An engineering perspective of ceramics applied in dental reconstructions.

The demands for dental materials continue to grow, driven by the desire to reach a better performance than currently achieved by the available materials. In the dental restorative ceramic field, the structures evolved from the metal-ceramic systems to highly translucent multilayered zirconia, aiming not only for tailored mechanical properties but also for the aesthetics to mimic natural teeth. Ceramics are widely used in prosthetic dentistry due to their attractive clinical properties, including high strength, biocompatibility, chemical stability, and a good combination of optical properties. Metal-ceramics type has always been the golden standard of dental reconstruction. However, this system lacks aesthetic aspects. For this reason, efforts are made to develop materials that met both the mechanical features necessary for the safe performance of the restoration as well as the aesthetic aspects, aiming for a beautiful smile. In this field, glass and high-strength core ceramics have been highly investigated for applications in dental restoration due to their excellent combination of mechanical properties and translucency. However, since these are recent materials when compared with the metal-ceramic system, many studies are still required to guarantee the quality and longevity of these systems. Therefore, a background on available dental materials properties is a starting point to provoke a discussion on the development of potential alternatives to rehabilitate lost hard and soft tissue structures with ceramic-based tooth and implant-supported reconstructions. This review aims to bring the most recent materials research of the two major categories of ceramic restorations: ceramic-metal system and all-ceramic restorations. The practical aspects are herein presented regarding the evolution and development of materials, technologies applications, strength, color, and aesthetics. A trend was observed to use high-strength core ceramics type due to their ability to be manufactured by CAD/CAM technology. In addition, the impacts of COVID-19 on the market of dental restorative ceramics are presented.

Effect of a Nutritional Behavioral Intervention on Intuitive Eating in Overweight Women With Chronic Kidney Disease.

OBJECTIVES: This study aimed to evaluate the impact of a nutritional behavioral intervention on intuitive eating (IE) scores of overweight non-dialysis-dependent women with chronic kidney disease and to investigate the relationship of IE scores with demographic, nutritional, and quality of life parameters in this group. DESIGN AND METHODS: This is a prospective noncontrolled clinical trial of a behavioral multisession group intervention for dietary management. Each group comprised five to eight participants in 14 weekly or biweekly sessions lasting about 90 minutes each. The IE principles were discussed during the meetings. The IE scale 2, translated and adapted to the study population, with a four-factor model was applied to assess IE attitudes. The 36-Item Short-Form Health Survey questionnaire was applied to assess health-related quality of life. RESULTS: Of the 33 patients who began participation in the study, 23 patients (median [interquartile range]: age = 62.0 years [58.0-68.0]; 52.2% with diabetes; body mass index = 32.6 kg/m2 [30.2-39.3]; estimated glomerular filtration rate = 28.0 mL/min/1.73 m2 [22.0-31.0]) completed the intervention. Except for the IE subscale Body-Food Choice Congruence, the IE total score and all its subscales (Unconditional Permission to Eat, Eating for Physical Rather than Emotional Reasons, Reliance on Hunger and Satiety Cues, and Body-Food Choice Congruence) improved after the intervention. In a cross-sectional analysis, more intuitive eaters were older and had better scores for health-related quality of life. CONCLUSIONS: The nutritional behavioral intervention embracing IE principles was effective to improve IE attitudes for this group of chronic kidney disease patients. These results are promising and may contribute to a paradigm change in the strategies to enhance motivation and adherence to dietary recommendations in this population.

An engineering perspective of ceramics applied in dental reconstructions

Abstract The demands for dental materials continue to grow, driven by the desire to reach a better performance than currently achieved by the available materials. In the dental restorative ceramic field, the structures evolved from the metal-ceramic systems to highly translucent multilayered zirconia, aiming not only for tailored mechanical properties but also for the aesthetics to mimic natural teeth. Ceramics are widely used in prosthetic dentistry due to their attractive clinical properties, including high strength, biocompatibility, chemical stability, and a good combination of optical properties. Metal-ceramics type has always been the golden standard of dental reconstruction. However, this system lacks aesthetic aspects. For this reason, efforts are made to develop materials that met both the mechanical features necessary for the safe performance of the restoration as well as the aesthetic aspects, aiming for a beautiful smile. In this field, glass and high-strength core ceramics have been highly investigated for applications in dental restoration due to their excellent combination of mechanical properties and translucency. However, since these are recent materials when compared with the metal-ceramic system, many studies are still required to guarantee the quality and longevity of these systems. Therefore, a background on available dental materials properties is a starting point to provoke a discussion on the development of potential alternatives to rehabilitate lost hard and soft tissue structures with ceramic-based tooth and implant-supported reconstructions. This review aims to bring the most recent materials research of the two major categories of ceramic restorations: ceramic-metal system and all-ceramic restorations. The practical aspects are herein presented regarding the evolution and development of materials, technologies applications, strength, color, and aesthetics. A trend was observed to use high-strength core ceramics type due to their ability to be manufactured by CAD/CAM technology. In addition, the impacts of COVID-19 on the market of dental restorative ceramics are presented.

Retención del conocimiento de estudiantes después de una capacitación teórico-laboratorial para detección de caries / Retenção de conhecimento de graduandos após 1. 5 ano de treinamento teórico-laboratorial para detecção de cárie / Students' knowledge retention after theoretical-laboratory training for caries detection in pediatric dentistry. 1. 5 Year-assessment

Este estudio evaluó la retención de conocimientos, de estudiantes de pregrado expuestos a una actividad educativa de detección de lesiones de caries. Estudiantes de Odontología de los últimos años fueron invitados a participar del estudio. Ellos recibieron la capacitación 1 año y medio antes. Para evaluar su retención de conocimientos se realizaron evaluaciones teóricas y prácticas para dimensionar los conocimientos, habilidades y actitudes de los estudiantes. Cada prueba se valoró entre 0 a 10. Análisis de regresión multinivel se usaron para ver la asociación entre el desempeño de los estudiantes y su percepción sobre la importancia de la actividad. Otras peculiaridades relacionadas al desempeño en temas específicos y diferentes tipos de evaluación también fueron estudiadas. 302 estudiantes fueron evaluados. En promedio, los estudiantes tuvieron una nota 6.68 para la teórica y 5.5 para la práctica, con desviación estándar de 1.88 y de 2.27, respectivamente. La percepción de los estudiantes sobre la actividad didáctica fue asociada a su desempeño. En la evaluación teórica, los estudiantes fueron peores al relacionar la condición clínica con la histológica (21% de aciertos) y al justificar su conducta frente a lesiones inactivas (36% de aciertos). En la evaluación práctica, el 70-90% de los estudiantes demostraron tener capacidad para detectar, valorar la actividad y tomar decisiones clínicas sobre lesiones iniciales y severas. Solo 50% detectó correctamente lesiones moderadas y 32% sabe su manejo. Concluimos que la retención de conocimientos de los alumnos en mediano plazo es moderada está dentro de lo esperado.

Este estudo avaliou a retenção de conhecimento, em médio prazo, de graduandos expostos a uma atividade educativa de detecção de cárie. Esta é uma parte do estudo multicêntrico IuSTC. Alunos dos últimos anos foram convidados a participar e passaram pela atividade. Foram avaliados quanto à retenção do conhecimento após 1,5 ano. Avaliações teóricas e práticas (pontuadas de 0 a 10) foram preparadas para avaliar conhecimento, habilidades e atitudes. Os escores foram definidos como desfechos. Análises de regressão multinível testaram a associação entre a performance dos alunos e sua percepção sobre a importância da atividade dentro do seu currículo. Particularidades relacionadas à performance em tópicos específicos e diferentes tipos de avaliação também foram explorados. 302 alunos participaram das avaliações. Em média, os alunos tiveram medias (desvio-padrão (DP), de 6,68 (1,88) teórica e 5,5 (2,27) prática. A percepção dos alunos esteve associada com sua performance. Na avaliação teórica, os alunos tiveram pior performance ao relacionar a condição clínica com a histológica (21% de acertos) ou em justificar a conduta frente a lesões inativas (36% de acertos). Na avaliação prática, 70-90% dos alunos demonstraram habilidade de detectar, avaliar atividade e tomar decisões clínicas frente a lesões iniciais e severas, enquanto 50% avaliaram adequadamente as lesões moderadas e apenas 32% demonstrou atitude correta do manejo. Em conclusão, a retenção do conhecimento dos alunos está dentro do esperado em uma análise de médio prazo. Para alguns tópicos (por exemplo, relacionados a prática e justificativa de atitudes), a performance dos alunos tende a ser pior.

This study aimed to evaluate undergraduate students' medium-term knowledge retention after a learning activity related to caries lesions detection. This study is part of the IuSTC multicenter study. Last-years dental students were invited to participate and were exposed to the teaching activity. Their knowledge retention after 1.5 year was assessed. Theoretical and practical tests (scored 0 to 10) were prepared to evaluate knowledge, abilities and attitudes The scores were set as outcomes. Multilevel regression analyses were used to assess the association between students' performance and his/her perception about the importance of such learning activity in curriculum. Particularities related to students' performance in specific topics and types of evaluations were also explored. 302 students participated. On average, students achieved 6.68 (SD=1.88) in theoretical and 5.5 (SD=2.27) in practical assessment. Student's perception was associated with their performance. In theoretical test, students performed worse (21% of correct answers) in linking clinical and histological condition or justifying clinical decision-making for inactive lesions (36% of correct answers). In the practical test, 70-90% demonstrated ability to detect, assess activity and make the decision about management of initial or severe lesions, while 50% of students could assess adequately moderate caries lesions and only 32% demonstrated correct attitude related to their management. Undergraduate students' knowledge retention related to the detection of caries lesions is moderate in a medium-term analysis. It is noted that for some topics (e.g. not related to practice/justification of attitudes), the students' performance tends to be worse.

Calix[n]arene-based immunogens: A new non-proteic strategy for anti-cocaine vaccine.

Introduction: Cocaine use disorder is a significant public health issue without a current specific approved treatment. Among different approaches to this disorder, it is possible to highlight a promising immunologic strategy in which an immunogenic agent may reduce the reinforcing effects of the drug if they are able to yield sufficient specific antibodies capable to bind cocaine and/or its psychoactive metabolites before entering into the brain. Several carriers have been investigated in the anti-cocaine vaccine development; however, they generally present a very complex chemical structure, which potentially hampers the proper assessment of the coupling efficiency between the hapten units and the protein structure. Objectives: The present study reports the design, synthesis and preclinical evaluation of two novel calix[n]arene-based anti-cocaine immunogens (herein named as V4N2 and V8N2) by the tethering of the hydrolysis-tolerant hapten GNE (15) on calix[4]arene and calix[8]arene moieties. Methods: The preclinical assessment corresponded to the immunogenicity and dose-response evaluation of V4N2 and V8N2. The potential of the produced antibodies to reduce the passage of cocaine analogue through the blood-brain-barrier (BBB), modifying its biodistribution was also investigated. Results: Both calix[n]arene-based immunogens elicited high titers of cocaine antibodies that modified the biodistribution of a cocaine radiolabeled analogue (99mTc-TRODAT-1) and decreased cocaine-induced behavior, according to an animal model. Conclusion: The present results demonstrate the potential of V4N2 and V8N2 as immunogens for the treatment of cocaine use disorder.

The GNE-KLH anti-cocaine vaccine protects dams and offspring from cocaine-induced effects during the prenatal and lactating periods.

Protecting children from prenatal cocaine exposure is a significant challenge for physicians and childbearing women with cocaine use disorder. Cocaine use is highly prevalent among reproductive-aged women and prenatal cocaine exposure produces obstetric, foetal neurodevelopmental and long-term behavioural impairments. Cocaine crosses the maternal and foetal blood-brain barrier and the placenta by diffusion. The best approach to prevent prenatal cocaine exposure is to stop cocaine use. However, only 25% of cocaine users can discontinue their use during pregnancy. Anti-cocaine vaccination decreases cocaine passage through the blood-brain barrier. This study describes an innovative approach for preventing prenatal cocaine exposure using the GNE-KLH anti-cocaine vaccine, a novel use for the named anti-drug vaccines. Here, we show that anti-cocaine vaccination with GNE-KLH produced and maintained anti-cocaine IgG antibody titres and avidity during pregnancy. These antibodies protected the pregnant rats and their pups against prenatal cocaine damage during pregnancy until weaning. The present work is the first preclinical evidence of the efficacy of an innovative mechanism to prevent prenatal cocaine exposure damage, a worldwide public health care issue. In the future, this mechanism may be useful in pregnant women with cocaine use disorder. Further studies to understand the mechanisms of how anti-cocaine antibodies exert their protective effects in pregnancy are warranted.

Current advances in drug delivery of nanoparticles for respiratory disease treatment.

Cases of respiratory diseases have been increasing around the world, affecting the health and quality of life of millions of people every year. Chronic respiratory diseases (CRDs) and acute respiratory infections (ARIs) are responsible for many hospital admissions and deaths, requiring sophisticated treatments that facilitate the delivery of therapeutics to specific target sites with controlled release. In this context, different nanoparticles (NPs) have been explored to match this demand, such as lipid, liposome, protein, carbon-based, polymeric, metallic, oxide, and magnetic NPs. The use of NPs as drug delivery systems can improve the efficacy of commercial drugs due to their advantages related to sustained drug release, targeting effects, and patient compliance. The current review presents an updated summary of recent advances regarding the use of NPs as drug delivery systems to treat diseases related to the respiratory tract, such as CRDs and ARIs. The latest applications presented in the literature were considered, and the opportunities and challenges of NPs in the drug delivery field are discussed.

Arbovirus expansion: New species of culicids infected by the Chikungunya virus in an urban park of Brazil.

The Dengue, Zika and Chikungunya viruses have been spreading in tropical regions, causing epidemics with high morbidity rates and fatal cases. The aim of this study was to assess the diversity and abundance of culicid species and the presence of arboviruses in mosquitoes, at the epicenter of an epidemic outbreak that occurred in people living near an urban Atlantic Forest park. Mosquitoes were captured with a Shannon trap between 2 and 6 pm in seven months of 2019. The Chikungunya virus was investigated according to the protocol described by Lanciotti (2007). The most abundant species were Wyeomyia bourrouli (66.9%) and Aedes albopictus (23.9%). Also captured were Aedes fluviatilis (3.2%); Haemagogus leucocelaenus (2.2%); Aedes scapularis (2.2%); Aedes aegypti (1.6%); Aedes serratus and (0.3%) and Aedes taeniorhynchus (0.3%). The Chikungunya virus was identified in A. aegypti females; A. albopictus females and males; Aedes fluviatilis and Wy.bourrouli. The presence of the Chikungunya virus in the afore mentioned mosquitoes reinforces the hypothesis that arbovirus expansion is associated with the participation of other mosquito species in the transmission areas, primarily the Chikungunya virus in the study area. The data also demonstrate the need for permanent entomological surveillance and measures to preserve the area, in order to hinder its degradation, the adaptation of culicid species to new habitats and the formation of enzootic cycles of these viruses in the forest.

Diet in Chronic Kidney Disease: an integrated approach to nutritional therapy.

A healthy diet is an essential requirement to promote and preserve health, even in the presence of diseases, such as chronic kidney disease (CKD). In this review, nutritional therapy for CKD will be addressed considering not only the main nutrients such as protein, phosphorus, potassium, and sodium, which require adjustments as a result of changes that accompany the reduction of renal functions, but also the benefits of adopting dietary patterns associated with better outcomes for both preventing and treating CKD. We will also emphasize that these aspects should also be combined with a process of giving new meaning to a healthy diet so that it can be promoted. Finally, we will present the perspective of an integrated approach to the individual with CKD, exploring the importance of considering biological, psychological, social, cultural, and economic aspects. This approach has the potential to contribute to better adherence to treatment, thus improving the patient's quality of life.

Diet in Chronic Kidney Disease: an integrated approach to nutritional therapy

SUMMARY A healthy diet is an essential requirement to promote and preserve health, even in the presence of diseases, such as chronic kidney disease (CKD). In this review, nutritional therapy for CKD will be addressed considering not only the main nutrients such as protein, phosphorus, potassium, and sodium, which require adjustments as a result of changes that accompany the reduction of renal functions, but also the benefits of adopting dietary patterns associated with better outcomes for both preventing and treating CKD. We will also emphasize that these aspects should also be combined with a process of giving new meaning to a healthy diet so that it can be promoted. Finally, we will present the perspective of an integrated approach to the individual with CKD, exploring the importance of considering biological, psychological, social, cultural, and economic aspects. This approach has the potential to contribute to better adherence to treatment, thus improving the patient's quality of life.

RESUMO Uma dieta saudável é essencial para promover e preservar a saúde, mesmo na presença de doenças como a Doença Renal Crônica (DRC). Nesta revisão, a terapia nutricional para pacientes de DRC será abordada levando em conta não só os principais nutrientes que precisam ser ajustados devido às alterações que acompanham a redução das funções renais, tais como proteínas, fósforo, potássio e sódio. Abordaremos também os benefícios da adoção de padrões alimentares associados a desfechos melhores tanto para a prevenção quanto para o tratamento da DRC. Também enfatizaremos que esses aspectos devem ser aliados a um processo de ressignificação do conceito de dieta saudável para que seja possível a sua promoção. Por último, apresentaremos a perspectiva de uma abordagem integrada para o indivíduo com DRC, explorando a importância de considerar aspectos biológicos, psicológicos, sociais, culturais e econômicos. Essa abordagem tem o potencial de contribuir para uma melhor adesão ao tratamento, melhorando assim a qualidade de vida do paciente.

Logística reversa de resíduos de equipamentos elétricos e eletrônicos: proposta de indicadores de monitoramento para órgãos ambientais / Take-back systems for waste electrical and electronic equipment proposal of monitoring indicators for environmental agencies

A Política Nacional de Resíduos Sólidos, de 2010, representou um novo paradigma para a gestão de resíduos de equipamentos elétricos e eletrônicos, responsabilizando fabricantes, importadores, distribuidores e comerciantes pela coleta e destinação adequada desses resíduos por meio de sistemas de logística reversa. Dentro do cenário nacional, o Estado de São Paulo encontra-se em uma posição pioneira frente à implementação da logística reversa. Em âmbito internacional, destacam-se os casos japonês e europeu como referência na gestão de tais resíduos. Nesse contexto, esta dissertação tem o objetivo principal de desenvolver um conjunto de indicadores para avaliação de sistemas de logística reversa de resíduos de equipamentos elétricos e eletrônicos, com a finalidade de contribuir para o acompanhamento e avaliação de tais sistemas pelos órgãos ambientais. Foram realizadas revisão bibliográfica e pesquisa documental sobre os modelos de gestão de resíduos de equipamentos elétricos e eletrônicos e os sistemas de logística reversa na Europa, no Japão e no Brasil, e sobre indicadores e critérios para avaliação de sistemas de logística reversa desses resíduos. Em seguida, foram aplicados questionários para identificar quais indicadores são utilizados para os sistemas europeus e japoneses, quais são sugeridos por especialistas e pelas entidades gestoras nacionais. Como resultado, foi proposto um conjunto de indicadores para avaliação de sistemas de logística reversa de resíduos de equipamentos elétricos e eletrônicos, o qual foi submetido à validação de especialistas por meio da técnica Delphi. O conjunto proposto após a etapa de validação é composto por cinco parâmetros que exprimem uma caracterização básica do sistema e por 31 indicadores, classificados em seis dimensões: i) abrangência, ii) representatividade, iii) parcerias, iv) coleta, v) destinação e disposição final, e vi) custos e investimentos. Por fim, foi proposto um modelo de relatório para tais sistemas, integrado ao conjunto, para fornecer os dados necessários aos indicadores

The National Solid Waste Policy of 2010 represented a new paradigm for the management of waste electrical and electronic equipment, making manufacturers, importers, distributors and merchants accountable for the collection and proper disposal of these wastes through take-back systems. Within the national scenario, the State of São Paulo is in a pioneering position regarding the implementation of reverse logistics. At the international level, the Japanese and European cases stand out as a reference in the management of such waste. In this context, the research proposed herein has the main objective of developing a set of indicators for the evaluation of waste electrical and electronic equipment take-back systems, with the purpose of contributing to the monitoring and evaluation of such systems by environmental agencies. A bibliographic review and documentary research were carried out on models of waste electrical and electronic equipment management and take-back systems in Europe, Japan and Brazil, and on indicators and criteria for the evaluation of take-back systems of such waste. Questionnaires were then applied to identify which indicators are used for the European and Japanese systems and which are suggested by experts and national producer responsibility organizations. As a result, a set of indicators was proposed for the evaluation of waste electrical and electronic equipment take-back systems, which was submitted to the validation of specialists through the Delphi method. The set proposed after the validation step is composed of five parameters that express a basic characterization of the system and 31 indicators, classified into six dimensions: i) comprehensiveness, ii) representativeness, iii) partnerships, iv) collection, v) recycling and disposal, and vi) costs and investments. Finally, a reporting model for such systems, integrated with the set of indicators, was proposed to provide the necessary data for the indicators

Sarcopenia in chronic kidney disease on conservative therapy: prevalence and association with mortality.

BACKGROUND: In chronic kidney disease (CKD), multiple metabolic and nutritional abnormalities contribute to the impairment of skeletal muscle mass and function thus predisposing patients to the condition of sarcopenia. Herein, we investigated the prevalence and mortality predictive power of sarcopenia, defined by three different methods, in non-dialysis-dependent (NDD) CKD patients. METHODS: We evaluated 287 NDD-CKD patients in stages 3-5 [59.9 ± 10.5 years; 62% men; 49% diabetics; glomerular filtration rate (GFR) 25.0 ± 15.8 mL/min/1.73 m(2)]. Sarcopenia was defined as reduced muscle function assessed by handgrip strength (HGS <30th percentile of a population-based reference adjusted for sex and age) plus diminished muscle mass assessed by three different methods: (i) midarm muscle circumference (MAMC) <90% of reference value (A), (ii) muscle wasting by subjective global assessment (B) and (iii) reduced skeletal muscle mass index (<10.76 kg/m² men; <6.76 kg/m² women) estimated by bioelectrical impedance analysis (BIA) (C). Patients were followed for up to 40 months for all-cause mortality, and there was no loss of follow-up. RESULTS: The prevalence of sarcopenia was 9.8% (A), 9.4% (B) and 5.9% (C). The kappa agreement between the methods were 0.69 (A versus B), 0.49 (A versus C) and 0.46 (B versus C). During follow-up, 51 patients (18%) died, and the frequency of sarcopenia was significantly higher among non-survivors. In crude Cox analysis, sarcopenia diagnosed by the three methods was associated with a higher hazard for mortality; however, only sarcopenia diagnosed by method C remained as a predictor of mortality after multivariate adjustment. CONCLUSIONS: The prevalence of sarcopenia in CKD patients on conservative therapy varies according to the method applied. Sarcopenia defined as reduced handgrip strength and low skeletal muscle mass index estimated by BIA was an independent predictor of mortality in these patients.

Diagnósticos de enfermagem prevalentes no paciente internado com sepse no centro de terapia intensiva / Prevalent nursing diagnosis in patients hospitalized with sepsis at the intensive care unit / Diagnósticos de enfermería prevalentes en paciente internado con sepsis en centro de terapia intensiva

O objetivo deste estudo foi identificar os diagnósticos de enfermagem prevalentes nos pacientes internados com sepse, sepse grave ou choque séptico em um Centro de Terapia Intensiva. A população foi constituída pelos pacientes com idade superior a 18 anos, internados no Centro de Terapia Intensiva, de janeiro a dezembro de 2010. As informações foram coletadas do prontuário, de acordo com as características sociodemográficas e clínicas e diagnósticos de enfermagem registrados. No período estudado, foram internados 103 pacientes, sendo que 79,4% foram a óbito. Os diagnósticos de enfermagem identificados foram: risco de infecção, risco de aspiração, risco para integridade da pele prejudicada, ventilação espontânea prejudicada, troca de gases prejudicada, perfusão tissular ineficaz cardiopulmonar e integridade da pele prejudicada. Em conclusão, espera-se que a identificação dos diagnósticos, presentes nos prontuários de pacientes com sepse, possam contribuir para a assistência de enfermagem a essa clientela.

The objective in this study was to identify the prevalent nursing diagnoses in patients hospitalized with sepsis, severe sepsis or septic shock at an Intensive Care Unit. The population consisted of patients over 18 years of age, hospitalized at the Intensive Care Unit between January and December 2010. The information was collected from the patient histories, according to the sociodemographic and clinical characteristics and nursing diagnoses registered. In the study period, 103 patients were hospitalized, 79.4% of whom died. The following nursing diagnoses were identified: risk for infection, risk for aspiration, risk for impaired skin integrity, impaired spontaneous ventilation, impaired gas exchange, ineffective cardiopulmonary tissue perfusion and impaired skin integrity. In conclusion, the identification of the diagnoses present in the histories of sepsis patients is expected to contribute to nursing care for these clients.

El objetivo de este estudio fue identificar los diagnósticos de enfermería prevalentes en los pacientes internados con sepsis, sepsis grave o choque séptico en un Centro de Terapia Intensiva. La población fue constituida por los pacientes con edad superior a 18 años, internados en el Centro de Terapia Intensiva, de enero a diciembre de 2010. Las informaciones fueron obtenidas del prontuario, de acuerdo con las características sociodemográficas y clínicas, así como diagnósticos de enfermería registrados. En el periodo estudiado, fueron internados 103 pacientes, siendo que 79,4% fueron a óbito. Los diagnósticos de enfermería identificados fueron: riesgo de infección, riesgo de aspiración, riesgo para integridad de la piel perjudicada, ventilación espontánea perjudicada, cambio de gases perjudicado, perfusión tisular ineficaz cardiopulmonar y integridad de la piel perjudicada. Se concluye que es necesario que la identificación de los diagnósticos, presentes en los prontuarios de pacientes con sepsis, pueda contribuir para la asistencia de enfermería a esa clientela.

Adductor pollicis muscle thickness as a predictor of handgrip strength in hemodialysis patients.

INTRODUCTION: Recently, the adductor pollicis muscle thickness (APMT) has been suggested as a new nutritional marker in several population. OBJECTIVE: In view of the scarce data regarding the use of this marker in CKD patients, we aimed to evaluate APMT and its association with nutritional parameters in patients on hemodialysis. METHODS: We evaluated 73 hemodialysis patients (52.3 ± 17 years, without residual renal function). The APMT was assessed in the non vascular access arm by means of skinfold caliper. Body composition (bioelectrical impedance), handgrip strength (HGS, dynamometer), nutritional status (subjective global assessment), and laboratory parameters (creatinine, total protein and albumin) were also evaluated. RESULTS: Subjects with APMT values above the median were in greater proportion black/ brown, younger and had higher HGS. The APMT correlated positively with HGS, albumin and body cell mass (%), and negatively with age. In the linear regression analysis adjusted for sex, age and length on hemodialysis, APMT was independently associated with HGS. CONCLUSION: APMT was able to predict HGS in hemodialysis patients, suggesting APMT as a promising nutritional marker in this population.

Espessura do músculo adutor do polegar como preditor da força de preensão manual nos pacientes em hemodiálise / Adductor pollicis muscle thickness as a predictor of handgrip strength in hemodialysis patients

INTODUÇÃO: A espessura do músculo adutor do polegar (EMAP) tem sido sugerida como um novo marcador de estado nutricional em diversas populações. OBJETIVO: Diante da escassez de dados sobre o uso desse marcador nos pacientes com doença renal crônica, o objetivo deste estudo foi avaliar a EMAP e sua associação com indicadores nutricionais em pacientes em hemodiálise. MÉTODOS: Foram avaliados 73 pacientes em hemodiálise (52,3 ± 17 anos, sem função renal residual). A EMAP foi aferida no braço sem o acesso vascular com o auxílio de um adipômetro. A composição corporal (bioimpedância elétrica), a força de preensão manual (dinamômetro), o estado nutricional (Avaliação Global Subjetiva) e os exames laboratoriais (creatinina, proteína total e albumina) também foram avaliados. RESULTADOS: Indivíduos com valores de EMAP acima da mediana eram em maior proporção negros/pardos, jovens e possuíam maior força de preensão manual. A EMAP correlacionou-se positivamente com a força de preensão manual, albumina sérica e massa celular (%), e negativamente com a idade. Na análise de regressão linear ajustada para sexo, idade e tempo em hemodiálise, a EMAP esteve independentemente associada com a força de preensão manual. CONCLUSÃO: A EMAP foi capaz de predizer a força de preensão manual nos pacientes em hemodiálise, o que sugere a EMAP como um marcador promissor de estado nutricional nessa população.

INTRODUCTION: Recently, the adductor pollicis muscle thickness (APMT) has been suggested as a new nutritional marker in several population. OBJECTIVE: In view of the scarce data regarding the use of this marker in CKD patients, we aimed to evaluate APMT and its association with nutritional parameters in patients on hemodialysis. METHODS: We evaluated 73 hemodialysis patients (52.3 ± 17 years, without residual renal function). The APMT was assessed in the non vascular access arm by means of skinfold caliper. Body composition (bioelectrical impedance), handgrip strength (HGS, dynamometer), nutritional status (subjective global assessment), and laboratory parameters (creatinine, total protein and albumin) were also evaluated. RESULTS: Subjects with APMT values above the median were in greater proportion black/ brown, younger and had higher HGS. The APMT correlated positively with HGS, albumin and body cell mass (%), and negatively with age. In the linear regression analysis adjusted for sex, age and length on hemodialysis, APMT was independently associated with HGS. CONCLUSION: APMT was able to predict HGS in hemodialysis patients, suggesting APMT as a promising nutritional marker in this population.

Nitric oxide is responsible for oxidative skin injury and modulation of cell proliferation after 24 hours of UVB exposures.

Nitric oxide (NO) is produced by various mammalian cells and plays a variety of regulatory roles in normal physiology and in pathological processes. This article provides evidence regarding the participation of NO in UVB-induced skin lesions and in the modulation of skin cell proliferation following UVB skin irradiation. Hairless mice were subjected to UVB irradiation for 3 hours and the skin evaluated immediately, 6 and 24 hours postirradiation. The skin lipid peroxidation, and NO levels evaluated by chemiluminescence and inducible nitric oxide synthase (iNOS) and nitrotyrosine immunolabelling increased significantly 24 hours after irradiation and decreased under the treatment with aminoguanidine (AG). On the other hand, cell proliferation markers, PCNA and VEGF showed a strong labelling index when AG was used. The data indicate that NO mediates, at least in part, the lipid peroxidation and protein nitration and also promotes the down regulation of factors involved in cell proliferation. This work shows that the NO plays an important role in the oxidative stress damage and on modulation of cell proliferation pathways in UVB irradiated skin.