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Resumo Introdução O metabólito do benzeno ácido trans, trans-mucônico (t, t-MA) urinário é considerado bom bioindicador de exposição a níveis de benzeno no ar superiores a 0,50 ppm. Objetivo Determinar níveis urinários de ácido trans, trans-mucônico (t, t-MA) e investigar relação com potenciais fontes de exposição ao benzeno e associação com parâmetros hematológicos. Método Estudo seccional, com 150 moradores de Açailândia, Maranhão, Brasil. Utilizou-se questionário estruturado para caracterização sociodemográfica, ocupacional, dentre outras. Coletaram-se amostras de urina e sangue para determinar níveis de t, t-MA e realização de hemograma. As associações foram exploradas mediante regressão logística e linear múltipla. Resultados O t, t-MA foi detectado em 27% dos participantes, sendo a média da concentração 0,15 mg/g de creatinina. As alterações hematológicas mais frequentes foram bastonetes baixos (41%), eosinofilia (33%) e níveis reduzidos de hemoglobina (19%). Não encontrou-se correlação estatisticamente significativa entre t, t-MA e parâmetros do hemograma. Os fatores que influenciaram de forma significativa a excreção de t, t-MA foram cor da pele, prática regular de atividades de lazer com exposição a solventes orgânicos e consumo de refrigerante e refresco nas últimas 24 horas. Conclusão A população parece não estar exposta a concentrações elevadas de benzeno. Entretanto, o perfil hematológico revelou presença de alterações bioquímicas compatíveis com anemia e comprometimento imunológico.
Abstract Background The urine benzene metabolite trans,trans-muconic (t,t-MA) is considered a good bioindicator of exposure to benzene levels in the air above 0.50 ppm. Objective Determine urinary levels of trans, trans-muconic acid (t,t-MA) and investigate the relationship with potential sources of exposure to benzene and its association with hematological parameters. Method A sectional study was carried out with 150 residents of Açailândia, Maranhão, Brazil. A structured questionnaire was used for sociodemographic and occupational characterization, among others. Urine and blood samples were collected to determine t,t-MA levels and blood counts. Associations were explored using multiple linear and logistic regressions. Results The t,t-MA was detected in 27% of the participants, with an average concentration of 0.15 mg/g creatinine. The most frequent hematological changes were low rods (41%), eosinophilia (33%), and reduced hemoglobin levels (19%). No statistically significant correlation was found between t,t-MA and blood count parameters. The factors that significantly influenced the excretion of t, t-MA were skin color, regular practice of leisure activities with exposure to organic solvents, and consumption of soda and soft drinks in the last 24 hours. Conclusion The population does not appear to be exposed to high concentrations of benzene. However, the hematological profile revealed the presence of biochemical changes compatible with anemia and immunological impairment.
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Research has shown the effort to develop conceptual models that relate anthropic stressors to changes in aquatic environment state. Several of these models come from the structure Drivers, Pressures, State, Impact and Response (DPSIR), which has been used since the 1990s. However, there is a lack of conceptual models that consider in its structure the connection between the damages caused in the aquatic environment and technological disasters. This research develops a general conceptual model based on the DPSIR structure incorporating technological disasters. Based on the general conceptual model guidelines and the methodological procedure associated with it, a model was developed to assess the Lower Doce River waters' state, by considering Fundão's iron-ore dam failure scenario, which took place in November 2015, in the municipality of Mariana, state of Minas Gerais, Brazil. The relevant aspects of this adaptation of the DPSIR structure were: I) it considers the combined effect of drivers and pressures that already existed in the study area with those originated from the technological disaster; and II) the causal relationships among elements of the model were explicited through a systemic conceptual map, allowing a more holistic and integrated view of the problem. The application of the conceptual model to Doce River's scenario before the disaster allowed us to verify that a set of environmental pressures was already acting in a way to stress it, making the river vulnerable. For the post-disaster scenario, it was possible to determine that the already existing vulnerability condition, caused by urbanization, agriculture1 and mining, had been intensified by adding new pressures due to the tailings dam failure.
Assuntos
Desastres , Poluentes Químicos da Água , Brasil , Monitoramento Ambiental , Rios , Poluentes Químicos da Água/análiseRESUMO
The Teaching Hospital Restructuring Program was introduced as a strategy to fight the crisis in this sector. It brings to new funding, management and relationship standards between teaching hospitals and health system. This study presents the results obtained from a multiple case study involving four teaching hospitals whose contracts were executed in 2004. In 2010, a number of 32 interviews were conducted with both hospital and SUS managers, in addition to managers connected with the Federal Government Departments involved in the contracting system. By using elements from the micropolicy of health organizations as theoretical reference, the database was revisited with the goal of analyzing possible changes derived from such governmental policy applied in the daily life of teaching hospitals, in an attempt to explain the position taken by the diverse institutional actors as well as the main role played by the managers and the difficulties encountered in its introduction. Despite the improvements in the financial situation, the changes observed in teaching hospitals were not significant. An analysis of the contracting policy leads to an understanding of how a consistent and idealized project can reproduce the usual conservative behavior found in public management.
O Programa de Reestruturação dos Hospitais de Ensino (HE) foi implantado como uma das estratégias para enfrentar a crise do setor. Pretendia introduzir novos modos de financiamento, de gestão e articulação destes hospitais com a rede de saúde. O artigo apresenta resultados de estudo qualitativo, de caso múltiplo, envolvendo quatro HE contratualizados em 2004. Foram entrevistados, em 2010, 32 dirigentes hospitalares, gestores do Sistema Único de Saúde (SUS) e dos ministérios envolvidos. Utilizando como referencial teórico elementos da micropolítica das organizações de saúde, revisitou-se o banco de dados como objetivo analisar as mudanças decorrentes dessa política governamental no cotidiano dos HE, procurando caracterizar o posicionamento e protagonismo dos diferentes atores institucionais e as dificuldades na sua implementação. A despeito da melhoria das condições financeiras, as mudanças observadas nos HE foram restritas. Analisar a política de contratualização permite compreender como um projeto consistente e idealizado pode reproduzir o comportamento conservador que caracteriza a gestão pública.
Assuntos
Contratos , Atenção à Saúde , Programas Governamentais , Política de Saúde , Hospitais de Ensino , Humanos , PolíticasRESUMO
Resumo O Programa de Reestruturação dos Hospitais de Ensino (HE) foi implantado como uma das estratégias para enfrentar a crise do setor. Pretendia introduzir novos modos de financiamento, de gestão e articulação destes hospitais com a rede de saúde. O artigo apresenta resultados de estudo qualitativo, de caso múltiplo, envolvendo quatro HE contratualizados em 2004. Foram entrevistados, em 2010, 32 dirigentes hospitalares, gestores do Sistema Único de Saúde (SUS) e dos ministérios envolvidos. Utilizando como referencial teórico elementos da micropolítica das organizações de saúde, revisitou-se o banco de dados como objetivo analisar as mudanças decorrentes dessa política governamental no cotidiano dos HE, procurando caracterizar o posicionamento e protagonismo dos diferentes atores institucionais e as dificuldades na sua implementação. A despeito da melhoria das condições financeiras, as mudanças observadas nos HE foram restritas. Analisar a política de contratualização permite compreender como um projeto consistente e idealizado pode reproduzir o comportamento conservador que caracteriza a gestão pública.
Abstract The Teaching Hospital Restructuring Program was introduced as a strategy to fight the crisis in this sector. It brings to new funding, management and relationship standards between teaching hospitals and health system. This study presents the results obtained from a multiple case study involving four teaching hospitals whose contracts were executed in 2004. In 2010, a number of 32 interviews were conducted with both hospital and SUS managers, in addition to managers connected with the Federal Government Departments involved in the contracting system. By using elements from the micropolicy of health organizations as theoretical reference, the database was revisited with the goal of analyzing possible changes derived from such governmental policy applied in the daily life of teaching hospitals, in an attempt to explain the position taken by the diverse institutional actors as well as the main role played by the managers and the difficulties encountered in its introduction. Despite the improvements in the financial situation, the changes observed in teaching hospitals were not significant. An analysis of the contracting policy leads to an understanding of how a consistent and idealized project can reproduce the usual conservative behavior found in public management.
Assuntos
Humanos , Atenção à Saúde , Contratos , Políticas , Programas Governamentais , Política de Saúde , Hospitais de EnsinoRESUMO
OBJECTIVE: to understand the changing roles of nurses in labor division organization in hospitals from the Manchester Triage System implementation in an emergency hospital. METHODS: this is an ethnographic study that used different production techniques and data analysis. RESULTS: the Manchester Triage System organized flows and places resulting in quality of care and changes in work processes. Conflict relationships related to disagreements in risk stratification were present. FINAL CONSIDERATIONS: the traditional roles of nurses have been transformed, but it cannot be said that there was a structural change in their position in labor division organization in hospitals. The frontiers of autonomy, therefore of increasing the professionalization of nurses, are neither fixed nor stable, expanding or contracting according to the micropolitical changes in the governance of care.
Assuntos
Serviços Médicos de Emergência , Enfermagem em Emergência/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Enfermeiras e Enfermeiros/psicologia , Administração dos Cuidados ao Paciente , Triagem , Emergências , Humanos , Cuidados de EnfermagemRESUMO
AIM: This study sets out to evaluate the antiproteolytic activity of copaiba oil-based emulsion at the resin/dentin adhesive interface union formed with conventional and self-etching adhesives systems. METHODS: At in situ zymography, 30 teeth were sectioned 2 mm below the enamel-dentin junction; a smear layer was standardized and subdivided into four groups. Gelatin conjugated with fluorescein was used and taken to the fluorescence microscope for evaluation. In cytotoxicity, the Trypan Blue method was used at four different time points. The tested groups were (G1) control with distilled water; (G2) 2% chlorhexidine (CLX); (G3) emulsion based on copaiba oil (EC) 10% + X; (G4) 10% EC + Y; and (G5) EC 10% alkaline. The zymographic assay used the same groups described, but in 30 seconds and 10 and 20 minutes. HT1080 cells were incubated and submitted to electrophoresis. The gel was analyzed using ImageJ software. Mann-Whitney and Kruskal-Wallis tests were used in the statistical analysis (p < 0.05). RESULTS: ECs showed higher cell viability in the cytotoxicity test and showed a significant difference in 10 and 20 minutes. In the zymographic assay, alkaline EC reduced 67% of MMP-2 activity and 44% of MMP-9 compared to 2% chlorhexidine. At in situ zymography in qualitative evaluation, all groups tested showed inhibition of activity in metalloproteinases. CONCLUSION: EC showed activity in the inhibition of metalloproteinases in vitro and in situ, especially the alkaline one. The survey shows the possibility of using ECs, a product from Amazonian biodiversity, as a biomodifier in dentistry.
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ABSTRACT Objective: to understand the changing roles of nurses in labor division organization in hospitals from the Manchester Triage System implementation in an emergency hospital. Methods: this is an ethnographic study that used different production techniques and data analysis. Results: the Manchester Triage System organized flows and places resulting in quality of care and changes in work processes. Conflict relationships related to disagreements in risk stratification were present. Final considerations: the traditional roles of nurses have been transformed, but it cannot be said that there was a structural change in their position in labor division organization in hospitals. The frontiers of autonomy, therefore of increasing the professionalization of nurses, are neither fixed nor stable, expanding or contracting according to the micropolitical changes in the governance of care.
RESUMEN Objetivo: comprender los roles cambiantes de las enfermeras en la organización de la división del trabajo en el hospital desde la implementación del Sistema de Triaje Manchester en un hospital de urgencia y emergencia. Métodos: estudio etnográfico, utilizando diferentes técnicas de producción y análisis de datos. Resultados: el Sistema de Triaje Manchester organizó flujos y lugares, lo que resultó en calidad de atención y cambios en los procesos de trabajo. Estuvieron presentes relaciones conflictivas relacionadas con desacuerdos en la clasificación del riesgo. Consideraciones finales: los roles tradicionales de las enfermeras se han transformado, pero no se puede decir que hubo un cambio estructural en su posición en la organización de la división del trabajo en el hospital. Las fronteras de la autonomía, por tanto de incrementar la profesionalización del enfermero, no son fijas ni estables, ampliándose o contrayéndose según los cambios micropolíticos en la gobernanza del cuidado.
RESUMO Objetivos: compreender as mudanças de papéis dos enfermeiros na organização da divisão do trabalho no hospital a partir da implantação do Sistema Manchester de Classificação de Risco em hospital de urgência e emergência. Métodos: estudo etnográfico, com o emprego de diferentes técnicas de produção e de análise de dados. Resultados: o Sistema Manchester de Classificação de Risco organizou os fluxos e lugares, resultando em qualidade do cuidado e em mudanças nos processos de trabalho. Relações de conflito relacionadas às discordâncias na classificação do risco estiveram presentes. Considerações finais: os papé is tradicionais dos enfermeiros se transformaram, mas não se pode afirmar que houve mudança estrutural da posição deles na organização da divisão do trabalho no hospital. As fronteiras da autonomia, portanto de aumento de profissionalização dos enfermeiros, não são fixas nem estáveis, alargando ou contraindo de acordo com as mudanças micropolíticas da governabilidade do cuidado.
Assuntos
Humanos , Administração dos Cuidados ao Paciente , Triagem , Enfermagem em Emergência/organização & administração , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência/organização & administração , Enfermeiras e Enfermeiros/psicologia , Emergências , Cuidados de EnfermagemRESUMO
This study analyzed the effect of prior application of copaiba oil (CO) emulsions as a dentin cleaning substance on microleakage and microtensile adhesive strength. Twenty-five premolars and sixty-four molars were used for microleakage and microtensile assays. For the microleakage assays, specimens with standard class V cavities were divided (n = 5), according to the tested CO emulsions: CO10%X, CO10%Y, and CO10%Z, as well as chlorhexidine 2% (CHX) and distilled water (DW), as positive and negative controls, respectively. Restorations were performed using the Adper Single Bond® and/or Clearfil SE Bond® systems. Cervical, occlusal, distal and mesial sections were assessed for tracer penetration degree at the composite/tooth interface. For the microtensile assay, healthy molars were divided into sixteen groups, in which artificial caries were induced in half of the groups. Dentin surfaces were treated with CO10%X and CO10%Y, CHX and DW. Microtensile bond strength was measured by fixing each sample to the plate of a universal testing machine operated at a speed of 0.5 mm/minute until failure. Dentin treated with CO10%X showed a lower infiltration rate than dentin treated with the other CO emulsions, CHX2% and DW. According to the microtensile assay, both healthy and affected dentin treated with CO10%X and Adper Single Bond® adhesive system presented higher adhesive strength. CO emulsion, used as a dentin biomodifier, interfered positively in microleakage and improved adhesive strength after acid etching in the Adper Single Bond® adhesive system, or before applying the Clearfil SE Bond® self-etching system.
Assuntos
Colagem Dentária/métodos , Adesivos Dentinários/química , Dentina/efeitos dos fármacos , Fabaceae/química , Óleos de Plantas/química , Análise de Variância , Clorexidina/química , Resinas Compostas/química , Cimentos Dentários/química , Infiltração Dentária , Dentina/química , Emulsões/química , Humanos , Teste de Materiais , Reprodutibilidade dos Testes , Cimentos de Resina/química , Estatísticas não Paramétricas , Propriedades de Superfície , Resistência à TraçãoRESUMO
BACKGROUND: Yellow fever (YF) is a severe, infectious, but non-communicable arboviral hemorrhagic disease. In the last decades, yellow fever virus (YFV) infections have been prevalent in endemic areas in Brazil, affecting human and non-human primate (NHP) populations. Monitoring of NHP infection started in 1999, and reports of epizootic diseases are considered important indicators of viral transmission, particularly in relation to the sylvatic cycle. This study presents the monitoring of YFV by real-time RT-PCR and the epidemiological findings related to the deaths of NHPs in the south-eastern states and in the north-eastern state of Bahia, during the outbreak of YF in Brazil during 2017 and 2018. METHODS: A total of 4198 samples from 2099 NHPs from south-eastern and north-eastern Brazilian states were analyzed by real-time reverse transcription polymerase chain reaction (rtRT-PCR). RESULTS: A total of 4198 samples from 2099 NHPs from south-eastern and north-eastern Brazilian states were collected between 2017 and 2018. The samples were subjected to molecular diagnostics for YFV detection using real-time reverse transcription polymerase chain reaction (rtRT-PCR) techniques. Epizootics were coincident with human YF cases. Furthermore, our results showed that the YF frequency was higher among marmosets (Callithrix sp.) than in previous reports. Viremia in species of the genus Alouatta and Callithrix differed greatly. DISCUSSION: Our results indicate a need for further investigation of the role of Callithrix spp. in the transmission cycles of YFV in Brazil. In particular, YFV transmission was observed in a region where viral circulation has not been recorded for decades and thus vaccination has not been previously recommended. CONCLUSIONS: This highlights the need to straighten epizootic surveillance and evaluate the extent of vaccination programmes in Brazil in previously considered "YFV-free" areas of the country.
Assuntos
Doenças dos Primatas/epidemiologia , Febre Amarela/veterinária , Alouatta/virologia , Animais , Brasil/epidemiologia , Callithrix/virologia , Surtos de Doenças , Humanos , Doenças dos Primatas/transmissão , Doenças dos Primatas/virologia , Febre Amarela/epidemiologia , Febre Amarela/virologia , Zoonoses/epidemiologia , Zoonoses/virologiaRESUMO
This study aimed to evaluate papaya elite lines and hybrids as to fruit physicochemical and sensory characteristics, thus identifying the most promising ones for the market. Fruits from improved genotypes of the Solo group (CMF H10.60, CMF L78, and UC 14) and Formosa group (CMF L10, UC 10, and UC 12) were evaluated, and the commercial cultivars Golden and Tainung nº 1 were used as controls. The following physical and physicochemical evaluations were performed: fruit length and diameter, fruit inner cavity diameter, fruit weight, fruit and pulp firmness, soluble solids, pH, titratable acidity, Ratio (soluble solids and titratable acidit relation), and firmness of peeled and unpeeled ripe fruits. Sensory tests were performed with 50 papaya consumers. In general, the improved genotypes of the Solo and Formosa groups showed similar physical and physicochemical characteristics to the Golden and Tainung n 1 controls. The CMF L78 line of the Solo group and the UC10 hybrid of the Formosa group showed similar fruit firmness and ratio characteristics compared to both commercial cultivars. The three new genotypes in the Solo group showed superior sensory characteristics to the commercial cultivar Golden. The internal preference mapping of this group revealed a higher preference for the genotypes UC 14 and CMF L78, for having fruits with more intense color, stronger flavor, and firmer texture than the others. In the Formosa group, the UC 10 genotype outperformed the cultivar Tainung nº 1, with a global acceptance percentage of 96.15%, due to a more intense aroma, color, and flavor. The CMF L78 line of the Solo group and the UC 10 hybrid of the Formosa group have excellent physicochemical and sensory characteristics and are therefore promising alternatives to replace both commercial cultivars (Golden and Tainung nº 1).(AU)
O objetivo deste trabalho foi avaliar linhagens e híbridos elites de mamoeiro quanto às características físico-químicas e sensoriais de frutos, visando identificar os mais promissores para o mercado. Foram avaliados frutos de genótipos melhorados do grupo Solo (CMF H10.60, CMF L78, UC 14) e do grupo Formosa (CMF L10, UC 10, UC 12), e como testemunhas as variedades comerciais Golden e Tainung nº 1. Foram realizadas as seguintes avaliações físicas e físico-químicas: comprimento e diâmetro do fruto, diâmetro da cavidade interna dos frutos, peso do fruto, firmeza do fruto e da polpa, sólidos solúveis, pH, acidez titulável Ratio (razão entre sólidos solúveis e acidez titulável) e firmeza dos frutos maduros com casca e sem a casca. Os testes sensoriais foram realizados com 50 consumidores de mamão. De uma forma geral, os genótipos melhorados do grupo Solo e Formosa apresentaram características físicas e físico-químicas semelhantes às testemunhas Golden e Tainung nº1. A linhagem CMF L78, do grupo Solo, e o híbrido UC10, do grupo Formosa, apresentaram características de firmeza de fruto e Ratio semelhantes às cultivares comerciais Golden e Tainung nº1. Em relação às características sensoriais dos genótipos do grupo Solo, os três novos genótipos superaram a cultivar comercial Golden. O mapa de preferência interno desse grupo revelou uma maior preferência para os genótipos UC 14 e CMF L78, que foram considerados frutos com cor mais intensa, sabor mais forte e textura mais firme que os demais. No grupo Formosa, o genótipo UC 10 superou a cultivar Tainung n°1, com percentual de aceitação global 96,15% e foi considerado com aroma, cor e sabor mais intensos. A linhagem CMF L78, do grupo Solo, e o híbrido UC 10, do grupo Formosa, apresentam excelentes características físico-químicas e sensoriais e, portanto, são alternativas promissoras para substituir as cultivares comerciais Golden e Tainung n°1.(AU)
Assuntos
Fenômenos Químicos , Carica/química , Carica/crescimento & desenvolvimento , Frutas/química , Frutas/crescimento & desenvolvimento , Melhoramento Vegetal/economiaRESUMO
This study aimed to evaluate papaya elite lines and hybrids as to fruit physicochemical and sensory characteristics, thus identifying the most promising ones for the market. Fruits from improved genotypes of the Solo group (CMF H10.60, CMF L78, and UC 14) and Formosa group (CMF L10, UC 10, and UC 12) were evaluated, and the commercial cultivars Golden and Tainung nº 1 were used as controls. The following physical and physicochemical evaluations were performed: fruit length and diameter, fruit inner cavity diameter, fruit weight, fruit and pulp firmness, soluble solids, pH, titratable acidity, Ratio (soluble solids and titratable acidit relation), and firmness of peeled and unpeeled ripe fruits. Sensory tests were performed with 50 papaya consumers. In general, the improved genotypes of the Solo and Formosa groups showed similar physical and physicochemical characteristics to the Golden and Tainung n 1 controls. The CMF L78 line of the Solo group and the UC10 hybrid of the Formosa group showed similar fruit firmness and ratio characteristics compared to both commercial cultivars. The three new genotypes in the Solo group showed superior sensory characteristics to the commercial cultivar Golden. The internal preference mapping of this group revealed a higher preference for the genotypes UC 14 and CMF L78, for having fruits with more intense color, stronger flavor, and firmer texture than the others. In the Formosa group, the UC 10 genotype outperformed the cultivar Tainung nº 1, with a global acceptance percentage of 96.15%, due to a more intense aroma, color, and flavor. The CMF L78 line of the Solo group and the UC 10 hybrid of the Formosa group have excellent physicochemical and sensory characteristics and are therefore promising alternatives to replace both commercial cultivars (Golden and Tainung nº 1).
O objetivo deste trabalho foi avaliar linhagens e híbridos elites de mamoeiro quanto às características físico-químicas e sensoriais de frutos, visando identificar os mais promissores para o mercado. Foram avaliados frutos de genótipos melhorados do grupo Solo (CMF H10.60, CMF L78, UC 14) e do grupo Formosa (CMF L10, UC 10, UC 12), e como testemunhas as variedades comerciais Golden e Tainung nº 1. Foram realizadas as seguintes avaliações físicas e físico-químicas: comprimento e diâmetro do fruto, diâmetro da cavidade interna dos frutos, peso do fruto, firmeza do fruto e da polpa, sólidos solúveis, pH, acidez titulável Ratio (razão entre sólidos solúveis e acidez titulável) e firmeza dos frutos maduros com casca e sem a casca. Os testes sensoriais foram realizados com 50 consumidores de mamão. De uma forma geral, os genótipos melhorados do grupo Solo e Formosa apresentaram características físicas e físico-químicas semelhantes às testemunhas Golden e Tainung nº1. A linhagem CMF L78, do grupo Solo, e o híbrido UC10, do grupo Formosa, apresentaram características de firmeza de fruto e Ratio semelhantes às cultivares comerciais Golden e Tainung nº1. Em relação às características sensoriais dos genótipos do grupo Solo, os três novos genótipos superaram a cultivar comercial Golden. O mapa de preferência interno desse grupo revelou uma maior preferência para os genótipos UC 14 e CMF L78, que foram considerados frutos com cor mais intensa, sabor mais forte e textura mais firme que os demais. No grupo Formosa, o genótipo UC 10 superou a cultivar Tainung n°1, com percentual de aceitação global 96,15% e foi considerado com aroma, cor e sabor mais intensos. A linhagem CMF L78, do grupo Solo, e o híbrido UC 10, do grupo Formosa, apresentam excelentes características físico-químicas e sensoriais e, portanto, são alternativas promissoras para substituir as cultivares comerciais Golden e Tainung n°1.
Assuntos
Carica/crescimento & desenvolvimento , Carica/química , Fenômenos Químicos , Frutas/crescimento & desenvolvimento , Frutas/química , Melhoramento Vegetal/economiaRESUMO
Abstract This study analyzed the effect of prior application of copaiba oil (CO) emulsions as a dentin cleaning substance on microleakage and microtensile adhesive strength. Twenty-five premolars and sixty-four molars were used for microleakage and microtensile assays. For the microleakage assays, specimens with standard class V cavities were divided (n = 5), according to the tested CO emulsions: CO10%X, CO10%Y, and CO10%Z, as well as chlorhexidine 2% (CHX) and distilled water (DW), as positive and negative controls, respectively. Restorations were performed using the Adper Single Bond® and/or Clearfil SE Bond® systems. Cervical, occlusal, distal and mesial sections were assessed for tracer penetration degree at the composite/tooth interface. For the microtensile assay, healthy molars were divided into sixteen groups, in which artificial caries were induced in half of the groups. Dentin surfaces were treated with CO10%X and CO10%Y, CHX and DW. Microtensile bond strength was measured by fixing each sample to the plate of a universal testing machine operated at a speed of 0.5 mm/minute until failure. Dentin treated with CO10%X showed a lower infiltration rate than dentin treated with the other CO emulsions, CHX2% and DW. According to the microtensile assay, both healthy and affected dentin treated with CO10%X and Adper Single Bond® adhesive system presented higher adhesive strength. CO emulsion, used as a dentin biomodifier, interfered positively in microleakage and improved adhesive strength after acid etching in the Adper Single Bond® adhesive system, or before applying the Clearfil SE Bond® self-etching system.
Assuntos
Humanos , Óleos de Plantas/química , Colagem Dentária/métodos , Adesivos Dentinários/química , Dentina/efeitos dos fármacos , Fabaceae/química , Propriedades de Superfície , Resistência à Tração , Teste de Materiais , Clorexidina/química , Reprodutibilidade dos Testes , Análise de Variância , Estatísticas não Paramétricas , Resinas Compostas/química , Cimentos de Resina/química , Cimentos Dentários/química , Infiltração Dentária , Dentina/química , Emulsões/químicaRESUMO
Abstract This study analyzed the effect of prior application of copaiba oil (CO) emulsions as a dentin cleaning substance on microleakage and microtensile adhesive strength. Twenty-five premolars and sixty-four molars were used for microleakage and microtensile assays. For the microleakage assays, specimens with standard class V cavities were divided (n = 5), according to the tested CO emulsions: CO10%X, CO10%Y, and CO10%Z, as well as chlorhexidine 2% (CHX) and distilled water (DW), as positive and negative controls, respectively. Restorations were performed using the Adper Single Bond® and/or Clearfil SE Bond® systems. Cervical, occlusal, distal and mesial sections were assessed for tracer penetration degree at the composite/tooth interface. For the microtensile assay, healthy molars were divided into sixteen groups, in which artificial caries were induced in half of the groups. Dentin surfaces were treated with CO10%X and CO10%Y, CHX and DW. Microtensile bond strength was measured by fixing each sample to the plate of a universal testing machine operated at a speed of 0.5 mm/minute until failure. Dentin treated with CO10%X showed a lower infiltration rate than dentin treated with the other CO emulsions, CHX2% and DW. According to the microtensile assay, both healthy and affected dentin treated with CO10%X and Adper Single Bond® adhesive system presented higher adhesive strength. CO emulsion, used as a dentin biomodifier, interfered positively in microleakage and improved adhesive strength after acid etching in the Adper Single Bond® adhesive system, or before applying the Clearfil SE Bond® self-etching system.
Assuntos
Humanos , Óleos de Plantas/química , Colagem Dentária/métodos , Adesivos Dentinários/química , Dentina/efeitos dos fármacos , Fabaceae/química , Propriedades de Superfície , Resistência à Tração , Teste de Materiais , Clorexidina/química , Reprodutibilidade dos Testes , Análise de Variância , Estatísticas não Paramétricas , Resinas Compostas/química , Cimentos de Resina/química , Cimentos Dentários/química , Infiltração Dentária , Dentina/química , Emulsões/químicaRESUMO
The hyperendemicity and co-circulation of different dengue serotypes in Brazil have increased the number of severe dengue cases and the rate of hospitalization for dengue. Virological and individual factors are associated with the complexity of the disease. Antigenemia levels of nonstructural glycoprotein-1 (NS1) have been associated with severe dengue. Aiming to identify a severity marker during the acute phase (days 0 to 5 of disease), the association of NS1 antigenemia with clinical presentation, sex, age range, immune response, number of days of disease, and serotype RNA levels was evaluated in serum samples of patients from the state of Rio de Janeiro clinically classified as having dengue without warning signs (DWWS) or dengue with warning signs/severe dengue (DWWS/SD). The immune response was classified by in-house enzyme-linked immunosorbent assay, antigenemia was determined by quantification of NS1, and viremia was quantified by real-time PCR. Of the total number of patients, 36.6% (74 of 202) presented warning signs/severe dengue and 72.3% (146 of 202) were classified with primary infection. DENV-2 presented an association between clinical presentation and antigenemia (P = 0.02). DENV-3 had higher levels of NS1 (P < 0.0001). This study has shown that the infecting serotype influences circulating NS1 levels in the host, as well as NS1 antigenemia may vary as to the clinical presentation of the patient infected with DENV-2. However, the criterion used to screen patients for clinical presentation, in DWWS and DWWS/SD patients, was not a good marker for dengue severity in our study.
Assuntos
Vírus da Dengue/isolamento & purificação , Dengue/patologia , Dengue/virologia , Glicoproteínas/genética , Sorogrupo , Proteínas não Estruturais Virais/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antivirais/sangue , Brasil , Vírus da Dengue/genética , Vírus da Dengue/imunologia , Ensaio de Imunoadsorção Enzimática , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , RNA Viral/sangue , RNA Viral/genética , Reação em Cadeia da Polimerase em Tempo Real , Estudos Retrospectivos , Proteínas não Estruturais Virais/imunologia , Viremia , Adulto JovemRESUMO
This article describes the elements present in medical practice that contribute to understand its acknowledged low adhesion to the guidelines set forth by the Brazilian Primary Health Care (PHC) Policy. The empirical material produced by the two investigations of a qualitative nature led by the research team were put into use. In the first, in interviews involving managers and social control in cities the State of São Paulo, Brazil, physicians (acknowledged as central professionals for the construction of the Brazilian Unified Health System - SUS), are referred to as important assets to explain the difficulties to form a qualified primary health care service: the so-called "villain physicians." In the latter, ethnographic/cartographic research carried out in seven PHC Units in cities of São Paulo, with the use of scenes showing the doctors in action and/or thinking about their jobs, and the health team observing their work, more complex physicians emerge: fragile professionals with a reduced set of instruments to act before the "social factor" that invade their practices, threatened in their autonomy, finding it hard to engage in teamwork, dispossessed of their regulatory functions, and unaware of the space reserved for primary practices: decidedly human physicians - neither heroes nor villains.
O artigo sistematiza e discute elementos presentes na prática médica que contribuam para uma melhor compreensão da sua reconhecida baixa adesão às diretrizes da Política Nacional de Atenção Básica (PNAB). Para tanto, fez uso de material empírico produzido em duas investigações de caráter qualitativo conduzidas pelo mesmo grupo de pesquisa. Na primeira, entrevistas feitas com dirigentes gestores e controle social de dois municípios paulistas, os médicos são apontados como explicação importante para as dificuldades de se construir uma atenção básica qualificada e resolutiva: um "médico vilão". Na segunda, utilizou-se observação direta do cotidiano em sete unidades básicas de saúde em três municípios paulistas, com registros de cenas do médico em ação e/ou quando reflete sobre seu trabalho ou quando observado pela equipe. Emerge assim um médico mais complexo, fragilizado, com instrumental reduzido para atuar perante o "social" que invade seu consultório, ameaçado em sua autonomia profissional, com dificuldade de integrar-se ao trabalho em equipe, expropriado das funções regulatórias e nem sempre com clareza do lugar reservado para a clínica na atenção básica: um médico humano, demasiado humano, nem herói, nem vilão.
Assuntos
Atenção à Saúde/organização & administração , Política de Saúde , Programas Nacionais de Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Brasil , Fidelidade a Diretrizes , Humanos , Entrevistas como Assunto , Médicos/organização & administração , Guias de Prática Clínica como AssuntoRESUMO
Resumo O artigo sistematiza e discute elementos presentes na prática médica que contribuam para uma melhor compreensão da sua reconhecida baixa adesão às diretrizes da Política Nacional de Atenção Básica (PNAB). Para tanto, fez uso de material empírico produzido em duas investigações de caráter qualitativo conduzidas pelo mesmo grupo de pesquisa. Na primeira, entrevistas feitas com dirigentes gestores e controle social de dois municípios paulistas, os médicos são apontados como explicação importante para as dificuldades de se construir uma atenção básica qualificada e resolutiva: um "médico vilão". Na segunda, utilizou-se observação direta do cotidiano em sete unidades básicas de saúde em três municípios paulistas, com registros de cenas do médico em ação e/ou quando reflete sobre seu trabalho ou quando observado pela equipe. Emerge assim um médico mais complexo, fragilizado, com instrumental reduzido para atuar perante o "social" que invade seu consultório, ameaçado em sua autonomia profissional, com dificuldade de integrar-se ao trabalho em equipe, expropriado das funções regulatórias e nem sempre com clareza do lugar reservado para a clínica na atenção básica: um médico humano, demasiado humano, nem herói, nem vilão.
Abstract This article describes the elements present in medical practice that contribute to understand its acknowledged low adhesion to the guidelines set forth by the Brazilian Primary Health Care (PHC) Policy. The empirical material produced by the two investigations of a qualitative nature led by the research team were put into use. In the first, in interviews involving managers and social control in cities the State of São Paulo, Brazil, physicians (acknowledged as central professionals for the construction of the Brazilian Unified Health System - SUS), are referred to as important assets to explain the difficulties to form a qualified primary health care service: the so-called "villain physicians." In the latter, ethnographic/cartographic research carried out in seven PHC Units in cities of São Paulo, with the use of scenes showing the doctors in action and/or thinking about their jobs, and the health team observing their work, more complex physicians emerge: fragile professionals with a reduced set of instruments to act before the "social factor" that invade their practices, threatened in their autonomy, finding it hard to engage in teamwork, dispossessed of their regulatory functions, and unaware of the space reserved for primary practices: decidedly human physicians - neither heroes nor villains.
Assuntos
Humanos , Atenção Primária à Saúde/organização & administração , Atenção à Saúde/organização & administração , Política de Saúde , Programas Nacionais de Saúde/organização & administração , Médicos/organização & administração , Brasil , Entrevistas como Assunto , Guias de Prática Clínica como Assunto , Fidelidade a DiretrizesRESUMO
BACKGROUND: Dengue viruses (DENV) have emerged and reemerged in Brazil in the past 30 years causing explosive epidemics. The disease may range from clinically asymptomatic infections to severe and fatal outcomes. We aimed to describe the epidemiological, clinical and laboratorial aspects of the dengue fatal cases received by a Regional Reference Laboratory, Brazil in 30 years. METHODS: A total of 1047 suspected fatal dengue cases were received from 1986 to 2015 and analyzed in the Laboratory of Flavivirus, FIOCRUZ. Suspected cases were submitted to viral detection, serological and molecular methods for cases confirmation. Influence of gender, age, serotype and type of infection (primary/secondary) on death outcome, as well the interactions between serotype and age or infection and age and type of infection were also studied. RESULTS: A total of 359 cases (34.2%) were confirmed and DENV-1 (11.1%), DENV-2 (43.9%), DENV-3 (32.8%) and DENV-4 (13.7%) were detected. Overall, fatal cases occurred more often in primary infections (59.3%, p = 0.001). However, in 2008, fatal cases were mainly associated to secondary infections (p = 0.003). In 2008 and 2011, deaths were more frequent on children and those infected by DENV-2 presented a higher risk for fatal outcome. Moreover, children with secondary infections had a 4-fold higher risk for death. CONCLUSIONS: Dengue is a multifactorial disease and, factors such as viral strain/serotype, occurrence of secondary infections and co-morbidities may lead to a severe outcome. However, the high dengue incidence and transmission during epidemics, such as those observed in Brazil may overwhelm and collapse the public health services, potentially impacting on increased disease severity and mortality.
Assuntos
Dengue , Brasil/epidemiologia , Dengue/epidemiologia , Dengue/mortalidade , Dengue/virologia , Humanos , Epidemiologia MolecularRESUMO
The dengue virus (DENV), of the genus Flavivirus (Flaviviridae), has four antigenically distinct serotypes, of which DENV-3 is classified into five genotypes. Here, we describe the detection of DENV-3 genotype I in sera of a Brazilian patient travelling from Singapore to Rio de Janeiro, Brazil, by using multiplex real-time RT-PCR, DNA sequencing of the whole envelope protein gene, and phylogenetic analysis. The virus shares ancestry with those identified in Bali, Indonesia, in 2015. It is possible that arboviruses such as Chikungunya ECSA genotype, DENV-4 genotype I, and Zika were introduced in Brazil from other continents during the multiple international events hosted by the country over the last four years, including World Youth Day, the Soccer World Cup, and the Summer Olympics.
Assuntos
Doenças Transmissíveis Importadas/virologia , Vírus da Dengue/genética , Dengue/virologia , Genótipo , Infecção por Zika virus/virologia , Zika virus/genética , Brasil , Vírus da Dengue/isolamento & purificação , Variação Genética , Humanos , Filogenia , Reação em Cadeia da Polimerase , Análise de Sequência de DNA , SorogrupoRESUMO
BACKGROUND: Zika virus (ZIKV) emergence in South America revealed the lack of knowledge regarding clinical manifestations in HIV-infected individuals. OBJECTIVES: We described the clinical characteristics, laboratory manifestations, differential diagnosis, and outcome of ZIKV infection in a large, single-center cohort of HIV-infected patients. METHODS: HIV-infected patients aged 18 years and older with clinical suspected arboviral disease from an ongoing cohort were followed from February 2015 through December 2015. Acute serum samples were tested for ZIKV, dengue virus (DENV), and chikungunya virus by real-time reverse transcriptase polymerase chain reaction, anti-DENV immunoglobulin (Ig)M/IgG, and syphilis assays; convalescent samples were tested for anti-DENV IgM/IgG; and urine samples were tested for ZIKV by real-time reverse transcriptase polymerase chain reaction. ZIKV disease was defined according to the Pan American Health Organization (PAHO) guidelines. RESULTS: Of 101 patients, ZIKV was confirmed in 43 cases and suspected in 34, and another diagnosis was assumed for 24 patients (dengue, secondary/latent syphilis, respiratory infections, human parvovirus B19, adverse drug reaction, musculoskeletal disorders, and acute gastroenteritis). ZIKV-confirmed and ZIKV-suspected patients reported similar signs and symptoms. Pruritic rash was the most common symptom, followed by myalgia, nonpurulent conjunctivitis, arthralgia, prostration, and headache. In the short-term follow-up [median 67.5 days (interquartile range: 32-104.5)], CD4 cell count (Z = -0.831, P = 0.406) and HIV viral load (Z = -0.447, P = 0.655) did not change significantly after ZIKV infection. There were no hospitalizations, complications, or deaths. CONCLUSIONS: Among HIV-infected patients with suspected arboviral disease, 42.6% were ZIKV-infected. CD4 cell counts and HIV viral load were not different after ZIKV infection. Differential diagnosis with other diseases and adverse drug reaction should be evaluated.
Assuntos
Infecções por HIV/complicações , Infecção por Zika virus/diagnóstico , Adulto , Estudos de Coortes , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecção por Zika virus/complicaçõesRESUMO
The burden of arboviruses in the Americas is high and may result in long-term sequelae with infants disabled by Zika virus infection (ZIKV) and arthritis caused by infection with Chikungunya virus (CHIKV). We aimed to identify environmental drivers of arbovirus epidemics to predict where the next epidemics will occur and prioritize municipalities for vector control and eventual vaccination. We screened sera and urine samples (n = 10,459) from residents of 48 municipalities in the state of Rio de Janeiro for CHIKV, dengue virus (DENV), and ZIKV by molecular PCR diagnostics. Further, we assessed the spatial pattern of arbovirus incidence at the municipal and neighborhood scales and the timing of epidemics and major rainfall events. Lab-confirmed cases included 1,717 infections with ZIKV (43.8%) and 2,170 with CHIKV (55.4%) and only 29 (<1%) with DENV. ZIKV incidence was greater in neighborhoods with little access to municipal water infrastructure (r = -0.47, p = 1.2x10-8). CHIKV incidence was weakly correlated with urbanization (r = 0.2, p = 0.02). Rains began in October 2015 and were followed one month later by the largest wave of ZIKV epidemic. ZIKV cases markedly declined in February 2016, which coincided with the start of a CHIKV outbreak. Rainfall predicted ZIKV and CHIKV with a lead time of 3 weeks each time. The association between rainfall and epidemics reflects vector ecology as the larval stages of Aedes aegypti require pools of water to develop. The temporal dynamics of ZIKV and CHIKV may be explained by the shorter incubation period of the viruses in the mosquito vector; 2 days for CHIKV versus 10 days for ZIKV.