Anti-biofilm effectiveness of protocols for cleaning complete dentures in hospitalized patients: a randomized controlled trial.

BACKGROUND: Denture biofilm acts as a potential reservoir for respiratory pathogens, considerably increasing the risk of lung infections, specifically aspiration pneumonia, mainly 48h after hospital admission. The establishment of a straightforward, affordable, and applicable hygiene protocol in a hospital environment for the effective control of denture biofilm can be particularly useful to prevent respiratory infections or reduce the course of established lung disease. OBJECTIVES: To evaluate the anti-biofilm effectiveness of denture cleaning protocols in hospitalized patients. METHODOLOGY: The maxillary complete dentures (MCDs) of 340 hospitalized participants were randomly cleaned once using one of the following 17 protocols (n=20): brushing with distilled water, toothpaste, or neutral liquid soap (controls); immersion in chemical solutions (1% sodium hypochlorite, alkaline peroxide, 0.12% or 2% chlorhexidine digluconate), or microwave irradiation (650 W for 3 min) combined or not with brushing. Before and after the application of the protocols, the biofilm of the intaglio surface of the MCDs was evaluated using two methods: denture biofilm coverage area (%) and microbiological quantitative cultures on blood agar and Sabouraud Dextrose Agar (CFU/mL). Data were subjected to the Wilcoxon and Kruskal-Wallis tests (α=0.05). RESULTS: All 17 protocols significantly reduced the percentage area of denture biofilm and microbial and fungal load (P<0.05). The highest percentage reductions in the area of denture biofilm were observed for 1% hypochlorite solution with or without brushing and for 2% chlorhexidine solution and microwave irradiation only in association with brushing (P<0.05). The greatest reductions in microbial and fungal load were found for the groups that used solutions of 2% chlorhexidine and 1% hypochlorite and microwave irradiation, regardless of the association with brushing (P<0.05). CONCLUSIONS: A single immersion for 10 min in 1% sodium hypochlorite, even in the absence of brushing, proved to be a straightforward, rapid, low-cost, and effective protocol for cleaning the dentures of hospitalized patients.

Anti-biofilm effectiveness of protocols for cleaning complete dentures in hospitalized patients: a randomized controlled trial

Abstract Denture biofilm acts as a potential reservoir for respiratory pathogens, considerably increasing the risk of lung infections, specifically aspiration pneumonia, mainly 48h after hospital admission. The establishment of a straightforward, affordable, and applicable hygiene protocol in a hospital environment for the effective control of denture biofilm can be particularly useful to prevent respiratory infections or reduce the course of established lung disease. Objectives To evaluate the anti-biofilm effectiveness of denture cleaning protocols in hospitalized patients. Methodology The maxillary complete dentures (MCDs) of 340 hospitalized participants were randomly cleaned once using one of the following 17 protocols (n=20): brushing with distilled water, toothpaste, or neutral liquid soap (controls); immersion in chemical solutions (1% sodium hypochlorite, alkaline peroxide, 0.12% or 2% chlorhexidine digluconate), or microwave irradiation (650 W for 3 min) combined or not with brushing. Before and after the application of the protocols, the biofilm of the intaglio surface of the MCDs was evaluated using two methods: denture biofilm coverage area (%) and microbiological quantitative cultures on blood agar and Sabouraud Dextrose Agar (CFU/mL). Data were subjected to the Wilcoxon and Kruskal-Wallis tests (α=0.05). Results All 17 protocols significantly reduced the percentage area of denture biofilm and microbial and fungal load (P<0.05). The highest percentage reductions in the area of denture biofilm were observed for 1% hypochlorite solution with or without brushing and for 2% chlorhexidine solution and microwave irradiation only in association with brushing (P<0.05). The greatest reductions in microbial and fungal load were found for the groups that used solutions of 2% chlorhexidine and 1% hypochlorite and microwave irradiation, regardless of the association with brushing (P<0.05). Conclusions A single immersion for 10 min in 1% sodium hypochlorite, even in the absence of brushing, proved to be a straightforward, rapid, low-cost, and effective protocol for cleaning the dentures of hospitalized patients.

Empowerment-based nutrition interventions on blood pressure: a randomized comparative effectiveness trial.

Introduction: Empowerment lifestyle programs are needed to reduce the risk of hypertension. Our study compared the effectiveness of two empowerment-based approaches toward blood pressure (BP) reduction: salt reduction-specific program vs. healthy lifestyle general program. Methods: Three hundred and eleven adults (median age of 44 years, IQR 34-54 years) were randomly assigned to a salt reduction (n = 147) or a healthy lifestyle program (n = 164). The outcome measures were urinary sodium (Na+) and potassium (K+) excretion, systolic (SBP) and diastolic (DBP) blood pressure, weight, and waist circumference. Results: There were no significant differences in primary and secondary outcomes between the two program groups. When comparing each program to baseline, the program focused on salt reduction was effective in lowering BP following a 12-week intervention with a mean change of -2.5 mm Hg in SBP (95% CI, -4.1 to -0.8) and - 2.7 mm Hg in DBP (95% CI, -3.8 to -1.5) in the intention-to-treat (ITT) analysis. In the complete-case (CC) analysis, the mean change was -2.1 mm Hg in SBP (95% CI, -3.7 to -0.5) and - 2.3 mm Hg in DBP (95% CI, -3.4 to -1.1). This effect increases in subjects with high-normal BP or hypertension [SBP - 7.9 mm Hg (95% CI, -12.5 to -3.3); DBP - 7.3 mm Hg (95% CI, -10.2 to -4.4)]. The healthy lifestyle group also exhibited BP improvements after 12 weeks; however, the changes were less pronounced compared to the salt reduction group and were observed only for DBP [mean change of -1.5 mm Hg (95% CI, -2.6 to -0.4) in ITT analysis and - 1.4 mm Hg (95% CI, -2.4 to -0.3) in CC analysis, relative to baseline]. Overall, improvements in Na+/K+ ratio, weight, and Mediterranean diet adherence resulted in clinically significant SBP decreases. Importantly, BP reduction is attributed to improved dietary quality, rather than being solely linked to changes in the Na+/K+ ratio. Conclusion: Salt-focused programs are effective public health tools mainly in managing individuals at high risk of hypertension. Nevertheless, in general, empowerment-based approaches are important strategies for lowering BP, by promoting health literacy that culminates in adherence to the Mediterranean diet and weight reduction.

A importância da atuação do cirurgião-dentista frente à violência contra a mulher: revisão de literatura / The importance of the dentist's acting in face of violence against women: literature review

A violência contra as mulheres é um fenômeno complexo, pois se manifesta em diversas formas, classes sociais e contextos, tornando-se responsável por danos capazes de afetar a saúde das vítimas de maneira irreversível. Esta revisão de literatura buscou descrever os principais tipos de trauma dento alveolar que acometem mulheres vítimas de violência doméstica com o intuito de apontar a importância dos cirurgiões dentistas no atendimento inicial e na identificação de possíveis vítimas bem como do diagnóstico das lesões, tratamento e notificação de casos de violências contra as mulheres. Foi realizada uma pesquisa bibliográfica nas bases de dados Scielo, Lilacs, Pubmed e Capes utilizando as palavras-chaves, "Violência contra a Mulher", "Violência", "Odontologia" e "Notificação". Após a leitura de títulos e resumos foram incluídos 39 artigos e utilizados para esta revisão de literatura. Os critérios de inclusão foram artigos nos idiomas português, inglês e espanhol que contivessem achados clínicos das lesões na região da cabeça e pescoço, dados epidemiológicos e legislativos referentes aos aspectos éticos-legais dos profissionais de saúde. Os critérios de exclusão foram artigos incompletos e estudos relacionados à violência contra idosos, adolescentes, crianças e violência sexual. Os estudos apresentaram que profissionais de Odontologia possuem pouco conhecimento sobre o tema, evidenciando falta de preparo na identificação da violência e prevenção de potenciais prejuízos à saúde. Ainda demonstrou a necessidade de maiores esclarecimentos científicos, da inclusão do tema na graduação e em cursos de capacitações aos profissionais já formados. Mesmo em casos de suspeita de violência é indispensável que os cirurgiões-dentistas tenham conhecimento acerca da importância em notificarem e não limitar seu atendimento apenas aos cuidados das lesões físicas, de forma que possam contribuir na prevenção e redução deste fenômeno, por meio de um atendimento integral e humanizado

Violence against women is a complex phenomenon, as it manifests itself in different forms, social classes, and contexts, being it responsible for irreversible damages capable of affecting the health of the victims. This literature review sought to describe the main types of alveolar dento trauma that affect women victims of domestic violence. In order to point out the importance of dentists in the initial care and identification of possible victims as well as the diagnosis of injuries, treatment and notification of cases of violence against women. A bibliographic search was carried out in Scielo, Lilacs, Pubmed, and Capes databases using the keywords, "Violence against Women", "Violence", "Dentistry" and "Notification". After reading titles and abstracts, 39 articles were included and used for this literature review. The inclusion criteria were articles in Portuguese, English, and Spanish that contained clinical findings of lesions in the head and neck region, epidemiological and legislative data regarding the ethical-legal aspects of health professionals. Exclusion criteria were incomplete articles and studies related to violence against elderly people, adolescents, children, and sexual violence. The studies showed that dentistry professionals have little or no knowledge on the subject, evidencing a lack of training in carrying out the diagnosis and preventing potential damage to health. It also demonstrated the need for further scientific clarification, the inclusion of the topic in undergraduate programs, and training courses for professionals who have already graduated. Even in cases of suspected violence, it is essential that dentists are aware of the importance of reporting it and not limit their care only to the care of physical injuries so that they can contribute to the prevention and reduction of this phenomenon, through comprehensive and humanized care

Considerações sobre os tipos de próteses parciais removíveis e seu impacto na qualidade de vida / Considerations on types of removable partial dentures and their impact on oral health

O objetivo deste estudo foi discutir, por meio de uma revisão de literatura, as indicações, contraindicações, vantagens, desvantagens das alternativas reabilitadoras mais comuns utilizando PPRs e o impacto desses tratamentos na qualidade de vida relacionada à saúde bucal dos pacientes. Foi realizada uma pesquisa ampla na literatura, com a utilização dos termos "Prótese Parcial Removível", "Qualidade de Vida", "Saúde bucal"; "Satisfação do Paciente", no período entre 1990 e 2018, no Medline, Google Scholar, internet e livros didáticos. Foi demonstrado que a reabilitação com PPRs associadas a implantes resultou em melhor qualidade de vida associada à saúde bucal dos usuários, seguida por PPRs retidas por encaixe e PPRs convencionais. Entretanto, o profissional deve considerar as condições sistêmicas, bucais e econômicas de cada paciente, tendo o conhecimento biomecânico bem como a ciência dos benefícios e das desvantagens de cada tipo de tratamento para estabelecer um correto diagnóstico do caso e, assim, indicar o melhor tipo de PPR. Dessa forma, é possível oferecer o melhor tratamento para cada paciente parcialmente edêntulo, devolvendo estética e função de maneira satisfatória de modo a resultar em maior nível de satisfação e qualidade de vida(AU)

The purpose of this study was to discuss, through a review of the literature, indications, contraindications, advantages, disadvantages of the most common rehabilitation alternatives using RPDs and the impact of these treatments on patients' oral health quality of life. A broad research was conducted in the literature, using the terms "Partial Removable Prosthesis", "Quality of Life", "Oral Health"; "Patient Satisfaction" in the period between 1990 and 2018, in Medline, Google Scholar, internet and textbooks. It was demonstrated that rehabilitation with RPDs associated with implants resulted in a better oral health quality of life of users, followed by RPDs with attachments and conventional RPDs. However, the professional should consider the systemic, oral and economic conditions of each patient, based on the biomechanical knowledge, as well as the science of the benefits and disadvantages of each type of treatment to establish a correct diagnosis of the case, and thus, indicate the best type of RPD. In this way, it is possible to offer the best treatment for each partially edentulous patient, returning aesthetics and function in a satisfactory manner in order to result in a higher level of satisfaction and quality of life(AU)

Determining acceptable limits for water sorption and solubility of interim denture resilient liners.

STATEMENT OF PROBLEM: Specifications for determining acceptable limits of water sorption (WS) and solubility for interim denture resilient liners are lacking. PURPOSE: The purpose of this in vitro study was to evaluate the WS and solubility of interim resilient materials throughout their lifespans. MATERIAL AND METHODS: Specimens (n=10) of 7 tissue conditioners, Coe-Comfort (CC), Softone (ST), Rite-Line (RL), Dura Conditioner (DC), Hydrocast (HC), Dentusoft (DS), and Visco-gel (VG) and 2 interim resilient liners, Trusoft (TS) and Coe-Soft (CS), were submitted to desorption until weight stabilization. Next, they were immersed in distilled water at 37°C for 3, 5, 7, or 14 days and then weighed, dried, and reweighed. Data (%) were analyzed using 2-way ANOVA and the Tukey honestly significant difference (HSD) test (α=.05). RESULTS: VG demonstrated the highest WS (12.06 ±0.93%-16.62 ±0.87%) and solubility (20.30 ±4.26%-23.59 ±2.24%; P<.05) percentages. Low WS values were presented by CC (2.23 ±0.53%-2.99 ±0.49%; P<.05). The WS showed no significant changes for CC, CS, and TS over 14 days (P>.05). SL presented intermediate solubility values (4.09 ±1.60%-8.80 ±1.15%), and the other materials showed values lower than 3.35 ±0.70%. CC, DC, DS, HC, RL, TS, and CS showed no changes in solubility throughout the 14-day trial. CONCLUSIONS: Over the lifespan of a tissue conditioner (7 days), CC, RL, DC, HC, DS, CS, and TS presented suitable in vitro performance. Among the tested materials, CC, CS, and TS were considered best suited for denture relining for up to 14 days.

Porosity of temporary denture soft liners containing antifungal agents.

OBJECTIVE:: To evaluate the porosity of a tissue conditioner (Softone) and a temporary resilient liner (Trusoft) modified by minimum inhibitory concentrations (MICs) of antifungal agents for Candida albicans biofilm. MATERIAL AND METHODS:: The porosity was measured by water absorption, based on exclusion of the plasticizer effect. Initially, it was determined by sorption isotherms that the adequate storage solution for specimens (65×10×3.3 mm) of both materials was 50% anhydrous calcium chloride (S50). Then, the porosity factor (PF) was calculated for the study groups (n=10) formed by specimens without (control) or with drug incorporation at MICs (nystatin: Ny-0.032 g, chlorhexidine diacetate: Chx-0.064 g, or ketoconazole: Ke-0.128 g each per gram of soft liner powder) after storage in distilled water or S50 for 24 h, seven and 14 d. Data were statistically analyzed by 4-way repeated measures ANOVA and Tukey's test (α=.05). RESULTS:: Ke resulted in no significant changes in PF for both liners in water over 14 days (p>0.05). Compared with the controls, Softone and Trusoft PFs were increased at 14-day water immersion only after addition of Ny and Chx, and Chx, respectively (p<0.05). Both materials showed no significant changes in PF in up to 14 days of S50 immersion, compared with the controls (p>0.05). In all experimental conditions, Softone and Trusoft PFs were significantly lower when immersed in S50 compared with distilled water (p<0.05). CONCLUSIONS:: The addition of antifungals at MICs resulted in no harmful effects for the porosity of both temporary soft liners in different periods of water immersion, except for Chx and Ny in Softone and Chx in Trusoft at 14 days. No deleterious effect was observed for the porosity of both soft liners modified by the drugs at MICs over 14 days of S50 immersion.

Porosity of temporary denture soft liners containing antifungal agents

ABSTRACT Incorporation of antifungals in temporary denture soft liners has been recommended for denture stomatitis treatment; however, it may affect their properties. Objective: To evaluate the porosity of a tissue conditioner (Softone) and a temporary resilient liner (Trusoft) modified by minimum inhibitory concentrations (MICs) of antifungal agents for Candida albicans biofilm. Material and Methods: The porosity was measured by water absorption, based on exclusion of the plasticizer effect. Initially, it was determined by sorption isotherms that the adequate storage solution for specimens (65×10×3.3 mm) of both materials was 50% anhydrous calcium chloride (S50). Then, the porosity factor (PF) was calculated for the study groups (n=10) formed by specimens without (control) or with drug incorporation at MICs (nystatin: Ny-0.032 g, chlorhexidine diacetate: Chx-0.064 g, or ketoconazole: Ke-0.128 g each per gram of soft liner powder) after storage in distilled water or S50 for 24 h, seven and 14 d. Data were statistically analyzed by 4-way repeated measures ANOVA and Tukey's test (α=.05). Results: Ke resulted in no significant changes in PF for both liners in water over 14 days (p>0.05). Compared with the controls, Softone and Trusoft PFs were increased at 14-day water immersion only after addition of Ny and Chx, and Chx, respectively (p<0.05). Both materials showed no significant changes in PF in up to 14 days of S50 immersion, compared with the controls (p>0.05). In all experimental conditions, Softone and Trusoft PFs were significantly lower when immersed in S50 compared with distilled water (p<0.05). Conclusions: The addition of antifungals at MICs resulted in no harmful effects for the porosity of both temporary soft liners in different periods of water immersion, except for Chx and Ny in Softone and Chx in Trusoft at 14 days. No deleterious effect was observed for the porosity of both soft liners modified by the drugs at MICs over 14 days of S50 immersion.

Effect of incorporating antifungals on the water sorption and solubility of interim resilient liners for denture base relining.

STATEMENT OF PROBLEM: Incorporating antifungals into interim denture resilient liners has been proposed to prolong their clinical longevity and to treat denture stomatitis. However, information is lacking on the effect of this addition on water sorption and solubility. PURPOSE: The purpose of this in vitro study was to evaluate the addition of minimum inhibitory concentrations (MICs) of antifungals for Candida albicans biofilm on the water sorption (WS) and solubility of interim denture resilient liners. MATERIAL AND METHODS: Disk-shaped specimens (n=10; 50×0.5 mm) of tissue conditioner (Softone) and resilient liner (Trusoft) were created either without (control) or with the incorporation of 1 of the 3 following drugs at MICs (g of drug per g of resilient material powder): nystatin (Ny, 0.032g/g), chlorhexidine diacetate (Chx, 0.064g/g), and ketoconazole (Ke, 0.128g/g). Specimens were dried; immersed in water for 24 hours and 7 or 14 days; weighed, dried, and weighed again. Data (µg/mm(3)) were analyzed by 3-way ANOVA followed by the Tukey-Kramer honest significant differences test (α=.05). RESULTS: At the 14-day interval, only the addition of Chx (483.0 ±61.0 µg/mm(3)) increased the WS of the tissue conditioner compared with the control group (244.0 ±42.0 µg/mm(3); P<.001). For all periods, the solubility of both materials increased with the addition of Chx (27.7 ±6.1 µg/mm(3)) and Ke (30.9 ±5.3 µg/mm(3)) compared with the control group (22.5 ±6.0 µg/mm(3); P<.001). CONCLUSIONS: After 14 days, the addition of Ny and Ke at MICs in both Softone and Trusoft and addition of Chx in Trusoft did not affect WS. The solubility of the 2 interim materials was not altered by the addition of Ny for up to 14 days.

Schistosomias in the northern state of Espírito Santo, Brazil

Estima-se que o Schistosoma mansoni esteja presente em 19 estados brasileiros e um dos fatores responsáveis pela expansão da esquistossomose é a migração de indivíduos de áreas endêmicas, principalmente do Nordeste do país. O presente estudo teve por objetivo avaliar a ocorrência da esquistossomose entre trabalhadores, migrantes da Região Nordeste do país, que atuavam em Conceição da Barra, norte do Espírito Santo, no corte da cana-de-açúcar para uma indústria de produção de álcool. Para a determinação dos parasitos intestinais, foram utilizadas as técnicas de sedimentação espontânea e Kato-Katz. Dos 287 indivíduos analisados, 45 (15,7 por cento), provenientes dos estados de Alagoas, Pernambuco e Bahia, estavam positivos para S. mansoni. Do total de positivos, 38 (84,4 por cento) eram provenientes do estado de Alagoas, 6 (13,3 por cento) do estado de Pernambuco e apenas 1 (2,2 por cento) do estado da Bahia. Os resultados indicam a possibilidade de expansão da esquistossomose na região norte do Espírito Santo.

It is estimated that Schistosoma mansoni is present in 19 Brazilian states and one of the factorsresponsible for the spread of schistosomiasis is the migration of individuals from endemic areas,particularly from northeastern Brazil. In the municipality of Conceição da Barra, northern stateof Espírito Santo, the present study aimed to evaluate the occurrence of schistosomiasis amongsugarcane cutting workers in the alcohol industry, who migrated from the northeastern region ofthe country. For the diagnosis of intestinal parasites, spontaneous sedimentation and Kato-Katztechniques were used. Of the 287 individuals analyzed, 45 (15.7 por cento), from the states of Alagoas,Pernambuco and Bahia, were positive for S. mansoni. Of the total positive individuals, 38 (84.4 por cento)were from the state of Alagoas, 6 (13.3 por cento) from Pernambuco and 1 (2.2 por cento) from Bahia. The resultsindicate the possibility of schistosomiasis expansion in the northern state of Espírito Santo.

Atenção de Enfermagem nas reações adversas relacionadas à administração de hemocomponentes em pacientes portadores de doença oncológica / Nursing care in adverse reactions related to administration of blood transfusions in patients with malignant disease

É sabido que o tratamento das doenças oncológicas espolia os pacientes em determinados elementos do sangue, onde a correção desses elementos é imprescindível para a continuidade da terapêutica estabeleci da. A correção dos elementos do sangue se dá através da terapêutica transfusional que consiste na administração de sangue total, seus componentes ou derivados (hemácias, plaquetas, granulócitos e derivados plasmáticos), conforme as necessidades de cada paciente. Embora a transfusão seja uma forma de terapia segura e efetiva, existe o risco de efeitos adversos. Diante disso, o presente trabalho tem como tema atenção de enfermagem nas reações adversas relacionadas à administração de hemocomponentes em pacientes portadores de doença oncológica. Para a realização desse trabalho foi feito um levantamento bibliográfico em livros de oncologia e de enfermagem, pesquisas em home pages relativas ao assunto e artigos publicados em periódicos na base de dados do MEDLlNE. O objetivo desse estudo foi discutir medidas de intervenção da equipe de enfermagem diante uma reação transfusional em pacientes oncológicos e para isso discutimos os sinais e sintomas relacionados a todas as reações transfusionais imediatas e tardias. Também foi discutida a atuação legal e prática da equipe de enfermagem na administração de hemocomponentes. Porém, faz-se necessário que mais estudos sobre a temática sejam realizados, principalmente no que diz respeito à conduta de enfermagem frente ao uso desses hemocomponentes em pacientes oncológicos, já que sabemos que esse paciente é especial quanto aos seus estados imunológíco e hematológíco, sendo preciso muitas vezes inúmeras transfusões sanguíneas durante todo o seu tratamento

Characteristics of the bological cycle of Lutzomyia evandroi Costa Lima & Antunes, 1936 (Diptera: Psychodidae) under experimental conditions

Lutzomyia evandroi Costa Lima and Antunes, 1936 is found in Rio Grande do Norte, northeastern Brazil, in areas of visceral and mucocutaneous leishmaniasis and follows the same geographic distribution of L. longipalpis. The biological cycle, oviposition, morphological and behavioral characteristics of the species were studied under experimental conditions. The average number of eggs per wild caught female varied from 21 to 50 eggs along the year, with a peak occurring between January and March and another in August, with oviposition lasting for 4 to 12 days. The mean larval phase was 24 days. Ovipositing rates were influenced by rainfall and temperature indexes, with an increase of eggs per oviposition at the beginning and at the end of the rainy season, and a decrease at the peak of the rainy season