Avaliação de métodos de triagem e de detecção fenotípica de ß-lactamase de espectro ampliado (ESBL)

The catalytic function of extended-spectrum β-lactamases can result in high degrees of bacterial resistance to β-lactamic antimicrobials and in the emergence of ESBL among the members of Enterobacteriaceae family, especially Klebsiella pneumoniae and Escherichia coli. This occurs due to the dissemination and emergence of new variants of these enzymes caused by the high utilization of antibiotics like broad-spectrum cephalosporins. The ESBL are β-lactamases capable of conferring bacterial resistance to the penicillins, 1st, 2nd and 3rd generation cephalosporins, and aztreonam (but not cephamycins and carbapenems) through the hydrolysis of these antibiotics. In view of this phenomenon, the exact screening and detection of the producers of ESBL are essential for the appropriate selection of the antimicrobial therapy. The purposes of this study were to evaluate the best antimicrobial for the selection of ESBL producers and to determine the best method for the detection of such microorganisms. We evaluated 200 sequential bacterial samples including the species Klebsiella pneumoniae (56.5%), Escherichia coli (34%), Proteus mirabilis (8.5%) and Klebsiella oxytoca (1%), previously characterized as ESBL producers between February and September 2008 in the Laboratory of Microbiology, Botucatu Medical School - UNESP, Botucatu, São Paulo State, Brazil. To select the ESBL-producer bacteria, we used the disks recommended by CLSI 2008, aztreonam (ATM), cefpodoxime (CPD), ceftriaxone (CRO), cefotaxime (CTX) and ceftazidime (CAZ), besides cefepime (FEP). ESBL production was confirmed by three methods: double disk screening, ESBL Etest®, and Vitek® automated system. The disks employed in the double disk screening were: penicillin associated with β-lactamase inhibitor, amoxicillin-clavulanic acid, and two β-lactamic antibiotics, ceftazidime and cefotaxime...(Complete abstract click electronic access below)

Articulação temporomandibular: anatomia, dinâmica e disfunções temporomandibulares

This study gathered some of the most relevant researches already undertaken regarding the Temporomandibular Joint, presenting descriptions of its anatomy and dynamics, and relating them to the main aspects of joint dysfunctions. Literature recognizes that the Temporomandibular Joint, responsible for lower jaw movements, comprehends the skull base and the jaw bone. Its anatomy and dynamics are of great importance in order to understand the functions of Stomatognathic System as well as to study Temporomandibular Joint Dysfunction. The elements that compose this synovial joint and the bilateral characteristic confer eminent importance to the ATM before the skeleton head, the ability to perform broad movements and high complexity in its operation. It is accepted that the overload of one anatomical structure from the TMJ or other components of the Stomatognathic System leads to Temporomandibular Joint Dysfunctions. These disorders have different etiologies, ranging from malocclusion to emotional stress, and various forms of treatment, which are related in this study

Efectos de los aparatos propulsores mandibulares fijos en la articulación temporomandibular

Fixed mandibular propulsion appliances are an alternative for the treatment of Class II malocclusion in individuals with mandibular deficiency. Since they are fixed appliances, said devices keep the mandible in an anterior-forced position during rest and during all mandibular functions. When a propulsive appliance is used, the lower jaw is displaced forward and downward. This movement leads to a new position of the condyle, which can, ultimately affect the normal functioning of the temporomandibular joint (TMJ). The aim of this paper was to review effects of fixed mandibular propulsive appliance on TMJ. Inclusion criteria considered studies on animals or humans using TMJ radiography, computed tomography, and magnetic resonance imaging. Studies confirm a favorable relation between condyle and glenoid fossa following treatment with fixed mandibular propulsion appliances.

Influencia dos hábitos de sucção na manifestação de dor temporo-mandibular: revisão sistemática

Objective: To assess the attitudes and knowledge about hepatitis by scholars and dental practitioners from Recife and its metropolitan region. Method: The research protocol was submitted and approved by the Ethics and Human Research Committee of the Federal University of Pernambuco. There were included 230 undergraduate students in dentistry and 104 dentists who exercise their professional activity in Recife and its Metropolitan Region. They signed a consent form and answered a questionnaire, the evaluative instrument, with objective questions about biosafety, transmission of hepatitis and sexually transmitted diseases. Results: About the types of hepatitis 133 (57.8%) students and 61 (58.7%) professionals claimed to know the types A, B and C. Concerning transmission 31 (13.5%) students and 25 (24.0%) professionals said that the main route of transmission were sexual and bloodstream respectively. Relating to imunization 221 (96.1%) students and 99 (95.2%) professionals reported that have been vaccinated against hepatitis B, however, only 126 (54.8%) students and 55 (52.9%) professionals have followed the immunization’s schema. Regarding the cleaning of the office equipment, 18.7% of the students replied that they do not know who does it. 56.7% of professionals said that it was performed with alcohol 70 ° GL.Conclusions: The findings indicate that there is a concern for biosafety but the knowledge about the forms of hepatitis transmission and biosecurity measures need to be better settled.

Uso de hialuronidato de sódio para tratamento de deslocamento anterior de disco articular com travamento bucal

Temporomandibular joint disorders causing limitation of mouth opening and pain may be related to the restriction of slipping or forward displacement of the mandibular condyle. Temporomandibluar arthrocentesis is the lavage of the joint and is regarded as a simple method that produces good results in patients with these symptoms. This article reports a case of disc displacement and closed lock in a patient who reported limited mouth opening and pain as the main symptoms. The treatment proposed was arthrocentesis and lavage, combining a corticosteroid with a sodium hyaluronate solution. It is concluded that arthrocentesis is a simple, efficient and barely invasive method for particular types of temporomandibular joint disorders and should be considered before opting for more invasive surgical procedures.

Dor orofacial e qualidade de vida de adultos

To determine the prevalence and intensity of orofacial pain in adults that participated in a health program at Ribeirão Preto. Methodology: The study was conducted by a self-administered questionnaire, with 19 questions in 99 people aged 18 to 66 years. The method used for data collection was the index Oral Impacton Daily Performances (OIDP), which evaluated the six months preceding the survey, pain experiences in the mouth, teeth or dentures and how these factors interfere with daily activities. Statistical analysis was performed using Epi Info version 3.4. Results: The majority of the adults who participated in this survey (52.5%) reported having an excellent or good oral health, reported having problems with their teeth (60.6%), no problems with the gums (77.8%), no bad taste in mouth (77.8%) or bad breath (77.8%). Among the participants of the study, 56.6% felt orofacial pain in the last six months and the pain were more frequently caused by cold or hot liquids (30.3%), spontaneous pain (17.2%), during the mouth opening (17.2%), pain in the face (13.1%) and ATM (13.1%). Regarding the severity rate, the highest proportion varied from mild to moderate. Conclusions: Even observing a low severity of orofacial pain, its prevalence was high, which probably has a negative effect on life quality of these people.

Responsabilidade do profissional da saúde no esclarecimento equivocado do paciente para obter o seu consentimento livre e esclarecido

Ao paciente é necessário fornecer esclarecimentos sobre as possibilidades terapêuticas, apresentando os riscos, benefícios, prognóstico e custos de cada alternativa possível e indicada. Esta é uma determinação ética e jurídica. Não obstante, o profissional da saúde detém o conhecimento clínico/técnico/científico, e determina quais informações serão (ou não) fornecidas. O paciente decide submeter-se a um tratamento, fornecendo o seu Consentimento Livre e Esclarecido com base nos dados a ele apresentados. Infelizmente, pode ocorrer de alguns profissionais não fornecerem todas as informações necessárias a uma tomada de decisão esclarecida ou, depois de obtido o consentimento do paciente, apresentarem-lhe informação que cause sua desistência do tratamento inicialmente aceito. Esta última informação, se pertinente, e não se tratando de fato superveniente, deveria ter sido fornecida inicialmente. Porém, a informação pode não ser de todo verdadeira, e levar o paciente a decidir baseado, por exemplo, em riscos apresentados e mensurados de forma equivocada. A reabilitação crânio-facial da Articulação Têmporo-Mandibular (ATM), por meio de prótese de ATM, é indicada em muitas situações. Amiúde, pacientes que necessitam de tais próteses apresentam problemas funcionais e estéticos; a expectativa gerada com a reabilitação é grande. Este trabalho apresenta um caso e discute questões éticas e legais, incluindo a responsabilidade civil, do fornecimento parcial e inadequado de esclarecimentos a um paciente.

Prevalência de alterações locais e sistêmicas em indivíduos com disfunção temporomandibular

Temporomandibular disorder describes a variety of conditions including joint and muscle in the stomatognathic system, characterized by pain, TMJ sounds, functions irregular jaw and represent the leading cause of nondental pain in the orofacial region. The objective of this research was to evaluate the prevalence of ophthalmological, otological and cognitive-behavioral changes, parafunctional habits in individuals with temporomandibular disorders (TMD). A total of 117 medical records of female and male individuals, aged 18 to 60 years, from the Occlusion, Temporomandibular Dysfunction and Orofacial Pain of the Ribeirão Preto School of Dentistry – USP, between 2010 and 2011. The anamnesis index proposed by Helkimo was used to classify the individuals according to TMD severity degree and to divide them into two groups: AiI (mild to moderate) with 69 individuals and AiII (severe) with 48 individuals. The groups were then subdivided with respect to gender (72.64% female and 27.36% male) and age. There was predominance in the 18-40 year age group (60.68%) when compared to the 41-60 year age group (39.32%). Data were collected through an interview with questions about the presence of parafunctional habits, otological, ophthalmological and behavioral changes. Data were subjected to the statistical analysis using the Kruskal-Wallis test. The prevalence of each change was also evaluated. The results showed statistically significant for all groups according to gender, age and degree of severity. Individuals with temporomandibular disorders exhibited high prevalence of systemic and local dysfunctions.

Estimation of lower flammability limits of C-H compounds in air at atmospheric pressure, evaluation of temperature dependence and diluent effect

Estimation of the lower flammability limits of C-H compounds at 25 degrees C and 1 atm; at moderate temperatures and in presence of diluent was the objective of this study. A set of 120 degrees C H compounds was divided into a correlation set and a prediction set of 60 compounds each. The absolute average relative error for the total set was 7.89%; for the correlation set, it was 6.09%; and for the prediction set it was 9.68%. However, it was shown that by considering different sources of experimental data the values were reduced to 6.5% for the prediction set and to 6.29% for the total set. The method showed consistency with Le Chatelier's law for binary mixtures of C H compounds. When tested for a temperature range from 5 degrees C to 100 degrees C , the absolute average relative errors were 2.41% for methane; 4.78% for propane; 0.29% for iso-butane and 3.86% for propylene. When nitrogen was added, the absolute average relative errors were 2.48% for methane; 5.13% for propane; 0.11% for iso-butane and 0.15% for propylene. When carbon dioxide was added, the absolute relative errors were 1.80% for methane; 5.38% for propane; 0.86% for iso-butane and 1.06% for propylene. (C) 2014 Elsevier B.V. All rights reserved.

Monte Carlo simulation of water-tetrahydrofuran mixtures

Monte Carlo simulations of water-tetrahydrofuran (THF) mixtures were performed in the isothermal-isobaric ensemble (NPT) at T = 298 K and p = 1 atm. The interaction energy was calculated using the TIP4P model for water and a five-site united atom representation for the THF molecule. The potential energy surfaces for water-THF interactions were obtained by using combining rules and the original potential functions used for pure liquids. Theoretical values obtained for the average interaction energy as a function of concentration are in good agreement with available experimental data. Results from the partitioning of the total interaction energy into water-water, water-THF and THF-THF contributions are presented. These results are useful to distinguish between the quantitative contributions of these molecular interactions to the energetic behavior of the water-THF mixing process. The radial distribution functions for HW-OTHF and OW-OTHF site-site interactions show the salient features of hydrogen-bonded liquids. Comparison of the average number of water-water complexes interacting through hydrogen bonding in water-THF and water-methanol mixtures shows an enhancement of the water-water coordination number in a THF rich environment. © 1995.

Análise estrutural de aerogéis via espalhamento de luz a baixo ângulo

The sol-gel process is a method for obtaining vitreous or vitro-ceramic materials which, are prepared a sol and by drying the liquid phase. This technique has been used extensively for the preparation of glassy gels, films, fibers and particles from the hydrolysis and polycondensation reactions of metal alkoxides. The usual methods for drying are: evaporation drying (xerogels), freeze drying (criogéis) and via supercritical CO2 extraction (aerogels). In the present work, we studied the preparation of silica gels by the sol-gel process from the hydrolysis of alkoxides tetraethylorthosilicate (TEOS) and 3-glycidoxypropyltrimethoxysilane (GPTS). The hydrolysis was promoted from GPTS and TEOS in proportion (4: 1) under acidic conditions. The hydrolysis reaction was promoted inside a Becker at room temperature. After hydrolyses the prepared sol had pH 2, and kept under mechanical agitation for a period of 1 hour. In order to accelerate the polycondensation reaction, the pH was corrected to a value near 5 by slowly adding NH4OH. Then the sols were leaked in sealed polycarbonate containers and maintained for 20 days at 40°C for gelation. Silica aerogels were prepared via supercritical CO2 extraction of the wet gel at temperature and pressure higher than 31°C and 74 atm, in an autoclave specially developed for the process. The structural characteristics were studied in the dry gel (aerogel). Aerogels were then characterized by nitrogen adsorption and small angle light scattering. The nitrogen adsorption data were analyzed for the determination of the BET specific surface (SBET), the total pore volume Vp, the pore mean size (lP=4Vp/SBET), the particle mean size (lS) and the pore size distribution (PSD). And the data from small angle light scattering were analyzed to determine the correlation function (γ'), the area per unit volume (S/V), average pore size (l ) and the average particle size...

Acupuntura em disfunção temporomandibular: relato de caso clínico

A técnica milenar da Acupuntura vem sendo empregada na Odontologia e obtendo bons resultados em diversas situações. Analgesia, relaxamento muscular e inflamação vêm sendo controlados, demonstrando assim conexão entre Acupuntura e redução de certas sintomatologias. As reações locais e à distância necessitam de correto posicionamento das agulhas assim como integridade do sistema nervoso, e são decorrentes da liberação de neurotransmissores (noradrenalina, acetilcolina, serotoninas e dopamina). Dentro da Odontologia, podemos nos utilizar dos seus efeitos no pré e pós operatório, em xerostomia, cefaléias, trismos, disfunção de ATM por estresse, parestesias, paresias, ansiedade, entre outras condições. Nos casos de disfunção de Articulação Temporomandibular por hiperatividade muscular, podemos utilizar a Acupuntura ao invés de relaxante muscular e antiinflamatório. Nesse trabalho, apresentaremos um caso clínico (paciente MCH, 23 anos, gênero feminino), a qual apresentava crises de dor de cabeça (região temporal), fazendo uso constante de medicação analgésica e antiinflamatória, o diagnóstico estabelecido foi Dor Muscular Local associado à hiperatividade muscular. Através do uso da Acupuntura, após aplicações semanais por 3 meses, houve remissão da dor por completo.

Prótese total imediata: relato de caso clínico

The immediate complete denture is defined as a removable or partial denture made to be installed immediately after the extraction of the natural teeth. This type of prosthesis can be used for a short period of time, for aesthetic reasons, mastication, occlusal support, convenience or for the adaptation of the patients to the edentulous state, until the final prosthesis is installed. The objective of this study was to report a surgical and prosthetic rehabilitation planning of a patient by means of an immediate complete maxillary denture, and the results obtained with this treatment modality. The immediate complete denture is a necessary, well-established, useful and effective prosthetic procedure for patients who, inevitably, will present an edentulous state, despite it is a slightly more expensive and it requires more sessions for adjust

Reabilitação total bimaxilar e o restabelecimento da tríade: função, fonética e estética

O tratamento de indivíduos totalmente desdentados, desde os primórdios dos conceitos e fundamentos da reabilita-ção oral, tem sido um grande desafio para os profissionais da odontologia, especialmente em relação à retenção, suporte e estabilidade das próteses totais. Esses pré-requisitos protéticos estão geralmente deficientes em pacientes que apresentam um longo período de desdentamento, com grande atrofia e reabsor-ção dos rebordos alveolares, especialmente no arco mandibular. Com o advento da implantodontia e com a evolução sequencial dos estudos envolvendo o processo de osseointegração essa filosofia se tornou otimizada pelas próteses totais fixas implantossuportadas, denominadas próteses protocolo, repre-sentando uma modalidade clinicamente previsível no âmbito da dontologia moderna. Com base nessa premissa, o objetivo do presente trabalho é elucidar a sequência clínica de uma reabilitação total bimaxilar, conjugando-se uma prótese total convencional superior e uma prótese protocolo inferior.