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Introduction: The high prevalence of temporomandibular disorders and tinnitus along with the negative effects on the quality of life of affected individuals makes this association a matter of public health., Objective: To assess the knowledge of primary health care professionals about the interrelationship between temporomandibular disorders and tinnitus., Materials and Methods: This was a quantitative cross-sectional study, using a structured, self-administered questionnaire for a group of 54 dental surgeons. The statistical analysis used involved descriptive analyses through absolute and relative frequency distributions., Results: The results showed that the professionals do not, as a routine, examine the temporomandibular joints and masticatory muscles during physical examination. In addition, there was a low percentage of correct answers on questions that assess knowledge., Conclusions: There is a need to inform dentists about the interrelationship between temporomandibular disorders and tinnitus. Furthermore, there is a need to encourage managers to establish teaching and learning tools that support and strengthen the role of dentists in primary health care. In this way, routine visits might minimize these disorders, and thus contribute to the quality of life of the population.

Background: In spite of the advances in sepsis diagnosis and treatment in the last years, the morbidity and mortality are still high., Objective: To assess the prevalence, in-hospital evolution and prognosis of patients that presented sepsis in the postoperative period of cardiac surgery., Methods: This is a prospective study that included patients (n = 7,332) submitted to cardiac surgery (valvular or coronary) between January 1995 and December 2007. The classic criteria of sepsis diagnosis were used to identify the patients that developed such condition and the preoperative comorbidities, in-hospital evolution and prognosis were evaluated., Results: Sepsis occurred in 29 patients (prevalence = 0.39%). There was a predominance of the male when compared to the female sex (79% vs. 21%). Mean age was 69 +/- 6.5 years. The main preoperative comorbidities were: systemic arterial hypertension (79%), dyslipidemia (48%) and family history of coronary artery disease (38%). The mean Apache score was 18 +/- 7, whereas the Sofa score was 14.2 +/- 3.8. The primary infectious focus was pulmonary in 19 patients (55%). There were 19 positive cultures and the mean IV hydration during the first 24 hours was 1,016 +/- 803 ml. The main complications were acute renal failure (65%), low cardiac output syndrome (55%) and malignant ventricular arrhythmia (55%). Mortality was 79% (23 patients)., Conclusion: The occurrence of sepsis after cardiac surgery was a rare event; however, its occurrence showed catastrophic clinical outcomes. The high morbidity and mortality showed the need to improve treatment, aiming at patients' better clinical evolution.

Background: Stroke is a feared complication after coronary artery bypass grafting surgery (CABG), with an incidence between 1.3 and 4.3%., Objective: To identify predictive factors for stroke after CABG in the modern era of cardiac surgery., Methods: This is a case-control study of 65 pairs of patients, paired by sex, age (+ 3 years) and date of CABG (+ 3 months). The cases were patients submitted to elective CABG with extracorporeal circulation (ECC) that presented stroke (defined as clinical neurological deficit up to 24 hours post-operatively and confirmed by imaging assessment) and the controls were those individuals submitted to elective CABG with ECC, but without stroke., Results: The univariate analysis demonstrated that the number of revascularized vessels was associated with the occurrence of stroke after the CABG (3 +/- 0.8 vs. 2.76 +/- 0.8, p = 0.01). The multivariate analysis by conditional logistic regression showed that systemic arterial hypertension (SAH) [OR: 6.1 (1.5 - 24), p = 0.009] and diabetes mellitus (DM) [OR: 3.1 (1.09 - 11), p= 0.03] were the determinants of the highest chance of stroke after CABG, whereas acute myocardial infarction (AMI) > 1 month, was the determinant of the lowest chance of stroke [OR: 0.1 (0.03 - 0.36), p = 0.003]., Conclusion: Hypertension and diabetes mellitus were identified as independent predictors of stroke within the first 24 postoperative hours after CABG. In patients with such risk factors, it is possible that the knowledge of the causal mechanisms of brain injury represents a strategy capable of decreasing the incidence of stroke after CABG.

Objective: We sought to describe the use of both internal mammary arteries (IMA) in patients with diabetes mellitus (DM) submitted to coronary artery bypass grafting (CABG)., Method: Between January of 1995 to August of 2005, 4.569 patients received isolated CABG in our institution, of these, 1.298 had DM. Mean sample age was 62 years, and total mortality was 2.18% (100 patients). We have used both IMA's in 700 patients, that here are split in two groups, with DM (group I, 148 patients), and without DM (group II, 552 patients). Patient selection for double IMA grafting was based on coronary artery anatomy and sternal bone quality, the later was evaluated during sternal transsection. When these two factors were considered favorable, we harvested both IMA's, not mattering if the patient had or had not DM. During IMA's harvest, care was taken not to open the pleural spaces., Results: There was small difference between the two groups in terms of morbidity and mortality., Conclusion: Our data suggest that patients with DM can benefit of double IMA's grafting, with little increase in risk for complications if its application is carefully indicated.

This report of experience has the objective of presenting the results of the evaluation workshops on the implantation of an operating system of CIPESC, which simultaneously describes, validates, quantifies and qualifies the nursing practices in collective health carried out in the scope of extra-internment in the Units of Health of the city of Curitiba, in the State of Paraná. The workshops provided subsidies for identification of the strong points and the difficulties of implementing the CIPESC-Curitiba nomenclature, but at the same time revealed contradictions in the nurses' speeches. It is agreed upon that it is through conscious practice that these contradictions are overcome, and, starting from them, is built a Nursing with potential of intervention in the population's epidemiological profiles.