Hospital Madre Teresa

A tributação contemporânea tem ampliado suas funções para além da arrecadação fiscal, passando a atuar também como instrumento de regulação econômica e social. Nesse contexto, destaca-se o imposto seletivo como mecanismo de extrafiscalidade voltado à correção de externalidades negativas associadas ao consumo de determinados bens e serviços. O presente estudo tem como objetivo analisar o imposto seletivo como elemento de extrafiscalidade no sistema tributário brasileiro, examinando seus fundamentos teóricos, sua função regulatória e sua relevância no contexto das políticas públicas contemporâneas. Para alcançar esse objetivo, foi realizada uma pesquisa de natureza qualitativa, com abordagem exploratória e descritiva, baseada em revisão bibliográfica de estudos científicos recentes sobre extrafiscalidade tributária, seletividade fiscal e regulação econômica por meio da tributação. A análise da literatura permitiu identificar que o imposto seletivo possui potencial significativo para influenciar padrões de consumo e produção, especialmente quando direcionado a produtos considerados prejudiciais à saúde ou ao meio ambiente. Os resultados evidenciam que a utilização da tributação seletiva pode contribuir para a mitigação de externalidades negativas, para a promoção de políticas públicas e para o fortalecimento de estratégias estatais voltadas ao desenvolvimento sustentável. Conclui-se que o imposto seletivo representa importante instrumento de política fiscal no contexto contemporâneo, ao permitir que o sistema tributário atue não apenas como mecanismo arrecadatório, mas também como ferramenta de regulação econômica e promoção do interesse coletivo.

Este artigo analisa os impactos da Emenda Constitucional nº 95/2016, que instituiu o teto de gastos públicos, sobre o financiamento da saúde pública no Brasil no contexto pós-pandemia da COVID-19. O estudo busca compreender os limites constitucionais impostos à restrição fiscal e discutir a possibilidade de sua inconstitucionalidade quando compromete o mínimo existencial, princípio fundamental que assegura direitos sociais básicos. A pesquisa fundamenta-se em revisão bibliográfica e análise de documentos oficiais, doutrina e jurisprudência, evidenciando que a rigidez orçamentária da EC 95 afeta diretamente a efetivação do direito à saúde, violando princípios constitucionais como a dignidade da pessoa humana e a vedação ao retrocesso. Conclui-se que a austeridade fiscal deve ser harmonizada com a proteção dos direitos fundamentais, e que a restrição excessiva pode ser juridicamente contestada.

Abstract Purpose To evaluate the reproducibility and consistency of the Radiographic Union Score for Tibial fractures (RUST) in diaphyseal fractures treated with intramedullary nailing among orthopedic residents with different levels of experience, and to compare their performance with artificial intelligence (AI) analysis. Methods Radiographs from 47 patients were assessed by four orthopedic residents (R1–R4) at two independent time points using the RUST scale. The same images were evaluated by AI. Intra- and interobserver agreement were calculated using the Intraclass Correlation Coefficient (ICC). Differences between human and AI evaluations were analyzed using Wilcoxon and Friedman tests with a 5% significance level. Results The sample consisted predominantly of men (71.7%) with a mean age of 32.9 years. AI classified 61.7% of fractures as consolidated (score ≥ 7). Absolute agreement between residents and AI was 17%, with residents overestimating scores in 45.2% and underestimating in 37.8% of cases. Observer R3 showed the best agreement with AI (ICC = 0.58), while R2 demonstrated a significant difference (p = 0.009). Interobserver reproducibility among residents was excellent (ICC = 0.93; 95% CI 0.84–0.96) but decreased to 0.61 when AI was included. Intraobserver consistency was very good (global ICC = 0.72; 95% CI 0.63–0.78), with R4 presenting the highest stability (ICC = 0.78). Conclusion The RUST scale showed high reproducibility among residents but limited agreement with AI, suggesting the need for additional training to improve consistency between human interpretation and algorithmic assessment.

O bruxismo é uma condição multifatorial caracterizada por atividade muscular mastigatória repetitiva, associada a dor miofascial, desgaste dentário e disfunções temporomandibulares, representando um desafio clínico relevante na Odontologia contemporânea. Este estudo tem como objetivo analisar as evidências científicas recentes acerca do uso da toxina botulínica tipo A no manejo do bruxismo e propor diretrizes para um protocolo odontológico integrado aplicado ao contexto clínico de pacientes atendidos em Manaus, Amazonas. Trata-se de uma pesquisa qualitativa, do tipo revisão de literatura, com abordagem descritiva e analítica, baseada na seleção de artigos científicos publicados entre 2021 e 2026 em bases de acesso aberto. Os resultados demonstram que a toxina botulínica apresenta eficácia na redução da hiperatividade muscular, da dor miofascial e da atividade mastigatória noturna, especialmente quando utilizada de forma individualizada e integrada a outras terapias, como placas oclusais. Observou-se ainda que fatores como dose, técnica de aplicação e perfil clínico do paciente influenciam diretamente os desfechos terapêuticos. Conclui-se que a toxina botulínica tipo A constitui recurso seguro e promissor no manejo do bruxismo quando inserida em protocolos clínicos estruturados, contribuindo para maior previsibilidade terapêutica, qualidade de vida do paciente e fortalecimento da prática odontológica baseada em evidências.

Here we describe Philodendron quartziticola, a new species of Araceae from the Atlantic Forest of Espírito Santo, Southeastern Brazil. The species is commonly associated with quartzitic substrates, in addition to environments locally referred to as “Morros de Sal”, which are characterized by saccharoidal quartzite formations. Morphological comparisons with closely related taxa are provided to delimit the new species, as well as photographic plates, field images, and a distribution map to document its morphology and range. This discovery is particularly relevant due to the species’ occurrence in environments heavily impacted by mineral extraction and land-use change.

This research seeks to analyze the socioeconomic profile of e-cigarette users, their frequency of use and symptoms induced by e-cigarettes. It is composed of 562 participants and divided into three stages: approach via social media, data collection by means of a self-administered online questionnaire, and descriptive data analysis. The demographic profile was characterized by young university students with higher education and middle/upper class income. The most prevalent symptoms were throat irritation and/or hoarseness (56.3%), cough (57.4%), nasal congestion (27.6%), anxiety (21.4%). In conclusion the results verified the association of demographic profile aspects, which pointed to a tendency for older individuals with a higher socioeconomic status to present more symptoms resulting from the use of electronic cigarettes; a greater proportion of individuals who reported not having knowledge about the composition of e-liquids was found, and this fact was associated with a greater presence and prevalence of symptoms harmful to health.

Introduction: Patients with rheumatic heart disease (RHD) who undergo surgical early mitral valve replacement (MVR) may later require reintervention. Transcatheter mitral valve-in-valve (ViV) implantation is a challenging but increasingly viable option, especially in high-risk patients. We report a complex mitral ViV procedure in a 78-year-old woman with multiple comorbidities and severe mitral bioprosthetic valve failure. Case Report: A 78-year-old woman with a history of RHD and surgical MVR 12 years prior was readmitted for progressive dyspnea (NYHA III) and pulmonary edema despite high-dose diuretics. Past history included hypertension, atrial fibrillation, chronic kidney disease (Cr=3.0 mg/dL), and VVi pacemaker. Catheterization revealed severe pulmonary venocapillary hypertension (27 mmHg), moderate pulmonary artery hypertension (59×22 [35] mmHg), and elevated right atrial pressure (19 mmHg). Transesophageal echo showed severe regurgitation of a severely calcified mitral bioprosthesis (external effective annulus=26 mm). Left ventricle (LV) outflow tract obstruction risk was low (area: 292 mm 2 ). STS-PROM mortality for surgical reintervention was 8.2%. The heart team opted for mitral ViV with a Sapien Ultra 29mm valve. Using a Swartz 8F sheath and BRK needle, a posteroinferior transseptal puncture was performed, and a 0.035" guidewire was advanced to the LV and exchanged for a pigtail catheter. A Safari extra-support guide was then positioned in the LV, and a second stiff wire was placed in the superior left pulmonary vein. Due to difficulty advancing the prosthesis, sequential septal dilations were performed with 8.0 mm and 10.0 mm balloons. The Sapien Ultra was then advanced across the septum but could not cross the stenotic surgical valve. The wire was repositioned from the pulmonary vein to the LV, and valvuloplasty was done with a 20×30 mm AltoSa balloon. The valve was then successfully navigated and implanted under rapid pacing with nominal deployment. Post-procedure 3D echo confirmed good valve dynamics with a mean gradient of 2 mmHg and visualization of a ruptured surgical leaflet. At 4-month follow-up, the patient remains in NYHA class I, with no adverse events. Conclusion: This case illustrates the feasibility of mitral ViV in RHD with severe prosthetic calcification. Preprocedural planning, balloon preparation, and wire strategy were critical for success. The Sapien Ultra prosthesis provided excellent hemodynamic results in a high-risk patient.

The topic of freedom of expression has received increasing attention worldwide, being the subject of controversial debates that have reached the Supreme Courts. The relevance of this fundamental right lies in the possibility of promoting the circulation of ideas and social dialogue, essential for democratic coexistence. This article discusses different situations that highlight the limits of freedom of expression. In the view of the legal philosopher Ronald Dworkin, it is legitimate to ridicule ideas, but protection ends when ridicule reaches the personal sphere, constituting a violation of the rights of third parties. Karl Popper, in formulating the Paradox of Tolerance, questions "to what extent should we tolerate the intolerant?", highlighting the need to contain discourses that threaten tolerance itself. The Covid-19 pandemic, in addition to its health impact, revealed a scenario of massive dissemination of fake news, which caused misinformation and aggravated social tensions. Finally, Habeas Corpus No. 1 is analyzed. 82,424, in which the Supreme Federal Court debated whether antisemitic publications would constitute the crime of racism, with the rapporteur, Minister Moreira Alves, concluding that the legal concept of racism transcends biological aspects, encompassing a social and political reality.