Aptidão funcional e qualidade de vida de idosos praticantes de Lian Gong, Tai Chi e Qigong / Aptitud funcional y calidad de vida de adultos mayores que practican Lian Gong, Tai Chi y Qigong / Functional fitness and quality of life of elderly Lian Gong, Tai Chi and Qigong practitioners

Resumo Objetivo Comparar a aptidão funcional e as dimensões da qualidade de vida de idosos participantes e não participantes das práticas orientadas Lian Gong, Tai Chi e Qigong. Métodos Estudo caso-controle, desenvolvido no município de São Paulo - SP, Brasil, com 118 idosos, pareados por sexo e idade: 59 no grupo caso, participantes das práticas corporais, divididos em subgrupos por tempo de adesão:< 24 meses e ≥ 24 meses; e 59 no grupo controle, não participantes das práticas. Para a coleta de dados, aplicaram-se: questionário com variáveis sociodemográficas e de saúde, testes funcionais e o instrumento Medical Outcomes Study 36- Item Short-Form Health Survey (SF36). As análises estatísticas foram realizadas com o programa R versão 3.3.2. Os dados foram inicialmente analisados de forma descritiva e, em seguida, efetuou-se regressão logística univariada e o teste Kruskal Wallis. Os aspectos éticos da pesquisa com seres humanos foram obedecidos. Resultados Verificou-se que, no grupo caso, idosos com tempo de adesão às práticas ≥ 24 meses apresentaram resultado superior no teste funcional de levantar e sentar da cadeira (p=0,006), bem como melhor desempenho nos seguintes domínios da qualidade de vida: dor (p= 0,003), vitalidade (p=0,021), aspectos emocionais (p=0,034) e saúde mental (p=0,020). Conclusão A participação nas práticas corporais, orientadas, Lian Gong, Tai Chi e Qigong pode contribuir para a qualidade de vida e a aptidão funcional de idosos.

Resumen Objetivo Comparar la aptitud funcional y las dimensiones de la calidad de vida de adultos mayores que participan y que no participan en prácticas orientadas Lian Gong, Tai Chi y Qigong. Métodos Estudio caso-control, realizado en el municipio de São Paulo - estado de São Paulo, Brasil, con 118 adultos mayores, pareados por sexo y edad: 59 en el grupo caso, participantes de las prácticas corporales, divididos en subgrupos por tiempo de participación: < 24 meses y ≥ 24 meses; y 59 en el grupo control, no participantes de las prácticas. Para la recopilación de datos, se aplicó un cuestionario con variables sociodemográficas y de salud, pruebas funcionales y el instrumento Medical Outcomes Study 36- Item Short-Form Health Survey (SF36). Los análisis estadísticos se realizaron con el programa R versión 3.3.2. Los datos se analizaron inicialmente de forma descriptiva y, a continuación, se realizó regresión logística univariada y la prueba de Kruskal Wallis. Los aspectos éticos de la investigación con seres humanos fueron cumplidos. Resultados Se verificó que, en el grupo caso, los adultos mayores con tiempo de participación en las prácticas ≥ 24 meses presentaron un resultado superior a la prueba funcional de levantarse y sentarse en la silla (p=0,006), como también un mejor desempeño en los siguientes dominios de calidad de vida: dolor (p= 0,003), vitalidad (p=0,021), aspectos emocionales (p=0,034) y salud mental (p=0,020). Conclusión La participación en las prácticas corporales orientadas Lian Gong, Tai Chi y Qigong puede contribuir para la calidad de vida y para la aptitud funcional de adultos mayores.

Abstract Objective To compare functional fitness and quality of life dimensions of elderly participants and non-participants of Lian Gong, Tai Chi and Qigong guided practices. Methods This is a case-control study, carried out in the city of São Paulo, SP, Brazil, with 118 elderly people, matched by sex and age: 59 in the case group, participants in body practices, divided into subgroups by time of compliance: < 24 months and ≥ 24 months; and 59 in the control group, non-participants in body practices. For data collection, the following were applied: a questionnaire with sociodemographic and health variables, functional tests and the Medical Outcomes Study 36- Item Short-Form Health Survey (SF-36). Statistical analyzes were performed using R version 3.3.2. The data were initially analyzed in a descriptive way and, then, a univariate logistic regression and the Kruskal Wallis test were performed. The ethical aspects of research with human beings were obeyed. Results It was found that, in the case group, elderly people with a time of compliance with practices ≥ 24 months showed a superior result in the functional 30-second chair stand test (p=0.006), as well as better performance in the following quality of life domains: bodily pain (p=0.003); vitality (p=0.021); role emotional (p=0.034); and mental health (p=0.020). Conclusion Participation in guided body practices, Lian Gong, Tai Chi and Qigong, can contribute to elderly people's quality of life and functional fitness.

Human Placenta Simulator for Intracranial-Intracranial Bypass: Vascular Anatomy and 5 Bypass Techniques.

BACKGROUND: Intracranial-intracranial (IC-IC) bypass surgery involves the use of significant technical bimanual skills. Indications for this procedure are limited, so training in a simulator with brain vessels similarity could maintain microsurgical dexterity. Our goal is to describe the human placenta vascular anatomy to guide IC-IC bypasses apprenticeship. METHODS: Human placenta vascular anatomy was reported and validated with comparison to brain main vessels after studying the vascular tree of 100 placentas. Five simulated IC-IC bypasses (end to end, end to lateral, lateral to lateral, aneurysm bridge, and aneurysm exiting branch transposition) were developed and construct and concurrent validated. Statistical analysis using the t variance test was performed with a confidence interval of 0.95. RESULTS: A total of 1200 placenta vessels were used for test-retest validation with a reliability index of 0.95. All 100 human placentas were suitable to perform the 5 different bypasses. Construct validity showed a P < 0.005. Concurrent validity highlighted the technical differences among simulators. CONCLUSIONS: An ex vivo bypass model offers great similarity to main brain vessels with the possibility to practice a variety of IC-IC bypass techniques in a single simulator. Placenta vascular anatomy knowledge can improve laboratory microsurgical training.

Physical activity program for elderly and economy for the health system / Programa de atividade física para idosos e economia para o sistema de saúde

ABSTRACT Objective: To evaluate the impact of physical activity on the use of the health system and the quality of life in sedentary elderly. Methods: A prospective interventional study was carried out between March 2010 and February 2011 with 100 subjects (60-90 years of age,) divided into active group (AG) and control group (CG). During this period, AG performed physical exercise twice a week in 60-minute sessions and the CG remained sedentary with observation of their activities. Before and after the study, all subjects were clinically evaluated and completed a quality of life questionnaire. Results: Eighty-nine subjects (AG = 44; CG = 45) were analyzed. AG had fewer visits to emergency room (p = 0.0056), hospitalizations (p = 0.0011), length of hospital stay (p = 0.0012) and fewer subsidiary tests (p = 0.0236) compared to the CG. The quality of life score analyzed before and after physical activity increased in AG compared to CG (p < 0.0001) and among subjects in AG (p < 0.0001), with no change in the CG. Conclusion: The intervention of a physical activity program for sedentary elderly can contribute to reduce the use of the health system and improve the quality of life. Level of evidence II, Therapeutics Studies. Prospective comparative study.

RESUMO Objetivo: Avaliar o impacto da atividade física sobre o uso do sistema de saúde e a qualidade de vida em idosos sedentários. Métodos: Estudo prospectivo intervencionista (março/2010 a fevereiro/2011) com 100 indivíduos (mín. 60 e máx. 90 anos de idade), divididos em grupo ativo (GA) e grupo controle (GC). Nesse período, o GA realizou exercício físico duas vezes por semana, em sessões de 60 minutos e o GC permaneceu sedentário, com observação de suas atividades. Antes e depois do estudo, todos os indivíduos foram avaliados clinicamente e responderam a um questionário de qualidade de vida. Resultados: Foram analisados 89 indivíduos (44 no GA, e 45 no GC). O GA teve menor número de visitas ao pronto-socorro (p = 0,0056), internações (p = 0,0011), tempo de internação (p = 0,0012) e de exames subsidiários realizados (p = 0,0236) comparado com o GC. O escore de qualidade de vida, analisado pré e pós-atividade física apresentou aumento no GA em comparação com o GC (p < 0,0001) e entre os indivíduos do próprio GA (p < 0,0001), não havendo alteração no GC. Conclusão: A intervenção de um programa de atividade física para idosos sedentários pode contribuir para reduzir a utilização do sistema de saúde e melhorar a qualidade de vida. Nível de Evidência II, Estudos terapêuticos. Estudo prospectivo comparativo.

Learning brain aneurysm microsurgical skills in a human placenta model: predictive validity.

OBJECTIVE Surgery for brain aneurysms is technically demanding. In recent years, the process to learn the technical skills necessary for these challenging procedures has been affected by a decrease in the number of surgical cases available and progressive restrictions on resident training hours. To overcome these limitations, surgical simulators such as cadaver heads and human placenta models have been developed. However, the effectiveness of these models in improving technical skills is unknown. This study assessed concurrent and predictive validity of brain aneurysm surgery simulation in a human placenta model compared with a "live" human brain cadaveric model. METHODS Two human cadaver heads and 30 human placentas were used. Twelve neurosurgeons participated in the concurrent validity part of this study, each operating on 1 human cadaver head aneurysm model and 1 human placenta model. Simulators were evaluated regarding their ability to simulate different surgical steps encountered during real surgery. The time to complete the entire aneurysm task in each simulator was analyzed. The predictive validity component of the study involved 9 neurosurgical residents divided into 3 groups to perform simulation exercises, each lasting 6 weeks. The training for the 3 groups consisted of educational video only (3 residents), human cadaver only (3 residents), and human placenta only (3 residents). All residents had equivalent microsurgical experience with superficial brain tumor surgery. After completing their practice training, residents in each of the 3 simulation groups performed surgery for an unruptured middle cerebral artery (MCA) aneurysm, and their performance was assessed by an experienced vascular neurosurgeon who watched the operative videos. RESULTS All human cadaver heads and human placentas were suitable to simulate brain aneurysm surgery. In the concurrent validity portion of the experiment, the placenta model required a longer time (p < 0.001) than cadavers to complete the task. The placenta model was considered more effective than the cadaver model in simulating sylvian fissure splitting, bipolar coagulation of oozing microvessels, and aneurysm neck and dome dissection. Both models were equally effective in simulating neck aneurysm clipping, while the cadaver model was considered superior for simulation of intraoperative rupture and for reproduction of real anatomy during simulation. In the predictive validity portion of the experiment, residents were evaluated for 4 tasks: sylvian fissure dissection, microvessel bipolar coagulation, aneurysm dissection, and aneurysm clipping. Residents trained in the human placenta simulator consistently had the highest overall performance scores when compared with those who had trained in the cadaver model and those who had simply watched operative videos (p < 0.001). CONCLUSIONS The human placenta biological simulator provides excellent simulation for some critical tasks of aneurysm surgery such as splitting of the sylvian fissure, dissection of the aneurysm neck and dome, and bipolar coagulation of surrounding microvessels. When performing surgery for an unruptured MCA aneurysm, residents who had trained in the human placenta model performed better than residents trained with other simulation scenarios/models. In this age of reduced exposure to aneurysm surgery and restrictions on resident working hours, the placenta model is a valid simulation for microneurosurgery with striking similarities with real surgery.

Automated Inclusion Microanalysis in Steel by Computer-Based Scanning Electron Microscopy: Accelerating Voltage, Backscattered Electron Image Quality, and Analysis Time.

Automated inclusion microanalysis in steel samples by computer-based scanning electron microscopy provides rapid quantitative information on micro-inclusion distribution, composition, size distribution, morphology, and concentration. Performing the analysis at a lower accelerating voltage (10 kV), rather than the generally used 20 kV, improves analysis accuracy and may improve spatial resolution, but at the cost of a smaller backscattered electron signal and potentially smaller rate of generation of characteristic X-rays. These effects were quantified by simulation and practical measurements.

Face, Content, and Construct Validity of Brain Tumor Microsurgery Simulation Using a Human Placenta Model.

BACKGROUND: Brain tumors are complex 3-dimensional lesions. Their resection involves training and the use of the multiple microsurgical techniques available for removal. Simulation models, with haptic and visual realism, may be useful for improving the bimanual technical skills of neurosurgical residents and neurosurgeons, potentially decreasing surgical errors and thus improving patient outcomes. OBJECTIVE: To describe and assess an ex vivo placental model for brain tumor microsurgery using a simulation tool in neurosurgical psychomotor teaching and assessment. METHODS: Sixteen human placentas were used in this research project. Intravascular blood remnants were removed by continuous saline solution irrigation of the 2 placental arteries and placental vein. Brain tumors were simulated using silicone injections in the placental stroma. Eight neurosurgeons and 8 neurosurgical residents carried out the resection of simulated tumors using the same surgical instruments and bimanual microsurgical techniques used to perform human brain tumor operations. Face and content validity was assessed using a subjective evaluation based on a 5-point Likert scale. Construct validity was assessed by analyzing the surgical performance of the neurosurgeon and resident groups. RESULTS: The placenta model simulated brain tumor surgical procedures with high fidelity. Results showed face and content validity. Construct validity was demonstrated by statistically different surgical performances among the evaluated groups. CONCLUSION: Human placentas are useful haptic models to simulate brain tumor microsurgical removal. Results using this model demonstrate face, content, and construct validity.

Assesment of the treatment of earlobe keloids with triamcinolone injections, surgical resection, and local pressure.

OBJECTIVE: To evaluate the combined treatment of ear lobe keloids. METHODS: We studied 46 consecutive patients with 81 ear lobe keloids. Patients underwent local infiltration of triamcinolone acetonide (TCN) at concentrations of 40 mg/ml (Group 1), 20 mg/ml (Group 2) and 10mg/ml (Group 3). The volume of TCN infiltrate varied according to the size of the lesion. Treatment consisted of three monthly injections before surgery, excision of keloid in the fourth month and perioperative infiltration, followed by two more leaks TCN within two months. Patients used earrings pressure on the scar after operation for four months. The pressure exerted by earrings in the ear lobe was measured electronically. Post-treatment follow-up of patients was 24 months. RESULTS: TCN at concentrations of 20mg/ml and 40 mg/ml were effective for the treatment of keloids, no difference between the groups (p = 0.58). However, patients in which TCN was infiltrated the 10mg/ml had poor involution of keloid and the study of this group was stopped. CONCLUSION: the combination of infiltration TCN month to 20 mg/mL (1.2mg to 2.0mg per mm3 TCN injury), surgical excision and pressure application device is effective for treatment of keloid ear lobe.

Assesment of the treatment of earlobe keloids with triamcinolone injections, surgical resection, and local pressure / Avaliação do tratamento de queloide do lóbulo da orelha com infiltração de triancinolona, retirada cirúrgica e compressão da cicatriz

OBJECTIVE: To evaluate the combined treatment of ear lobe keloids. METHODS: We studied 46 consecutive patients with 81 ear lobe keloids. Patients underwent local infiltration of triamcinolone acetonide (TCN) at concentrations of 40mg/ml (Group 1), 20 mg/ml (Group 2) and 10mg/ml (Group 3). The volume of TCN infiltrate varied according to the size of the lesion. Treatment consisted of three monthly injections before surgery, excision of keloid in the fourth month and perioperative infiltration, followed by two more leaks TCN within two months. Patients used earrings pressure on the scar after operation for four months. The pressure exerted by earrings in the ear lobe was measured electronically. Post-treatment follow-up of patients was 24 months. RESULTS: TCN at concentrations of 20mg/ml and 40mg/ml were effective for the treatment of keloids, no difference between the groups (p = 0.58). However, patients in which TCN was infiltrated the 10mg/ml had poor involution of keloid and the study of this group was stopped. CONCLUSION: the combination of infiltration TCN month to 20 mg/mL (1.2mg to 2.0mg per mm3 TCN injury), surgical excision and pressure application device is effective for treatment of keloid ear lobe.

OBJETIVO: avaliar o tratamento combinado do queloide do lóbulo da orelha. MÉTODOS: Foram estudados 46 pacientes consecutivos com 81 queloides de lóbulo da orelha. Os pacientes submeteram-se a infiltração local de triancinolona acetonida (TCN) nas concentrações de 40mg/ml (Grupo 1), 20mg/ml (Grupo 2) e 10mg/ml (Grupo 3). O volume de TCN infiltrado variou de acordo com o tamanho da lesão. O tratamento consistiu em três infiltrações mensais no pré-operatório, exérese do queloide no quarto mês e infiltração peroperatória, seguida de mais duas infiltrações de TCN nos dois meses seguintes. Os pacientes usaram brincos de pressão sobre a cicatriz após a operação durante quatro meses. A pressão exercida pelos brincos no lóbulo da orelha foi aferida eletronicamente. O seguimento pós-tratamento dos pacientes foi 24 meses. RESULTADOS: A TCN nas concentrações de 20mg/ml e 40mg/ml foram eficazes para o tratamento do queloide, sem diferença entre si (p=0,58). No entanto, os pacientes nos quais a TCN foi infiltrada a 10mg/ml não tiveram involução satisfatória do queloide e o estudo desse grupo foi interrompido. CONCLUSÃO: A combinação de infiltração mensal de TCN a 20mg/ml (1,2mg a 2,0mg de TCN por mm3 de lesão), exérese cirúrgica e aplicação de dispositivo de pressão é eficaz para tratamento do queloide de lóbulo da orelha.

Realidade virtual e estereoscopia no ensino da neuroanatomia e neurocirurgia / Virtual reality and stereoscopy for neuroanatomy and neurosurgery teaching

Objetivo: Por motivos diversos, o ensino da neuroanatomia durante a graduação médica e na residência de neurocirurgia é deficitário. Apresentamos a realidade virtual e a estereoscopia como eventuais métodos complementares de ensino à neuroanatomia e neurocirurgia. Método: Diversa gama de conteúdo digital interativo e estereoscópico foi produzida utilizando esterogramas de dissecações anatômicas. Resultados: A realidade virtual tenta melhor elaborar o ensino da neuroanatomia e neurocirurgia. Embora o trabalho verse sobre neuroanatomia e neurocirurgia, esses recursos podem ser empregados em qualquer área médica. Conteúdo anatômico de excelência foi adquirido e armazenado de modo que pôde ser manipulado por programa de realidade virtual e estereoscopia. Conclusão: A realidade virtual e a estereoscopia são ferramentas úteis no ensino e na aprendizagem da neuroanatomia e da neurocirurgia.

Objective: Because of numerous factors, neuroanatomy and microneurosurgical anatomy knowledge are insufficient during medical school and medical residency in neurosurgery. We present virtual reality and stereoscopy as eventual complementary teaching tools of neuroanatomy and neurosurgery. Method: A vast array of digital interactive and stereoscopic material has been created based on stereograms of real anatomical dissections. Results: The purpose of virtual reality is try to offer a better and more elaborate means for teaching neuroanatomy and neurosurgery. Although this paper has focused virtual reality and stereoscopy on neuroanatomy and neurosurgery, these tools can be applied to virtually all s of medicine. An excellent anatomical content has been collected and included in the virtual reality program, using stereoscopy. Conclusion: The virtual reality and stereoscopy are useful learning and teaching tools for neuroanatomy and neurosurgery.

[Epidemiology and economic impact of cervical cancer in Roraima, a Northern state of Brazil: the public health system perspective]. / Epidemiologia e impacto econômico do câncer de colo de útero no Estado de Roraima: a perspectiva do SUS.

PURPOSE: to evaluate the incidence and direct economic impact of cervical cancer (CC) in Roraima, in 2009, and to analyze the epidemiological profile of patients with this disease. METHODS: the histopathologic reports issued in Roraima in 2009 were reviewed, as were hospital records of female patients under treatment for cancer. Clinical data and medical procedures related to CC were recorded. CC carriers were treated under expenses of the public Brazilian health system (SUS) in Roraima underwent an interview dealing with socio-economic topics. RESULTS: we registered 90 cases of CC and high grade pre-invasive lesions. Roraima has the highest incidence of CC of Brazil (46.21 cases/100,000 women), which is 3 times higher than that of breast cancer, comparable to low-income developing countries. The epidemiological profile shows patients with economic deprivation, social disadvantage, low education, early first intercourse (mean age is 13.8 years), and high parity (medium of 5.5 gestations). Among the patients included in this report, 71.7% had never been submited to a Pap smear, and ignorance about it was the main reported reason (47.4%). As a public health problem, the management of CC generates direct annual expenditures of more than R$ 600,000, with an average cost per patient of R$ 8,711. CONCLUSIONS: CC is the most common cancer among women from Roraima, and represents a serious public health problem in Roraima. Its high economic impact favors the implementation of preventive strategies from the standpoint of cost-effectiveness. The profile of patients reveals the ineffectiveness of preventive services in reaching patients with a socio-economic exclusion profile at high risk for cervical cancer.

Epidemiologia e impacto econômico do câncer de colo de útero no Estado de Roraima: a perspectiva do SUS / Epidemiology and economic impact of cervical cancer in Roraima, a Northern state of Brazil: the public health system perspective

OBJETIVO: avaliar a incidência e o impacto econômico direto do câncer de colo de útero (CCU) em Roraima, no ano de 2009, e analisar o perfil epidemiológico e socioeconômico das pacientes portadoras dessa doença. MÉTODOS: os laudos histopatológicos emitidos em Roraima em 2009 foram revisados, assim como os prontuários de pacientes femininas em tratamento oncológico. Foram registrados dados clínicos e procedimentos médicos (terapêuticos e diagnósticos) realizados em pacientes portadoras de CCU no único centro de tratamento oncológico do Estado de Roraima. Portadoras de CCU tratadas no Sistema Único de Saúde (SUS) de Roraima foram submetidas a entrevista abordando temas socioeconômicos e fatores de risco. RESULTADOS: registramos 90 casos de CCU e lesões pré-malignas de alto grau. Roraima possui a maior incidência de CCU do Brasil (46,21 casos/100.000 mulheres), sendo 3 vezes mais incidente que o de mama e comparável a países subdesenvolvidos de baixa renda. O perfil epidemiológico revela pacientes com privação econômica, socialmente desfavorecidas, baixa escolaridade, sexarca precoce (média de 13,8 anos), multiparidade (média de 5,5 gestações). Das pacientes estudadas, 71,7 por cento nunca haviam realizado o teste de Papanicolaou, e o desconhecimento foi o motivo mais relatado (47,4 por cento). Como problema de saúde pública, o manejo do CCU gera gastos anuais diretos de mais de R$ 600 mil, com custo médio por paciente de R$ 8.711,00. CONCLUSÕES: o CCU é o câncer mais incidente em mulheres roraimenses e um grave problema de saúde pública no Estado. Seu elevado impacto econômico favorece a implantação de medidas preventivas do ponto de vista de custo-efetividade. O perfil da pacientes revela a ineficiência dos serviços preventivos em alcançar pacientes com perfil de exclusão socioeconômico e alto risco para o câncer de colo uterino.

PURPOSE: to evaluate the incidence and direct economic impact of cervical cancer (CC) in Roraima, in 2009, and to analyze the epidemiological profile of patients with this disease. METHODS: the histopathologic reports issued in Roraima in 2009 were reviewed, as were hospital records of female patients under treatment for cancer. Clinical data and medical procedures related to CC were recorded. CC carriers were treated under expenses of the public Brazilian health system (SUS) in Roraima underwent an interview dealing with socio-economic topics. RESULTS: we registered 90 cases of CC and high grade pre-invasive lesions. Roraima has the highest incidence of CC of Brazil (46.21 cases/100,000 women), which is 3 times higher than that of breast cancer, comparable to low-income developing countries. The epidemiological profile shows patients with economic deprivation, social disadvantage, low education, early first intercourse (mean age is 13.8 years), and high parity (medium of 5.5 gestations). Among the patients included in this report, 71.7 percent had never been submited to a Pap smear, and ignorance about it was the main reported reason (47.4 percent). As a public health problem, the management of CC generates direct annual expenditures of more than R$ 600,000, with an average cost per patient of R$ 8,711. CONCLUSIONS: CC is the most common cancer among women from Roraima, and represents a serious public health problem in Roraima. Its high economic impact favors the implementation of preventive strategies from the standpoint of cost-effectiveness. The profile of patients reveals the ineffectiveness of preventive services in reaching patients with a socio-economic exclusion profile at high risk for cervical cancer.

Feira de saúde do curso de medicina da UFRR: uma aproximação com a comunidade / Health fairs held by the UFRR school of medicine: an approach to the community

As Feiras de Saúde do curso de Medicina da Universidade Federal de Roraima (UFRR) buscam informar e sensibilizar a comunidade quanto à melhoria da qualidade de vida a partir da prevenção, orientando para a mudança de hábitos de vida e diagnosticando precocemente as doenças a fim de tratá-las e curá-las. Além disso, a UFRR busca se aproximar da população boa-vistense por meio desse trabalho de extensão universitária e da realização de um serviço de utilidade pública de grande relevância acadêmica e comunitária. A diversidade das lições aprendidas, registradas como relatos de experiências ou como estudos, pelo conjunto de profissionais, gestores, pesquisadores e acadêmicos constituiu um importante estímulo ao debate acerca dos limites e possibilidades do Programa Saúde da Família e da interação do acadêmico na comunidade.

Health fairs held by the School of Medicine at the Federal University in Roraima (UFRR) aim to raise community awareness concerning improved quality of life based on prevention, orienting people for lifestyle changes and early diagnosis of diseases. The university also promotes greater exchange with the population of Boa Vista through this extension work, a highly relevant public utility service for academia and the local community. The range of lessons learned, documented through reports of experiences and case studies by health professionals, administrators, researchers, and students, provided an important stimulus for the debate on the limits and possibilities of the Family Health Program and interaction between medical students and the community.

Comparison between posterior lumbar fusion with pedicle screws and posterior lumbar interbody fusion with pedicle screws in adult spondylolisthesis.

The purpose of this study was to compare patients with lumbar spondylolisthesis submitted to two different surgical approaches, and evaluate the results and outcomes in both groups. In a two-year period, 60 adult patients with lumbar spondylolisthesis, both isthmic and degenerative, were submitted to surgery at the Biocor Institute, Brazil. All patients were operated on by the same surgeon (FLRD) in a single institution, and the results were analyzed prospectively. Group I comprised the first 30 consecutive patients that were submitted to a posterior lumbar spinal fusion with pedicle screws (PLF). Group II comprised the last 30 consecutive patients submitted to a posterior lumbar interbody fusion procedure (PLIF) with pedicle screws. All patients underwent foraminotomy for nerve root decompression. Clinical evaluation was carried out using the Prolo Economic and Functional Scale and the Rolland-Morris and the Oswestry questionnaire. Mean age was 52.4 for Group I (PLF), and 47.6 for Group II (PLIF). The mean follow-up was 3.2 years. Both surgical procedures were effective. The PLIF with pedicle screws group presented better clinical outcomes. Group I presented more complications when compared with Group II. Group II presented better results as indicated in the Prolo Economic and Functional Scale.

Comparison between posterior lumbar fusion with pedicle screws and posterior lumbar interbody fusion with pedicle screws in adult spondylolisthesis

The purpose of this study was to compare patients with lumbar spondylolisthesis submitted to two different surgical approaches, and evaluate the results and outcomes in both groups. In a two-year period, 60 adult patients with lumbar spondylolisthesis, both isthmic and degenerative, were submitted to surgery at the Biocor Institute, Brazil. All patients were operated on by the same surgeon (FLRD) in a single institution, and the results were analyzed prospectively. Group I comprised the first 30 consecutive patients that were submitted to a posterior lumbar spinal fusion with pedicle screws (PLF). Group II comprised the last 30 consecutive patients submitted to a posterior lumbar interbody fusion procedure (PLIF) with pedicle screws. All patients underwent foraminotomy for nerve root decompression. Clinical evaluation was carried out using the Prolo Economic and Functional Scale and the Rolland-Morris and the Oswestry questionnaire. Mean age was 52.4 for Group I (PLF), and 47.6 for Group II (PLIF). The mean follow-up was 3.2 years. Both surgical procedures were effective. The PLIF with pedicle screws group presented better clinical outcomes. Group I presented more complications when compared with Group II. Group II presented better results as indicated in the Prolo Economic and Functional Scale.

O objetivo foi comparar dois grupos de pacientes portadores de espondilolistese lombar que foram submetidos a dois procedimentos cirúrgicos distintos, avaliando os resultados clínicos levando em consideração a qualidade de vida. Durante o período de 1998 a 2001 sessenta pacientes portadores de espondilolistese da coluna lombar ístmica e degenerativa foram submetidos a tratamento cirúrgico no Hospital Biocor em Belo Horizonte, por um mesmo cirurgião foram analisados prospectivamente. Os primeiros trinta pacientes foram submetidos a fusão posterior com parafusos pediculares e os trinta seguintes a fusão posterior com parafusos pediculares associada a fusão intersomática posterior. Os pacientes foram submetidos a liberação radicular com laminectomia e foraminotomia. A avaliação clínica foi feita utilizando as escalas de Prolo Econômico e Funcional, o questionário de Rolland-Morris e de Oswestry. Os resultados clínicos apresentaram que os dois procedimentos realizados foram eficazes. Houve maior número de complicações relacionadas com a biomecânica no grupo que foi submetido somente à fusão posterior e o grupo submetido à fusão posterior associada a fusão intersomática apresentou melhores resultados com retorno as atividades diárias e melhora da qualidade de vida.

Nível de conhecimento da simbologia gráfica utilizada para caracterizar comandos e controles de máquinas agrícolas / Level of knowledge of graphic symbols used to characterize commands and controls of agricultural machines

Este trabalho foi realizado no período compreendido entre março de 2000 a junho de 2005, com entrevistados de várias regiões do Brasil, e teve por objetivo realizar uma pesquisa analítica a respeito do grau de conhecimento sobre símbolos gráficos, para a identificação dos comandos e controles de operação e manutenção em máquinas agrícolas, dos principais clientes envolvidos no processo, desde o projeto da máquina agrícola até sua utilização e conseqüente manutenção. Os resultados encontrados indicam que o conhecimento sobre o significado que possuem os símbolos gráficos utilizados para caracterizar comandos e controles de máquinas agrícolas é bastante reduzido por parte dos principais envolvidos no processo.

The present study was carried out from March 2000 to June 2005 by interviewing many people from several parts of Brazil. It was aimed at assessing the level of knowledge on technical graphic symbols used for identification of commands and operation controls, and support in agricultural machines. The main customers involved in the process from the project of the agricultural machine to its use and support were interviewed. Results suggest that the knowledge of the graphic symbols meaning is quite reduced among the main customers involved in the process.

Tendência da morbimortalidade por pneumonia na região metropolitana de Salvador- 1980 a 2004 / Morbidity and mortality trends due to pneumonia in the metropolitan region of Salvador, Brazil, 1980 to 2004

A pneumonia é um problema de saúde pública responsável por óbitos, principalmente entre pacientes idosos e crianças internados por causas respiratórias. Este estudo analisou a tendência da morbidade e da mortalidade por pneumonia na Região Metropolitana de Salvador, Brasil. Realizou-se um estudo de agregados de séries temporais, com base em dados de mortalidade e hospitalização disponibilizados no Sistema de Informação em Saúde do DATASUS do Ministério da Saúde. Calcularam-se coeficientes padronizados de mortalidade e de morbidade por sexo e faixa etária e utilizou-se a regressão linear simples, o coeficiente de correlação de Pearson e o coeficiente de determinação. As proporções de óbito e de internação foram sempre mais altas para o sexo masculino, para as crianças menores de um ano e para os indivíduos acima de 60 anos de idade. Observou-se uma redução nos coeficientes de mortalidade e de morbidade por pneumonia, mas notou-se uma tendência crescente da morbidade nos últimos três anos. Além disso, observou-se uma correlação positiva entre os coeficientes de morbidade e os índices pluviométricos e uma correlação negativa entre cobertura vacinal contra Haemophilus influenzae tipo b nas crianças menores de um ano e coeficientes de mortalidade. Recomenda-se a intensificação de ações voltadas para os mais susceptíveis, para ampliar os programas educacionais e as coberturas vacinais nos extremos etários, especialmente antes dos períodos chuvosos.

The radical transbasal approach for resection of anterior and midline skull base lesions.

OBJECT: Craniofacial surgery can be performed to treat midline and anterior skull base lesions by creating a bicoronal scalp incision without the need for an additional transfacial procedure. Originally described as the transbasal approach, several modifications for further exposure of the skull base have been described. The authors present data on the application and outcomes of a modified transbasal approach. The radical transbasal approach consists of a bifrontal craniotomy and a frontoorbitonasal osteotomy. METHODS: Between 1992 and 2002, 41 patients (28 male and 13 female patients with a mean age of 38.3 years [range 7-77 years]) underwent 44 radical transbasal procedures. Twenty-three malignant and 18 benign lesions involving the midline skull base were treated. These cases were reviewed retrospectively. Gross-total resection of 30 lesions was achieved. Seven lesions were resected subtotally and six partially; one lesion was debulked. Complications occurred in 26 (59.1%) of the 44 operations and mostly consisted of cerebrospinal fluid leakage. The surgery-related mortality rate was 6.8% (three patients). Based on their pre- and postoperative Karnofsky Performance Scale scores, 86.4% of patients improved or remained the same. CONCLUSIONS: The radical transbasal approach increases the midline craniofacial corridor by allowing the globes to be safely retracted laterally. It also enhances exposure of the maxillary sinus from above. The morbidity and mortality rates associated with this procedure are high but consistent with the known rates for craniofacial surgery. This approach is best suited for the treatment of anterior skull base tumors that extend into the nasal cavity, orbit, ethmoid sinus, nasopharynx, and upper clivus. The approach may allow resection of tumors involving the maxillary sinus area without the need for an additional transfacial approach.

Exposure of midline cranial base without a facial incision through a combined craniofacial-transfacial procedure.

OBJECTIVE: A single-stage combined craniofacial-transfacial approach that exposes the midline cranial base without visible facial incisions is described. METHODS: Between 1992 and 1998, eight patients underwent surgery for five different anterior cranial base pathological findings: four angiofibromas, one mesenchymal chondrosarcoma, one esthesioneuroblastoma, one odontogenic myxoma, and one encephalocele. In all cases, the surgical exposure consisted of a bicoronal scalp incision with a bifrontal craniotomy and fronto-orbitonasal osteotomy, and then a sublabial incision for transmaxillary exposure. RESULTS: Gross total resection was achieved in five cases. The encephalocele was resected with complete reconstruction of the bony defect. Seven patients developed complications, primarily wound infections, cerebrospinal fluid leaks, and anemia. Postoperative Karnofsky Performance Scale scores ranged between 80 and 100 (mean, 92.5). Long-term follow-up information (mean, 56 mo; median, 59.5 mo; range, 5-108 mo) was available for all patients. CONCLUSION: Large anterior cranial base lesions can be resected and excellent cosmetic outcomes can be achieved with a single-stage combined transfacial-craniofacial approach that exposes the entire midline cranial base and requires no facial incisions.

Prospecção de evidências científicas para tomada de decisão na gestão da saúde pública: a experiência da Secretaria de Estado de Saúde de Minas Gerais

Objetivos: Obter evidências para orientar o gestor de saúde quanto à  implementação de serviços de cirurgia cardíaca. Método: Revisão assistemática da literatura. Resultados: Exceto o pólo macrorregional do Jequitinhonha, todos os outros contemplam o critério populacional de 500 mil habitantes para instalação de um serviço de cirurgia cardíaca. Os poucos serviços de cirurgiacardíaca que apresentavam grande volume e os que realizaram um volume mínimo de 150 cirurgias/ano estão, em sua maioria, apresentando estabilidade ou tendência decrescente no volume desses procedimentos. Alguns, com volume abaixo de 200 cirurgias/ano, apresentam tendência incremental.A maioria (88%) dos serviços de cirurgia cardíaca apresenta taxa de mortalidade acima de 5%. Conclusão£o: Apesar do critério populacional ter sido contemplado, a maioria dos serviços de cirurgia cardíaca não satisfaz importantes critério de qualidade largamente utilizados para o credenciamento desse tipo de tecnologia.

Salvage of advanced squamous cell carcinomas of the head and neck: internal carotid artery sacrifice and extracranial-intracranial revascularization.

OBJECT: Squamous cell carcinoma (SCC) of the head and neck may involve the carotid artery (CA) in the neck or skull base. Whether tumor resection should be associated with sacrifice of the CA is debatable. METHODS: Records obtained in five consecutive patients (three men, and two women; mean age 58 years, range 47-69 years) treated for recurrent or progressive SCC involving the internal carotid artery (ICA) at the skull base were reviewed retrospectively. The ICA was sacrificed, an extracranial-intracranial (EC-IC) bypass was performed using a saphenous vein graft, and the tumor and involved ICA segment were resected. Gross-total resection of the SCC was achieved in four cases. One patient died of an acute postoperative stroke due to bypass occlusion and did not undergo tumor resection. No other permanent ischemic or neurological deficits were noted. The other four patients died of tumor progression (survival range 2-40 months, mean 14 months). One patient survived for more than 2 years (2-year overall survival rate 20%). Histological tumor invasion of the CA wall was verified in one of the three evaluated specimens. CONCLUSIONS: A high rate of morbidity and mortality is associated with cases in which skull base CA sacrifice and an EC-IC bypass are performed. Not all resected arteries are shown to have malignant infiltration on histological examination. Better preoperative imaging criteria are needed to define malignant infiltration of the ICA at the skull base. Chemotherapy and radiotherapy without aggressive tumor resection may be an option for these patients.