Efficacy, Safety, and Acceptability of Misoprostol in the Treatment of Incomplete Miscarriage: A Systematic Review and Meta-analysis / Eficácia, segurança e aceitabilidade do misoprostol no tratamento do aborto incompleto: Uma revisão sistemática e metanálise

Abstract Objective To assess the efficacy, safety, and acceptability of misoprostol in the treatment of incomplete miscarriage. Data sources The PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Clinical Trials databases (clinicaltrials.gov) were searched for the relevant articles, and search strategies were developed using a combination of thematic Medical Subject Headings terms and text words. The last search was conducted on July 4, 2022. No language restrictions were applied. Selection of studies Randomized clinical trials with patients of gestational age up to 6/7 weeks with a diagnosis of incomplete abortion and who were managed with at least 1 of the 3 types of treatment studied were included. A total of 8,087 studies were screened. Data collection Data were synthesized using the statistical package Review Manager V.5.1 (The Cochrane Collaboration, Oxford, United Kingdom). For dichotomous outcomes, the odds ratio (OR) and 95% confidence interval (CI) were derived for each study. Heterogeneity between the trial results was evaluated using the standard test, I2 statistic. Data synthesis When comparing misoprostol with medical vacuum aspiration (MVA), the rate of complete abortion was higher in the MVA group (OR = 0.16; 95%CI = 0.07-0.36). Hemorrhage or heavy bleeding was more common in the misoprostol group (OR = 3.00; 95%CI = 1.96-4.59), but pain after treatment was more common in patients treated with MVA (OR = 0.65; 95%CI = 0.52-0.80). No statistically significant differences were observed in the general acceptability of the treatments. Conclusion Misoprostol has been determined as a safe option with good acceptance by patients.

Resumo Objetivo Avaliar a eficácia, segurança e aceitabilidade do misoprostol no tratamento do aborto incompleto. Fontes de dados Os bancos de dados PubMed, Scopus, Embase, Web of Science, Cochrane Library e bancos de dados de Ensaios Clínicos (clinicaltrials.gov) foram pesquisados para os artigos relevantes, e estratégias de busca foram desenvolvidas usando uma combinação de termos temáticos de Medical Subject Headings e palavras de texto. A última pesquisa foi realizada em 4 de julho de 2022. Nenhuma restrição de idioma foi aplicada. Seleção dos estudos Foram incluídos ensaios clínicos randomizados com pacientes com idade gestacional até 6/7 semanas com diagnóstico de aborto incompleto e que foram manejadas com pelo menos um dos três tipos de tratamento estudados. Um total de 8.087 estudos foram selecionados. Coleta de dados Os dados foram sintetizados usando o pacote estatístico Review Manager V.5.1 (The Cochrane Collaboration, Oxford, United Kingdom). Para resultados dicotômicos, o odds ratio (OR, na sigla em inglês) e o intervalo de confiança (IC) de 95% foram derivados para cada estudo. A heterogeneidade entre os resultados do ensaio foi avaliada usando o teste padrão, estatística I2. Síntese dos dados Ao comparar misoprostol com aspiração a vácuo médico (MVA, na sigla em inglês), a taxa de aborto completo foi maior no grupo MVA (OR = 0,16; IC95% = 0,07-0,36). Hemorragia ou sangramento intenso foi mais comum no grupo do misoprostol (OR = 3,00; 95%CI = 1,96-4,59), mas a dor após o tratamento foi mais comum em pacientes tratados com MVA (OR = 0,65; 95%CI = 0,52-0,80). Não foram observadas diferenças estatisticamente significativas na aceitabilidade geral dos tratamentos. Conclusão O misoprostol tem se mostrado uma opção segura e com boa aceitação pelos pacientes.

Efficacy, Safety, and Acceptability of Misoprostol in the Treatment of Incomplete Miscarriage: A Systematic Review and Meta-analysis.

OBJECTIVE: To assess the efficacy, safety, and acceptability of misoprostol in the treatment of incomplete miscarriage. DATA SOURCES: The PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Clinical Trials databases (clinicaltrials.gov) were searched for the relevant articles, and search strategies were developed using a combination of thematic Medical Subject Headings terms and text words. The last search was conducted on July 4, 2022. No language restrictions were applied. SELECTION OF STUDIES: Randomized clinical trials with patients of gestational age up to 6/7 weeks with a diagnosis of incomplete abortion and who were managed with at least 1 of the 3 types of treatment studied were included. A total of 8,087 studies were screened. DATA COLLECTION: Data were synthesized using the statistical package Review Manager V.5.1 (The Cochrane Collaboration, Oxford, United Kingdom). For dichotomous outcomes, the odds ratio (OR) and 95% confidence interval (CI) were derived for each study. Heterogeneity between the trial results was evaluated using the standard test, I2 statistic. DATA SYNTHESIS: When comparing misoprostol with medical vacuum aspiration (MVA), the rate of complete abortion was higher in the MVA group (OR = 0.16; 95%CI = 0.07-0.36). Hemorrhage or heavy bleeding was more common in the misoprostol group (OR = 3.00; 95%CI = 1.96-4.59), but pain after treatment was more common in patients treated with MVA (OR = 0.65; 95%CI = 0.52-0.80). No statistically significant differences were observed in the general acceptability of the treatments. CONCLUSION: Misoprostol has been determined as a safe option with good acceptance by patients.

OBJETIVO: Avaliar a eficácia, segurança e aceitabilidade do misoprostol no tratamento do aborto incompleto. FONTES DE DADOS: Os bancos de dados PubMed, Scopus, Embase, Web of Science, Cochrane Library e bancos de dados de Ensaios Clínicos (clinicaltrials.gov) foram pesquisados para os artigos relevantes, e estratégias de busca foram desenvolvidas usando uma combinação de termos temáticos de Medical Subject Headings e palavras de texto. A última pesquisa foi realizada em 4 de julho de 2022. Nenhuma restrição de idioma foi aplicada. SELEçãO DOS ESTUDOS: Foram incluídos ensaios clínicos randomizados com pacientes com idade gestacional até 6/7 semanas com diagnóstico de aborto incompleto e que foram manejadas com pelo menos um dos três tipos de tratamento estudados. Um total de 8.087 estudos foram selecionados. COLETA DE DADOS: Os dados foram sintetizados usando o pacote estatístico Review Manager V.5.1 (The Cochrane Collaboration, Oxford, United Kingdom). Para resultados dicotômicos, o odds ratio (OR, na sigla em inglês) e o intervalo de confiança (IC) de 95% foram derivados para cada estudo. A heterogeneidade entre os resultados do ensaio foi avaliada usando o teste padrão, estatística I2. SíNTESE DOS DADOS: Ao comparar misoprostol com aspiração a vácuo médico (MVA, na sigla em inglês), a taxa de aborto completo foi maior no grupo MVA (OR = 0,16; IC95% = 0,07­0,36). Hemorragia ou sangramento intenso foi mais comum no grupo do misoprostol (OR = 3,00; 95%CI = 1,96­4,59), mas a dor após o tratamento foi mais comum em pacientes tratados com MVA (OR = 0,65; 95%CI = 0,52­0,80). Não foram observadas diferenças estatisticamente significativas na aceitabilidade geral dos tratamentos. CONCLUSãO: O misoprostol tem se mostrado uma opção segura e com boa aceitação pelos pacientes.

Maternal-fetal outcomes of women with hypertensive disorders of pregnancy.

OBJECTIVE: The objective of this study was to determine adverse maternal and perinatal outcomes in pregnant women with hypertensive disorders of pregnancy. METHODS: An analytical cross-sectional study was conducted on women admitted with hypertensive disorders of pregnancies to a university maternity hospital from August 2020 to August 2022. Data were collected using a pretested structured questionnaire. Variables associated with adverse maternal and perinatal outcomes were compared using multivariable binomial regression. RESULTS: Of 501 women with pregnancies, 2, 35, 14, and 49% had eclampsia, preeclampsia, chronic hypertension, and gestational hypertension, respectively. Women with preeclampsia/eclampsia had significantly higher risks of cesarean section (79.4 vs. 65%; adjusted RR, 2,139; 95%CI, 1,386-3,302; p=0.001) and preterm delivery at <34 weeks' gestation (20.5 vs. 6%; adjusted RR, 2.5; 95%CI, 1.19-5.25; p=0.01) than those of women with chronic/gestational hypertension. Risks of prolonged maternal hospitalization (43.9 vs. 27.1%), neonatal intensive care unit admission (30.7 vs. 19.8%), and perinatal mortality (23.5 vs. 11.2%) were higher among women with preeclampsia/eclampsia. CONCLUSIONS: Women with preeclampsia/eclampsia had a higher risk of adverse maternal and neonatal outcomes than those with chronic or gestational hypertension. This major maternity care center requires strategies for preventing and managing preeclampsia/eclampsia to improve pregnancy outcomes.

Maternal-fetal outcomes of women with hypertensive disorders of pregnancy

SUMMARY OBJECTIVE: The objective of this study was to determine adverse maternal and perinatal outcomes in pregnant women with hypertensive disorders of pregnancy. METHODS: An analytical cross-sectional study was conducted on women admitted with hypertensive disorders of pregnancies to a university maternity hospital from August 2020 to August 2022. Data were collected using a pretested structured questionnaire. Variables associated with adverse maternal and perinatal outcomes were compared using multivariable binomial regression. RESULTS: Of 501 women with pregnancies, 2, 35, 14, and 49% had eclampsia, preeclampsia, chronic hypertension, and gestational hypertension, respectively. Women with preeclampsia/eclampsia had significantly higher risks of cesarean section (79.4 vs. 65%; adjusted RR, 2,139; 95%CI, 1,386-3,302; p=0.001) and preterm delivery at <34 weeks' gestation (20.5 vs. 6%; adjusted RR, 2.5; 95%CI, 1.19-5.25; p=0.01) than those of women with chronic/gestational hypertension. Risks of prolonged maternal hospitalization (43.9 vs. 27.1%), neonatal intensive care unit admission (30.7 vs. 19.8%), and perinatal mortality (23.5 vs. 11.2%) were higher among women with preeclampsia/eclampsia. CONCLUSIONS: Women with preeclampsia/eclampsia had a higher risk of adverse maternal and neonatal outcomes than those with chronic or gestational hypertension. This major maternity care center requires strategies for preventing and managing preeclampsia/eclampsia to improve pregnancy outcomes.

Impact of experimental obesity on diaphragm structure, function, and bioenergetics.

Obesity is associated with bioenergetic dysfunction of peripheral muscles; however, little is known regarding the impact of obesity on the diaphragm. We hypothesized that obesity would be associated with diaphragm dysfunction attributable to mitochondrial oxygen consumption and structural and ultrastructural changes. Wistar rat litters were culled to 3 pups to induce early postnatal overfeeding and consequent obesity. Control animals were obtained from unculled litters. From postnatal day 150, diaphragm ultrasound, computed tomography, high-resolution respirometry, immunohistochemical, biomolecular, and ultrastructural histological analyses were performed. The diaphragms of obese animals, compared with those of controls, presented changes in morphology as increased thickening fraction, diaphragm excursion, and diaphragm dome height, as well as increased mitochondrial respiratory capacity coupled to ATP synthesis and maximal respiratory capacity. Fatty acid synthase gene expression was also higher in obese animals, suggesting a source of energy for the respiratory chain. Myosin heavy chain-IIA was increased, indicating shift from glycolytic toward oxidative muscle fiber profile. Diaphragm tissue also exhibited ultrastructural changes, such as compact, round, and swollen mitochondria with fainter cristae and more lysosomal bodies. Dynamin-1 expression in the diaphragm was reduced in obese rats, suggesting decreased mitochondrial fission. Furthermore, gene expressions of peroxisome γ proliferator-activated receptor coactivator-1α and superoxide dismutase-2 were lower in obese animals than in controls, which may indicate a predisposition to oxidative injury. In conclusion, in the obesity model used herein, muscle fiber phenotype was altered in a manner likely associated with increased mitochondrial respiratory capability, suggesting respiratory adaptation to increased metabolic demand.NEW & NOTEWORTHY Obesity has been associated with peripheral muscle dysfunction; however, little is known about its impact on the diaphragm. In the current study, we found high oxygen consumption in diaphragm tissue and changes in muscle fiber phenotypes toward a more oxidative profile in experimental obesity.

Satisfação profissional e ambiente de trabalho da equipe de enfermagem em unidades de terapia intensiva / Professional satisfaction and work environment of the nursing team in intensive care units / Satisfacción profesional y ambiente laboral del equipo de enfermería en unidades de terapia intensiva

OBJETIVO: verificar a associação do ambiente de trabalho e da satisfação profissional de trabalhadores de Enfermagem pelo tipo de unidade de terapia intensiva, adulto e infantil. MÉTODO: estudo transversal e analítico. Foi realizado com profissionais de Enfermagem (n=226) de unidades de terapia intensiva de três hospitais (H1, H2 e H3) gerais do Paraná, Brasil. Para mensuração da satisfação profissional, utilizou-se a versão brasileira validada do Index of Work Satisfaction e, para extrair a percepção da equipe de Enfermagem sobre o ambiente de trabalho, utilizou-se a versão brasileira validada do Nursing Work Index-Revised. Após os dados tabulados procedeu-se à análise estatística descritiva e inferencial. RESULTADOS: de forma geral, as equipes de todos os hospitais e unidades referiam boa satisfação e percepção sobre ambiente de trabalho. As diferenças estatisticamente significativas a respeito da satisfação profissional foram as seguintes: domínio remuneração pior na UTI infantil em H2 (p-valor=0,035); e domínio interação e interação enfermeiro-médico com médias superiores (piores) na UTI adulto em H3 (p-valor=0,036 e 0,011, respectivamente). Acerca do ambiente de trabalho, houve média superior (pior ambiente) na UTI adulto em H3 para o domínio relação médico-enfermeiro (p-valor=0,023). Não houve significância estatística na comparação dos escores sobre o ambiente de trabalho para as demais instituições. CONCLUSÃO: as equipes estavam satisfeitas com o trabalho e avaliaram positivamente o seu ambiente de prática. Contudo, algumas diferenças pontuais entre as UTIs adulto e infantil podem ser consideradas para estratégias gerenciais mais assertivas, principalmente sobre aspectos relacionais na UTI adulto do hospital público.(AU)

Objectives: to verify the association between the work environment and the professional satisfaction of Nursing workers by type of intensive care unit: adult and child. Method: a cross-sectional and analytical study. It was performed with Nursing professionals (n=226) from intensive care units of three general hospitals (H1, H2 and H3) in Paraná, Brazil. To measure job satisfaction, the validated Brazilian version of the Index of Work Satisfaction was used, and to extract the Nursing team's perception of the work environment, the validated Brazilian version of the Nursing Work Index-Revised was chosen. After the tabulated data, a descriptive and inferential statistical analysis was performed. Results: overall, the teams from all hospitals and units reported a good satisfaction and perception about their work environments. The statistically significant differences regarding job satisfaction were as follows: worse remuneration domain in the child ICU in H2 (p-value=0.035); and interaction and nurse-physician interaction domain with higher (worse) mean values in the adult ICU in H3 (p-values=0.036 and 0.011, respectively). Regarding the work environment, there was a higher mean (worse environment) in the adult ICU in H3 for the physician-nurse relationship domain (p-value=0.023). There was no statistical significance in the comparison of the work environment scores for the other institutions. Conclusion: the teams were satisfied with their work and positively...(AU)

Objetivo: verificar la asociación del entorno laboral y de la satisfacción profesional de los trabajadores de enfermería por tipo de unidad de cuidados intensivos, adulto e infantil. Método: estudio transversal y analítico llevado a cabo con profesionales de enfermería (n = 226) de unidades de cuidados intensivos de tres hospitales generales (H1, H2 y H3) de Paraná, Brasil. Para medir la satisfacción laboral se utilizó la versión brasileña validada del Índice de Satisfacción Laboral, y para extraer la percepción del equipo de enfermería del entorno laboral se utilizó la versión brasileña validada del Índice de Trabajo de EnfermeríaRevisado. Después de la tabulación de datos, se realizó un análisis estadístico descriptivo e inferencial. Resultados: en general, los equipos de todos los hospitales y unidades informaron buena satisfacción y percepción sobre el entorno laboral. Las diferencias estadísticamente significativas con respecto a la satisfacción laboral fueron las siguientes: dominio salario peor en la UCI infantil en H2 (valor p = 0,035); dominio interacción entre el enfermero y el médico promedios más altos (peores) en la UCI de adultos en H3 (valor p = 0,036 y 0,011, respectivamente). Con respecto al ambiente de trabajo, hubo un promedio más alto (peor ambiente) en la UCI de adultos en H3 para el dominio de relación médico-enfermero (valor p = 0,023). No hubo significación estadística en la comparación de las puntuaciones del entorno laboral para las otras instituciones. Conclusión: los equipos quedaron satisfechos con el trabajo y evaluaron positivamente su entorno de práctica. Sin embargo, se pueden considerar algunas diferencias puntuales entre las UCI de adultos y niños para estrategias de manejo más asertivas, especialmente con respecto a los aspectos relacionales en la UCI de adultos del hospital público.(AU)

Fatores que influenciam a segurança do paciente em serviços de urgência e emergência: revisão integrativa / Factores que influyen en la seguridad del paciente en los servicios de urgencia y emergencia: revisión integradora / Factors that influence patient safety in urgency and emergency services: integrative review

Objetivo identificar evidências disponíveis na literatura científica acerca de fatores que interferem na segurança do paciente em serviços de urgência e emergência. Método revisão integrativa da literatura realizada conforme as etapas: identificação do tema e questão norteadora; estabelecimento de critérios de inclusão e exclusão para os estudos; busca na literatura de estudos primários; avaliação da amostra de estudos incluídos na revisão, com extração de dados; interpretação dos resultados e apresentação. Resultados foram selecionadas 1.449 publicações que, após aplicação dos critérios de inclusão e leitura detalhada, compuseram um conjunto de oito publicações. Nos textos foram identificados diferentes aspectos que influenciam a segurança do paciente nos serviços de urgência e emergência, os quais foram categorizados de acordo com a técnica análise de conteúdo: fatores organizacionais; falhas na comunicação da equipe e fragilidades no processo de medicação. Conclusão múltiplos fatores interferem na segurança do paciente no ambiente emergencial, destacando-se o moderado número de pacientes e a sobrecarga de trabalho.

Objetivo identificar la evidencia disponible en la literatura científica acerca de los factores que interfieren en la seguridad del paciente en los servicios de urgencia y emergencia. Método revisión integradora de la literatura realizada de acuerdo con los siguientes pasos: identificación del tema y de la pregunta orientadora; establecimiento de los criterios de inclusión y exclusión para el estudio; búsqueda en la literatura de los estudios primarios; evaluación de la muestra de los estudios incluidos en la revisión, con extracción de datos; interpretación de los resultados y presentación. Resultados se seleccionaron 1.449 publicaciones que, después de aplicar los criterios de inclusión y lectura detallada, compusieron un conjunto de ocho publicaciones. En los textos, fueron identificados diferentes aspectos que influyen en la seguridad del paciente en los servicios de urgencia y emergencia, que fueron clasificados de acuerdo con la técnica de análisis de contenido: factores organizativos; comunicación falla del equipo y debilidades en el proceso de medicación. Conclusión múltiples factores interfieren en la seguridad de los pacientes en situación de urgencia, destacando el número moderado de pacientes y la sobrecarga de trabajo.

Objective to identify the available evidence in the scientific literature about factors that interfere in patient safety in urgency and emergency services. Method integrative literature review performed according to the following steps: identification of the theme and guiding question; establishment of inclusion and exclusion criteria for the study; search in the literature for primary studies; evaluation of the sample of studies included in the review, with data extraction; interpretation of results and presentation. Results 1,449 publications were selected, which, after applying the inclusion criteria and detailed reading, comprised a set of eight publications. The texts revealed different aspects that influence patient safety in urgency and emergency services, categorized according to the content analysis technique: organizational factors; team communication failures and weaknesses in the medication process. Conclusion multiple factors interfere in patient safety in the emergency environment, highlighting the moderate number of patients and work overload.

Genomic survey and expression analysis of DNA repair genes in the genus Leptospira.

Leptospirosis is an emerging zoonosis with important economic and public health consequences and is caused by pathogenic leptospires. The genus Leptospira belongs to the order Spirochaetales and comprises saprophytic (L. biflexa), pathogenic (L. interrogans) and host-dependent (L. borgpetersenii) members. Here, we present an in silico search for DNA repair pathways in Leptospira spp. The relevance of such DNA repair pathways was assessed through the identification of mRNA levels of some genes during infection in animal model and after exposition to spleen cells. The search was performed by comparison of available Leptospira spp. genomes in public databases with known DNA repair-related genes. Leptospires exhibit some distinct and unexpected characteristics, for instance the existence of a redundant mechanism for repairing a chemically diverse spectrum of alkylated nucleobases, a new mutS-like gene and a new shorter version of uvrD. Leptospira spp. shares some characteristics from Gram-positive, as the presence of PcrA, two RecQ paralogs and two SSB proteins; the latter is considered a feature shared by naturally competent bacteria. We did not find a significant reduction in the number of DNA repair-related genes in both pathogenic and host-dependent species. Pathogenic leptospires were enriched for genes dedicated to base excision repair and non-homologous end joining. Their evolutionary history reveals a remarkable importance of lateral gene transfer events for the evolution of the genus. Up-regulation of specific DNA repair genes, including components of SOS regulon, during infection in animal model validates the critical role of DNA repair mechanisms for the complex interplay between host/pathogen.

Genes involved in thoracic exoskeleton formation during the pupal-to-adult molt in a social insect model, Apis mellifera.

BACKGROUND: The insect exoskeleton provides shape, waterproofing, and locomotion via attached somatic muscles. The exoskeleton is renewed during molting, a process regulated by ecdysteroid hormones. The holometabolous pupa transforms into an adult during the imaginal molt, when the epidermis synthe3sizes the definitive exoskeleton that then differentiates progressively. An important issue in insect development concerns how the exoskeletal regions are constructed to provide their morphological, physiological and mechanical functions. We used whole-genome oligonucleotide microarrays to screen for genes involved in exoskeletal formation in the honeybee thoracic dorsum. Our analysis included three sampling times during the pupal-to-adult molt, i.e., before, during and after the ecdysteroid-induced apolysis that triggers synthesis of the adult exoskeleton. RESULTS: Gene ontology annotation based on orthologous relationships with Drosophila melanogaster genes placed the honeybee differentially expressed genes (DEGs) into distinct categories of Biological Process and Molecular Function, depending on developmental time, revealing the functional elements required for adult exoskeleton formation. Of the 1,253 unique DEGs, 547 were upregulated in the thoracic dorsum after apolysis, suggesting induction by the ecdysteroid pulse. The upregulated gene set included 20 of the 47 cuticular protein (CP) genes that were previously identified in the honeybee genome, and three novel putative CP genes that do not belong to a known CP family. In situ hybridization showed that two of the novel genes were abundantly expressed in the epidermis during adult exoskeleton formation, strongly implicating them as genuine CP genes. Conserved sequence motifs identified the CP genes as members of the CPR, Tweedle, Apidermin, CPF, CPLCP1 and Analogous-to-Peritrophins families. Furthermore, 28 of the 36 muscle-related DEGs were upregulated during the de novo formation of striated fibers attached to the exoskeleton. A search for cis-regulatory motifs in the 5'-untranslated region of the DEGs revealed potential binding sites for known transcription factors. Construction of a regulatory network showed that various upregulated CP- and muscle-related genes (15 and 21 genes, respectively) share common elements, suggesting co-regulation during thoracic exoskeleton formation. CONCLUSIONS: These findings help reveal molecular aspects of rigid thoracic exoskeleton formation during the ecdysteroid-coordinated pupal-to-adult molt in the honeybee.

[The reality of the oral/dental health of the elderly in the Brazilian Southeast]. / A realidade da saúde bucal do idoso no Sudeste brasileiro.

The scope of this work was to describe the alterations revealed in oral/dental structures resulting from ageing and to verify, through the national scientific production, with emphasis on the Southeastern region, the prevaling oral/dental problems in the elderly. A review of the literature on the theme of ageing in the context of dentistry was conducted. The results pointed to the fact that the elderly population is the fastest growing population segment. The prevailing oral/dental problems in this age bracket are radicular caries and periodontal illness, which contribute to the vast majority of dental extractions. In the Southeastern region of Brazil, the use of prostheses is low when compared with the high rate of tooth loss and the percentage of partially toothed elderly people; the value of the CPOD index is high and the elderly have a positive perception on their teeth, despite the fact that oral/dental problems have a negative impact on their lives. It is concluded that the inclusion of a dental surgeon in the healthcare team of the institutions and the systematization of oral/dental hygiene are pressing needs, in addition to the need for ongoing work of guidance for the the oral/dental healthcare of the elderly. Broadening of the study in this area is also fundamental to ensure dental care and treatment of these individuals.

A realidade da saúde bucal do idoso no Sudeste brasileiro / The reality of the oral/dental health of the elderly in the Brazilian Southeast

Este trabalho teve como objetivos descrever as alterações manifestadas nas estruturas bucais decorrentes do envelhecimento e verificar, através da produção científica nacional, com ênfase na Região Sudeste, os problemas bucais prevalentes nos idosos. Foi realizada uma revisão de literatura abordando a temática envelhecimento no contexto da odontologia. Os resultados apontaram que a população idosa é o segmento populacional que mais cresce. Os problemas bucais prevalentes nessa faixa etária são as cáries radiculares e a doença periodontal, que contribuem para a grande maioria das extrações dentárias. Na Região Sudeste do Brasil, o uso de prótese é baixo quando comparado à alta taxa de edentulismo e ao percentual de idosos parcialmente dentados; o valor do índice CPOD é alto e os idosos apresentam uma percepção positiva sobre seus dentes, apesar de os problemas bucais terem impacto negativo nas suas vidas. Conclui-se que a incorporação do cirurgião-dentista na equipe de saúde das instituições e a sistematização das práticas de higiene bucal são necessidades reais, além da necessidade de um trabalho continuado de orientação para o cuidado da saúde bucal do idoso. É também fundamental a ampliação do estudo nessa área, visando qualificar a atenção e o tratamento odontológico para esses indivíduos.

The scope of this work was to describe the alterations revealed in oral/dental structures resulting from ageing and to verify, through the national scientific production, with emphasis on the Southeastern region, the prevaling oral/dental problems in the elderly. A review of the literature on the theme of ageing in the context of dentistry was conducted. The results pointed to the fact that the elderly population is the fastest growing population segment. The prevailing oral/dental problems in this age bracket are radicular caries and periodontal illness, which contribute to the vast majority of dental extractions. In the Southeastern region of Brazil, the use of prostheses is low when compared with the high rate of tooth loss and the percentage of partially toothed elderly people; the value of the CPOD index is high and the elderly have a positive perception on their teeth, despite the fact that oral/dental problems have a negative impact on their lives. It is concluded that the inclusion of a dental surgeon in the healthcare team of the institutions and the systematization of oral/dental hygiene are pressing needs, in addition to the need for ongoing work of guidance for the the oral/dental healthcare of the elderly. Broadening of the study in this area is also fundamental to ensure dental care and treatment of these individuals.

Conhecimento dos professores sobre o manejo da criança com diabetes mellitus / Knowledge of the teachers about the management of the diabetic children / El conocimiento de los profesores sobre el manejo de los niños diabéticos

Trata-se de um estudo seccional e descritivo que objetivou verificar o conhecimento dos professores sobre o diabetes mellitus e as dificuldades encontradas no manejo da criança com diabetes. Participaram 184 professores da educação infantil de escolas municipais do município de Uberaba-MG, entre os meses de abril e julho de 2009. Os dados foram coletados por meio de questionário e analisados por estatística descritiva. Os resultados evidenciaram que os professores investigados denotaram conhecimento sobre o que é diabetes (58,15 por cento); no entanto, demonstraram desconhecer as manifestações clínicas (27,72 por cento), as abordagens terapêuticas (33,70 por cento) e as principais condutas adotadas diante de situações adversas (42,40 por cento). Este estudo contribuiu para enfatizar a necessidade de capacitar os professores da educação infantil na temática diabetes mellitus, a fim de possibilitar a abordagem à criança com conhecimento e segurança.

This is a descriptive and sectional study that aimed to verify the teachers' knowledge about the diabetes mellitus and the difficulties found in the management of children with diabetes. Participated 184 teachers of infant education in municipal schools of the city of Uberaba, Minas Gerais, between the months of April to July 2009. Data were collected through questionnaire and analyzed using descriptive statistics. The results showed that investigates teachers had denoted knowledge about what is diabetes (58.15 percent), however, showed disregard the clinical manifestations (27.72 percent), therapeutic approaches (33.70 percent) and the main procedures to be adopted in adverse situations (42.40 percent). This study contributed to emphasize the need to train teachers of the infant education in thematic diabetes in the subject, to enable the approach to children with knowledge and safety.

Este estudio descriptivo de corte transversal tuvo como objetivo verificar el conocimiento sobre la diabetes mellitus y las dificultades encontradas por los profesores en el manejo de los niños diabéticos. El estudio se hizo con 184 profesores de educación preescolar en las escuelas municipales del municipio de Uberaba-MG, entre abril y julio de 2009. Los datos fueron recolectados a través de cuestionario y se analizaron mediante estadística descriptiva. Los resultados mostraron que los profesores entrevistados tienen conocimiento acerca de la diabetes (58,15 por ciento), sin embargo, mostraron desconocimiento sobre las manifestaciones clínicas (27,72 por ciento), los enfoques terapéuticos (33,70 por ciento) y los principales procedimientos que se adoptarán en situaciones adversas (42,40 por ciento). Este estudio contribuyó a resaltar la necesidad de capacitar a los maestros sobre el tema de la diabetes mellitus de la primera infancia, para permitir el acercamiento al niño con conocimiento y seguridad.

Glial fibrillary acidic protein in tumor types with cartilaginous differentiation.

Glial fibrillary acidic protein (GFAP) is a member of the intermediary filament protein family. It is an important component of astrocytes and a known diagnostic marker of glial differentiation. GFAP is expressed in other neural tumors and pleomorphic adenoma and, less frequently, in cartilage tumors, chordomas, and soft tissue myoepitheliomas. The aim of this study was to evaluate the role of GFAP and its reliability in nonglial tumors as an immunohistochemical marker. We evaluated GFAP gene and protein expression using Q-PCR and immunohistochemistry, respectively, in 81 and 387 cases of soft tissue, bone tumors, and salivary pleomorphic adenomas. Immunohistochemistry staining for GFAP was observed in all osteosarcomas (8 cases), all pleomorphic adenomas (7 cases), in 5 of 6 soft tissue myoepitheliomas, and in 21 of 76 chondrosarcomas. By Q-PCR, GFAP was highly expressed in pleomorphic adenomas and, to a lesser extent, chondrosarcomas, soft tissue myoepitheliomas, and chondroblastic osteosarcomas. The results that we obtained by immunohistochemistry and Q-PCR were well correlated. GFAP is a potential marker for tumors with cartilaginous differentiation, supported by evidence that GFAP is expressed in certain cases of myoepithelial tumors by immunohistochemistry, including soft tissue myoepitheliomas, which are related to cartilaginous differentiation. These findings contribute significantly to the diagnosis of soft tissue myoepitheliomas with cartilaginous differentiation and chondroblastic osteosarcoma in mesenchymal tumors.

Transcription profiling of signal transduction-related genes in sugarcane tissues.

A collection of 237,954 sugarcane ESTs was examined in search of signal transduction genes. Over 3500 components involved in several aspects of signal transduction, transcription, development, cell cycle, stress responses and pathogen interaction were compiled into the Sugarcane Signal Transduction (SUCAST) Catalogue. Sequence comparisons and protein domain analysis revealed 477 receptors, 510 protein kinases, 107 protein phosphatases, 75 small GTPases, 17 G-proteins, 114 calcium and inositol metabolism proteins, and over 600 transcription factors. The elements were distributed into 29 main categories subdivided into 409 sub-categories. Genes with no matches in the public databases and of unknown function were also catalogued. A cDNA microarray was constructed to profile individual variation of plants cultivated in the field and transcript abundance in six plant organs (flowers, roots, leaves, lateral buds, and 1st and 4th internodes). From 1280 distinct elements analyzed, 217 (17%) presented differential expression in two biological samples of at least one of the tissues tested. A total of 153 genes (12%) presented highly similar expression levels in all tissues. A virtual profile matrix was constructed and the expression profiles were validated by real-time PCR. The expression data presented can aid in assigning function for the sugarcane genes and be useful for promoter characterization of this and other economically important grasses.

The sugarcane signal transduction (SUCAST) catalogue: prospecting signal transduction in sugarcane

O sequenciamento de ESTs (etiquetas de seqüências transcritas) tem possibilitado a descoberta de muitos novos genes em uma ampla variedade de organismos. Um aumento do aproveitamento desta informaçäo pela comunidade científica tem sido possível graças ao desenvolvimento de base de dados contendo seqüências completamente anotadas. O trabalho aqui relatado teve como objetivo a identiflcaçäo de ESTs de cana de açúcar seqüenciadas através do projeto SUCEST (http://sucest.lad.ic.unicamp.br) que codificam para proteínas envolvidas em mecanismos de transduçäo de sinal. Nós também preparamos um catálogo dos componentes de transduçäo de sinal da cana de açúcar (SUCAST) englobando as principais categorias e vias conhecidas (http://sucest.lad.ic.unicamp.br/private/mining-reports/QG/QG-mining.htm). ESTs codificadoras de enzimas envolvidas nas rotas de biossíntese de hormônios (giberelinas, etileno, auxinas, ácido abscíssico, ácido jasmônico) foram encontradas e sua expressäo específica nos tecidos foi inferida a partir de seu enriquecimento nas diferentes bibliotecas. Quando possível, transmissores do sinal hormonal e da resposta a peptídeos produzidos pela planta foram associados a suas respectivas vias. Mais de 100 receptores foram encontrados na cana de açúcar, entre os quais uma grande família de receptores Ser/Thr quinase e também de fotoreceptores, receptores do tipo histidina quinase e seus respectivos reguladores da resposta. Proteínas G e GTPases pequenas foram também analisadas e comparadas com membros destas famílias já conhecidos em mamíferos e plantas. As vias principais que envolvem a participaçäo de proteínas quinases e fosfatases foram mapeadas, em especial as vias da quinase MAP quinase e do inositol que säo bem estudadas em plantas.