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Anterior knee instability associated with a varus deformity is a complex condition with several treatment possibilities. Among these, anterior cruciate ligament (ACL) associated to a simultaneous valgus tibial osteotomy is a increasing indication. This simultaneous procedure adds technical issues to those related to the isolated surgeries. Thus, the osteotomy plane and location of fixation hardware shouldn?t conflict with tibial tunnel and ACL graft fixation. Authors analyze the relations between a opening tibial valgus osteotomy stabilized with a Puddu plate and ACL reconstruction with a patellar tendon graft fixated with interference screws in 10 human cadaver knees. A straight oblique tibial osteotomy starting on the medial tibial cortex and oriented laterally and proximally was performed on all knees with a 10mm opening medially and stabilized with a Puddu plate on the most posterior aspect of the medial tibia, and a tibial tunnel drilled 50° to tibial plateau. With this technique there was no intersection between tibial tunnel or interference screw and the osteotomy or the plate fixation screws.

OBJETIVO: Conhecer a prevalência de cárie e necessidades de tratamento em escolares do interior do Estado de Goiás, Brasil. MÉTODOS: A amostra foi constituída de 1.419 escolares de 6 a 12 anos de idade, de ambos os sexos, que freqüentavam 25 escolas públicas na zona urbana de 9 municípios. RESULTADOS: A percentagem de escolares livres de cárie foi muito baixa em todas as idades, sendo 4,4% aos 12 anos. O índice CPO-D variou de 0,41 aos 6 anos a 5,19 aos 12 anos. O índice ceo-d nesta faixa etária variou de 4,93 a 0,29. As necessidades de tratamento superaram as necessidades atendidas, tanto na dentição decídua quanto na permanente. CONCLUSÃO: A alta prevalência de cárie em escolares do interior de Goiás sugere a necessidade de se implantar medidas educativas e preventivas em saúde bucal que intervenham nos reais determinantes da doença na população.

OBJETIVO: Investigou-se a prevalência de cárie e necessidades de tratamento em escolares de Goiânia-GO, Brasil, que possui água fluoretada há 9 anos. METODOLOGIA: A amostra foi constituída de 1.400 escolares de 6 a 12 anos de idade que freqüentavam escolas públicas na zona urbana do município estudado. RESULTADOS: Os índices CPO-D e ceo-d encontrados no total da amostra foram 2,19 e 2,86, respectivamente, demonstrando uma redução de 57,1% em relação ao CPO-D verificado na região Centro-Oeste, em 1986. Para os escolares de 12 anos de idade, o CPO-D encontrado foi 4,59, estando acima da meta estabelecida para o ano 2.000 pela FDI/OMS. Verificou-se que a percentagem de escolares livres de cárie foi muito baixa em todas as idades, apresentando-se em torno de 11% para o total da amostra. Houve predomínio do tratamento restaurador na dentição decídua em todas as idades e na permanente a partir dos 9 anos de idade. CONCLUSÃO: A prevalência de cárie em escolares de Goiânia-GO é alta e comparável à situação verificada na maioria dos países da América Latina e nas regiões menos favorecidas de países desenvolvidos. Há necessidade de se implantar medidas educativas e preventivas em saúde bucal que intervenham nos reais determinantes da doença na população.

Sickle cell disease is an inherited chronic haemolytic anaemia whose clinical manifestations arise from the tendency of the haemoglobin to polymerize and deform red blood cells into the characteristic sickle shape (HbS), with vaso-occlusive phenomena, pain and organ damage. Sickle cell anaemia, the prototype disease, is the homozygous state and represents the most severe form of sickle cell disease. A variety of other sickle cell syndromes are a result of an interaction between HbS and certain variant haemoglobins as HbC and thalassemia. We describe the case of a 28-year-old, black man, with recurrent episodes of musculoskeletal pain. Physical examination revealed spenomegaly. Laboratory tests showed haemolytic anemia and microcytosis. The peripheral blood smear revealed frequent target cells. The high performance liquid chromatography (HPLC) detected the absence of HbA, increased HbA2 and the presence of HbS and HbC, in equal amounts. In this case, we want to draw attention to less common and non-rheumatic causes of musculoskeletal pain as well as alert to the importance of early diagnosis of sickle cell disease that can minimize and prevent many of its complications.

Dural sinus thrombosis is a rare condition and is often underdiagnosed. Because of its potentially lethal complications, it should always be considered in acute headache differential diagnosis. The authors present a report of two cases, both diagnosed on our department. They make an approach to clinical presentation, diagnosis and treatment of this disease.

This paper investigates the levels of occupational stress and work engagement among military police officers. This cross-sectional, descriptive, and analytical study was conducted with 268 police officers from the 3rd Military Police Battalion of Paraná state. We observed significant levels of occupational stress in 125 (46.7%) police officers. The main stressors were lack of career growth prospects (3.7; ±1.3); inadequate training (3.4; ±1.2); discrimination/favoritism in the work environment (3.1; ±1.4); long working hours (3.0; ±1.4); distribution of tasks (2.7; ±1.1); control type (2.7; ±1.1); gaps in disclosing information about organizational decisions (2.7; ±1.2); low valuation (2.7; ±1.2). Levels of work engagement ranged from 3.8 [medium] to 4.1 [high]. The correlation between occupational stress and work engagement was low for the dimensions of Absorption (r: -.284; p<0.001) and Overall Score (r: -0.393; p<0.001) and moderate for the dimensions Vigor (r: -0.422; p<0.001) and Dedication (r: -0.414; p<0.001). We concluded that an important number of police officers had shown occupational stress. However, they displayed good levels of work engagement and are enthusiastic, inspired, and proud of their work.

Objective: Assess levels of career commitment and career entrenchment among Primary Health Care workers., Methods: This Cross-sectional study addressed 393 workers using the Brazilian versions of the Career Commitment Measure (CCM) and Career Entrenchment Measure (CEM)., Results: Levels of Career commitment [75.5-77.5] were higher (p<0.001) than Career Entrenchment [66.7-69.2]. Identity levels [82.7-85.5] were higher (p<0.001) than Investment levels [60.4-65.0]. Career resilience levels [75.1-79.2] were higher (p<0.001) than Emotional costs [69.0-72.1]. Planning levels [64.2-67.1] were lower (p<0.001) than levels of limitedness of career alternatives [68.1-71.0]., Conclusion: The highest scores were obtained in Career commitment, showing the workers' identification and positive relationship with their careers, that is, these workers remain in Primary Health Care services because they identify themselves with their professions.

Objective: Asthma and obesity are prevalent and interrelated diseases. In the pediatric population, the effect of systemic inflammation associated to obesity, leading to inflammation of the airways, is currently controversial. Our aim was to compare inflammatory, clinical and spirometric patterns between children with asthma and obesity and those within the normal weight status range., Methods: A total of 79 boys and girls from 6 to 10 years old were selected and divided into four groups: obese asthmatics, non-obese asthmatics, obese non-asthmatics, and non-obese non-asthmatics. In addition to collecting clinical and anthropometric data, all children underwent spirometry and skin prick tests for inhalant allergens. Blood samples for measurement of cytokines and adipokines were also collected., Results: Obese asthmatics had significantly worse control of asthma than non-obese asthmatics (OR 4.9; 95%CI 1.1‒22.1), regardless of sex, physical activity and atopy. No differences in spirometry, Th1 and Th2 cytokines and adipokines levels were observed among the four groups. The prick tests were positive in 81.8 and 80% of non-obese asthmatics and obese asthmatics, respectively., Conclusions: The degree of control of asthma was significantly lower in the obese group, regardless of the findings of no differences in spirometry. Extra-pulmonary factors could be responsible for this symptomatic profile. High positivity of skin test in both groups, which is considered a good marker of atopy, shows a preponderant atopic component in the genesis of asthma, both in children with obesity and in those within the normal weight status.

Objective: To develop and test a beat-to-beat blood pressure monitoring device during coronary angiography, and compare it with invasive blood pressure monitoring., Methods: Twenty-eight patients with an indication for hemodynamic study were selected for this investigation, and kept in supine position. Before starting the coronary angiography, they were instructed about the use of the left radial bracelet for beat-to-beat blood pressure monitoring., Results: There was a significant difference between the time required for the catheterization laboratory team to acquire the first invasive blood pressure reading and the time to obtain the first beat-to-beat reading (11.1±5.1 and 1.5±1.8, respectively; p<0.0001). The intraclass correlation coefficients (95%CI) of systolic and diastolic blood pressures were 0.897 (0.780-0.952) and 0.876 (0.734-0.942), indicating good reproducibility., Conclusion: This study showed the process to develop a beat-to-beat blood pressure monitoring device. When compared to invasive blood pressure monitoring, there were no significant differences between the two methods. This technique may play a promising coadjuvant role when combined with invasive monitoring during coronary angiography procedures.

Objective: To correlate arrhythmic symptoms with the presence of significant arrhythmias through the external event monitoring (web-loop)., Methods: Between January and December 2011, the web-loop was connected to 112 patients (46% of them were women, mean age 52±21 years old). Specific arrhythmic symptoms were defined as palpitations, pre-syncope and syncope observed during the monitoring. Supraventricular tachycardia, atrial flutter or fibrillation, ventricular tachycardia, pauses greater than 2 seconds or advanced atrioventricular block were classified as significant arrhythmia. The association between symptoms and significant arrhythmias were analyzed., Results: The web-loop recorded arrhythmic symptoms in 74 (66%) patients. Of these, in only 14 (19%) patients the association between symptoms and significant cardiac arrhythmia was detected. Moreover, significant arrhythmia was found in 11 (9.8%) asymptomatic patients. There was no association between presence of major symptoms and significant cardiac arrhythmia (OR=0.57, CI95%: 0.21-1.57; p=0.23)., Conclusion: We found no association between major symptoms and significant cardiac arrhythmia in patients submitted to event recorder monitoring. Event loop recorder was useful to elucidate cases of palpitations and syncope in symptomatic patients.

Objective: To describe the share of health care activities in the Brazilian economy between 2000 and 2007 in terms of economic value added and creation of jobs., Methods: Secondary data from the Brazilian Institute of Geography and Statistics (IBGE) for the years 2000 to 2007 were employed. The following health care activities were analyzed: public health, production of private health services and private social services, health insurance, the pharmaceutical industry, medical equipment manufacturing, and medical and pharmaceutical product sales. The share of each activity in the total economy and in the health care sector was calculated, as well as the percentage share of value-added components from the perspective of income for health care activities and the real growth in value added by health care activity. To complement the analysis, the average income of workers and the number of jobs per activity were established., Results: The participation of the health care sector in the economy ranged from 5.2% to 5.8%. The share of public health increased from 1.7% to 2.0%, and that of private healthcare services fell from 2.4% to 2.2%. The average annual growth of 3.5% for the sector was close to the 3.4% annual growth recorded for the economy. The share of medical and pharmaceutical product commerce in the sector increased from 9.1% to 13.2%. The activities with the highest accumulated growth were: manufacture of medical/hospital devices (42.7%), public health (39.4%), and health insurance (35.8%). Health care represented 4.1% of jobs in the economy in 2000 vs. 4.4% in 2007, with 1 million new jobs. Income from labor represented 6.7% of the total economy in 2000 and 7.5% in 2007., Conclusions: The health care sector has an important stake in the Brazilian economy, although this share is still lower than that observed in high-income countries. The rising share of public services in the sector's added value, the relative growth of medical and pharmaceutical product sales margins, and a real growth below the average for the pharmaceutical industry should be monitored.

Objectives: To verify the impact of obesity on metabolic syndrome components and adipokine levels in prepubertal children., Methods: This cross-sectional study compared 30 obese, 31 overweight and 33 eutrophic children attending a university hospital-based outpatient pediatric clinic. Parameters assessed included glucose, serum lipids, insulin, homeostasis model assessment-insulin resistance (HOMA-IR), glucose/insulin relation, adiponectin, and leptin. We compared the frequency of acanthosis nigricans and changes in waist, blood pressure, glucose, serum lipids, and insulin. The correlation between body mass index (BMI) z score and adipokines was evaluated., Results: Among obese children, there was a difference in the mean values of HDL cholesterol and adiponectin, whereas among the eutrophic children, there was a difference in the mean values of insulin, HOMA-IR, glucose/insulin relation, and leptin (p < 0.001). A difference was also observed regarding the frequency of acanthosis nigricans and alteration in waist and HDL cholesterol (p < 0.005) in the obese group. The BMI z score showed a positive correlation with leptin (p < 0.001) and a negative correlation with adiponectin (p = 0.001). In multiple linear regression, this correlation was maintained only for leptin; HDL-cholesterol correlated with adiponectin (p = 0.007) and HOMA-IR correlated with both variables (p < 0.05)., Conclusions: These findings provide evidence of the influence of obesity on metabolic syndrome components and on adipokine levels in prepubertal children, indicating that these components may contribute to the beginning of cardiovascular diseases.

Objective: To establish, among the cut-off values for the homeostatic model assessment for insulin resistance index (HOMA-IR) cited in the literature, the best in identifying metabolic syndrome (MS) in obese and overweight children., Methods: A total of 106 pre-pubertal children were studied. The definition of MS was adapted from that of the International Diabetes Federation. For each cut-off values for HOMA-IR, it was estimated sensibility and specificity for MS. A receiver operating characteristic (ROC) curve was generated using these values., Results: The study included 106 obese (37 girls and 69 boys) and 34 overweight (19 girls and 15 boys) children aged 6,5 +/- 2,3 years. The accuracy of the ROC curve was 72%, and the best cut-off value for HOMAIR was 2,5, with sensitivity of 61% and specificity of 74%., Conclusions: HOMA-IR may be useful to detect MS and the cut-off 2,5 seems to be the best in obese and overweight pre-pubertal children.

Despite their importance for hospital operations, discussions of healthcare organization logistics and supply and materials management are notably lacking in Brazilian literature. This paper describes a methodology for organizing the supply of medical materials in public hospitals, based on an action-research approach. Interventions were based on the assumption that a significant portion of problems in Brazil's National Health System (SUS) facilities derive from the fact that their clinical and administrative departments do not see themselves as belonging to the same production chain - neither the hospital nor the supply department is aware of what the other produces. The development of the methodology and its main steps are presented and discussed, against a background of recent literature and total quality and supply chain management concepts.

This study evaluated the follow-up of high-risk patients with thyroid cancer after initial therapy. A total of 125 high-risk patients (tumor >4 cm and/or extrathyroid invasion and/or lymph node metastases, and age >45 years), with complete resection of the tumor, were selected. All patients underwent total thyroidectomy and ablation with (131)I[3.7-5.5 GBq (100-150 mCi)]. Eighteen patients (14.8%) presenting metastases on post-dose whole-body scan (RxWBS) were excluded. The negative predictive value of stimulated Tg < or =1 ng/ml in combination with neck US during first assessment (612 mo. after ablative therapy) was 96.2% for the absence of recurrence up to 5 years. This value increased to 98.7% when adding WBS performed with 185 MBq (5 mCi) (131)I (DxWBS). The positive predictive value (PPV) of stimulated Tg >1 ng/ml was 52% for the detection of the presence of metastases up to 5 years; however, considering only patients with initially negative DxWBS and US, the PPV was 19% (9% if Tg of 110 ng/ml vs. 40% if Tg >10 ng/ml). Tg levels decreased spontaneously in patients with stimulated Tg >1 ng/ml during first assessment, negative US and DxWBS, and no recurrence during follow-up, with Tg being undetectable in half these patients at the end of 5 years. Twenty patients presented uptake in the thyroid bed upon DxWBS during the first year after ablative therapy, with stimulated Tg and US being negative, and were not treated with 131I; these patients did not relapse and no uptake on DxWBS was observed in 60% after 5 years. Recurrence after 5 years was only 1.3% in patients without apparent disease (negative US and DxWBS) and stimulated Tg <1 ng/ml. An algorithm for the follow-up of high-risk patients after initial therapy is presented in this study.

This study aimed to analyze the conception of the nurse on the National Health System principles and lines of direction and to point the limits, advances and perspectives of the nurse facing the health municipally process in Itabuna-BA. Data were collected through semi-structured interview. The subjects were 13 nurses. For data analysis it was used the hermeneutic dialetic method. Results point that nurses conceive the Health System in its principles and lines of direction; the knowledge and the awareness of the nurse on the Naional Health System are important for her adhesion and involvement in the municipally process; nurses see as limits, the established care model, the sevice disarticulation and, mainly, the lack of autonomy. Related to the perspectives, it is expected that the National Health System will be effetive and healthcare will be expanded with increase in quality.

Study about the decentralization process of the health system in the '80s and '90s in the city of Itabuna-BA. It is aimed at describing the city's health decentralization process, identifying the nurse's insertion/participation in this process. Descriptive/qualitative study of exploratory nature that utilized both the semistructured interview and documental analysis for data collection. The results show that the nurse's insertion in the decentralization process took place according to the changes that occurred at every municipal management, where the nurse acted more effectively as the set of circumstances was established and was influenced by the several conjunctures formed by the implemented policies or implemented in each context of the management of the municipal health system.

The purpose of this cross-sectional study was to evaluate the prevalence of epilepsy in a population based sample: the Bakairi indians, who live on the banks of Paranatinga river in the central plateau of Mato Grosso state, Brazil. This population is composed of 483 inhabitants. The study was outlined in two stages, and the investigation was door-to-door in a total of 103 houses. The results of the instrument showed a sensitivity of 88% (CI- 95%, 84.9-93), specificity of 97.8% (CI-95, 95-98). The prevalence of active epilepsy was 12.4 per mil, and inactive was 6.2 per mil. This prevalence of the epilepsy was considered high probably due to some familial risk factor (p=0.04) among those Indians, while other factors were not important.

We report a case of Aicardi syndrome in a female child with 2 month old, ocular abnormalities "chorioretinal lacunae", flexion in spasms, hipsarrhythmic "split brain", callosal agenesis referred to Service of Neuropediatric and Neurophysiology of Base Hospital of São José do Rio Preto, SP, Brazil.

This study aims to evaluate, prospectively, the epileptic syndromes and seizures types upon work based on a sample of 412 out-patients from Hospital de Base, São José do Rio Preto, SP, Brazil. It was observed that the epileptic syndromes were significant in relation to the patients' labor skills (p= 0.001): the idiopathic syndromes showed less prejudiced, while the symptomatic was more. The seizures types also had some influence in relation to the patients' labor skills (p=0.016): the generalized non-convulsive seizures had no involvement; the simple partial and the non-classified had moderately involvement; and the simple partial seizures evolving to complex and tonic-clonic generalized were the seizures which mostly have taken the patients away from work. The seizure severity was also analyzed.

This study aims to evaluate, prospectively, the relationship of the active epilepsy length and the work, of the 379 out-patients from Hospital de Base, São José do Rio Preto. Epilepsy length was subdivided into 5 time rates and by age, into 3 age-groups. There was no relationship, not considering the age of patient among the epilepsy length and the work, but young patient (14 at 29 years old) and with recent epilepsy (length of 0 at 5 years) lost more work than the adult and elderly epileptic.

This study aims to assess epileptic patients migration in different sorts of paid/non paid and formal/informal work, unemployment and retirement. Eighty one epileptic patients were evolutively analyzed (cohort) at the Epilepsy Department of Hospital de Base, Medical School, São José do Rio Preto, Brazil. The epileptic percentages in different sorts of work, in March 1996 was compared with the one after three-year follow-up period in March 1999. There were no statistical significant changes among the same sorts of work in this period. However, there were intense migrations in relation to different sorts of work. Paid work showed migration to unemployment and retirement. This research shows the significant migration of epileptic patient either to some kind of a less qualified work or to some social security dependence as well as to early retirement.

Unlabelled: This study aims to determine the age at which the rolandic spikes (RS) appear and disappear in routine EEGs., Method: It has been carried out a hospital based prospective study of 412 EEGs records of 160 children who had been assisted at the neuropediatric out-patient department during the period between March, 1989 and March, 1998. Recordings were made on 8-channel instruments and 10/20 system has been to place the electrodes. The children have been divided into 4 groups, according to their age (1 to 4; 5 to 8; 9 to 16; 1 to 16), and the actuarial curve method has been used to show the disappearance of the rolandic spikes., Results: RS distribution between boys and girls has been 64/36 ratio. RS have been found at average age of 7 years (boys, 7.2 and girls, 6.6). In a small group of children with normal EEGs previous to the RS appearance, the average age has been 6.8 years old. After this 7-year follow up period, the percentage of patients free from RSs was 60% for 1 to 4 year old group at admission; 84% for the 5 to 8 year old group and for the 9 to 16 year old group. For the total group (1 to 16 year old), the percentage of those free from RSs after this 7 year follow up period was 78%., Conclusion: This study shows that RSs appear at the average age of 7 years old, and are likely to disappear up to the end of a 7-year follow up period, independently on the appearance age.