A comparative analysis between Mexican and Chinese health systems / Un análisis comparativo entre los sistemas de salud de México y China

Abstract Objective: The comparative network analysis of national health macrosystems is an area whose academic development has not reached due relevance if its influence on decision-making related to the design of public health policies is considered; the establishment of comparative elements between two socially, economically and culturally distant countries, such as Mexico and China, is a complex process given the difficulty of locating equivalent evaluation indicators among some of its elements. Materials and methods: The present work reflects on the similarities and dissimilarities between the national health systems, with an impact on the care provided to the most vulnerable population segments, applying a comparative nodes and networks analysis considering social and economic factors. Results: The network analysis shows that, for practical purposes, the nodes considered in the Mexican health system is superior to those nodes identified in the Chinese health system in terms of quality, mainly in nodes such as convenience of the location, using cutting-edge technology in health institutions and the skill and competence of medical personnel; conversely, the Chinese system is superior to the Mexican in terms of efficiency, mainly involuntary co-payment insurance systems to reduce the catastrophic health expenditure of the vulnerable rural population. Conclusions: The conclusions drawn may serve for subsequent studies to identify opportunities for improvement, correlations and/or trends that could be implemented in the Mexican health system, once the pertinent feasibility studies have been carried out.

Resumen Objetivo: El análisis de redes comparativo de macrosistemas nacionales de salud es un ámbito cuyo desarrollo académico no ha alcanzado la relevancia debida si se considera su influencia en la toma de decisiones relativas al diseño de políticas de salud pública. Así, el establecimiento de elementos comparativos entre dos países social, económica y culturalmente distantes, como México y China, es un proceso complejo dada la dificultad de ubicar indicadores equivalentes de evaluación entre algunos de sus elementos. Materiales y método: El presente trabajo reflexiona sobre las similitudes y diferencias entre los mencionados sistemas nacionales de salud, con incidencia en la atención que se brinda a los segmentos poblacionales más vulnerables, aplicando un análisis comparativo de nodos y redes considerando factores sociales y económicos. Resultados: El análisis de red muestra que, para efectos prácticos, los nodos considerados en el sistema de salud mexicano son superiores a los nodos identificados en el sistema de salud chino en términos de calidad, principalmente en nodos como conveniencia de la ubicación, utilizando tecnología de punta en instituciones de salud y la habilidad y competencia del personal médico; Por el contrario, el sistema chino es superior al mexicano en términos de eficiencia, principalmente sistemas de seguro de copago involuntario para reducir el gasto catastrófico en salud de la población rural vulnerable. Conclusiones: Las conclusiones extraídas podrán servir a estudios posteriores para identificar oportunidades de mejora, correlaciones y/o tendencias que pudieran implementarse en el sistema mexicano de salud, una vez efectuados los estudios de viabilidad pertinentes.

Brasil e Espanha: uma análise comparada sobre a concepção das políticas esportivas / Brazil and Spain: a comparative analysis on the design of sports policies

O estudo busca analisar como o esporte é tratado nos ordenamentos legais e dispositivos políticos do Brasil e da Espanha. Para tanto foi realizado um estudo comparado através de levantamento documental e revisão bibliográfica. Observou-se que o esporte aparece como dever do Estado em ambos os países, entretanto, a legislação infraconstitucional e os dispositivos, em quase sua totalidade, caminha no sentido de consolidar as práticas esportivas como mercadorias.

The study seeks to analyze how sport is treated in the legal systems and political provisions of Brazil and Spain. For this purpose, a comparative study was carried out through documentary survey and bibliographic review. It was observed that sport appears as a duty of the State in both countries, however, the infra-constitutional legislation and the devices, in almost their entirety, are moving towards consolidating sports practices as commodities.

Transportability of Conclusions From Confined Field Trials: A Case Study Using the Virus Resistant Transgenic Bean Developed in Brazil.

The conceptual framework for Data Transportability, builds on the premise that well-designed studies conducted for the environmental and food/feed risk assessment of transgenic crops may be transportable across geographies. Beyond individual data, provided that certain criteria are met, the general conclusions of comparative assessments of a transgenic crop with its conventional counterpart would also be transportable. In spite of this, many regulatory agencies still require in-country field trials to complete risk assessments of transgenic crops. A sub-team from ILSI Argentina's (International Life Sciences Institute, Argentina. www.ilsi.org.ar) Biotechnology Working Group tested the applicability of the transportability concept to the case of the golden mosaic virus-resistant transgenic bean, developed by EMBRAPA (EMBRAPA: Brazilian Agricultural Research Corporation). To this end, regulatory confined field trials (CFTs) carried out in Brazil to gather agro-phenotypic and compositional data were analyzed. The transportability of the conclusions of these studies to the bean cropping areas in Argentina was assessed as a conceptual exercise (with no intention to conclude on the biosafety of the common bean event). Comparative studies included the transgenic bean and its conventional parental line and were run in different agroecological environments so that any relevant differences could be observed. The main criteria to enable transportability were set by the sub-team and found to be met by the CFTs carried out in Brazil to inform a potential risk evaluation for Argentina.

Similaridades e diferenças entre o Mestrado Acadêmico e o Mestrado Profissional enquanto política pública de formação no campo da Saúde Pública / Similarities and diferences between Academic and Professional Master Programs as Educational Public Policy in the field of Public Health

Resumo Ao buscar uma especificidade para o Mestrado Profissional (MP) em Saúde Pública, interrogamos, o que ele, ao se instituir, procurou do ponto de vista de seus meios e finalidades, conservar ou romper com os modelos de formação dos Mestrados Acadêmicos (MA). No campo da Saúde Pública, o tema ganha outros temperos se considerarmos que tanto o MP quanto o MA preservam na finalidade a formação para o Sistema Único de Saúde. Nesse sentido, a pesquisa buscou investigar a vocação heurística e inovadora do MP face ao MA como uma política pública de formação. Em uma perspectiva comparada, analisamos as principais características dos cursos de MP em saúde pública, frente ao processo de flexibilização da pós-graduação brasileira que o diferencia do MA, e discutimos se essas características tornam o MP uma política pública de formação. Na análise dos dados utilizamos o método da Análise de Conteúdo. Concluímos que as instituições de ensino tendem a reproduzir o modelo de formação do MA no MP e a expectativa de tornar o serviço de saúde matéria e motivo para a formação não é suficiente para distinguir ambas modalidades.

Abstract In the attempt to find a specificity for the Professional Master Program in Public Health (PM), we asked, what is, from the point of view of its means and purposes, kept or broke from the training models of the Academic (traditional) Masters Program (AM). In the public health field, this discussion possess an extra "flavor", as both program aim, in Brazil, to prepare health professionals to the Brazilian Unified Health System (SUS). Therefore, this research sought to investigate the heuristic and innovative vocation of the PM vis-à-vis the AM as an education public policy. From a comparative approach, we analyzed the main characteristics and differences among AM and PM, face the flexibilization process of graduate programs in Brazil, and discussed if these features would characterize the PM into an educational public policy. Data was analyzed by the Content Analysis method. We conclude that educational institutions tend to reproduce the AM training model in the PM and the expectation of making the health service matter and reason for training is not sufficient to distinguish both modes.

The social location of harm from others' drinking in 10 societies.

AIMS: Survey data from 10 diverse countries were used to analyse the social location of harms from others' drinking: which segments of the population are more likely to be adversely affected by such harm, and how does this differ between societies? METHODS: General-population surveys in Australia, Chile, India, Laos, New Zealand, Nigeria, Sri Lanka, Thailand, United States and Vietnam, with a primary focus on the social location of the harmed person by gender, age groups, rural/urban residence and drinking status. Harms from known drinkers were analysed separately from harms from strangers. RESULTS: In all sites, risky or moderate drinkers were more likely than abstainers to report harm from the drinking of known drinkers, with risky drinkers the most likely to report harm. This was also generally true for harm from strangers' drinking, although the patterns were more mixed in Vietnam and Thailand. Harm from strangers' drinking was more often reported by males, while gender disparity in harm from known drinkers varied between sites. Younger adults were more likely to experience harm both from known drinkers and from strangers in some, but not all, societies. Only a few sites showed significant urban/rural differences, with disparities varying in direction. In multivariate analyses, most relationships remained, although some were no longer significant. CONCLUSION: The social location of harms from others' drinking, whether known or a stranger, varies considerably between societies. One near-commonality among the societies is that those who are themselves risky drinkers are more likely to suffer harm from others' drinking.

Comparison of semi-automated and manual methods to measure the volume of prostate cancer on magnetic resonance imaging.

PURPOSE: The purpose of this study was to determine the accuracy of manual semi-automated and volumetric measurements to assess prostate cancer volume on multiparametric magnetic resonance imaging (MP-MRI) using whole-mount histopathology for validation. MATERIALS AND METHODS: We evaluated 30 consecutive men (median age, 65.7 years; interquartile range [IQR], 61.5-70.9 years) with a median prostatic specific antigen of 8.5ng/dL (IQR, 5.5-10.5ng/dL), who underwent MP-MRI before radical prostatectomy. Index tumor volume was determined prospectively and independently on the basis of MRI and whole-mount section volumetric assessment using the maximum histologic diameter (MHD) and the histologic volume (HV). The MRI index tumor volume was determined by two independent radiologists using a single measurement of the maximum tumor dimension (MTD), a simplified MR ellipsoid volume (MREV) calculation and a MR region of interest volume (MROV) segmentation displayed by a commercially available OsiriX®. MTD was compared to MHD, whereas MREV and MROV were compared to HV. RESULTS: Thirty index lesions (median HV, 1.514 cm3; IQR, 0.05-3.780 cm3) were analyzed. The MREV, MROV and HD were significantly correlated with each other (r>0.5). Inter-observer agreement for measurements was good for each method (r>0.780). The MTD was the best predictor of maximum histologic diameter (r=0.980 and 0.791) and had an excellent inter-variability correlation (P<0.0001). CONCLUSION: Prostate cancer histologic volume can be assessed using MREV or MROV with a good accuracy and low inter-observer variability. MTD has the lowest inter-observer variability and provides best degrees of correlation with MHD. MTD should be used on MRI for selecting and following patients for active surveillance and staging before focal treatment of prostate cancer.

Influences on the Knowledge and Beliefs of Ordinary People about Developmental Hierarchies.

This paper is motivated by the idea that development and developmental hierarchies have been constructed and embraced for centuries by scholars and policy makers, and have been disseminated among ordinary people. Recent research shows that most people have constructions of development hierarchies that are similar across countries. In this paper, we extend this research by examining how basic social factors influence ordinary people´s beliefs about development and developmental hierarchies in six countries: Argentina, China, Egypt, Iran, Nepal and the United States. Results show that the understanding and perception of developmental hierarchies vary by gender and education. These results are important because they show how distinct groups of people have differential access to information or ideas.

RM fetal: patología torácica y abdómino-pélvica / Fetal MRI: thoracic, abdominal ana pelvic pathology

Aunque la ecografía (US) es el método de elección en la evaluación del feto, la resonancia magnética (RM) es una técnica complementaria a la US en el diagnóstico de las anomalías fetales. Entre las ventajas de la RM se destacan un excelente contraste tisular, un campo de visión grande y una relativa operador-independencia. La mayoría de los trabajos previos de RM fetal han estudiado el sistema nervioso central (SNC). Sin embargo, la RM es útil en la evaluación de las anomalías torácicas y abdominales. En este artículo se muestran los diferentes aspectos por RM de las anomalías fetales torácicas y abdominales y se discuten las indicaciones y ventajas de la RM fetal.(AU)

Ultrasonography (US) is the method of chotee in fetal examina³on. However, magnetic resonance (MR) imaging is a complementan/ technique that contributes to the aecurate diagnosis of fetal anomalies. The benefits of MR include excellent tissue contrast, large field of view and relative operator independence. Most previous reports on fetal MR have focused on central nervous system (CNS). However, MR is a useful tool for the examination of fetal thoracic and abdominal anomalies. This article illustrates the different features of fetal thoracic and abdominal anomalies on MR, and further discusses the indications and benefits of fetal MR.(AU)

RM fetal: patología torácica y abdómino-pélvica / Fetal MRI: thoracic, abdominal ana pelvic pathology

Aunque la ecografía (US) es el método de elección en la evaluación del feto, la resonancia magnética (RM) es una técnica complementaria a la US en el diagnóstico de las anomalías fetales. Entre las ventajas de la RM se destacan un excelente contraste tisular, un campo de visión grande y una relativa operador-independencia. La mayoría de los trabajos previos de RM fetal han estudiado el sistema nervioso central (SNC). Sin embargo, la RM es útil en la evaluación de las anomalías torácicas y abdominales. En este artículo se muestran los diferentes aspectos por RM de las anomalías fetales torácicas y abdominales y se discuten las indicaciones y ventajas de la RM fetal.(AU)

Ultrasonography (US) is the method of chotee in fetal examinaüon. However, magnetic resonance (MR) imaging is a complementan/ technique that contributes to the aecurate diagnosis of fetal anomalies. The benefits of MR include excellent tissue contrast, large field of view and relative operator independence. Most previous reports on fetal MR have focused on central nervous system (CNS). However, MR is a useful tool for the examination of fetal thoracic and abdominal anomalies. This article illustrates the different features of fetal thoracic and abdominal anomalies on MR, and further discusses the indications and benefits of fetal MR.(AU)

Avaliação comparativa entre o desempenho dos reagentes paratoxoplasmose AxSYM, VIDAS e VIDIA em um país latinoamericano com alta soroprevalência / Comparative evaluation of AxSYM, VIDAS and VIDIA toxoplasmosis reagent performance in a high seroprevalence Latin American country

Aims: The purpose of this study was to compare the performance of three automated immunoassays for the detection of IgM and IgG Toxoplasma gondii antibodies using sera of pregnant women living in Colombia, a Latin American country with a high seroprevalence. Methods: A total of 905 sera were tested for IgM antibodies and 914 for IgG antibodies with AxSYM, VIDAS and VIDIA immunoassays. Discrepancies were resolved by using the dye test for IgG antibodies, and the ISAGA test for IgM. Results: The overall agreement between AxSYM, VIDAS and VIDIA assays was excellent for detection of IgG and IgM antibodies, and discrepancies were relatively rare (3.6% and 5.5% of sera for IgG and IgM antibodies, respectively). The performance of the three immunoassays was similar for the detection of IgG antibodies with high sensitivity (100.00% for VIDIA, 99.59% for VIDAS, 99.38% for AxSYM) and specificity (99.04% for VIDIA, 98.82% for AxSYM, 98.57% for VIDAS). The specificity for IgM antibodies was excellent for the three immunassays (99.88% for VIDIA, 99.76% for AxSYM and VIDAS). The sensitivity of the detection of IgM antibodies was higher with VIDIA (95.12%) than with VIDAS (76.74%) and AxSYM (61.90%) assays. The correlation between IgG titers was limited between AxSYM and VIDAS assays and between AxSYM and VIDIA assays, but was excellent between VIDIA and VIDAS assays. Conclusions: Our study performed with Latin American sera confirmed the excellent specificity of AxSYM, VIDAS and VIDIA assays for the detection of IgG and IgM antibodies already reported in other countries. The sensitivity of the detection of IgG antibodies was slightly higher with VIDIA than with VIDAS and AxSYM assays. The sensitivity of the detection of IgM antibodies was higher with VIDIA than with VIDAS and AxSYM assays.

Estudo comparativo entre duas plataformas para realização de Lasik personalizado para correção de miopia e astigmatismo: Alcon CustomCornea® versus Bausch & Lomb Zyoptix® / Wavefront-Guided Lasik for low to moderate myopia: CustomCornea® versus Zyoptix®

OBJETIVO: Comparar os resultados obtidos após o Lasik personalizado utilizando duas plataformas diferentes. MÉTODOS: Estudo prospectivo, randomizado com 50 pacientes míopes submetidos a cirurgia refrativa em ambos os olhos. Foram selecionados para o estudo, pacientes com equivalente esférico semelhante entre os olhos. Todos foram submetidos a Lasik bilateral e simultâneo, sendo que um olho foi operado pela plataforma CustomCornea® e o outro pela Zyoptix®. Acuidade visual sem e com correção, refração dinâmica e estática, medida das aberrações oculares, teste de sensibilidade ao contraste foram realizados no período pré-operatório e pós-operatório de 1, 3 e 6 meses. RESULTADOS: No período pré-operatório a média do equivalente esférico era de -3,29 ± 1,56 D no grupo CustomCornea® e de -3,22 ± 1,50 D no Zyoptix® (p=0,267). No sexto mês de pós-operatório, a média do equivalente esférico no grupo CustomCornea® era de -0,077 ± 0,23 D e -0,282 ± 0,30 D no Zyoptix® (p<0,001*). Acuidade visual sem correção > 20/20 foi alcançada em 86 por cento dos olhos no grupo CustomCornea® e 70 por cento no grupo Zyoptix® (p=0,094). Nenhum paciente perdeu duas ou mais linhas da melhor acuidade visual corrigida. Cem por cento dos olhos CustomCornea® e 88 por cento dos Zyoptix® ficaram entre ± 0,50 D da emetropia (p=0,014*). Melhora da sensibilidade ao contraste em todas as frequências espaciais testadas foi observada em ambos os grupos. A aberração esférica apresentou aumento em ambos os grupos, porém este foi estatisticamente maior na plataforma Zyoptix® (p<0,001). CONCLUSÃO: Não foram observadas diferenças entre os grupos quanto à eficácia e segurança. O tratamento com a plataforma Zyoptix® consumiu menor quantidade de estroma. Melhor previsibilidade da correção cirúrgica foi obtida pelo grupo CustomCornea®, bem como menor indução de aberração esférica.

PURPOSE: To compare the visual and clinical outcomes of Wavefront-guided laser in situ keratomileusis (Lasik) with Alcon CustomCornea® and Zyoptix® systems. METHODS: A prospective, randomized, masked and bilateral study was conducted. Fifty patients with preoperative spherical equivalent ranging from -1.00 to -6.50 D were enrolled for customized ablation in both eyes. All of them were submitted to Lasik CustomCornea® treatment in one eye and Zyoptix® in the other eye. Uncorrected visual acuity, best correct visual acuity (BCVA), manifest refraction, wavefront measurements, and contrast sensitivity testing were performed preoperatively and postoperatively at 1, 3 and 6 months. RESULTS: Preoperatively manifest refractive spherical equivalent was -3.29 ± 1.56 D in the CustomCornea® group and -3.22 ± 1.50 D in the Zyoptix® group. At 6 months, 86 percent of CustomCornea® eyes and 70 percent of Zyoptix® eyes had UCVA > 20/20. One hundred percent of the CustomCornea® group and 88 percent of the eyes in the Zyoptix® were within 0.50 D of emmetropia. In both groups, the contrast sensitivity improved. Spherical aberration increased in both groups, with the CustomCornea® group showing lower levels (p<0,001). CONCLUSION: There were no differences between the systems according to safety and effectiveness. The Zyoptix® platform showed greater spherical aberration.

Comparative study between trapezium resection and tendon interposition with and without ligamentplasty in the management of carpometacarpal arthrosis of the thumb.

PURPOSE: Treating arthrosis in the base of the thumb has been a highly controverted subject. Many surgeries have been described, such as the isolated trapezium resection; resection with interposition with and without ligament plasty; arthrodesis, and arthroplasties. The purpose of this paper is to compare the two techniques which are currently the most used in this treatment. METHODS: A prospective study has been made to compare the surgical results between the trapezium resection with tendon interposition (tenoarthroplasty) - 22 cases - and tenoarthroplasty associated to ligament plasty-24 cases. Objective evaluation was done by measuring opponence, movements of the metacarpophalangeal joint, pinch and grasp strength, radiographic measurement of the distance between the base of first metacarpal and the scaphoid, and measurement of the angle between the first and the second metacarpals. Subjective evaluation was done with a DASH questionnaire, visual analog scale to evaluate pain and patient satisfaction. RESULTS AND CONCLUSION: After application of the criteria described and using Student 't' tests for statistical analysis, the authors concluded that the ligament reconstruction has no advantage over the simple resection and tendon interposition in carpometacarpal arthrosis of the thumb.

Ressonância magnética vs cintilografia com pirofosfato marcado com tecnécio-99m para a detecção de necrose miocárdica perioperatória / Magnetic resonance vs technetium-99m pyrophosphate scintigraphy in the detection of perioperative myocardial necrosis

FUNDAMENTO: O infarto do miocárdio perioperatório (IMPO) é uma complicação da cirurgia de revascularização miocárdica (CRM) com potencial impacto prognóstico. A cintilografia miocárdica (CM) com pirofosfato marcado com tecnécio-99m é utilizada no diagnóstico de IMPO, mas demonstra limitada sensibilidade para lesões subendocárdicas. A ressonância magnética cardiovascular (RMC), por sua vez, detém alta acurácia para a detecção de necrose miocárdica. OBJETIVO: Comparar a RMC e a CM para a detecção de IMPO após CRM. MÉTODOS: Foram estudados 24 pacientes portadores de doença arterial coronária crônica, com a técnica de realce tardio pela RMC e com a CM, antes e depois da CRM, analisando-se o surgimento de áreas de necrose miocárdica perioperatória (IMPO). Mensuraram-se também marcadores bioquímicos de lesão miocárdica (CKMB e troponina I), antes e depois da cirurgia. RESULTADOS: Dezenove pacientes completaram o estudo. Desses, 6 (32 por cento) apresentaram IMPO à RMC, e 4 (21 por cento) à CM (p = NS). Dos 323 segmentos do ventrículo esquerdo avaliados, 17 (5,3 por cento) exibiram necrose perioperatória à RMC, e 7 (2,2 por cento) à CM (p = 0,013). Observou-se moderada concordância entre os métodos (kappa = 0,46), havendo divergência, quanto ao diagnóstico de IMPO, em 4 (21 por cento) casos, a maioria com pequenas áreas de necrose perioperatória à RMC, não visualizadas à CM. Em todos os casos com IMPO à RMC, houve elevação significativa de CKMB e troponina I. CONCLUSÃO: Houve moderada concordância diagnóstica entre os métodos para a detecção de IMPO, mas a RMC permitiu a visualização de pequenas áreas de necrose miocárdica perioperatória, não identificadas pela CM e associadas à elevação de marcadores bioquímicos de lesão miocárdica.

BACKGROUND: Perioperative myocardial infarction (POMI) is a complication of coronary artery bypass grafting (CABG) with a potential prognostic impact. Technetium-99m pyrophosphate myocardial scintigraphy (MS) is used in the diagnosis of POMI; however it shows a limited sensitivity for subendocardial lesions. Cardiovascular magnetic resonance imaging (CMRI), in turn, has a high accuracy in the detection of myocardial necrosis. OBJECTIVE: To compare CMRI and MS for the detection of POMI after CABG. METHODS: A total of 24 patients with chronic coronary artery disease were studied using the delayed contrast enhanced CMRI and MS before and after CABG by analyzing the development of areas of perioperative myocardial necrosis (POMI). Biochemical markers of myocardial injury (CKMB and troponin I) were also determined before and after surgery. RESULTS: Nineteen patients completed the study. Of these, 6 (32 percent) presented POMI on CMRI and 4 (21 percent) on MS (p = NS). Of the 323 left ventricular segments assessed, 17 (5.3 percent) showed perioperative necrosis on CMRI and 7 (2.2 percent) on MS (p = 0.013). Moderate agreement was observed between the methods (kappa = 0.46). There was disagreement regarding the diagnosis of POMI in 4 (21 percent) cases, most of them with small areas of perioperative necrosis on CMRI which were not visualized on MS. In all cases with POMI on CMRI, significant CKMB and troponin I elevations were observed. CONCLUSION: Moderate diagnostic agreement was observed between the methods for the detection of POMI, but CMRI enabled visualization of small areas of perioperative myocardial necrosis which were not identified on MS and were associated with elevation of biochemical markers of myocardial injury.

Avaliação comparativa da perda de extensão entre acessos cirúrgicos para revisão de artroplastia total do joelho / Comparative assessment of extension loss among different surgical approaches to the revision of total knee arthroplasty

OBJETIVO: Avaliar a possibilidade de perda de extensão do joelho, após artroplastias de revisão, realizadas com acessos do tipo quadriceps snip e osteotomia do tubérculo anterior da tíbia (TAT), comparativamente, entre ambos e com um grupo controle, em que foi utilizado o acesso parapatelar medial convencional. MÉTODO: Este estudo foi aprovado pelo Comitê de Ética em Pesquisa do INTO. A perda de extensão do joelho foi avaliada em pacientes submetidos a artroplastias de revisão, unilaterais, realizadas pelo Grupo de Joelho do Instituto Nacional de Traumatologia e Ortopedia - INTO, em que foram utilizados um dos seguintes acessos: convencional - parapatelar medial, snip do quadríceps ou osteotomia do tubérculo anterior da tíbia. A amostra foi composta por 26 indivíduos, cuja idade variou entre 52 e 80 anos, distribuídos em três grupos: grupo I: acesso parapatelar medial convencional (n = 10); grupo II: quadriceps snip (n = 8); e grupo III: osteotomia do TAT (n = 8). O tempo de seguimento médio foi de 18,57 meses. A perda da extensão do joelho foi determinada pela diferença entre o grau de extensão ativa pré e pós-operatória. Na avaliação estatística, foi utilizado o teste de análise de variância ANOVA, de fator único, com o nível de significância a = 0,05 (5 por cento). RESULTADOS: A perda média de extensão da série foi igual a 8,57º, variando entre 2º e 30º. O p-valor obtido foi igual a 0,112, o que permite assumir a hipótese de igualdade entre os grupos. CONCLUSÃO: No presente estudo, não foi observada diferença significativa entre os grupos compostos pelos três tipos de acesso utilizados para as revisões de artroplastias, no que tange ao parâmetro perda de extensão.

OBJECTIVE: To assess the possibility of extension loss of the knee after revision arthroplasties performed with approaches like quadriceps snip and TAT osteotomy, comparing the two methods and using a control group in who the conventional medial parapatellar approach was used. METHOD: This study was approved by the INTO Research Ethics Committee. The loss of extension of the knee was evaluated in patients submitted to unilateral revision arthroplasties of the knee conducted by the Knee Group of the INTO - National Institute of Traumatology and Orthopedics, the following approaches having been used: conventional - medial parapatellar, quadriceps snip, or anterior tibial tubercle osteotomy. The series included 26 individuals, ages ranging from 52 to 80, distributed into three groups: Group I: conventional - medial parapatellar approach (n = 10); Group II: quadriceps snip (n = 8); and Group III: TAT osteotomy (n = 8). Mean follow-up was 18.57 months. Extension loss of the knee was determined by the difference between the range of active extension before and after surgery. In the statistical assessment, the ANOVA variance analysis test was used, with a single factor, with significance level a = 0,05 (5 percent). RESULTS: Mean extension loss in the series was equal to 8.57º, varying between 2º and 30º. The p-value obtained was equal to 0.112, which leads to presume the hypothesis that groups are equal to one another. CONCLUSION: No significant difference was observed among the groups made up by the three types of approach used for arthroplasty revisions in terms of the loss of extension parameter.

Estudo comparativo entre ressecção do trapézio e interposição tendinosa com e sem ligamentoplastia no tratamento da artrose carpometacarpiana do polegar / Comparative study between trapezium resection and tendon interposition with and without ligament plasty in the management of carpometacarpal arthrosis of the thumb

OBJETIVOS: O tratamento da artrose da base do polegar tem sido tema de grande controvérsia. Numerosas cirurgias têm sido descritas, como ressecção isolada do trapézio, ressecção com interposição com e sem reforço ligamentar, artrodese e artroplastias. O objetivo deste trabalho foi o de comparar os resultados das duas técnicas mais utilizadas nesse tratamento. MÉTODOS: Foi realizado estudo prospectivo a fim de comparar os resultados cirúrgicos de ressecção do trapézio com interposição tendinosa (tenoartroplastia) - 22 casos e tenoartroplastia associada a ligamentoplastia - 24 casos. A avaliação objetiva foi feita através das medidas de oponência, dos movimentos da articulação metacarpofalangiana, da força de pinça e de preensão, da medida radiográfica da distância entre a base do 1º metacarpiano e o escafóide e do ângulo entre o 1º e o 2º metacarpianos. A avaliação subjetiva foi realizada através do questionário DASH, uma escala analógico-digital para avaliar a dor e a satisfação do paciente. RESULTADOS E CONCLUSÃO: Após a aplicação dos critérios descritos e usada análise estatística pelo teste t de Student, os autores concluem não haver vantagens da reconstrução ligamentar sobre a simples interposição tendinosa na artrose carpometacarpiana do polegar.

OBJECTIVES: Treating arthrosis in the base of the thumb has been a highly controverted subject. Many surgeries have been described, such as the isolated trapezium resection; resection with interposition with and without ligament plasty, arthrodesis, and arthroplasties. The purpose of this paper is to compare the two techniques which are the most used in this treatment. METHODS: A prospective study has been made to compare the surgical results between the trapezium resection with tendon interposition (tendon arthroplasty) - 22 cases - and tendon arthroplasty associated to ligament plasty - 24 cases. Objective evaluation was done by measuring opponency, movements of the metacarpophalangeal joint, pinching and pressure strength, radiographic measurement of the distance between the first metacarpian and the scaphoid, and measurement of the angle between the first and the second metacarpian. Subjective evaluation was done with a DASH questionnaire, an analogical-digital scale to evaluate pain and patient satisfaction. RESULTS AND CONCLUSION: After application of the criteria described and using Student t test for statistical analysis, the authors concluded that the ligament reconstruction has no advantage over the simple tendon interposition in carpometacarpal arthrosis of the thumb.

Concordância e correlação entre a perimetria de freqüência dupla e a perimetria azul-amarelo no glaucoma: sem suporte para seletividade / Agreement and correlation between the frequency doubling perimetry and the blue-yellow perimetry in glaucoma: no support for selective damage

OBJETIVO: Avaliar a concordância e correlação entre a perimetria de freqüência dupla e a perimetria azul-amarelo no glaucoma. MÉTODOS: Pacientes com glaucoma foram selecionados do Setor de Glaucoma do Centro de Referência em Oftalmologia (CEROF) da Universidade Federal de Goiás, e submetidos aos exames de perimetria de freqüência dupla e perimetria azul-amarelo em ambos os olhos (quando elegíveis) no mesmo dia de maneira aleatória. Foi obtido a correlação (Pearson) entre os índices globais (mean deviation - MD e pattern standard deviation - PSD) e a concordância entre os exames (índice Kappa) para a gravidade do dano glaucomatoso. RESULTADOS: Quarenta e três olhos de 26 pacientes foram incluídos no estudo. Comparando-se o MD (-4,5±4,5 dB para o perimetria de freqüência dupla e -8,0±6,8 dB para o perimetria azul-amarelo, p<0,001) e o PSD (6,4±2,8 dB para o perimetria de freqüência dupla e 5,8±2,4 dB para o perimetria azul-amarelo, p=0,1), verificamos que apenas o MD mostrou diferença estatisticamente significativa entre os grupos. Os índices globais MD e PSD foram altamente correlacionados comparando-se o perimetria de freqüência dupla e o perimetria azul-amarelo (r=0,644, p<0,001 e r=0,586, p<0,001, respectivamente). A concordância entre as classificações da gravidade da perda glaucomatosa mostrou-se significativa (Kappa=0,319, p<0,001). CONCLUSÃO: Existe alta correlação entre os índices globais e alta concordância em termos de classificação da gravidade do dano glaucomatoso entre a perimetria azul-amarelo e a perimetria de freqüência dupla, refletindo ausência de seletividade no dano glaucomatoso, ou que os instrumentos disponíveis não sejam capazes de isolar as células ganglionares de forma completa.

PURPOSE: To test the agreement and correlation between the frequency doubling technology and the short wavelength perimetry in glaucoma. METHODS: Glaucoma patients were selected from the Glaucoma Sector of CEROF - Universidade Federal de Goiás, and then underwent frequency doubling technology and short wavelength perimetry examinations in both eyes (if eligible) on the same day in a random sequence. Pearson's correlation between the global indices (mean deviation - MD e pattern standard deviation - PSD) and the agreement between the examinations (Kappa) were obtained. RESULTS: Forty-three eyes from 26 patients were included in the study. Comparing the MD (-4.5±4.5 dB for the frequency doubling technology and -8.0±6.8 dB for the short wavelength perimetry, p<0.001) and PSD (6.4±2.8 dB for the FDT and 5.8±2.4 dB for SWAP, p=0.1), only MD was statistically different between the groups. The global indices MD e PSD were highly correlated between the frequency doubling technology and short wavelength perimetry (r=0.644, p<0.001 and r=0.586, p<0.001, respectively). There was a high agreement between the examinations (Kappa=0.319, p<0.001). CONCLUSION: In the present study, a high correlation between the global indices (MD and PSD) by the frequency doubling technology and short wavelength perimetry was found, as well as a high agreement between the examinations. These observations indicate either that both cell populations are similarly affected by glaucomatous damage or that both methods measure activity in the same cell populations.

Morbidade puerperal em portadoras e não-portadoras do vírus da imunodeficiência humana / Puerperal morbidity in HIV-infected and non-infected women

OBJETIVO: comparar a morbidade de puérperas portadoras e não-portadoras do vírus da imunodeficiência humana (HIV). MÉTODOS: estudo prospectivo, controlado, realizado entre julho de 2001 e setembro de 2003, com inclusão na ocasião do parto de pacientes portadoras e não-portadoras do HIV. A morbidade foi dividida em menor (sangramento pós-parto aumentado, febre e endometrite) e maior (hemotransfusão, alterações profundas da ferida operatória e necessidade de intervenção cirúrgica), e foi avaliada quanto à presença ou não de infecção pelo HIV e o tipo de parto. Foram avaliadas 205 puérperas: 82 portadoras do HIV (grupo HIV-casos) e 123 não-portadoras. As variáveis contínuas foram analisadas pelo teste t de Student, e as categóricas pelos testes do chi2 e exato de Fisher, por meio do software Epi-Info 2000 (CDC, Atlanta). RESULTADOS: ocorreu morbidade puerperal em 18 pacientes do grupo HIV-casos (22 por cento) e 17 do grupo-controle (14 por cento), com predomínio das variáveis de morbidade menor, sem diferença significativa entre os grupos, exceto pelo risco mais alto de endometrite no grupo HIV-casos (RR=1,05; IC a 95 por cento:1,01-1,1). Não foi observada diferença significativa entre os grupos quanto aos tipos de parto. Houve somente duas ocorrências de morbidade maior: hemotransfusão e fasciite necrotizante. CONCLUSÕES: puérperas portadoras do HIV apresentam morbidade semelhante à das puérperas não-portadoras do vírus, apesar da predominância de morbidade menor e do risco aumentado de endometrite no grupo portador do vírus. O acompanhamento clínico no puerpério imediato é estratégico para a identificação precoce da morbidade materna.

PURPOSE: to evaluate puerperal morbidity in HIV-infected and HIV non-infected puerperal women. METHODS: longitudinal and controlled study performed from July 2001 to September 2003, in 205 pregnant women admitted for birth delivery at Odete Valadares Maternity, divided in two groups: HIV-infected women (82) and HIV non-infected women (123). Postpartum morbidity evaluation was performed from birth delivery up to 15 days postpartum. Morbidity was categorized as minor (postpartum hemorrhage, fever and endometritis) or major (blood transfusion, deep alterations of the surgical wound and indication for surgical intervention), and was evaluated both according to the presence or absence of HIV infection and the mode of delivery. Continuous variables were analyzed by the Students t-test, and categorical variables were analyzed by chi2 and Fishers exact test using Epi-Info 2000 (CDC, Atlanta). RESULTS: puerperal morbidity was observed in 18 patients from the HIV group (22 percent) and in 17 patients from the control group (14 percent) with predominance of minor morbidity, without statistical significance, except for an increased risk of endometritis in the HIV group (RR=1.05; CI 95 percent:1.01-1.10). No significant difference was observed concerning the mode of delivery between the two groups. There were only two major morbidities: blood transfusion and necrotizing fasciitis. CONCLUSIONS: HIV-infected and non-infected puerperal women have a similar morbidity, despite the lower morbidity in the HIV non-infected group and the increased risk of endometritis in the HIV group. Clinical puerperium follow-up is a strategic control tool for an early identification of maternal morbidity.

Ação do laser de Er:YAG e de diodo na adesão de elementos sanguíneos e na morfologia de superfícies radiculares irradiadas: estudo através de microscopia eletrônica de varredura / Effect of Er:YAG and diode lasers in the adhesion of blood components and in the morphology of irradiated root surfaces: a scanning electronic microscopy study

O objetivo deste estudo foi avaliar in vitro, a adesão de elementos sanguíneos sobre superfícies radiculares irradiadas com laser de Er:YAG e de Diodo, e a ação destes sobre as superfícies radiculares. Foram obtidas 120 amostras de dentes humanos extraídos por doença periodontal, que foram previamente raspados e aplainados com instrumentos manuais, sendo a seguir divididas aleatoriamente em 6 grupos com 20 amostras cada. O G1 (controle)- não recebeu nenhum tratamento; o G2- recebeu aplicação tópica de EDTA 24%; G3- foi irradiado com laser de Er:YAG com 7,6 J/cm2 ; o G4- irradiado com laser de Er:YAG com 12,9 J/cm 2 ; o G5 -irradiado com laser de Diodo com 90 J/cm2 e o G6 - foi irradiado com laser de Diodo com 108 J/cm2 . Após a realização dos tratamentos, em 10 amostras de cada grupo foi depositado imediatamente a sua punção, tecido sanguíneo originado da vascularização periférica de humano, sendo que 10 amostras não receberam tal tratamento. Após processamento laboratorial as amostras foram analisadas através de microscopia eletrônica de varredura. As fotomicrografias obtidas foram avaliadas através de dois índices: adesão de elementos sanguineos e de morfologia da superfície radicular e estatisticamente analisadas (Kruskall Wallis e Mann-Whitney). Os resultados demonstraram que em relação a adesão de elementos sanguíneos não houve diferenças estatisticamente significante entre o grupo controle e os tratados com o laser de Er:YAG (p=0,7733 e 0,7831) ; O G5 mostrou-se menos efetivo que o controle na adesão de elementos sanguíneos ( p=0,0305 ) e o G2 foi o menos efetivo de todos na adesão. Com relação a morfologia da superfície radicular houve diferenças significantes entre o controle e os grupos do laser de Er:YAG (p= 0,0001) e entre o G5 do Diodo (0,0259); entre o EDTA e os grupos do laser de Er:YAG (p=0,0150 ) e entre o Diodo (G6) e os do Er:YAG (p= 0,0032 ). Concluiu-se que nenhum tratamento proposto aumentou a adesão de elementos sanguíneos de forma significativa quando comparado ao controle; o EDTA inibiu a adesão do tecido sanguíneo; o laser de Er:YAG (12,9 J/cm2 ) foi mais efetivo que o Diodo (90 J/cm2 ) na adesão e independente do parâmetro, promoveu alterações na morfologia das superfícies radiculares irradiadas, como microrugosidades e o laser de Diodo, dependendo do parâmetro utilizado, pode inibir a adesão.

The aim of this study was to evaluate in vitro the adhesion of blood components on root surfaces irradiated with Er:YAG and Diode lasers and these lasers effects on root surfaces. It was obtained 120 samples of human teeth extracted by periodontal disease. They were planed and scaled previously with manual instruments and randomly divided into 06 groups of 20 samples each. The groups were treated according to the following procedures: G1 (Control Group) - received no treatment; G2- had a topical application of EDTA 24%; G3- was irradiated with Er:YAG laser (7,6 J/cm²); G4 - was irradiated with Er:YAG laser (12,9 J/cm²); G5 - was irradiated with Diode laser (90 J/cm²) and G6 was irradiated with Diode laser (108 J/cm²). After these treatments were conducted, 10 samples of each group received a stippler, a blood tissue originated from peripheral vascularization, and the reminiscent samples did not receive such treatment. After laboratorial analysis the samples were analyzed through a scanning electronic microscopy. The photomicrographs obtained were evaluated according to adhesion of blood components and morphology of root surface; and statistically analyzed (Kruskall Wallis and Mann-Whitney). With relation to the adhesion of blood components, the results have shown that there were no significant differences between the Control Group and the groups treated with Er:YAG laser (p=0,7733 and 0,7831); G5 was less effective than the Control Group in adhesion of blood components (p=0,0305) and G2 was the least effective of all groups in this case. With relation to the morphology of root surface there were significant differences among the Control Group, the Er:YAG laser groups (p=0,0001) and the Diode laser G5 (p=0,0259); between the EDTA and the Er:YAG laser groups (p=0,0150) and also between the Diode laser G6 and the Er:YAG laser groups (p=0,0032).Within the limit of this study, it is concluded that no proposed treatment increased the adhesion of blood components in a significant way when compared to the Control Group; EDTA inhibited the adhesion of the blood tissue; the Er:YAG laser (12,9 J/cm2 ) were more effective in the adhesion of blood components than Diode laser (90 J/cm2 ) and caused more changes on the root surface and also Diode laser may inhibit the adhesion depending on the parameter it is applied.