Teoria Sistêmica, subsistema do Direito e o novo paradigma da Saúde Única / Systemic Theory, Law subsystem and the new One Health paradigm / La Teoría Sistémica, el sistema del Derecho y el nuevo paradigma One Health

Objetivo: discutir o novo paradigma da Saúde Única à luz da Teoria Sistêmica de Niklas Luhmann e a atuação do subsistema do Direito em face das interconexões da abordagem. Metodologia: tratou-se de um ensaio crítico inédito, com utilização da teoria luhmaniana e os novos conceitos da saúde única. Resultados: a teoria dos sistemas sociais de Luhmann possibilita o subsistema do Direito, em sua autopoiese, além de compreender e passar a operar com as novas abordagens integradas de saúde humana, saúde animal e meio ambiente. Conclusão: o subsistema do Direito está apto a incorporar em sua comunicação interna o novo paradigma, reconhecendo a futura legislação da saúde única.

Objective: to discuss the new One Health paradigm in the light of Niklas Luhmann's Systemic Theory and the performance of the Law subsystem in view of the interconnections of the approach. Methodology: this was an unprecedented critical essay, using Luhmanian theory and the new concepts of single health. Results: Luhmann's theory of social systems enables the subsystem of Law, in its autopoiesis, to understand and begin to operate with the new integrated approaches to human health, animal health and the environment. Conclusion: the Law subsystem can incorporate the new paradigm into its internal communication, recognizing the future single health legislation.

Objetivo: discutir el nuevo paradigma One Health a la luz de la Teoría Sistémica de Niklas Luhmann y el desempeño del subsistema del Derecho frente a las interconexiones del abordaje. Metodología: se trató de un ensayo crítico inédito, utilizando la teoría luhmaniana y los nuevos conceptos de salud única. Resultados: la teoría de los sistemas sociales de Luhmann permite al subsistema Derecho, en su autopoiesis, comprender y pasar a operar con los nuevos enfoques integrados de la salud humana, la salud animal y el medio ambiente. Conclusión: el subsistema del Derecho logra incorporar el nuevo paradigma en su comunicación interna, reconociendo la futura legislación de la salud única.

Polymicrobial Leakage and Retention of MTA and Portland Cement in a Model of Apexification

Abstract Objective: To evaluate the sealing capacity and retention of apical barriers made with mineral trioxide aggregate (MTA) and Portland cement (PC). Material and Methods: Fifty-six bovine incisors were sectioned 8 mm above and 12 mm below the cement-enamel junction. The root canal was enlarged with a diamond drill to create a standard 2.5 mm diameter opening. Apical sheets of 5 mm thickness were placed using white MTA-Angelus or white PC. Fifteen samples of each material were exposed to human saliva in a dual chamber apparatus and casting was evaluated at 30 days. Samples without apical barriers and fully sealed samples were used as positive and negative controls (n = 3), respectively. Data were analyzed by Fisher's exact test (p<0.05) after 3 periods: 1 to 10 days (P1); days 11 to 20 (P2); and days 21 to 30 (P3). Then, three 1 mm thick sections were obtained at the apical level of other root samples of each material (n = 10) and the push-out test was performed Results: The leakage rates in P1, P2 and P3 were 60%, 73.3% and 100% for the MTA; and 73.3%, 86.7% and 100% for CP, with no significant difference between materials, regardless of the period analyzed. There were no significant differences between the bond strengths for both cements (p>0.05) Conclusion: Mineral trioxide aggregate and Portland cement apical barriers presented similar sealing ability and bond strength values.

Microbiota intestinal e associações com desordens clínicas em função da faixa etária de idosos: um estudo analítico transversal / Gut microbiota and associations with clinical disorders for each age range of elderly: analytical and cross-sectional study

O envelhecimento da população e as projeções para o aumento crescente de idosos é uma realidade mundial, que desperta interesse da comunidade científica no intuito de esclarecer os aspetos relacionados ao envelhecimento saudável. As características da microbiota intestinal podem estar relacionadas com indicadores de saúde/doença e a sua relação com o processo de envelhecimento é parcialmente compreendida. O objetivo deste estudo foi quantificar dois grupos de bactérias intestinais em indivíduos idosos institucionalizados, em função da faixa etária, e verificar possíveis associações a variáveis clínicas. Trata-se de uma pesquisa quantitativa, analítica e transversal, realizada com 62 idosos residentes em uma instituição de longa permanência para idosos no estado de Minas Gerais, Brasil. Foram realizadas análises parasitológica e microbiológica em amostras de fezes e aplicação de um questionário individual. Os resultados demonstraram um aumento de enterobactérias totais com o avançar da idade em mulheres de 70-79 anos com relação aos homens da mesma faixa etária. Verificou-se, ainda, que os idosos com idade superior a 80 anos e dependentes nas atividades de vida diária apresentam um aumento de lactobacilos presuntivos. Não se observou relação significativa entre gêneros e contagens de lactobacilos presuntivos nem houve associação entre as contagens e constipação intestinal, incontinência urinária e hipertensão.

The aging population and projections for the increasing number of elderly is a global reality, that arouses interest of the scientific community to clarify aspects related to healthy aging. The characteristics of the gut microbiota may be related to disease or health indicators and their relationship to the aging process is only partially understood. The aim of this study was to quantify two groups of intestinal bacteria in elderly institutionalized individuals, according to age, and investigate possible associations with clinical variables. This is a quantitative, analytical and cross-sectional research conducted with 62 elderly in a long term residence in the Minas Gerais state - Brazil . Parasitological and microbiological analysis in fecal samples and application of an questionnaire for each elderly were performed. The results showed an increase of total enterobacteria with advancing age, and in women of 70-79 years compared to men of the same range age. It was also found that elderly older than 80 years and dependent in basic activities of daily living, presented an increase of presumptive Lactobacilli. There was no significant relationship between gender and scores of presumptive Lactobacilli, or there was an association between the scores and constipation, urinary incontinence and hypertension.

Agreement between rapd, api20c aux, chromagar candida and microculture on oral candida identification

Aim: To measure the agreement of methods for identification of Candida species in oral cavity samples, comparing the CHROMagar Candida, microculture, API 20C AUX and RAPD techniques. Methods: Ninety-one colonies of Candida were isolated and presumptively identified in CHROMagar Candida, submitted to microculture, API 20C AUX and RAPD techniques. After this, agreement among methods using Kappa test was performed. Results: Agreement rates between RAPD and CHROMagar Candida, showed significant accuracy for C. albicans, C. tropicalis, C. dubliniensis and C. krusei (Kappa: 0.760, 0.640, 0.416 and 0.360, respectively, p<0.05). Comparing RAPD results with microculture, the highest agreement was for C. albicans (Kappa: 0.851 - p<0.05) but no significant agreement for C. lusitaniae, C. krusei and C. guilliermondii was obtained (p>0.05). The agreement was significant for all identified species when RAPD (OPE-18) and API 20C AUX (p<0.05) were used. Critical levels of agreement between RAPD and microculture were observed when C. lusitaniae, C. krusei and C. guilliermondii were identified.

Antifungal Susceptibility In Vitro Determined by the Etest(r) for Candida Obtained from the Oral Cavity of Irradiated and Elderly Individuals

This study aimed to evaluate the in vitro antifungal susceptibility of Candida species of head-and-neck-irradiated patients (Group 1), non-institutionalized (Group 2) and institutionalized elders (Group 3) using Etest(r) methodology. Candida was isolated from saliva and presumptively identified by CHROMagar Candida(r), confirmed by morphological criteria, carbohydrate assimilation (API 20C AUX(r)) and genetic typing (OPE 18). The collection was made from 29, 34 and 29 individuals (Groups 1, 2 and 3, respectively) with 67 isolates. Etest(r) strips (ketoconazole, itraconazole, fluconazole, amphotericin B and flucytosine) on RPMI (Roswell Park Memorial Institute) agar, on duplicate, were used to evaluate susceptibility. ATTC (American Type Culture Collection) 10231 (Candida albicans) was used as quality control. Among the 67 isolates of Candida species, most were susceptible to azoles, flucytosine and amphotericin B. None of the isolates showed resistance and dose-dependent susceptibility to amphotericin B. There were nine strains resistant to itraconazole, six to fluconazole and two to ketoconazole and ten dose-dependent, mainly to flucytocine. The highest MIC (minimum inhibitory concentration) to C. albicans, C. tropicalis, C. parapsilosis was 2.671 μg.mL-1, 8.104 μg.mL-1, 4.429 μg.mL-1, all for flucytosine. C. krusei and C. glabrata were associated with higher MIC for azoles and C. glabrata with higher MIC to flucytosine. In summary, susceptibility to all tested antifungal agents was evident. The isolates were more resistant to itraconazole and dose-dependent to flucytosine. A comparison of C. albicans in the three groups showed no outliers. Higher MIC was associated with C. krusei and C. glabrata.

Esse estudo objetivou avaliar a susceptibilidade antifúngica in vitro de espécies de Candida obtidas de pacientes irradiados em cabeça e pescoço (Grupo 1), idosos não institucionalizados (Grupo 2) e idosos institucionalizados (Grupo 3) usando a metodologia Etest(r). Candida foi isolada da saliva e identificada presuntivamente pelo teste CHROMagar Candida(r), confirmada pelo critério morfológico, assimilação de carboidratos API 20C AUX(r) e identificação genética (OPE 18). A coleta foi feita em 29, 34 e 29 indivíduos (Grupos 1, 2 and 3, respectivamente) com 67 isolados. As fitas de Etest(r) (cetoconazol, itraconazol, fluconazol, anfotericina B and flucitosina) em meio ágar RPMI (Roswell Park Memorial Institute), em duplicata, foram utilizados para avaliar a susceptibilidade. A ATTC (American Type Culture Collection) 10231 (Candida albicans) foi usada como controle de qualidade. Dos 67 isolados de espécies de Candida, a maioria foi susceptíveis aos azoles, flucitosina e anfotericina B. Nenhum dos isolados mostrou resistência ou susceptibilidade dose-dependente a anfotericina B. Houve nove espécies resistentes ao itraconazol, seis ao fluconazol e duas ao cetoconazol e dez dose-dependentes, principalmente a flucitosina. Os maiores valores de MIC (mínima concentração inibitória) para C. albicans, C. tropicalis, C. parapsilosis foram, respectivamente, 2,671 μg.mL-1, 8,104 μg.mL-1, 4, 429 μg.mL-1, todos para a flucitosina. C. krusei e C. glabrata foram associadas a um maior MIC para azoles e C. glabrata com maior MIC para flucitosina. Em resumo, a susceptibilidade a todos os antifúngicos testados foi evidente. Os isolados foram mais resistentes ao itraconazol e dose dependentes para a flucitosina. A comparação para C. albicans nos três grupos não mostrou diferença. Os maiores valores de MIC estavam relacionados a C. krusei e C. glabrata.

Sealing ability of MTA-Angelus with propyleneglycol in furcal perforations

This study evaluated the sealing ability of gray MTA-Angelus mixed with propyleneglycol in furcal perforations using a bacterial leakage test. Furcal perforations were created in 30 human mandibular molars using a size 3 round bur. The samples were divided randomly into 2 experimental groups (n=10) according to the mixing agent. In G1, the MTA powder was mixed with propyleneglycol, while distilled water was used in G2. A 3:1 powder-liquid ratio was used for both groups. The MTA was placed in the perforation with an MTA carrier and condensed with hand pluggers. Nonrepaired (n=5) and totally sealed (n=5) perforations served as positive and negative controls, respectively. Bacterial leakage was assessed daily for 30 days in a double-chamber apparatus with Enterococcus faecalis. Data were analyzed using Fisher exact test (p<0.05) for three leakage periods: 1st to 10th day (P1); 11th to 20th day (P2); and 21st to 30th day (P3). The positive control presented leakage in all specimens within the first 24 hours, while no leakage was observed in the negative control during the experimental period. Leakage was observed in five (50%) of the 10 samples of the propyleneglycol group (G1) and seven (70%) of the distilled water group (G2) by the 20th day, without significant difference between the groups in periods P1 and P2 (p=0.137). The leakage was significantly lower for G1 than G2 in period P3 (50% versus 100%, respectively, p=0.016). In this single aerobic bacterial leakage method, the use of propyleneglycol as a vehicle for gray MTAAngelus increased its sealing ability in furcal perforations at the end of the 30-day experimental period.

Este estudo avaliou a capacidade de selamento do MTA-Angelus cinza manipulado com propilenoglicol em perfuracoes de furca usando um teste de infiltracao bacteriana. Perfuracoes de furca foram criadas em 30 molares inferiores usando uma broca esferica numero 3. As amostras foram divididas aleatoriamente em dois grupos experimentais (n=10) de acordo com o agente de manipulacao. Em G1, o po do MTA foi manipulado com propilenoglicol enquanto que a agua destilado foi utilizada no G2. A proporcao po-liquido de 3:1 foi usada para ambos os grupos. O MTA foi colocado na perfuracao com uma porta- MTA e condensado com condensadores manuais. Perfuracoes nao-reparadas (n=5) e totalmente impermeabilizadas (n=5) serviram como controle positivo e negativo, respectivamente. A infiltracao bacteriana foi verificada diariamente durante 30 dias em um aparato de dupla camara com Enterococcus faecalis. Os dados foram analisados pelo teste exato de Fisher (p<0,05) para tres periodos: 1o ao 10o dia (P1), 11o ao 20o dia (P2) e do 21o ao 30o dia (P3). O controle positivo apresentou infiltracao em todas as amostras nas primeiras 24 horas, enquanto nenhuma infiltracao foi observada no controle positivo durante o periodo experimental. Infiltracao foi observada em 5 (50%) das 10 amostras do grupo do propilenoglicol (G1) e 7 (70%) do grupo da agua destilada no 20o dia, sem diferenca significativa entre o grupos nos periodos P1 e P2 (p=0,0137). A infiltracao foi significantemente menor para G1 que para G2 no periodo P3 (50% versus 100%, respectivamente, p=0,016). Neste metodo de infiltracao de apenas uma bacteria aerobica, o uso do propilenoglicol como veiculo para o MTA-Angelus cinza aumentou sua capacidade de selamento em perfuracoes de furca no final do periodo experimental de 30 dias.