RESUMO

OBJECTIVE: Several prospective randomized trials have shown that hypofractionation has the same efficacy and safety as the conventional fractionation in the treatment of localized prostate cancer. There are many benefits of hypofractionation, including a more convenient schedule for the patients and better use of resources, which is especially important in low- and middle-income countries like Brasil. Based on these data, the Brazilian Society of Radiotherapy (Sociedade Brasileira de Radioterapia) organized this consensus to guide and support the use of hypofractionated radiotherapy for localized prostate cancer in Brasil. METHODS: The relevant literature regarding moderate hypofractionation (mHypo) and ultra-hypofractionation (uHypo) was reviewed and discussed by a group of experts from public and private centers of different parts of Brasil. Several key questions concerning clinical indications, outcomes and technological requirements for hypofractionation were discussed and voted. For each question, consensus was reached if there was an agreement of at least 75% of the panel members. RESULTS: The recommendations are described in this article. CONCLUSION: This initiative will assist Brazilian radiation oncologists and medical physicists to safely treat localized prostate cancer patients with hypofractionation.

Assuntos

Neoplasias da Próstata , Radioterapia de Intensidade Modulada , Brasil , Humanos , Masculino , Estudos Prospectivos , Neoplasias da Próstata/radioterapia , Hipofracionamento da Dose de Radiação , Resultado do Tratamento

RESUMO

PURPOSE: A group of international urology and medical oncology experts developed and completed a survey on prostate cancer (PCa) in developing countries. The results are reviewed and summarized, and recommendations on consensus statements for very low-, low-, and intermediate-risk PCa focused on developing countries were developed. METHODS: A panel of experts developed more than 300 survey questions of which 66 questions concern the principal areas of interest of this paper: very low, low, and intermediate risk of PCa in developing countries. A larger panel of 99 international multidisciplinary cancer experts voted on these questions to create the recommendations for treatment and follow-up for very low-, low-, and intermediate-risk PCa in areas of limited resources discussed in this manuscript. RESULTS: The panel voted publicly but anonymously on the predefined questions. Each question was deemed consensus if 75% or more of the full panel had selected a particular answer. These answers are based on panelist opinion not a literature review or meta-analysis. For questions that refer to an area of limited resources, the recommendations consider cost-effectiveness and the possible therapies with easier and greater access. Each question had five to seven relevant answers including two nonanswers. The results were tabulated in real time. CONCLUSION: The voting results and recommendations presented in this document can be used by physicians to support management for very low, low, and intermediate risk of PCa in areas of limited resources. Individual clinical decision making should be supported by available data; however, as guidelines for treatment for very low, low, and intermediate risk of PCa in developing countries have not been developed, this document will serve as a point of reference when confronted with this disease.

Assuntos

Médicos , Neoplasias da Próstata , Consenso , Países em Desenvolvimento , Humanos , Masculino , Neoplasias da Próstata/terapia

RESUMO

SUMMARY OBJECTIVE: Several prospective randomized trials have shown that hypofractionation has the same efficacy and safety as the conventional fractionation in the treatment of localized prostate cancer. There are many benefits of hypofractionation, including a more convenient schedule for the patients and better use of resources, which is especially important in low- and middle-income countries like Brasil. Based on these data, the Brazilian Society of Radiotherapy (Sociedade Brasileira de Radioterapia) organized this consensus to guide and support the use of hypofractionated radiotherapy for localized prostate cancer in Brasil. METHODS: The relevant literature regarding moderate hypofractionation (mHypo) and ultra-hypofractionation (uHypo) was reviewed and discussed by a group of experts from public and private centers of different parts of Brasil. Several key questions concerning clinical indications, outcomes and technological requirements for hypofractionation were discussed and voted. For each question, consensus was reached if there was an agreement of at least 75% of the panel members. RESULTS: The recommendations are described in this article. CONCLUSION: This initiative will assist Brazilian radiation oncologists and medical physicists to safely treat localized prostate cancer patients with hypofractionation.

Assuntos

Neoplasias da Próstata/radioterapia , Radioterapia de Intensidade Modulada , Brasil , Estudos Prospectivos , Resultado do Tratamento , Hipofracionamento da Dose de Radiação

RESUMO

PURPOSE: Describe sociodemographic and clinical characteristics of patients with hepatocellular carcinoma (HCC) and establish their history in the Brazilian public health system. METHODS: Retrospective observational study was conducted using the database from the Department of Informatics of the Unified Health System (DataSUS). Patients with at least one claim of HCC between July/2011 and June/2016 were included. A record linkage methodology was performed to obtain longitudinal data across different databases. Demographic and clinical data were evaluated, including the time elapsed between diagnosis of HCC risk-factors and the cancer development. Data was analyzed using descriptive statistics. RESULTS: A total of 28,822 HCC cases were identified between July/2011 and June/2016. Mean age was 59.7 years (SD = 14.7), and most patients were men (55.9%). The highest relative number of HCC cases was detected in the south of Brazil (> 20 cases/100,000 inhabitants). About 86.5% of the patients had diagnosis of HCC without previous liver diseases. Only 8% had diagnosis of chronic viral hepatitis and 3.5% cirrhosis. About 76% were diagnosed at an advanced stage, and only 11% of the patients had early stage HCC. Approximately 58% of patients with previous underlying liver diseases were diagnosed at early stages, compared with only 24% of patients without prior record of underlying diseases. CONCLUSION: The diagnosis of HCC in the Brazilian public health is usually made in patients with no previous diagnosis of liver disease and in advanced stages, when no curative treatment is available and survival rates are low. Public health policies are key for the screening and monitoring liver disease and, consequently, HCC.

Assuntos

Carcinoma Hepatocelular/epidemiologia , Neoplasias Hepáticas/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Carcinoma Hepatocelular/patologia , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Lactente , Hepatopatias/diagnóstico , Hepatopatias/epidemiologia , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem

RESUMO

This study aims to assess the prevalence of electrocardiographic abnormalities based on the Minnesota code from a large sample of 1.01 m adult Brazilian primary care patients and to evaluate its association with age, sex, and cardiovascular risk factors. A large electrocardiogram (ECG) database of such patients aged ≥18 years (mean age 52 ± 17 years-old with 60.2% female). was analyzed and the results were stratified by sex and age. The prevalence of abnormalities was more common in men and the elderly population. Major electrocardiographic abnormalities were observed in 20.2% of adults and 43.1% of elderly patients, and minor abnormalities were found in 46.0% 39.4%, respectively. For adult patients, the number and percentage of major abnormalities rise depending on the number of cardiovascular risk factors. For elderly patients, the correlation between these variables is not clear, and the percentage of major abnormalities remains stable independently of the number of risk factors.

Assuntos

Doenças Cardiovasculares , Eletrocardiografia , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Feminino , Hispânico ou Latino , Humanos , Masculino , Pessoa de Meia-Idade , Minnesota , Prevalência , Atenção Primária à Saúde , Fatores de Risco

RESUMO

Background: The majority of patients diagnosed with glioblastoma develop recurrent disease resulting in poor prognoses. The current study aimed to determine the survival rates of patients diagnosed with glioblastoma in Brazil accounting for the influence of age, treatment modalities, public and private practices, and educational level using a population-based national database. Methods: Patients diagnosed with glioblastoma from 1999-2020 were identified from The Fundação Oncocentro de São Paulo database to create a retrospective cohort. Patients were described according to age, education level treatment modalities and medical practice. In a Cox proportional hazards model, controlled for confounding factors for overall survival, the hazard ratio and 95% CI of overall survival in adults was evaluated. Findings: A total of 4,511 patients were included. The median lengths of survival for patients treated in the public and private settings were 8 and 17 months (p<0.001), respectively. Young patients had longer median overall survival (OS: 18 to 40 years, 41 to 60 years, 61 to 65 years, 66 to 70 years and over than 70 years was 22 months, 10 months, 6 months, 5 months, 4 months, respectively (p<0.001). In general, combined treatments were associated with higher median survival compared to monotherapy. The higher educational level, the higher median survival was observed (4 months for illiterate versus 14 months for university degree). In the multivariable analyses, the significant independent predictors for overall survival were practice setting, educational level, age and treatment modalities. Interpretation: Public practice, older patients, less intensive treatment, and lower educational level were associated with worse survival outcomes in Brazilian glioblastoma patients.

RESUMO

BACKGROUND: Knowledge of the normal limits of the electrocardiogram (ECG) is mandatory for establishing which patients have abnormal ECGs. No studies have assessed the reference standards for a Latin American population. Our aim was to establish the normal ranges of the ECG for pediatric and adult Brazilian primary care patients. METHODS: This retrospective observational study assessed all the consecutive 12-lead digital electrocardiograms of primary care patients at least 1 year old in Minas Gerais state, Brazil, recorded between 2010 and 2015. ECGs were excluded if there were technical problems, selected abnormalities were present or patients with selected self-declared comorbidities or on drug therapy. Only the first ECG from patients with multiple ECGs was accepted. The University of Glasgow ECG analysis program was used to automatically interpret the ECGs. For each variable, the 1st, 2nd, 50th, 98th and 99th percentiles were determined and results were compared to selected studies. RESULTS: A total of 1,493,905 ECGs were recorded. 1,007,891 were excluded and 486.014 were analyzed. This large study provided normal values for heart rate, P, QRS and T frontal axis, P and QRS overall duration, PR and QT overall intervals and QTc corrected by Hodges, Bazett, Fridericia and Framingham formulae. Overall, the results were similar to those from other studies performed in different populations but there were differences in extreme ages and specific measurements. CONCLUSIONS: This study has provided reference values for Latinos of both sexes older than 1 year. Our results are comparable to studies performed in different populations.

Assuntos

Doenças Cardiovasculares/diagnóstico , Mineração de Dados/métodos , Eletrocardiografia/normas , Frequência Cardíaca , Atenção Primária à Saúde , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/fisiopatologia , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Reconhecimento Automatizado de Padrão , Valor Preditivo dos Testes , Valores de Referência , Estudos Retrospectivos , Distribuição por Sexo , Fatores Sexuais , Processamento de Sinais Assistido por Computador , Software , Adulto Jovem

RESUMO

The aim of this study was to investigate the effect of cyclosporine A (CsA) therapy on bone healing around osseointegrated implants in the rabbit by means of descriptive histologic and histomorphometric analyses. Eighteen rabbits received one implant each in the right tibia proximal metaphysis. After the bone-healing period of 3 months, 6 randomly selected animals were sacrificed (Group CTL-12) before the immunosuppression therapy initiation to obtain a standard of implant integration. Another six randomly selected animals were submitted to a daily subcutaneous (sc) injection of 10 mg/kg CsA (Group CsA) whereas the six remaining animals received daily sc injections of saline solution (Group CTL-24). Groups CTL-24 and CsA were sacrificed after another 12 weeks. Bone-to-implant contact (BIC), and bone area fraction occupancy (BAFO) within the implant threads were measured. Bone density (BD) and descriptive histological analyses were also accomplished. Rabbits under CsA therapy presented statistically lower percentage of BIC (33.28 ± 6.19) compared to the animals of CLT-24 (55.6 ± 17.73). No differences were found between CsA and CTL-12 (38.7 ± 7.87). Significant decreased percentage of BAFO between the implant threads in the CsA (48.43 ± 9.48) group compared to the CTL-24 (72.26 ± 11.72) was observed. No differences were found between CsA and CTL-12 (61.99 ± 13.94) groups. BD analysis showed significant lower BD in the CsA (48.56 ± 9.32) group compared to the CTL-12 (68.74 ± 10.89) and CTL-24 (77.96 ± 4.96) groups. Collectively, our findings demonstrated that CsA therapy negatively affect the bone healing around osseointegrated implants due to the significant lower values for BIC, BAFO, and BD.

Assuntos

Interface Osso-Implante/fisiologia , Ciclosporina/farmacologia , Implantes Dentários , Osseointegração/efeitos dos fármacos , Tíbia , Animais , Ciclosporina/administração & dosagem , Masculino , Coelhos , Tíbia/efeitos dos fármacos , Tíbia/cirurgia , Titânio/uso terapêutico

RESUMO

BACKGROUND: Chagas disease (ChD) used to be a disease restricted to Latin America, but has become a worldwide problem due to migration of infected individuals to developed countries. Electrocardiography has been considered an essential exam to evaluate ChD patients. OBJECTIVE: This study sought to identify prevalent electrocardiographic abnormalities in a large sample of ChD patients evaluated in the primary care setting. METHODS: This retrospective observational study assessed all consecutive digital 12-lead electrocardiograms (ECG) performed by the Telehealth Network of Minas Gerais, Brazil, from January 1 to December 31, 2011. In that time, the service attended primary care patients in 660 cities in the Minas Gerais province. ChD was self-reported, and the individuals who did not report having ChD were considered noninfected. The prevalence of electrocardiographic abnormalities was assessed. RESULTS: Self-reported ChD patients comprised 7,590 (2.9%) of 264,324 patients who underwent ECG during the study period. The mean age for ChD patients was 57.0 ± 13.7 years, and 64.1% of patients were women. The most common comorbidities were hypertension (61.3%), diabetes (9.1%), and dyslipidemia (6.9%), and 10.7% were smokers. The most frequent electrocardiographic abnormalities were nonspecific repolarization abnormalities (34.6%), right bundle branch block (RBBB) (22.7%), left anterior hemiblock (LAH) (22.5%), ventricular premature beats (5.4%), and atrial fibrillation (5.4%). Only 31.5% of the patients had no electrocardiographic abnormality versus 61.2% in noninfected individuals (p < 0.001). The prevalence of normal ECG decreased with aging and was significantly lower than for noninfected individuals in all age groups. Pacemaker rhythm (odds ratio [OR]: 13.3, 95% confidence intervals [CI]: 11.5 to 15.4), RBBB (OR: 10.7, 95% CI: 10.1 to 11.4), especially in association with LAH (OR: 12.1, 95% CI: 11.2 to 13.0), second atrioventricular block (OR: 4.1, 95% CI: 2.5 to 6.6), and third atrioventricular block (OR: 13.3, 95% CI: 11.5 to 15.4) were strongly related to ChD. CONCLUSIONS: In this large sample of primary care patients with ChD, there was a high prevalence of electrocardiographic abnormalities. Pacemaker rhythm, RBBB, especially in association with LAH, and second and third atrioventricular block were strongly related to ChD.

Assuntos

Bloqueio Atrioventricular/epidemiologia , Bloqueio de Ramo/epidemiologia , Cardiomiopatia Chagásica/epidemiologia , Atenção Primária à Saúde , Adulto , Fatores Etários , Idoso , Bloqueio Atrioventricular/fisiopatologia , Brasil/epidemiologia , Bloqueio de Ramo/fisiopatologia , Estudos de Casos e Controles , Cardiomiopatia Chagásica/fisiopatologia , Doença de Chagas/epidemiologia , Bases de Dados Factuais , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Estudos Retrospectivos

RESUMO

In 722 cities of Minas Gerais (Brazil), primary care patients can have their ECGs remotely interpreted by cardiologists of the Telehealth Network of Minas Gerais (TNMG), a public telehealth service. As of December 2014, more than 1.9 million ECGs were interpreted. This study analyzed the database of all ECGs performed by the TNMG on primary care patients from 2009 to 2013 (n=1,101,993). Structured patient data and the results of automated ECG interpretation by the Glasgow Program are described. Mean patient age is 51 years old, 59% of them are women. The average body mass index is 25.9 kg/m2, with an average increase of 0.15 kg/m2 per civil year. Those patients notably have hypertension (33.2%), family history of coronary artery disease (14.5%), smoking (6.9%), diabetes (5.8%), obesity (5.8%) or Chagas Disease (3.0%). Seventy percent of ECGs are normal. This percentage is higher in women (72.3%) and decreases in average by 7.4 every 10 years of life. There are notably 12% of possible myocardial infarction, 10% of possible left ventricular hypertrophy and 8% of possible supraventricular extra systole.

Assuntos

Eletrocardiografia/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Cardiopatias/diagnóstico , Cardiopatias/epidemiologia , Atenção Primária à Saúde/estatística & dados numéricos , Consulta Remota/estatística & dados numéricos , Brasil/epidemiologia , Mineração de Dados/métodos , Mineração de Dados/estatística & dados numéricos , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco

RESUMO

OBJECTIVE: To describe mortality by suicide among physicians in the state of São Paulo, Brazil, between 2000 and 2009. METHODS: Secondary analysis of government mortality data. The variable of interest was "underlying cause of death", specifically deaths classified by the ICD-10 as intentional self-harm (X60 to X84). RESULTS: The analyses examined 2,297 declarations of death, among which suicide accounted for 50 cases, i.e., 1.7% of all causes of death. Women comprised 13.2% of the total sample and represented 24% of the death-by-suicide group, indicating an overrepresentation of women in the latter (p = 0.02). Deaths by suicide occurred on average 20 years earlier than deaths by other causes (46.8 ± 14.2 years and 68.1 ± 15.8 years, respectively; p = 0.001). There was a significant association between single and/or divorced status and suicide (p < 0.001). The average mortality rate during the study period was 4.2 deaths per 100,000 physicians registered with the Regional Board of Medicine of the State of São Paulo. CONCLUSION: Deaths by suicide occurred 20 years earlier than deaths by other causes. Medical institutions should develop strategies for the prevention and early detection of mental disorders and occupational stressors that elevate the risk of suicide among physicians.

Assuntos

Médicos/estatística & dados numéricos , Suicídio/estatística & dados numéricos , Idoso , Brasil/epidemiologia , Causas de Morte , Atestado de Óbito , Feminino , Humanos , Masculino , Estado Civil/estatística & dados numéricos , Pessoa de Meia-Idade , Médicos/psicologia , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Prevenção do Suicídio

RESUMO

AIMS: Although an increasing prevalence of atrial fibrillation (AF) has been reported worldwide, there are few studies from low- and middle-income countries. Our objective is to assess the prevalence of AF and the associated medical conditions in Brazilian primary care patients. METHODS AND RESULTS: This is an observational retrospective study. Patients ≥5 years of age from primary care centres of 658 municipalities in Minas Gerais, Brazil, who performed digital electrocardiograms (ECGs) by a public telehealth service in 2011 were assessed. Clinical data were self-reported, and ECGs were interpreted by a team of trained cardiologists using standardized criteria. To assess the relation between clinical characteristics and AF, odds ratios were estimated by logistic regression. A total of 262 685 primary care patients were included, mean (SD) age of 50.3 (19.3) years, 59.6% female. Hypertension was reported in 32.0%, family history of coronary heart disease in 15.0%, diabetes in 5.4%, hyperlipidaemia in 2.8%, Chagas disease in 2.9%, and 7.1% reported current smoking. The prevalence of AF was 1.8% overall: 2.4% in men (ranging from 0.001% from 5-19 years old to 14.6% in nonagenarians) and 1.3% in women (ranging from 0.001% from 5-19 years old to 8.7% in nonagenarians) (P < 0.001). The prevalence of AF increased with advancing age. The comorbidities associated with AF were Chagas disease, previous myocardial infarction, hypertension, and chronic obstructive pulmonary disease. Vitamin K antagonist use was reported by 1.5% of patients. CONCLUSION: The prevalence and age distribution of AF were similar to studies in high-income countries. The proportion of patients who reported the use of anticoagulants was alarmingly low. Our findings point out the necessity to formulate effective treatment strategies for AF in Brazilian primary care settings.

Assuntos

Fibrilação Atrial/epidemiologia , Atenção Primária à Saúde , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Brasil/epidemiologia , Criança , Pré-Escolar , Comorbidade , Bases de Dados Factuais , Eletrocardiografia , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Valor Preditivo dos Testes , Prevalência , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Fumar/efeitos adversos , Fumar/epidemiologia , Telemedicina , Fatores de Tempo , Adulto Jovem

RESUMO

A Implantodontia caracterizou-se como um dos grandes avan‡os dentro da Odontologia moderna. Nas £ltimas d‚cadas, as inova‡ães e desenvolvimento dos implantes dent rios tˆm sido crescentes, e na necessidade de acompanhar tais evolu‡ães, as t‚cnicas no campo das pr¢teses e reabilita‡ães tamb‚m tiveram de se reinventar. Atualmente, um dos grandes trunfos do uso dos implantes dent rios ‚ associ -los a uma restaura‡Æo imediatamente ap¢s sua implanta‡Æo, com ganhos funcionais e, especialmente, est‚ticos. A previsibilidade do tratamento ‚ indispens vel no sucesso do mesmo. Assim, ‚ poss¡vel prever o posicionamento mais ideal para a restaura‡Æo imediata. Al‚m disso, configura-se como indispens vel a rapidez do procedimento, uma vez que quanto menos exposto ficar o campo cir£rgico, melhor ser  o comportamento p¢s-operat¢rio da regiÆo reabilitada. Portanto, no intuito de se conciliar fidelidade de posicionamento da restaura‡Æo imediata com rapidez e otimiza‡Æo do tempo transoperat¢rio, este artigo e seus autores se propãem a compartilhar uma t‚cnica desenvolvida para viabiliza‡Æo de tal procedimento de forma r pida e previs¡vel (T‚cnica da muralha e faceta adaptada - Palhares e Toniollo).

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Implantology is one of the great advances in modern Dentistry. In recent decades innovations and development of dental implants are occurring continuously thereby techniques and rehabilitation also had to be reinvented. Currently, one of the great advantages of the use of dental implants is the possibility of associating them to a restoration immediately after their deployment, with functional and especially aesthetic gains. Predictability is essential to the success of the treatment. Thus, it is possible to predict the most optimal placement for the immediate restoration. Accelerating the procedure also seems to be fundamental since the less exposed the surgical field, the better the postoperative behavior of the rehabilitated area. Therefore, in order to reconcile fidelity and fast positioning of the immediate restoration to optimize time, this article and its authors intended to share a technique developed for the feasibility of this procedure in a quick and way (Technique of the wall and adapted veneer - Palhares and Toniollo).

Assuntos

Humanos , Masculino , Adulto , Estética Dentária , Implantação Dentária , Planejamento de Dentadura , Restauração Dentária Temporária , Silicones , Tomografia Computadorizada por Raios X/instrumentação

RESUMO

OBJECTIVE: Knowing the proportion the proportion of normal and abnormal electrocardiograms (ECGs) in primary care patients allows us to estimate the proportion of exams that can be analyzed by the general practitioner with minimal training in ECG interpretation, in addition to being epidemiologically relevant. The objective of this study is to assess the prevalence of normal ECGs in primary care patients. METHODS: All digital ECGs analyzed by the cardiologists of Telehealth Network of Minas Gerais (TNMG) in 2011 were evaluated. TNMG is a public telehealth service that provides support to primary care professionals in 662 municipalities in the state of Minas Gerais, Brazil. RESULTS: During the study period, 290,795 ECGs were analyzed (mean age 51 ± 19 years), 57.6% were normal. This proportion was higher in women (60.1 vs 57.6%, p <0.001) and lower in patients with hypertension (45.8% vs 63.2%, p <0.001) or diabetes (43.3% vs 63.2%, p <0.001). A progressive reduction in the prevalence of normal ECG with increasing age was observed. Among the ECGs of patients under investigation for chest pain, 58.7% showed no abnormalities. CONCLUSION: The prevalence of normal ECGs in primary care patients is higher than 50% and this proportion decreases with age and comorbidities. Most ECGs performed for investigation of chest pain in primary care shows no abnormality.

Assuntos

Dor no Peito/epidemiologia , Eletrocardiografia/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Dor no Peito/diagnóstico , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Telemedicina/estatística & dados numéricos

RESUMO

Objective: Knowing the proportion the proportion of normal and abnormal electrocardiograms (ECGs) in primary care patients allows us to estimate the proportion of exams that can be analyzed by the general practitioner with minimal training in ECG interpretation, in addition to being epidemiologically relevant. The objective of this study is to assess the prevalence of normal ECGs in primary care patients. Methods: all digital ECGs analyzed by the cardiologists of Telehealth Network of Minas Gerais (TNMG) in 2011 were evaluated. TNMG is a public telehealth service that provides support to primary care professionals in 662 municipalities in the state of Minas Gerais, Brazil. Results: during the study period, 290,795 ECGs were analyzed (mean age 51 ± 19 years), 57.6% were normal. This proportion was higher in women (60.1 vs 57.6%, p <0.001) and lower in patients with hypertension (45.8% vs 63.2%, p <0.001) or diabetes (43.3% vs 63.2%, p <0.001). A progressive reduction in the prevalence of normal ECG with increasing age was observed. Among the ECGs of patients under investigation for chest pain, 58.7% showed no abnormalities. Conclusion: the prevalence of normal ECGs in primary care patients is higher than 50% and this proportion decreases with age and comorbidities. Most ECGs performed for investigation of chest pain in primary care shows no abnormality. .

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Objetivo: o conhecimento da proporção de eletrocardiogramas (ECG) normais e alterados em pacientes atendidos na atenção primária permite estimar a proporção de exames que pode ser analisada pelo médico generalista com formação mínima na interpretação do ECG, além de ter relevância epidemiológica. O objetivo deste estudo é avaliar a prevalência de ECG sem alterações em pacientes atendidos na Atenção Primária. Métodos: todos os ECG digitais analisados pelos cardiologistas da Rede de Teleassistência de Minas Gerais (RTMG) no ano de 2011 foram avaliados. A RTMG é um serviço público de telessaúde, que atende a atenção primária em 662 municípios em Minas Gerais, Brasil. Resultados: no período do estudo, 290.795 ECG foram analisados (idade média 51±19 anos) e 57,6% deles eram normais. Essa proporção foi maior em mulheres (60,1 vs. 57,6%, p < 0,001) e menor em pacientes com hipertensão (45,8% vs. 63,2%, p < 0,001) ou diabetes (43,3% vs. 63,2%, p < 0,001). Foi observada redução progressiva na prevalência de ECG normal com o aumento da idade. Entre os ECG de pacientes em investigação para dor torácica, 58,7% não apresentaram alterações. Conclusão: a prevalência de ECG normais em pacientes da atenção primária é superior a 50% e essa proporção diminui com a idade e a presença de comorbidades. A maioria dos ECG realizados para investigação de dor torácica na atenção primária não tem alterações. .

Assuntos

Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor no Peito/epidemiologia , Eletrocardiografia/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Distribuição por Idade , Brasil/epidemiologia , Dor no Peito/diagnóstico , Comorbidade , Eletrocardiografia , Prevalência , Estudos Retrospectivos , Telemedicina/estatística & dados numéricos

RESUMO

pós o advento e sucesso comprovado da ósseointegração, a Implantodontia teve sua ascensão de forma rápida, previsível, consolidada e resolutiva. Para o efetivo e correto funcionamento do tratamento reabilitador utilizando os implantes dentários é necessário que se respeite os diversos fatores que permeiam seu comportamento biomecânico, mas também que se preze pelos fatores diretamente atrelados ao sucesso esperado pelo paciente que, muitas vezes, é relacionado à chamada “estética vermelha”, a qual tem extrema responsabilidade no resultado final do tratamento. Para isso, não só a fim de obter contorno, suporte e harmonia do tecido mole marginal à prótese sobre implante, mas também visando a manutenção e respeito a essa estrutura tão nobre, faz-se conveniente a moldagem personalizada do perfil de emergência da referida região, principalmente em casos unitários, a fim de preservar toda a estrutura conseguida por meio do uso dos provisórios. Este artigo traz um relato de caso clínico em que tal procedimento de extrema valia é descrito detalhadamente no intuito de ser reproduzível por outros profissionais da área na intenção de se obter máximo resultado estético, respeitando-se as estruturas nobres circunjacentes ao implante e respectiva reabilitação.

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After the advent and proven success of osseointegration, Implantology raised quickly, predictably, in a consolidated and resolute way. For effective and proper effect of rehabilitation treatment with dental implants it is necessary to respect the various factors involved in its biomechanical behavior, but also by respect the expectation of the patient regarding the success of the treatment. This is often related to the call “red aesthetic” that has an important role on the treatment outcome. Therefore besides obtaining contour, support, and harmony of the peri-implant soft tissue, in order to maintain and respect this noble structure, it is recommended to make a customized molding of the emergency profile of that region, especially in single cases, preserving the whole structure obtained through the use of provisional prosthesis. This article presents a case report in which this procedure is described in details so that other professionals may reproduce it in an attempt to obtain maximum aesthetic result respecting the noble structures surrounding the implant and their rehabilitation

Assuntos

Adulto , Materiais para Moldagem Odontológica , Estética Dentária , /métodos , Peri-Implantite/diagnóstico , Peri-Implantite , Prótese Dentária Fixada por Implante/métodos

Assuntos

Dermatologia/métodos , Atenção Primária à Saúde/organização & administração , Consulta Remota/métodos , Serviços de Saúde Rural/organização & administração , Dermatopatias/diagnóstico , Atitude do Pessoal de Saúde , Brasil , Comportamento do Consumidor , Dermatologia/estatística & dados numéricos , Humanos , Consulta Remota/normas , Consulta Remota/estatística & dados numéricos , Estudos Retrospectivos

RESUMO

O protocolo proposto por Branemark em 19854 era composto por duas fases cirúrgicas, com tempos de espera para mandíbula de 3 a 4 meses, e para maxila de 4 a 6 meses, e após esse período era iniciada a instalação das próteses. Ao longo dos anos houve o aumento da utilização de carga imediata em implantes osseointegráveis na região anterior da mandíbula sendo efetuada com sucesso, analisando-se cuidadosamente e individualmente cada caso, respeitando suas particularidades anatômicas, histológicas e fisiológicas. A realização do protocolo com carga imediata funcional demonstrou-se com bom resultado clinico e alto grau de satisfação do paciente, destacando-se ainda a redução de custos e a diminuição do tempo do tratamento como benefícios comprovados, contribuindo ainda mais com a função e estética restabelecida de modo satisfatório. No entanto, para tal, a sincronia entre cirurgião-dentista e protético deve estar aguçada a fim de que se possam realizar todos os procedimentos necessários em até 48 horas de serviço. O presente artigo tem o intuito de esclarecer todos os procedimentos técnicos clínicos e, principalmente, laboratoriais, para que os profissionais da área entendam quais os procedimentos envolvidos no processo e quão sensíveis eles são

Assuntos

Humanos , Feminino , Adulto , Protocolos Clínicos , Implantação Dentária , Técnicos em Prótese Dentária , Carga Imediata em Implante Dentário , Prótese Mandibular , Próteses e Implantes

RESUMO

INTRODUCTION: Endoscopic submucosal dissection (ESD) of early neoplasias of the gastrointestinal tract (GIT) has been increasingly applied as an alternative to invasive surgical procedures, with the aim to preserve the patient's organ and quality of life, although it does not allow the histopathological analysis of lymph nodes. Previous studies demonstrated that the presence of neoplastic emboli in lymphatic (lymphatic vascular invasion [LVI]) or blood vessels (blood vascular invasion [BVI]) is considered a positive predictive factor for the occurrence of lymph node metastasis. The assessment of vascular invasion carried out only by routine hematoxylin and eosin staining (HE) may yield both falsepositive and false-negative results. D2-40 is a specific monoclonal antibody to the lymphatic endothelium. Thus, it is useful for identifying LVI and distinguishing if tumor embolization is found in blood or lymphatic vessels. OBJECTIVE: To determine the role of immunohistochemistry (IHC) in the assessment of ESD specimens by comparing the detection of LVI and BVI by HE and IHC with D2-40 and CD34 immunolabeling. METHOD: We conducted the IHC study using D2-40 and CD34 markers (pan-endothelial) in 30 cases of ESD with histological diagnosis of carcinoma in order to assess the presence of LVI and BVI. RESULTS: The detection of LVI was more prevalent than BVI. Three out of six cases with LVI were false-positive by HE and six were false-negative by IHC. Regarding BVI, five cases were identified and one was false-negative by IHC. CONCLUSION: Our results indicated that the histopathological analysis of ESD specimens by exclusively routine HE staining does not allow proper evaluation of BVI or LVI.

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INTRODUÇÃO: A dissecção endoscópica da submucosa (DES) de neoplasias precoces do trato gastrointestinal (TGI) tem sido cada vez mais aplicada como alternativa aos procedimentos cirúrgicos invasivos, visando a preservar o órgão e a qualidade de vida do paciente, contudo, não possibilita a avaliação histopatológica de linfonodos. Estudos anteriores demonstraram que a presença de êmbolos neoplásicos, em vasos linfáticos (invasão vascular linfática [IVL]) ou sanguíneos (invasão vascular sanguínea [IVS]), é considerada um fator preditivo positivo para ocorrência de metástase linfonodal. A avaliação da invasão vascular realizada apenas pela coloração de rotina hematoxilina e eosina (HE) pode gerar resultados falso-positivos e falso-negativos. O D2-40 é um anticorpo monoclonal específico para endotélio linfático, sendo, portanto, útil para identificar IVL e distinguir se a embolização tumoral encontra-se em vasos sanguíneos ou linfáticos. OBJETIVO: Determinar o papel do estudo imuno-histoquímico (IHQ) na avaliação de espécimes de DES, comparando a detecção de IVL e IVS, pelo HE e IHQ com marcação por D2-40 e CD34. MÉTODO: Foi realizado estudo IHQ utilizando os marcadores D2-40 e CD34 (pan-endotelial) em 30 casos de produtos de DES com diagnóstico histológico de carcinoma para avaliar a presença de IVL e IVS. RESULTADOS: A detecção de IVL foi maior que a de IVS. Dos seis casos com IVL ao HE, três eram falso-positivos e seis, falso-negativos à IHQ. Em relação à IVS, foram identificados cinco casos falsopositivos e um falso-negativo à IHQ. CONCLUSÃO: Nossos resultados indicaram que a análise histopatológica dos produtos de DES realizando apenas a coloração HE não permite a avaliação adequada da presença de IVS ou IVL.