Neural network-based method to stratify people at risk for developing diabetic foot: A support system for health professionals.

BACKGROUND AND OBJECTIVE: Diabetes Mellitus (DM) is a chronic disease with a high worldwide prevalence. Diabetic foot is one of the DM complications and compromises health and quality of life, due to the risk of lower limb amputation. This work aimed to build a risk classification system for the evolution of diabetic foot, using Artificial Neural Networks (ANN). METHODS: This methodological study used two databases, one for system design (training and validation) containing 250 participants with DM and another for testing, containing 141 participants. Each subject answered a questionnaire with 54 questions about foot care and sociodemographic information. Participants from both databases were classified by specialists as high or low risk for diabetic foot. Supervised ANN (multi-layer Perceptron-MLP) models were exploited and a smartphone app was built. The app returns a personalized report indicating self-care for each user. The System Usability Scale (SUS) was used for the usability evaluation. RESULTS: MLP models were built and, based on the principle of parsimony, the simplest model was chosen to be implemented in the application. The model achieved accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 85%, 76%, 91%, 89%, and 79%, respectively, for the test data. The app presented good usability (93.33 points on a scale from 0 to 100). CONCLUSIONS: The study showed that the proposed model has satisfactory performance and is simple, considering that it requires only 10 variables. This simplicity facilitates its use by health professionals and patients with diabetes.

COVID-19 signalome: Potential therapeutic interventions.

The COVID-19 pandemic has triggered intensive research and development of drugs and vaccines against SARS-CoV-2 during the last two years. The major success was especially observed with development of vaccines based on viral vectors, nucleic acids and whole viral particles, which have received emergent authorization leading to global mass vaccinations. Although the vaccine programs have made a big impact on COVID-19 spread and severity, emerging novel variants have raised serious concerns about vaccine efficacy. Due to the urgent demand, drug development had originally to rely on repurposing of antiviral drugs developed against other infectious diseases. For both drug and vaccine development the focus has been mainly on SARS-CoV-2 surface proteins and host cell receptors involved in viral attachment and entry. In this review, we expand the spectrum of SARS-CoV-2 targets by investigating the COVID-19 signalome. In addition to the SARS-CoV-2 Spike protein, the envelope, membrane, and nucleoprotein targets have been subjected to research. Moreover, viral proteases have presented the possibility to develop different strategies for the inhibition of SARS-CoV-2 replication and spread. Several signaling pathways involving the renin-angiotensin system, angiotensin-converting enzymes, immune pathways, hypoxia, and calcium signaling have provided attractive alternative targets for more efficient drug development.

COVID-19 signalome: Pathways for SARS-CoV-2 infection and impact on COVID-19 associated comorbidity.

The COVID-19 pandemic has been the focus of research the past two years. The major breakthrough was made by discovering pathways related to SARS-CoV-2 infection through cellular interaction by angiotensin-converting enzyme (ACE2) and cytokine storm. The presence of ACE2 in lungs, intestines, cardiovascular tissues, brain, kidneys, liver, and eyes shows that SARS-CoV-2 may have targeted these organs to further activate intracellular signalling pathways that lead to cytokine release syndrome. It has also been reported that SARS-CoV-2 can hijack coatomer protein-I (COPI) for S protein retrograde trafficking to the endoplasmic reticulum-Golgi intermediate compartment (ERGIC), which, in turn, acts as the assembly site for viral progeny. In infected cells, the newly synthesized S protein in endoplasmic reticulum (ER) is transported first to the Golgi body, and then from the Golgi body to the ERGIC compartment resulting in the formation of specific a motif at the C-terminal end. This review summarizes major events of SARS-CoV-2 infection route, immune response following host-cell infection as an important factor for disease outcome, as well as comorbidity issues of various tissues and organs arising due to COVID-19. Investigations on alterations of host-cell machinery and viral interactions with multiple intracellular signaling pathways could represent a major factor in more effective disease management.

Myopericarditis associated with acute Zika virus infection: a case report.

BACKGROUND: Zika virus infection is commonly described as a mild and self-limiting illness. However, cardiac complications were associated with acute Zika virus infection. CASE PRESENTATION: A 46-year-old woman without previous comorbidities with a 1-day history of symptoms tested positive for ZIKV by real time reverse transcriptase polymerase chain reaction (rRT-PCR). She was admitted two days after with clinical worsening, cardiac enzymes elevated, and cardiac imaging findings, and the diagnosis of myopericarditis was made. The patient was treated and presented significant clinical improvement after one year. CONCLUSIONS: Cardiac complication following ZIKV infection appears to be infrequent. Here, we report a rare case of viral myopericarditis caused by ZIKV infection.

Cuidados maternos em ambiente penal: representação por meio de desenho-estória / Maternal care in a prison environment: representation by story drawing / Cuidados maternos en la cárcel: representación de la historia a través de dibujos

Objetivo: compreender os sentimentos maternos em relação ao cuidado com o filho dentro da unidade penal. Método: a pesquisa tem abordagem qualitativa. Participaram do estudo gestantes a partir do terceiro trimestre e mães que se encontravam com os filhos no berçário de uma unidade Penal em Aquiráz/Ceará, totalizando 17 participantes nos 9 encontros realizados. A coleta se deu entre junho e outubro de 2018. Foi usada a técnica de Desenho-Estória. A análise dos desenhos foi feita de forma individual com cada detenta e categorizada pelas pesquisadoras. O trabalho obteve aprovação do Comitê de Ética. Resultados: a atividade de Desenho-Estória possibilitou a compreensão do sentimento materno em relação aos cuidados com os filhos e, a partir disso, foi possível a definição de ações vistas como cuidado dentro da unidade. Conclusão: a partir da análise da vivência da maternidade na prisão, é possível a compreensão de sentimentos que perpassam o desenvolvimento do papel materno.

Objective: to understand mothers' feelings about caring for their children in prison. Method: the participants in this qualitative study were women in the seventh to ninth months of pregnancy, and mothers with children in the nursery, at a Prison Unit in Aquiráz, Ceará, totaling 17 participants in the 9 meetings held. Data were collected between June and October 2018 using the story-drawing technique. The drawings were analyzed individually with each prisoner and categorized by the researchers. The study had research ethics committee approval. Results: the story-drawing activity made it possible to understand how the mothers' felt about caring for their children and, from that, it was possible to specify measures seen as care inside the prison. Conclusion: from analysis of the experience of motherhood in prison, it is possible to comprehend the feelings running through the role of motherhood.

Objetivo: comprender los sentimientos maternos respecto al cuidado con el hijo dentro de una cárcel. Método: la investigación tiene enfoque cualitativo. Se analizaron mujeres a partir del tercer trimestre de embarazo y madres cuyos hijos se encontraban en la guardería de una prisión en Aquiraz/Ceará, totalizando 17 participantes en los 9 encuentros realizados. La recolección de datos se hizo entre junio y octubre de 2018. Se usó la técnica de historia a través de dibujos. El análisis de los dibujos se hizo de forma individual con cada reclusa y fue categorizado por las investigadoras. El trabajo obtuvo aprobación del Comité de Ética. Resultados: la actividad de historia a través de dibujos posibilitó la comprensión del sentimiento materno respeto al cuidado con sus hijos y, a partir de ello, se hizo posible definir acciones consideradas como atención dentro de la cárcel. Conclusión: a partir del análisis de la vivencia de la maternidad en la prisión, se posibilita la comprensión de sentimientos que atraviesan el desarrollo del rol materno.

Competitive neural layer-based method to identify people with high risk for diabetic foot.

BACKGROUND AND OBJECTIVE: To automatically identify patients with diabetes mellitus (DM) who have high risk of developing diabetic foot, via an unsupervised machine learning technique. METHODS: We collected a new database containing 54 known risk factors from 250 patients diagnosed with diabetes mellitus. The database also contained a separate validation cohort composed of 73 subjects, where the perceived risk was annotated by expert nurses. A competitive neuron layer-based method was used to automatically split training data into two risk groups. RESULTS: We found that one of the groups was composed of patients with higher risk of developing diabetic foot. The dominant variables that described group membership via our method agreed with the findings from other studies, and indicated a greater risk for developing such a condition. Our method was validated on the available test data, reaching 71% sensitivity, 100% specificity, and 90% accuracy. CONCLUSIONS: Unsupervised learning may be deployed to screen patients with diabetes mellitus, pointing out high-risk individuals who require priority follow-up in the prevention of diabetic foot with very high accuracy. The proposed method is automatic and does not require clinical examinations to perform risk assessment, being solely based on the information of a questionnaire answered by patients. Our study found that discriminant variables for predicting risk group membership are highly correlated with expert opinion.

Doenças associadas à deficiência do sistema complemento / Diseases associated with the deficiency of the complement system

Introdução: O sistema complemento é composto por diversas proteínas plasmáticas e é um importante mecanismo de defesa da imunidade inata e adquirida, que exerce funções homeostáticas e fisiológicas, como a remoção de células apoptóticas e complexos imunes. A deficiência neste mecanismo pode ser hereditária ou adquirida, e leva ao aumento da susceptibilidade a doenças infecciosas e não infecciosas, raras e fatais. Objetivo: Descrever as principais causas e consequências da deficiência do sistema complemento e relacioná-las com múltiplas patologias. Material e Métodos: Trata-se de uma revisão bibliográfica narrativa, tendo como base de dados, artigos publicados no Scientific Electronic Library Online (SciELO), National Library of Medicine (PubMed), Medical Literature Analysis and retrieval System Online (MEDLINE), nos últimos 5 anos. Resultados: A associação do complemento e doenças foram observadas em situações de deficiência do sistema complemento, anormalidades na regulação e nas inflamações. Mutações genéticas ou aumento do consumo do complemento levam à ativação imprópria ou excessiva do complemento, podendo conduzir a consequências lesivas e ao desenvolvimento de diversas doenças, como, lúpus eritematoso sistêmico, síndrome urêmica hemolítica atípica, glomerulopatia C3, hemoglobinúria paroxística noturna, glomerulonefrite pós-infecciosas, artrite reumatoide, dentre outras. Conclusão: É evidente a participação do sistema complemento na patogênese e patogenia de diversas doenças. O investimento em pesquisas, que visem ampliar o entendimento do papel do mecanismo do sistema complemento, pode contribuir para o desenvolvimento de intervenções terapêuticas paliativas e ou de cura de diversas doenças, com a consequente melhoria da qualidade de vida dos indivíduos acometidos.

Introduction: The complement system is composed of several plasma proteins and is an important defense mechanism of innate and acquired immunity, which exerts homeostatic and physiological functions, such as the removal of apoptotic cells and immune complexes. Deficiency in this mechanism may be hereditary or acquired, and leads to increased susceptibility to infectious and non-infectious, rare and fatal diseases. Objective: To describe the main causes and consequences of the deficiency of the complement system and to relate them to multiple pathologies. Material and Methods: This is a bibliographical narrative review, based on data published in SciELO (Scientific Electronic Library Online), PubMed (National Library of Medicine), MEDLINE (Medical Literature Analysis and retrieval System Online), last five years. Results:The associations of complement and diseases were observed in situations of deficiency of the complement system, abnormalities in regulation and inflammation. Genetic mutations lead to inappropriate or excessive activation of the complement, as well as increased the consumption of the complement. This can lead to harmful consequences and the development of several diseases, such as systemic lupus erythematosus, atypical hemolytic uremic syndrome, C3 glomerulopathy, nocturnal paroxysmal hemoglobinuria, postpartum glomerulonephritis, infectious diseases, rheumatoid arthritis, among others. Conclusion: The participation of the complement system in the pathogenesis and pathogenesis of several diseases is evident. Investing in research, aimed at broadening the understanding of the role of the complement system mechanism, may contribute to the development of palliative therapeutic interventions and or cure of various diseases, with the consequent improvement in the quality of life of affected individuals.

Ipsilateral proprioceptive neuromuscular facilitation patterns improve overflow and reduce foot drop in patients with demyelinating polyneuropathy.

The purpose of this study was to evaluate the response of the tibialis anterior muscle (TAm) using surface electromyography in patients with Charcot-Marie-Tooth disease (CMT-IA), after ipsilateral proprioceptive neuromuscular patterns (PNF). Thirteen CMT-IA patients (both sexes) were treated twice a week, for 5 weeks, with bilateral PNF pattern, four times per treatment. During the execution of the patterns, we recorded the bilateral activation of the TAm in root mean square (RMS). We used the Student paired t-test for the first and last treatments, P-value set at <0.05. Clinical significance (CS) was obtained by subtracting the values of the first treatment from the last. Chopping pattern to the right side increased RMS for the right (t=-3.52, CS=52%), but not the left TAm (t= -3.35). Flexion-abduction with external rotation pattern to the right (t= -2.46, CS=55%) and left (t=-2.07, CS=53%) significantly increased RMS for TAm on both sides. Extension-adduction with internal rotation pattern to the right (t=-0.25) and left (t=-1.84) did not produce any changes in TAm. Ipsilateral PNF patterns selectively produce TAm overflow in peripheral polyneuropathy patients and can be successfully used as supportive therapy for foot drop.

Cuidado ao lactente para mães em consultas de puericultura: intervenção em sala de espera / Care for lactating mothers in puericulture consultations: intervention in the waiting room

Objetivo: relatar a experiência da realização de sessões educativas para mães acerca do cuidado ao lactenteem sala de espera de consultas de puericultura. Método: estudo qualitativo, descritivo, tipo relato deexperiência, em que ocorreram as sessões educativas em uma Unidade de Atenção Primária à Saúde, cujacoleta de dados ocorreu de agosto de 2015 a março de 2017. Resultados: foram realizadas seis sessõeseducativas verificando o conhecimento pré-existente, implementando estratégias de educação em saúde e,posteriormente, verificando o conhecimento. Destaca-se o tópico “posicionamento da criança no momento daamamentação e das características da pega correta”. Verificou-se que, das mães, 40% (pré-teste) jáconheciam a temática e, após as explanações, o percentual acresceu para 75% (pós-teste), apresentandosignificância de p<0,016. Outro tópico em destaque foi “Vitamina D”; o quantitativo de acertos foi de 7,69%(pré-teste) para 76,92% (pós-teste), com valor significante (p<0,04). Conclusão: as sessões educativasassumiram uma conotação valorosa, tendo em vista que possibilitaram melhorar o conhecimento das mães.

Perfil de cirurgiões-dentistas e demandas de qualificação em UNACON e CACON no estado Rio de Janeiro / Profile of dentists and qualification demands in Unacon and CACON in Rio de Janeiro state

Objetivo: Analisar o perfil dos cirurgiões-dentistas que atuam nos hospitais habilitados em oncologia no âmbito do estado do Rio de Janeiro e identificar demandas de qualificação nessa área. Métodos: Trata-se de estudo exploratório descritivo do tipo survey destinado a gestores e profissionais dos hospitais habilitados em oncologia do estado do Rio de Janeiro. A análise dos dados foi realizada por meio de estatística descritiva. Resultados: Responderam aos formulários 14 gestores e 85 cirurgiões dentistas. Apesar do número de profissionais atuando nas unidades participantes, poucos são os profissionais que prestam o cuidado direto ao paciente oncológico. Os profissionais possuem, comparando com a média nacional, faixa etária mais elevada (47 anos), maior tempo de experiência profissional (24 anos) e de vínculo com a instituição (14 anos). Além disso, a maioria dos profissionais são especialistas (91,8%) e alguns fizeram mestrado (30,6%) e doutorado (3,5%). Apesar dos profissionais atuarem em unidades habilitadas para o cuidado oncológico, somente sete (8,2%) declararam terem feito cursos em oncologia. Diante da estrutura das instituições, a utilização da estratégia de ensino a distância pode otimizar os esforços e superar as dificuldades, porém, é necessário planejamento pedagógico coerente com o perfil dos profissionais. Conclusão: Os dados apontam para a necessidade de ampliação e qualificação da rede de cuidado odontológico aos pacientes oncológicos.(AU)

Aim: To analyze the profile of dentists who work in cancer hospitals in the state of Rio de Janeiro, Brazil, and identify skill requirements in this area. Methods: This is a descriptive-exploratory, surveylike study geared toward managers and professionals in cancer hospitals in the state of Rio de Janeiro. Data analysis was performed using descriptive statistics. Results: Fourteen managers and 85 dentists answered the questionnaire. Despite the adequate number of professionals working in the participating units, few professionals actually provide direct care to cancer patients. Compared to the national average, the professionals are of an older age (47 years), and have a longer professional experience (24 years) and a longer time working at the institution (14 years). In addition, most professionals are experts (91.8%), while some have completed their Masters (30.6%) and Ph.D. (3.5%). Although the professionals work in cancer care units, only seven (8.2%) reported having taken courses in oncology. Given the structure of the institutions, the use of a distance learning strategy could optimize efforts and overcome difficulties; however, pedagogical planning that is consistent with the profile of the professionals is necessary. Conclusion: The data point out the need for the expansion and qualification of the dental care network for cancer patients.(AU)

PARKOUR: MENSURAÇÃO DO METABOLISMO ENERGÉTICO E MORFOFISIOLÓGICO DE SEUS PRATICANTES / PARKOUR: MEASUREMENT OF ENERGETIC AND MORPHOPHISIOLOGICAL METABOLISM IN ITS PRACTITIONERS / PARKOUR: MEDICIÓN DEL METABOLISMO ENERGÉTICO Y MORFOFISIOLÓGICO DE SUS PRACTICANTES

RESUMO Introdução: O parkour é uma atividade que utiliza o próprio corpo para deslocar-se de um ponto a outro no ambiente. Objetivo: Analisar o comportamento do metabolismo energético e do sistema cardiorrespiratório durante uma sessão de parkour. Método: Foram avaliados 18 indivíduos praticantes da modalidade. O comportamento do metabolismo energético durante uma sessão de parkour foi avaliado por meio da frequência cardíaca (FC), lactato e glicose. Resultados: Os resultados indicaram que a FC média durante a sessão de treino foi de 167,64 ± 7,05 bpm representando 84,36 ± 3,52 %. O lactato inicial foi de 4,49 ± 3,08 mmol/L e o final de 9,23 ± 3,08 mmol/L onde p-valor para as variáveis foi de p = 0,0007. A glicose inicial foi de 73,6 ± 20,71 mg/dL e final de 76,06 ± 20,20 mg/dL assumindo um p-valor de p = 0,7408. Em se tratando da composição corporal, o percentual de gordura foi de 8,78 ± 2,82 %, a dobra que mais apresentou acúmulo de gordura foi do abdômen 12,32 ± 5,69 mm. Conclusão: Conclui-se que a modalidade parkour tem predominância do metabolismo anaeróbio glicolítico, com suporte do metabolismo aeróbio. Além disso, devido à especificidade da modalidade, seus praticantes possuem baixo percentual de gordura.

ABSTRACT Introduction: Parkour is an activity that uses the own body to move from a point to another in the environment. Objective: Analyzing the behavior of the energetic metabolism and the cardiorespiratory system during a parkour session. Method: Eighteen parkour practitioners were evaluated. The behavior of the energetic metabolism during the parkour session was measured by heart rate (HR), lactate and glucose. Results: The results indicated that the average HR during the training session was 167.64 ± 7.05 bpm representing 84.36 ± 3.52 %. The initial lactate level was 4.49 ± 3.08 mmol/L and the final level was 9.23 ± 3.08 mmol/L where p-value for both variables was p = 0.0007. The initial glucose was 73.6 ± 20.71 mg/dL and the final glucose 76.06 ± 20.20 mg/dL, with a p-value of p = 0.7408. In terms of body composition, the fat percentage was 8.78 ± 2.82 %, the skinfold with highest fat amount was the abdomen 12.32 ± 5.69 mm. Conclusion: The conclusion was that the parkour modality has predominance of the anaerobic glycolytic metabolism, with support of the aerobic metabolism. Besides, due to the specificity of the modality, its practitioners have low levels of body fat.

RESUMEN Introducción: Parkour es una actividad que utiliza el propio cuerpo para desplazarse de un punto a otro en el ambiente. Objetivo: Analizar el comportamiento del metabolismo energético y del sistema cardiorrespiratorio durante una sesión de parkour. Metodología: Se evaluaron 18 individuos que practican el la modalidadparkour. Fue evaluado el comportamiento del metabolismo energético durante una sesión de parkour a través de la frecuencia cardiaca (FC), lactato y glucosa. Resultados: Los resultados indicaron que el FC promedio durante la sesión de entrenamiento fue de 167,64 ± 7,05 lpm lo que representa 84,36 ± 3,52 %. El lactato inicial fue de 4,49 ± 3,08 mmol/L y el final 9,23 ± 3,08 mmol/L en donde el p-valor para las variables fue de p = 0,0007. La glucosa inicial fue de 73,6 ± 20,71 mg/dL y la final 76,06 ± 20,20 mg/dL asumiendo un valor de p = 0,7408. Al tratarse de la composición corporal, el porcentaje de grasa fue de 8,78 ± 2,82 %, el pliegue que mostró más acumulación de grasa fue del abdomen 12,32 ± 5,69 mm. Conclusión: Se concluye que la modalidad parkour tiene predominio del metabolismo anaeróbico glucolítico con el apoyo del metabolismo aeróbico. Además, debido a la especificidad de la modalidad, sus practicantes tienen bajo porcentaje de grasa corporal.

A cela não se abre no momento da dor: assistência de enfermagem em penitenciárias masculinas / The cell does not open at the moment of pain: nursing care in prisons for men / La prisión no se abre em el momento de dolor: asistencia de enfermería en prisiones masculinas

Objetivo: conhecer a assistência de enfermagem em penitenciárias masculinas. Método: estudo descritivo, de abordagem qualitativa, realizado em duas penitenciárias da região metropolitana de Fortaleza-CE, Brasil, com 13 profissionais de enfermagem. Os dados foram produzidos entre abril e junho de 2013, por meio de entrevista semiestruturada, organizados e apresentados pela Técnica de Análise de Conteúdo, na modalidade análise temática. O projeto foi aprovado pelo Comitê de Ética em Pesquisa, CAAE 12657213.5.0000.5037. Resultados: a partir da leitura compreensiva das falas, emergiram três categorias << Ações de enfermagem no sistema penal >>, << Dificuldades que limitam a atuação de enfermagem no sistema penal >> e << Necessidades para melhorias das ações de enfermagem >>. Conclusão: apesar das limitações, a atuação da enfermagem esteve pautada nos princípios éticos e legais da profissão, buscando qualidade de vida dos detentos, com vistas à atenção integral à saúde, respeito à vida e dignidade.(AU)

Objective: raise knowledge on the nursing care in prisons for men. Method: descriptive study of qualitative approach, carried out in two prisons in the metropolitan area of Fortaleza, Brazil, with 13 nursing professionals. Data was produced between April and June of 2013 through semi-structured interview, organized and presented by the content analysis technique, in the modality thematic analysis. The project was approved by the Research Ethics Committee, CAAE 12657213.5.0000.5037. Results: three categories emerged as result of the comprehensive reading of the speeches << Nursing actions in the penal system >>, << Difficulties that limit nursing activities in the penal system >> and << Needs for improvement of nursing actions >>. Conclusion: despite limitations, the nursing action was guided by ethical and legal principles of the profession, seeking quality of life of detainees, with a view to health integrated care, respect for life and dignity.(AU)

Objetivo: conocer la asistencia de enfermería en prisiones masculinas. Método: estudio descriptivo, de enfoque cualitativo, realizado en dos prisiones de la región metropolitana de Fortaleza-CE, Brasil, con 13 profesionales de enfermería. Los datos fueron producidos entre abril y junio de 2013, por medio de entrevista semi-estructurada, organizados y presentados por la Técnica de Análisis de Contenido, en la modalidad análisis temático. El proyecto fue aprobado por el Comité de Ética en Investigación, CAAE 12657213.5.0000.5037. Resultados: a partir de la lectura comprensiva de los discursos, surgieron tres categorías << Acciones de la enfermería en el sistema penal >>, << Dificultades que limitan la actuación de enfermería en el sistema penal >> y << Necesidades para mejorías de las acciones de enfermería >>. Conclusión: a pesar de las limitaciones, la actuación de la enfermería estuvo pautada en los principios éticos y legales de la profesión, buscando calidad de vida de los detenidos, para la atención integral a la salud, respecto a la vida y dignidad.(AU)

Effect of acidic solutions on the surface degradation of a micro-hybrid composite resin.

Composite resins may undergo wear by the action of chemical substances (e.g., saliva, alcohol, bacterial acids) of the oral environment, which may affect the material's structure and surface properties. This study evaluated the effect of acidic substances on the surface properties of a micro-hybrid composite resin (Filtek Z-250). Eighty specimens were prepared, and baseline hardness and surface roughness (KMN0 and Ra0, respectively) were measured. The specimens were subjected to sorption (SO) and solubility (SL) tests according to ISO 4049:2009, but using different storage solutions: deionized water; 75/25 vol% ethanol/water solution; lactic acid; propionic acid; and acetic acid. The acids were used in two concentrations: PA and 0.02 N. pH was measured for all solutions and final hardness (KMN1) and surface roughness (Ra1) were measured. Data were analyzed with paired t-tests and one-way ANOVA and Tukey's test (a=5%). All solutions decreased hardness and increased the Ra values, except for the specimens stored in water and 0.02 N lactic acid, which maintained the hardness. All solutions produced similar SO and SL phenomena, except for the 0.02 N lactic acid, which caused lower solubility than the other solutions. Ethanol showed the highest pH (6.6) and the 0.02 N lactic acid the lowest one (2.5). The solutions affected negatively the surface properties of the composite resin; in addition, an acidic pH did not seem to be a significant factor that intensifies the surface degradation phenomena.

Acceptability, efficacy and safety of two treatment protocols for dental fluorosis: a randomized clinical trial.

OBJECTIVES: This parallel randomized clinical trial evaluated the efficacy of two treatments for removing fluorosis stains. METHODS: Seventy individuals living in an area endemic for fluorosis, with at least four maxillary anterior teeth presenting fluorosis with a Thylstrup and Fejerskov index from 1 to 7, were randomized into two treatment groups (n=35): GI - enamel microabrasion or GII - microabrasion associated with at-home bleaching. Microabrasion was performed using 37% phosphoric acid and pumice and, at-home tooth bleaching was performed with 10% carbamide peroxide. Areas of enamel opacities were recorded by digital camera at baseline and 1-month (1M) after treatment. Two blinded examiners evaluated the reduction in the area (mm(2)) of opacity using software. Two visual analogue scales were used: one for recording tooth sensitivity and/or gingival irritation ranging from 1 (none) to 5 (severe) and the other to evaluate participant satisfaction with the treatment used ranging from 1 (no improvement) to 7 (exceptional improvement). RESULTS: 1M after treatment, both groups showed a significant reduction in the area of enamel opacity (p=0.0001) and there was no difference between groups (p=0.1). Most of the participants from both treatment groups reported no or mild tooth sensitivity and gingival irritation (p>0.05). Participants reported that they were happy with the improvement in dental appearance, however, individuals from GII reported that they were happier than those from GI (p=0.004). CONCLUSIONS: Both treatment protocols were effective in reducing fluoride stains, however, when home bleaching was associated to enamel microabrasion, patients reported a major satisfaction with dental appearance.

Effect of Acidic Solutions on the Surface Degradation of a Micro-Hybrid Composite Resin

Composite resins may undergo wear by the action of chemical substances (e.g., saliva, alcohol, bacterial acids) of the oral environment, which may affect the material's structure and surface properties. This study evaluated the effect of acidic substances on the surface properties of a micro-hybrid composite resin (Filtek Z-250). Eighty specimens were prepared, and baseline hardness and surface roughness (KMN0 and Ra0, respectively) were measured. The specimens were subjected to sorption (SO) and solubility (SL) tests according to ISO 4049:2009, but using different storage solutions: deionized water; 75/25 vol% ethanol/water solution; lactic acid; propionic acid; and acetic acid. The acids were used in two concentrations: PA and 0.02 N. pH was measured for all solutions and final hardness (KMN1) and surface roughness (Ra1) were measured. Data were analyzed with paired t-tests and one-way ANOVA and Tukey's test (a=5%). All solutions decreased hardness and increased the Ra values, except for the specimens stored in water and 0.02 N lactic acid, which maintained the hardness. All solutions produced similar SO and SL phenomena, except for the 0.02 N lactic acid, which caused lower solubility than the other solutions. Ethanol showed the highest pH (6.6) and the 0.02 N lactic acid the lowest one (2.5). The solutions affected negatively the surface properties of the composite resin; in addition, an acidic pH did not seem to be a significant factor that intensifies the surface degradation phenomena.

Resinas compostas podem sofrer desgaste pela ação de substâncias químicas (saliva, álcool, ácidos bacterianos) presentes no ambiente oral, que podem afetar a estrutura e as propriedades superficiais do material. Assim, este estudo avaliou o efeito de substâncias ácidas nas propriedades superficiais de uma resina composta micro-híbrida (Filtek Z-250). Oitenta espécimes foram preparados e mensurados quanto à dureza e rugosidade superficial iniciais (KMN0 e Ra0, respectivamente). Os espécimes foram submetidos a testes de sorção (SO) e solubilidade (SL) de acordo com a ISO 4049:2009, porém usando diferentes soluções de armazenamento: água deionizada, solução etanol/água 75/25% em volume, ácido lático, ácido propiônico e ácido acético. Os ácidos foram utilizados em duas concentrações: PA e 0,02 N. O pH foi mensurado para todas as soluções e a dureza e rugosidade superficial finais (KMN1 e Ra1, respectivamente) foram mensuradas. Os dados foram analisados com testes t-pareado e ANOVA a um fator, e teste de Tukey (p<0,05). Todas as soluções reduziram a dureza e aumentaram os valores de Ra, exceto para os espécimes armazenados em água e ácido lático 0,02 N, que mantiveram a dureza. Todas as soluções produziram fenômenos de SO e SL similares, exceto o ácido lático 0,02 N, que causou menor solubilidade do que as outras soluções. Etanol mostrou o maior pH (6,6) e o ácido lático 0,02 N o menor deles (2,5). As soluções afetaram negativamente as propriedades superficiais da resina composta; além disso, um pH ácido não parece ser um fator significante para intensificar os fenômenos de degradação superficial.

An estimate of the cost of treating non-melanoma skin cancer in the state of São Paulo, Brazil.

BACKGROUND: The most common form of cancer in Brazil is non-melanoma skin cancer, which affects approximately 0.06% of the population. There are no public policies for its prevention and the economic impact of its diagnosis has yet to be established. OBJECTIVES: To estimate the costs of the diagnosis and treatment of non-melanoma skin cancer in the state of São Paulo between 2000 and 2007 and to compare them with the costs associated with skin melanoma in the same period. METHODS: The Clinical Practice Guidelines in Oncology (National Comprehensive Cancer Network) was used as a procedure model, adapted to the procedures at the SOBECCan Foundation at the Ribeirão Preto Cancer Hospital in São Paulo. The estimated costs were based on the costs of medical treatment in the public and private sectors in 2007. RESULTS: The mean annual costs of each individual treatment of non-melanoma skin cancer were much lower than those estimated for the treatment of skin melanoma. Nevertheless, when the total costs of the treatment of non-melanoma skin cancer were taken into consideration, it was found that the total cost of the 42,184 cases of this type of cancer in São Paulo within the study period was 14% higher than the costs of the 2,740 cases of skin melanoma registered in the same period within the Brazilian National Health Service (SUS). However, in the private sector, the total cost was approximately 34% less for the treatment of non-melanoma skin cancer compared to melanoma. CONCLUSION: The high number of cases of non-melanoma skin cancer in Brazil, with 114,000 new cases predicted for 2010, 95% of which are diagnosed at early stages, represents a financial burden to the public and private healthcare systems of around R$37 million and R$26 million annually, respectively.

Antimicrobianos de uso odontológico: informação para uma boa prática / Antibiotics of odontological use: information to correct pratice

Os antibióticos são substâncias químicas produzidas por microrganismos vivos ou através por meio de processos semissintéticos, que têm a capacidade de impedir o crescimento ou destruir microrganismos patogênicos. A prescrição de antibióticos é indispensável na prática odontológica. Para tanto, o conhecimento do medicamento utilizado bem como a dosagem correta para o processo de cura são necessários. Este trabalho tem por objetivo fazer uma revisão crítica da literatura sobre os antibióticos de uso odontológico bem como esclarecer os mecanismos de ação, as formas farmacêuticas existentes no mercado e suas principais indicações, posologia e efeitos colaterais mais comuns. O cirurgião-dentista tem disponível uma infinidade de formulações medicamentosas, entretanto a farmacologia é uma área muito pouco explorada pelos profissionais de odontologia. Isso requer uma maior disseminação desse conhecimento para o estabelecimento de uma correta prática diária quando da administração de antimicrobianos.

Antibiotics are chemistry substance that inhibit the growing or destroy the microorganism. The prescription of antibiotics is necessary in the odontological clinic. Knowledge of medicine, the dosage correctly to the process of health is necessary. This paper is make a critical literature review about antibiotics of use odontological, as well as knowledge mechanisms of action, as comercial presentation and indications, dosages and adverse effects more frequently. The dentistry has an infinity available of medicines formulations, however, the pharmacology is a little bit explored area by the dentistry. That requests a larger popularization of that knowledge for the establishment of a correct daily practice when of the antibiotics administration.

Estimativa do custo do tratamento do câncer de pele tipo não-melanoma no Estado de São Paulo - Brasil / An estimate of the cost of treating non-melanoma skin cancer in the state of São Paulo, Brazil

FUNDAMENTOS: O câncer de maior incidência no Brasil é o de pele não-melanoma, que afeta aproximadamente 0,06 por cento da população. Não existem políticas públicas para sua prevenção e o impacto econômico do seu diagnóstico não tem sido avaliado. OBJETIVOS: Estimar os custos do diagnóstico e tratamento do câncer de pele não-melanoma no Estado de São Paulo entre 2000 a 2007 e compará-los com os do melanoma cutâneo no mesmo período. MÉTODOS: Foi utilizado como modelo de procedimento o projeto diretriz Clinical Practice Guidelines in Oncology, (National Comprehensive Cancer Network), adequado aos procedimentos da Fundação SOBECCan - Hospital do Câncer de Ribeirão Preto - SP. Os custos estimados baseiam-se nos valores do tratamento médico pagos pelos setores público e privado em 2007. RESULTADOS: Os valores médios de custo individual do tratamento anual do câncer de pele não-melanoma são muito mais baixos do que os estimados para o tratamento do melanoma cutâneo. Entretanto, observados os gastos totais no tratamento do câncer de pele não-melanoma, percebe-se que os 42.184 casos deste câncer em São Paulo, no período estudado, fazem com que o custo total do seu tratamento seja 14 por cento superior ao dos 2.740 casos de melanoma cutâneo registrados no mesmo período para o SUS. Porém, para o sistema privado, o gasto total é, aproximadamente, 34 por cento menor para o tratamento do câncer de pele não-melanoma. CONCLUSÃO: O elevado número de casos de câncer de pele não-melanoma no Brasil - com 114 mil novos casos previstos para 2010, sendo 95 por cento diagnosticados em estágios precoces - representa um impacto financeiro ao sistema público e aos sistemas privados de saúde de cerca de R$ 37 milhões e R$ 26 milhões ao ano, respectivamente.

BACKGROUND: The most common form of cancer in Brazil is non-melanoma skin cancer, which affects approximately 0.06 percent of the population. There are no public policies for its prevention and the economic impact of its diagnosis has yet to be established. OBJECTIVES: To estimate the costs of the diagnosis and treatment of non-melanoma skin cancer in the state of São Paulo between 2000 and 2007 and to compare them with the costs associated with skin melanoma in the same period. METHODS: The Clinical Practice Guidelines in Oncology (National Comprehensive Cancer Network) was used as a procedure model, adapted to the procedures at the SOBECCan Foundation at the Ribeirão Preto Cancer Hospital in São Paulo. The estimated costs were based on the costs of medical treatment in the public and private sectors in 2007. RESULTS: The mean annual costs of each individual treatment of non-melanoma skin cancer were much lower than those estimated for the treatment of skin melanoma. Nevertheless, when the total costs of the treatment of non-melanoma skin cancer were taken into consideration, it was found that the total cost of the 42,184 cases of this type of cancer in São Paulo within the study period was 14 percent higher than the costs of the 2,740 cases of skin melanoma registered in the same period within the Brazilian National Health Service (SUS). However, in the private sector, the total cost was approximately 34 percent less for the treatment of non-melanoma skin cancer compared to melanoma. CONCLUSION: The high number of cases of non-melanoma skin cancer in Brazil, with 114,000 new cases predicted for 2010, 95 percent of which are diagnosed at early stages, represents a financial burden to the public and private healthcare systems of around R$37 million and R$26 million annually, respectively.

Avaliação topográfica do forame infraorbital em crânios secos humanos / Topographic evaluation of the infraorbital foramen in dry human skulls

Objetivo: mensurar a localização do forame infraorbital (FIO) em peças anatômicas maceradas, considerando-se o dimorfismo sexual. Método: utilizou-se uma abordagem indutiva, procedimento estatístico e técnica de observação direta em laboratório, mediante crânios do acervo do Ossário do Departamento de Morfologia da Universidade Federal da Paraíba. O projeto obteve aprovação do Comitê de Ética em Pesquisa. Definiu-se a posição do FIO em relação aos dentes pelo método visual, e para as mensurações realizadas com paquímetro digital utilizaram-se duas distâncias: medida sagital (MS): margem infra-orbital - margem superior do forame; e medida transversal (MT): abertura piriforme - margem mediais do FIO, efetuadas por pesquisador calibrado. Obteve-se uma amostra de 23 crânios, procedendo-se a análise estatística com o teste t. Resultados: dentre os crânios dentados (34,8%; n=8) identificou-se o FIO no longo eixo do segundo pré-molar superior em 62,5% (n=5) no lado direito (LD) e 87,5% (n=7), lado esquerdo (LE). As médias, em milímetros, para a MS no sexo masculino foram 6,21 (±1,43) e 5,9 (±1,22) no LD e LE, respectivamente e para o feminino, 4,69 (±1,09) e 5,55 (±1,35). Na MT, as médias masculinas foram 16,56 (±1,94) para o LD e 16,38 (±1,75) para o LE. As médias femininas foram 15,55 (±2,53) e 16,64 (±1,94). Não houve diferença estatisticamente significante entre as medidas MS e MT direitas e esquerdas (p>0,05). No entanto, verificou-se significância entre a MS direita masculina e a feminina (p menor que 0,05). Conclusão: não houve variação significante na topografia do FIO em um mesmo indivíduo e no mesmo sexo, havendo, portanto variação entre os sexos.

Objective: to measure the location of the infraorbital foramen (IOF) in macerated anatomical specimens, considering the sexual dimorphism. Methods: it was used an inductive approach, a statistical technique and direct observation at the laboratory by means of skulls of the Ossuary's collection of Morphology's Department, Federal University of Paraíba. The project was approved by the Ethics Committee in Research. It was defined the position of IOF in relation to the teeth by the visual method and to the measurements, we used two different distances: sagittal measure (SM): infraorbital margin - foramen's superior margin; transverse measurement (TM): pyriform opening - the IOF's medial margin, conducted by calibrated researcher with a digital caliper. It was obtained a sample of 23 skulls, proceeding to statistical analysis using t test. Results: among dentate skulls (34.8%; n = 8), it was identified the IOF on the long axis of the second premolar in 62.5% (n = 5) on the right side (RS) and 87.5% (n = 7), left side (LS). The averages, in millimeters, for the SM in males was 6.21 (± 1.43) and 5.9 (± 1.22) in RS and LS, respectively and for females, 4.69 (± 1 09) and 5.55 (± 1.35). In TM, the male average was 16.56 (± 1.94) for RS and 16.38 (± 1.75) for the LS. The female average was 15.55 (± 2.53) and 16.64 (± 1.94). There wasn't statistically significant difference between the measurements SM and TM right and left (p greater than 0.05). However, there was significance between male and female MS right (p less than 0.05). Conclusion: there wasn't significant variation in the topography of IOF in the same individual and in the same sex, so, there is variation between the sexes.

Intoxicação exógena: fatores desencadeantes e ações imediatas no momento do acidente / Exogenous intoxication: triggering factors and immediate actions at the time of the accident

O artigo tem como objetivo identificar os fatores desencadeantes de intoxicação exógena por ingestão na faixa etária de 0 a quatro anos de idade. É um estudo quantitativo do tipo exploratório e descritivo realizado com 17 responsáveis de crianças na idade mencionada. A maioria das crianças (87%) estava na presença de um adulto. Das crianças atendidadas, a maioria (88%) era a primeira vez que ingeria substância tóxica. Em relação ao conhecimento sobre o efeito tóxico dos produtos químicos, que as crianças ingeriram, nove responsáveis (53%) afirmaram ter conhecimento, e oito (47%) desconheciam tal efeito. Quanto ao conhecimento da substância ingerida pela criança 11 (55%) dos responsáveis relataram conhecer e diante da conduta a ser tomada no momento do acidente. Dez responsáveis (59%) afirmaram não saber, e sobre a atitude tomada nessa situação, 39% procuraram ajuda. Os resultados evidenciaram que o contexto socioeconômico influenciou na quantidade e qualidade dos casos atendidos.

The article aims to identify the triggering factors of exogenous intoxication by ingestion among children from 0 to four years old. It is an exploratory and descriptive quantitative study with 17 guardians of children between 0-4 years. Most children (87%) were in the presence of an adult. Among the children treated, the majority (88%) had ingested toxic substances for the first time. Concerning the knowledge about the effects of toxic chemicals for the children, 9 (53%) guardians claimed to have knowledge and 8 (47%) were unaware of such an effect. Concerning the knowledge of the substance ingested by the child, 11 (55%) of those guardians reported to know it. Concerning the actions to be taken at the time of the accident, 10 (59%) guardians said they did not know. In this situation, 39% informed they sought help. The results showed that the social and economic context influence on the quantity and quality of cases treated.

El artículo tiene como objetivo identificar los factores desencadenantes de la intoxicación por ingestión entre niños de 0 a cuatro años de edad. Estudio cuantitativo del estudio exploratorio y descriptivo, con 17 tutores de niños entre 0-4 años. La mayoría de los niños (87%) estaba en la presencia de un adulto. De los niños tratados, la mayoría (88%) había ingerido sustancias tóxicas por la primera vez. En relación a los conocimientos sobre el efecto de sustancias químicas tóxicas en los niños, 9 (53%) de los responsables afirmaran haber conocimientos. 8 (47%) no tenían conocimiento de tal efecto. En relación a la sustancia ingerida por el niño, 11 (55%) de los responsables informaran conocerla, y 10 líderes dijeron que no sabían informar sobre las medidas que deben adoptarse en el momento del accidente. En esta situación, 39% dijeran tener buscado ayuda. Los resultados mostraron una influencia socioeconómica en la cantidad y calidad de los casos tratados.