Os desafios na conduta terapêutica em pacientes acometidos com feridas crônicas / Challenges in the therapeutic conduct in patients affected with chronic wounds / Retos en la conducta terapéutica en pacientes afectados de heridas crónicas

Considerado um grave problema em saúde pública, as feridas crônicas são patologias que desafiam o manejo terapêutico e infelizmente acometem milhares de pessoas em todo o mundo. Essa doença apresenta altos índices de morbidade impactando negativamente na qualidade de vida dos seus portadores, além de influenciar negativamente no domínio "bem-estar", principalmente quando associado aos fatores clínicos podendo estar relacionado há anos de tratamento sem cura da ferida. As feridas crônicas são caracterizadas por demora ou dificuldade nos processos de cicatrização e reparação ordenada da integridade anatômica e funcional da pele durante um período de no mínimo três meses. Porém, algumas lesões permanecem por anos e até décadas sem cicatrizar. Objetivo: O escopo dessa revisão é mostrar o limitado arsenal terapêutico bem como a dificuldade no manejo clínico e dessa forma proporcionar uma reflexão sobre sua fisiopatologia e a urgente necessidade de novas opções e condutas terapêuticas que possam auxiliar no tratamento desses pacientes. Metodologia: Trata-se de uma revisão integrativa da literatura sobre feridas crônicas, cujo critérios de inclusão foram artigos publicados no período de janeiro de 2005 a fevereiro de 2023. Conclusão: A problemática acerca dessa patologia é vasta, tratando de uma doença de difícil cura, com uma gama de fatores associados que dificultam a cura da lesão, estendendo essa doença a altos índices de morbidade. Novas condutas terapêuticas e novos fármacos, precisam ser desenvolvidos urgentemente. Destaca-se que o uso de probióticos e o emprego da nanotecnologia tem mostrado um grande potencial inovador no tratamento de pacientes portadores de feridas crônicas.

Considered a serious public health problem, chronic wounds are pathologies that defy therapeutic management and unfortunately affect thousands of people around the world. This disease has high morbidity rates, negatively impacting the quality of life of its patients, in addition to negatively influencing the "well-being" domain, especially when associated with clinical factors, which may be related to years of treatment without healing of the wound. Chronic wounds are characterized by delay or difficulty in healing processes and orderly repair of the anatomical and functional integrity of the skin over a period of at least three months. However, some injuries remain for years and even decades without healing. Objective: The scope of this review is to show the limited therapeutic arsenal as well as the difficulty in clinical management and thus provide a reflection on its pathophysiology and the urgent need for new options and therapeutic approaches that can help in the treatment of these patients. Methodology: This is an integrative review of the literature on chronic wounds, whose inclusion criteria were articles published from January 2005 to February 2023. Conclusion: The problem surrounding this pathology is vast, dealing with a difficult-to-cure disease, with a range of associated factors that make healing of the lesion difficult, extending this disease to high morbidity rates. New therapeutic approaches and new drugs need to be developed urgently. It is noteworthy that the use of probiotics and the use of nanotechnology have shown great innovative potential in the treatment of patients with chronic wounds.

Consideradas un grave problema de salud pública, las heridas crónicas son patologías que desafían el manejo terapéutico y que, lamentablemente, afectan a miles de personas en todo el mundo. Esta enfermedad presenta altas tasas de morbilidad, impactando negativamente en la calidad de vida de sus pacientes, además de influir negativamente en el dominio "bienestar", especialmente cuando se asocia a factores clínicos, que pueden estar relacionados con años de tratamiento sin curación de la herida. Las heridas crónicas se caracterizan por un retraso o dificultad en los procesos de cicatrización y reparación ordenada de la integridad anatómica y funcional de la piel durante un periodo de al menos tres meses. Sin embargo, algunas heridas permanecen durante años e incluso décadas sin cicatrizar. Objetivo: El alcance de esta revisión es mostrar el limitado arsenal terapéutico así como la dificultad en el manejo clínico y así aportar una reflexión sobre su fisiopatología y la urgente necesidad de nuevas opciones y enfoques terapéuticos que puedan ayudar en el tratamiento de estos pacientes. Metodología: Se trata de una revisión integradora de la literatura sobre heridas crónicas, cuyos criterios de inclusión fueron artículos publicados desde enero de 2005 hasta febrero de 2023. Conclusiones: La problemática que rodea a esta patología es amplia, tratándose de una enfermedad de difícil curación, con una serie de factores asociados que dificultan la cicatrización de la lesión, extendiendo esta enfermedad a altas tasas de morbilidad. Es urgente desarrollar nuevos enfoques terapéuticos y nuevos fármacos. Cabe destacar que el uso de probióticos y el empleo de nanotecnología han mostrado un gran potencial innovador en el tratamiento de pacientes con heridas crónicas.

Satisfação das gestantes durante a consulta odontológica no Sistema Unico de Saúde, Brasil / Satisfaction of pregnant women during dental consults in Brazilian Unified Health System / Satisfacción de las mujeres embarazadas durante la consulta odontológica en el Sistema Único de Salud de Brasil

RESUMO Objetivo O objetivo do trabalho foi verificar a taxa de gestantes satisfeitas com a consulta odontológica realizada no Sistema Único de Saúde (SUS-Brasil) e fatores associados. Metodologia O estudo foi do tipo transversal. Para coleta de dados foi elaborado um questionário abordando variáveis sociodemográficas e relacionadas a gestação. A coleta de dados foi realizada através de entrevistas face a face em um hospital maternidade da região metropolitana de Porto Alegre-RS-Brasil. O teste de qui-quadrado e a regressão de Poisson com variância robusta (p<0,05) foram utilizados nas análises bi e multivariada. Resultados Das 302 mulheres entrevistadas, 50%(n=151) realizaram consulta odontológica durante a gestação e destas, 86% (n=131) estavam satisfeitas com a consulta. Na análise multivariada verificou-se que a variável avaliação das consultas de pré-natal como boa aumentou em 14% [Razão de Prevalência (RP)=1,14; Intervalo de Confiança (IC) 95%:1,01-1,27] a probabilidade de as mulheres expressarem satisfação com a variável desfecho. Conclusão Conclui-se que foi alta taxa de satisfação com as consultas odontológicas realizadas no SUS pelas gestantes e avaliação das consultas de pré-natal como boa foi fator associado. Estes resultados poderiam ser considerados durante o planejamento estratégico, execução e avaliação das políticas de saúde direcionadas para este grupo operativo.

ABSTRACT Objective The study aimed to verify the rate of satisfaction among pregnant women with dental consults performed in the Brazilian Unified Health System (BUHS), and associated factors. Methodology The design of the study was cross-sectional. To collect data a questionnaire approaching variables sociodemographic and relationship whit pregnancy were used. The data gathering was realized across interviews face to face in a maternity hospital in the metropolitan region of Porto Alegre-RS-Brazil. The chi-square test and Poisson regression with robust variance (p<0.05) were used for the bivariate and multivariate analyses. Results A total of 302 pregnant women were interviewed, 50% (n=151) performed dental consults, and 86% (131) related that they were satisfied with the consult. In the multivariate analysis it was found that the variable evaluating prenatal visits as good increased the likelihood of women expressing satisfaction with the outcome variable by 14% [Prevalence Ratio (PR) =1.14; 95% Confidence Interval (CI): 1.01-1.27]. Conclusions The present study suggests that a high satisfaction rate with dental consult could be due to the highest satisfaction in prenatal consults performed in primary health care units, materializing the relationship of trust/connection between professional and user. This variable can be considered by workers and health managers during estrategic planning, performance, and evaluation of health policies.

RESUMEN Objetivo El objetivo del trabajo fue evaluar la tasa de mujeres embarazadas satisfechas con la consulta odontológica que realiza el Sistema Único de Salud-Brasil (SUS-Brasil) y factores asociados. Metodología Estudio de tipo transversal. Para colección de los dados se elaboró un cuestionario que abordaba las variables sociodemográficas y relacionadas con la gestación. La colección de los datos fue realizada por medio de entrevistas cara a cara en un hospital de maternidad de la región metropolitana del Porto Alegre, Brasil. Para comprobar la asociación de los factores con la satisfacción de las mujeres embarazadas con la consulta odontológica se usó el test de chi-cuadrado y la regresión del Poisson, con varianza robusta (p<0,05). Resultados De las 302 mujeres entrevistadas, 50% (n=151) realizaron consulta odontológica durante de la gestación y estas 86%(n=131) manifestaron estar satisfechas con la consulta. En el análisis multivariado se encontró que la variable que evaluaba las consultas prenatales como buenas aumentaba en un 14% [Razón de Prevalencia (RP)=1,14; Intervalo de Confianza (IC) del 95%:1,01-1,27] la probabilidad de que las mujeres expresaran satisfacción con la variable de resultado. Conclusiones Se concluyó que un alto índice de satisfacción con las consultas odontológicas realizadas en el SUS por parte de las embarazadas y la evaluación de las consultas prenatales como buenas fue un factor asociado. Estos resultados podrían ser considerados durante la planificación estratégica, ejecución y evaluación de las políticas de la salud pública direccionadas para este grupo operativo.

Lesión del nervio laríngeo recurrente en cirugía tiroidea / Recurring laryngeal nerve injury in thyroid surgery

La lesión del nervio laríngeo recurrente (NLR) es una de las complicaciones más severas en las tiroidectomías. La lesión unilateral genera trastornos disfónicos que se manifiesta por voz débil y una posición paramedial de la cuerda vocal afectada, mientas que la bilateral genera trastornos respiratorios, incluyendo la asfixia. Se ha estimado que la lesión del NLR en las tiroidectomías se encuentra entre un rango de 0.3%- 18.9%. Se ha visto que con el neuromonitoreo intraoperatorio ha disminuido la incidencia de lesión, aunque debemos tener en cuenta un factor muy importante a la hora de solicitarlo y utilizarlo, el económico. La tasa de lesión permanente del nervio laríngeo recurrente debe permanecer por debajo de 1 a 2 %. Sin embargo, existen circunstancias en las cuales los nervios están expuestos a un mayor riesgo y son muchos los factores involucrados en su mecanismo de lesión. Este artículo pretende hacer una revisión del tema enfatizando en la importancia de la preservación de la funcionalidad e integridad de ambos nervios laríngeos recurrentes.

Recurrent laryngeal nerve injury (RLN) is one of the most severe complications in thyroidectomies. Unilateral injury generates dysphonic disorders manifested by weak voice and a paramedial position of the affected vocal cord, while bilateral injury generates respiratory disorders, including suffocation. RLN injury in thyroidectomies has been estimated to be in the range of 0.3% - 18.9%. It has been seen that with intraoperative neuromonitoring the incidence of injury has decreased, although we must take into account a very important factor when requesting and using it, the economic one. The rate of permanent injury to the recurrent laryngeal nerve should remain below 1% to 2%. However, there are circumstances in which the nerves are exposed to greater risk and many factors are involved in their mechanism of injury. This article aims to review the subject, emphasizing the importance of preserving the functionality and integrity of both recurrent laryngeal nerves

Relation between CANDIDA species isolated from vaginal mucosa and lesions caused by high-risk human papillomavirus hpv for cervical cancer

This study characterized and related yeasts of the genus Candida isolated from vaginal mucous membranes of women with lesions caused by high-risk HPV for cervical cancer. Forty-two women treated at the Lower Genital Tract Pathology Clinic of the University of São Paulo Medical School Hospital of Clinics were examined, with 30 high-grade (G1) uterine lesions with a mean age of 36.5 years ± 11. 1 and 12 with low grade (G2) uterine lesions with a mean age of 34.7 years ± 15.5. Clinical conditions and laboratory data on HPV were collected from patients' medical records; the socio-demographic data obtained from an appropriate questionnaire. For the study of association between the variables, Odds Ratio analysis was used from the STATA 13.1 program. Patients G1 had a higher prevalence for diabetes and the results indicated 27% prevalence of Candida spp. in vaginal mucosa, in G2 this was 33% in vaginal mucosa. Among the species found in vaginal mucosa of patients, Candida albicans was the most isolated with 88%, followed by C. tropicalis (8%) and C. glabrata (4%). The strains of C. albicans isolated from mucosa presented sensitivity to all antifungal agents tested, unlike the C. tropicalis strain isolated in G2 in vaginal mucosa, which presented a resistance profile to fluconazole. Thus, monitoring and supervision through clinical and laboratory testing of HPV patients is important, reinforcing the need for care, treatment and prevention of HPV-related infections and Candida spp.

Multicenter study of Candida species in oral mucosa of different patients: analysis of 711 strains and literature review

This study aimed to identify Candida spp. collected from oral mucosa and maintained in culture collections, correlating the findings with the medical history of patients and comparing with data from the literature over the past five years. Seven hundred and eleven oral Candida spp. isolates, collected between 2013 and 2017, were selected and identified using traditional and molecular methods. In addition, a literature review was performed with the key words: "Oral", "Candida" and "Yeast". Seven species of the genus Candida: were identified C. albicans(73.3%); C. tropicalis (9.3%); C. parapsilosis (8.2%); C. glabrata (3.9%); C. guilliermondii(2.8%); C. krusei (1.7%) and C. lusitaniae (0.3%). The strains identified as C. albicans were submitted to molecular methods using specific primers and of these, 5.8% were identified as C. dubliniensis strains. The greatest diversity of strains was found in patients presenting no systemic diseases or HIV +, while the highest percentage of strains of Candidanon-albicanswere observed in cancer patients. This study reports a representative distribution of Candidaspecies among individuals exhibiting distinct clinical conditions, in order to contribute to the design of future research on details of aspects involved in the infections caused by these microorganisms. The correct identification of oral Candida strains contributes to a realistic epidemiological approach and future clinical protocols against these pathogens

Does Endodontic Re-Treatment in Primary Teeth Increase the Functional Tooth Retention? A Clinical, Retrospective, University-Based Study

Objective: To investigate the longevity of endodontic treatments and the survival of endodontic re-treatments performed in primary teeth. Material and Methods: The sample included endodontic treatments and re-treatments conducted in anterior and posterior primary teeth without sedation or general anesthesia among children attending a university dental service. Information collected retrospectively from clinical records was used for analyzing data. The Kaplan-Meier estimator test was used to analyze the longevity and survival of endodontic treatment and re-treatments, respectively. Results: A total of 73 patients with endodontic therapy in primary teeth were included in the study, and 116 teeth were analyzed. After one year, the longevity of endodontic treatments performed on primary teeth was 65.74% with an annual failure rate (AFR) of 34.2%. From 47 endodontic treatment failures, 14 teeth (29.8%) were endodontically re-treated. When the endodontic re-treatment was considered as survival, the longevity of treatments reached 68.06% with 31.9% of AFR after one year of follow-up. There was a significant increase in functional tooth retention in those patients that received an endodontic re-treatment (p<0.001). Retreatment provided an additional mean survival time of 8.3 months. Conclusion: Endodontic treatments performed in primary teeth presented a limited longevity. Endodontic re-treatment is a more conservative alternative for endodontically treated primary teeth that have failed and significantly increase tooth retention.

Antifungal efficiency of chemically and thermally-activated acrylic resins after surface treatment using poly (diallyldimethylammonium chloride)

Abstract INTRODUCTION: Acrylic resins are used in the preparation of facial prostheses and may be colonized by fungi. Here, we verified the antifungal efficacy of this material after surface treatment using poly (diallyldimethylammonium chloride). METHODS: Acrylic resin specimens with and without surface treatment were subjected to tests for fungistatic and fungicidal activities. Standard strains of Candida albicans and Aspergillus niger were used. RESULTS: After surface treatment, the fungistatic and fungicidal efficacies of the resins against C. albicans and fungistatic action against A. niger were verified. CONCLUSIONS: The surface treatment was a determinant of the antifungal activity of the material.

Saúde itinerante nos centros municipais de educação infantil do município de Guarapuava - PR; os desafios da promoção da saúde em crianças expostas a doenças parasitárias / Travelling health in the municipal kindergartens in the city of Guarapuava - PR; the challenges of health promotion in children exposed to parasitic diseases

A presença de enteroparasitoses em crianças em idade pré-escolar tem sido motivo de preocupação pelos órgãos de saúde principalmente devido ao impacto negativo sobre o crescimento e desenvolvimento intelectual dessas crianças. As infecções por parasitas intestinais podem levar a quadros de desnutrição e formas de gastroenterite crônica. O presente trabalho analisou crianças em idade pré-escolar frequentadoras de 11 unidades CMEIs (Centros Municipais de Educação Infantil) na cidade de Guarapuava-PR em 11 unidades. Foram estudadas 287 crianças e o índice de positividade para enteroparasitoses foi de 13,9%. A idade média das 287 crianças foi de 2,7 anos e a maioria das crianças analisadas foram domicialiadas em zona urbana 84,3% e somente 15,7% em zona rural, com média de filhos por família de 2,08 membros. A prevalência das parasitoses mostrou que G. duodenalis foi o protozoário mais isolado com 70,4%, seguido de Ascaris lumbricoides 6,8% o único helminto encontrado. Com relação à terapêutica empregada 20% das crianças tratadas com o fármaco albendazol continuaram apresentando exames positivos para os mesmos parasitas. Já com o fármaco benzoilmetronidazol todas as crianças apresentaram resultados negativos para presença de parasitas nas fezes. Os fatores de risco para enteroparasitoses indicaram que a presença da variável água tratada foi menor nos casos positivos. Nossos resultados mostraram que G. duodenalis foi o parasita mais isolado em crianças em idade pré-escolar.

The presence of enteroparasitoses in pre-school children has been a concern of health agencies mainly due to the negative impact on the growth and intellectual development of those children. Intestinal parasite infections can lead to malnutrition and chronic forms of gastroenteritis. The present study analyzed pre-school children attending 11 CMEIs (Municipal Kindergarten Schools) in the city of Guarapuava ­ PR. A total of 287 children were studied, resulting in a positive index for enteroparasitoses of 13.9%. The mean age of the 287 children was 2.7 years and most of the children analyzed were domiciled in urban areas (84.3%), with only 15.7% living in rural areas, with a mean number of children per family of 2.08. The parasite prevalence showed that G. duodenalis was the most frequently isolated protozoan, with 70.4%; followed by Ascaris lumbricoides with 6.8%, the only helminth found. Regarding therapy, 20% of the children treated with albendazole continued to present positive tests for the same parasites. When treated with benzoylmetronidazole, all children presented negative results for the presence of parasites in the faeces. The risk factors for enteroparasitoses showed that the variable treated water was lower in the positive cases. The results of this study showed that G. duodenalis was the most frequently parasite isolated in pre-school children.

Tuberculosis associated factors caused by Mycobacterium tuberculosis of the RDRio genotype

BACKGROUND Tuberculosis (TB) continues to be a disease that affects many countries around the world, including Brazil. Recently, a subtype of Latin American-Mediterranean family strain was identified and characterised by RDRio. The strain has been associated with different characteristics of the disease. OBJECTIVES In the present study we investigated the association of epidemiological, clinical, radiological and bacteriological variables with pulmonary tuberculosis caused by RDRioMycobacterium tuberculosis strain in large regions of São Paulo. METHODS We conducted a cross-sectional study in 530 patients with pulmonary tuberculosis, diagnosed using sputum culture, from two regions of the São Paulo state in Brazil. The samples were brought to São Paulo reference laboratories for epidemiological, clinical, radiological and bacteriological analyses, and the data were obtained from a TB notification system. RDRio genotyping and Spoligotyping of the samples were performed. For the analysis of the categorical variables we used the chi-square test or the Fisher’s exact test, and for the continuous variables, the Mann-Whitney test. In addition, a logistic regression was used for multivariate analysis. Differences with p < 0.05 were considered significant. FINDINGS The RDRio deletion was identified in 152 (28.7%) samples. In the univariate analysis, both the age groups above 25 years and alcohol consumption were associated with the RDRio deletion. The multivariate analysis confirmed the association of the RDRio deletion with the age groups: 25-35 years old [OR: 2.28 (1.02-5.07; p = 0.04)] and 36-60 years old (OR: 2.36 (1.11-5.05); p = 0.03], and also with alcohol consumption [OR: 1.63 (1.05-2.54); p = 0,03]. MAIN CONCLUSIONS In this study, we identified new factors associated with the M. tuberculosis of the RDRio deletion strains infection.

Phenotypic and genotypic detection of Candida albicans and Candida dubliniensis strains isolated from oral mucosa of AIDS pediatric patients

ABSTRACT The aim of this study was to assess a collection of yeasts to verify the presence of Candida dubliniensis among strains isolated from the oral mucosa of AIDS pediatric patients which were initially characterized as Candida albicans by the traditional phenotypic method, as well as to evaluate the main phenotypic methods used in the discrimination between the two species and confirm the identification through genotypic techniques, i.e., DNA sequencing. Twenty-nine samples of C. albicans isolated from this population and kept in a fungi collection were evaluated and re-characterized. In order to differentiate the two species, phenotypic tests (Thermotolerance tests, Chromogenic medium, Staib agar, Tobacco agar, Hypertonic medium) were performed and genotypic techniques using DNA sequencing were employed for confirmation of isolated species. Susceptibility and specificity were calculated for each test. No phenotypic test alone was sufficient to provide definitive identification of C. dubliniensis or C. albicans, as opposed to results of molecular tests. After amplification and sequencing of specific regions of the 29 studied strains, 93.1% of the isolates were identified as C. albicans and 6.9% as C. dubliniensis. The Staib agar assay showed a higher susceptibility (96.3%) in comparison with other phenotypic techniques. Therefore, genotypic methods are indispensable for the conclusive identification and differentiation between these species.

FUNGEMIA CAUSED BY Candida SPECIES IN A CHILDREN'S PUBLIC HOSPITAL IN THE CITY OF SÃO PAULO, BRAZIL: STUDY IN THE PERIOD 2007-2010 / Fungemia por espécies de Candida em Hospital Pediátrico da cidade de São Paulo, Brasil: estudo no período de 2007 a 2010

Candidemia remains a major cause of morbidity and mortality in the health care environment. The epidemiology of Candida infection is changing, mainly in relation to the number of episodes caused by species C. non-albicans. The overall objective of this study was to evaluate the frequency of yeasts of the genus Candida, in a four-year period, isolated from blood of pediatric patients hospitalized in a public hospital of the city of São Paulo, Brazil. In this period, yeasts from blood of 104 patients were isolated and, the identified species of Candida by phenotypic and genotypic methods were: C. albicans (39/104), C. tropicalis (25/104), C. parapsilosis (23/104), Pichia anomala (6/104), C. guilliermondii (5/104), C. krusei (3/104), C. glabrata (2/104) and C. pararugosa (1/104). During the period of the study, a higher frequency of isolates of C. non-albicans (63.55%) (p = 0.0286) was verified. In this study we verified the increase of the non-albicans species throughout the years (mainly in 2009 and 2010). Thus, considering the peculiarities presented by Candida species, a correct identification of species is recommended to lead to a faster diagnosis and an efficient treatment.

Candidemia permance como a maior causa de morbidade e mortalidade em ambiente hospitalar. A epidemiologia de infecções por Candida vem se alterando, principalmente em relação ao número de episódios causados por espécies não-albicans. Este estudo teve como objetivo avaliar a frequência, em um período de quatro anos, de leveduras do gênero Candida isoladas de sangue de pacientes pediátricos internados em hospital público da cidade de São Paulo, Brasil. Neste período foram isoladas leveduras de sangue de 104 pacientes, e as espécies de Candida identificadas, por métodos fenotípicos e genotípicos, foram: C. albicans (39/104), C. tropicalis (25/104), C. parapsilosis (23/104), Pichia anomala (6/104), C. guilliermondii (5/104), C. krusei (3/104), C. glabrata (2/104) e C. pararugosa (1/104). Em todo período do estudo foi observada maior frequência de isolamento de C. não-albicans (63,55%) (p = 0,0286). Neste estudo verificou-se aumento das espécies não-albicans ao longo dos anos (principalmente em 2009 e 2010), assim, ressalta-se que correta identificação em nível de espécie é recomendável, para que isso acarrete diagnóstico rápido e tratamento eficaz.

Species distribution and antifungal susceptibility of yeasts isolated from vaginal mucosa

Aims: Vulvovaginal candidiasis is one of the most common complaints in the medical clinic. In recent years, due to the increasing frequency of non-albicans species, the number of cases of therapeutic failure has increased considerably, generating the need for research to learn the profile of yeasts isolated in vulvovaginal candidiasis. The aims of this study were to collect samples of vaginal secretion, verify the presence of yeast, identify the species of yeast, and verify their in vitro susceptibility profile against six antifungal agents – amphotericin B, nystatin, fluconazole, itraconazole, ketoconazole and voriconazole. Materials and Methods: Vaginal secretion was collected from 130 patients with symptoms characteristic of vulvovaginal candidiasis (VVC). For amphotericin B, fluconazole, itraconazole, ketoconazole and voriconazole, the in-vitro tests were carried out using the commercial Etest susceptibility testing kit; for nystatin the disk diffusion method was used. Results: The yeasts isolated were: Candida albicans (90 percent), C. glabrata (5 percent), C. parapsilosis (3 percent) and C. tropicalis (2 percent). By the CLSI method, all the isolates were susceptible to fluconazole, ketoconazole, nystatin and voriconazole. Tests showed that 98.8 percent of the isolates were susceptible to amphotericin B and 97.6 percent to itraconazole. Conclusion: Although a high number of resistant strains were not found, these studies may help guide physicians to the most convenient therapeutic orientation, conducting treatment specific to the identified yeast species.

Candidíase vulvovaginal é uma das queixas mais comuns na clínica médica. Nos últimos anos, devido ao aumento da frequência das espécies não albicans, o número de casos em que há falha terapêutica também aumentou, gerando a necessidade de pesquisas para conhecer o perfil das leveduras isoladas nos casos de candidíase vulvovaginal. Os objetivos deste estudo foram coletar amostras de secreção vaginal, verificar a presença de leveduras, identificar as espécies mais frequentes, e verificar o seu perfil in vitro de suscetibilidade frente a seis agentes antifúngicos – anfotericina B, nistatina, fluconazol, itraconazol, cetoconazol e voriconazol. Material e Métodos: A secreção vaginal foi coletada de 130 pacientes com sintomas característicos da candidíase vulvovaginal (CVV). Para anfotericina B, fluconazol, itraconazol, cetoconazol e voriconazol, os testes in vitro foram realizados utilizando o kit de sensibilidade comercial Etest, para nistatina, o método utilizado foi utilizado de difusão em disco. Resultados: As leveduras isoladas foram: C. albicans (90 porcento), C. glabrata (5 porcento), C. parapsilosis (3 porcento) e C. tropicalis (2 porcento). Pelo método CLSI, todas as amostras foram sensíveis ao fluconazol, cetoconazol, nistatina e voriconazol. Os testes mostraram que 98,8 porcento dos isolados foram sensíveis à anfotericina B e 97,6 porcento para itraconazol. Conclusão: Embora, não tenha sido encontrado um grande número de isolados resistentes, este estudo pode auxiliar o médico, na escolha da orientação terapêutica mais conveniente visando à realização de tratamento para as espécies de leveduras identificadas.

Declínio da cárie dentária em escolares entre 1998 e 2004 em Leme, São Paulo, Brasil / The decline in dental caries in school children between 1998 and 2004 in Leme, São Paulo, Brazil

Objetivos: Avaliar a prevalência de cárie dentária, bem como, as necessidades de tratamento em escolares de 5 e 12 anos em 2004 e comparar estes dados com os encontrados em 1998, em Leme, São Paulo. Métodos: Os examinados foram pré-escolares de 5 anos e escolares de 12 anos, matriculados em escolas públicas de Leme. Os exames, nos dois momentos, seguiram as recomendações da Organização Mundial de Saúde. Resultados: Aos 5 anos, o ceod em 1998 foi de 2,39 (IC 95%=1,53-3,25) e em 2004 de 1,99 (IC 95%=1,39-2,57), apresentando uma redução na experiência de cárie de 16,4% neste período (p=0,559). Atualmente, os livres de cárie representam 49,3% dos pré-escolares, com um aumento de 12,9% (p=0,055) desta condição. Aos 12 anos de idade, foi observada redução do CPOD de 3,3 (IC 95%=2,45-4,17) para 1,97 (IC 95%=1,53-2,40), que representou uma diminuição de 40,3% (p<0,001). O percentual de escolares livres de cárie aumentou de 25,6% para 41,6% (p=0,010). Aos 5 anos, o valor do Significant Caries Index passou de 5,93 (1998) para 5,26 (2004). Aos 12 anos, este foi de 6,36 (1998) para 4,66 (2004). Aos 5 anos, verifica-se que as restaurações de uma superfície diminuíram, entretanto, a necessidade de restauração de duas ou mais superfícies quase dobrou no período. Aos 12 anos, verifica-se que aumentou o número de restaurações de uma superfície e diminuíram as necessidades de exodontias. Conclusão: Observa-se uma melhoria nas condições de saúde bucal nas duas idades após seis anos, apesar disto, sugere-se que os cuidados continuem sendo intensificados principalmente aos cinco anos.

Objectives: To evaluate the dental caries prevalence and the treatment needs in 5- and 12 year-old schoolchildren in 2004 and to compare these data with those found in Leme, São Paulo, in 1998. Methods: The exams were performed in schoolchildren at public schools in Leme. The exams, in the two years, followed the recommendations of the World Health Organization. Results: In 5 year-olds the Mean dfmt was 2.39 (IC 95%=1.53-3.25), in 1998, and in 2004, the dmft was 1.99 (IC 95%=1.39-2.57), presenting a 16.4% reduction in dental caries experience in this period (p=0.559). At present, 49.3% of the schoolchildren were caries-free, with a 12.9% (p=0.055) increase in this condition. In 12 year-olds, DFMT was 3.3 (IC 95%=2.45-4.17), in 1998 and 1.97 (IC 95%=1.53-2.40), in 2004, representing a reduction of 40.3% (p <0.001). The percentage of caries-free children at this age increased from 25.6% to 41.6% (p=0.010).At 5 years of age, the Significant Caries Index went from 5.93 (1998) to 5.26 (2004), in 12 year-olds, it went from 6.36 (1998) to 4.66 (2004).At 5 years, it was verified that the need for restoring one surface decreased, however, the need for restoring two or more surfaces was higher in the period. At 12 years, it was verified that need for restoring one surface increased and the need for extractions decreased.Conclusion: After six years of study, an improvement was found in the oral health conditions in the two age groups, suggesting that care should continue to be intensified, particularly among five-year-old children.

Candiduria in a public hospital of São Paulo (1999-2004): characteristics of the yeast isolates

The study involved 100 yeast isolates, obtained from urine samples provided by a Public Pediatric Hospital of São Paulo, Brazil, from 1999 to 2004. The most frequent species was Candida albicans, followed by C. tropicalis, C. glabrata and C. parapsilosis. In regard to virulence, 97 percent of the isolates showed index 3 for proteinase and 63 percent index 2 for phospholipase. The most frequent killer biotypes were 511 and 888.

Estudou-se 100 amostras de leveduras, isoladas de urina, provenientes de Hospital Público Infantil de São Paulo Brasil, no período de 1999-2004. A espécie mais freqüente foi Candida albicans, seguida de C. tropicalis, C. glabrata e C. parapsilosis. Em relação à virulência, 97 por cento dos isolados apresentaram índice 3 para proteinase e, 63 por cento índice 2 para fosfolipase. Os biótipos "killer" mais freqüentes foram o 511 e 888.

Molecular identification of Candida dubliniensis isolated from oral lesions of HIV-positive and HIV-negative patients in São Paulo, Brazil

Candida dubliniensis é uma nova espécie recentemente descrita. Este patógeno oral emergente compartilha muitas características fenotípicas e bioquímicas com C. albicans dificultando assim a diferenciação entre elas. As mesmas, porém, mostram-se genotipicamente distintas. Este trabalho tem como objetivo identificar, pela técnica de PCR (Polymerase Chain Reaction), a possível presença de C. dubliniensis dentre amostras isoladas de candidose oral eritematosa, provenientes de pacientes HIV positivos e HIV negativos. Em um total de 37 amostras identificadas anteriormente, por método clássico, como C. albicans encontramos duas amostras de C. dubliniensis (5,4%) utilizando a técnica do PCR. Esta técnica mostrou-se útil, prática e com identificação taxonômica mais acurada.