada com diferentes parâmetros oclusais (AU).

Introduction:Malocclusion is considered a second mostcommon oral disease in children and young adults. It is important to know how to identify these changes in order to allow proper development of the occlusion.The diagnosis of anabnormal development in primary dentition is relevant for prevention and when necessary, early intervention.Objective:The aim of this cross sectional study was to evaluate the prevalence of malocclusion in children with deciduous dentition and relate this prevalence with sex, age and with different occlusal parameters.Methodology:300 children of both sexes, aged between 3 and 6 years were observed. Data collection was carried out from the clinical examination using observation kits, in schools, in the Group of schools of Porto de Mós, Health District of Leiria. The following characteristics were analyzed: Baume arc Type, spaces, diastemas, crowding, the deciduous second molars distal relation, canine relationship, Overbite and overjet, anterior and posterior bite.Results:The recorded prevalence of malocclusion was 67.7%, was lower at six years old, without any differences in both sexes. The overjet was the most prevalent malocclusion (42.7%) in the observed children. There was a high prevalence of malocclusion in children with type II Baume arch, without spaces or primate spaces, with distal step, canine class II or with the middle line shifted to the right.Conclusions:There there was a high prevalence of malocclusion in children of the schools in the municipality of Porto de Mós, and is related to the different occlusal parameters (AU).

Introducción: La maloclusión se considera la segunda enfermedad bucal más común en niños y adultos jóvenes. Es importanteidentificar estos cambios para llograr un adecuado desarrollo de la oclusión. El diagnóstico precoz deldesarrollo anormal en la dentición temporal es relevante para la prevención y cuando sea necesario una intervención temprana. Objetivo: El objetivo de este estudio transversal fue evaluar la prevalencia de maloclusión en niñoscon dentición temporal y relacionarla con diferentes parámetros. Metodología: Fueran observados 300 niños de ambos sexos, con edadesentre los 3 y los 6 años. La recogida de datos del examen clínico se realizó mediante kits de observación, en un entorno escolar, en el Grupo Escolar dePorto de Mós, Distrito Sanitariode Leiria. Se analizaron las siguientes características: tipo de arco de Baume, espaciosprimates, diastemas, apiñamientos, relación distal de los segundos molares deciduos, relación canina, sobremordida horizontal y vertical, mordida anterior y posterior. Resultados: La prevalencia de maloclusión registrada fue de 67,7%, la cual resultó ser menor a los seis años, sin mostrar diferencias significativas en ambos sexos. El overjet fue la maloclusión más prevalente (42,7%) en los niños observados, seguida de la mordida abierta anterior (23,3%). Hubo una alta prevalencia de maloclusión en niños con arco de Baume tipo II, sin diastemas ni espacios de primates, con apiñamiento, paso distal, canino clase II o desviación de la línea media hacia la derecha.Conclusiones: Se encontró que hayuna alta prevalencia de maloclusión en niños dela comunidad escolar del municipio de Porto de Mós, y que se relaciona,con diferentes parámetros oclusales (AU).

OUTCOME AND NUTRITIONAL ASSESSMENT OF CHRONIC LIVER DISEASE PATIENTS USING ANTHROPOMETRY AND SUBJECTIVE GLOBAL ASSESSMENT.

BACKGROUND:: Protein-calorie malnutrition is common in chronic liver disease (CLD) but adequate clinical tools for nutritional assessment are not defined. OBJECTIVE:: In CLD patients, it was aimed: 1. Characterize protein-calorie malnutrition; 2. Compare several clinical, anthropometric and functional tools; 3. Study the association malnutrition/CLD severity and malnutrition/outcome. METHODS:: Observational, prospective study. Consecutive CLD ambulatory/hospitalised patients were recruited from 01-03-2012 to 31-08-2012, studied according with age, gender, etiology, alcohol consumption and CLD severity defined by Child-Turcotte-Pugh. Nutritional assessment used subjective global assessment, anthropometry, namely body-mass index (BMI), triceps skinfold, mid upper arm circumference, mid arm muscular circumference and handgrip strength. Patients were followed during two years and survival data was recorded. RESULTS:: A total of 130 CLD patients (80 men), aged 22-89 years (mean 60 years) were included. Most suffered from alcoholic cirrhosis (45%). Hospitalised patients presented more severe disease ( P <0.001) and worst nutritional status defined by BMI ( P =0.002), mid upper arm circumference ( P <0.001), mid arm muscular circumference ( P <0.001), triceps skinfold ( P =0.07) and subjective global assessment ( P <0.001). A third presented deficient/low handgrip strength. Alcohol consumption ( P =0.03) and malnutrition detected by BMI ( P =0.03), mid upper arm circumference ( P =0.001), triceps skinfold ( P =0.06), mid arm muscular circumference ( P =0.02) and subjective global assessment ( P <0.001) were associated with CLD severity. From 25 patients deceased during follow-up, 17 patients were severely malnourished according with triceps skinfold. Malnutrition defined by triceps skinfold predicted mortality ( P <0.001). CONCLUSION:: Protein-calorie malnutrition is common in CLD patients and alcohol plays an important role. Triceps skinfold is the most efficient anthropometric parameter and is associated with mortality. Nutritional assessment should be considered mandatory in the routine care of CLD patients.

Prognóstico e avaliação nutricional de doentes com doença hepática crônica com recurso à antropometria e avaliação global subjetiva / Outcome and nutritional assessment of chronic liver disease patients using anthropometry and subjective global assessment

ABSTRACT BACKGROUND: Protein-calorie malnutrition is common in chronic liver disease (CLD) but adequate clinical tools for nutritional assessment are not defined. OBJECTIVE: In CLD patients, it was aimed: 1. Characterize protein-calorie malnutrition; 2. Compare several clinical, anthropometric and functional tools; 3. Study the association malnutrition/CLD severity and malnutrition/outcome. METHODS: Observational, prospective study. Consecutive CLD ambulatory/hospitalised patients were recruited from 01-03-2012 to 31-08-2012, studied according with age, gender, etiology, alcohol consumption and CLD severity defined by Child-Turcotte-Pugh. Nutritional assessment used subjective global assessment, anthropometry, namely body-mass index (BMI), triceps skinfold, mid upper arm circumference, mid arm muscular circumference and handgrip strength. Patients were followed during two years and survival data was recorded. RESULTS: A total of 130 CLD patients (80 men), aged 22-89 years (mean 60 years) were included. Most suffered from alcoholic cirrhosis (45%). Hospitalised patients presented more severe disease ( P <0.001) and worst nutritional status defined by BMI ( P =0.002), mid upper arm circumference ( P <0.001), mid arm muscular circumference ( P <0.001), triceps skinfold ( P =0.07) and subjective global assessment ( P <0.001). A third presented deficient/low handgrip strength. Alcohol consumption ( P =0.03) and malnutrition detected by BMI ( P =0.03), mid upper arm circumference ( P =0.001), triceps skinfold ( P =0.06), mid arm muscular circumference ( P =0.02) and subjective global assessment ( P <0.001) were associated with CLD severity. From 25 patients deceased during follow-up, 17 patients were severely malnourished according with triceps skinfold. Malnutrition defined by triceps skinfold predicted mortality ( P <0.001). CONCLUSION: Protein-calorie malnutrition is common in CLD patients and alcohol plays an important role. Triceps skinfold is the most efficient anthropometric parameter and is associated with mortality. Nutritional assessment should be considered mandatory in the routine care of CLD patients.

RESUMO CONTEXTO: A desnutrição calórico-proteica é frequente na doença hepática crônica (DHC), no entanto, ferramentas clínicas adequadas para avaliação nutricional destes doentes não estão definidas. OBJETIVO: Em doentes com DHC, pretendeu-se: 1. Caracterizar a desnutrição calórico-proteica; 2. Comparar diferentes ferramentas clínicas, antropométricas e funcionais de avaliação nutricional; 3. Estudar a associação desnutrição/gravidade da DHC e desnutrição/prognóstico. MÉTODOS: Estudo observacional e prospetivo. Foram recrutados doentes ambulatórios/hospitalizados de 01-03-2012 a 31-08-2012 e estudados tendo em conta a idade, gênero, etiologia, consumo alcoólico e gravidade da DHC definida pelo score Child-Turcotte-Pugh. A avaliação nutricional incluiu a utilização da avaliação global subjetiva, antropometria nomeadamente índice de massa corporal (IMC), perímetro braquial, circunferência muscular do braço, prega cutânea tricipital e dinamometria. Os doentes foram seguidos durante 2 anos e foi registada a respectiva sobrevida. RESULTADOS: Foram incluídos 130 doentes com DHC (80 homens) com idade 22-89 anos (média 60 anos). A maioria apresentava cirrose alcoólica (45%). Os doentes hospitalizados apresentaram doença hepática mais severa ( P <0,001) e pior estado nutricional, definido pelo IMC ( P =0,002), perímetro braquial ( P <0,001), circunferência muscular do braço ( P <0,001), prega cutânea tricipital ( P =0,07) e avaliação global subjetiva ( P <0,001). Um terço apresentava força de preensão manual deficiente/baixa. O consumo alcoólico ( P =0,03) e a desnutrição detetada pelo IMC ( P =0,03), perímetro braquial ( P =0,001), prega cutânea tricipital ( P =0,06), circunferência muscular do braço ( P =0,02) e avaliação global subjetiva ( P <0,001) encontraram-se associados à gravidade da DHC. Dos 25 doentes que faleceram durante o seguimento, 17 apresentavam desnutrição severa definida pela prega cutânea tricipital. A desnutrição definida pela prega cutânea tricipital revelou ser um fator preditivo de mortalidade ( P <0,001). CONCLUSÃO: A desnutrição calórico-proteica é comum na DHC para a qual o álcool desempenha um papel importante. A prega cutânea tricipital é o parâmetro antropométrico mais eficiente e encontra-se associado à mortalidade. A avaliação nutricional deve ser considerada mandatória na abordagem rotineira de doentes com DHC.

Primary care education: medical student and young doctors' perspective from Brazil, India and Portugal.

This opinion paper is a collaborative effort describing recent developments in primary care education in three different countries; representing diverse socioeconomic and political systems. The authors describe their respective perspectives from the point of student (Brazil), trainee (Portugal) and young doctor (India). The section on Brazil focuses on the response of the medical education system to the developments before and after political reforms, leading to creation of the Unified Health System. The Indian experience focuses on the challenges faced by recently qualified doctors and ongoing debates about the medical education system in a highly populated but rapidly growing economy. The Portuguese section presents an evolving primary care education system for family doctors and describes the detail of the training programme. Education in primary care is an ever-evolving process that needs to be adequate for each country's health care system. Reading and learning from other experiences may highlight education strategies that may be adopted by peers from other countries. Medical students, doctors in training and recently qualified doctors are the key stakeholders in this process.

Protein contact dermatitis--case report.

Protein contact dermatitis is a skin condition not well known and underdiagnosed by dermatologists, resulting from an IgE-mediated allergic reaction. Clinically it presents as a chronic hand and/or forearms eczema of occupational origin, especially in professionals who work as food handlers. Epicutaneous tests are negative, and to diagnose this condition it is necessary to perform immediate-type allergy tests. The most sensitive and practical is the prick-by-prick test with food that the patient refers to cause intense itching after immediate skin contact. Treatment is symptomatic, and it is mandatory to avoid the responsible allergen, wearing plastic gloves and even sometimes leaving the workplace for symptom resolution.

Protein contact dermatitis - case report / Dermatite de contacto proteinica - relato de caso

Protein contact dermatitis is a skin condition not well known and underdiagnosed by dermatologists, resulting from an IgE-mediated allergic reaction. Clinically it presents as a chronic hand and/or forearms eczema of occupational origin, especially in professionals who work as food handlers. Epicutaneous tests are negative, and to diagnose this condition it is necessary to perform immediate-type allergy tests. The most sensitive and practical is the prick-by-prick test with food that the patient refers to cause intense itching after immediate skin contact. Treatment is symptomatic, and it is mandatory to avoid the responsible allergen, wearing plastic gloves and even sometimes leaving the workplace for symptom resolution.

A dermatite de contacto proteínica é uma condição pouco conhecida e infra-diagnosticada pelos dermatologistas, resultante de uma resposta alérgica de tipo imediato, mediada por IgE. Clinicamente apresenta-se como um eczema crónico em mãos e/ou antebraços de origem ocupacional, sobretudo em profissionais que trabalham manipulando alimentos. As provas epicutâneas são negativas e para realizar o diagnóstico desta condição há que realizar testes alérgicos de tipo imediato, sendo o mais sensível e rápido, o prick-by-prick test com os alimentos que o paciente refere causar-lhe prurido intenso e imediato ao seu contacto. O tratamento é sintomático, sendo necessário evitar o alérgeno responsável, utilizar luvas de plástico e em ocasiões abandonar o posto de trabalho para a sua resolução.