Epidemiology and medical practice

In this unpublished work by Ricardo Bruno Mendes Gonçalves, a key figure in the field of collective health, the relationship between epidemiology and medical practice is considered. The text is based on an inaugural lecture delivered on December 16, 1988 as part of a seminar called “Clinical epidemiology: possible scientific field or new medical ideology?” organized by the Department of Preventive Medicine at the Federal University of Bahia School of Medicine, Brazil. This manually transcribed version of the lecture was prepared, revised, and in many cases rewritten by Naomar de Almeida Filho and Jose Ricardo Ayres, who always sought to preserve the original meaning and colloquial tone that was characteristic of his lectures

Integração de um sistema de monotorização ambiental urbano numa smart city

O objetivo principal deste artigo é apresentar um sistema de monitorização ambiental urbano e estudar a sua possível integração numa rede de smart city. As diferentes fases de desenvolvimento do sistema são abordadas, desde a sua construção, modo de operação e partilha dos dados obtidos. O projeto designado SMMART Vila Real (Sistema Municipal de Monitorização do Ar, Ruído e Tráfego) é constituído por uma unidade móvel de monitorização de parâmetros ambientais (ruído, partículas em suspensão e parâmetros meteorológicos), um centro de análise e tratamento de dados e uma plataforma web de informação ao público essencialmente sobre parâmetros de qualidade ambiental urbana. Neste projeto o município aceitou o desafio de desenvolver uma plataforma onde a população consegue obter informações sobre a qualidade ambiental urbana da sua cidade. No final, o projeto demonstrou ser capaz de cumprir os objetivos propostos e de ser bem aceite pelo município e pela população.The aim of this paper is to present a system for urban environmental monitoring and study the possibility of the integration of the system in a smart city network. The different phases of the system development are presented, from its construction, operation mode and sharing the data obtained. The project called SMMART Vila Real (in English “Municipal System for Monitoring Air, Noise and Traffic”) is constituted by a mobile unit for monitoring environmental parameters (noise, suspended particles and meteorological parameters), an analysis and treatment center of the data and a web platform essentially for public consultation about the urban environment quality. In this project the municipality accepted the challenge of developing a platform whereby the population is informed about the quality of their own city. In the end, the project has demonstrated being able to accomplish the goals proposed and was well accepted by the municipality and the population

“Como um som de noite e um faiscar de dia”: os impactes da poluição sonora de baixa frequência em áreas residenciais no município de Guimarães, Portugal

Esta pesquisa tem por objetivo compreender os impactes da poluição sonora de baixa frequência na qualidade de vida da população e na sustentabilidade dos lugares, no município de Guimarães, Portugal. A investigação realizada foi desdobrada em duas vertentes. A primeira compreendeu medições sumárias realizadas em 2014, totalizando 9 pontos, com o grupo ‘próximo da fonte’, residentes no raio de até 50 metros, e o grupo ‘distante da fonte’, a mais de 250 metros de distância em relação à fonte. A segunda abarcou medições de 72 horas realizadas em 2015, com o grupo ‘muito próximo da fonte’ até 20 metros da fonte. A dimensão subjetiva compreendeu a percepção da incomodidade do ruído pela população usando um inquérito, adaptado da metodologia da Universidade de Salford. Na primeira abordagem, o ruído ultrapassa os valores da curva critério independente do grupo. Na segunda abordagem, os níveis de ruído medidos apresentam características flutuantes, e de acordo com a mesma metodologia, o ruído causado por essas infraestruturas pode ser incomodativo.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPE

Effect of amount of biomaterial used for maxillary sinus lift on volume maintenance of grafts

Regardless of the kind of biomaterial used for the graft, it is clear that, over time, the graft undergoes dimensional changes that could influence the final bone volume obtained, which could alter the stability of the installed implants. The aim of the present study was to compared and correlated the graft behavior with the amount (in grams) of xenogeneic and alloplastic biomaterials used in grafts for maxillary sinus lift. This retrospective cohort study used 148 CBCT images of 74 grafts from 68 maxillary sinuses lift patients in a university, post-graduate clinic. The weights of biomaterials, categorized in intervals according to amount used, were correlated with the graft volumes at V1 (10 days) and V2 (180 days). Kruskal-Wallis test was used to evaluate the possible bias effect of weight on graft maintenance. Mean weights of biomaterials used were: Bio-Oss Small® (1.58g); Bio-Oss Large® (1.35g); Endobon® (0.72g); BoneCeramic®+Emdogaim® (0.96g); Cerasorb® (1.13g) and Osteogen® (2.70g). No significant differences (p>0.05). Were found for the influence of these mean amounts in graft maintenance: Bio-Oss Small® (18); Bio-Oss Large® (10); Endobon® (17); BoneCeramic®+Emdogaim® (10); Cerasorb® (11); and Osteogen® (08) at V1 and V2. However, when biomaterials were categorized by intervals, all Cerasorb® interval groups showed statistically significant differences (p<0.001) in graft volume at V2. The amounts of the biomaterials used could influence the final volume; depending on the biomaterial characteristics. Implant installation was possible with all studied grafts, although graft volume shrinkage should be considered when selecting biomaterial for sinus lift

Molecular basis of the non-classical hereditary hemochromatosis in Portugal

A Hemocromatose Hereditária (HH) é uma doença autossómica recessiva caracterizada pela absorção excessiva de ferro a nível intestinal e sua acumulação em órgãos vitais, podendo originar cardiomiopatia, cirrose e carcinoma hepatocelular. O correspondente diagnóstico molecular é obtido pela associação com genótipos específicos no gene HFE (homozigotia para p.Cys282Tyr ou heterozigotia composta p.Cys282Tyr/p.His63Asp). Contudo, nos países do sul da Europa, cerca de um terço dos doentes com diagnóstico clínico de HH não apresenta os referidos genótipos. Para identificar a base molecular da HH não-clássica em Portugal usaram-se metodologias de pesquisa geral de variantes genéticas (SSCP e dHPLC), Next-Generation Sequencing (NGS) e sequenciação de Sanger, cobrindo seis genes relacionados com o metabolismo do ferro em 303 doentes. Identificaram-se 69 variantes diferentes e de vários tipos, por ex. missense, nonsense, de splicing, que perturbam a transcrição do gene ou a regulação da tradução do mRNA. Seguidamente, realizaram-se estudos in silico e in vitro para esclarecer o significado etiológico de algumas das novas variantes. Concluiu-se que a base molecular desta patologia é bastante heterogénea e que a NGS é uma ferramenta adequada para efetuar a análise simultânea dos vários genes num grande número de amostras. Contudo, o estabelecimento da relevância clínica de algumas variantes requer a realização de estudos funcionais.Hereditary Hemochromatosis (HH) is an autosomal recessive disorder characterized by excessive intestinal iron absorption and deposition in vital organs leading to cardiac failure, cirrhosis and hepatocellular carcinoma. Molecular diagnosis of common HH is made by the presence of specific genotypes in HFE gene (p.Cys282Tyr homozygosity or p.Cys282Tyr/p.His63Asp compound heterozygosity). However, in Southern European countries up to one third of the patients with a clinical diagnosis of HH do not have these genotypes. In order to identify the molecular basis of the non-classical HH in Portugal, we used genetic screening methods for the detection of unknown mutations (SSCP and dHPLC), Next-Generation Sequencing (NGS) and/or Sanger sequencing in six HH-related genes in 303 patients. Sixty-nine different variants were identified, including missense, nonsense and splicing variants, and variants that impair gene transcription or mRNA translation regulation. In silico and in vitro studies were performed to know the likely etiologic significance of some of the novel variants found. We can conclude that the molecular basis of the non-classical HH in Portuguese population is largely heterogeneous. NGS revealed to be an appropriate tool for fast analysis of the HH-related genes in a large number of samples. However, establishing the clinical relevance of some novel variants requires further functional studies

Victims profile in function of motorcycle engine potency and assisted by the Fire Department of Uberlândia, Brazil

Introduction: Traffic accidents are a global issue, especially in emerging countries, resulting in a high number of deaths and significant social and economic expenditures with victims. Motorcycle accidents stand out mainly by its greater vulnerability, and studies relating bike engine potency and accidents are still rare. Objective: To trace the profile of victims involved in motorcycle accidents as a function of motorcycle power that were assisted by the Fire Department in Uberlândia, Brazil.&nbsp; Methodology: A transversal, retrospective, analytic and quantitative study, based on a public database. Twelve thousand nine hundred occurrence reports were retrospectively analyzed between 2015 and 2018 in the Integrated System of Social Defense from the Military Fire Department of Minas Gerais state database. Variables that allowed accident characterization were collected (such as motorcycle conductor or passenger and from the accident itself) and were compared in function of the motorcycle power or engine potency (less than 250 CC as low and more than 250 CC as high).&nbsp; Results: There was a lack of information in reports about the accident and even greater lack about the injured person, ranging from 0% to 52%. The predominance of accidents was with motorcycles below 250 CC. The values of severity and clinical data scores were not different between engine potency categories, except for the heart frequency of the injured, with a median of 82 and 80 beats for high and low engine potency, respectively. A greater frequency of accidents involving men, single, with higher education conducting motorcycles over 250 CC, involved in falls, with occurrence between 18:01 and 24:00 hours was noted. However, accidents occurred mostly with small-sized vehicles and motorcycles and did not differ between days of the week. Accidents showed a spatial pattern where most accidents occurred downtown and, consequently, in more commercial regions, with no major differences in engine potency.&nbsp; Conclusion: Even though accident severity did not differ between engine potency categories, the profile of participants showed some differences. This information, along with more complete and broader data in the reports, can offer subsides for more assertive public policy implementation to mitigate traffic accidents

Primary melanoma of the oral cavity:a multi-institutional retrospective analysis in Brazil

Melanoma is an aggressive malignant tumor, rarely observed in the oral cavity. The aim of this study was to describe the clinicopathologic features of a series of oral melanomas. A retrospective descriptive study was performed. A total of 15,482 biopsy records from two oral and maxillofacial pathology services in Brazil were analyzed. All cases of oral melanomas were reviewed, and clinical, demographic, histopathological data, treatment, and follow-up status were collected. In addition, immunohistochemistry stains (pan-cytokeratin AE1/AE3, vimentin, ?-SMA, CD45, S-100 protein, HMB-45, Melan A, and Ki-67) were performed. The series comprised of 5 males (71.4%) and 2 females (28.6%), with a mean age of 58.0 ± 9.2 years (range: 45-69 years) and a 2.5:1 male-to-female ratio. The gingiva (n = 3, 42.8%) and hard palate (n = 2, 28.6%) were the most common affected sites, presenting clinically as ulcerated swellings with a brown to black color. Cervical lymph node metastasis was detected in three patients during the first examination. Microscopically, 6 cases (85.7%) were melanotic, and one (14.3%) was amelanotic. Most cases (n = 4, 57.1%) presented a predominance of epithelioid cells. S-100 and HMB-45 were positive in all cases (n = 7, 100.0%). In contrast, only 4 cases (57.1%) were positive for Melan-A. The proliferative index with Ki-67 was high, with labeling index ranging from 70.0% to more than 90% of positive cells. Five patients died from complications of the tumors after a mean follow-up period of 7.8 months. Melanoma is an aggressive malignant tumor that rarely occurs in the oral cavity. It occurs mainly in adult and elderly patients and often is diagnosed in advanced stages. The current findings were similar to previous studies and reflected the characteristics of the services from where lesions were retrieved

Novas evidências na abordagem terapêutica das infecções do trato urinário (ITUs) em mulheres

No mundo, as infecções do trato urinário (ITUs) acometem em torno de 150 milhões de pessoas a cada ano. Ademais, as ITUs representam uma importante causa de morbidade em aproximadamente 10 a 20% das mulheres com idade entre 25 e 80 anos, acometendo em uma proporção de 8 mulheres para cada homem. O presente estudo de revisão buscou avaliar novas evidências na abordagem terapêutica das ITUs em mulheres, documentadas por meio de estudos clínicos e randomizados. Trata-se de uma pesquisa de revisão integrativa realizada por meio da base de dados PubMed, que levou em consideração os seguintes critérios de inclusão: ensaios clínicos e testes controlados e aleatórios; artigos publicados no último ano; que possuíam texto completo disponível e que abordassem acerca da terapêutica das ITUs em mulheres. Ficou constatado que a fosfomicina figura como opção de tratamento antibiótico oral adicional para casos de ITU na população feminina. Além disso, a diminuição potencial do impacto ecológico que a fosfomicina pode exercer sobre casos de ITU MDR é alvo para novos estudos. Já em relação às terapias não antibióticas, o hipurato de metenamina, produtos do cranberry, como as proantocianidinas de cranberry, sozinho ou combinado com antibióticos, além da uva ursi (UU) e do estrogênio vaginal são terapêuticas que mostraram benefícios nos casos de ITU ou ITU recorrente, mas que continuam sendo alvo para estudos potenciais futuros

Minas esgotada : antecedentes e impactos do desastre da Vale na Bacia do Paraopeba

-A obra oferece um panorama das questões sociais e ambientais ligadas à mineração em Minas Gerais, trazendo os sujeitos e a paisagem como protagonistas da narrativa. Ela reúne autores que assumem a responsabilidade social do fazer científico, analisando a assimetria de poder, o jogo político, os antecedentes e consequências ambientais do rompimento da barragem da Vale S.A no Complexo Paraopeba II, em 2019. Os textos transitam entre esforços teórico-reflexivos e aproximações empíricas; nascem do histórico de engajamento dos pesquisadores com a problemática da mineração e questões socioambientais, adornado por sucessivos trabalhos de campo e contatos com a população atingida