Tratamento de pigmentações melânicas com instrumentos rotatórios e lâmina de bisturi Treatment of melanic pigmentations with rotary instruments and scalpel blade

Introduction: Oral pigmentary lesions may have different clinical characteristics, ranging from physiological pigmentation, such as melanin spots, to something more serious, such as malignant melanoma. Due to the great variety of pigmented lesions, the treatments are varied and individualized. Objective: This clinical case reports a case of melanocytic removal through a surgical technique that associates rotary instruments and scalpel blade. Case report: A 45-year-old patient, melanoderma, sought care at the Positivo University, complaining about the dark spots visible on his gum, and the discomfort they caused him when smiling. After the clinical examination, the presence of melanocytic pigmentation was diagnosed and the proposed treatment was surgical removal of spots with a drill and scalpel blade. In the immediate postoperative period, the patient presented good healing and reported only mild burning in the first three days. After 60 days, the gingiva was healed, with no relapsing spots. Conclusion: The technique chosen was effective because it presented adequate healing and absence of relapse of the pigmentation in the postoperative follow-upIntroduction: Oral pigmentary lesions may have different clinical characteristics, ranging from physiological pigmentation, such as melanin spots, to something more serious, such as malignant melanoma. Due to the great variety of pigmented lesions, the treatments are varied and individualized. Objective: This clinical case reports a case of melanocytic removal through a surgical technique that associates rotary instruments and scalpel blade. Case report: A 45-year-old patient, melanoderma, sought care at the Positivo University, complaining about the dark spots visible on his gum, and the discomfort they caused him when smiling. After the clinical examination, the presence of melanocytic pigmentation was diagnosed and the proposed treatment was surgical removal of spots with a drill and scalpel blade. In the immediate postoperative period, the patient presented good healing and reported only mild burning in the first three days. After 60 days, the gingiva was healed, with no relapsing spots. Conclusion: The technique chosen was effective because it presented adequate healing and absence of relapse of the pigmentation in the postoperative follow-u

Anticorpo monoclonal no manejo da cefaleia em salvas: Monoclonal antibody in the management of cluster headache

Introdução: A cefaleia em salvas (CS) é caracterizada por uma dor de cabeça intensa em apenas um lado da cabeça, que surge em crises. Não há cura para a CS e o seu tratamento consiste em minimizar a dor e diminuir a frequência das crises. Nesse cenário, que surge a investigação de maneiras eficazes para promover esse tratamento, entre eles o anticorpo monoclonal. Objetivo: Mostrar o que estudos recentes sobre o emprego de anticorpo monoclonal para esse fim têm trazido sobre sua segurança e eficácia. Metodologia: Trata-se de uma revisão sistemática da literatura realizada nos bancos de dados PubMed e BVS, com: “(Cluster Headache OR Headache Disorders) AND Antibodies, Monoclonal”. Excluiu-se os artigos que não se enquadravam nos objetivos. Resultados e Discussão: Grande parte dos estudos mostrou uma melhora significativa na frequência das crises, enquanto o uso para diminuir foi inconclusivo em quase todos estudos, principalmente quando usado a longo prazo, mas apesar disso, foi considerada uma opção segura para uso. Conclusão: É um tema ainda novo e com poucos estudos, principalmente de longos prazos, que diverge sobre a eficácia na redução da dor durante as crises, mas tende a convergir sobre a eficiência para redução dos intervalos das crises

Tipologia das regiões de saúde: condicionantes estruturais para a regionalização no Brasil

O desenvolvimento socioeconômico, a oferta e a complexidade das ações e dos serviços de saúde no contexto regional podem ser considerados condicionantes estruturais para o êxito do atual processo de regionalização da saúde no Brasil. O presente estudo tem como objetivo identificar os condicionantes estruturais do processo de regionalização por meio da construção de uma tipologia das regiões de saúde no Brasil. Foi construída tipologia das regiões de saúde brasileiras a partir de fonte de dados secundários disponível. A identificação das dimensões e dos grupos - que compõem a tipologia - foi realizada por meio de análise fatorial e de agrupamentos/clusters. Também foram identificados o tipo de prestador de ações e os serviços predominantes na região tanto para a produção ambulatorial quanto para a internação. As regiões foram classificadas em cinco grupos, de forma independente, de acordo com suas características socioeconômicas e de oferta de serviços de saúde. A caracterização das regiões de saúde brasileiras, a partir da tipologia apresentada, demonstra heterogeneidade do território nacional e a complexidade de organizar sistemas de saúde regionais. A tipologia proposta pode auxiliar na investigação e no melhor entendimento desse cenário contraditório e complexo, apoiando o urgente desenvolvimento de políticas públicas regionais integradas que envolvam, concomitantemente, desenvolvimento econômico e social; e o fortalecimento dos espaços de governança regional, a fim de promover a organização de sistemas de saúde regionais alicerçados nos princípios do SUS e numa gestão compartilhada e solidária que tenha como imagem-objetivo a garantia do direito à saúde

The relationship between sentiment and risk in financial markets

This article estimates association coefficients between measures of market sentiment and risk in the U.S., German and Chinese markets. In terms of risk, four measures were considered: standard deviation, value at risk, expected shortfall and shortfall deviation risk. For market sentiment, data was collected using the Psych Signal technology, which is based on the behavior of investors on social networks. The results indicate significant statistical associations, with the direction of association having financial meaning. Moreover, the empirical findings are valid for all risk measurements. The results are in keeping with the Prospect Theory, since in moments when the sentiment indicates low liquidity (a negative value for the difference between Bullish and Bearish Intensities) investors try to reduce the negotiation volume, which has a positive impact on risk. On the other hand, under the inverted scenario, when sentiment indicates high liquidity, there is an increase in the negotiation volume and a consequent decrease in risk. This article is important because its observations of market sentiment as measured by social media data show a consistent relationship with measures of financial risk

The Relationship between Sentiment and Risk in Financial Markets

This article estimates association coefficients between measures of market sentiment and risk in the U.S., German and Chinese markets. In terms of risk, four measures were considered: standard deviation, value at risk, expected shortfall and shortfall deviation risk. For market sentiment, data was collected using the Psych Signal technology, which is based on the behavior of investors on social networks. The results indicate significant statistical associations, with the direction of association having financial meaning. Moreover, the empirical findings are valid for all risk measurements. The results are in keeping with the Prospect Theory, since in moments when the sentiment indicates low liquidity (a negative value for the difference between Bullish and Bearish Intensities) investors try to reduce the negotiation volume, which has a positive impact on risk. On the other hand, under the inverted scenario, when sentiment indicates high liquidity, there is an increase in the negotiation volume and a consequent decrease in risk. This article is important because its observations of market sentiment as measured by social media data show a consistent relationship with measures of financial risk

Necessidades de cuidadores de crianças com transtorno de neurodesenvolvimento: "overview"

Objective: analyze strategies that can provide health support for families/caregivers of children diagnosed with neurodevelopmental disorders (NDD) by the health system and other support networks. Methods: it is an overview of reviews structured according to the PRISMA checklist and registered on the PROSPERO CRD42018102193 platform. Searches were performed on ten literature databases with standardized MESH descriptors. Narrative analysis was carried out to systematize elements of the strategies, aspects of implementation and equity.Results: 3215 titles and abstracts were screened, after duplicates were removed and the title and abstract were read, 127 were selected for complete reading, and 11 met the eligibility criteria. The caregivers needs were approached in four strategies: 1. Encourage that health care strategies are centered on the family of children with NDD, 2. Promote better living conditions for families, through emotional, social and financial support, 3. Encourage strengthening affective bonds between caregivers and health professionals, 4. Promote lines of care for caregivers, centered on autonomy and self-care. Conclusions: The four strategies addressed seek to meet the needs of caregivers of children with NDD to promote greater support for families. They are independent, but complementary, and it is important that the four pillars are present for quality support.Objetivo: analisar estratégias de como o sistema de saúde e outras redes de apoio podem prover suporte de saúde de famílias/cuidadores de crianças com transtorno de neurodesenvolvimento (TND). Métodos: trata-se de um overview de revisões estruturada de acordo com o checklist PRISMA e registrada na plataforma PROSPERO CRD42018102193. Buscas foram realizadas em dez bases da literatura com descritores padronizados MESH. A análise narrativa foi realizada para sistematizar elementos das estratégias, aspectos de implementação e equidade. Resultados: foram triados 3215 títulos e resumos, após retirada de duplicidades e leitura de título e resumo, 127 foram para leitura completa e 11 atenderam aos critérios. Quatro estratégias abordaram as principais necessidades dos cuidadores: 1. Estimular que as estratégias de atenção integral à saúde sejam centradas na família das crianças com TND, 2. Promover melhores condições de vida para as famílias, por meio de apoio emocional, social e financeiro, 3. Incentivar e fortalecer vínculos afetivos entre os cuidadores e os profissionais da saúde, 4. Promover linhas de cuidado para os cuidadores, centradas na autonomia e no autocuidado. Conclusões: as quatro estratégias abordadas procuram atender às necessidades dos cuidadores de crianças com TND para promover um maior suporte às famílias

Circulating Dipeptidyl Peptidase IV Activity Correlates With Cardiac Dysfunction in Human and Experimental Heart Failure

Background the present study addresses the hypothesis that the activity of dipeptidyl peptidase IV (DPPIV), an enzyme that inactivates peptides that possess cardioprotective actions, correlates with adverse outcomes in heart failure (HF). the therapeutic potential of DPPIV inhibition in preventing cardiac dysfunction is also investigated.Methods and Results Measurements of DPPIV activity in blood samples obtained from 190 patients with HF and 42 controls demonstrated that patients with HF exhibited an increase of approximate to 130% in circulating DPPIV activity compared with healthy subjects. Furthermore, an inverse correlation was observed between serum DPPIV activity and left ventricular (LV) ejection fraction in patients with HF. Similarly, radiofrequency LV ablation-induced HF rats displayed higher DPPIV activity in the plasma (approximate to 50%) and heart tissue (approximate to 3.5-fold) compared with sham-operated rats. Moreover, positive correlations were observed between the plasma DPPIV activity and LV end-diastolic pressure and lung congestion. Two days after surgery, 1 group of LV ablation-induced HF rats was treated with the DPPIV inhibitor sitagliptin (40 mg/kg BID) for 6 weeks, whereas the remaining rats were administered water. Hemodynamic measurements demonstrated that radiofrequency LV-ablated rats treated with sitagliptin exhibited a significant attenuation of HF-related cardiac dysfunction, including LV end-diastolic pressure, systolic performance, and chamber stiffness. Sitagliptin treatment also attenuated cardiac remodeling and cardiomyocyte apoptosis and minimized pulmonary congestion.Conclusions Collectively, the results presented herein associate circulating DPPIV activity with poorer cardiovascular outcomes in human and experimental HF. Moreover, the results demonstrate that long-term DPPIV inhibition mitigates the development and progression of HF in rats