Undergraduate dental sudents' perspectives about experiences in primary care for their education in the field of health / Perspectivas de graduandos em odontologia acerca das experiências na atenção básica para sua formação em saúde

Supervised training periods in primary care have been used as spaces for teaching and extension in the area of health, making it feasible to include undergraduates in concrete teaching-learning scenarios. The aim of this study was to analyze the perceptions of dental students about the importance of supervised training periods in Family Health Units to their professional education. The sample consisted of 185 students who answered the question: What is your opinion about the importance of this training period in SUS to your professional education? Comment on this experience and its positive and negative aspects The responses were analyzed by the quali-quantitative Collective Subject Discourse (CSD) technique. The students appreciated learning through practice in the service; contact with professionals from other areas; opportunity for technical-operative improvement and demonstrated sensitivity in the face of social reality, although they appeared to be concerned about being absent from the faculty, arguing that they were being prejudiced as regards their intramural clinical productivity, exhaustively demanded of them. It was concluded that students placed value on the extramural experience, however, it was perceived that there was still a predominant influence of focus on intramural clinical training.

Os estágios supervisionados na atenção básica vêm sendo utilizados como espaços de ensino e extensão nas áreas da saúde, viabilizando a inserção dos graduandos em cenários concretos de ensino-aprendizagem. O objetivo deste estudo foi analisar as percepções de acadêmicos de odontologia sobre a importância do estágio supervisionado em Unidades de Saúde da Família, para sua formação profissional. A amostra foi constituída por 184 acadêmicos que responderam à questão: Qual a sua opinião em relação à importância deste estágio no SUS para a sua formação profissional? Comente esta experiência e seus aspectos positivos e negativos. As respostas foram analisadas através da técnica qualiquantitativa do discurso do sujeito coletivo. Os alunos valorizaram o aprendizado através da prática no serviço, do contato com profissionais de outras áreas, da oportunidade de aperfeiçoamento técnico-operatório e demonstraram sensibilização frente à realidade social, embora tenham aparentado incômodo por se ausentarem da faculdade, sob o argumento de serem prejudicados quanto à produtividade da clínica intramuros, exaustivamente cobrada. Concluiu-se que os alunos valorizaram a experiência extramural, entretanto, percebeu-se que ainda há uma hegemonia do foco no treinamento clínico intramuros.

O custo de soluções alcalinas em sessões de hemodiálise ambulatorial: uma análise sobre o desperdício a partir do controle dos processos / The cost of alkaline solutions in ambulatory hemodialysis: an analysis about wasteful from the processes control

Introdução: São escassos estudos dos custos dos insumos consumidos em hemodiálise e, dentre estes gastos, os compostos que compõem o dialisato estão entre os valores considerados como representativos nessa terapia. Contudo, não foram encontrados estudos que orientem sobre o comportamento de custos dessas soluções. Objetivo: O objetivo do artigo é avaliar se há desperdício no consumo de soluções alcalinas em hemodiálise ambulatorial e, consequentemente, a possibilidade de redução no custo a partir da simulação de padronização no processo de estabelecimento do fluxo do dialisato nos períodos entre turnos em sessões de hemodiálise ambulatorial. Métodos: Partindo de um estudo observacional analítico, foi realizada uma simulação de 20 cenários, sendo 10 estabelecidos pela padronização dos processos de controle no fluxo do dialisato nos intervalos das sessões. A combinação dos dados foi realizada tomando por base os preços de três fornecedores de soluções alcalinas líquidas ou em pó. Resultados: Observou-se, dentre os cenários com processos padronizados, uma variação entre 7,7% e 33,3% de economia no custo da solução alcalina (em pó ou líquida), pela redução do desperdício. Conclusão: É possível refrear o desperdício no uso de soluções alcalinas, tanto em pó quanto líquidas e, consequentemente, seus custos, a partir da padronização na redução do fluxo de dialisato durante os intervalos verificados entre os turnos na hemodiálise ambulatorial. Todavia, estes resultados estão condicionados ao comprometimento de profissionais de saúde, principalmente no que tange ao exercício da supervisão e controle das atividades ...

Introduction: There are few studies about costs of inputs used in hemodialysis and among these expenditures, the compounds that make up the dialysate are one of the values considered as representative of this therapy. However, there aren’t costs studies that guiding solutions. Objective: The objective of this article is discuss whether there is wasteful of alkaline solutions in ambulatory hemodialysis and hence the possibility of reduction in cost from the standardization process simulation of establishment of dialysate flow in periods between shifts in hemodialysis outpatients. Methods: Starting from an observational analytic, a simulation was performed twenty case scenarios, which ten cases established by standardizing processes control on the dialysate flow in recession. The combination of data was performed using as a basis the prices of three suppliers of alkali liquid or powder. Results: It was observed among the scenarios with standardized processes, ranging between 7.7% and 33.3% savings in the alkaline solution cost (powder or liquid), by reducing waste. Conclusion: It is possible to restrain the wasteful use of alkaline solutions, both powder and liquid. Consequently, its cost from the patterning on reducing the flow of dialysate during the intervals between shifts observed in the outpatient hemodialysis. However, these results are conditional upon the commitment of health professionals, mainly to supervision exercise and control of activities in quality function deployment. .

Búsqueda intencionada y reclasificación de muertes maternas en México: el efecto en la distribución de las causas / Intentional search and reclassification of maternal deaths in Mexico: The effect on the distribution of causes

Objetivo. Corregir la mala clasificación y mejorar la calidad de la información sobre la mortalidad materna en México. Material y métodos. A través de los registros clínicos y autopsias verbales, se estudiaron todas las defunciones certificadas como maternas y una selección de defunciones de mujeres en edad fértil, cuyas causas fueron consideradas como sospechosas de encubrir una muerte materna; todas ocurridas durante 2011 en México. Resultados. La búsqueda intencionada y reclasificación de muertes maternas permitió rescatar más de 100 muertes que no habían sido registradas ni codificadas inicialmente como maternas y se ratificaron o rectificaron las causas anotadas en los certificados de defunción. Este procedimiento también permitió reclasificar como muertes maternas 297 defunciones de la base preliminar del Instituto Nacional de Estadística y Geografía. Conclusiones. La Búsqueda Intencionada y Reclasificación de Muertes Maternas es un procedimiento muy útil para mejorar la calidad de la información sobre la mortalidad materna.

Objective. To correct the misclassification and improve the quality of information on maternal mortality in Mexico. Materials and methods. Using clinical records and verbal autopsies, we studied all deaths certified as maternal deaths as well as a selection of deaths of women of childbearing age whose causes were considered as suspected of hiding a maternal death, all of which occurred during 2011 within Mexico. Results. The deliberate search of maternal deaths and reclassification allowed the rescue of just over 100 deaths that were not originally registered or coded as maternal and confirmed or corrected the causes of death recorded on death certificates as confirmed maternal deaths. This procedure also allowed the reclassification of 297 maternal deaths of women in the groundwork of the National Institute of Statistics and Geography. Conclusions. International Search and Reclassification of Maternal Deaths is a very useful procedure for improving the classification of cases that were not classified as maternal deaths and the effect was greater with the coding of indirect obstetric deaths.

Biosynthesis of gold nanoparticles by actinomycete Streptomyces viridogens strain HM10.

Biosynthesis of gold nanoparticles by Streptomycetes from Himalayan Mountain was undertaken for the first time. Out of 10 actinomycete strains tested, four strains (D10, HM10, ANS2 and MSU) showed evidence for the intracellular biosynthesis of gold nanoparticles, among which the strain HM10 showed high potency. Presence of spherical and rod shaped gold nanoparticles in mycelium of the strain HM10 was determined by transmission electron microscopy (TEM) and X-ray diffraction analysis. The average particle size ranged from 18-20 nm. UV spectral analysis indicated that the reduction of chloroauric acid (HAuCl4) occurred within 24 h of reaction period. Further, the strain HM10 showed enhanced growth at 1 and 10 mM concentration of HAuCl4. The gold nanoparticles synthesized by the strain HM10 showed good antibacterial activity against S. aureus and E. coli in well-diffusion method. The potential actinomycete HM10 strain was phenotypically characterized and identified as Streptomyces viridogens (HM10). Thus, actinomycete strain HM10 reported in this study is a newly added source for the biosynthesis of gold nanoparticles.

Suppression of CFTR-mediated Cl- Secretion of Airway Epithelium in Vitamin C-deficient Mice

Hyperoxic ventilation induces detrimental effects on the respiratory system, and ambient oxygen may be harmful unless compensated by physiological anti-oxidants, such as vitamin C. Here we investigate the changes in electrolyte transport of airway epithelium in mice exposed to normobaric hyperoxia and in gulonolacton oxidase knock-out (gulo[-/-]) mice without vitamin C (Vit-C) supplementation. Short-circuit current (Isc) of tracheal epithelium was measured using Ussing chamber technique. After confirming amiloride-sensitive Na+ absorption (DeltaIsc,amil), cAMP-dependent Cl- secretion (DeltaIsc,forsk) was induced by forskolin. To evaluate Ca2+-dependent Cl- secretion, ATP was applied to the luminal side (DeltaIsc,ATP). In mice exposed to 98% PO2 for 36 hr, DeltaIsc,forsk decreased, DeltaIsc,amil and DeltaIsc,ATP was not affected. In gulo(-/-) mice, both DeltaIsc,forsk and DeltaIsc,ATP decreased from three weeks after Vit-C deprivation, while both were unchanged with Vit-C supplementation. At the fourth week, tissue resistance and all electrolyte transport activities were decreased. An immunofluorescence study showed that the expression of cystic fibrosis conductance regulator (CFTR) was decreased in gulo(-/-) mice, whereas the expression of KCNQ1 K+ channel was preserved. Taken together, the CFTR-mediated Cl- secretion of airway epithelium is susceptible to oxidative stress, which suggests that supplementation of the antioxidant might be beneficial for the maintenance of airway surface liquid.

Functional characteristics and molecular identification of swelling-activated chloride conductance in adult rabbit heart ventricles / 华中科技大学学报（医学）（英德文版）

Outwardly rectifying swelling-activated chloride conductance (ICl,Swell) in rabbit heart plays a critical role in cardioprotection following ischemic preconditioning (IP). But the functional characterization and molecular basis of this chloride conductance in rabbit heart ventricular myocytes is not clear. Candidate chloride channel clones (e.g. ClC-2, ClC-3, ClC-4 and ClC-5) were determined using RT-PCR and Western blot analysis. Whole cell ICl,Swell was recorded from isolated rabbit ventricular myocytes using patch clamp techniques during hypo-osmotic stress. The inhibitory effects of 4,4' isothiocyanato-2,2-disulfonic acid (DIDS), 5-nitro-2(3-phenylroylamino) benzoic acid (NPPB) and indanyloxyacetic acid 94 (IAA-94) on ICl,Swell were examined. The expected size of PCR products for ClC-2, ClC-3 and ClC-4 but not for ClC-5 was obtained. ClC-2 and ClC-3 expression was confirmed by automated fluorescent DNA sequencing. RT-PCR and Western blot showed that ClC-4 was expressed in abundance and ClC-2 was expressed at somewhat lower levels. The biological and pharmacological properties of I(Cl,Swell), including outward rectification, activation due to cell volume change, sensitivity to DIDS, IAA-94 and NPPB were identical to those known properties of ICl,Swell in exogenously expressed systems and other mammals hearts. It was concluded that ClC-3 or ClC-4 might be responsible for the outwardly rectifying part of ICl,Swell and may be the molecular targets of cardioprotection associated with ischemic preconditioning or hypo-osmotic shock.

Cell volume regulation in the perfused liver of a freshwater air-breathing cat fish Clarias batrachus under aniso-osmotic conditions: roles of inorganic ions and taurine.

The roles of various inorganic ions and taurine, an organic osmolyte, in cell volume regulation were investigated in the perfused liver of a freshwater air-breathing catfish Clarias batrachus under aniso-osmotic conditions. There was a transient increase and decrease of liver cell volume following hypotonic (-80 mOsmol/l) and hypertonic (+80 mOsmol/l) exposures,respectively, which gradually decreased/increased near to the control level due to release/uptake of water within a period of 25-30 min. Liver volume decrease was accompanied by enhanced efflux of K+ (9.45 +/- 0.54 micromol/g liver) due to activation of Ba(2+)- and quinidine-sensitive K(+) channel, and to a lesser extent due to enhanced efflux of Cl(-) (4.35+/- 0.25 micromol/g liver) and Na+ (3.68+/- 0.37 micromol/g liver). Conversely, upon hypertonic exposure, there was amiloride-and ouabain-sensitive uptake of K+ (9.78+/- 0.65 micromol/g liver), and also Cl(-) (3.72 +/- 0.25 micromol/g liver).The alkalization/acidification of the liver effluents under hypo-/hypertonicity was mainly due to movement of various ions during volume regulatory processes. Taurine,an important organic osmolyte, appears also to play a very important role in hepatocyte cell volume regulation in the walking catfish as evidenced by the fact that hypo- and hyper-osmolarity caused transient efflux (5.68 +/- 0.38 micromol/g liver) and uptake (6.38 +/- 0.45 micromol/g liver) of taurine, respectively. The taurine efflux was sensitive to 4,4' -di-isothiocyanatostilbene-2,2'-disulphonic acid (DIDS, an anion channel blocker), but the uptake was insensitive to DIDS, thus indicating that the release and uptake of taurine during volume regulatory processes are unidirectional. Although the liver of walking catfish possesses the RVD and RVI mechanisms, it is to be noted that liver cells remain partly swollen and shrunken during anisotonic exposures,thereby possibly causing various volume-sensitive metabolic changes in the liver as reported earlier.

Clorhidrorrea congénita / Congenital chloride diarrhea

Congenital chloride diarrhea (CCD) is a rare hereditary disease, with a prenatal onset, secondary to a deficit in the intestinal chloride transport. In the present study, we describe the clinical characteristics of three patients with congenital watery diarrhea, two of them females, aged between 9 and 14 months at the first visit. All patients presented perinatal antecedents of polyhydramnios and prematurity, watery stools since birth and growth failure. Metabolic alkalosis, hypokalemia and hypochloremia were found. Stool ionogram with elevated doses of chloride, exceeding both sodium and potassium, confirmed the diagnosis of CCD. Substitute treatment with sodium and potassium chloride was started with good results. CCD should be considered as a differential diagnosis to congenital watery diarrhea, since early diagnosis and appropriate treatment are mandatory for the normal development of the child, avoiding severe complications such as neurological sequelae and even death.

La clorhidrorrea congénita (CHC) es una enfermedad hereditaria rara, de comienzo prenatal secundaria aun defecto en el transporte intestinal de cloro. En este trabajo describimos las características clínicas de tres pacientes con diarrea acuosa congénita, dos desexo femenino, con edades comprendidas entre 9 y 14meses al momento de la consulta. Todos presentaban antecedentes perinatales de polihidramnios y prematurez,deposiciones líquidas desde el nacimiento y mal progreso ponderal. Se comprobó alcalosis metabólica,hipokalemia e hipocloremia. El ionograma en materia fecal, con dosajes de cloro elevado que superaban la sumade sodio y potasio, permitió confirmar el diagnóstico de CHC. Se instituyó tratamiento sustitutivo con cloruro de sodio y de potasio, con evolución favorable. Es de suma importancia tener en cuenta la CHC dentro de los diagnósticos diferenciales de diarrea acuosa congénita, ya que el diagnóstico precoz y el tratamiento adecuado permiten un desarrollo normal, evitandocomplicaciones graves, como secuelas neurológicas e incluso la muerte.

Increased oxygen consumption caused by cAMP- and Ca2+-mediated chloride secretion in rat distal colon

El transporte iónico epitelial exige aporte de ATP provisto por el metabolismo aeróbico. En el colon distal de rata, la secreción de cloruro explica la mayor parte del transporte electrogénico medido como corriente de cortocircuito (ISC). La inhibición de la secreción basal de cloruro reduce el consumo epitelial de oxígeno (QO2), mientras que la serotonina aumenta proporcionalmente ISC y QO2. El efecto de la serotonina es mediado por receptores 5HT4 acoplados a adenilato ciclasa medianteproteína G estimulante (GS). En este trabajo seestudió si el aumento del QO2 asociado con la secreción de cloruro es un efecto común a otros agentes que actúan sobre cAMP o Ca2+. Los efectos del inhibidor de la fosfodiesterasa, 3-isobutil-1-metilxantina (IBMX) y del agonista muscarínico carbacol (ambos a 0.1 mmol/L) se evaluaron en la mucosa aislada del colon distal de rata montado en una cámara de Ussing modificada para determinación continua de la concentración de oxígeno, permitiendo medir QO2. Se compararon la ISC y el QO2 basales con las resultantes del añadido de serotonina (control activo), IBMX, carbacol, o IBMX y carbacol. Todos aumentaron proporcionalmente ISC y QO2. Aunque el efecto de IBMX solo fue modesto y el del carbacol fue breve, se observó una sinergia cuando fueron agregados simultáneamente. El análisis de regresión lineal mostró una correlación significativa entre los incrementos de ISC y de QO2 (r2 = 0.746; P menor que 0.0001). Por tanto, la estimulación de la secreción de cloruro aumenta el QO2 independientemente de la vía efectora intracelular involucrada. Estos resultados corroboran el estrecho acoplamiento entre secreción de cloruro y QO2 en este epitelio.

Epithelial ion transport is dependent on ATP supply provided by aerobic metabolism. In the rat distal colon chloride secretion accounts for the largest portion of electrogenic transport measured as the short-circuit current (ISC). Inhibition of basal chloride secretion decreases epithelial oxygen consumption (QO2) in this tissue, while serotonin (5-hydroxytryptamine) proportionally increases both Isc and QO2. The effect of serotonin in this tissue is mainly mediated by 5HT4 receptors linked to adenylate cyclase through a stimulant G protein (GS). This work assessed whether the chloride secretion-induced increase in QO2 is a common characteristic of secretagogues, which act through either cAMP-dependent or Ca2+-dependent mechanisms. The effects of phosphodiesterase inhibitor 3-isobutyl-1- methylxantine (IBMX) and muscarinic agonist carbachol (both 0.1 mmol/L) were studied in rat distal colon isolated mucosa mounted in an Ussing chamber adapted for continuous measurement of oxygen concentration, allowing determination of QO2. Baseline ISC and QO2 were compared with ISC and QO2 after addition of either serotonin as an active control, IBMX, carbachol or IBMX plus carbachol. Each drug increased proportionally Isc and QO2. Although the effect of IBMX alone was modest and that of carbachol was short-lived, a synergic effect on Isc and QO2 was seen when both drugs were simultaneously added. Linear regression analysis showed a significant correlation between increases in ISC and QO2 (r2 = 0.746; P < 0.0001). Thus, stimulation of chloride secretion increases QO2 regardless of the intracellular pathway involved. These results extend previous findings, corroborating the close coupling between chloride secretion and QO2 in this epithelium

Scanning electron microscopic evaluation of effect of cortisol on chloride cells of tilapia, Oreochromis mossambicus.

The effect of exogenous administration of cortisol (0.2 microg/g body weight) for 24, 48 and 72 hr on the gill epithelium of Tilapia has been studied. The results clearly revealed that out of the three sub-types of chloride cells viz., shallow basin, wavy convex and deep hole, the shallow basin ones are the most abundant in number. In vivo administration of cortisol conspicuously increased the number of the shallow basin chloride cells and caused noticeable changes in the microridges of pavement cells right from 24 hr treatment onwards. The present study confirms heterogeneity of chloride cells in teleosts.

Renal abnormalities in congenital chloride diarrhea

Congenital chloride diarrhea CLD is a rare autosomal recessive disorder caused by a defect in the chloride/ bicarbonate exchange in the ileum and colon. It is characterized by watery diarrhea, abdominal distension, hypochloremic hypokalemic metabolic alkalosis with high fecal content of chloride >90 mmol/l. We report 3 patients with CLD associated with various renal abnormalities including chronic renal failure secondary to renal hypoplasia, nephrocalcinosis and congenital nephrotic syndrome

The cystic fibrosis transmembrane regulator (CFTR) in the kidney

The cystic fibrosis transmembrane regulator (CFTR) is a Cl- channel. Mutations of this transporter lead to a defect of chloride secretion by epithelial cells causing the Cystic Fibrosis disease (CF). In spite of the high expression of CFTR in the kidney, patients with CF do not show major renal dysfunction, but it is known that both the urinary excretion of drugs and the renal capacity to concentrate and dilute urine is deficient. CFTR mRNA is expressed in all nephron segments and its protein is involved with chloride secretion in the distal tubule, and the principal cells of the cortical (CCD) and medullary (IMCD) collecting ducts. Several studies have demonstrated that CFTR does not only transport Cl- but also secretes ATP and, thus, controls other conductances such as Na+ (ENaC) and K+ (ROMK2) channels, especially in CCD. In the polycystic kidney the secretion of chloride through CFTR contributes to the cyst enlargement. This review is focused on the role of CFTR in the kidney and the implications of extracellular volume regulators, such as hormones, on its function and expression.

Beta agonist regulation of sodium transport in fetal lung epithelium: roles of cell volume, cytosolic chloride and protein tyrosine kinase

1) A beta agonist stimulated Na+ transport and decreased the intracellular Cl concentration ([Cl]c) associated with cell shrinkage via an increase in cytosolic cAMP level by activating adenylate cyclase in rat fetal distal lung epithelial (FDLE) cells. 2) Lowering [Cl-]c activated a 28-pS nonselective cation (NSC) channel by elongating the open time of the channel. 3) cAMP signals were converted to a protein tyrosine kinase (PTK)-mediated signal. 4) The PTK-mediated signal was involved in the cAMP-stimulated Na+ transport in rat FDLE cells.

Regulation of Na+ absorption and Cl- secretion in the endometrium: switching mechanisms

No abstract available.

CFTR, a rectifying, non-rectifying anion channel?

No abstract available.

Stimulation of inflammatory mediators secretion by chemotactic peptides in rat colitis model

Colonic inflammation was produced in rats by chemotactic peptides acting on polymorphonuclear leucocytes. Instillation during one hour of formylated tripeptide: formylmethionyl-leucy-phenylalanine (FMLP) and a tetrapeptide: alanine-glycine-sefine-glutamine (AGSG) into rat colon caused erosions and exulcerations. Neutrophils increased secondary to instillation, predominantly with FMLP, and mucus depletion was marked in the cecum. Chloride ion secretion and mucosal permeability were significatively greater in the colonic lumen with the chemotactic peptides. Histamine and serotonin concentration were greater in the colonic fluid in animals treated with the peptides. These observations could suggest that the presence of chemotactic peptides at the colonic lumen produce changes at the mucosal wall, that would participate in generation and perpetuation of the colonic inflammation.

Complicaciones metabólicas encontradas en pacientes sometidos a derivación urinaria del tipo Indiana / Metabolic complications found in patients with Indiana-type urinary deviation

Se efectuó un estudio prospectivo, descriptivo, analítico y aleatorio de un total de 32 pacientes a quienes se les realizó derivación urinaria de tipo Indiana por diferentes trastornos patológicos, los más frecuentes cáncer vesical (37.5 por ciento) y mielomeningocele (21.8 por ciento), entre otras causas. En los 32 pacientes se determinaron las alteraciones metabólicas desde el punto de vista clínico y de laboratorio, así como por la presencia de litiasis e infección de vías urinarias. Entre los datos sobresalientes se encontraron hipocalcemia 42.5 por ciento), acidosis metabólica compensada (33.3 por ciento) y acidosis metabólica acompañada de hipercloremia en 20.8 por ciento de los casos. No se observó elevación de azoados en ningún paciente. Sólo en uno de ellos ocurrió litiasis en el reservorio urinario

Salmonella typhimurium enterotoxin mediated fluid secretion.

Unidirectional Na+ and Cl- fluxes were studied in rats treated with S. typhimurium enterotoxin (S-LT). There was net absorption of Na+ and Cl- in the control group, while in the toxin treated animals there was net secretion of Na+ and Cl- (P less than 0.001). There was no change in the transport of D-glucose in the toxin treated group as compared to the control animals. The Na+, K(+)-ATPase pump was unaltered in the S-LT treated animals (198.67 +/- 11.23 nmoles Pi/mg protein/min) as compared to the control group (189.93 +/- 10.09 nmoles Pi/mg protein/min). There was no change in the unidirectional fluxes of Ca+2 in the S-LT treated animals as compared to the control animals, suggesting no change in the permeability of the S-LT treated intestinal membrane to Ca+2.