56 resultados para Commission for Evaluation of Medical Events


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The exoantigen of Paracoccidioides brasiliensis standardized by Camargo et al. [1] (AgR) was used to evaluate the in vivo and in vitro cell immune response of experimental animals and of patients with paracoccidioidomycosis (PBM). Fava Netto antigen (AgF) was tested in parallel as a control antigen. The study was conducted with mice and guinea pigs infected with P. brasiliensis or immunized with its fungal antigens, on patients with PBM and on their respective control groups. The cell immune response was analysed by skin tests, and by the macrophage and leucocyte migration inhibition tests (MMIT and LMIT) in the animals and in the patients, respectively. The skin test with AgR as paracoccidioidin was positive in infected or immunized mice and guinea pigs and negative in control animals. The skin tests with AgR (24 h) showed 96.7% positivity in patients with PBM and were negative in control individuals. Histopathological study of the in vivo tests in the different experimental models was consistent with a delayed hypersensitivity response (DHR). Immunohistochemical study of the skin tests of PBM patients demonstrated a predominance of T lymphocytes, confirming the nature of a DHR to the fungal antigens. The in vitro cell immune response showed variable results for the various experimental models, i.e. significant rates of MMIT in immunized mice, a tendency to positivity in infected guinea pigs, and the absence of migration inhibition in PBM patients. Taken together, the data indicate that the AgR is efficient as paracoccidioidin in the evaluation of DHR in PBM, with an optimum time of reading the test of 24 h.

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In recent years, many researchers in the field of biomedical sciences have made successful use of mathematical models to study, in a quantitative way, a multitude of phenomena such as those found in disease dynamics, control of physiological systems, optimization of drug therapy, economics of the preventive medicine and many other applications. The availability of good dynamic models have been providing means for simulation and design of novel control strategies in the context of biological events. This work concerns a particular model related to HIV infection dynamics which is used to allow a comparative evaluation of schemes for treatment of AIDS patients. The mathematical model adopted in this work was proposed by Nowak & Bangham, 1996 and describes the dynamics of viral concentration in terms of interaction with CD4 cells and the cytotoxic T lymphocytes, which are responsible for the defense of the organism. Two conceptually distinct techniques for drug therapy are analyzed: Open Loop Treatment, where a priori fixed dosage is prescribed and Closed Loop Treatment, where the doses are adjusted according to results obtained by laboratory analysis. Simulation results show that the Closed Loop Scheme can achieve improved quality of the treatment in terms of reduction in the viral load and quantity of administered drugs, but with the inconvenience related to the necessity of frequent and periodic laboratory analysis.

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Randomly amplified polymorphic DNA (RAPD) analysis of 35 Paracoccidioides brasiliensis isolates was carried out to evaluate the correlation of RAPD profiles with the virulence degree or the type of the clinical manifestations of human paracoccidioidomycosis. The dendrogram presented two main groups sharing 64% genetic similarity. Group A included two isolates from patients with chronic paracoccidioidomycosis; group B comprised the following isolates showing 65% similarity: two non-virulent, six attenuated, five virulent, eight from patients with chronic paracoccidioidomycosis and two from patients with acute paracoccidioidomycosis. The virulent Pb18 isolate and six attenuated or non-virulent samples derived from it were genetically indistinguishable (100% of similarity). Thus, in our study, RAPD patterns could not discriminate among 35 P. brasiliensis isolates according to their differences either in the degree of virulence or in the type of the clinical manifestation of this fungal infection. © 2002 Federation of European Microbiological Societies. Published by Elsevier Science B.V. All rights reserved.

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Objective: The goal of the present study was to evaluate the microleakage on the cementum/dentin and enamel surfaces in Class II restorations, using different kinds of resin composite (microhybrid, flowable, and compactable). Method and materials: Forty human caries-free molars were extracted and selected. Eighty Class II standardized cavities were made in the cervical wall at the cementoenamel junction (CEJ) and at the mesial and distal surfaces. The teeth were divided into four groups: G1 - adhesive system + microhybrid resin composite Z100; G2 - adhesive system + compactable resin composite Prodigy Condensable; G3 - adhesive system + flowable resin composite Revolution + Z100 resin composite; G4 - adhesive system + Revolution fluid resin + compactable resin composite Prodigy Condensable. The adhesive system used in this study was Scotchbond Multi-Purpose Plus. The specimens were thermocycled in baths of 5°C and 55°C for 1,000 cycles and immersed in 50% silver nitrate solution. The specimens then were sectioned and evaluated on degree of dye penetration. Results: The results were evaluated using the nonparametric Kruskall-Wallis test, which showed a statistically significant difference between groups G1 and G4, G2 and G4, and G3 and G4. Conclusions: None of the materials was able to eliminate the marginal microleakage at the cervical wall; the application of a low-viscosity resin composite combined with a compactable resin composite significantly decreased the microleakage.

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A crude aqueous extract of the leaves of the guava tree, Psidium guajava L. (Myrtaceae), were studied for antidiarrhoeal effects, to place one of its traditional medical uses. The extract induced a decrease in the propulsive movements of the intestinal contents in mice. These findings suggested that an aqueous extract of guava leaves may be used as an effective treatment for non-specific diarrhoea in folk medicine.

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The purpose of this study was to assess the influence of cleaning pits and fissures with an aluminum oxide air abrasion system on the detection of occlusal caries in primary teeth using laser fluorescence (LF) and visual examination. Methods: The sample comprised 65 pit and fissure sites on extracted primary teeth suspected to be carious. The sites were submitted to 2 visual examinations (examiner JAR) and 2 LF readings (examiner TMV). Next, the occlusal surfaces were air-abraded and re-examined thereafter using both methods. The teeth were sectioned, and the histological analysis of the sites with a stereoscopic magnifying lens at X32 magnifi cation was used as the gold standard. Results: Cohen's kappa statistic for LF and visual examination were, respectively, 0.282/0.884 before and 0.896/0.905 after air abrasion. LF showed a sensitivity of 0.28 increasing to 0.49 and a specifi city of 0.50 increasing to 0.92. Visual examination showed sensitivity of 0.78 and specifi city of 0.73. Both increased after air abrasion. Conclusion: The findings suggest that cleaning pits and fissures with aluminum oxide air abrasion increased the accuracy of LF and visual examination for detection of occlusal caries in primary teeth.

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The aim of this study was to evaluate the Shore A hardness and color stability of two soft lining materials after thermocycling and when chemical polishing was used or omitted. Two acrylic-based soft lining materials were tested: Coe-Soft and Soft Confort, 14 specimens were made for each material. They were distributed in four groups according to the treatment performed. The specimens were thermocycled (1000 cycles) and half of the group submitted to chemical polishing (methyl methacrylate). Shore A hardness was determined and color stability was calculated by means of Commission International de l'Eclairage Lab uniform color scale using a spectrophotometer, the measurements were made immediately after deflasked, chemical polishing and thermocycling. Analysis of variance (ANOVA) and Tukey's tests were performed at p < 0.01. Color changes (deltaE) were observed after thermocycling in both soft lining materials: Soft Confort (10.60) showed significantly higher values than Coe-Soft (4.57). Coe-Soft (26.42) showed higher Shore A hardness values than Soft Confort (19.42). Chemical polishing did not influence in the color stability of both materials; however, influenced in the hardness values of Coe-Soft.

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A porous material for bone ingrowth with adequate pore structure and appropriate mechanical properties has long been sought as the ideal bone-implant interface. This study aimed to assess in vivo the influence of three types of porous titanium implant on the new bone ingrowth. The implants were produced by means of a powder metallurgy technique with different porosities and pore sizes: Group 1 = 30% and 180 μm; Group 2 = 30% and 300 μm; and Group 3 = 40% and 180 μm. Six rabbits received one implant of each type in the right and left tibiae and were sacrificed 8 weeks after surgery for histological and histomor-phometric analyses. Histological analysis confirmed new bone in contact with the implant, formed in direction of pores. Histomorphometric evaluation demonstrated that the new bone formation was statistically significantly lower in the group G1 than in group G3, (P = 0.023). Based on these results, increased porosity and pore size were concluded to have a positive effect on the amount of bone ingrowth.

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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Background: Studies with Doppler ultrassonography started at the end of the 90s for the determination of physiological and pathological alterations in the reproductive tract of the mare. Uterine alterations caused by inflammation, response from seminal plasma infusion, hormonal variations during estrous and diestrus, pregnancy and action of various vasoactive factors influence on the vascular perfusion detected by Doppler ultrasound. The development of efficient methods for uterine quality evaluation is of big importance for field equine reproduction veterinarians, once uterine environment is responsible for pregnancy maintenance. Review: Nowadays, the most used methods of uterine evaluation are the mode B ultrassonography, cytology, culture and biopsy. Hemodynamic evaluation of the uterus can be done by spectral data collected from large vessels, as A. uterine and its ramifications, or from subjective or objective evaluations from endometrium, miometrium and mesometrium attachment, which provide data referent to local and specific alterations of the evaluated area. Alterations in uterine vascular perfusion has been detected during estrous cycle, during pregnancy and in cases of infusion of inflammatory substances. These alterations happen because of vasoactive substances that act in the uterus during these events, however, most of these vasoactive substances are probably not even known. Also, important hemodynamic alterations in old mares, as an increase in vascular resistance, have been described. This increase might result from fibrosis of the uterus and in women it is considered to be a cause of infertility. In mares, periglandular fibrosis of the endometrium is considered to be the major diagnosable cause of embryonic and fetal loss in older mares. For the CL, ovarian artery of the mare supplies the ovary as well as the oviduct and therefore can be used for evaluation of these areas. The CL evaluation can also be done by the percentage of luteum area with colored signals as an indicator of the extent of blood flow. The percentage of the CL area with colored signals is determined subjectively by images observations in real time and/or by a freezing Power Doppler cross-section image with the maximum number of color pixels taped and the total number of color pixels is assessed by a computer analysis system. Therefore, a high correlation between plasmatic progesterone and CL vascularization also allows the CL evalution by this technique. In a first report, CL circulation reached its maximum on D5, the progesterone concentration in peripheral blood increased until D7 and in a posterior report, maximum perfusion was achieved two days after the maximum progesterone concentration (D8). Blood flow reduced between D10-D14 some days before the plasma progesterone decrease and, during the luteolytic period (D15-D17), the decline in CL blood-flow area was greater than blood flow decrease. Conclusion: Doppler ultrassonography add knowledge about uterine viability and CL functionality can be easily used by veterinarians in the field. It is a noninvasive method that provides real time results. However, because of the short time studies in this area have been done, many other answers still need to be found until normal and pathological patterns will be established.

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This investigation was carried out within São Paulo State, Brazil, and involved the sampling of well-known mineral bottled waters for performing a comparative hydrochemical study and of a spring occurring at Corumbataí city, in order to evaluate its suitability for bottling. Several methods were utilized for acquiring the hydrochemical data like the methyl orange end-point titration, potentiometry, ion selective electrode, colorimetry, flame photometry and inductively-coupled plasma spectrometry. The results obtained for the analyzed samples were compared with the guideline values established by the National Commission of Rules and Standards for Food of the Brazilian Health Ministry published in 1976. The Brazilian Code for Mineral Waters that was established by Register 7841 published on 8 August 1945 was also taken into account for verifying if the spring waters are mineralized. The hydrochemical data allowed identify some constituents impoverishing the water quality, thus, implying on its nonutilization for commercial purposes (bottling). In one specific case, the spring water only can become appropriate for human consumption after previous chemical treatment. © 201 WIT Press.

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This study investigated the effect of low-level laser therapy (LLLT) on the masticatory performance (MP), pressure pain threshold (PPT), and pain intensity in patients with myofascial pain. Twenty-one subjects, with myofascial pain according to Research Diagnostic Criteria/temporomandibular dysfunction, were divided into laser group (n = 12) and placebo group (n = 9) to receive laser therapy (active or placebo) two times per week for 4 weeks. The measured variables were: (1) MP by analysis of the geometric mean diameter (GMD) of the chewed particles using Optocal test material, (2) PPT by a pressure algometer, and (3) pain intensity by the visual analog scale (VAS). Measurements of MP and PPT were obtained at three time points: baseline, at the end of treatment with low-level laser and 30 days after (follow-up). VAS was measured at the same times as above and weekly throughout the laser therapy. The Friedman test was used at a significance level of 5 % for data analysis. The study was approved by the Ethics Committee of the Federal University of Sergipe (CAAE: 0025.0.107.000-10). A reduction in the GMD of crushed particles (p < 0.01) and an increase in PPT (p < 0.05) were seen only in the laser group when comparing the baseline and end-of-treatment values. Both groups showed a decrease in pain intensity at the end of treatment. LLLT promoted an improvement in MP and PPT of the masticatory muscles. © 2012 Springer-Verlag London.

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The Brazilian public health system requires competent professionals sensitive to the needs of the population. The Foundation for Advancement of International Medical Education and Research (FAIMER) provides a two-year faculty development programme for health professions educators, aiming to build leadership in education to improve health. A partnership with governmental initiatives and FAIMER was established for meeting these needs. This paper describes the initial process evaluation results of the Brazilian FAIMER Institute Fellowship (FAIMER BR). Methods: Data were analysed for the classes 2007-2010 regarding: application processes; innovation project themes; retrospective post-pre self-ratings of knowledge acquisition; and professional development portfolios. Results: Seventeen of 26 Brazilian states were represented among 98 Fellows, predominantly from public medical schools (75.5%) and schools awarded Ministry of Health grants to align education with public health services (89.8%). One-third (n = 32) of Fellows' innovation projects were related to these grants. Significant increases occurred in all topic subscales on self-report of knowledge acquisition (eff ect sizes, 1.21-2.77). In the follow up questionnaire, 63% of Fellows reported that their projects were incorporated into the curriculum or institutional policies. The majority reported that the programme deepened their knowledge (98%), provided new ideas about medical education (90%) and provided skills for conflict management (63%). One-half of the Fellows reported sustained benefits from the programme listserv and other communications, including breadth of expertise, establishment of research collaboration and receiving emotional support. Conclusion: Contributors to initial programme success included alignment of curriculum with governmental initiatives, curriculum design merging educational technology, leadership and management skills and central role of an innovation educational project responding to local needs.

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The daily-to-day of medical practice is marked by a constant search for an accurate diagnosis and therapeutic assessment. For this purpose the doctor serves up a wide variety of imaging techniques, however, the methods using ionizing radiation still the most widely used because it is considered cheaper and above all very efficient when used with control and quality. The optimization of the risk-benefit ratio is considered a major breakthrough in relation to conventional radiology, though this is not the reality of computing and digital radiology, where Brazil has not established standards and protocols for this purpose. This work aims to optimize computational chest radiographs (anterior-posterior projection-AP). To achieve this objective were used a homogeneous phantoms that simulate the characteristics of absorption and scattering of radiation close to the chest of a patient standard. Another factor studied was the subjective evaluation of image quality, carried out by visual grading assessment (VGA) by specialists in radiology, using an anthropomorphic phantom to identify the best image for a particular pathology (fracture or pneumonia). Quantifying the corresponding images indicated by the radiologist was performed from the quantification of physical parameters (Detective Quantum Efficiency - DQE, Modulation Transfer Function - MTF and Noise Power Spectrum - NPS) using the software MatLab®. © 2013 Springer-Verlag.

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Breast implants are medical devices that are used to augment breast size or to reconstruct the breast following mastectomy or to correct a congenital abnormality. Breast implants consist of a silicone outer shell and a filler (most commonly silicone gel or saline). Approximately 5 to 10 million women worldwide have breast implants. Histomorphometric study to evaluate the biological tissue compatibility of silicone implants suitable for plastic surgery and the adverse effects and risks of this material. Thirty Wistar white rats received subcutaneous implants and the revestiment of silicone gel Silimed ®®, and randomized into six groups of five animals each, according to the type of implanted material and the time of sacrifice. Eight areas of 60.11mm2 corresponding to the obtained surgical pieces were analyzed, counting mesenchymal cells, eosinophils, and foreign body giant cells, observing an acceptable biocompatibility in all implants, for subsequent statistical analysis by Tukey test. Silicone gel showed inflammation slightly greater than for other groups, with tissue reactions varying from light to moderate, whose result was the formation of a fibrous capsule around the material, recognized by the organism as a foreign body. Despite frequent local complications and adverse outcomes, this research showed that the silicone and top layer presented an acceptable chronic inflammatory reaction, which did not significantly differ from the control group. In general, it is possible to affirm that silicone gel had acceptable levels of biocompatibility, confirmed the rare presence of foreign body giant cells, and when of the rupture, formed a fibrous capsule around the material, separating the material of the organism. © AVICENA 2013.