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The aim of this report is to describe a presumptive diagnosis of spina bifida in a mixed breed dog, due to previous diagnostic inconsistencies. Spina bifida is an uncommon congenital anomaly characterized by poor bone formation due to incomplete closure orthe absence of the dorsal arch of the vertebral structure during the process of embryogenesis. Animals with this condition may have difficulties in the locomotion process, which constantly threatens the quality and survival of those affected. Spina bifidacan present itself in four different forms and degrees. A 5-month-old mixed breed dog was assisted at a veterinary clinic in Conselheiro Lafaiete/MG with difficulties in the locomotion process and previous diagnostic inconsistencies in other veterinary services. On physical examination, he had kyphosis in the thoracic region and decreased proprioceptive capacity in the hind limbs. After radiographs were taken, morphological thoracic alterations were observed in the segment between the T5 to T9 vertebrae, with duplicated spinous processes and a decrease in the dimensions of the intervertebral space. The radiographic examination suggested presumptive evidence of thoracic spina bifida due to the unavailability of the tutor to perform more sensitive exams such as tomography and magnetic resonance. Therefore, drugs for pain and neuropathic control such as gabapentin and pregabalin were prescribed, at different times, until new recommendations, which have shown therapeutic efficacy to the patient. Currently, the patient uses a wheelchair adapted for locomotion due to the loss of movement of the hind limbs, in addition to weekly physical therapy follow-up and acupuncture sessions.(AU)

O objetivo do presente relato é descrever um diagnóstico presuntivo de espinha bífida em um cão sem raça definida, mediante inconsistências diagnósticas prévias. A espinha bífida é uma anomalia congênita incomum, caracterizada pela má formação óssea mediante o fechamento incompleto ou a inexistência do arco dorsal da estrutura vertebral durante o processo de embriogênese. Os animais portadores dessa condição podem apresentar principalmentedificuldades no processo de locomoção, o que ameaça constantemente a qualidade e a sobrevida dos afetados. A espinha bífida pode se apresentar de quatro diferentes formas e em graus variados. Um cão sem raça definida de 5 meses foi atendido em uma clínicaveterinária em Conselheiro Lafaeite/MG com dificuldades no processo de locomoção e inconsistências diagnósticas prévias em outros serviços veterinários. No exame físico, ele apresentava cifose em região torácica e diminuição da capacidade proprioceptiva nos membros posteriores. Após a realização de radiografias, foram observadas alterações morfológicas torácicas no segmento entre as vértebras T5 a T9, com processos espinhosos duplicados e decréscimo nas dimensões do espaço intervertebral. O exame radiográfico sugeriu evidências presuntivas de espinha bífida torácica, em virtude da indisponibilidade financeira da tutora para a realização de exames mais sensíveis como tomografia e ressonância. Diante dos sinais clínicos e exames apresentados, prescreveu-se fármacos para controle álgico e neuropático como gabapentina e pregabalina, em momentos distintos, até novas recomendações, sendo que estes demonstraram eficácia terapêutica ao paciente. Atualmente, o paciente faz uso de cadeirinha adaptada para locomoção devido à perda da movimentação dos membros posteriores, além do acompanhamento fisioterápico semanal e sessões de acupuntura.(AU)

El objetivo de este informe es describir un diagnóstico presuntivo de espina bífida en un perro sin raza definida, debido a inconsistencias diagnósticas previas. La espina bífida es una anomalía congénita poco frecuente caracterizada por una mala formación ósea debido a un cierre incompleto o la ausencia del arco dorsal de la estructura vertebral durante el proceso de embriogénesis. Los animales con esta condición pueden tener dificultades en el proceso de locomoción, lo que amenaza constantemente la calidad y supervivencia de los afectados. La espina bífida puede presentarse en cuatro formas diferentes y en diversos grados. Un perro mestizo de 5 meses de edad fue atendido en una clínica veterinaria en Conselheiro Lafaiete/MG con dificultades en el proceso de locomoción e inconsistencias diagnósticas previas en otros servicios veterinarios. Al examen físico presentaba cifosis en región torácica y disminución de la capacidad propioceptiva en miembros posteriores. Después de la toma de radiografías, se observaron alteraciones morfológicas torácicas en el segmento entre las vértebras T5 a T9, con procesos espinosos duplicados y disminución de las dimensiones del espacio intervertebral. El examen radiográfico sugirió evidencia presuntiva de espina bífida torácica debido a la falta de disponibilidad del tutor para realizar exámenes más sensibles como tomografía y resonancia magnética. Por ello, fármacos para el control del dolor y neuropático como la gabapentina y la pregabalina fueron prescritos, en diferentes momentos, hasta nuevas recomendaciones, que han demostrado eficacia terapéutica al paciente. Actualmente el paciente utiliza una silla de ruedas adaptada para la locomoción debido a la pérdida de movimiento de los miembros posteriores, además de seguimiento semanal de fisioterapia y sesiones de acupuntura.(AU)

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RESUMO: A partir da constatação de contradições cotidianas e de sua recepção na lógica clássica, onde não são admitidas, este trabalho teórico interroga, junto a outros campos, fenômenos linguageiros considerados indesejáveis e, consequentemente, descartáveis em descrições e análises. A discussão reconhece na Lógica paraconsistente avanços importantes para a abordagem das contradições em sistemas lógicos. Na Clínica de Linguagem, tropeços e embaraços são tratados como dados de subjetividade relevantes para elaborações teórico-clínicas; ali encontramos contribuições para discutir a contradição na Psicanálise. Resta dizer que o interesse pela questão decorre da afirmação de Freud de que a vida psíquica é composta de contradições.

ABSTRACT: Based on the observation of everyday contradictions and their reception in classical logic, where they are not admitted, this theoretical work interrogates, together with other fields, linguistic phenomena considered undesirable and disposable in descriptions and analyses. The discussion recognizes in Paraconsistent Logic important advances for the approach of contradictions in logical systems. At the Language Clinic, stumbling blocks and embarrassments are treated as relevant subjectivity data for theoretical-clinical elaborations; there we find contributions to discuss the contradiction in Psychoanalysis. It remains to be said that the interest in the question stems from Freud's assertion that psychic life is made up of contradictions.

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(1) Background: The dynamics of hand tremors involve nonrandom and short-term motor patterns (STMPs). This study aimed to (i) identify STMPs in Parkinson's disease (PD) and physiological resting tremor and (ii) characterize STMPs by amplitude, persistence, and regularity. (2) Methods: This study included healthy (N = 12, 60.1 ± 5.9 years old) and PD (N = 14, 65 ± 11.54 years old) participants. The signals were collected using a triaxial gyroscope on the dorsal side of the hand during a resting condition. Data were preprocessed and seven features were extracted from each 1 s window with 50% overlap. The STMPs were identified using the clustering technique k-means applied to the data in the two-dimensional space given by t-Distributed Stochastic Neighbor Embedding (t-SNE). The frequency, transition probability, and duration of the STMPs for each group were assessed. All STMP features were averaged across groups. (3) Results: Three STMPs were identified in tremor signals (p < 0.05). STMP 1 was prevalent in the healthy control (HC) subjects, STMP 2 in both groups, and STMP3 in PD. Only the coefficient of variation and complexity differed significantly between groups. (4) Conclusion: These results can help professionals characterize and evaluate tremor severity and treatment efficacy.

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Esophageal stenosis is a morphofunctional alteration that causes inflammatory lesion in the submucosal and muscular layers of the esophagus, inducing them to fibrosis and altering the esophageal diameter. The present report addresses the use of a balloon dilator as an auxiliary way to correct esophageal stenosis in a canine, female, Pug patient, with a history of recurrent vomiting as the main complaint. Through endoscopy, it was observed that the thoracic esophagus was inflamed, with thickened and fibrotic mucosa, in addition to whitish colored fibrous rings, which hindered the passage of the probe, enabling the determination of the diagnosis of esophageal stenosis. In this report, we opted for the use of a dilator balloon, with three procedures being performed one week apart, to improve the symptomatic condition. After the dilator procedure, the favorable development of the clinical condition presented by the patient was possible.

A estenose esofágica é uma alteração morfofuncional que ocasiona em lesão inflamatória das camadas submucosa e muscular do esôfago, induzindo-as a fibrose e que altera o diâmetro esofágico. O presente relato aborda a utilização de balão dilatador, como forma auxiliar de correção de estenose esofágica em paciente canino, fêmea, da raça Pug, apresentando histórico de vômitos recorrentes como queixa principal. Por meio da endoscopia, observou-se que o esôfago torácico estava inflamado, com a mucosa espessada e fibrótica, além de anéis fibrosos de coloração esbranquiçada, o que dificultava a passagem da sonda, possibilitando a determinação do diagnóstico de estenose esofágica. Nesse relato, optou-se pelo uso do balão dilatador, sendo feitos três procedimentos intervalados de uma semana entre eles, para a melhora da condição sintomática. Após o procedimento dilatador, foi possível o desenvolvimento favorável do quadro clínico apresentado pela paciente.

La estenosis esofágica es una alteración morfofuncional que provoca una lesión inflamatoria en las capas submucosas y musculares del esófago, induciéndolas a la fibrosis y alterando el diámetro esofágico. El presente informe aborda el uso de un dilatador de balón como vía auxiliar para corregir la estenosis esofágica en un paciente canino, hembra, Pug, con antecedentes de vómitos recurrentes como principal síntoma. Mediante endoscopia se observó que el esófago torácico estaba inflamado, con mucosa engrosada y fibrótica, además de anillos fibrosos de color blanquecino, lo que dificultaba el paso de la sonda, lo que permitía determinar el diagnóstico de estenosis esofágica. En este informe se optó por el uso de balón dilatador, realizándose tres procedimientos con una semana de diferencia, para mejorar la condición sintomática. Tras el procedimiento dilatador, fue posible el desarrollo favorable del cuadro clínico presentado por el paciente.

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La estenosis esofágica es una alteración morfofuncional que provoca una lesión inflamatoria en las capas submucosas y musculares del esófago, induciéndolas a la fibrosis y alterando el diámetro esofágico. El presente informe aborda el uso de un dilatador de balón como vía auxiliar para corregir la estenosis esofágica en un paciente canino, hembra, Pug, con antecedentes de vómitos recurrentes como principal síntoma. Mediante endoscopia se observó que el esófago torácico estaba inflamado, con mucosa engrosada y fibrótica, además de anillos fibrosos de color blanquecino, lo que dificultaba el paso de la sonda, lo que permitía determinar el diagnóstico de estenosis esofágica. En este informe se optó por el uso de balón dilatador, realizándose tres procedimientos con una semana de diferencia, para mejorar la condición sintomática. Tras el procedimiento dilatador, fue posible el desarrollo favorable del cuadro clínico presentado por el paciente.

Esophageal stenosis is a morphofunctional alteration that causes inflammatory lesion in the submucosal and muscular layers of the esophagus, inducing them to fibrosis and altering the esophageal diameter. The present report addresses the use of a balloon dilator as an auxiliary way to correct esophageal stenosis in a canine, female, Pug patient, with a history of recurrent vomiting as the main complaint. Through endoscopy, it was observed that the thoracic esophagus was inflamed, with thickened and fibrotic mucosa, in addition to whitish colored fibrous rings, which hindered the passage of the probe, enabling the determination of the diagnosis of esophageal stenosis. In this report, we opted for the use of a dilator balloon, with three procedures being performed one week apart, to improve the symptomatic condition. After the dilator procedure, the favorable development of the clinical condition presented by the patient was possible.

A estenose esofágica é uma alteração morfofuncional que ocasiona em lesão inflamatória das camadas submucosa e muscular do esôfago, induzindo-as a fibrose e que altera o diâmetro esofágico. O presente relato aborda a utilização de balão dilatador, como forma auxiliar de correção de estenose esofágica em paciente canino, fêmea, da raça Pug, apresentando histórico de vômitos recorrentes como queixa principal. Por meio da endoscopia, observou-se que o esôfago torácico estava inflamado, com a mucosa espessada e fibrótica, além de anéis fibrosos de coloração esbranquiçada, o que dificultava a passagem da sonda, possibilitando a determinação do diagnóstico de estenose esofágica. Nesse relato, optou-se pelo uso do balão dilatador, sendo feitos três procedimentos intervalados de uma semana entre eles, para a melhora da condição sintomática. Após o procedimento dilatador, foi possível o desenvolvimento favorável do quadro clínico apresentado pela paciente.

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OBJECTIVE: To evaluate the epidemiological and clinical characteristics of knee injuries in Brazilian Jiu-Jitsu (BJJ) practitioners. METHODS: Cross-sectional study, using a mixed questionnaire, based on the Referred Morbidity Index. RESULTS: 198 amateur and professional BJJ fighters, of both sexes, aged between 18 and 60 years, participated in the study. The majority (88%) of the fighters had only one knee injury (p < 0.001). In total, 29.8% proportion of knee injuries (p < 0.001) was identified, which were mainly from the medial collateral ligament (38%), caused by a sprain mechanism (86%) and conservative treatment (65%). CONCLUSION: A high prevalence of knee injuries in JJB fighters was found, compared to other sports that also perform rotational movements and have great body contact, such as mixed martial arts (MMA), judo, soccer, basketball and handball. Some JJB strikes, such as the key and the projection, can cause greater knee joint stress, both in the attacking fighter and in the opponent. The knowledge of the epidemiological characteristics of sports injuries is important in the elaboration of prevention and training protocols more specific to the sport and for the understanding of the complex mechanisms involved with this outcome in sport. Level of Evidence IV, Case Series.

OBJETIVO: Avaliar as características epidemiológicas e clínicas das lesões no joelho de praticantes de jiu-jitsu brasileiro (JJB). MÉTODOS: Estudo de desenho transversal, por meio de questionário do tipo misto, baseado no Índice de Morbidade Referida. RESULTADOS: Participaram 198 lutadores amadores e profissionais de JJB, de ambos os sexos, com idades entre 18 e 60 anos. A grande maioria (88%) dos lutadores apresentou apenas uma lesão no joelho (p < 0,001). Observou-se proporção de 29,8% de lesões no joelho (p < 0,001), que foram principalmente do ligamento colateral medial (38%), causadas por mecanismo de entorse (86%) e de tratamento conservador (65%). CONCLUSÕES: Observou-se alta prevalência de lesões no joelho em lutadores de JJB, comparativamente a outros esportes que também realizam movimentos rotacionais e têm grande contato corporal, como as artes marciais mistas (MMA), o judô, o futebol, o basquetebol e o handebol. Alguns golpes do JJB, como a chave e a projeção, podem causar maior estresse articular no joelho, tanto no lutador que ataca quanto no oponente. O conhecimento das características epidemiológicas das lesões esportivas é importante na elaboração de protocolos de prevenção e treinamento mais específicos à modalidade e também para a compreensão dos mecanismos complexos envolvidos com esse desfecho no esporte. Nível de Evidência IV, Série de Casos.

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ABSTRACT Objective: To evaluate the epidemiological and clinical characteristics of knee injuries in Brazilian Jiu-Jitsu (BJJ) practitioners. Methods: Cross-sectional study, using a mixed questionnaire, based on the Referred Morbidity Index. Results: 198 amateur and professional BJJ fighters, of both sexes, aged between 18 and 60 years, participated in the study. The majority (88%) of the fighters had only one knee injury (p < 0.001). In total, 29.8% proportion of knee injuries (p < 0.001) was identified, which were mainly from the medial collateral ligament (38%), caused by a sprain mechanism (86%) and conservative treatment (65%). Conclusion: A high prevalence of knee injuries in JJB fighters was found, compared to other sports that also perform rotational movements and have great body contact, such as mixed martial arts (MMA), judo, soccer, basketball and handball. Some JJB strikes, such as the key and the projection, can cause greater knee joint stress, both in the attacking fighter and in the opponent. The knowledge of the epidemiological characteristics of sports injuries is important in the elaboration of prevention and training protocols more specific to the sport and for the understanding of the complex mechanisms involved with this outcome in sport. Level of Evidence IV, Case Series.

RESUMO Objetivo: Avaliar as características epidemiológicas e clínicas das lesões no joelho de praticantes de jiu-jitsu brasileiro (JJB). Métodos: Estudo de desenho transversal, por meio de questionário do tipo misto, baseado no Índice de Morbidade Referida. Resultados: Participaram 198 lutadores amadores e profissionais de JJB, de ambos os sexos, com idades entre 18 e 60 anos. A grande maioria (88%) dos lutadores apresentou apenas uma lesão no joelho (p < 0,001). Observou-se proporção de 29,8% de lesões no joelho (p < 0,001), que foram principalmente do ligamento colateral medial (38%), causadas por mecanismo de entorse (86%) e de tratamento conservador (65%). Conclusões: Observou-se alta prevalência de lesões no joelho em lutadores de JJB, comparativamente a outros esportes que também realizam movimentos rotacionais e têm grande contato corporal, como as artes marciais mistas (MMA), o judô, o futebol, o basquetebol e o handebol. Alguns golpes do JJB, como a chave e a projeção, podem causar maior estresse articular no joelho, tanto no lutador que ataca quanto no oponente. O conhecimento das características epidemiológicas das lesões esportivas é importante na elaboração de protocolos de prevenção e treinamento mais específicos à modalidade e também para a compreensão dos mecanismos complexos envolvidos com esse desfecho no esporte. Nível de Evidência IV, Série de Casos.

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PURPOSE: To evaluate the prevalence and characteristics of orthopedic injuries associated with the technical-tactical profiles of Brazilian Jiu-Jitsu (BJJ) fighters, according to the fighters' graduation level (beginner and advanced). PATIENTS AND METHODS: Cross-sectional study, which included the participation of amateur and professional BJJ athletes, aged between 18 and 60 years and practitioners of the sport for at least six months. All answered a mixed self-reported morbidity questionnaire. Participants were divided into four groups, according to the technical-tactical profile in the fight (keeper and passer) and the fighter's graduation level (beginner and advanced), and also into four subgroups, divided by joining the groups in pairs above. Descriptive and analytical statistical procedures were used, with a level of statistical significance set at 5% (p < 0.05). RESULTS: A total of 198 participants were included in the study. There was a higher prevalence of musculoskeletal injuries in advanced fighters (p<0.001), with no significant difference between the profiles of guard and passer fighters. Sprains were the most common type of injury in all studied groups and subgroups. The anatomical segments knee and shoulder, respectively, were the most affected in all groups, and both segments showed significant associations of the athletes in the advanced and guard groups. CONCLUSION: The study showed important data for creation of specifics injury prevention protocols, through the higher prevalence of injuries in athletes of the advanced profile and in the segments of the knee and shoulder, with emphasis on the guard fighters.

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Aspiração traqueal é utilizada rotineiramente após cirurgia cardíaca para garantir adequada ventilação. OBJETIVO: Verificar se a ausência da aspiração traqueal antes da extubação em pacientes sem sinais de secreção brônquica influencia na incidência de complicações pulmonares, além de repercussões hemodinâmicas e ventilatórias do procedimento e custos. MÉTODOS: Pacientes foram avaliados entre agosto/2012 e julho/2014, divididos igualmente em Grupo ASP (aspiração traqueal prévia à extubação) e NASP (sem aspiração prévia). Foram incluídos indivíduos com: primeira cirurgia cardíaca, idade entre 18 e 75 anos, IMC ≤ 30 kg/m² e sem doença pulmonar prévia. Foram excluídos indivíduos com tempo de CEC > 120 minutos, necessidade de assistência circulatória mecânica, relação PaO2/FiO2 < 200, SpO2 < 92%, tempo de intubação > 12 horas, PAM < 60 mmHg e sinais de secreção pulmonar. Variáveis hemodinâmicas, ventilatórias, complicações pulmonares e custos hospitalares foram avaliados. RESULTADOS: Foram analisados 228 pacientes (ASP= 114 NASP= 114). FC, PAS, PAD e PAM elevaram-se após aspiração e pós extubação nos grupos, retornando aos valores basais no decorrer do tempo. Não houve diferença estatística na FR e SpO2. Complicações pulmonares representaram 7,8%, sem diferença entre os grupos. CONCLUSÃO: A supressão da aspiração traqueal nos pacientes em pós-operatório imediato de cirurgia cardíaca não influenciou na incidência de complicações pulmonares e evolução clínica pós-operatória. Durante aspiração, houve alterações hemodinâmicas e respiratórias, sem repercussões clínicas, porém estas mesmas alterações ocorreram no grupo NASP após extubação, em menor intensidade. Aspiração endotraqueal sem indicação mostrou-se custosa e com desperdício de tempo dos profissionais.

Endotracheal suction is routinely used after cardiac surgery to ensure adequate ventilation. OBJECTIVE: To verify if that the absence of endotracheal suctioning before extubation in patients without signs of bronchial secretion have influence on the incidence of pulmonary complications, beyond hemodynamic and ventilatory repercussions of the procedure and costs. METHODS: Patients were evaluated between August/2012 and July/2014, divided equally into ASP Group (tracheal aspiration prior to extubation) and NASP (without prior aspiration). Individuals with: first cardiac surgery, age between 18 and 75 years, BMI ≤ 30 kg / m² and without previous lung disease were included. Individuals with ECC time > 120 minutes, need for mechanical circulatory assistance, PaO2 / FiO2 ratio <200, SpO2 <92%, intubation time> 12 hours, MBP <60 mmHg and signs of pulmonary secretion were excluded. Hemodynamic, ventilatory variables, pulmonary complications and hospital costs were assessed. RESULTS: 228 patients were analyzed (ASP = 114 NASP = 114). HR, SBP, DBP and MBP increased after aspiration and post extubation in the groups, returning to baseline values over time. There was no statistical difference in RR and SpO2. Pulmonary complications accounted for 7.8%, with no difference between groups. CONCLUSION: The suppression of tracheal suctioning in patients in the immediate postoperative period of cardiac surgery did not influence the incidence of pulmonary complications and postoperative clinical evolution. During aspiration, there were hemodynamic and respiratory changes, with no clinical repercussions, but these same changes occurred in the NASP group after extubation, to a lesser extent. Endotracheal suctioning

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Despite the availability of effective antimicrobials, tuberculosis (TB) is still a serious health threat. Mortality is even higher in people living with HIV who are diagnosed with TB. New therapies are needed to shorten the time required to cure TB and decrease fatality rates in this population. N-acetylcysteine (NAC) is a glutathione precursor and has shown recently in experimental setting to present in vitro and in vivo anti-mycobacterial activity. We test the hypothesis that NAC is safe, well tolerated and secondarily efficacious as adjunctive anti-TB therapy in hospitalized individuals with HIV-associated TB. Patients were enrolled sequentially in a tertiary care center, in the Brazilian Amazon. We performed a randomized, parallel group, single-center, open study trial of two arms, in hospitalized patients over 18 years of age, with microbiologically confirmed pulmonary TB in HIV: one with rifampicin, isoniazid, pyrazinamide and ethambutol at standard doses (Control Group), and a second in which NAC 600 mg bid for eight weeks was added (NAC Group). A total of 21 and 18 patients were enrolled to the Control Group and NAC Group, respectively. Adverse event rates were similar in the two arms. Our findings suggest that in the more critical population of hospitalized patients with HIV-associated TB, the use of NAC was not unsafe, despite the low sample size, and a potential impact on faster negative cultures needs to be further explored in larger studies.

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OBJECTIVES: to evaluate the attributes of primary health care, care coordination and longitudinality, from the perception of the professional and patients in the state of Amazonas, Brazil. METHODS: quantitative evaluative study, in which was used an external evaluation instrument with 469 professionals and 1,888 patients from 367 primary health care facilities that adhered to the Program for Improving Access and Quality of primary health care (Portuguese acronym: PMAQ) standardized by the Ministry of Health. Data were grouped by multivariate cluster analysis in order to find a classification of primary health care from the perspective of professionals and patients. RESULTS: the attributes of coordination and longitudinality are still expressed in a weak and undeveloped way in the Brazilian Amazon scenario. CONCLUSIONS: it is necessary to recognize the organizational barriers and what could promote conditions for the performance of health care teams in the perspective of a continuous, integral and coordinated care.

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ABSTRACT Objectives: to evaluate the attributes of primary health care, care coordination and longitudinality, from the perception of the professional and patients in the state of Amazonas, Brazil. Methods: quantitative evaluative study, in which was used an external evaluation instrument with 469 professionals and 1,888 patients from 367 primary health care facilities that adhered to the Program for Improving Access and Quality of primary health care (Portuguese acronym: PMAQ) standardized by the Ministry of Health. Data were grouped by multivariate cluster analysis in order to find a classification of primary health care from the perspective of professionals and patients. Results: the attributes of coordination and longitudinality are still expressed in a weak and undeveloped way in the Brazilian Amazon scenario. Conclusions: it is necessary to recognize the organizational barriers and what could promote conditions for the performance of health care teams in the perspective of a continuous, integral and coordinated care.

RESUMEN Objetivos: evaluar los atributos de atención primaria de salud, longitudinalidad y coordinación del cuidado, a partir de la percepción del profesional y los pacientes en el estado de Amazonas, Brasil. Métodos: investigación evaluativa cuantitativa en la que se utilizó un instrumento de evaluación externa con 469 profesionales y 1.888 pacientes de 367 centros de atención primaria de salud, que se adhirieron al Programa de Mejora del Acceso y Calidad de la atención primaria de salud estandarizado por el Ministerio de Salud de Brasil. Los datos se agruparon por análisis de grupos multivariados de cluster para encontrar una clasificación de la atención primaria de salud desde el punto de vista de profesionales y pacientes. Resultados: los atributos de coordinación y longitudinalidad todavía se expresan de manera débil y poco desarrollado en el escenario de la Amazonia brasileña. Conclusiones: es necesario reconocer las barreras organizativas y lo que puede promover las condiciones para que los equipos de atención primaria de salud actúen desde la perspectiva de una atención continua, integral y coordenada.

RESUMO Objetivos: avaliar os atributos da atenção básica, longitudinalidade e coordenação do cuidar, a partir da percepção do profissional e dos pacientes no estado do Amazonas, Brasil. Métodos: pesquisa avaliativa quantitativa em que foi utilizado um instrumento de avaliação externa com 469 profissionais e 1.888 pacientes de 367 unidades básicas de saúde, que aderiram ao Programa de Melhoria de Acesso e Qualidade da Atenção Primária à Saúde padronizados pelo Ministério da Saúde do Brasil. Os dados foram agrupados por análise multivariada de cluster para encontrar uma classificação da atenção primária à saúde sob o ponto de vista de profissionais e pacientes. Resultados: os atributos de coordenação e longitudinalidade ainda são expressos de forma fraca e pouco desenvolvida no cenário da Amazônia brasileira. Conclusões: é necessário reconhecer as barreiras organizacionais e o que pode promover condições para que as equipes de atenção primária à saúde atuem sob a perspectiva de um cuidado contínuo, integral e coordenado.

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Abstract Introduction The aim of this pilot study based on convenience sampling was to analyze the feasibility to quantitatively discriminate Trendelenburg sign (TS), a characteristic drop in pelvic position during gait in hip disfunctions, in patients with total hip arthroplasty (THA), by assessing gait variability and symmetry using inertial sensors. Methods Thirteen patients with right THA, divided into two groups with (GTS, n=4) and without TS (GnTS, n=9) assessed by experienced physician, were enrolled in the study. Harris Hip Score was applied for specific evaluation of THA. The protocol consisted in walking on a level treadmill during 3 minutes with two inertial sensors attached at anterior superior iliac spine of both sides. For each left and right step, features were extracted from the Y-axis gyroscope signals: peak value, mean absolute value, standard deviation and range. For each feature, a symmetry ratio was calculated as the ratio between left and right side. Results No significant differences were found in Harris Hip Score between groups. The variability assessed by standard deviation for left step, contralateral to the replaced side, was significantly larger for GTS group (p<0.001). Significant differences in the symmetry ratios were found between GTS and GnTS for all features extracted from gyroscopes Y-axis (W=144, p<0.001). The symmetry ratios for GnTS group were approximately equal one (except for range), whereas for the GTS group they exceed the 10% criterion. Conclusion The variability and symmetry ratios of gait features extracted from inertial sensors were successful to discriminate TS in THA patients.

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Parkinson's disease (PD) presents several motor signs, including tremor and bradykinesia. However, these signs can also be found in other motor disorders and in neurologically healthy older adults. The incidence of bradykinesia in PD is relatively high in all stages of the disorder, even when compared to tremor. Thus, this research proposes an objective assessment of bradykinesia in patients with PD (G PD: 15 older adults with Parkinson's disease, 65.3 ± 9.1 years) and older adults (G HV: 12 healthy older adults, 60.1 ± 6.1 years). The severity of bradykinesia in the participants of G PD was assessed using the Unified Parkinson's Disease Rating Scale. Movement and muscular activity were detected by means of inertial (accelerometer, gyroscope, magnetometer) and electromyographic sensors while the participants performed wrist extension against gravity with the forearm on pronation. Mean and standard error of inertial and electromyographic signal parameters could discriminate PD patients from healthy older adults (p value <0.05). In discriminating patients with PD from healthy older adults, the mean sensitivity and specificity were respectively 86.67 and 83.33%. The discrimination between the groups, based on the objective evaluation of bradykinesia, may contribute to the accurate diagnosis of PD and to the monitoring of therapies to control parkinsonian bradykinesia, and opens the possibility for further comparative studies considering individuals suffering from other motor disorders.

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RESUMO

Este artigo debate a questão do estatuto financeiro e social da profissão docente, com base em uma revisão bibliográfica sobre o tema e relacionada aos dados empíricos de um estudo comparativo qualitativo e quantitativo que analisou questionários e entrevistas feitos com professores do sexo masculino que trabalham no ensino público primário do Rio de Janeiro-Brasil (RJ-BR) e em Aveiro-Portugal (AV-PT). A discussão bibliográfica teve como objetivo verificar se a consideração dos professores envolvidos sobre a remuneração da profissão tem alguma fundamentação. Tal estudo é importante porque a questão da remuneração da profissão é um dos aspectos que pode influenciar a escolha profissional, a satisfação com a docência, mas também que pode gerar insatisfação com o ofício. Foram encontradas grandes diferenças entre as respostas dos professores tanto do RJ-BR e de AV-PT quanto dentro de cada localidade, o que mostra que os referenciais dos diferentes professores com relação ao salário do professor não são os mesmos.

This article discusses the financial and social status of teachers from a literature review on the topic and related to empirical data from a qualitative and quantitative comparative study that analyzed questionnaires and interviews carried out with male teachers working in public primary schools of Rio de Janeiro - Brasil (RJ-BR) and Aveiro - Portugal (AV-PT). The bibliographical review conducted aimed to examine whether the consideration of the involved teachers about their remuneration has some justification. This study is relevant as remuneration is one of the aspects that may influence the career choice and the satisfaction with the teaching profession, although it may also generate dissatisfaction. Great differences were found between the responses of male teachers from RJ-BR and AV-PT, as in each locality, which shows that salary referential of different teachers is not the same.