"Multivariate analysis of the impact of sleep and working hours on medical errors: a MICE approach".

BACKGROUND: The main objective of this study was to describe the relationship between working conditions, sleep and psycho-affective variables and medical errors. METHODS: This was an observational, analytical and cross-sectional study in which 661 medical residents answered questionnaires about working conditions, sleep and psycho-affective variables. Actigraphic sleep parameters and peripheral temperature circadian rhythm were measured in a subgroup of 38 subjects. Bivariate and multivariate predictors of medical errors were assessed. RESULTS: Medical residents reported working 66.2 ± 21.9 weekly hours. The longest continuous shift was of 28.4 ± 10.9 h. They reported sleeping 6.1 ± 1.6 h per day, with a sleep debt of 94 ± 129 min in workdays. A high percentage of them reported symptoms related to psycho-affective disorders. The longest continuous shift duration (OR = 1.03 [95% CI, 1.00-1.05], p = 0.01), working more than six monthly on-call shifts (OR = 1.87 [95% CI, 1.16-3.02], p = 0.01) and sleeping less than six hours per working day (OR = 1.66 [95% CI, 1.10-2.51], p = 0.02) were independently associated with self-reported medical errors. The report of medical errors was associated with an increase in the percentage of diurnal sleep (2.2% [95% CI, 0.1-4.3] vs 14.5% [95% CI, 5.9-23.0]; p = 0.01) in the actigraphic recording. CONCLUSIONS: Medical residents have a high working hour load that affect their sleep opportunities, circadian rhythms and psycho-affective health, which are also related to the report of medical errors. These results highlight the importance of implementing multidimensional strategies to improve medical trainees' sleep and wellbeing, increasing in turn their own and patients' safety.

Dogs naturally infected by Rangelia vitalii, Babesia canis vogeli, and Ehrlichia canis in São Paulo, Brazil / Cães naturalmente infectados por Rangelia vitalii, Babesia canis vogeli, e Ehrlichia canis em São Paulo, Brasil

Several agents can cause hemoparasitic diseases in dogs, and blood-sucking arthropods transmit these diseases. These agents can cause several clinical manifestations and, in some cases, can kill the host. Because these agents are essential in animal health, this study aims to detect the frequency of Ehrlichia canis, Rickettsia rickettsii, Anaplasma platys, and Rangelia vitalii by real-time PCR and Babesia vogeli in dogs in the southern region of the city of São Paulo, São Paulo. Of the 98 dog samples, 18 (18.4%) tested positive with real-time polymerase chain reaction for at least one studied agent. Of these 18 samples, 17 tested positive for a single agent (11.2% for B. canis vogeli, 1.02% for R. vitalii, and 5.1% for E. canis), and one showed co-infection with B. canis vogeli and R. vitalii. The results demonstrate the presence of hemoparasites in the studied animals, which can influence the quality and life expectancy of these animals. The Rangeliadetection warns small animal clinicians to include it as a differential diagnosis for hemoparasitosis.(AU)

As hemoparasitoses em cães podem ser causadas por diversos agentes, sendo essas doenças transmitidas por artrópodes hematófagos. Esses agentes podem causar diversas manifestações clínicas e, em alguns casos, podem matar o hospedeiro. Este estudo teve como objetivo detectar por PCR em tempo real a frequência de Ehrlichia canis, Rickettsia rickettsii, Anaplasma platys, Rangelia vitalii e Babesia canis vogeli em amostras de cães da zona sul da cidade de São Paulo, Brasil. Das 98 amostras de cães, 18 (18,4%) testaram positivo com reação em cadeia da polimerase em tempo real para pelo menos um agente estudado. Destas 18 amostras, 17 testaram positivo para um único agente (11,2% para B. canis vogeli, 1,02% para R. vitalii e 5,1% para E. canis), e uma apresentou coinfecção com B. canis vogeli e R. vitalii. Os resultados demonstram a presença de hemoparasitas nos animais estudados, o que pode influenciar a qualidade e a expectativa de vida desses animais. Além disso, é o primeiro relato da detecção de R. vitalli na zona sul de São Paulo e serve de alerta para os clínicos de pequenos animais incluírem esse agente como diagnóstico diferencial para as hemoparasitoses.(AU)

Hyperbaric Oxygen Therapy as a Complementary Treatment in Glioblastoma-A Scoping Review.

Glioblastoma (GBM) is the most common and aggressive malignant brain tumor in adults. The mainstay of management for GBM is surgical resection, radiation (RT), and chemotherapy (CT). Even with optimized multimodal treatment, GBM has a high recurrence and poor survival rates ranging from 12 to 24 months in most patients. Recently, relevant advances in understanding GBM pathophysiology have opened new avenues for therapies for recurrent and newly diagnosed diseases. GBM's hypoxic microenvironment has been shown to be highly associated with aggressive biology and resistance to RT and CT. Hyperbaric oxygen therapy (HBOT) may increase anticancer therapy sensitivity by increasing oxygen tension within the hypoxic regions of the neoplastic tissue. Previous data have investigated HBOT in combination with cytostatic compounds, with an improvement of neoplastic tissue oxygenation, inhibition of HIF-1α activity, and a significant reduction in the proliferation of GBM cells. The biological effect of ionizing radiation has been reported to be higher when it is delivered under well-oxygenated rather than anoxic conditions. Several hypoxia-targeting strategies reported that HBOT showed the most significant effect that could potentially improve RT outcomes, with higher response rates and survival and no serious adverse events. However, further prospective and randomized studies are necessary to validate HBOT's effectiveness in the 'real world' GBM clinical practice.

[Pre-pandemic melatonin treatment for sleep disorders and COVID-19 infection. A retrospective cross-sectional study]. / Tratamiento con melatonina pre-pandemia por trastornos del sueño e infección por COVID-19. Estudio de corte transversal, retrospectivo.

INTRODUCTION: Melatonin is a safe medication with multiple uses in sleep medicine for the treatment of circadian rhythm disorders, insomnia, and REM sleep behavior disorder. In view that melatonin has been recommended as an adjuvant treatment in COVID-19 pandemic mainly due to its anti-inflammatory properties, the objective of the present study was to evaluate the history of COVID-19 infection and the requirement of hospitalization in a group of adult patients previously treated with melatonin for various sleep disorders. MATERIAL AND METHODS: This is a retrospective cross-sectional study of data from a closed population of 110 adult patients at a University Hospital treated with melatonin for various sleep disorders, analyzed until the onset of COVID-19 pandemic. Demographic and melatonin-related variables (dose, treatment time) were analyzed and were reevaluated during the pandemic period, by scheduled tele-consultation regarding diagnosis, hospitalization requirements, variables related to COVID-19 infection prior to specific vaccination. Categorical variables were described as relative and absolute frequencies. RESULTS: N = 110 patients. Age range = 40- 96 years (mean = 71 years ± 9.9), older adults > 65 years: N =87 (79,1%). COVID-19 infection was recorded in 15 patients (13.5%) requiring hospitalization in 5 of those infected, only one of them with severe pneumonia. There were no deaths due to COVID-19. There were no differences between infected vs. uninfected in age (p = 0.74), body mass index (p = 0.65) or melatonin dose (p = 0.10).The melatonin dose range was 3-150 mg / day (mean = 46.33 ± 34.1), older adults receiving a mean dose of 50,3 ± 35,6.The 75.5% of the patients were treated for at least 12 months with melatonin. CONCLUSION: We found that 13.5% of patients previously treated with melatonin for various sleep disorders were infected by COVID-19, requiring hospitalization with subsequent medical discharge one third of them. According to national records the lethality rate in older adults in August 2020 was 10.5%. No patient treated with melatonin died for this cause in this sample. We did not find statistically significant differences in terms of indicated melatonin dose, age or body mass index, when comparing those infected with those not infected. The patients in general were mostly older adults, treated with a mean dose greater than 40 mg / day of melatonin for various sleep disorders, mainly for complaints of insomnia, for more than 12 months. The results are consistent with a possible preventive effect of melatonin in the COVID-19 pandemic.

Cardiac computed tomographic angiography after abnormal ischemia test as a gatekeeper to invasive coronary angiography.

This study aimed to determine the impact of systematic coronary computed tomographic angiography (CCTA) use following an abnormal non-invasive ischemia test (NIST) on patient selection strategy for invasive coronary angiography (ICA). In patients with suspected stable coronary artery disease (CAD), NIST use frequently results in sub-optimal diagnostic and revascularization yields of ICA. This randomized clinical trial, conducted at a single academic tertiary center, selected 220 symptomatic patients with mild-to-moderately abnormal NIST results who were referred for ICA. Patients received either the originally intended ICA (n = 105) or CCTA (n = 115). The primary endpoint was the diagnostic yield of ICA in each group. Revascularization yield and major adverse cardiovascular events at 12 months were also assessed. The patients were 69 ± 9 years old, 60% were men, and 31% had typical angina. Mean pre-test probability of obstructive CAD was 34%. Overall prevalence of obstructive CAD was 37.7% on the index angiographic procedure. In the CCTA group, ICA was cancelled by referring physicians in 83 patients (72.2%) after receiving CCTA results. For those undergoing ICA, diagnostic (84.4% vs. 41.7%, p<0.001) and revascularization (71.9% vs. 38.8%, p = 0.001) yields were significantly higher for CCTA-guided ICA than for standard NIST-guided ICA. Mean cumulative radiation exposure was significantly lower in the CCTA-guided ICA arm than in the NIST-guided ICA arm (12 ± 9 vs. 16 ± 10 mSv, respectively, p = 0.024). There were no significant differences in the primary safety endpoint rates between the strategies (p = 0.439). In patients with suspected CAD and mild-to-moderately abnormal ischemia tests, a diagnostic strategy including CCTA as a gatekeeper is safe and effective and significantly improves diagnostic and revascularization yields of ICA.

Hyperbaric oxygen therapy as a complementary treatment for radiation proctitis: Useless or useful? - A literature review.

Radiotherapy (RT) is the backbone of multimodality treatment of more than half of cancer cases. Despite new modern RT techniques, late complications may occur such as radiation proctitis (RP). The natural history of RP is unpredictable. Minor symptoms may resolve spontaneously or require conservative treatment. On the other hand, for similar and uncomplicated clinical contexts, symptoms may persist and can even be refractory to the progressive increase in treatment measures. Over the last decades, an enormous therapeutic armamentarium has been considered in RP, including hyperbaric oxygen therapy (HBOT). Currently, the evidence regarding the impact of HBOT on RP and its benefits is conflicting. Additional prospective and randomised studies are necessary to validate HBOT's effectiveness in the 'real world' clinical practice. This article reviewed the relevant literature on pathophysiology, clinical presentation, different classifications and discuss RP management including a proposal for a therapeutic algorithm with a focus on HBOT.

The Role of Hyperbaric Oxygen Therapy in Pneumatosis Cystoides Intestinalis-A Scoping Review.

Pneumatosis cystoides intestinalis (PCI) is characterized by gas-filled cysts within gastrointestinal tract wall from esophagus to rectum, with preferential involvement of large and small intestine. PCI is rare with an estimated incidence of 0.03 to 0-2% in general population. PCI can be distinguished into idiopathic (15%) or secondary (85%) and the clinical picture ranges from completely asymptomatic to life-threatening intraabdominal complications. Although etiology of PCI appears to be multifactorial, the exact pathophysiology is poorly understood and two main theories have been proposed (mechanical and bacterial). Over the last decades, an enormous therapeutic armamentarium was considered in PCI's management, including hyperbaric oxygen therapy (HBOT). Treatment comprises conservative treatment in mild cases to surgery in highly symptomatic and complicated PCI. In the late 70s, HBOT started to be used in selected cases of PCI not responding to conservative measures. Since then, several case reports, case series, and reviews have been published in the literature with variable outcomes. The overall response rate and complete response were 92.1% (n = 82/89) and 65.2% (n = 58/89), respectively, with a median follow-up of 7 months. Furthermore, HBOT is extremely safe, with few reported complications in the literature when used for PCI. Nevertheless, a randomized, controlled, and double-blind clinical trial is unlikely to occur given the rarity of PCI, logistical issues of HBOT, and methodological considerations related to adequate blinding with a sham-controlled group. HBOT in combination with personalized diet and antibiotics may be beneficial for moderate to severe PCI in patients with no indication for emergency exploratory laparotomy. The purpose of this article is to synthesize the existing data, analyse results of previous studies, identify gaps in knowledge, and discuss PCI' management, including the proposal of an algorithm, with a special focus on HBOT.

Procedure for detecting the shape and size of defects on metallic substrates under composite repairs using shearography.

This paper presents a numerical-experimental procedure to characterize through-holes with arbitrary shapes present on metallic substrates under composite material sleeves using pulsed laser shearography and dynamic excitation combined to the finite element method. The so-called fitting process consists of matching experimental and numerical results in order to determine the shape and dimensions of the holes under the composite repair, or even quantify defects between layers of the composite laminate. The results show that the technique is capable of characterizing, in the worst case, the geometry of a hole with 83% accuracy and its respective area with a maximum error of approximately 20%. The advantageous results achieved in this research show that the fitting process can be very useful for real applications in the oil and petroleum industry.

Synthesis and anticancer activity of open-resorcinarene conjugates.

The first example of conjugation of open-resorcinarenes with chlorambucil, ibuprofen, naproxen and indomethacin are presented. The cytotoxic properties of the obtained conjugates were tested against the cancer cell lines U-251, PC-3, K-562, HCT-15, MCF-7 and SKLU-1. It was found that the conjugate with chlorambucil, naproxen or indomethacin (having 8 moieties) was toxic towards cancer cell lines U-251 and K-562, with no activity against non-cancerous COS-7 cells. The conjugates with naproxen and indomethacin showed high selectivity towards U-251 tumor cells.

Food safety in global supply chains: A literature review.

This paper aimed to revisit the literature on food safety in global supply chains and analyze the evolution and contemporary challenges in this research field. It conducted a systematic literature review in two steps based on a selection of 178 articles. It analyzed safety in food supply chains using the Six T's Framework to evaluate food safety management. In the supply chain literature, traceability was the most studied element of the original framework. The research identified studies that have incorporated the topics of "tactics" and "targets" in their analysis of safety in supply chains. This article presented an expanded framework, a tool for categorizing research, and areas for advancement in the identification of quality indicators in global food chains for the current research agenda. The paper contributed theoretically to the discussion of safety elements in food supply chains and incorporated new elements into the originally conceived framework. Thus, it helped to delineate the research field and opened up an agenda for future research.

Complete atrioventricular block in acute coronary syndrome: prevalence, characterisation and implication on outcome.

PURPOSE: The aim was to characterise acute coronary syndrome patients with complete atrioventricular block and to assess the effect on outcome. METHODS: Patients admitted with acute coronary syndrome were divided according to the presence of complete atrioventricular block: group 1, with complete atrioventricular block; group 2, without complete atrioventricular block. Clinical, electrocardiographic and echocardiographic characteristics and prognosis during one year follow-up were compared between the groups. RESULTS: Among 4799 acute coronary syndrome patients admitted during the study period, 91 (1.9%) presented with complete atrioventricular block. At presentation, group 1 patients presented with lower systolic blood pressure, higher Killip class and incidence of syncope. In group 1, 86.8% presented with ST-segment elevation myocardial infarction (STEMI), and inferior STEMI was verified in 79.1% of patients in group 1 compared with 21.9% in group 2 ( P<0.001). Right ventricular myocardial infarction was more frequent in group 1 (3.3% vs. 0.2%; P<0.001). Among patients who underwent fibrinolysis complete atrioventricular block was observed in 7.3% in contrast to 2.5% in patients submitted to primary percutaneous coronary intervention ( P<0.001). During hospitalisation group 1 had worse outcomes, with a higher incidence of cardiogenic shock (33.0% vs. 4.5%; P<0.001), ventricular arrhythmias (17.6% vs. 3.6%; P<0.001) and the need for invasive mechanical ventilation (25.3% vs. 5.1%; P<0.001). After a propensity score analysis, in a multivariate regression model, complete atrioventricular block was an independent predictor of hospital mortality (odds ratio 3.671; P=0.045). There was no significant difference in mortality at one-year follow-up between the study groups. CONCLUSION: Complete atrioventricular block conferred a worse outcome during hospitalisation, including a higher incidence of cardiogenic shock, ventricular arrhythmias and death.

A rash decision. The hazards of the wrongful use of adrenaline.

Anaphylaxis is life-threatening and should be addressed urgently. Its treatment is not without side effects and an accurate diagnosis must be made to prevent potential harm by the wrongful use of medication. A 46-year-old woman with hypertension treated with angiotensin converting enzyme inhibitor (ACEI) presented to the emergency department with non-pitting oedema of the face and limbs. A hasty diagnosis of anaphylaxis was made and intravenous adrenaline administered. The patient developed a myocardial infarction caused by coronary artery spasm that required invasive intervention. The initial clinical picture was resolved when the ACEI was discontinued unmasking a case of ACEI-induced angioedema. The correct differentiation of these two apparently similar clinical entities is of utmost importance in the management of emergency department patients.

HIV and coronary disease - When secondary prevention is insufficient. / VIH e doença coronária ­ quando a prevenção secundária é insuficiente.

Highly active antiretroviral therapy (HAART) has created a new paradigm for human immunodeficiency virus (HIV)-infected patients, but their increased risk for coronary disease is well documented. We present the case of a 57-year-old man, co-infected with HIV-2 and hepatitis B virus, adequately controlled and with insulin-treated type 2 diabetes and dyslipidemia, who was admitted with non-ST elevation acute myocardial infarction. Coronary angiography performed on day four of hospital stay documented two-vessel disease (mid segment of the right coronary artery [RCA, 90% stenosis] and the first marginal). Two drug-eluting stents were successfully implanted. The patient was discharged under dual antiplatelet therapy (aspirin 100 mg/day and clopidogrel 75 mg/day) and standard coronary artery disease medication. He was admitted to the emergency room four hours after discharge with chest pain radiating to the left arm and inferior ST-segment elevation myocardial infarction was diagnosed. Coronary angiography was performed within one hour and documented thrombosis of both stents. Optical coherence tomography revealed good apposition of the stent in the RCA, with intrastent thrombus. Angioplasty was performed, with a good outcome. The acute stent thrombosis might be explained by the thrombotic potential of HIV infection and diabetes. There are no specific guidelines regarding HAART in secondary prevention of acute coronary syndromes. A multidisciplinary approach is essential for optimal management of these patients.

Low-protein diet disrupts the crosstalk between the PKA and PKC signaling pathways in isolated pancreatic islets.

Protein restriction in the early stages of life can result in several changes in pancreatic function. These alterations include documented reductions in insulin secretion and in cytoplasmic calcium concentration [Ca(2+)]i. However, the mechanisms underlying these changes have not been completely elucidated and may result, in part, from alterations in signaling pathways that potentiate insulin secretion in the presence of glucose. Our findings suggest that protein restriction disrupts the insulin secretory synergism between Cyclic adenosine monophosphate (cAMP)-dependent protein kinase (PKA) and Ca(2+)-dependent protein kinase C (PKC) in isolated islets. Western blot analysis demonstrated reduced levels of both phospho-cAMP response element-binding protein (phospho-CREB) at Ser-133 and substrates phosphorylated by PKCs (Phospho-(Ser) PKC substrate), suggesting that PKA and PKC activity was impaired in islets from rats fed a low-protein diet (LP). cAMP levels and global Ca(2+) entry were also reduced in LP islets. In summary, our findings showed that protein restriction altered the crosstalk between PKA and PKC signaling pathways, resulting in the alteration of secretory synergism in isolated islets.

Infecção por estreptococos ß-hemolíticos do grupo a (streptococcuspyogenes) em crianças com infecções respiratórias agudas assistidas no centro de saúde da polana caniço, cidade de maputo / Infection with ß-hemolytic streptococci in group a (streptococcuspyogenes) in children with acute respiratory infections assisted at the polana caniço health center, maputo city

Background: Group A streptococcal ß-hemolytic (GAS) is an important cause of morbidity and mortality among children and responsible for 20 ­ 30% of bacterial pharyngitis. Rare to few published data on the pattern of GAS epidemiology in Mozambique exists. Objective: To Characterize the epidemiology of GAS infection in patients with signs and symptoms of pharyngitis at the Polana Canico Health Center (PCHC) in Maputo. Methods: A cross sectional study was conducted on 81 children aged 5-15 years with pharyngitis who attended the PCHC from July to September, 2014. Demographic and clinical data were collected through a standardized questionnaire. Throat swabs were collected and processed with standard microbiological techniques to isolate GAS. The data analysis was performed using Epi Info 7 statistical software. Results: Females accounted for 55,6 % of children with symptoms of pharyngitis. Fifty five point six percent of the children were 5 - 9 years old, 83.9% lived less than 10 km from the Health facility. Most children lived in a household with more than 6 people (55.5) %, and 9,8% in houses constructed with non conventional materials . Children care givers had only primary education (54.3%), no formal occupation (77.7%) and a monthly income below the minimum wage (56.7%) The most common signs and symptoms were sore throat (86.4%), fever (50.6%) and redsess of the mucosa palate (16.0%). On physical examination, 30.8% had inflammation of the tonsils and 32.1% of them had palpable and painful cervical lymphadenopaties. Eighty one swab samples were processed, five (6.1%) were positive for GAS in children aged between 10-15 years (60%), female (60%) and most lived in households with less than 6 people (60%). All the children with positive GAS had sore throat. Conclusions: Streptococcus pyogenes was detected among patients assisted at the PCHC with symptoms of pharyngitis mainly affecting female, early teenaged children. Children with GAS infection presented sore throats, fever and tonsillar hypertrophy. Considering the high prevalence of rheumatic heart disease in the Mozambican population, it is urgent to define protocols for diagnosis and treatment. Treatment should focus on the use of empirical antibiotic therapy through identification of specific clinical signs and symptoms since laboratory tests are not widely available.

Infeção por estreptococos ß-hemolíticos do grupo a (streptococcuspyogenes) em crianças com infecções respiratórias agudas assistidas no centro de saúde da polana caniço, cidade de Maputo / Group A ß-hemolytic streptococci (streptococcuspyogenes) infection in children with assisted acute respiratory infections at the health center of polana caniço, maputo city

Background: Group A streptococcal ß-hemolytic (GAS) is an important cause of morbidity and mortality among children and responsible for 20 ­30% of bacterial pharyngitis. Rare to few published data on the pattern of GAS epidemiology in Mozambique exists. Objective: To Characterize the epidemiology of GAS infection in patients with signs and symptoms of pharyngitis at the Polana Canico Health Center (PCHC) in Maputo. Methods: A cross sectional study was conducted on 81 children aged 5-15 years with pharyngitis who attended the PCHC from July to September, 2014. Demographic and clinical data were collected through a standardized questionnaire. Throat swabs were collected and processed with standard microbiological techniques to isolate GAS. The data analysis was performed using Epi Info 7 statistical software. Results: Females accounted for 55,6 % of children with symptoms of pharyngitis. Fifty five point six percent of the children were 5 -9 years old,83.9% lived less than 10 km from the Health facility. Most children lived in a house hold with more than 6 people (55.5) %, and 9,8% in houses constructed with non-conventional materials .Children care givers had only primary education (54.3%), no formal occupation(77.7%) and a monthly income below the minimum wage (56.7%) The most common signs and symptoms were sore throat (86.4%), fever (50.6%) and redress of the mucosa palate (16.0%).On physical examination, 30.8% had inflammation of the tonsils and 32.1% of them had palpable and painfulcervicallymphadenopaties. Eighty one swab samples were processed, five (6.1%) were positive for GAS in children aged between 10-15 years (60%), female (60%) and most lived in households with less than 6 people (60%). All the children with positive GAS had sore throat. Conclusions: Streptococcus pyogeneswas detected among patients assisted at the PCHC with symptoms of pharyngitis mainly affecting female, early teenaged children. Children with GAS infection presented sore throats, fever and tonsillar hypertrophy. Considering the high prevalence of rheumatic heart disease in the Mozambican population, it is urgent to define protocols for diagnosis and treatment. Treatment should focus on the use of empirical antibiotic therapy through identification of specific clinical signs and symptoms since laboratory tests are not widely available.

Effect of surgical defect coverage on cervical dentin hypersensitivity and quality of life.

BACKGROUND: Root exposure due to gingival recession (GR) can cause cervical dentin hypersensitivity (CDH), which is characterized by tooth pain. The aim of this study is to evaluate the effect of surgical defect coverage on CDH and quality of life in patients with GR. METHODS: Twenty-five GRs in maxillary canines and premolars were treated with coronally positioned flap plus connective tissue graft. GR dimensions, amount of keratinized gingiva, and clinical attachment level were evaluated. CDH was assessed by thermal and evaporative stimuli. Quality of life was assessed by use of the Oral Health Impact Profile-14 (OHIP-14) questionnaire. All parameters were evaluated at baseline and after 3 months. RESULTS: Statistically significant reduction in CDH (P <0.001), significant reduction in impact of oral health on quality of life (P <0.001), and significant changes in periodontal parameters were observed after 3 months. Mean defect coverage of 67.90% was achieved, with full coverage in 11 cases. Percentage defect coverage showed no correlation with air blast-stimulated CDH (P = 0.256) or cold stimulus (P = 0.563). The OHIP-14 physical disability dimension was correlated with the amount of keratinized tissue (P = 0.010) and also with defect coverage (P = 0.035). CONCLUSIONS: Surgical defect coverage may reduce CDH and improve patient quality of life, by keratinized gingiva augmentation and impact on physical disability, irrespective of amount of defect coverage.

Bioquímica de la caries dental / Biochemistry of dental caries

La caries dental constituye una de las enfermedades crónicas y transmisibles que con mayor frecuencia afecta a los seres humanos, por lo que es objeto de estudio de numerosos investigadores con el propósito de lograr su prevención y tratamiento. En el siguiente trabajo, realizamos una revisión bibliográfica con el objetivo de profundizar en los conocimientos teóricos acerca de la caries dental describiendo los factores y mecanismos que propician la aparición de esta patología, así como los mecanismos de acción de los fluoruros, los edulcorantes, los agentes antibacterianos y el ozono(AU)

The dental caries constitutes one of the chronic and transferable illnesses that affects the human beings with more frequency, for what is object of numerous investigators' study with the purpose of achieving its prevention and treatment. In the following work we carry out a bibliographical revision with the objective of deepening in the theoretical knowledge about the dental caries describing the actors and mechanisms that propitiate the appearance of this pathology, as well as the mechanisms of action of the fluorides, antibacterial agents, the edulcorating and the ozone(AU)

Personalidad y estrés en el personal sometido a un trabajo de tensión y riesgo / Personality and stress in personnel subjected to stressful and risky works

Se realizó un estudio de algunos aspectos del estrés (la vulnerabilidad y los signos), las cualidades de la personalidad, el temperamento y las características tipológicas del sistema nervioso en un grupo de especialistas sometidos a un trabajo con tensión y de riesgo. Para la investigación se utilizó una batería de tests e instrumentos psicológicos compuesta por un cuestionario de signos de estrés, la prueba de cálculo numérico regresiva asociada con la frecuencia cardíaca, el inventario de la personalidad 16 PF de Cattell y los tests de Spielberger, vulnerabilidad, Eysenck y Kasan. Las conclusiones permitieron detectar el porcentaje de personas vulnerables al estrés y cuales presentan signos ligeros y severos de éste, además, el tipo de temperamento. Se identificaron las características tipológicas del sistema nervioso del personal vulnerable, así como la revelación de las cualidades de personalidad: la reserva, la timidez, la emotividad y la desconfianza(AU)

Personalidad y estrés en el personal sometido a un trabajo de tensión y riesgo / Personality and stress in personnel subjected to stressful and risky works

Se realizó un estudio de algunos aspectos del estrés (la vulnerabilidad y los signos), las cualidades de la personalidad, el temperamento y las características tipológicas del sistema nervioso en un grupo de especialistas sometidos a un trabajo con tensión y de riesgo. Para la investigación se utilizó una batería de tests e instrumentos psicológicos compuesta por un cuestionario de signos de estrés, la prueba de cálculo numérico regresiva asociada con la frecuencia cardíaca, el inventario de la personalidad 16 PF de Cattell y los tests de Spielberger, vulnerabilidad, Eysenck y Kasan. Las conclusiones permitieron detectar el porcentaje de personas vulnerables al estrés y cuales presentan signos ligeros y severos de éste, además, el tipo de temperamento. Se identificaron las características tipológicas del sistema nervioso del personal vulnerable, así como la revelación de las cualidades de personalidad: la reserva, la timidez, la emotividad y la desconfianza