Differences between attendance in emergency care of male and female victims of traffic accidents in Porto Alegre, Rio Grande do Sul state, Brazil.

Driving under the influence of alcohol/ drugs (DUI) is a well-established risk factor for traffic accidents, and men and women have different consumption patterns. The scope of this paper is to analyze differences in alcohol and drug consumption, as well as on behavior associated with traffic accidents among men and women. A cross-sectional study was conducted with 609 sequential traffic accident victims attended in emergency care from Porto Alegre. Subjects gave a structured interview, were breathalyzed and had a saliva test for alcohol/drug screening. Results showed that women were mainly passengers or pedestrians (p < 0.001). There was no significant difference in positive blood alcohol concentration. However, men reported more binge drinking and THC use, while women had more benzodiazepine in their saliva (p<0.05). This is the first Brazilian study to compare alcohol and drug use among men and women who were the victims of traffic accidents. Results point to differences in the pattern of substance abuse, as well on risk behavior. Data may be useful for specific prevention strategies that take gender differences into consideration.

Differences between attendance in emergency care of male and female victims of traffic accidents in Porto alegre, Rio Grande do Sul state, Brazil / Diferenças entre homens e mulheres vítimas de acidente de trânsito atendidos em emergências de Porto Alegre, RS, Brasil

Driving under the influence of alcohol/ drugs (DUI) is a well-established risk factor for traffic accidents, and men and women have different consumption patterns. The scope of this paper is to analyze differences in alcohol and drug consumption, as well as on behavior associated with traffic accidents among men and women. A cross-sectional study was conducted with 609 sequential traffic accident victims attended in emergency care from Porto Alegre. Subjects gave a structured interview, were breathalyzed and had a saliva test for alcohol/drug screening. Results showed that women were mainly passengers or pedestrians (p < 0.001). There was no significant difference in positive blood alcohol concentration. However, men reported more binge drinking and THC use, while women had more benzodiazepine in their saliva (p<0.05). This is the first Brazilian study to compare alcohol and drug use among men and women who were the victims of traffic accidents. Results point to differences in the pattern of substance abuse, as well on risk behavior. Data may be useful for specific prevention strategies that take gender differences into consideration.

Dirigir sob a influência de álcool/drogas (DUI) contribui para ocorrência de acidentes de trânsito, sendo que homens e mulheres diferem quanto ao seu consumo. Objetivo: Analisar as diferenças no consumo de álcool/drogas e nos comportamentos de risco para dirigir entre homens e mulheres. Método: Estudo transversal, com amostra consecutiva de 609 vítimas de acidentes de trânsito atendidas nas emergências de Porto Alegre. Realizou-se entrevista estruturada, teste de bafômetro e saliva para screening de álcool e drogas. Resultados: As mulheres acidentaram-se principalmente como passageiras e pedestres, (p < 0.001). Não houve diferença na triagem para abuso/dependência ou alcoolemia positiva. Porém, os homens referiram mais "beber pesado" e utilizaram mais THC e cocaína, enquanto as mulheres utilizaram benzodiazepínicos (p < 0.05). Conclusão: Este é o primeiro estudo brasileiro a comparar uso de álcool e drogas entre homens e mulheres vítimas de acidentes de trânsito. Os dados podem ser úteis na elaboração de estratégias específicas de prevenção que considerem as diferenças de gênero. .

Clinical accuracy of flapless computer-guided surgery for implant placement in edentulous arches.

PURPOSE: Although flapless computer-guided implant placement provides important benefits, deviations from the planned implant placement in the edentulous arch may pose significant risks. This study evaluated the reliability and accuracy of a flapless computer-guided surgical approach. MATERIALS AND METHODS: Computer-generated preoperative implant planning was compared to actual placement by cone-beam computerized tomography (CBCT) scanning of patients before and after surgery. A well-fitting complete denture or optimized prosthetic tooth arrangement was used and converted to a radiographic template. Prior to scanning, esthetics and functional aspects were checked clinically. The implant positions were virtually determined by the implant planning software relative to the bone structure and prospective tooth position. After implant placement, new CBCT scans were obtained for each subject. Software was used to fuse the images of the planned and placed implants, and the locations and axes were compared. The normality of the data distribution was evaluated by the Kolmogorov-Smirnov test. Mean values were compared between groups based on the upper or lower jaws with the t test for independent samples. The level of significance was fixed at 5%. RESULTS: Sixty-two implants were placed in edentulous arches with stereolithographic surgical guides in 14 patients. Damage due to implant placement was not observed in any critical anatomical structure. Compared to the planned implants, placed implants showed mean and standard deviation linear measurements at the cervical, middle, and apical implant portions of 2.17 (± 0.87), 2.32 (± 1.52), and 2.86 (± 2.17) mm, for the maxilla, and 1.42 (± 0.76), 1.42 (± 0.76), and 1.42 (± 0.76) mm, for the mandible, respectively. The angular deviations were 1.93 (± 0.17) and 1.85 (± 0.75) degrees for the maxilla and mandible, respectively. The linear deviation differed significantlybetween the upper and lower jaws, but the angular deviation did not. CONCLUSION: Flapless computer-guided surgery may be a viable treatment option for rehabilitating the edentulous arch.

Estabelecimento de um protocolo clínico controlado para a cirurgia guiada sem retalho em maxilas totalmente edêntulas / Establishment of a controlled clinical protocol for flapless-guided surgery on completely edentulous maxillary arches

O objetivo deste trabalho foi verificar a precisão da técnica de cirurgia guiada e sem retalho, comparando os desvios angulares e lineares dos implantes cone-morse antes e depois da cirurgia, baseado em cortes tomográficos gerados em um ambiente tridimensional virtual computadorizado. Cinco pacientes com maxilas totalmente edêntulas foram utilizados neste estudo piloto. Após o planejamento reverso para montagem dos dentes e confecção do guia tomográfico, TCs foram obtidas com cortes de 0,2 mm de espessura, e as imagens geradas no software Dental Slice (Bioparts) para posicionamento dos implantes cone-morse Titamax EX (3,5-3,75 mm de diâmetro; Neoguide, Neodent). Após a cirurgia, novas TCs foram realizadas de acordo com o mesmo protocolo e inseridas no software. O desvio angular médio foi 2,033 ± 0,782º; a diferença linear na posição da plataforma, terço médio e apical foi 1,082 ± 0,907 mm, 1,599 ± 1,22 mm e 2,542 ± 2,047 mm, respectivamente. Todas as próteses com infraestrutura metálica e recobrimento de resina acrílica foram instaladas após 48 horas e os ajustes oclusais depois de 72 horas. Nenhuma complicação foi vista clinicamente, e as próteses e implantes permaneceram em função. Dentro dos limites deste estudo, os resultados demonstraram que a técnica é segura e precisa para ser utilizada nos consultórios. Entretanto, estes valores devem ser confirmados por estudos posteriores.

The aim of this study was to evaluate the precision of flapless, guided-surgery comparing angular and linear deviations of cone-morse dental implants before and after surgical procedures through CT slices generated on a computerized three-dimensional virtual environment. Five completely edentulous patients were enrolled in this pilot study. After reverse planning for tooth set-up and tomographic guide fabrication, CTs were made 0,2mm thick with images generated on Dental Slice (Bioparts) for placement of Titamax EX cone-morse implants (Neoguide, Neodent; 3.5-3.75mm in diameter). After implant placement, new CTs were made following the same protocol and transferred to Dental Slice software. Mean angular deviation values were of 2.033 ± 0.782º; registered linear differences at implant platform, middle and apical thirds were 1.082 ± 0.907mm, 1.599 ± 1.22mm, and 2.542 ± 2.047mm, respectively. All acrylic-veneered, metal-reinforced definitive prostheses were installed after 48 hours and occlusal adjustments provided after 72 hours. No clinical complications were seen, with all implants and prostheses remaining into function. Within the limits of this study, the results showed that this technique is safe and accurate for routine dental practice. However, these values must be confirmed in further studies.

A construção de uma identidade para o adulto maduro a partir da subjetividade do imaginário social / La construcción de una identidad para el adulto maduro a partir de la subjetividad del imaginario social / The construction of an identity for the mature adult from the subjectivity of the social imaginary

Este texto busca refletir sobre a construção da identidade do adulto maduro inserido no imaginário social dentro da complexidade do ser humano na concepção biopsicossocial e ambiental. É descrito o fenômeno do medo de engordar tão comum nas pessoas como expressão do resultado de um conjunto de fatores e não somente do peso numérico na balança. Enfatizado a necessidade de compreender globalmente a pessoa acometida de um transtorno e não de partes isoladas.

This text reflects about the construction of the mature adult identity added in a social imaginary inside the complexity of the human being on the biopsychosocial and environmentalconception. It's described the fear of getting fat phenomenon, so common among the people as the expression of the result of a set of factors and not only the weight on the balance. Emphasizingthe need of a global understanding of the person involved with a disorder and not only isolated parts.

Este texto intenta reflejar sobre la construcción de la identidad del adulto maduro, inserido en el imaginario social dentro de la complejidad del ser humano en la concepción biopsicosocial y ambiental. El fenómeno del medo de engordar es tan común en las personas, como expresión del resultado de un conjunto de factores y no solamente del peso numérico en la báscula. Enfatizando la necesidad de entender globalmente la persona acometida por un trastorno y no solo de partes aisladas.

Histological esophagitis before and after surgical treatment of morbid obesity (Capella technique): a prospective study.

BACKGROUND: The effects of vertical banded gastroplasty/Roux-en-Y gastric bypass (Capella) on the esophageal mucosa of patients with histological esophagitis are poorly understood. To evaluate long-term effects, we investigated the persistence, aggravation or disappearance of histological esophagitis in patients with morbid obesity and reflux esophagitis (diagnosed by endoscopic biopsy) after Roux-en-Y gastric bypass. METHODS: Twenty-one patients with morbid obesity and esophagitis (histological diagnosis) were submitted to gastric bypass (Fobi-Capella technique) and underwent upper endoscopy and esophageal biopsy during the late postoperative period. RESULTS: The mean age of the patients was 42.57 +/- 7.49 years (30 to 56). Nineteen (90.48%) patients were women, and two (9.52%) were men. Before surgery, the patients presented a mean weight of 124.26 +/- 19.09 kg and a mean body mass index (BMI) of 48.46 +/- 6.37 kg/m(2). Thirteen (61.90%) patients had endoscopic esophagitis before surgery. The mean weight and BMI were 81.65 +/- 13.16 kg and 31.91 +/- 4.99 kg/m(2), respectively, during the late postoperative period (29.80 +/- 8.91 months). The mean percentage of excess weight loss was 68.7 +/- 14.6%. Among the 21 patients with a preoperative histological diagnosis of reflux esophagitis, five (23.18%) had the same diagnosis after surgery, and four (19.04%) continued to present findings of endoscopic esophagitis. CONCLUSION: Vertical banded gastroplasty/Roux-en-Y gastric bypass (Capella technique) is effective in the treatment of reflux esophagitis. No association was observed between the percentage of excess weight loss and improvement of esophagitis.

Buried bumper syndrome: abordagem endoscópica: relato de caso / Buried bumper syndrome: endoscopic approach: case report

A buried bumper syndrome (BBS) é uma rara complicação da gastrostomia endoscópica percutânea (PEG) definida pelo sepultamento do anteparo da sonda de gastrostomia na mucosa gástrica, ficando este anteparo alojado na parede gástrica ou abdominal. Pode ocorrer, então, a obstrução do orifício da sonda, que impede a administração da dieta. Descreve-se uma abordagem endoscópica dessa síndrome, usando um estilete, tipo papilótomo pré-corte, para seccionar a mucosa gástrica até a exposição do anteparo, que é laçado com a alça. O conjunto éretirado pela cavidade oral e uma nova PEG écolocada no mesmo procedimento, utilizando o orifício prévio

Carcinoma gástrico intramucoso: apresentação de casos / Intramucosal gastric cancer: presentation of cases

O câncer gástrico intramucoso proporciona índice de cura de 95 a 100por cento em cinco anos, mas para isso o diagnóstico nessa fase deve ser procurado nos exames endoscópicos. São apresentados dois casos de câncer gástrico intramucoso diagnosticados em pacientes assintommáticos, submetidos a endoscopia de controle. É enfatizada pelos autores a necessidade de maior número de biópsias endoscópicas e da valorização das pequenas lesões,mesmmo de aspecto benigno para o endoscopista

O padrao alimentar anormal em estudantes de Porto Alegre: levantamento epidemiologico medido pelo EAT-26

Este estudo de rastreamento para detectar a ocorrencia de Padrao Alimentar Anormal (PAA) entre 806 estudantes de duas escolas do Ensino Medio na cidade de Porto Alegre, utilizou o Eating Attitudes Test (EAT-26). O indice de positividade encontrado foi de 14,4 por cento. As mulheres apresentaram indices de positividade quase cinco vezes superior ao dos homens. A populacao de maior risco, levando em consideracao a positividade no EAT-26 e Indice de Massa Corporal (IMC) menor que 20, foi de 4,09 por cento. As pesquisas epidemiologicas sobre PAA, em nosso pais, ainda estao em fase inicial e muito ainda ha a ser investigado ate que se possa estabelecer com maior exatidao os aspectos preponderantes na instalacao, desenvolvimento e tratamento e assim podermos estabelecer medidas preventivas cada vez mais eficazes para minorar um problema que afeta pessoas tao jovens.

Hipocondria, somatizacao e transtornos psicossomaticos

Descreve as diretrizes diagnosticas e a compreensao psicodinamica dos transtornos somatoformes, enfatizando a concepcao psicossomatica na abordagem terapeutica interdisciplinar.

Urgências em psiquiatria / Psychiatric urgencies

A propósito das urgências psiquiátricas, tais como sídromes histérica, ansiosa, de abstinência ao alcool, de agitaçäo psicomotora e depressiva, o autor faz comentários genéricos e expöe orientaçöes ao médico plantonista, denominado "médico de dia", no âmbito dos hospitais da Aeronáutica. A forma de abordagem, desde o manejo verbal à contençäo física, é detalhada de modo a consolidar a conduta a ser adotada pelo médico assistente em cada caso. Enfatiza que o médico que presta o atendimento use o bom senso, expresse firmeza, confiança e disponibilidade para o atendimento

Contrato psicoterápico / Psychotherapeutic contract

Neste trabalho é observada a importância da entrevista de avaliaçäo para uma adequada compreençäo psicodinâmica do paciente antes do estabelecimento do contrato psicoterápico. Entendemos que o contrato é um momento de clarificaçäo do tratamento, tanto para o paciente como para o terapeuta, nos diversos aspectos referentes aos objetivos, tempo, honorários e ausência, além de outros fatores da realidade