Distribuição da rede de oferta de serviços de saúde na região norte: uma análise espacial multivariada

The goal of this paper is to analyze the spatial localization of health services supply at Brazilian north region. At Amazon region, where distances among localities are huge and the transport system has deficiencies, the supply of health infra-structure and human resources are crucial issues to identify the planning possibilities in order to improve the access to those services. We used municipal data on equipments, physical installations and human resources from Pesquisa de Assistência Médico-Sanitária 2002 (AMS). The urban network identification was held due to multivariate analysis, specifically cluster analysis. The clusters spatial association was tested by Local Indicators of Spatial Association (LISA). The results point to an unevenly distributed urban network of health services, concentrated on region's most important cities as Manaus and Belém. We could also realize the existence of big areas of absolute deficiencies in all kind of infrastructure - even those of primary attention - and an unfilled urban system, lacking central places of intermediate hierarchy.health services supply; Brazil

Novel magnetic stimulation methodology for low-current implantable medical devices

Recent studies highlight the ability of inductive architectures to deliver therapeutic magnetic stimuli to target tissues and to be embedded into small-scale intracorporeal medical devices. However, to date, current micro-scale biomagnetic devices require very high electric current excitations (usually exceeding 1 A) to ensure the delivery of efficient magnetic flux densities. This is a critical problem as advanced implantable devices demand self-powering, stand-alone and long-term operation. This work provides, for the first time, a novel small-scale magnetic stimulation system that requires up to 50-fold lower electric current excitations than required by relevant biomagnetic technology recently proposed. Computational models were developed to analyse the magnetic stimuli distributions and densities delivered to cellular tissues during in vitro experiments, such that the feasibility of this novel stimulator can be firstly evaluated on cell culture tests. The results demonstrate that this new stimulative technology is able to deliver osteogenic stimuli (0.1-7 mT range) by current excitations in the 0.06-4.3 mA range. Moreover, it allows coil designs with heights lower than 1 mm without significant loss of magnetic stimuli capability. Finally, suitable core diameters and stimulator-stimulator distances allow to define heterogeneity or quasi-homogeneity stimuli distributions. These results support the design of high-sophisticated biomagnetic devices for a wide range of therapeutic applications.This work was funded by the Portuguese Foundation for Science and Technology (FCT), through the grant references SFRH/BPD/117475/2016, SFRH/BD/129340/2017 and IF/01089/2015, and by the European Structural and Investment Funds, through the project reference POCI-01-0145-FEDER-031132 and POCI-01-0145-FEDER-007679. It was also support by the TEMA - Centre for Mechanical Technology & Automation (UID/EMS/00481/2013-FCT and CENTRO-01-0145-FEDER-022083) and CICECO - Aveiro Institute of Materials (UID /CTM /50011/ 2013).in publicatio

REDE URBANA DA OFERTA DE SERVIÇOS DE SAÚDE: UMA ANÁLISE MULTIVARIADA MACRO REGIONAL - BRASIL, 2002

Desde a regulamentação do SUS, em 1990, o sistema de saúde brasileiro tem passado por diversas transformações, como a descentralização e regionalização dos serviços de saúde, a fim de reduzir as desigualdades geográficas e sociais no acesso a estes serviços. O objetivo deste trabalho é identificar e analisar a rede urbana da oferta de serviços de saúde nas macro regiões do Brasil a partir de informações da Pesquisa de Assistência Médico-Sanitária (AMS) do ano de 2002 para todos os municípios brasileiros. Utilizando variáveis de equipamentos, instalação física e recursos humanos na área da saúde, identificou-se a rede urbana através de técnicas de análise multivariada, especificamente análise de cluster. A consistência dos resultados foi testada com técnicas de análise espacial (AEDE) e econometria espacial. Os resultados apontam que a rede urbana de serviços de saúde no Brasil é, ao mesmo tempo, não inclusiva, sobreposta, amplamente desigual na distribuição regional e concentrada nas regiões Sudeste e Sul do Brasil. Observa-se a existência de grandes áreas de deficiências absolutas em equipamentos, instalação física e recursos humanos – mesmo aqueles com baixos níveis de complexidade – além de um sistema de cidades poroso, com a virtual inexistência de centros urbanos de hierarquia intermediária

Discal Cyst: a Rare Cause of Neurologic Compression in the Young Adult

Introduction: discal cysts are rare pathology. Its clinical presentation can be mistaken for disc herniation, with back pain, radiculopathy and neurological defi cit. It is more common in male patients in their fourth life decade. Because they are rare, there is no consensus about the treatment. A great variety of procedures, from medication for the pain to endoscopic or microdiscectomy excision, have been described. Objetive: Describe a case of discal cyst on the l4-l5 level with compression of l5 right nerve root treated successfully with a minimal invasive procedure. Study design: Case report. Methods: Review medical records, pertinent images, interview with the patient and surgical team, intraoperative and histopathological fi ndings. The surgical technique used was minimally invasive. Results: Magnetic resonance imaging (MRI) demonstrated a cystic lesion imaging at the level of the L4-L5 disc. The cystic mass displaced the thecal sac dorsally compressed the L5 transversing root. The patient was submitted to a minimally invasive microendoscopic technique using a tubular retractor. He recovered completely after the procedure, presenting absence of leg pain and went back to his regular activities 3 weeks after the surgery. Histopathological examination of the cyst revealed thick fi brous connective tissue interspersed with areas of chronic infl ammation. Conclusion: Discal cysts are rare intraspinal lesions. They can trigger severe neurological symptoms, and should be differentiated from other forms of epidural cysts and tumors. There are many treatment options that can be chosen from but no consensus. We used a treatment that was less invasive than the ones described in the literature

A Decision Making: Implant or Endodontic Treatment? A Case Report

The present report describes the successful treatment of a tooth with an endo-perio lesion and an extensive area of bone resorption. The possibility of extraction and dental implant was discussed with the patient. Chemomechanical preparation was performed, and canals were filled with bioceramic cement and gutta-percha cones. After 12 months, clinical and radiographic evaluations showed remarkable remineralization. The decision to perform the endodontic treatment or implant was based on scientific evidence and correct clinical assessment

Oral findings in secondary syphilis

Syphilis is a sexually transmitted disease caused by Treponema pallidum. However, there are of hematogenic and vertical transmission. All health care professionals must be aware of the manifestations of this condition, such as oral lesions. This study to analyze and compare four clinical cases of syphilis that were diagnosed based on lesions in the oral cavity with published literature. Four patients with a confirmed sorologic and clinical diagnosis of syphilis were examined, confirmated from manifestation of oral lesions together with analysis of serological laboratory tests and histopathological analyses. Lesions were found in classic sites such as lips, tongue and skin. However, there were also lesions on the hard palate, and labial commissure, which correspond to less than 5% of the syphilis oral manifestations. The practice of unprotected oral sex may result in infection and development of syphilis. The acknowledgment of the oral manifestations of syphilis in all its period of training for health professionals is of basic importance, the association of clinical features, histopathological findings and serological tests are required to complete the diagnosis and correct treatment

Limitations and Management of Static-guided Endodontics Failure

Endodontic treatment in severely calcified canals is always a challenging task because it can result in accidents such as deviations or perforations. Recently, guided endodontics has become an alternative approach for pulp canal calcification, facilitating the location of root canals more predictably through the combined use of cone-beam computed tomographic imaging, oral scanning, and endodontic access guides. Although several reports have shown that guided endodontics is safer, faster and can be performed without an operating microscope and by less experienced operators, the technique has limitations, and iatrogenesis may occur. This article describes the limitations of static-guided endodontics and possible causes of failures. In the present case, not fixing the guide to the bone and inaccuracies generated by manually performing mesh merger software led to root perforation. Endodontic microsurgery was effective in resolving this case and should be considered the treatment of choice when guided endodontics cannot be used safely or when it fails

Push-out bond strength and marginal adaptation of apical plugs with bioactive endodontic cements in simulated immature teeth

Objectives: This study evaluates the bond strength and marginal adaptation of mineral trioxide aggregate (MTA) Repair HP and Biodentine used as apical plugs; MTA was used as reference material for comparison. Materials and Methods: A total of 30 single-rooted teeth with standardized, artificially created open apices were randomly divided into 3 groups (n = 10 per group), according to the material used to form 6-mm-thick apical plugs: group 1 (MTA Repair HP); group 2 (Biodentine); and group 3 (white MTA). Subsequently, the specimens were transversely sectioned to obtain 2 (cervical and apical) 2.5-mm-thick slices per root. Epoxy resin replicas were observed under a scanning electron microscope to measure the gap size at the material/dentin interface (the largest and smaller gaps were recorded for each replica). The bond strength of the investigated materials to dentin was determined using the push-out test. The variable bond strengths and gap sizes were evaluated independently at the apical and cervical root dentin slices. Data were analyzed using descriptive and analytic statistics. Results: The comparison between the groups regarding the variables' bond strengths and gap sizes showed no statistical difference (p > 0.05) except for a single difference in the smallest gap at the cervical root dentin slice, which was higher in group 3 than in group 1 (p < 0.05). Conclusions: The bond strength and marginal adaptation to root canal walls of MTA HP and Biodentine cement were comparable to white MTA