Leukotriene B4 loaded in microspheres regulate the expression of genes related to odontoblastic differentiation and biomineralization by dental pulp stem cells.

BACKGROUND: Leukotriene B4 (LTB4) is a potent lipid mediator that stimulate the immune response. Because dental pulp inflammation and dentin repair are intrinsically related responses, the aim of this research was to investigate the potential of LTB4 in inducing differentiation of dental pulp stem cells. METHODS: Microspheres (MS) loaded with LTB4 were prepared using an oil emulsion solvent extraction evaporation process and sterility, characterization, efficiency of LTB4 encapsulation and in vitro LTB4 release assay were investigated. Mouse dental pulp stem cells (OD-21) were stimulated with soluble LTB4 or MS loaded with LTB4 (0.01 and 0.1 µM). Cytotoxicity and cell viability was determined by lactate dehydrogenase and methylthiazol tetrazolium assays. Gene expression were measured by quantitative reverse transcription polymerase chain reaction after 3, 6, 24, 48 and 72 h. Mineralized nodule formation was assessed after 28 days of OD-21 cell stimulation with LTB4 in mineralized media or not. Groups were compared using one-way ANOVA test followed by Dunnett's post-test (α = 0.05). RESULTS: Treatment with LTB4 or MS loaded with LTB4 (0.01 and 0.1 µm-µM) were not cytotoxic to OD-21 cells. Treatment with LTB4 modulated the expression of the Ibsp (integrin binding sialoprotein) and Runx2 (runt-related transcription factor 2) genes differently depending on the experimental period analyzed. Interestingly LTB4 loaded in microspheres (0.1 µM) allowed long term dental pulp cell differentiation and biomineralization. CONCLUSION: LTB4, soluble or loaded in MS, were not cytotoxic and modulated the expression of the Ibsp and Runx2 genes in cultured OD-21 cells. When LTB4 was incorporated into MS, odontoblast differentiation and mineralization was induced in long term culture.

In Vivo Detection of External Apical Root Resorption Induced by Apical Periodontitis Using Periapical Radiography and Cone-Beam Computed Tomography

Abstract Objective: To compare the accuracy of periapical radiography (PR) and cone-beam computed tomography (CBCT) for the detection of external apical root resorption (EARR) due to root canal contamination. Material and Methods: Dog's teeth with experimentally induced root resorption due to root canal contamination underwent or not root canal treatment (n=62). True positives (TP), false positives (FP), true negatives (TN), and false negatives (FN) in PR and CBCT diagnoses were determined using histopathologic findings as the gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (TP + TN) in the diagnosis of EARR were calculated. Data were compared using chi-squared test (α=0.05). Results: EARR was detected in 35% of roots by PR, in 47% by CBCT, and in 50% of the roots by microscopy (p=0.03 PR versus microscopy; p=0.67 CBCT versus microscopy). Overall, CBCT produced more accurate diagnoses than PR (p=0.008). PR and CBCT allowed the identification of large resorption in 100% of the cases and showed the same accuracy. However, for small resorptions, PR showed an accuracy of 0.83, whereas CBCT showed an accuracy of 0.96 (p=0.003). Conclusion: Cone-beam computed tomography showed higher accuracy in detecting external apical root resorption of endodontic origin.

Surgical Management of Obesity in Brazil: Proposal for a Value-Based Healthcare Model and Preliminary Results.

OBJECTIVES: To describe the implementation and 1-year results of a value-based bariatric surgery program in Brazil. METHODS: The study was conducted at a private hospital in São Paulo, Brazil (Hospital Alemão Oswaldo Cruz). A value-based healthcare program was implemented by designing an episode of care for eligible patients and developing a bundled payment model in which a single payment was made for the bariatric surgery covering the preoperative workup and ending 30 days after discharge. Assessment of outcomes included complication rate, hospital length of stay, intensive care admissions, reoperations, readmissions, and visits to the emergency department in the 30-day postoperative period. The results were compared with real-world evidence retrieved from a Brazilian private insurance database containing information on bariatric procedures performed in similar institutions (benchmark group). RESULTS: Eighty-three patients were enrolled in the value-based healthcare program (80.7% women; 18.0% with type 2 diabetes mellitus; 31.0% with high blood pressure). The mean age was 40.9 years, and body mass index was 42.1 kg/m2. The outcomes recorded in the benchmark group versus the value-based healthcare group involved complication rate, 2.6% versus 1.4% (P = 0.69); length of stay, 2.5 versus 2.0 days (P = 0.0001); intensive care admissions, 4.0% versus 1.2% (P = 0.31); emergency care visits, 15.0% versus 6.0% (P = 0.04); and readmissions, 2.3% versus 0 (P = 0.35), with an estimated cost reduction of 7.1%. CONCLUSIONS: These initial results showed favorable surgical and 30-day outcomes, demonstrating the benefits of a value-based approach for the surgical management of obesity and its comorbidities.

As representações sociais da assistência estudantil para estudantes beneficiados e não beneficiados / The social representations of student assistance for benefited and not benefited students / Las representaciones sociales de la asistencia estudiantil para estudiantes beneficiados y no beneficiados

A Política Nacional de Assistência Estudantil- PNAES constitui-se em uma das políticas educacionais que têm contribuído para o desenvolvimento de diversas ações no cenário educacional brasileiro, visando à ampliação da permanência do aluno na Educação Superior. Nesta perspectiva, o presente estudo objetivou compreender as representações sociais da Assistência Estudantil para estudantes beneficiados e não beneficiados, em uma Instituição de Ensino Superior (IES) pública. A coleta de dados foi feita com 100 participantes, utilizando-se a Técnica de Associação Livre de Palavras - TALP, com a apresentação de uma palavra-estímulo, no caso, Assistência Estudantil, e em seguida o questionário sociodemográfico. A análise dos dados obtidos pela TALP foi feita a partir da rede semântica e as informações contidas nos questionários foram analisadas por meio do software SPSSWIN, versão 21, obtendo-se a caracterização do perfil sociodemográfico da amostra. Os resultados apontaram que os estudantes beneficiados e não beneficiados têm a representação social da Assistência Estudantil como uma ajuda e estando associada à renda, respectivamente. Essas compreensões apontam para o desconhecimento por parte de alguns alunos sobre um conjunto de ações que devem ser desenvolvidas por esta política pública para viabilizar a igualdade de oportunidades, de forma a contribuir para melhorar o desempenho acadêmico, atuando de maneira preventiva sobre as situações de retenção e evasão escolar pelos estudantes que apresentam vulnerabilidade socioeconômica. Portanto, deve-se pensar como as políticas educacionais estão afetando o ambiente universitário e qual o entendimento que se tem sobre estas, para que haja, de fato, sua efetivação, neste contexto.

The National Student Assistance Policy - PNAES is one of the educational policies that have been contributing to the development of several actions in the Brazilian educational scenario, aiming at expanding the student's permanence in Higher Education. In this perspective, the present study aimed to understand the social representations of Student Assistance for benefited and not benefited students, in a Public Higher Education Institution (IES). Data collection wascarried out with 100 participants, using the Free Word Assiciation Technique- TALP, with the presentation of a stimulus word, in this case, Student Assistance, and then the sociodemographic questionnaire. The data analysis obtained by the TALP was made from the semantic chain and the information contained in the questionnaires was analyzed using the SPSSWIN software, version 21, obtaining the characterization of the sample's sociodemographic profile. The results showed that the benefited and not benefited students have the social representation of Student Assistance as a support and associated with income, respectively. These understandings point to the lack of knowledge of some students about a set of actions that must be developed by this public policy to enable equal opportunities, in order to contribute to improve academic performance, acting in a preventive manner on retention situations and evasion school by students with socioeconomic vulnerability. Therefore, it is necessary to think about how educational policies are affecting the university environment, and what is the understanding about them, so that, in fact, its effectuation in this context.

La Política Nacional de Asistencia Estudiantil-PNAES constituyese en una de las políticas educativas que han contribuido en el desarrollo de diversas acciones en el escenario educativo brasileño, visando la ampliación de la permanencia del alumno en la Educación Superior. En esta perspectiva, el presente estudio objetivó comprender representaciones sociales de la Asistencia Estudiantil para estudiantes beneficiados y no beneficiados, en una Institución de Enseñanza Superior (IES) pública. La recolección de datos ocurrió con 100 participantes, utilizando la Técnica de Asociación Libre de Palabras - TALP, con presentación de una palabra-estímulo, en este caso, Asistencia Estudiantil, y luego el cuestionario sociodemográfico. El análisis de datos obtenidos por la TALP se realizó a partir de la red semántica y la información contenida en los cuestionarios fue analizada por el software SPSSWIN, versión 21, obteniéndose la caracterización del perfil sociodemográfico de la amuestra. Resultados apuntaron que estudiantes beneficiados y no beneficiados tienen la representación social de la Asistencia Estudiantil como un apoyo y está asociado a la renta, respectivamente. Esas comprensiones apuntan para el desconocimiento de algunos alumnos sobre un conjunto de acciones que deben ser desarrolladas por esta política pública para viabilizar la igualdad de oportunidades, para contribuir para mejoramiento del desempeño académico, actuando de manera preventiva sobre situaciones de retención y evasión escolar por los estudiantes que presentan vulnerabilidad socioeconómica. Así, se debe pensar cómo las políticas educativas están afectando el ambiente universitario, y cuál es el entendimiento que se tiene, para que haya, de hecho, su efectividad, en este contexto.

Real-world evidence of health outcomes and medication use 24 months after bariatric surgery in the public healthcare system in Brazil: a retrospective, single-center study.

OBJECTIVES: The number of bariatric procedures has significantly increased in Brazil, especially in the public Unified Health System. The present study describes health outcomes and medication use in obese patients treated in a major hospital that performs publicly funded surgery in Brazil. METHODS: A retrospective, single center study was conducted to collect real-world evidence of health outcomes and medication use in 247 obese patients (female, 82.2%) who underwent open Roux-en-Y gastric bypass. Changes in weight and body mass index (BMI), presence of apnea, hypertension, and type 2 diabetes (T2D), and medication use (hypertension, diabetes, and dyslipidemia) were assessed preoperatively and up to 24 months postoperatively. The mean cost of medications was calculated for the 12-month preoperative and 24-month postoperative periods. RESULTS: During the surgery, the mean age of patients was 43.42 years (standard deviation [SD], 10.9 years), and mean BMI was 46.7 kg/m2 (SD, 6.7 kg/m2). At 24 months, significant declines were noted in weight (mean, -37.6 kg), BMI (mean, -14.3 kg/m2); presence of T2D, hypertension, and apnea (-29.6%, -50.6%, and -20.9%, respectively); and number of patients using medications (-66.67% for diabetes, -41.86% for hypertension, and -55.26% for dyslipidemia). The mean cost of medications (total costs for all medications) decreased by >50% in 12-24 postoperative months compared to that in 12 preoperative months. CONCLUSION: Roux-en-Y gastric bypass successfully reduced weight, BMI, and comorbidities and medication use and cost at 24 months in Brazilian patients treated in the public Unified Health System.

Real-world evidence of health outcomes and medication use 24 months after bariatric surgery in the public healthcare system in Brazil: a retrospective, single-center study

OBJECTIVES: The number of bariatric procedures has significantly increased in Brazil, especially in the public Unified Health System. The present study describes health outcomes and medication use in obese patients treated in a major hospital that performs publicly funded surgery in Brazil. METHODS: A retrospective, single center study was conducted to collect real-world evidence of health outcomes and medication use in 247 obese patients (female, 82.2%) who underwent open Roux-en-Y gastric bypass. Changes in weight and body mass index (BMI), presence of apnea, hypertension, and type 2 diabetes (T2D), and medication use (hypertension, diabetes, and dyslipidemia) were assessed preoperatively and up to 24 months postoperatively. The mean cost of medications was calculated for the 12-month preoperative and 24-month postoperative periods. RESULTS: During the surgery, the mean age of patients was 43.42 years (standard deviation [SD], 10.9 years), and mean BMI was 46.7 kg/m2 (SD, 6.7 kg/m2). At 24 months, significant declines were noted in weight (mean, -37.6 kg), BMI (mean, -14.3 kg/m2); presence of T2D, hypertension, and apnea (-29.6%, -50.6%, and -20.9%, respectively); and number of patients using medications (-66.67% for diabetes, -41.86% for hypertension, and -55.26% for dyslipidemia). The mean cost of medications (total costs for all medications) decreased by >50% in 12-24 postoperative months compared to that in 12 preoperative months. CONCLUSION: Roux-en-Y gastric bypass successfully reduced weight, BMI, and comorbidities and medication use and cost at 24 months in Brazilian patients treated in the public Unified Health System.

Avaliação da implantação do Sistema de Vigilância Alimentar e Nutricional no município de São João da Boa Vista - SP / Evaluation of the implementation of the Food and Nutrition Surveillance System in São João da Boa Vista - SP

O Sistema de Vigilância Alimentar e Nutricional (Sisvan) tem como propósito principal avaliar e monitorar o estado nutricional e a situação alimentar da população. Este trabalho teve como objetivo avaliar o grau de implantação do Sisvan no município de São João da Boa Vista; para isso foi construído um modelo lógico definindo-se os indicadores de implantação, através da avaliação das condições das instalações físicas; equipamentos; disponibilidade de manuais; materiais de apoio técnico; adequação de recursos humanos e financeiros destinados a esse fim, bem como a adesão e as dificuldades com o sistema. Os resultados mostraram uma implantação parcial média e incipiente. O valor atribuído ao conjunto de indicadores foi 34%. As principais dificuldades foram estrutura física e equipamentos (33%) falta de impressos e de informações (22%), recursos humanos insuficientes 93%). Diante disso constata-se a necessidade da realização de treinamentos a fim de solucionar os pontos levantados durante a avaliação.

Avaliação da implantação do sistema de vigilância alimentar e nutricional no município de São João da Boa Vista - SP: o SISVAN como instrumento de diagnóstico e planejamento das ações em saúde / Evaluation of the implantation of the food and nutritional surveillance system in the city of São João da Boa Vista - SP: SISVAN as an instrument for diagnosis and planning of health actions

O sistema de vigilância alimentar e nutricional (SISVAN) enquanto um sistema de informações geradas pelos estabelecimentos de saúde, tem como propósito principal avaliar e monitorar o estado nutricional e a situação alimentar da população...(AU)

Noise levels in a pediatric intensive care unit: an observational and correlational study

Aim: To measure noise levels in a pediatric intensive care customer unit and discuss the consequences of such noise in relation to professional actions. Method: This is an observational and correlational study, performed in the pediatric intensive care unit of a federal hospital in Rio de Janeiro. We measured the noise level by decibel DEC-460 for five non-consecutive days and nights at five different hours. After a descriptive analysis of data, we performed a study of linear regression. Results: We identified an average of 62.64 dBA, with a standard deviation of 6.893 dBA and peak of 82.5 dBA during the daytime. The linear regression found that 44% of the variability of the noise is explained by the covariables. Discussion: The noise levels identified exceed recommendations of national and international organizations. We identified the professional actions and interactions as the main sources of noise. Conclusion: There is an urgent need to rethink this environment and establish educational strategies for noise reduction, making it safer and healthier.

Educação permanente e qualidade da assistência à saúde: aprendizagem significativa no trabalho da enfermagem / Educación permanente y calidad de la asistencia a la salud: aprendizaje significativo en el trabajo de enfermería / Continuing Education and the Quality of Health Care: Meaningful Learning in Nursing Practice

Este trabalho tem como objeto a educação permanente na prática de enfermagem. Atualmente, há uma preocupação com a mudança da estrutura de ensino e a aplicação das metodologias ativas para capacitar profissionais de saúde. Refletimos sobre o cotidiano da enfermagem e as atuais maneiras de subsidiar/fornecer informações técnico-científicas ao enfermeiro na prática hospitalar, visando enriquecer a assistência de enfermagem através da educação permanente. Objetivamos descrever as práticas transformadoras aplicadas pelo enfermeiro assistencial como elemento facilitador do processo ensino-aprendizagem. Trata-se de uma revisão integrativa, realizada nas bases de dados informatizadas. Para tanto, a seleção dos textos atenderam aos critérios de inclusão e exclusão, resultando em 50 artigos científicos. A educação permanente emergiu recentemente como um método em saúde, sendo indispensável para as práticas de formação, atenção, gestão, formulação de políticas públicas e controle social, estabelecendo uma integralidade do cuidar, e em conseqüência, transformar e interagir saberes e prática, no cenário real do público alvo. Concluímos que a motivação para atualizarmos permanentemente a prática profissional da equipe de enfermagem prevê a aplicação de um instrumento interdisciplinar de resolutividade que promova a visibilidade das ações pelos clientes e suas famílias.

El objetivo de este artículo es analizar la educación permanente en la práctica de la enfermería. En la actualidad, existe preocupación por los cambios introducidos en la estructura de enseñanza y la aplicación de metodologías activas para capacitar profesionales de salud. En el artículo se reflexiona sobre aspectos cotidianos de la enfermería y la manera actual de suministrar o proporcionar información tecnocientífica al enfermero durante la práctica en el hospital, tratando de enriquecer la asistencia de enfermería mediante la educación permanente. Se describen las prácticas trasformadoras aplicadas por el enfermero asistencial como elemento facilitador del proceso enseñanza-aprendizaje. Se lleva a cabo una revisión amplia de las bases de datos informáticas. En consecuencia, la selección de los textos se basa en los criterios de inclusión y exclusión, y dio origen a 50 artículos científicos. En años recientes, la educación permanente se introdujo como un método en el área de la salud, convirtiéndose en un aspecto indispensable en las prácticas de formación, atención, gestión, formulación de políticas públicas y control social. Así se estableció la idea de cuidado total y se trasformaron e integraron los saberes y las prácticas en el ámbito real del público al que va dirigido. Se concluye que la motivación para actualizar permanentemente la práctica profesional del equipo de enfermería prevé la aplicación de un instrumento interdisciplinario de solubilidad que promueva la visibilidad de las acciones por los clientes y sus familias.

The objective of this article is to analyze continuing education in nursing practice. There is concern nowadays about the changes introduced in the structure of teaching and the application of active methods to train health care professionals. The everyday aspects of nursing practice are examined, as is the way technological-scientific information now is being supplied to practicing nurses in hospitals, so as to enrich nursing care through continuing education. The transformative practices applied by nurse caregivers are described as an element that facilitates the teaching-learning process. There is a wide-ranging review of computer databases. Consequently, the choice of texts is based on inclusion and exclusion criteria, giving rise to 50 scientific articles. Recent years have seen the introduction of continuing education as a method in the field of health, having become an indispensable feature in practices for training, care, management, the development of public policy and social control. What has emerged is the concept of total care, with know-how and practices having been transformed and included in the real environment of those for whom they are intended. In conclusion, it is the motivation to continually up-date the professional practice of the nursing staff that provides for the application of an interdisciplinary instrument of solubility that makes actions more visible to clients and their families.

Querubismo: aspectos clínicos, radiográficos e terapêuticos* / Cherubism: clinical, radiographic and therapeutic aspects

O Querubismo é uma doença óssea rara, não neoplasica, de caráter hereditário, que acomete crianças com predileção pelo gênero masculino cujas características clínicas são aumento da mandíbula e maxila de maneira bilateral e indolor, que tende a progredir até a puberdade, quando acontece o processo de remissão espontânea. O tratamento para a doença depende do curso clínico, porém não existe nenhum protocolo definindo qual é o melhor tipo de tratamento para cada caso. Sendo assim, fica a critério do cirurgião-dentista avaliar o melhor procedimento para seu paciente