Speech therapy intervention before dental management in patients with special needs: A case report

Fragile X syndrome is a cytogenetic abnormality related to chromosomal X. This syndrome is frequently associated to intellectual disability, psychological problems, as well as heart, skeletal and join alterations. Intraoral anomalies include malloclusion, ogival palate, cleft palate, presence of mesiodens, dental hypomineralization and abrasion of the occlusal surfaces and incisai edges. The study of characteristics of this syndrome is important for the dentist in order to guide dental treatment and prevention. The aim of this study is to present a myofunctional therapy protocol, evaluated by surface electromyography. A case of a 21 year-old young man who attended the Training Program in Dentistry for Persons with Disabilities, School of Dentistry of São José dos Campos/UNESP is reported. He underwent myofunctional therapy before dental treatment and the masticatory muscles were evaluated by surface electromyography. The exercises of myofunctional therapy consisted of active and passive simple movements of opening and closing the mouth, tongue protrusion and retrusion, digital manipulation and also by using an electric massager on intraoral and perioral region of the masseter, buccinator and orbicularis oris. Action potentials of the masticatory muscles decreased in almost all the muscles and values for the bite force and mandibular opening capacity increased. This study showed that brief and immediate myofunctional therapy optimized clinical practice with positive repercussion on dental care.

Proactive management of extreme prematurity: Disagreement between obstetricians and neonatologists

Objective: To verify, in extremely preterm infants, if disagreement between obstetricians and neonatologists regarding proactive management is associated with early death.Study Design: Prospective cohort of 484 infants with 23 0/7 to 266/7 weeks, without malformations, born from January 2006 to December 2009 in eight Brazilian hospitals. Pro-active management was defined as indication of ≥1 dose of antenatal steroid or cesarean section (obstetrician) and resuscitation at birth according to the international guidelines (neonatologist). Main outcome was neonatal death in the first 24 h of life.Result: Obstetricians and neonatologists disagreed in 115 (24%) patients: only neonatologists were proactive in 107 of them. Disagreement between professionals increased 2.39 times the chance of death in the first day (95% confidence interval 1.40 to 4.09), adjusted for center and maternal/neonatal clinical conditions.Conclusion: In infants with 23 to 26 weeks of gestation, disagreement between obstetricians and neonatologists, translated as lack of antenatal steroids and/or vaginal delivery, despite resuscitation procedures, increases the odds of death in the first day. © 2012 Nature America, Inc.

Quality management promotion to improve competitiveness

Includes bibliography

The market and water management reform in Peru

Includes bibliography

Investing better in order to invest more. Finance and management of education in Latin America and the Caribbean

Includes bibliography

Paranasal sinus infection causing orbital subperiosteal abscess: Surgical management of this devastating entity

Background: Orbital infection is an uncommon devastating infection and is usually a complication of paranasal sinus infection. Without appropriate treatment, orbital infection may lead to serious complications, even death. Prompt treatment is mandatory to avoid visual loss or intracranial complications. The literature shows that initially, intravenous antibiotics should be administered, and after 48 h, if no improvement appears, the affected orbit and the sinuses must be surgically drained. The authors describe two cases of orbital cellulitis with a brief literature review. Case report: The authors describe two cases of orbital abscess caused by paranasal sinus infection. In case 1, the patient presented a decreased visual acuity associated with ophthalmoplegia of the right eye. In case 2, the patient presented a decreased visual acuity. Thus, administration of intravenous antibiotic combined with surgical drainage was performed. After surgical procedure, eye movements were normalized in case 1, and in both patients, the visual acuity returned to normal parameters. Discussion: The authors recommend early surgical drainage with parenteral antibiotic administration and careful postoperative observations by monitoring the signs and symptoms of the orbital complaint. © 2012 Springer-Verlag.

High condylectomy procedure: A valuable resource for surgical management of the mandibular condylar hyperplasia

Condylar hyperplasia is an overdevelopment of the condyle, which may manifest unilaterally or bilaterally. This pathological condition can lead to facial asymmetry, malocclusion, and dysfunction of the temporomandibular joint. The etiology and pathogenesis of condylar hyperplasia remain uncertain, but it has been suggested that its etiology may be associated with hormonal factors, trauma, and hereditary hypervascularity, affecting both genders. The diagnosis is made by clinical examination, and radiological imaging, and additionally, bone scintigraphy, is a fundamental resource for determining whether the affected condyle shows active growth. Patients with active condylar hyperplasia management have better results when they are subjected to the high condylectomy procedure. The authors report a case in a 20-year-old female subject with unilateral active condylar hyperplasia who was treated by high condylectomy. The patient has been followed up for 4 years without signs of recurrence and with good functional stability of the occlusion. © 2013 by Mutaz B. Habal, MD.

Failure of miniplate osteosynthesis for the management of atrophic mandibular fracture

Fractures of the severely atrophic (<10 mm) edentulous mandible are not common, and these fractures with a vertical height of 10 mm or less have long been recognized as being particularly problematic. Although there are advances in the treatment of the atrophic mandibular fracture, the treatment remains controversial. There are some options for treatment planning because of using small miniplates to large reconstruction plates. However, when the fixation method fails, it causes malunion, nonunion, and/or infection, and sometimes it has been associated with large bone defects. The authors describe a clinical report of a failed miniplate fixation for atrophic mandibular fracture management. The authors used a load-bearing reconstruction plate combined with autogenous bone graft from iliac crest for this retreatment. The authors show a follow-up of 6 months, with union of the fracture line and no complication postoperatively. © 2013 by Mutaz B. Habal, MD.

Using the bottom-up and outside-in sequence for panfacial fracture management: Does it provide a clinical significance?

Panfacial fractures usually refer to simultaneous facial fractures, which affect the upper, middle, and lower thirds of the face. The management of panfacial fracture is complex because of the lack of reliable landmarks. Literature has shown many approaches for management of panfacial fractures. Every segment of bone has a precise function in the repair. Therefore, the bottom-up and outside-in sequence is the most widely used approach in the management of panfacial fractures. These facial fractures present remarkable challenges for both experienced and inexperienced surgeons. This article aimed to report a case of a panfacial fracture (mandibular condylar and symphysis fractures associated with an atypical Le Fort III fracture) in a 48-year-old man. The patient was successfully treated using bottom-up and outside-in sequence by accessing all facial injuries. Postoperatively, radiograph examination revealed good reduction and fixation of titanium plates, and physical examination revealed good functional and esthetic outcomes. Copyright © 2013 by Mutaz B. Habal, MD.

The meaning of evidence-based management to brazilian senior nurse leaders

Purpose: The study objective was to understand the meaning of evidence-based management for senior nurse leaders in accredited, public hospitals in the State of Sao Paulo, Brazil. Design and Method: A phenomenological approach was used to analyze interviews conducted with 10 senior nurse leaders between August 2011 and March 2012. The analytic method was developed by the Brazilian phenomenologist, Martins. Findings: Senior nurse leaders described how they critically appraise many sources of evidence when making managerial decisions. They emphasized the importance of working with their teams to locally adapt and evaluate best evidence associated with managerial decision making and organizational innovations. Their statements also demonstrated how they use evidence-based management to support the adoption of evidence-based practices. They did not, however, provide specific strategies for seeking out and obtaining evidence. Notable challenges were traditional cultures and rigid bureaucracies, while major facilitators included accreditation, teamwork, and shared decision making. Conclusions: Evidence-based management necessitates a continuous process of locating, implementing, and evaluating evidence. In this study leaders provided multiple, concrete examples of all these processes except seeking out and locating evidence. They also gave examples of other leadership skills associated with successful adoption of evidence-based practice and management, particularly interdisciplinary teamwork and shared decision making. Clinical Relevance: This study demonstrates senior nurse leaders' awareness and utilization of evidence-based management. The study also suggests what aspects of evidence-based management need further development, such as more active identification of potential, new organizational innovations. © 2013 Sigma Theta Tau International.

Susceptibility profile of a Brazilian yeast stock collection of Candida species isolated from subjects with Candida-associated denture stomatitis with or without diabetes

Objective: This study investigated the susceptibility of 198 clinical isolates of Candida species against caspofungin, amphotericin B, itraconazole, and fluconazole. Study Design: Suspensions of the microorganisms were spread on Roswell Park Memorial Institute (RPMI) agar plates. Etest strips were placed on the plates, and the minimal inhibitory concentration (MIC) was read after incubation (48 h at 37°C). Data were analyzed by a factorial analysis of variance and a 2 × 2 post hoc test (α = .05). Results: C glabrata showed the highest MIC values (P < .001) against caspofungin, itraconazole, and fluconazole. For amphotericin B, the MIC values of C tropicalis and C glabrata (P = .0521) were higher than those of C albicans (P < .001). Itraconazole was the least effective antifungal; 93.3% of the C glabrata isolates, 3.3% of the C albicans, and 1.3% of the C tropicalis were resistant. All microorganisms were susceptible to caspofungin and amphotericin B. Conclusions: Caspofungin and amphotericin B should be recommended as an effective alternative for the management of oral Candida infections when treatment with topical or other systemic drugs has definitely failed. © 2013 Elsevier Inc. All rights reserved.

Ki-67 and CD100 immunohistochemical expression is associated with local recurrence and poor prognosis in soft tissue sarcomas, respectively

Soft tissue sarcomas (STSs) are a heterogeneous group of mesenchymal tumors of >50 subtypes. However, STSs represent <1% of types of cancer. Despite this low frequency, the disease is aggressive and treatment, when possible, is based on traditional chemotherapies. A number of cases of resistance to adjuvant therapies have been reported. Metastases are commonly identified in STS patients during diagnosis and the development of effective clinical parameters is crucial for correct management of the disease. The use of biological markers in cancer is a useful tool to determine patient prognosis. Ki--67 is a protein marker for proliferation of somatic cells and is widely used in prognostic studies of various types of tumor, including STSs. Cluster of differentiation 100 (CD100) is a member of the semaphorin family. The family was initially described as axon guidance molecules important for angiogenesis, organogenesis, apoptosis and neoplasia. CD100 was previously utilized as a prognostic factor in tumors and also in STSs. In the present study, protein expression of Ki--67 and CD100 was analyzed by immunohistochemistry in samples of STS patients of the Barretos Cancer Hospital (Barretos, Brazil) to establish prognostic criteria of the disease. Results demonstrate a correlation between CD100 expression and poor prognosis, consistent with a previous study. Moreover, the expression of Ki-67 was identified to correlate with presence of local or locoregional recurrence. To the best of our knowledge, no large casuistic study has revealed this correlation between Ki--67 and local recurrence in STSs. The use of Ki--67 and CD100 as markers in clinical pathological analysis may be suitable as a prognostic criterion in disease progression.

Information on disaster risk management: case study of five countries: Jamaica

Incluye Bibliografía

Electronic data interchange in port management: the experience of the port of Barcelona

Every port is unique. Although all ports exist for the same basic purpose (to act as an interface in the transfer from one mode of transport to another), no two are ever organized in the same way.Ports may be classified according to: Physical conditions: location (geographical position, man-made or natural harbour, estuary location, difficult weather conditions, tides, etc.) and size (large, small or medium-sized). Use: commercial (general cargo, bulk solids, bulk liquids, oil, break bulk, mixed), passenger, sport and leisure, fishing, mixed, etc. Ownership: private, municipal, regional or State-owned. The Port Authority's role in management of the port: Overall control, i.e. the Port Authority plans, sets up and operates the whole range of services. Facilitator, i.e. the Port Authority plans and sets up the infrastructure and the superstructure, but services are provided by private companies. Landlord, i.e. the Port Authority allows private companies to be responsible for the superstructure and provide port services. Different combinations of port types will therefore give rise to different kinds of organization and different information flows, which means that the associated information systems may differ significantly from port to port. Since this paper relates to the port of Barcelona, with its own specific characteristics, the contents may not always be applicable to other ports.

Physical quality of an Oxisol after different periods of management systems

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)