Avaliação dos custos da assistência de recém-nascidos de mães hipertensas no Hospital das Clínicas - UNESP - Botucatu

The Hypertension Arterial Gestationis is a of largest complications to the pregnant women, a time that is associated with to high risk of morbimortalidade fetal and maternal ;the term If referred the levels pressure equal or above of 140mmhg to the pressure systolic and of 90mmhg to the pressure diastolic (1).Hypertension in pregnancy can be classified into gestational hypertension, chronic hypertension, preeclampsia and eclampsia(3). This study aimed to calculate and analyze the cost of care of newborns of hypertensive mothers hospitalized in rooming, nursery and the neonatal intensive care unit (Neonatal UTI). It’s a study of exploratory, descriptive and quantitative data analysis, in newborns of mothers with hypertension, who underwent prenatal care in HCFMB, from January 1 to 31 in December 2010. The data analysis showed that the cost of care for newborn in rooming was R$ 38.62 for the control group and groups of hypertensive mothers were R$ 19.93 to R$ 37.38. The costs of care to the newborn in the nursery were R$ 1,781.81 for the control group and groups of hypertensive mothers were R$ 680.03 to 7544.10. The costs for the newborn who Neonatal UTI were R$ 7,468.60 for the control group and groups of hypertensive mothers were R$ 5,228.02 to R $ 18,372.75. The total costs of care for newborn in rooming, nursery and Neonatal UTI were R$ 916.15 for the control group, R$ 1,385.98 for the HAC group, R$ 327.23 for the group HAS, R$ 3,896.57 for the group of preeclampsia and R$ 6,326.54 for the group of eclampsia. Considerations It can be concluded that the costs of mothers with preeclampsia and eclampsia were higher, being conditions with increased risk of maternal-fetal morbidity / mortality, requiring care in intensive care unit and longer stay in hospital

Prevalência de infecção clamidiana em mulheres com diagnóstico de infertilidade primária e secundária atendidas no ambulatório de esterilidade do Hospital das Clínicas da Faculdade de Medicna de Botucatu, Unesp

A infertilidade está se tornando um problema emergente de saúde pública em muitos países do mundo e, para muitos autores, esse aumento parece coincidir com o crescente papel desempenhado pela Chlamydia trachomatis. A infecção por C. trachomatis é uma das principais causas de lesão tubária que pode levar a oclusão desta ou processos aderentes que comprometem o complexo tubo-ovariano. O objetivo deste trabalho foi avaliar a prevalência de cervicite por Chlamydia trachomatis em mulheres diagnosticadas com infertilidade primária ou secundária atendidas no Ambulatório de Esterilidade do Hospital das Clínicas da Faculdade de Medicina de Botucatu, UNESP. Foram incluídas no estudo 112 mulheres atendidas no período de julho de 2008 a junho de 2009, que concordaram em participar do estudo e que responderam ao questionário para caracterização sóciodemográfica e ginecológica, sendo 62 pacientes com infertilidade primária e 50 com infertilidade secundária. Durante o exame especular, foi coletada secreção cervical com cytobrush para pesquisa de C. trachomatis pela técnica de reação em cadeia da polimerase (PCR) e conteúdo vaginal por meio de swab para avaliação da flora vaginal pelo método de Gram. Em relação à caracterização das pacientes, 66,7% eram moradoras de municípios com menos de 100.000 habitantes, 63,4% relataram ter vínculo empregatício, 98,2% declararam união estável, 74,1% eram brancas e 14,3% fumantes. A mediana de idade das pacientes no momento da inclusão no estudo foi de 28 anos (14-44). A mediana de idade à menarca e ao início da atividade sexual foi de 12 anos (9-17) e 16 anos (11-38), respectivamente. A mediana do tempo de infertilidade foi de 4 anos (1-17). Ainda nesse estudo, 67,9% das pacientes relataram mais de três relações sexuais por semana, 25,0% relataram infecção do trato genital inferior anteriormente ao estudo, 23,2% relataram... (Resumo Completo, clicar acesso eletrônico abaixo)

Considerações clínicas em implantes imediatos

The biological principles of osseointegration caused the rehabilitation treatment with osseointegrated implant become a safe, well alternative accepted by the dental community for the high success rate, allowing the preparation of functional and aesthetic prostheses in edentulous and partial patients. We passed the initial phase of functional vision for an aesthetic approach, too, depending on the demands of the patient and the quest for excellence by professionals. Over these last years, implant treatment has undergone many changes in surgical and prosthetic protocols. The less invasive surgical techniques and the development of restorative materials, especially ceramics allow the prosthetic rehabilitation of high functional quality and aesthetics. The installation of implants in sockets immediately after extraction of teeth involved by fracture, periodontal disease, endodontic lesions, is part of the arsenal of techniques for rehabilitating a number of advantages that we get to the outcome of multidisciplinary treatment. For this, we must consider several criteria in its planning as a fundamental unit, adjacent teeth, multiple losses, system, form and number of implants, type of retention of the prosthesis components, the patient expectation of the outcome perspective, gingival biotype, standard of ridge resorption, the smile line, etc. occlusal analysis. With the three-dimensional placement of the implant can immediately join the biological processes of repair of the socket, implant osseointegration, speeding treatment time. Much has been made by companies in the surface treatment of endosseous implants to be osseointegration shortened and restorative procedures started earlier, bringing benefits to the patient and professional. Among the main advantages we can emphasize the preservation of the structures adjacent to the teeth replaced, minor resorption of bone tissue involved... (Complete abstract click electronic access below)

Análise dos acidentes automobilísticos atendidos no Hospital das Clínicas no ano de 2010, Botucatu

As a result of the 20th-century industrial development, and particularly after World War II, cars have become an important consumer good, and this has led to a large number of circulating vehicles. To this day, the number of cars has increased exponentially worldwide, which results in a high number of traffic accidents (TAs) every day. TAs are responsible for 1.2 million deaths worldwide each year, and in Brazil, they are considered to be a public health problem, considering that its traffic is regarded as one of the worst and most dangerous in the world. In addition to temporary or permanent physical disabilities that bring great harm to individuals, accidents also cause psychological disorders, such as the post-traumatic stress disorder. Hence, considering the importance of TAs in the country and their outcomes, this study aimed at investigating the epidemiological aspects of car accidents occurring in 2010 who were assisted in the emergency room of a university hospital in São Paulo state. By means of records made by the nursing team and medical records analysis, it was possible to extract a stratified sample of 88 cases involving adults and eight cases involving children. The sample was analyzed by the SAS software for Windows, version 9.2. As regards the accidents involving adults, there was a predominance of males (67%), with an approximate 2:1 ratio in relation to females. The victims’ most frequent age range was 20-29 years (39%), and they were mostly single (56%). The month showing the largest number of occurrences was July, with 17%, and the weekday was Sunday, with 25%. Showing 32%, the time period when most accidents occurred was from 06:00 o’clock p.m. to 11:59 p.m. As regards vehicles types involved, motorcycles were in first place, with 47% of cases, and the most common accident type was crashing between vehicles, with 43%... (Complete abstract click electronic access below)

Distribuição e dispersão dos níveis radiométricos do setor técnico de medicina nuclear do hospital das clínicas da faculdade de medicina de botucatu

Nuclear medicine uses non-sealed sources for exams and treatments, because the movement of these sources, source of patients injected or not, involve a wide range of environmental radiometric levels. To better control of these levels this study was aimed at monitoring points strategically distributed in all environments Sector Technical Nuclear Medicine, Hospital of the Botucatu Medical School, performing two measurements at random times daily for a period of three months, sampling the normal routine of the sector. The detector Geiger-Muller was used for the acquisition of exposure rates of the points, efficiency and reprodutibility test have shown good performance of this equipment for this purpose. The results allowed to make a projection of annual dose for each environment indicating higher risks for Occupationally Exposed Individuals as well as Public Individuals compared with the limits established by the National Commission of Nuclear Energy. Was developed a spatial map of dose that can be used as a visual warning to the regions with the highest exposure to ionizing radiation, enabling reduced risk of a potential exposure

Satisfação dos Usuários do Ambulatório Geral do Hospital das Clínicas de Botucatu

The searches for a health service it’s a part of a process, searches for a qualified evaluation can arise the perception, in form of irritating factors taking for an alert state. The personal expectation, it makes influence in its perceptions, too. The objective was to evaluate the satisfaction degree of the users of “Seção Técnica de Ambulatório Geral do Hospital das Clínicas de Botucatu”. The work is about a quantitative and transversal study, with calculated sample of 366 users, chosen randomly and invited to participate through a questionnaire. The population was compounded by a majority of women (64,5%), between 50 to 59 years old and average degree of education (38,3%). 25 specialties were cited. The evaluate about comfort, cleaning, reception, waiting time, medical attention and nursing vary between “very good” and “good”. Obtained significant “regular” assessment, the comfort in the waiting rooms (24%), silence (25%) and cleaning bathroom (63%). Others negative evaluation was the reception about the waiting time (26%), waiting time between arrival and the consultation (34%), waiting time between the request and consultation (27%). 30,6% report to know the place for complaints and 79,4% of these pointed to the ombudsman. 62% consider their problems solved, 84,4% would indicate the hospital, 57,4% would consider the hospital better than imagined. 42,62% used the opened area for thanking, critical for staff, suggestion infrastructure improvements, cleaning and waiting time. The biggest complaint was the staff turnover in the treatment. There was disharmony between the objective and subjective questions, but, all of them must be considered to propose improvements. The satisfaction evaluation makes the service more effective, bringing credibility to the health service and the patients adhere better to the treatment

Acidentes na infância atendidos no pronto socorro de pediatria do Hospital das Clínicas de Botucatu que motivaram internação

Accidents represent a major public health problem as they are frequent, preventable, and account for high morbidity and mortality rates. Children are the most vulnerable to accidents due to their inherent characteristics, and as a result of their physical, sensorial, psychomotor and cognitive limitations, which will only develop with time. Watchfulness and careful attention are of paramount importance, especially as children develop locomotor skills that are accompanied by curiosity about their surroundings. Child accidents, particularly those that could have been avoided, are the accidents most commonly seen in emergency and urgency departments. Urgency and emergency departments are the greatest allies in the attention to pediatric accidents as they offer adequate, immediate and specific high complexity care to patients at risk, viewing their vital stabilization. Investigating the causes and consequences of this insult is essential to establish a diagnosis and to contribute for the adoption of measures of prevention, control, and assistance. To identify the epidemiologic characteristics of the accidents involving children that received care at the pediatric emergency department of Botucatu Medical School Hospital and required hospitalization. This quantitative, retrospective, descriptiveanalytic epidemiologic study included all children aged 0-14 years who had had an accident and were seen at the Pediatric Emergency Department of Botucatu Medical School Hospital of São Paulo State University/UNESP between January 1/2008 and December 31/2009. A total of 227 medical charts were reviewed and 178 (78.4%) patients were included in this study. Of these, 116 (65.1%) were males and 62 (34.8%) were females. Children aged 5 - 9 years (38.9%) were the most affected, followed by those aged 10 - 14 years (37.5%). Fractures occurred in 138 (77.5%) of the cases, followed by foreign bodies... (Complete abstract click electronic access below)

Diversidade genética em Staphylococcus aureus resistentes à oxacilina em isolados de pacientes pediátricos do Hospital das Clínicas de Botucatu

Staphylococcus aureus é um patógeno ubíquo capaz de causar uma variedade de infecções em humanos. A resistência desse microrganismo a antibióticos como oxacilina e meticilina é um problema sério, de crescimento significativo para a terapêutica antimicrobiana clínica em pacientes acometidos por infecções estafilocócicas. A resistência à meticilina em S. aureus é decorrente da alteração do sítio de ação dos antibióticos β-lactâmicos, os quais agem através da inibição de enzimas que catalisam a síntese da parede celular. Essas enzimas são o sítio de ação das penicilinas, e por isso, passaram a ser chamadas de proteínas ligadoras de penicilinas (PBPs). O gene mecA codifica a PBP2a, que substitui a função das outras PBPs neste patógeno e confere resistência a β-lactâmicos. A PBP2a exibe uma afinidade reduzida pelo anel β-lactâmico e permite que a bactéria continue a sintetizar a parede bacteriana. Este gene faz parte de um elemento genético móvel encontrado em isolados de MRSA, designado cassete cromossômico estafilocócico mec (SCCmec), integrado ao cromossomo de S. aureus. O objetivo do estudo foi a caracterização molecular de 139 isolados de S.aureus provenientes de pacientes pediátricos com bacteremia durante o período de 1991 a 2010. Métodos moleculares foram utilizados para a determinação do perfil genético das amostras, incluindo, identificação do tipo de SCCmec, detecção do gene codificador de leucocidina de panton valentine (PVL) e similaridade clonal em gel de eletroforese em campo pulsado (PFGE). O gene mecA foi detectado em 32 (23%) amostras e houve predomínio do SCCmec IV (68,8%) em relação ao SCCmec III (31,2%). A presença de PVL foi encontrada em 18 amostras (12,9%), todas sensíveis à oxacilina. O clone epidêmico brasileiro, relacionado ao SCCmec tipo III, esteve presente na unidade neonatal do hospital... (Resumo completo, clicar acesso eletrônico abaixo)

Alterações clínicas e laboratoriais de equinos submetidos à biópsia hepática com agulha Tru-cut guiada por ultrassom

Pós-graduação em Medicina Veterinária - FCAV

Dinâmica linear e não linear da variabilidade da frequência cardíaca: sensibilidade, especificidade, valor preditivo e correlação de características físicas e clínicas no Diabetes Mellitus tipo 1

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

Extração seriada: considerações clínicas

The early malocclusion treatment has increased interest of orthodontic community. Among these is the serial extraction that harmonizes the differences between the amount of dental material and permanent deficiency of supporting bone. The technique is applied in mixed dentition through a predetermined sequence of extractions between deciduous and permanent teeth, in order to reach spontaneous immediately alignment of remaining permanent teeth with a minimum orthodontic mechanics. It will be reported a case where the serial extraction was performed in a growing patient with biprotrusion, Class I malocclusion and severe crowding. All functional and aesthetics goals were reached.

Características clínicas da associação entre o bruxismo do sono e o refluxo gastroesofágico merecem atenção profissional

Introduction: Bruxism has been defined as an oral parafunctional activity that includes clenching and/or grinding the teeth while asleep or awake. In addition to sleep bruxism (SB), various other orofacial movements sporadically occur during sleep. Occasional regurgitation and heartburn due to gastroesophageal reflux (GER) are frequent in the general population. GER refers to the presence of symptoms that are secondary to the reflux of gastric content through the esophagus with or without signs of esophageal mucosal lesions. Dentists are often the first health care professionals to diagnose GER through observation of its oral manifestation. Objective: The aim of the present case reports was to discuss the diagnosis and clinical procedures followed in two patients with SB and GER, thereby contributing to the dissemination of knowledge about these two entities. We therefore recommend dentists to be alert to identifying the first signs of GER that appear in the oral cavity. Conclusion: At this point, we highlight the importance of treating the patient as a whole, in an endeavor to identify other sources of the problems that could contribute as factors aggravating these conditions.

Próteses parciais removíveis associadas a encaixes: implicações clínicas e laboratoriais

Nowadays, the fixed partial dentures and/or dental implants is the most requested treatmentby the majority of partially edentulous patients. However, depending on the periodontal condition of the remaining teeth, as well as the bone condition of the prosthetic space, the oral rehabilitation with these treatments may be limited or even contraindicated. In such cases, the use of removable partial dentures associated to attachments becomes an important alternative for aesthetic and functional rehabilitation. Attachments are mechanical devices consisted of two parts (patrix-matrix), one placed inside another, which act as direct retainer, providing retention, support and stability to the dentures. These devices can be classified as intra or extracoronal attachments, considering their position in relation to the abutment tooth. However, regardless the type of attachment, the association between fixed and removable partial dentures should be performed respecting the biomechanical principles of both. Therefore, the purpose of this study was to review and discuss the literature about the clinical and laboratory implications of the association between fixed and removable partial dentures by means of attachments.

Sistemas cerámicos puros parte 2: materiales, propiedades ópticas y consideraciones clínicas

While dentistry continues to advance, the aesthetic techniques have evolved in proceedings more effective, functional and biocompatible. Meanwhile, cosmetic dentistry has become a bit more complex and technically difficult. With improvement of the properties (physical and optical) of the ceramics and the establishment of a working protocol, ceramic restorations have become increasingly popular. Currently there are several ceramic systems have excellent optical properties such as opalescence, fluorescence, translucency, chromaticity, which allow the restoration to mimic the tooth structure. From the physical point of view has restored biomechanical integrity and strengthening the remaining tooth structure. All this has led the profession to experience the use of new ceramic systems ranging from conventional feldspathic ceramics to modem ceramic reinforced, injected or computer-aid made. The material selection should be based on clinical need, aesthetic and functional requirements, restoration site, prosthetic design and laboratory techniques. In this article we will deal with the characteristics of the materials, their optical properties and clinical considerations for proper selection.

Estudo comparativo entre cinco diferentes tratamentos sobre as alterações clínicas e laboratoriais do rato diabético induzido pela aloxana

The long-term effects of five different treatments of diabetes were evaluated in alloxan-induced diabetic rats. Seven experimental groups, with 50 rats each (GN--normal control; GD--untreated diabetic control; GI, GA, GIA--treated groups with insulin, acarbose, and insulin plus acarbose, respectively; GTIL, GTPD--treated groups with islet of Langerhans and pancreas transplantation) were studied. Clinical (body weight, water intake, food intake and urine output) and laboratory (blood and urinary glucose, and plasma insulin) parameters were analyzed at the beginning of the study, and after 1, 3, 6, 9 and 12 months of follow-up. Mortality was observed in all groups, except GN, during 12 months (GD = 50%; GI = 20%; GA = 26%; GIA = 18%; GTIL = 4%; GTPD = 20%). Rats from the GD, GI, and GIA groups died due to metabolic or hydrossaline disbalance, and/or pneumonia, diarrhoea, and cachexy. All deaths observed in GTIL and GTPD groups were in decorrence of technical failure at the immediate postoperative, until 72h. Animals from the GI, GA and GIA had significative improving of the clinical and laboratory parameters (p < 0,05) observed in diabetic rats, being the efficacy of theses treatments equal. However, rats from the GTIL and GTPD groups had better control of these parameters than GI, GA, and GIA groups. Transplanted rats had complete restoration, at the normal levels, of all analyzed variables (p < 0.01). Conventional treatments with insulin, acarbose, and insulin plus acarbose improved the severe diabetic state of the alloxan-diabetic rats, but pancreas and islet transplantation have a better performance for treatment of diabetes.