Tessier 3 and 4 Clefts and Choanal Atresia: An Unusual Association?

INTRODUCTION: Craniofacial clefts are rare congenital anomalies that might involve both soft tissue and skeletal components. The association of Tessier cleft number 3 and 4 with choanal atresia appears to be unusual and only few clinical cases have been reported in published literature. OBJECTIVES: Report a series of 13 cases of choanal atresia in patients with Tessier numbers 3 or 4 clefts and the literature review on this topic. METHODS: A literature review was undertaken via PUBMED database before April 2020 addressing the association between Tessier numbers 3 or 4 clefts and choanal atresia. Retrospective chart review of patients diagnosed with both comorbidities at a tertiary hospital expertised in craniofacial anomalies. RESULTS: Literature review yielded 10 studies describing the relationship between choanal atresia and Tessier 3 and 4 facial clefts. We identified 98 patients diagnosed with medial oro-ocular facial clefts (Tessier 3 and 4) and 119 with choanal atresia at our institution over a 20 years time period. Altogether, 13 individuals were diagnosed with both malformations, 3 patients with number 3 cleft, and 10 patients with number 4 cleft. It represents 13.26% of the cases. CONCLUSION: This study highlights the features of Tessier 3 and 4 facial clefts associated with choanal atresia. Although the publications regarding this association are very scarce, the authors present the largest series of cases of Tessier number 3 and 4 clefts with choanal atresia showing that association between these conditions could be not so unusual.

Congenital Midline Cervical Cleft: A Variant of Tessier Number 30 Cleft Causing Micrognathia.

Congenital midline cervical cleft is a rare and generally isolated malformation of the ventral neck region with no clear etiology established. Mandibular deformities, such as micrognathia, could be considered as a consequence of a cleft cervical contracture. Complete surgical excision of the subcutaneous fibrous cord at an early age is the primary treatment modality, minimizing growth development problems on surrounding affected tissue. The aim of this study is to describe the clinical, surgical, and histological findings in a female child with congenital midline cervical cleft along with a relevant literature review. Three years follow-up after surgery exhibited satisfactory functional and cosmetic results.

Uso do protocolo Spikes no ensino de habilidades em transmissão de más notícias / Using the Spikes protocol to teach skills in breaking bad news

O termo "má notícia" designa qualquer informação transmitida ao paciente ou a seus familiares que implique, direta ou indiretamente, alguma alteração negativa na vida destes. Por ser uma tarefa tão estressante, muitos médicos a evitam ou a realizam de maneira inadequada. Esse fato traz inúmeras consequências negativas para o paciente e seus familiares. Embora seja objeto de estudo em diversos cursos de Medicina em nível internacional, o tema ainda é pouco abordado por professores e estudantes no contexto brasileiro. O protocolo Spikes descreve de maneira didática seis passos para comunicar más notícias. Esses passos foram utilizados em aula para alunos do terceiro semestre do curso de Medicina da Universidade Estadual do Ceará. Em seguida, os alunos avaliaram o método por meio de perguntas abertas. De maneira geral, foi considerado um modelo válido, apesar de serem consideradas possíveis limitações, como a necessidade de ser individualizado e adaptado a cada situação.

The term "bad news" refers to any information transmitted to patients or their families that directly or indirectly involves a negative change in their lives. Since breaking bad news is a stressful task, many physicians either avoid it or perform it inadequately. This situation has numerous negative consequences for patients and their families. Although the topic has been the object of study in various medical schools around the world, it has still received little attention by faculty and students in Brazil. The SPIKES protocol provides a didactic six-step approach for breaking bad news. These steps were used in the classroom by third-semester medical students at the State University of Ceará, Brazil. The students then evaluated the method using open-ended questions. The method was generally considered valid, despite possible limitations like the need for individualization and adaptation to each specific situation.

Multiple job contracts of physicians in Ceará, Northeastern Brazil.

OBJECTIVE: To analyze the multiple job contracts of physicians in the Brazilian National Health System in the State of Ceará. METHODS: Documental research was performed about the work contracts of the physicians, based on data of health professional contracts in the municipalities of Ceará state, Northeastern Brazil, in 2008. Indices were created for the quantity of contracts of each physician, as well as the municipalities where each physician maintained work contracts. The distances between the municipalities where they worked was calculated in order to estimate the total weekly hours of work. RESULTS: Of the 7,008 physicians employed by the Ceará state, 3,751 (53.5%) maintain between two and four job contracts and 39 (0.6%) between 11 and 20 contracts. One professional maintained 20 contracts. More than half (51.9%) of the physicians had work contracts that when summed totaled more than 40 weekly working hours and 27.0% (1,894) maintained job contracts with more than one municipality. CONCLUSIONS: In order to increase their work income, physicians undertake various jobs, practicing their profession in different locations and various municipalities, involving constant travel and contributing to the precarious conditions of their own lives and, therefore, of the public health system.

Multiplicidade de vínculos de médicos no Estado do Ceará / Multiple job contracts of physicians in Ceará, Northeastern Brazil

OBJETIVO: Analisar a multiplicidade de vínculos dos profissionais médicos do Sistema Único de Saúde no Estado do Ceará. MÉTODOS: Foi realizada pesquisa documental sobre os vínculos de trabalho dos médicos, a partir de um banco de dados de contratos de profissionais da saúde dos municípios no Estado do Ceará, em 2008. Foram criados índices para a quantidade de vínculos de cada médico, bem como para os municípios com os quais cada médico mantinha vínculos empregatícios. Foram computadas também as distâncias entre os municípios com os quais os profissionais mantinham vínculos, visando estimar os percursos realizados pelos médicos para cumprir os contratos de trabalho e sua carga horária semanal. RESULTADOS: Dos 7.008 médicos vinculados ao Estado, 3.751 (53,5 por cento) possuíam entre dois e quatro vínculos, e 39 (0,6 por cento) de 11 a 20 vínculos. Um profissional possuía 20 vínculos. Mais da metade (51,9 por cento) dos médicos possuía vínculos de trabalho que, quando somados, totalizavam uma jornada semanal acima de 40 horas e 27,0 por cento (1.894) mantinha vínculos em mais de um município. CONCLUSÕES: Para aumentar os ganhos com seu trabalho os médicos articulam vários empregos, exercendo a profissão em locais diferentes em um constante ir e vir, inclusive em variados municípios, contribuindo para a precarização da qualidade de suas vidas e, conseqüentemente, do sistema de saúde.