A rare case of a maxillary fourth molar: Case report

Introdução: O objetivo deste relato de caso clínico é descrever a presença de quarto molares bilaterais. A ocorrência de dentes supranumerários (ST) é uma anomalia dentária relativamente incomum. É ainda mais incomum encontrar pacientes com dentes distomolares também denominados dentes do quarto molar.  Apresentação do caso: Este artigo descreve um caso clínico de um paciente de 24 anos que apresentava quarto molar superior, diagnosticado por radiografia dentária, e resolução cirúrgica do caso. Conclusão: A cirurgia de extração dentária foi o procedimento clínico escolhido para tratar o dente impactado.Introduction: The objective of this clinical case report is to describe the presence of bilateral fourth molars. The occurrence of supernumerary teeth (ST) is a relatively unusual dental anomaly., It is even more unusual to find patients with distomolar teeth also denominated fourth molar teeth. Presentation of the case: This article describes a clinical case of a 24-year-old patient presenting with a maxillary fourth molar, who was diagnosed by dental x-ray, and surgical resolution of the case. Conclusion: Tooth extraction surgery was the clinical procedure chosen to treat the impacted tooth

The right to scientific information: one of the main elements of the unified health system

 Citizen care in the health field is a fundamental right provided by the federal constitution of Brazil. The Unified Health System (SUS) is one of the best and most important systems in the world and serves around 220 million people. The System is comprehensive and characterized by three pillars of support: universality, completeness and equity. The right to scientific information is one of the main elements of the SUS and the Journal of Human Growth and Development has contributed over its 27 years of existence providing a democratic scenario and a place to debate ideas in the field of public health and the irrefutable defence of SUS in Brazil. In this way, JHGD maintains its tradition of publishing articles devoted to the field of public health and contributing to the dissemination of knowledge and to the progress of science. The Journal intends to serve as a space for exchange knowledge among professionals in universities and help them to deal with the problems of human growth and development, improving the publication scenario of scientific articles refereed by peers, highlighting its commitment to communicate the knowledge obtained through ethic research with bilingual and free publications.The Citizen care in the health field is a fundamental right provided by the federal constitution of Brazil. The Unified Health System (SUS) is one of the best and most important systems in the world and serves around 220 million people. The System is comprehensive and characterized by three pillars of support: universality, completeness and equity. The right to scientific information is one of the main elements of the SUS and the Journal of Human Growth and Development has contributed over its 27 years of existence providing a democratic scenario and a place to debate ideas in the field of public health and the irrefutable defence of SUS in Brazil. In this way, JHGD maintains its tradition of publishing articles devoted to the field of public health and contributing to the dissemination of knowledge and to the progress of science. The Journal intends to serve as a space for exchange knowledge among professionals in universities and help them to deal with the problems of human growth and development, improving the publication scenario of scientific articles refereed by peers, highlighting its commitment to communicate the knowledge obtained through ethic research with bilingual and free publication

Modulação autonomica cardíaca na artrite idiopática juvenil com uso de medicação biológica: relato de caso

Introduction: The introduction of biological medication in Juvenile Idiopathic Arthritis (JIA) proposes better therapeutic results with decreased pain and inflammation and consequent reduction in joint damage. The autonomic state can be a predictor for verifying the response to immunomodulation therapy. Thus, measuring heart rate variability can express autonomous behavior and possibly accompany the response to therapy through the expression of the inflammatory condition. Objective: Analysis of heart rate variability in a child with Juvenile Idiopathic Arthritis using the anti-Tumor Necrosis Factor. Methods: This is a clinical case report of an 8-year-old male with a diagnosis of JIA - oligoarticular form, using etanercept, admitted to Clínica Escola de Fisioterapia UNINORTE, Acre, Brazil in 2017. We analyzed laboratory and imaging tests, kinetic-functional evaluation, examination of cardiac autonomic modulation and physiotherapeutic treatment for analgesic, anti-inflammatory purposes, gaining flexibility, strength and postural re-education, according to CARE guidelines, case report guidelines. Results: After medication administration, there was a decrease in pain and normalization of serum creatinine (0.50 mg / dL) and CRP (less than 6 mg / dL) and an increase in erythrocyte sedimentation rate (17 mm3). In the examination of heart rate variability, the linear indices in the time domain showed a predominance of parasympathetic activity (RMSSD: 35ms), with decreased sympathetic control measured through the frequency domain (LF: 27.1 un). However, non-linear methods showed low variability with little dispersion of RR intervals. Conclusion: In the present report, the linear indices showed parasympathetic predominance and in the non-linear analysis a low heart rate variability with abnormal and insufficient adaptation of the autonomic nervous system in a child with juvenile idiopathic arthritis using biological medication.Introdução: A introdução de medicamentos biológicos na Artrite Idiopática Juvenil (AIJ) propõe melhores resultados terapêuticos com diminuição da dor e inflamação e consequente redução no dano articular. O estado autonômico pode ser um preditor para verificar a resposta à terapia de imunomodulação. Assim, medir a variabilidade da frequência cardíaca pode expressar um comportamento autônomo e possivelmente acompanhar a resposta à terapia através da expressão da condição inflamatória.  Objetivo: Análise da variabilidade da frequência cardíaca em uma criança com artrite idiopática juvenil utilizando o Fator de Necrose Tumoral.  Método: Este é um relato de caso clínico de um homem de 8 anos com diagnóstico de AIJ - forma oligoarticular, usando etanercept, admitido na Clínica Escola de Fisioterapia UNINORTE, Acre, Brasil em 2017. Analisamos testes laboratoriais e de imagem, cinéticos - avaliação funcional, exame da modulação autonômica cardíaca e tratamento fisioterapêutico para fins analgésicos e antiinflamatórios, ganhando flexibilidade, força e reeducação postural, de acordo com as diretrizes da CARE, diretrizes de relato de caso.  Resultados: Após a administração da medicação, houve diminuição da dor e normalização da creatinina sérica (0,50 mg/dL) e PCR (menos de 6 mg/dL) e aumento da taxa de sedimentação de eritrócitos (17 mm3). No exame da variabilidade da frequência cardíaca, os índices lineares no domínio do tempo mostraram predominância da atividade parassimpática (RMSSD: 35ms), com diminuição do controle simpático medido pelo domínio da frequência (LF: 27,1 un). Entretanto, métodos não lineares apresentaram baixa variabilidade com pouca dispersão dos intervalos RR.  Conclusão: No presente relatório, os índices lineares mostraram predominância parassimpática e, na análise não linear, baixa variabilidade da frequência cardíaca com adaptação anormal e insuficiente do sistema nervoso autônomo em criança com artrite idiopática juvenil em uso de medicação biológica

Oral Sensorimotor System in Patients with Facial Lipoatrophy Living with AIDS

Introduction: Lipodystrophy Syndrome in people living with AIDS is characterized by body fat redistribution and metabolic abnormalities and is associated with the use of antiretroviral therapy (ART). It is socially and psychologically impacting once it reduces the quality of life of those who develop it. The prevalence varies from 6% to 69%.Objective: Characterize the Oral Sensorimotor System in patients with Facial Lipoatrophy living with AIDS.Methods: Cross-sectional convenience sample study. Sixty-four patients living with AIDS treated in the Lipodystrophy Clinic were clinically evaluated by the infectious disease physician and by the speech language pathologist. The Oral Sensorimotor System structures were evaluated through the Orofacial Assessment Protoco.Results: Changes in tone and mobility are associated with loss of subcutaneous fat.Conclusions: Changes presented in the morphology and function of the Oral Sensoriomotor System are associated with facial Lipoatrophy in patients living with AIDS

Factors associated with the delay in seeking legal abortion for pregnancy resulting from rape

AbstractBackground: about 7% of rape cases in Brazil result in pregnancy. Brazilian  women generally are unaware of the right to legal interruption of pregnancy  after rape and try to end abortion in an unsafe manner or last to request the  procedure. Objective: to analyse factors associated with the time of seeking  legal abortion after rape in a public hospital. Methods: this is an observational,  analytical, and cross-sectional study. Data are from medical records of 1,270  women who complained of rape and have requested legal abortion in a public  hospital in São Paulo between 1994 and 2013. The variables age, education,  race, marital status, religion, form of intimidation, vulnerable condition,  perpetrator of sexual violence, number of perpetrators, and police report were analysed in relation to gestational age, according to multiple multinomial logistic  regression models. Results: the delay in requesting abortion at intermediate  gestational age is associated to when a woman is vulnerable (p=0.015), late  gestational age is associated with the presence of a police report (p=0.029) and 48 marital status as ngle (p=0.05). Be a relative of the aggressor is associated with  both intermediate (p=0.016) and late gestational age (p=0.002). Conclusions:  women without partners, who suffered intimidation with threats, in a vulnerable  condition, who made a police report and, above all, who were raped by relatives,  composed the group who took longer to get the health service.Keywords: sexual violence; rape; unwanted pregnancy; legal abortio

The Lipodystrophy Syndrome as a Risk Marker for Cardiovascular Disease in Patients with HIV/AIDS Treated with HAART

Introduction: The classic risk factors for cardiovascular disease in healthy individuals are well known, however, it lacks in the literature the mechanisms that predicts cardiovascular disease in the population living with HIV-AIDS treated with HAART and presenting syndrome lipodystrophy. We aimed to investigate the risk of cardiovascular disease in HIV-AIDS patients treated with HAART and lipodystrophy syndrome. Methods: A search was performed in Medline, SciELO, Lilacs and Cochrane using the intersection between the keywords: "cardiovascular disease", "HIV", "AIDS", "HAART" and "lipodystrophy syndrome". Results: The selected studies demonstrated that metabolic disorders such as hyperlipidemia, central adipose hypertrophy and peripheral lipoatrophy, besides the metabolic syndrome and lipodystrophy are maker clear risks of developing cardiovascular disease in these individuals. Conclusion: The metabolic alterations in HIV-AIDS treated with HAART and presenting lipodystrophy syndrome may potentiate the development of cardiovascular diseases

A síndrome de lipodistrofia - um marcador de risco para doença cardiovascular em indivíduos com HIV-AIDS

Introduction: Highly-active antiretroviral therapy (HAART) has developed significant advance in the treatment of HIV/AIDS patients and so it acquired chronic disease characteristics. After HAART, several changes were observed such as lipodystrophy syndrome (LS), autonomic dysfunctions and metabolic imbalances, which greatly increases the risk of cardiovascular disease. Objective: Evaluate whether the lipodystrophy syndrome in individuals with HIV / AIDS is a risk marker for cardiovascular disease. Method: This is a cross-sectional study of a convenience sample, which analyzed 144 HIV/AIDS adult patients attended in a specialized service in a city of Greater Sao Paulo, Brazil, of which 72 have LS, The other patients (72) who have HIV/AIDS, however without that syndrome were used as control group. All patients are immunologically controlled and without clinical cardiovascular manifestations. We used the Framingham risk score and the characterization of metabolic syndrome for the assessment of cardiovascular risk of metabolic condition. In addition we performed the linear analysis of time and frequency indices of heart rate variability to access the cardiac autonomic modulation. We used Student's t and unpaired Mann-Whitney test. Was considered as significant values p<0.05. Results: After the criteria of inclusion and exclusion, the final sample consisted of 81 patients divided into the two groups. According to Framingham risk score, the cardiovascular risk was considerated from moderate to high in 46.59% of patients of experimental group and 14.29% of the control group. According to the definition of the NCEP-ATPIII, metabolic syndrome was observed in 54.76% of experimental group and 35.90% of control group. Finally the analysis of HRV showed statistically lower in the experimental group in LF (ms2), HF (ms2) and SDNN (ms2) indices compared to control group. Conclusion: Patients with HIV / AIDS and LS had higher cardiovascular risk compared with those without the syndrome. Lipodystrophy gives to HIV / AIDS patients a phenotype that identifies them and it is characterized as a cardiovascular risk marker.Introdução: A terapia antirretroviral, especialmente a altamente ativa (HAART), desenvolveu significativo avanço para o tratamento de pessoas que vivem com AIDS, e por isso a doença adquiriu características de moléstia crônica. Após a introdução da HAART, várias alterações foram observadas tais como a síndrome da lipodistrofia (SL), além de desajustes metabólicos e disfunções autonômicas. Objetivo: Avaliar se a síndrome da lipodistrofia em indivíduos com HIV/AIDS constitui marcador de risco para a doença cardiovascular. Método: Trata se de um estudo transversal, por amostragem de conveniência em que foram analisados 144 pacientes adultos, que vivem com HIV/AIDS em seguimento no ambulatório especifico no serviço de referência do Programa Municipal de DST/AIDS da Prefeitura de São Bernardo do Campo (PM-DST/AIDS-PSBC). Destes, 72 eram pacientes adultos que apresentavam a SL. Foram considerados também outros 72 pacientes adultos seguidos no referido ambulatório e que viviam com AIDS sem a SL e compuseram o grupo controle, todos controlados imunologicamente e sem manifestações clínicas de envolvimento cardiovascular. Foi utilizado escore de risco de Framingham e a caracterização de Síndrome Metabólica para a avaliação do risco cardiovascular. A análise da modulação autonômica foi realizada por intermédio dos índices de variabilidade da frequência cardíaca (VFC) com análise linear [nos domínios do tempo (DT) e da frequência (DF)]. Para análise dos dados, foram utilizados Teste T de Student não pareado e Mann-Whitney. Considerou-se como significante p<0,05. Resultados: Após critérios inclusão/exclusão, dos 144 pacientes recrutados, a amostra final constituiu-se de 81 pacientes que foram subdivididos e integraram dois grupos. De acordo com o escore de Framingham, o risco cardiovascular era moderado a alto em 46,59% dos pacientes do grupo com SL e 14,29% dos pacientes grupo sem a SL. De acordo com a definição do NCEP-ATPIII, a síndrome metabólica foi observada em 54,76% nos pacientes do grupo sem a SL e 35,90% dos pacientes com a SL. A analise da VFC demonstrou menor variabilidade estatisticamente nos pacientes com SL nos Indexes: LF(ms2), HF(ms2) e SDNN(ms2), em relação ao grupo sem a SL. Conclusão: Apresentaram maior risco cardiovascular os indivíduos que vivem com HIV/AIDS e com a SL quando comparados aos que não apresentavam a síndrome. A lipodistrofia confere aos 20 sujeitos com HIV/AIDS um fenótipo que os identifica e caracteriza como marcador de risco cardiovascular.Dados abertos - Sucupira - Teses e dissertações (2013 a 2016

Correction: Heart rate variability helps to distinguish the intensity of menopausal symptoms: A prospective, observational and transversal study.

[This corrects the article DOI: 10.1371/journal.pone.0225866.]

Prevalence of burnout syndrome in clinical nurses at a hospital of excellence

Background: Burnout syndrome can be defined as long-term work stress resulting from the interaction between constant emotional pressure associated with intense interpersonal involvement for long periods of time and personal characteristics. We investigated the prevalence/propensity of Burnout syndrome in clinical nurses, and the factors related to Burnout syndrome-associated such as socio-demographic characteristics, work load, social and family life, leisure activities, extra work activities, physical activities, and work-related health problems. Method: We conducted a cross-sectional, quantitative, prospective epidemiological study with 188 surgical clinic nurses. We used the Maslach Burnout Inventory (MBI), which is a socio-demographic questionnaire and the most widely used instrument to assess Burnout syndrome (three basic dimensions: emotional exhaustion, despersonalization and professional underachievement). The socio-demographic profile questionnaire wascomposed of questions regarding identification, training, time at work, work characteristics and personal circumstances. Results: The prevalence of Burnout syndrome was higher (10.1%) and 55, 4% of subjects had a propensity to develop this syndrome. The analysis of the socio-demographic profile of the nurse sample studied showed that most nurses were childless married women, over 35 years of age, working the day shift for 36 hours weekly on average, with 2-6 years of post-graduation experience, and without extra employments. Factors such as marital status, work load, emotion and work related stress aggravated the onset of the syndrome. Conclusion: The prevalence and propensity of Burnout syndrome were high. Some factors identified can be useful for the adoption of preventive actions in order to decrease the prevalence of the clinical nurses Burnout syndrome