Vulnerabilidades evidenciadas pela pandemia de covid-19 na perspectiva da bioética / Vulnerabilities highlighted by the COVID-19 pandemic from a bioethics perspective / Aumento de las vulnerabilidades en la pandemia del covid-19 desde la perspectiva de la bioética

Resumo Por meio de revisão integrativa da literatura, este artigo teve o objetivo de identificar vulnerabilidades da população brasileira evidenciadas durante a pandemia da covid-19. Realizou-se busca nas bases de dados SciELO, LILACS e PubMed no período de fevereiro a março de 2021, sendo selecionados sete artigos, que foram organizados conforme as informações a seguir: título, autor, abordagem dos estudos, objetivos e principais resultados. Foram encontradas as seguintes vulnerabilidades: negação de direitos, falta de poder socioeconômico e violência contra crianças e idosos. Estas foram sistematizadas nas categorias "vulnerabilidade por falta de poder" e "vulnerabilidade por momentos do desenvolvimento humano". Constatou-se que essas fragilidades são historicamente marcadas na população brasileira e têm sido acentuadas neste período de pandemia, o que ressalta a necessidade de intervenção ativa na perspectiva da bioética.

Abstract This integrative literature review sought to identify the vulnerabilities faced by the Brazil population and which were highlighted during the COVID-19 pandemic. Bibliographic search conducted on the SciELO, LILACS and PubMed databases from February to March 2021 identified seven articles, which were organized by title, author(s), methodology, objectives, and main findings. The analysis found the following vulnerabilities: denial of rights, lack of socioeconomic power, and violence against children and the aged. These were systemized into the categories "vulnerability by lack of power" and "vulnerability by human development cycle." Such vulnerabilities are historically marked in Brazil and have increased during the pandemic, thus highlighting the need for a bioethics-based active intervention.

Resumen Desde una revisión integradora de la literatura, este artículo tuvo como objetivo identificar el aumento de las vulnerabilidades de la población brasileña durante la pandemia del covid-19. Se realizó una búsqueda en las bases de datos SciELO, LILACS y PubMed, entre febrero y marzo de 2021, que dio como resultado siete artículos, que fueron organizados por: título, autor, enfoque del estudio, objetivos y principales resultados. Se encontraron las siguientes vulnerabilidades: Negación de derechos, falta de poder socioeconómico y violencia contra niños y adultos mayores. Estos datos se sistematizaron en las categorías de "vulnerabilidad por falta de poder" y "vulnerabilidad por momentos del desarrollo humano". Se constató que estas debilidades ya estaban históricamente marcadas en la población brasileña y se acentuaron aún más en este período de la pandemia, lo que muestra la necesidad de una intervención activa desde la perspectiva de la bioética.

Bilateral Sinonasal Inverted Papilloma: Report of an Uncommon Case Involving Sinuses of the Face and Orbital Cavity.

BACKGROUND Nasosinusal papilloma is a benign aggressive tumor. It usually occurs unilaterally in the nasal cavity and can extend to the sinuses. The diagnosis is made by the correlation of findings observed in tomographic and histopathological exams. The recommended treatment is surgical excision with clinical monitoring. Orbital involvement occurs in about 9% of cases of advanced SIP. However, there is no report of cases of a benign tumor that invaded the adjacent soft tissues. Therefore, our objective is to report an unusual case of SIP that bilaterally involved the nasal cavity and maxillary sinuses, and extended to involve the ethmoidal cells and sphenoid and frontal sinuses. CASE REPORT In this article, we report an unusual presentation of sinonasal inverted papilloma (SIP) in a 60-year-old man. The tumor bilaterally involved the nasal cavity and maxillary sinuses and extended to involve the ethmoidal cells and the sphenoid and frontal sinuses, as well as the orbital cavity on the right side. An open surgical procedure was performed for complete removal of the lesion and follow-up with imaging exams. CONCLUSIONS The involvement of these structures is uncommon in SIP. This highlights the importance of this case report. Diagnosis and surgical treatment must be carefully planned. In this work, we describe all the steps that helped guide the choice of the best surgical technique to be performed and offer the best clinical follow-up.

Role of hypoxia-related proteins in adenoid cystic carcinoma invasion.

BACKGROUND: Among cancers affecting the oral cavity, adenoid cystic carcinoma (ACC) is a relatively common malignant neoplasm. It has high rates of metastasis and recurrence and is associated with significant morbidity. During the progression of ACC, the oxygen concentration is reduced in specific areas of the tumour microenvironment, leading to intratumoural hypoxia. The expression of NOTCH1, a disintegrin and metalloproteinase 12 (ADAM-12), hypoxia-inducible factor 1 alpha (HIF-1α), and heparin-binding epidermal growth factor (HB-EGF) under hypoxic conditions has been implicated in invadopodia formation, tumour invasiveness, and metastasis. The aim of this study was to analyse the expression of these proteins to elucidate the mechanisms underlying ACC invasiveness. METHODS: Fifteen ACC samples and 10 normal-looking salivary gland (SG) samples were used to investigate the expression of these proteins by immunohistochemistry. Primary antibodies against NOTCH1, ADAM-12, HIF-1α, and HB-EGF were used. RESULTS: The immunoexpression of all proteins was higher in ACC samples than in SG samples (p < 0.05). CONCLUSIONS: There was increased expression of proteins associated with hypoxia and tumour invasiveness in ACC samples, which indicates a possible role of these proteins in the biological behaviour of this tumour.

HIF-1α, NOTCH1, ADAM12, and HB-EGF are overexpressed in mucoepidermoid carcinoma.

OBJECTIVE: Intratumoral hypoxia (IH) occurs during cellular proliferation of malignant tumors. This phenomenon is characterized by a decrease in oxygen levels in the neoplastic microenvironment. Throughout this condition, the proteins HIF-1α, NOTCH1, ADAM12, and HB-EGF can be activated, triggering signaling pathways associated with tumor invasiveness through invadopodia formation. This study aimed to evaluate the immunostaining of HIF-1α, NOTCH1, ADAM12, and HBEGF in 19 cases of mucoepidermoid carcinoma (MEC) and 10 samples of salivary glands (control group). STUDY DESIGN: The immunoperoxidase technique was employed to detect the proteins of interest. The Student t test was used to compare immunoexpression between MEC samples and the control group. RESULTS: Protein immunostaining was statistically significantly higher in MEC samples than in the control group (P < .01), and the proteins were especially overexpressed in epidermoid cells of MEC. CONCLUSIONS: We suggest that there is an association between the NOTCH1 signaling pathway activated by IH and the biologic behavior of MEC.

Odontologia e saúde mental: experiência do PET Saúde no Centro de Atenção Psicossocial Álcool e Drogas / Odontology and mental health: experience of PET Saúde in the Center for Psychosocial Care Alcohol and Drugs

A fim de discutir a importância de experiências multiprofissionais e o papel de inovação do PET - Saúde na formação acadêmica, este artigo relata a experiência do PET - Odontologia da UFPA junto à equipe multiprofissional de um CAPS AD localizado no município de Belém/PA, além de avaliar as condições de saúde bucal dos dependentes químicos. A experiência mostrou a integração entre os diferentes profissionais e motivou o desenvolvimento de habilidades dos discentes para o planejamento de ações integradas e criativas de promoção de saúde, através de metodologias ativas, apontando novos rumos de atenção à saúde, centrado na lógica da realidade da comunidade e não somente no ambiente clínico. As atividades realizadas pela equipe de Odontologia foram integradas às oficinas e grupos desenvolvidos na unidade, como oficinas culinárias e de confecção e o cuidado de hortas, que propiciaram momentos de educação em saúde bucal. Foram realizadas dinâmicas e rodas de conversas, sendo os usuários agentes ativos no processo de construção compartilhada de conhecimento. Ocorreu o "dia D no CAPS AD", no qual os usuários participaram de atividade de escovação supervisionada e foram examinados por equipe médica e odontológica, com coleta de informações clínicas. Considera-se que a interação entre ensino, serviço e comunidade potencializada pelo PET - Saúde conduz a formação em saúde a um novo perfil, em que os profissionais se tornam mais capazes de responder às necessidades dos usuários e atuar de maneira compartilhada nos diferentes cenários (AU).

In order to discuss the importance of multiprofessional experiences and the innovation role of the PET - Saúde in academic training, this article reports on the experience PET - Odontology of UFPA with the multi-professional team of a CAPS AD located in the city of Belém / PA, besides evaluating the oral health conditions of chemical dependents. The experience showed the integration among the different professionals and motivated the development ofthe students' abilities to the planning of integrated and creative actions of health promotion, through active methodologies, pointing out new directions of health care, centered on the logic of the community reality and not only in the clinical environment. The activities carried out by the Dentistry team were integrated with the workshops and groups developed at the unit, such as cooking and cooking workshops and garden care, which provided moments of education in oral health. Was made dynamics and wheels of conversations, and the users are active agents in the process of shared knowledge construction. "D-day at CAPS AD" occurred, in which users participated in supervised brushing activity and were examined by medical and dental staff, collecting clinical information. It is considered that the interaction between teaching, service and community enhanced by PET ­ Saúde leads health education to a new profile in which professionals become better able to respond to users' needs and act in a shared way in different scenarios (AU).

Saúde bucal da criança indígena: estudo em uma Reserva Indígena da Amazônia / Oral Health of indigenous children: study in an Amazon Indian Reserve

Objetivo: Identificar e descrever a condição de saúde bucal de crianças pertencentes à etnia Gavião, habitantes da Reserva Indígena Mãe Maria, Bom Jesus do Tocantins, no Estado do Pará, considerando-se aspectos antropológicos do processo saúde-doença desse povo.Métodos: Um estudo transversal foi conduzido com 93 crianças indígenas de 2 a 8 anos, de ambos os sexos e habitantes da Reserva. Exames clínicos foram realizados, analisando-se a prevalência de cárie dentária e qualidade da higiene bucal e a determinação dos índices CPO-D e Índice de Higiene Oral Simplificado (IHOS). Para a avaliação socioeconômica, de hábitos de higiene e alimentares foram aplicados questionários em forma de entrevistas aos responsáveis. Testes do Qui-quadrado e de Wilcoxon foram utilizados para analisar a associação entre variáveis, considerando-se valor de p ≤ 0,05. Resultados: O CPO-D médio foi de 5. Verificou-se que 10,7% dos examinados estavam livres de cárie. O percentual do componente "cariado" foi maior que os demais componentes do índice para ambos os sexos. O IHOS médio encontrado foi de 2,3, não diferindo quanto ao sexo. Encontrou-se associação entre as varáveis: CPO-D/ceo-d e experiência de dor (p = 0,02); CPO-D/ceo-d e o IHOS (p = 0,0001) e entre idade e IHOS (p = 0,0001). Evidenciou-se, portanto, alta prevalência de cárie e qualidade regular de higiene bucal entre os estudados. Conclusão: As crianças indígenas estudadas possuem índice acima da média nacional e regional, no que tange a doença cárie, quando comparado aos resultados nacionais aos 12 anos de idade. Os impactos trazidos pelo contato com a sociedade branca podem ter relação com a condição atual de saúde bucal desse povo.

Aim: To identify and describe the oral health status of Gavião children, an ethnic group inhabitant of the Mãe Maria, Bom Jesus do Tocantins Indigenous Reserve in the State of Pará. Anthropological features of the health-disease process of this people were considered.Methods: A cross-sectional study was conducted with 93 indigenous children, 2 to 8 years of age, from both sexes, inhabitants of the Indian Reserve. Clinical exams were performed to assay the prevalence of dental caries and oral hygiene quality through that set forth in the Decayed, Missing and Filled Teeth Index (DMFT/dmft) and Simplified Oral Hygiene Index (SOHI). Questionnaires were applied to indigenous mothers to evaluate their socioeconomic conditions, as well as their hygiene and eating habits. Chi-square and Wilcoxon tests were used to analyze the association between variables, considering a p-value ≤ 0.05.Results: The average DMFT/dmft was 5. It was found that 10.7% of the children were free of caries. The percentage of "caries" component was higher than the other components of the index for both sexes. The average SOHI found was 2.3, with no difference in sex. An association was found between the variables: DMFT/dmft and pain experience (p = 0,02); DMFT/dmft and the SOHI (p = 0.0001), and between age and SOHI (p = 0.0001). Therefore, this study observed a high prevalence of caries and the regular quality of oral hygiene among the participants. Conclusion: The indigenous children who participated in this study showed a higher index than national and regional averages for caries, when compared to the national results of 12-year-old children. The impacts brought about by contact with a white society may be related to the current oral health condition of these people.