Contribution to the study of antimicrobial prophylaxis in third molar extraction surgeries / Contribuição ao estudo da profilaxia antimicrobiana em cirurgias de extração dos terceiros molares

ABSTRACT The use of antibiotic prophylaxis in the extraction of third molars is extremely controversial, raising several discussions about the most appropriate clinical protocol to avoid postoperative complications. To review the literature on the subject, describing the evidence for and against antibiotic prophylaxis to prevent surgical site infections in third molar extractions, besides establishing a prophylactic protocol and dosage regimen. A literature review was carried out analyzing scientific evidence from articles on the PubMed and Scielo platforms by searching for the descriptors "antibiotic therapy and infection in third molar extraction surgery", "antimicrobial prophylaxis and infective endocarditis", "antibiotic prophylaxis and adverse effects", "antibiotic therapy in dentistry", "surgical time and incidence of infections in extractions", including original articles and double or triple blind randomized clinical trials, in Portuguese and English, published between 1980 and 2021, separated in chronological order. There is no consensus in the literature on the indication of antimicrobial prophylaxis, but factors as surgeon's skill, time elapsed during the procedure and the patient's general health status directly affect the incidence and severity of infections. Among all the literature analyzed for this study, it is possible to infer that the topic is still extremely questionable and, therefore, it is essential to conduct new experimental studies to obtain more conclusive data on the subject.

RESUMO O emprego da profilaxia antibiótica na exodontia de terceiros molares é extremamente controverso, gerando diversas discussões sobre o protocolo clínico mais adequado para evitar as complicações pós-operatórias. Revisar a literatura referente ao tema, descrevendo as evidências a favor e contra a profilaxia antibiótica para prevenir infecções do sítio cirúrgico nas extrações de terceiros molares, além de firmar um protocolo profilático e regime posológico. Realizou-se uma revisão de literatura analisando evidências científicas através de artigos nas plataformas PubMed e Scielo pela pesquisa de descritores "antibioticoterapia e infecção em cirurgia de extração de terceiros molares", "profilaxia antimicrobiana e endocardite infecciosa", "profilaxia antibiótica e efeitos adversos", "antibioticoterapia em odontologia", "tempo cirúrgico e incidência de infecções em exodontias", sendo incluídos artigos originais e ensaios clínicos duplos ou triplos cegos randomizados, nos idiomas português e inglês, publicados entre 1980 e 2021, separados em ordem cronológica. Não há consenso na literatura sobre a indicação da profilaxia antimicrobiana, porém há fatores como a habilidade do cirurgião, tempo decorrido durante o procedimento e estado de saúde geral do paciente afetam diretamente na incidência e severidade das infecções. Dentre toda a literatura analisada para este estudo, é possível aferir que o tema é ainda extremamente questionável e, portanto, é fundamental que novos estudos de caráter experimental sejam feitos para que se obtenha dados mais contundentes sobre o assunto.

Realistic simulation is associated with healthcare professionals' increased self-perception of confidence in providing acute stroke care: a before-after controlled study / Simulação realística é associada a aumento na autopercepção de segurança de profissionais de saúde no atendimento a pacientes com acidente vascular cerebral agudo: um estudo antes-depois controlado

ABSTRACT Background: Simulations are becoming widely used in medical education, but there is little evidence of their effectiveness on neurocritical care. Because acute stroke is a neurological emergency demanding prompt attention, it is a promising candidate for simulation training. Objective: To assess the impact of a stroke realistic simulation course on clinicians' self-perception of confidence in the management of acute stroke. Methods: We conducted a controlled, before-after study. For our intervention, 17 healthcare professionals participated in a stroke realistic simulation course. As controls, participants were chosen from a convenience sample of attendees to the courses Emergency Neurologic Life Support (ENLS) (18 participants) and Neurosonology (20 participants). All participants responded pre- and post-test questionnaires evaluating their self-perception of confidence in acute stroke care, ranging from 10 to 50 points. We evaluated the variation between pre- and post-test results to assess the change on trainees' self-perception of confidence in the management of acute stroke. Multivariate analysis was performed to control for potential confounders. Results: Forty-six (83.63%) subjects completed both questionnaires. The post-test scores were higher than those from the pretests in the stroke realistic simulation course group [pretest median (interquartile range - IQR): 41.5 (36.7-46.5) and post-test median (IQR): 47 (44.7-48); p=0.033], but not in the neurosonology [pretest median (IQR): 46 (44-47) and post-test median (IQR): 46 (44-47); p=0.739] or the ENLS [pretest median (IQR): 46.5 (39-48.2), post-test median (IQR): 47 (40.2-49); p=0.317] groups. Results were maintained after adjustment for covariates. Conclusions: This stroke realistic simulation course was associated with an improvement on trainees' self-perception of confidence in providing acute stroke care.

RESUMO Introdução: Simulações são amplamente utilizadas na educação médica, mas há pouca evidência de sua eficácia no tratamento de pacientes neurocríticos. Como o acidente vascular cerebral agudo (AVC) é uma patologia que requer atendimento imediato, o uso de simulação pode ser uma ferramenta útil no treinamento do manejo desses pacientes. Objetivo: Avaliar o impacto do uso de simulação realística na autopercepção de segurança no atendimento a pacientes vítimas de AVC agudo. Métodos: Estudo antes-depois controlado. No grupo da intervenção, 17 profissionais da área de saúde participaram de um curso de simulação realística de atendimento a pacientes com AVC. Como controles, os participantes foram escolhidos a partir de uma amostra de conveniência composta por 18 participantes do curso Emergency Neurologic Life Support (ENLS) e 20 participantes de um curso de Neurossonologia. Foram respondidos questionários antes e após o curso para avaliar a autopercepção de segurança no atendimento a pacientes vítimas de AVC agudo, variando de 10 a 50 pontos. Foi avaliada a variação entre os resultados pré- e pós-teste, para avaliar a mudança na autopercepção de confiança do trainee no manejo do AVC agudo. Análise multivariada foi realizada para controlar possíveis fatores de confusão. Resultados: Quarenta e seis (83,63%) participantes responderam aos questionários. A pontuação no questionário pós-curso foi maior do que a obtida no questionário pré-curso no grupo de participantes do curso de simulação realística em AVC [mediana do questionário pré-curso: 41,5 (36,7-46,5) e mediana do questionário pós-curso: 47,0 (44,7-48,0); p=0,033]. Essa diferença não foi observada no curso de Neurossonologia [mediana pré-curso (IQR): 46,0 (44,0-47,00), mediana pós-curso (IQR): 46,0 (44,0-47,0); p=0,739] nem no ENLS [mediana pré-curso (IQR): 46,5 (39,0-48,2) mediana pós-curso (IQR): 47,0 (40,2-49,0); p=0,317]. Esses resultados persistiram após ajuste das variáveis. Conclusão: O curso de simulação realística em AVC foi associado a um aumento na autopercepção de segurança dos participantes em atender pacientes vítimas de AVC agudo.

Positive fluid balance as an early biomarker for acute kidney injury: a prospective study in critically ill adult patients

OBJECTIVES: Positive fluid balance is frequent in critically ill patients and has been considered a potential biomarker for acute kidney injury (AKI). This study aimed to evaluate positive fluid balance as a biomarker for the early detection of AKI in critically ill patients. METHODS: This was a prospective cohort study. The sample was composed of patients ≥18 years old who stayed ≥3 days in an intensive care unit. Fluid balance, urinary output and serum creatinine were assessed daily. AKI was diagnosed by the Kidney Disease Improving Global Outcome criteria. RESULTS: The final cohort was composed of 233 patients. AKI occurred in 92 patients (40%) after a median of 3 (2-6) days following ICU admission. When fluid balance was assessed as a continuous variable, a 100-ml increase in fluid balance was independently associated with a 4% increase in the odds of AKI (OR 1.04; 95% CI 1.01-1.08). Positive fluid balance categorized using different thresholds was always significantly associated with subsequent detection of AKI. The mixed effects model showed that increased fluid balance preceded AKI by 4 to 6 days. CONCLUSION: These results suggest that a positive fluid balance might be an early biomarker for AKI development in critically ill patients.

Eficácia e segurança da milrinona no tratamento do vasoespasmo cerebral após hemorragia subaracnóidea: uma revisão sistemática / Efficacy and safety of milrinone in the treatment of cerebral vasospasm after subarachnoid hemorrhage: a systematic review

RESUMO Objetivo: Revisar sistematicamente a evidência atual da eficácia de milrinona no tratamento do vasoespasmo cerebral após hemorragia subaracnóidea. Métodos: Triaram-se as bases de dados Pubmed®, Cochrane e Embase quanto a artigos publicados entre abril de 2001 e fevereiro de 2019. Dois revisores independentes realizaram uma triagem metodológica da qualidade e a extração dos dados dos estudos. Resultados: Encontraram-se 22 estudos considerados relevantes, sendo que apenas um deles era um ensaio randomizado controlado. Os estudos demonstraram acentuada heterogeneidade e debilidade de seus critérios metodológicos. A maioria dos pacientes apresentava vasoespasmo moderado a grave. O principal método para diagnóstico do vasoespasmo foi a angiografia. Em três estudos, realizou-se administração de milrinona por via intra-arterial; em nove estudos, a administração foi endovenosa, e, em seis estudos, utilizaram-se ambas as vias de administração. A via intratecal foi utilizada em dois estudos, em um estudo, a administração foi realizada via cisterna e, em um estudo, a via de administração foi a endovascular. Os efeitos colaterais de milrinona foram descritos em seis estudos. Vinte e um estudos indicaram a resolução do vasoespasmo. Conclusão: A evidência atual indica que o uso de milrinona teve um papel no tratamento do vasoespasmo após hemorragia subaracnóidea aneurismática. Contudo, só foi realizado um ensaio randomizado controlado, com baixo nível de qualidade. Nossos achados indicam a necessidade de futuros estudos randomizados controlados com desfechos centrados no paciente, com o fim de proporcionar recomendações definitivas.

ABSTRACT Objective: To systematically review the current evidence on the efficacy of milrinone in the treatment of cerebral vasospasm after subarachnoid hemorrhage. Methods: The Pubmed®, Cochrane and Embase databases were screened for articles published from April 2001 to February 2019. Two independent reviewers performed the methodological quality screening and data extraction of the studies. Results: Twenty-two studies were found to be relevant, and only one of these was a randomized control trial. Studies showed marked heterogeneity and weaknesses in key methodological criteria. Most patients presented with moderate to severe vasospasm. Angiography was the main method of diagnosing vasospasm. Intra-arterial administration of milrinone was performed in three studies, intravenous administration was performed in nine studies, and both routes of administration in six studies; the intrathecal route was used in two studies, the cisternal route in one study and endovascular administration in one study. The side effects of milrinone were described in six studies. Twenty-one studies indicated resolution of vasospasm. Conclusion: The current evidence indicates that milrinone may have a role in treatment of vasospasm after aneurysmal subarachnoid hemorrhage. However, only one randomized control trial was performed, with a low quality level. Our findings indicate the need for future randomized control trials with patient-centered outcomes to provide definitive recommendations.

Efeitos de um programa de cuidados paliativos nas tendências de utilização da unidade de terapia intensiva e ordens de não reanimar durante hospitalizações terminais. Análise de séries temporais interrompidas / Effect of a palliative care program on trends in intensive care unit utilization and do-not-resuscitate orders during terminal hospitalizations. An interrupted time series analysis

RESUMO Objetivo: Avaliar os efeitos da implantação de um programa de cuidados paliativos no estabelecimento de ordens de não reanimar e na utilização da unidade de terapia intensiva em hospitalizações terminais. Método: Os dados de todos os pacientes que faleceram em um hospital terciário brasileiro, entre maio de 2014 e setembro de 2016, foram coletados de forma retrospectiva. Analisamos a frequência do estabelecimento de ordens de não reanimar e de admissões à unidade de terapia intensiva entre os casos de óbito hospitalar. Utilizou-se análise de séries temporais interrompidas para avaliar as diferenças, em termos de tendências de estabelecimento de ordens de não reanimar e de admissões à unidade de terapia intensiva antes (15 meses) e após (12 meses) a implantação do programa de cuidados paliativos. Resultados: Analisamos um total de 48.372 admissões ao hospital, dentre as quais 1.071 óbitos no hospital. Os óbitos foram precedidos de ordens de não reanimar em 276 (25,8%) casos e ocorreram admissões à unidade de terapia intensiva em 814 (76%) casos. O estabelecimento de ordens de não reanimar aumentou de 125 (20,4%) para 151 (33%) casos, na comparação entre os períodos antes e após a implantação do programa de cuidados paliativos (p < 0,001). Ocorreram admissões à unidade de terapia intensiva em 469 (76,5%) e 345 (75,3%) dos casos, respectivamente, nos períodos pré e após a implantação do programa de cuidados paliativos (p = 0,654). A análise de séries temporais confirmou tendência ao aumento do estabelecimento de ordens de não reanimar de 0,5% por mês antes da implantação para 2,9% ao mês após a implantação (p < 0,001), demonstrando-se tendência à diminuição de utilização da unidade de terapia intensiva, de uma tendência a aumento de 0,6% ao mês, antes da implantação do programa, para diminuição de -0,9% ao mês no período, após a implantação (p = 0,001). Conclusão: A implantação de um programa de cuidados paliativos se associou com tendência ao aumento no estabelecimento de ordens de não reanimar e à diminuição do uso da unidade de terapia intensiva durante hospitalizações terminais.

ABSTRACT Objective: To assess the effect of the implementation of a palliative care program on do-not-resuscitate orders and intensive care unit utilization during terminal hospitalizations. Methods: Data were retrospectively collected for all patients who died in a tertiary hospital in Brazil from May 2014 to September 2016. We analyzed the frequency of do-not-resuscitate orders and intensive care unit admissions among in-hospital deaths. Interrupted time series analyses were used to evaluate differences in trends of do-not-resuscitate orders and intensive care unit admissions before (17 months) and after (12 months) the implementation of a palliative care program. Results: We analyzed 48,372 hospital admissions and 1,071 in-hospital deaths. Deaths were preceded by do-not-resuscitate orders in 276 (25.8%) cases and admissions to the intensive care unit occurred in 814 (76%) cases. Do-not-resuscitate orders increased from 125 (20.4%) to 151 (33%) cases in the pre-implementation and post-implementation periods, respectively (p < 0.001). Intensive care unit admissions occurred in 469 (76.5%) and 345 (75.3%) cases in the pre-implementation and post-implementation periods, respectively (p = 0.654). Interrupted time series analyses confirmed a trend of increased do-not-resuscitate order registrations, from an increase of 0.5% per month pre-implementation to an increase of 2.9% per month post-implementation (p < 0.001), and demonstrated a trend of decreased intensive care unit utilization, from an increase of 0.6% per month pre-implementation to a decrease of -0.9% per month in the post-implementation period (p = 0.001). Conclusion: The implementation of a palliative care program was associated with a trend of increased registration of do-not-resuscitate orders and a trend of decreased intensive care unit utilization during terminal hospitalizations.

Vector aspects in risk areas for sylvatic yellow fever in the state of Mato Grosso do Sul, Brazil

Epizootics and yellow fever epidemics in 2008 in Brazil, Paraguay and Argentina marked a significant progression of the disease further south in the continent affecting non-vaccinated human populations. The state of Mato Grosso do Sul is located between the tropical endemic region and the subtropical epidemic region and, despite being an area recommended for vaccination since the 1980s, human and animal cases of the disease are still registered. The purpose of this study was to present the results of entomological surveys of probable sites of infection (PSI) geographically describing these areas regarding human cases and disease suspicion reported in 2008. Thirteen locations in nine municipalities were investigated. A total of 305 females of the genus Haemagogus and Sabethes and five specimens of Aedes albopictus were obtained. The genus Haemagogus was more abundant but Sabethes presented twice as many species (3 x 6) and higher distribution within the collection points. The most abundant species was Hg. janthinomys, with 102 individuals in one location. The other species found were: Hg. leucocelaenus, Hg. spegazzinii, Sa. albiprivus, Sa. belisarioi, Sa. chloropterus, Sa. glaucodaemun, Sa. intermedius and Sa. soperi. It was not possible to identify predominant species in relation to environmental and geographical characteristics of the collection points. Of the nine human cases, eight corresponded to persons not resident in the State, seven of them tourists. MS features a large diversity of rural and wildlife tourist attractions where the yellow fever vectors described in this work are present. In this sense, the monitoring of vaccination coverage and flow of non-vaccinated people through the area are crucial to controlling the disease.

SEROLOGICAL DETECTION OF HEPATITIS A VIRUS IN FREE-RANGING NEOTROPICAL PRIMATES (Sapajus spp., Alouatta caraya) FROM THE PARANÁ RIVER BASIN, BRAZIL

Nonhuman primates are considered as the natural hosts of Hepatitis A virus (HAV), as well as other pathogens, and can serve as natural sentinels to investigate epizootics and endemic diseases that are of public health importance. During this study, blood samples were collected from 112 Neotropical primates (NTPs) (Sapajus nigritus and S. cay, n = 75; Alouatta caraya, n = 37) trap-captured at the Paraná River basin, Brazil, located between the States of Paraná and Mato Grosso do Sul. Anti-HAV IgG antibodies were detected in 4.5% (5/112) of NTPs, specifically in 6.7% (5/75) of Sapajus spp. and 0% (0/37) of A. caraya. In addition, all samples were negative for the presence of IgM anti-HAV antibodies. These results suggest that free-ranging NTPs were exposed to HAV within the geographical regions evaluated.

Evaluation of arboviruses of public health interest in free-living non-human primates (Alouatta spp., Callithrix spp., Sapajus spp.) in Brazil

INTRODUCTION: The aim of the present study was to evaluate the presence of arboviruses from the Flavivirus genus in asymptomatic free-living non-human primates (NHPs) living in close contact with humans and vectors in the States of Paraná and Mato Grosso do Sul, Brazil. METHODS: NHP sera samples (total n = 80, Alouatta spp. n = 07, Callithrix spp. n = 29 and Sapajus spp. n = 44) were screened for the presence of viral genomes using reverse transcription polymerase chain reaction and 10% polyacrylamide gel electrophoresis techniques. RESULTS: All of the samples were negative for the Flavivirus genome following the 10% polyacrylamide gel electrophoresis analysis. CONCLUSIONS: These negative results indicate that the analyzed animals were not infected with arboviruses from the Flavivirus genus and did not represent a risk for viral transmission through vectors during the period in which the samples were collected. .

Detection of arboviruses of public health interest in free-living New World primates (Sapajus spp.; Alouatta caraya) captured in Mato Grosso do Sul, Brazil

Introduction A sero-epidemiological survey was undertaken to detect the circulation of arboviruses in free-living non-human primates. Methods Blood samples were obtained from 16 non-human primates (13 Sapajus spp. and three Alouatta caraya) that were captured using terrestrial traps and anesthetic darts in woodland regions in the municipalities of Campo Grande, Aquidauana, Jardim, Miranda and Corumbá in the State of Mato Grosso do Sul, Brazil. The samples were sent to the Instituto Evandro Chagas (IEC) in Ananindeua, Pará, Brazil, to detect antibodies against 19 species of arboviruses using a hemagglutination inhibition test (HI). Results Of the 16 primates investigated in the present study, five (31.2%) were serologically positive for an arbovirus. Of these five, two (12.5%) exhibited antibodies to the Flavivirus genus, one (6.2%) exhibited a monotypic reaction to Cacipacoré virus, one (6.2%) was associated with Mayaro virus, and one (6.2%) was positive for Oropouche virus. Conclusions Based on the positive serology observed in the present study, it was possible to conclude that arboviruses circulate among free-living primates. The viruses in the areas studied might have been introduced by infected humans or by primates from endemic or enzootic areas. Studies of this nature, as well as efficient and continuous surveillance programs, are needed to monitor viral activities in endemic and enzootic regions. .

Predicting the geographic distribution of Lutzomyia longipalpis (Diptera: Psychodidae) and visceral leishmaniasis in the state of Mato Grosso do Sul, Brazil

To understand the geographic distribution of visceral leishmaniasis (VL) in the state of Mato Grosso do Sul (MS), Brazil, both the climatic niches of Lutzomyia longipalpis and VL cases were analysed. Distributional data were obtained from 55 of the 79 counties of MS between 2003-2012. Ecological niche models (ENM) of Lu. longipalpis and VL cases were produced using the maximum entropy algorithm based on eight climatic variables. Lu. longipalpis showed a wide distribution in MS. The highest climatic suitability for Lu. longipalpis was observed in southern MS. Temperature seasonality and annual mean precipitation were the variables that most influenced these models. Two areas of high climatic suitability for the occurrence of VL cases were predicted: one near Aquidauana and another encompassing several municipalities in the southeast region of MS. As expected, a large overlap between the models for Lu. longipalpis and VL cases was detected. Northern and northwestern areas of MS were suitable for the occurrence of cases, but did not show high climatic suitability for Lu. longipalpis . ENM of vectors and human cases provided a greater understanding of the geographic distribution of VL in MS, which can be applied to the development of future surveillance strategies.

Fauna of phlebotomine sand flies (Diptera, Psychodidae) in areas with endemic American cutaneous leishmaniasis in the State of Mato Grosso do Sul, Brazil

Fauna of phlebotomine sand flies (Diptera, Psychodidae) in areas with endemic American cutaneous leishmaniasis in the State of Mato Grosso do Sul, Brazil. The aim of this study was to investigate the ecological aspects of the main vectors of American cutaneous leishmaniasis (ACL) in four monitoring stations situated in the municipalities of Naviraí, Nova Andradina, Novo Horizonte do Sul and Rio Verde de Mato Grosso. For each monitoring station, the captures of sand flies were undertaken each month from July 2008 to June 2010 using CDC and Shannon traps. The CDC traps were installed simultaneously for three consecutive nights in three collection sites: intradomicile, peridomicile and edge of the forest. A Shannon trap was installed from dusk to 10 pm, inside the forest, one night per month. A total of 7,651 sand flies belonging to nine genera and twenty-nine species were captured. Nyssomyia neivai (52.95%), Psathyromyia hermanlenti (10.91%), Psathyromyia runoides (9.16%), Nyssomyia whitmani (7.95%), Psathyromyia aragaoi (4. 89%), Nyssomyia antunesi (3.14%) and Evandromyia bourrouli (2.20%) were the most frequent species. Approximately 65% of the sand flies were collected in the forest environment. The municipalities presented significantly different indexes of species diversity. Naviraí presented the lowest species diversity index, however, it showed the highest abundance. Novo Horizonte do Sul had the highest species diversity index, but the lowest abundance (< 5%). It is noteworthy the occurrence of vector species of Leishmania in the areas studied, especially in Naviraí, where Ny. neivai presented high frequencies which may explain the increased number of ACL cases in this municipality.

Hfe mutations add iron overload in patients with alcoholic liver disease

Context Alcoholic liver disease (ALD) is generally associated with iron overload, which may contribute to its pathogenesis, through increased oxidative stress and cellular damage. There are conflicting reports in literature about hemochromatosis (HFE) gene mutations and the severity of liver disease in alcoholic patients. Objectives To compare the prevalence of mutations in the hemochromatosis (HFE) gene between patients with ALD and healthy controls; to assess the relation of HFE mutations with liver iron stores and liver disease severity. Methods Liver biopsy specimens were obtained from 63 ALD patients (during routine treatment) and 52 healthy controls (during elective cholecystectomy). All individuals underwent routine liver function tests and HFE genotyping (to detect wild-type sequences and C282Y, H63D, S65C, E168Q, E168X, V59M, H63H, P160delC, Q127H, Q283P, V53M and W164X mutations). Associations between HFE mutations and risk of excessive liver iron stores, abnormal serum ferritin, liver fibrosis, or necroinflammatory activity were assessed by multivariate logistic regression analysis. Results ALD patients had significantly higher serum ferritin and transferrin saturation than controls (both P<0.05), but the distribution of HFE mutations was similar between the two groups. For ALD patients, the odds ratio for having at least one HFE mutation and excessive liver iron stores was 17.23 (95% confidence interval (CI): 2.09-142.34, P = 0.008). However, the presence of at least one HFE mutation was not associated with an increased risk of liver fibrosis or necroinflammatory activity. Active alcohol ingestion showed the strongest association to increased serum ferritin (OR = 8.87, 95% CI: 2.11-34.78, P = 0.003). Conclusions ALD patients do not present with a differential profile of HFE mutations from healthy controls. In ALD patients, however, ...

Contexto A doença hepática alcoólica (DHA) está geralmente associada à sobrecarga de ferro, que pode contribuir para a sua patogênese, através do aumento do estresse oxidativo e dano celular. As descrições existentes na literatura sobre a associação entre mutações HFE e a gravidade da DHA nem sempre são concordantes. Objetivos Comparar a prevalência de mutações HFE entre um grupo de pacientes com DHA e uma população de controle. Avaliar a relação entre mutações HFE e os depósitos de ferro hepático. Avaliar se a presença dessas mutações está associada com a gravidade da DHA. Métodos Compararam-se 63 pacientes com DHA que efetuaram biopsia hepática com 52 controles saudáveis. A genotipagem HFE (wild type, C282Y, H63D, S65C, E168Q, E168X, V59M, H63H, P160delC, Q127H, Q283P, V53M, W164X) e uma avaliação laboratorial de rotina (incluindo cinética do ferro) foram feitos em todos os indivíduos. Realizou-se regressão logística multivariada nos casos para avaliar se a presença de mutações HFE estava relacionada com risco aumentado de depósitos de ferro hepático aumentados, ferritina sérica anormal, fibrose hepática significativa ou atividade necroinflamatória. Resultados Os pacientes apresentaram ferritina sérica e saturação da transferrina mais elevadas que os controles, mas não existiram diferenças significativas na distribuição de mutações HFE entre pacientes e controles. Considerando apenas os pacientes, o risco relativo de estes apresentarem pelo menos uma mutação HFE e depósitos de ferro hepático significativos foi de 17.23 (CI 95% 2.09-142.34, P = 0.008). Contudo, a presença ...

Comparative analysis between dactyloscopy and rugoscopy

Records form the evolutional history show primitive attempts of human individualization by hand printingon cave walls. Later, still under the need of differentiating among other animals, the ancestral used developedprocesses for personal identification. Nowadays, the human individualization continues based on unique morphological characteristics. This study aims to analyze the correlation between the fingerprints and the palatal rugae. A sample of 93 patients, out of 100, aged between 18 and 35 years, was selected. Fingerprintswere collected by impression on paper, and palatal rugae were registered through intra-oral photography.The Vucetich’s method was applied for the fingerprints analysis and the Carrea’s method was utilized for theanalysis on palatal rugae. Frequency of distribution was applied to describe the incidence of fingerprints andpalatal rugae patterns. The Chi-square test was used for correlation analysis between the two variables. Theexternal clip was the most common pattern among fingerprints on the right hand (48,39%), on the oppositeside the internal clip had major incidence (50,54%). The pattern type IV was observed as the most commonamong the palatal rugae (42,55%). The Chi-square test demonstrated significant result only when correlatedright and left hands. No statistical correlation was found involving palatal rugae. It is possible to concludethat genetic intervention is the main factor to explain relevant results on correlations between opposite hands.Considering the absence of previous studies in the literature, this research aims to provide initial support forfurther investigations.

Seroepidemiological monitoring in sentinel animals and vectors as part of arbovirus surveillance in the state of Mato Grosso do Sul, Brazil / Monitoramento soroepidemiológico em animais-sentinela e vetores como parte da vigilância de arbovírus, no estado de Mato Grosso do Sul, Brasil

INTRODUCTION: From February-September 2010, seroepidemiological surveys were conducted on non-human primates and transmitter vector capture was used to investigate the possible circulation of arboviruses in the municipalities of Bonito, Campo Grande, and Jardim, State of Mato Grosso do Sul, Brazil. METHODS: A total of 65 primates from the wild and captivity were used, and potential vectors were captured using Castro and dip nets. Serum samples were tested at the Instituto Evandro Chagas, State of Pará, using the hemagglutination inhibition test to detect total antibodies against 19 different arboviruses. Virus isolation was attempted from serum samples and arthropod suspensions using newborn mice and the C6/36 cell line clone. In addition, identification of the vector species was conducted. RESULTS: From the 19 serum samples from Campo Grande, 1 sample had a 1:20 titer for Flavivirus. From the 35 samples collected in Bonito, 17 samples had antibodies to arboviruses, 4 (11.4%) were positive for Alphavirus, and 5 (14.2%) were positive for Flavivirus. Monotypic reactions were observed for the Mayaro (n = 10) and Oropouche (n = 5) viruses, and 6 (17.1%) samples had titers for >1 virus. We captured 120 Culicidae individuals that were potential arbovirus transmitters in Jardim; however, all the samples were negative for the viruses. CONCLUSIONS: Mato Grosso do Sul has a variety of vertebrate hosts and transmission vectors, thereby providing ideal conditions for the emergence or reemergence of arboviruses, including some pathogenic to human beings.

INTRODUÇÃO: No período de fevereiro a setembro de 2010, foram realizados inquéritos soroepidemiológicos em primatas não humanos e captura de vetores transmissores, com o intuito de investigar a possível circulação de arbovírus nos municípios de Bonito, Campo Grande e Jardim, no Estado do Mato Grosso do Sul, Brasil. MÉTODOS: Foram utilizados 65 primatas de vida livre e de cativeiro, e potenciais vetores capturados por Castro e puçás. As amostras séricas foram testadas pelo teste de inibição da hemaglutinação para a detecção de anticorpos totais contra 19 diferentes arbovírus e a tentativa de isolamento viral (camundongo recém-nascido e linhagem celular-clone C6/36) nas amostras séricas e suspensões de artrópodes, bem como a identificação das espécies vetoriais foram realizadas no Instituto Evandro Chagas-IEC no Estado do Pará. RESULTADOS: Das 19 amostras séricas do município de Campo Grande, 1 apresentou titulo de 1:20 para Flavivirus. Das 35 amostras coletadas em Bonito, 17 apresentaram anticorpos para arbovírus, sendo 4 (11,4%) positivos para Alphavirus, e 5 (14,2%) positivos para Flavivirus. Reações monotipicas foram observados para o vírus Mayaro (n=10) e para o vírus Oropouche (n=5) e 6 (17,1%) amostras apresentaram títulos para mais de um dos vírus estudados. Foram capturados 120 Culicídeos potenciais transmissores de arbovírus no município de Jardim. Todas as amostras coletadas foram negativas para o isolamento viral. CONCLUSÕES: Por possuir uma variedade de hospedeiros vertebrados e vetores transmissores, o Mato Grosso do Sul apresenta condições propícias para a emergência ou reemergência de arbovírus, inclusive alguns patogênicos para os seres homem.

Influence of calcium hydroxide on marginal leakage of endodontically treated teeth

Aim: To evaluate the influence of residual calcium hydroxide (CH) intracanal medication consideringtwo dye leakage locations (apical foramen and middle root canal third) by quantifying the diffusionof India ink in length and depth. Methods: After biomechanical preparation, 72 single-rootedbovine teeth were divided into two groups in which half was filled with a CH and saline paste. After7 days, the medication was removed and the canals in both groups were filled. Half of thesamples had the apical third and part of middle third removed for infiltration of India ink at themiddle third (MTI), while the rest were infiltrated at the apical foramen (AI). The followingexperimental groups were formed (n = 18 each): A1 – CH-medicated + AI, A2 – CH-medicated+ MTI, B1 – non-medicated + AI, B2 – non-medicated + MTI. For evaluation of dye leakage, theexperimental specimens were cross-sectioned, photographed and had the infiltration perimetermeasured using the Image Tool 3.00 software. The Mann-Whitney U-test was used for statisticalanalysis (p<0.05). Results: The lowest values of dye penetration in length and depth werefound in the groups receiving intracanal medication (A1 and A2). Conclusions: Lower dyepenetration in length and depth at the two different locations was observed in the canals withresidual CH intracanal medication.

Perfil epidemiológico do trauma dentário e facial em Curitiba / Epidemiological profile of dental and facial trauma in Curitiba

Introdução: Trauma é uma lesão produzida por ação violenta, em geral de natureza física externa ao organismo.O atendimento é de urgência e alta complexidade. O trauma, além de sequelas físicas, traz também sequelas psicológicas graves. Os traumas faciais e dentários causam grandes conflitos psicológicos em virtude do comprometimento da estética. Objetivos: Analisar o perfil epidemiológico do trauma dentofacial nos pacientes atendidos no ano de 2009, no Pronto-Socorro Geral e Odontológico do Hospital Universitário Cajuru, na cidade de Curitiba (PR). Materiais e métodos: O estudo foi realizado por meio da análise retrospectiva de 1.380 prontuários de pacientes vítimas de trauma dentofacial atendidos no Hospital Universitário Cajuru no ano de 2009. Resultados: O sexo masculino compreendeu 66,37% dos pacientes traumatizados.A faixa etária de zero aos 10 anos foi a mais afetada, com 38,47%. As quedas foram o principal motivo dos traumas (53,92%). Os domingos (17,39%) e o período noturno (35,90%) foram os momentos mais frequentes dos traumatismos. O trauma dentário mais frequente foi a fratura coronária (30,25%) e os dentes mais acometidos foram os incisivos centrais (45,64%) Conclusão: As crianças foram as principais vítimas.O sexo masculino foi o mais acometido. Os traumas ocorrem, em sua maioria, durante a noite, sendo que no domingo a ocorrência desse tipo de trauma foi maior. A etiologia da maioria dos traumas são as quedas.O trauma dentário mais frequente foi a fratura coronária sendo que os dentes incisivos centrais são os mais frequentemente afetados. A maioria dos pacientes não sofreu fraturas ósseas associadas.

Introduction: Trauma is a lesion produced by a violent action, usually from outside the body. The service isurgent and of high complexity. The facial trauma brings high physiological conflict due to the impairment ofaesthetics. Objectives: The aim of the study was to analyze the epidemiological profile of dentofacial traumaof patients treated during the year 2009 in the Dental Emergency Service of the Cajuru Hospital, located inthe city of Curitiba (PR, Brazil). Materials and methods: The study was carried out through the retrospectiveanalysis of 1,380 medical records of patients victims of dentofacial trauma taken care in CajuruHospital duringthe year of 2009. Results: It was observed that 66,37% from the affected patients were men. Children (0 to 10years old) were the most affected age group, with 38,47%. The falls were the main cause of traumas (53,92%).Sundays (17,39%) and the nighttime (35,90%) were the most frequentperiod of time that traumas occurred.The most frequent type of trauma was the coronary fracture (30,25%) and the most affected teeth were centralincisors (45,64%). Conclusions: The children were the main victims of dentofacial trauma. The male sex wasthe most affected. It was noticed that traumas occur mostly during the night and on Sundays. The most frequentlyreported etiology of trauma was fall. The coronal fracture was the most frequent type of fracture andthe central incisor was the most affected tooth. Most of the patients did notreport associated bone fractures.

NMO-DBr: the Brazilian Neuromyelitis Optica Database System / NMO-DBr: o banco de dados brasileiro em neuromielite óptica

OBJECTIVE: To present the Brazilian Neuromyelitis Optica Database System (NMO-DBr), a database system which collects, stores, retrieves, and analyzes information from patients with NMO and NMO-related disorders. METHOD: NMO-DBr uses Flux, a LIMS (Laboratory Information Management Systems) for data management. We used information from medical records of patients with NMO spectrum disorders, and NMO variants, the latter defined by the presence of neurological symptoms associated with typical lesions on brain magnetic resonance imaging (MRI) or aquaporin-4 antibody seropositivity. RESULTS: NMO-DBr contains data related to patient's identification, symptoms, associated conditions, index events, recurrences, family history, visual and spinal cord evaluation, disability, cerebrospinal fluid and blood tests, MRI, optic coherence tomography, diagnosis and treatment. It guarantees confidentiality, performs cross-checking and statistical analysis. CONCLUSION: NMO-DBr is a tool which guides professionals to take the history, record and analyze information making medical practice more consistent and improving research in the area.

OBJETIVO: Apresentar o Brazilian Neuromyelitis Optica Database System (NMO-DBr), um sistema de banco de dados que coleta, arquiva, recupera e analisa informações de pacientes com neuromielite óptica (NMO) e doenças relacionadas. MÉTODO: NMO-DBr usa o sistema Flux, um LIMS (Laboratory Information Management Systems) para gerenciamento de informações. As informações foram colhidas dos prontuários de pacientes com espectro de NMO e variantes de NMO, estas últimas definidas por quadro neurológico associado a lesões encefálicas típicas à imagem pela ressonância magnética (IRM) ou à soropositividade do anticorpo anti-aquaporina-4. RESULTADOS: NMO-DBr contém dados relativos a identificação, sintomas, condições associadas, eventos índices, recorrências, história familiar, avaliação visual e da medula, incapacidade, exames do líquor e de sangue, IRM, tomografia de coerência óptica (OCT), diagnóstico e tratamento. O sistema assegura confidencialidade, cruza dados e faz análises estatísticas. CONCLUSÃO: NMO-DBr é uma ferramenta que possibilita a prática médica mais consistente e promove a pesquisa na área.

Assistência domiciliária de enfermagem: percepção da família / Home nursing assistance: perception of the family

É importante conhecer a percepção do familiar responsável por pacientes atendidos em assistência domiciliária. Desta forma, objetivou-se caracterizar clientes e familiares, usuários do sistema de internação domiciliar e identificar os fatores que influenciam no grau de satisfação dessa clientela. Pesquisa descritiva transversal que visa retratar a satisfação de 21 familiares responsáveis por pacientes de uma empresa de atendimento domiciliário do sistema privado de saúde em Fortaleza. Entre os familiares predominou sexo feminino (28,5 por cento), fi lhas (28,5 por cento) esposas (28,5 por cento), 3º grau completo (52,4 por cento) e idade entre 28 e 38 anos (33,3 por cento). Em relação aos pacientes assistidos: sexo masculino (52 por cento), com idade entre 71 e 93 anos (11 por cento), 2º grau completo (38 por cento) e de um a dois anos de internamento. Dos familiares, 62 por cento estavam satisfeitos com o serviço. Quanto às restrições, foram tempo, número de visitas e comportamento dos profissionais. O atendimento domiciliário demonstra ser uma boa opção para os casos com indicação.

Trabalho e saúde dos professores de educação física nas escolas municipais do Rio de Janeiro / Labor health of teachers of Physical Education in municipal schools in Rio de Janeiro

Esta dissertação buscou fazer uma reflexão acerca dos principais motivosque geraram um quadro de desânimo, desgaste físico e outros problemas desaúde encontrados de uma forma em geral nos professores da rede Municipal do Rio de Janeiro, em especial os docentes de Educação Física. A partir dos referenciais teóricos e metodológicos do campo da medicinado trabalho e saúde do trabalhador, pretende-se analisar saúde e qualidadede vida aliadas à atividade do docente de Educação Física, em seu cotidiano de convivência e trabalho. A nossa pesquisa buscou compreendera qualidade de vida no ambiente de trabalho e suas ações possíveis sobre asaúde do docente de Educação Física. Para tal deu-se um destaque ao localde trabalho desse profissional, ou seja, a escola, pois acreditamos ser umponto vital que precisa ser analisado. A saúde do trabalhador nos levou aocampo das pesquisas em saúde, entendidas como um caminho para secompreender as relações não apenas técnicas, mas também sociais juntoaos professores da rede municipal do Rio de Janeiro. O trabalho de campose deu no próprio espaço de atuação desse profissional – a escola. Atravésde observações participativas e entrevistas semi-estruturadas pode-seperceber como ocorrem às práticas do docente de Educação Física, suainteração social, as atividades realizadas, bem como sua rotina laboral. O estudo visou identificar as relações das atividades do trabalho como a saúdedesse profissional para mostrar que, a partir de um processo de conhecimento e condições de trabalho é possível uma mudança que permita que o ambiente de trabalho se torne menos prejudicial à saúde do professor de Educação Física.

The following essay sought to make a reflection about the main reasons which caused a condition of discouragement, as well as physical exhaustion and other health problems mostly found in teachers from the school chains of the Municipality in Rio de Janeiro –specially Physical Education teachers. Based on both methodological and theoretical background in the field of work medicine in addition to workers' health, health and quality of life (the latter linked to the activities of Physical Education teachers regardingtheir personal and professional everyday life. Our research aimed to comprehend the quality of life when it comes to the work environment and its possible effects on the health of the Physical Education teacher. Therefore emphasis has been given to thisprofessional's workplace, i.e. the school -for we believe it to be a crucial point to be analysed. The worker's health led us to the field of researches concerning health, seen as a way to grasp the relationships -not only technical but also social in relation to teachers from the Municipality of Rio de Janeiro. The work was conducted at the professional's workplace: the school. Through participating observations as well as semi-structured interviews, we could see how the practices of the Physical Education teacher areconducted, his/her social interaction, activities performed besides his/ her working routine. This study tried to identify the relationships between the working activities and this professional's health to show that, from an understanding process and workingconditions, it's possible make a change which allows the work environment to become less harmful to the health of the Physical Education teacher.