Sistema de recomenda����o �� preven����o odontol��gica, ortodontia e higiene oral

A tecnologia est�� em constante evolu����o e os benef��cios, em diversas ��reas, que ela nos traz s��o imensos. Uma das ��reas que tem vindo a usufruir desta evolu����o �� a medicina. Os avan��os na tecnologia m��dica t��m permitido aos m��dicos diagnosticar e tratar melhor os seus pacientes. O seu objetivo n��o �� substituir o m��dico mas sim aconselh��-los e ajud��-los a tomar a melhor decis��o face ao caso cl��nico que possam ter em m��os. Os sistemas de informa����o est��o j�� t��o ���entrela��ados��� com as pr��ticas m��dicas que a ideia de uma institui����o de presta����o de cuidados m��dicos n��o os possuir �� impens��vel. Isto porque a informa����o que estes sistemas processam diariamente �� imensa e variad��ssima (indo desde relat��rios cl��nicos, a exames efetuados entre outros) para cada utente. As doen��as orais fazem parte do grupo de patologias que afetam o maior n��mero de pessoas no mundo. As a����es preventivas para estes sintomas devem fazer parte da higiene di��ria dos indiv��duos logo desde os primeiros anos de vida. Assim a aplica����o apresentada nesta tese teve como objetivo a sensibiliza����o para uma pr��tica de higiene oral cuidada e constante. Teve tamb��m como objetivo a implementa����o de funcionalidades para gest��o de dados dos pacientes da cl��nica, nomeadamente para o hist��rico cl��nico, ficando este armazenado numa anamnese. Para a implementa����o do presente projeto procedeu-se a um estudo pr��vio do estado da arte e ao levantamento de requisitos. Estes foram definidos atrav��s de reuni��es de trabalho onde se analisou as necessidades da cl��nica com o objetivo de encontrar as solu����es que melhor se enquadravam a cada caso. Para garantir que as metas propostas foram alcan��adas, foram realizados inqu��ritos verificando assim o sucesso da aplica����o.

Enterobacteriaceae ISOLATES FROM THE ORAL CAVITY OF WORKERS IN A BRAZILIAN ONCOLOGY HOSPITAL

The evaluation of workers as potential reservoirs and disseminators of pathogenic bacteria has been described as a strategy for the prevention and control of healthcare-associated infections (HAIs). The aim of this study was to evaluate the presence of Enterobacteriaceae in the oral cavity of workers at an oncology hospital in the Midwest region of Brazil, as well as to characterize the phenotypic profile of the isolates. Saliva samples of 294 workers from the hospital’s healthcare and support teams were collected. Microbiological procedures were performed according to standard techniques. Among the participants, 55 (18.7%) were colonized by Enterobacteriaceae in the oral cavity. A total of 64 bacteria were isolated, including potentially pathogenic species. The most prevalent species was Enterobacter gergoviae (17.2%). The highest rates of resistance were observed for β-lactams, and 48.4% of the isolates were considered multiresistant. Regarding the enterobacteria isolated, the production of ESBL and KPC was negative. Nevertheless, among the 43 isolates of the CESP group, 51.2% were considered AmpC β-lactamase producers by induction, and 48.8% were hyper-producing mutants. The significant prevalence of carriers of Enterobacteriaceae and the phenotypic profile of the isolates represents a concern, especially due to the multiresistance and production of AmpC β-lactamases.

ROTAVIRUS GENOTYPES CIRCULATING IN BRAZIL, 2007-2012: IMPLICATIONS FOR THE VACCINE PROGRAM

SUMMARY Regarding public health in Brazil, a new scenario emerged with the establishment of universal rotavirus (RV) vaccination programs. Herein, the data from the five years of surveillance (2007-2012) of G- and P-type RV strains isolated from individuals with acute gastroenteritis in Brazil are reported. A total of 6,196 fecal specimens were investigated by ELISA and RT-PCR. RVs were detected in 19.1% (1,181/6,196). The peak of RV incidence moved from June-August to September. RV was detected less frequently (19.5%) among children ≤ 5 years than in older children and adolescents (6-18 years) (40.6%). Genotype distribution showed a different profile for each year: G2P[4] strains were most prevalent during 2007-2010, G9P[8] in 2011, and G12P[8] in 2012. Mixed infections (G1+G2P[4], G2+G3P[4]+P[8], G2+G12P[8]), unusual combinations (G1P[4], G2P[6]), and rare strains (G3P[3]) were also identified throughout the study period. Widespread vaccination may alter the RV seasonal pattern. The finding of RV disease affecting older children and adolescents after vaccine implementation has been reported worldwide. G2P[4] emergence most likely follows a global trend seemingly unrelated to vaccination, and G12, apparently, is emerging in the Brazilian population. The rapidly changing RV genotype patterns detected during this study illustrate a dynamic population of co-circulating wildtype RVs in Brazil.

RELATED FACTORS FOR COLONIZATION BY Candida SPECIES IN THE ORAL CAVITY OF HIV-INFECTED INDIVIDUALS

The colonization of the oral cavity is a prerequisite to the development of oropharyngeal candidiasis. Aims: The aims of this study were: to evaluate colonization and quantify Candida spp. in the oral cavity; to determine the predisposing factors for colonization; and to correlate the levels of CD4+ cells and viral load with the yeast count of colony forming units per milliliter (CFU/mL) in HIV-positive individuals treated at a University Hospital. Saliva samples were collected from 147 HIV patients and were plated on Sabouraud Dextrose Agar (SDA) and chromogenic agar, and incubated at 30 ��C for 72 h. Colonies with similar morphology in both media were counted and the result expressed in CFU/mL. Results: Of the 147 HIV patients, 89 had positive cultures for Candida spp., with a total of 111 isolates, of which C. albicans was the most frequent species (67.6%), and the mean of colonies counted was 8.8 �� 10�� CFU/mL. The main predisposing factors for oral colonization by Candida spp. were the use of antibiotics and oral prostheses. The use of reverse transcriptase inhibitors appears to have a greater protective effect for colonization. A low CD4+ T lymphocyte count is associated with a higher density of yeast in the saliva of HIV patients.

Pseudomonas spp. ISOLATED FROM THE ORAL CAVITY OF HEALTHCARE WORKERS FROM AN ONCOLOGY HOSPITAL IN MIDWESTERN BRAZIL

This cross-sectional study, performed in an oncology hospital in Goiania, aimed to characterize the prevalence of oral colonization and antimicrobial susceptibility of Pseudomonas spp. isolated from the saliva of healthcare workers. Microorganisms were subjected to biochemical tests, susceptibility profile, and phenotypic detection. Of 76 participants colonized with Gram negative bacilli, 12 (15.8%) harbored Pseudomonas spp. Of all isolates, P. aeruginosa (75.0%), P. stutzeri (16.7%), and P. fluorescens (8.3%), were resistant to cefoxitin, and therefore likely to be AmpC producers. The results are clinically relevant and emphasize the importance of surveillance to minimize bacterial dissemination and multiresistance.

PARACOCCIDIOIDOMYCOSIS: CHALLENGES IN THE DEVELOPMENT OF A VACCINE AGAINST AN ENDEMIC MYCOSIS IN THE AMERICAS

SUMMARYParacoccidioidomycosis (PCM), caused by Paracoccidioides spp, is an important endemic mycosis in Latin America. There are two recognized Paracoccidioides species, P. brasiliensis and P. lutzii, based on phylogenetic differences; however, the pathogenesis and disease manifestations of both are indistinguishable at present. Approximately 1,853 (~51,2%) of 3,583 confirmed deaths in Brazil due to systemic mycoses from 1996-2006 were caused by PCM. Antifungal treatment is required for patients with PCM. The initial treatment lasts from two to six months and sulfa derivatives, amphotericin B, azoles and terbinafine are used in clinical practice; however, despite prolonged therapy, relapses are still a problem. An effective Th1-biased cellular immune response is essential to control the disease, which can be induced by exogenous antigens or modulated by prophylactic or therapeutic vaccines. Stimulation of B cells or passive transference of monoclonal antibodies are also important means that may be used to improve the efficacy of paracoccidioidomycosis treatment in the future. This review critically details major challenges facing the development of a vaccine to combat PCM.

FACTORS RELATED TO ORAL CANDIDIASIS IN ELDERLY USERS AND NON-USERS OF REMOVABLE DENTAL PROSTHESES

This study examined the association between oral candidiasis in elderly users and nonusers of prosthesis and its predisposing factors. To this end, we performed a cross-sectional study where saliva samples from 48 patients were collected they used prosthesis and 43 patients (control group) who did not use. Among the 91 patients, Candida spp were isolated in 40 (83.3%) who used prosthesis and in 23 (53.5%) in the control group. A statistically significant association was determined between the two groups, the isolation of yeasts and dental prosthesis (p < 0.05, OR = 4.3). The most common etiological agent was Candida albicans (37 isolates), with 23 (62.2%) in the denture group and 14 (37.8%) (control group). Among patients who presented clinical manifestations of oral candidiasis (n = 24), 83.3% (n = 20) belonged to the group that wore dentures, while only 16.7% (n = 4) belonged to the control group. Elderly patients with diabetes had 4.4 times higher estimated risk of developing oral candidiasis when compared with individuals without this condition. There was no statistically significant association between being user prostheses and have diabetes with the onset of candidiasis. No statistically significant association was determined between xerostomia, use of prosthesis and oral candidiasis. The use of prosthetics and poor oral hygiene in elderly patients predisposes to the development of oral candidiasis.

Bi��psia per-oral do intestino delgado em 150 casos de diferentes enteroparasitoses

Os autores fazem uma apresenta����o sum��ria de alguns tipos de instrumentos utilizados na realiza����o da bi��psia duodeno-jejunal atrav��s intuba����o oral, ao mesmo tempo que comentam a import��ncia do m��todo no estudo da patologia intestinal. Em seguida apresentam os resultados de sua experi��ncia empregando 6 diferentes tipos de sondas e mostram os resultados histopatol��gicos observados em 150 casos de diversas parasitoses intestinais, submetidos a estudo. Entre os resultados chamam a aten����o para a presen��a freq��ente da Giardia lamblia, detectada em 16 dos 50 (32%) casos desta parasitose, contra 3 dos 27 (11,1%) de esquistossomose e apenas 2 dos 108 (1,8%) de estrongiloid��ase. Relatam tamb��m o achado de numerosas leishm��nias no c��rion da mucosa jejunal de um paciente parasitado pela Giardia lamblia, que era portador de Calazar. Apreciam, ainda, o significado de outras altera����es, consideradas inespec��ficas, sobre as quais aguardam estudos mais completos, para chegar a conclus��es mais v��lidas. Entre estas, merece destaque o achado de atrofia das vilosidades intestinais em 27 pacientes infectados pelo Strongyloides stercoialis tendo que em 5 d��les havia parasitismo exclusivo pelo referido nemat��ide.

Avalia����o sorol��gica da vacina oral, tipo Sabin, contra a poliomielite em regi��o semi-rural: I. Forma����o de anticorpos em vacinados

Os autores descrevem, os resultados obtidos em um programa de avalia����o sorol��gica da vacina oral, tipo Sabin, contra a poliomielite, em uma comunidade semi-rural, pr��xima a cidade do Rio de Janeiro. Em condi����es controladas 114 crian��as, com idades entre 3 meses a 3 anos (Tabela 1) foram vacinadas, com vacinas trivalentes (500.000, 200.000, e 300.000 TCD50 por dose, dos tipos 1, 2 e 3 respectivamente), usando-se tr��s doses, com intervalos de 8 semanas entre as doses. Amostras de sangue foram coletadas por pun����o venosa ou discos de papel de filtro, juntamente com a 1.�� e a 3.�� dose de vacina e 9 semanas ap��s esta ��ltima dose de vacina. As taxas de convers��o alcan��aram (dilui����o de s��ro 1/8) 82,7%, 98,5% e 75,4% para os tipos 1, 2 e 3 respectivamente, ap��s tr��s doses de vacina (Tabela 2). A distribui����o de idade de indiv��duos sem anticorpos ap��s a vacina����o (Tabela 3) mostra o grupo et��rio de 1 a 2 anos como o que apresenta a mais baixa taxa de convers��o. Os autores acentuam que as condi����es de vida da popula����o estudada correspondem ��quelas de grandes partes da popula����o brasileira, nas ��reas rurais do pa��s; e uma avalia����o semelhante da vacina em ��reas urbanas, seria desej��vel. Os autores sugerem ainda o aumento da quantidade de v��rus do tipo 1 na vacina como medida prov��velmente eficaz na melhora das taxas de convers��o em popula����es como a estudada. Estudos quantitativos s��bre anticorpos para Enterov��rus, presentes na popula����o estudada, est��o sendo realizados e ser��o pr��ximamente apresentados.

Modelling resilience in supply chain

Disserta����o para obten����o do Grau de Doutor em Engenharia Industrial

Avalia����o sorol��gica da vacina oral, tipo Sabin, contra a poliomielite em regi��o semi - rural: II - Aspectos quantitativos dos anticorpos formados e anticorpos para outros enterovirus

Os autores apresentam dados quantitativos s��bre os anticorpos presentes em vacinados com vacina oral trivalente, contra a poliomielite (Tabela 1). Apos a 3.�� dose de vacina verificou-se um aumento do t��tulo geom��trico m��dio da popula����o em rela����o aos t��tulos obtidos com duas doses de vacina. Infec����es naturais devem ter contribu��do para forma����o de anticorpos para poliomielite na popula����o, ao lado da vacina. Anticorpos para enterov��rus n��o-p��lio (Coxsackie B e alguns tipos de v��rus ECHO) s��o apresentados na Tabela II e referem-se a amostras de s��ro colhidas quando da 1.�� dose de vacina. Os autores chamam a aten����o para a incid��ncia de enterov��rus na regi��o, embora poucos sejam os dados ainda dispon��veis.

Unilateral Oral Mucous Membrane Pemphigoid: Refractory Atypical Presentation Successfully Treated with Intravenous Immunoglobulins

A 57-year-old male presented with a 6-month history of blisters and painful erosions on the right buccal mucosa. No skin or other mucosal involvement was seen. The findings of histopathological and direct immunofluorescence examinations were sufficient for the diagnosis of oral mucous membrane pemphigoid in the context of adequate clinical correlation. No response was seen after topical therapies and oral corticosteroids or dapsone. Intravenous immunoglobulin was started and repeated every three weeks. Complete remission was achieved after three cycles and no recurrence was seen after two years of follow-up. The authors report a rare unilateral presentation of oral mucous membrane pemphigoid on the right buccal and hard palate mucosa, without additional involvement during a period of five years. Local trauma or autoimmune factors are possible etiologic factors for this rare disorder, here with unique presentation.

Ensino a dist��ncia do Portugu��s L��ngua Estrangeira ��� a pr��tica da comunica����o oral

Disserta����o apresentada para cumprimento dos requisitos necess��rios �� obten����o do grau de Mestre em Ensino do Portugu��s como L��ngua Segunda e Estrangeira

A imagem digital como meio de desenvolvimento da express��o oral e escrita em l��ngua estrangeira

Relat��rio de Est��gio apresentado para cumprimento dos requisitos necess��rios �� obten����o do grau de Mestre em Ensino de Ingl��s e de L��ngua estrangeira (Franc��s) no 3�� ciclo do ensino b��sico e secund��rio

The vaccination of h uman beings with live avirulent vaccine of Trypanosoma cruzi: A two year follow-up of the first two cases

A two year follow-up of the first two volunteers vaccinated icith the live PF Trypanosoma cruzi strain demonstrated that the parasitological and clinical test were negative during and after that period. Of the serological tests employed, the CFT presented, in only one case, conflicting results, particulary in one laboratory and among different laboratories. However negative results were greater than all doubtful and positive one combined. The IFT icere negative in both patients. Some comments are made about the sensibility and specificity of these tests. The author concluded that the vaccine, in spite of the very large dose used in these cases, seems to be safe for human beings.