Denise Vieira Travassos

Judicialização da Saúde: um estudo de caso de três tribunais brasileiros

The scope of this study was to describe and compare records of the results of lawsuits filed in three Brazilian courts in cases involving the Unified Health System. A survey was made of the judgments listed on electronic sites of Courts of Justice in the states of Pernambuco, Rio Grande do Sul and Minas Gerais using a specific script. A total of 558 judgments was analyzed. There was a greater frequency of ordinary lawsuits (73.1%). In the majority of cases, it was not possible to identify the economic situation of the plaintiff or the legal representative of the defendant (54.5%). In cases where such identification was possible, a public defender was the most common (71.5%). The cases were predominantly individual in all three states. There was a large number of requests for injunctions (83.8%), which were almost always granted (91.2%), with the allegation of urgency/emergency in almost all cases (98.8%). The majority of decisions were favorable to the users of the public healthcare system (97.8%). The decisions studied showed that the users sought to ensure their right to health individually, using the public authorities to file their lawsuit, but there is a perceived difference in posture between legal courts evaluated. There is a strong tendency of the judiciary to accept these requests.As infeccoes respiratorias constituem um conjunto de doencas comumente relacionadas aos idosos, considerando que o virus da influenza e um dos principais agentes etiologicos. A vacinacao desses individuos e considerada pela Organizacao Mundial de Saude como a mais efetiva estrategia para a reducao da morbimortalidade pela doenca. O Brasil tem buscado nesses ultimos anos, como meta vacinar 80% da populacao alvo. Este estudo objetivou relacionar a cobertura vacinal da influenza e a taxa de mortalidade por doencas respiratorias em idosos. Trata-se de um estudo transversal com analise secundaria de dados. Os dados sobre cobertura vacinal no ano de 2010 em idosos dos 496 municipios gauchos foram obtidos na pagina do Programa Nacional de Imunizacao e de mortalidade no Sistema Informacao de Mortalidade. Os resultados evidenciaram que 49% municipios gauchos atingiram a meta de 80% de idosos vacinados, nos municipios com cobertura vacinal abaixo da meta o numero de mortes foi de 5,2 por 1.000 idosos, media essa significativamente maior que nos municipios com cobertura igual ou maior que 80%. Concluimos que a meta proposta pelo Ministerio da Saude Brasileiro de vacinar 80% ou mais de idosos e eficiente para a diminuicao da mortalidade por doencas respiratorias.

Dental care before cardiac valve surgery: Is it important to prevent infective endocarditis?

Background Infective endocarditis (IE) is a serious disease that affects the surface of the endocardium. The spread of microorganisms from the oral cavity has been associated with the occurrence of IE. Objective To analyze whether dental treatment before cardiac valve surgery (CVS) influenced the occurrence of IE. Methods We performed a retrospective analysis of the medical and dental histories of patients undergoing CVS from 2004 to 2014. The sample consisted of 481 patients who underwent CVS divided into two groups: patients submitted to dental treatment prior to CVS (n = 110) and patients undergoing CVS without dental treatment (n = 371). Results Of the total sample, 38 patients (8%) were diagnosed with IE. No significant difference was detected (p = 0.496) in comparing the occurrence of IE in the group with dental preparation (6.4%) and without dental preparation (8.4%). The logistic regression model confirmed that dental treatment did not change the IE risk (p = 0.504) and indicated that age (p < 0.003) and gender (p = 0.013) were significant risk factors for IE. There was a high demand for dental procedures in the group receiving dental preparation, with no significant differences between the patients with or without IE. Hemoculture indicated qualitative differences in comparing patients with and without dental treatment, especially in the frequency of Staphylococcus and Streptococcus. Conclusions The results did not allow for the determination of the impact of dental treatment before CVS on IE outcomes. However, it was not possible to exclude the potential beneficial effects of dental treatment in the prevention of IE.

Intraoral granulocytic sarcoma as a manifestation of myelofibrosis: A case report and review of the literature

Granulocytic sarcoma (GS) is an extramedullary tumor associated with myelodysplastic syndromes or myeloproliferative diseases. Intraoral manifestations are considered uncommon, with a reasonable number of cases, and are mostly related to leukemia. The association of oral GS and myelofibrosis is very rare and only three cases have been published. In this paper, we report the fourth case of oral lesion in a patient with a diagnosis of myelofibrosis. The aim of this study was to present a review of the literature, discussing the current and previous cases of oral GS associated with myelofibrosis or other hematological disorders and the importance of accurate diagnosis through clinical, microscopic, and immunohistochemical features.

The removable acrylic partial denture in primary care: the experience and satisfaction of dental surgeons

Introduction: The guidelines of the National Politics of Oral Health have led to the inclusion of elemental prostheses in the list of Primary Care procedures. Objective: This paper aimed to evaluate the performance and satisfaction of dental surgeons with the implementation of Acrylic Partial Dentures. Methodology: The sample was composed by 159 dental surgeons (sample calculation), in Belo Horizonte, MG, Brazil, selected via raffle (simple random sampling). A structured questionnaire was built with 72 questions on the daily practice of the performance of dental surgeons, using the SurveyMonkey platform. Result: The results showed that for most of dental surgeons, the inclusion on the list of primary care procedures was a positive initiative and they have enjoyed the experience of using Acrylic Partial Dentures. Dental surgeons who had graduated in private institutions reported to have had more failures than those who had graduated in public institutions. The better prepared dental surgeons reported less difficulties and failures, and the more satisfied professionals with the performance of Acrylic Partial Dentures related had also experienced fewer failures. Considering the indication, the majority of participants did it according to the protocol of the institution (only for anterior teeth) but many revealed the use of dentures also for premolars. Conclusion: Acrylic partial dentures have been a reality in the Brazilian social context even before their inclusion in the list of Primary Care procedures. Such inclusion indicates their relevance; however, it is necessary to have their confection systematized by a protocol in public services. Descriptors: Partial dentures; dentists; job satisfaction; clinical protocols. Rev Odontol UNESP. 2017 Nov-Dec; 46(6): 336-342 The removable acrylic... 337

Identifying missing people: the contribution of forensic dentistry and DNA

AbstractIntroduction: Human identification is considered one of the major steps concerning missing people. The Forensic Anthropology Sector of Legal Medical Institutes identifies corpses. Forensic dentistry and DNA tests stand out among the existing standard tests. Objective: This article aimed to evaluate human identification effectiveness through forensic dental examination performed in the forensic anthropology sector in a Forensic Medical Institute, comparing them with DNA analyses. Methodology: This is a cross-sectional study using secondary data available in the department´s database, from 2008 to 2014, concerning identification procedures using forensic dentistry and DNA techniques. Result : The analysis of the examinations eligible to this study (241) showed that DNA analysis was the method used for identification in 79.3% of the cases and forensic dental examinations were used in 20.7% of the cases. As for the type of biological material used during these examinations, unidentified corpses corresponded to 131 cases (53.9%), skeleton structures corresponded to 109 cases (44.9%) and there were 3 cases of body segments (1.2%). When analyzing the time spent to complete the tests, dental examinations were faster than DNA tests. The time spent for forensic dental examination does not depend on the type of dental documentation evaluated.

Dental management for patients undergoing heart valve surgery

This study sought to review current guidelines and the most optimal dental management for patients undergoing cardiac valve surgery.

Severe Periodontal Disease Associated with Long-Term Treatment with Intravenous Immunoglobulin

Intravenous immunoglobulin (IVIG) is used in the treatment of neuropathy. This case report presents, for the first time, a patient with severe periodontal destruction after chronic therapy with IVIG. The patient reported having extracted his maxillary anterior teeth himself due to high mobility. Clinical examination and radiographic images show a generalized and severe periodontitis. No significant alterations in genetic or microbiological features were observed. The present case suggests that periodontal disease aggravation could be considered a new adverse effect of IVIG therapy. Postulated mechanisms are immune complexes formation, complement activation, and a direct effect in osteoclasts. In conclusion, it is important that patients that will receive IVIG treatment underwent dental evaluation.