Os Centros de Especialidades Odontológicas como suporte da atenção básica: uma avaliação na perspectiva da integralidade

The public dental services in Brazil were limited, practically, to the basic care, so that the specialized services acted, up to 2002, no more than 3,5% of the total of clinical procedures. That lower offer reveals the difficulty of continuity of the attention, that is, the comprehensiveness in the assistance, particulary, the reference and counter-reference system. Brasil Sorridente search to supply those needs when proposing Speciality Dental's Centers(CEOs Centros de Especialidades Odontológicas, Brazil) to compose the services of average complexity. In 2005, Ministry of Health enabled the three CEOs of Natal, located in the North II, East and West Sanitary Districts. This investigation evaluated the implantation of these CEOs, as support of the family health care teams, in the perspective of organization of the services in assistencial nets in Natal/RN. It was a study of evaluation, with qualitative approach and some quantitative data as contribution. Dentists, users and managers were interviewed to identify and to understand their perceptions, relationships and experiences in the daily of the services. The conceptual base that orientated the investigation was the principle of comprehensiveness, in its operational sense of the hierarchization in health attention levels. The collection of data was done with documental research, direct observation and semi-structured interview. The analysis was accomplished by triangulation of the extracted content from the used techniques and sources of interviewed groups depositions, looking for theoretical-conceptual support in specific bibliography. The results pointed aspects that go away from the comprehensiveness like: low resolution of problems in the basic net; little valorization of the space in the health units; traditional models of access to health services, insufficient offer for some specialties, compromising the reference and counter-reference system; practices centered in procedures in the CEO; bureaucratic directions from basic care to the specialized service; disintegrated and disjointed system among levels of attention; disrespect to the municipal protocol. On the other hand, there is an approach of compreensiveness in situations like: increase of the access and covering in the Family Health Strategy (ESF Estratégia Saúde da Família, Brazil); larger approach between professional and user; tendency to the quantitative and qualitative growth of specialized actions; punctual initiatives of relationships among levels; existence of protocol to guide professionals

Extraction and clean-up procedure for analysis of organochlorine pesticide residues in ethoxylated lanolin

In the present study an evaluation was made of a method for the determination of organochlorine pesticide residues in ethoxylated lanolin. Samples were homogenized with Celite, transferred to chromatographic columns, prepacked with silica gel deactivated to 10%. The pesticide elution was processed with n-hexane-dichloromethane and the concentrated eluate was analyzed using gas-liquid chromatography (GC) with electron capture detection (ECD). The composition of the elution solvent was a significant factor for the recovery of the pesticides. Mean recoveries obtained for fortified samples ranged from 87 to 94% for p,p'-DDE, dieldrin, endrin, p,p'-DDD and p,p'-DDT. Optimization of the experimental conditions resulted in a small-scale method that combines extraction and cleanup in a single step. (C) 2000 Elsevier B.V. S.A. All rights reserved.

Use of homeopathic preparations in experimental studies with healthy plants

Background. The last comprehensive review of experimental research on effects of homeopathic treatments on plants was published in 1984, and lacked formal predefined criteria to assess study quality. Since then several new studies with more advanced methods have been published.Objectives: To compile a review of the literature on basic research in homeopathy with healthy plants with particular reference to studies investigating specific effects of homeopathic remedies.Methods: The literature search included English, French, German, Italian, Portuguese and Spanish publications from 1920 to April 2009, using predefined selection criteria. We included experiments with healthy whole plants, seeds, plant parts and cells. The outcomes had to be measured by established procedures and statistically evaluated. We developed a Manuscript Information Score (MIS) and included only publications which provided enough information for proper interpretation (MIS >= 5). A formallised Study Methods Evaluation Procedure (SMEP) was used to evaluate these studies, and the subgroup of studies with adequate controls to identify specific effects.Results: A total of 86 studies in 79 publications was identified, 43 studies included statistics, 29 had MIS >= 5, and 15 studies investigated the specificity of homeopathic preparations. Specific effects of decimal, centesimal and fifty millesimal potencies were found including dilution levels far beyond the Avogadro number. In consecutive series of potencies only some of the tested potencies showed effects. There were many individual studies with diverse methods and very few reproduction trials.Conclusions: Healthy plant models seem an useful approach to investigate basic research questions about the specificity of homeopathic preparations. More investigations with more advanced methods are recommended, especially in the sectors of potentisation techniques, effective potency levels and conditions for reproducibility. Systematic negative control experiments should become a routine procedure to control the stability of the experimental systems. Homeopathy (2009) 98, 228-243.

BLOQUEIO PERIDURAL E TERMOMETRIA CUTANEA COMO CRITERIO PARA INDICACAO CIRURGICA DE SIMPATECTOMIA LOMBAR

To find a valuable tool in achieving a good accuracy in predicting the outcome from sympathectomy, changes in limb skin temperatures (LST) before and after epidural lumbar anesthesia (ELA) and before and after lumbar sympathectomy were studied in 13 patients with thrombangiitis obliterans or arteriosclerosis obliterans. The results were compared with the clinical course and follow-up from 1 to 5 years. In seven patients there was a rise in LST after ELA and after sympathectomy, and this pattern of variation was associated with good clinical course. In three patients there was decrease in the LST after ELA and after sympathectomy and they did not do well. In two patients there was no change in temperature before or after the procedure; one of them had a good and the other a bad clinical course. The same measurements were performed in three other patients who had had a sympathectomy some years previously and the data showed that LST was lowered after ELA. It is concluded that the measurement of limb skin temperature before and after epidural lumbar anesthesia aids in determining which patients are more likely to benefit from sympathectomy.

Effect of dentine surface treatment on leakage of root fillings with a glass ionomer sealer.

The purpose of this study was to observe the quality of seal of the glass ionomer cement, Ketac-Endo, after treatment of the root canal wall. The root canals of 140 extracted human teeth were prepared biomechanically. The root canals were treated with either EDTA or received an intracanal dressing of calcium hydroxide or camphorated paramonochlorphenol. The root canals were filled by the lateral condensation technique with gutta-percha points and the sealer Ketac-Endo, or zinc oxide-eugenol cement or Sealapex. The teeth were placed into a 2% methylene blue dye solution inside a flask, which was attached to a vacuum pump. Leakage was measured linearly. Sealapex exhibited significantly less leakage than Ketac-Endo or zinc oxide-eugenol cement (P<0.01). The use of EDTA and intermediary dressings reduced significantly (P<0.01) the leakage observed with the zinc oxide-eugenol sealer and Ketac-Endo.

Avaliacao da necessidade da dosagem rotineira de hematocrito, hemoglobina, ureia e creatinina sericos durante a avaliacao pre-anestesica

Background and Objectives - There are many questions and opinions about the value of routine preoperative tests as an integral part of the preanesthetic evaluation. Current trends suggest that such tests should be based on detailed clinical and physical evaluation. Since such tests are still routinely performed and questions about their real value still persist, the aim of this study was to assess the value of routine hematocrit (Ht), hemoglobin concentration (Hb), blood urea nitrogen (BUN) and serum creatinine results in patients undergoing elective surgery, to establish when they are needed and aiming at answering such questions. Methods - 1065 patients aged 12 years and above, physical status ASA I, II and III, scheduled for elective surgery were studied. Patients were divided into 7 different age groups with randomized distribution of gender. Ht, Hb, BUN and serum creatinine results, routinely asked by our surgical departments, were observed and analyzed. Variance Analysis was used for each variable, and the Bonferroni Multiple Comparison Test was used to compare group to group. Differences were considered significant when p < 0.05 (5%). Results - For all patients, 4025 laboratory tests were obtained. The number of tests was the same for each group. There were no differences in Ht and Hb values which remained within normal ranges. Considering BUN and serum creatinine, there was a difference between younger and older patients, but the results were normal in all groups. Conclusions - We concluded that mean Ht, Hb, BUN and serum creatinine values in all age groups were all acceptable for surgical patients in general. However, they are barely useful if performed regardless of clinical evaluation. Thus, such preoperative routine tests should be abandoned and the good clinical practice with common sense should prevail in indicating them.

Systemic hypertension in patients with glomerulonephritis

Although systemic hypertension is very common in patients with glomerulonephritis there is a dispute if this alteration is consequence of the glomerulonephritis per se or is a consequence of the renal failure secondary to the glomerular lesion. With the aim to analyze the factors associated with systemic hypertension, 196 patients with different forms of nephritis were studied. The systemic arterial pressure was measured by standard sphygmomanometer, renal function was evaluated by the determination of the serum creatinine concentration or creatinine clearance. The diagnosis of the type of glomerulonephritis was made on the basis of an examination of kidney biopsy specimens. The prevalence of arterial hypertension among patients with glomerulonephritis was 62.7%. The hypertensive patients were older (hypertensive = 30.6 ± 12.8; normotensive = 25.4 ± 1.6 years; P = 0.03). The prevalence of arterial hypertension was lower in patients with minimal glomerular lesion (12.5%), though their ages were also lower (18.1 ± 3.6 and 29.1 ± 1.03 years; P = 0.03). Arterial hypertension did not correlate with the serum levels of creatinine and albumin; creatinine clearance and 24-h proteinuria. In conclusion: In the patients with glomerulonephritis, the presence of arterial hypertension was associated with a higher mean age whereas the intensity of proteinuria, the level of renal function or the type of glomerulonephritis was not different between the two groups.

Glutathione S-transferase activity in acetochlor, atrazine and oxyfluorfen metabolization in maize (Zea mays L.), sorghum (Sorghum bicolor L.) and wheat (Triticum aestivum L.) (Poaceae)

This experiment was conducted to evaluate the acetochlor, atrazine and oxyfluorfen herbicides plant selectivity, in relation to glutathione S-transferase activity (GST) in maize (Zea mays L.), sorghum (Sorghum bicolor L.) and wheat (Triticum aestivum L) (Poaceae) plants. GST activity was detected 24, 48 and 72 hours after treatment applications. The experiment's treatments consisted of spraying plants with water (control), acetochlor (3 L.ha -1), atrazine (4 L.ha -1) and oxyfluorfen (1 L.ha -1). The highest GST activities were observed in presence of acetochlor, mainly at 48 hours after treatment. These increments were 105, 148 and 118% when compared to maize, sorghum and wheat control groups, respectively. It is suggested that the GST may have a role in acetochlor degradation and it may be a reason for this herbicide's selectivity in these crops.

Collagen fibers in human prostatic lesions: histochemistry and anisotropies

The present study focuses on establishing patterns of collagen fibers distribution in prostatic nodular hyperplasia and adenocarcinomas, in comparison with the normal tissue. Sections of prostatic transurethral resection were subjected to Gömöri's method for collagen fibers and reticulin and analyzed under ordinary and polarized light microscopy. Controls and hyperplastic regions present collagen fibers with variable thickness that run in different directions, establishing a tridimensional network. These fibers exhibit birefringence and dichroism thus demonstrating their fibrillar integrity. On the other hand, increased variability in collagen fiber distribution and anisotropical properties occur in adenocarcinomas evaluated in accordance with the Gleason's score. In some of their areas, a well-defined collagen network delimitates the base of transformed epithelial cells whereas in other areas the collagen fibers are disorganized and do not establish a boundary between the epithelial structures and the stroma. In these areas, collagen is found in the stroma. It was also observed that adenocarcinoma tumor cells rest on a scaffold of thin and dendritic collagen fibers. Collagen fibers of the prostatic stroma of the adenocarcinomas may show a modification in arrangement and fibrillar compactness. In prostatic nodular hyperplasia, there is no change in collagen molecular integrity, since collagen affinity for silver and collagen birefringence are similar to controls. In adenocarcinoma with high dedifferentiation degree, thin and branched strongly argyrophilic and birefringent collagen fibers are detected in regions of cell proliferation. In the adjacent stroma, hyaline plaques are indicative of matrix degradation or remodellation.

Histomorphometric analysis of homogenous demineralized dentin matrix as osteopromotive material in rabbit mandibles

Purpose: The aim of this work was to evaluate the effectiveness of homogenous demineralized dentin matrix (HDDM) slices in surgical bone defects created in the mandibles of rabbits and occluded with a polytetrafluoroethylene (PTFE) membrane in the promotion of bone growth. Materials and Methods: Surgical bone defects were created in 36 adult rabbits and divided into 4 groups: bone defect (control), bone defect with PTFE membrane, bone defect with HDDM, and bone defect with both HDDM and a PTFE membrane (HDDM + PTFE). The rabbits were sacrificed after 30, 60, and 90 days, and the bone defects were examined histologically and by histomorphometric analysis (analysis of variance and the Tukey test). Results: The volume of newly formed bone matrix was significantly greater in the HDDM and HDDM + PTFE groups than in the control and PTFE groups. The discrete inflammatory reaction found in the HDDM and HDDM + PTFE groups did not prevent the osteopromotive activity of the dentin matrix. Discussion: HDDM slices were biocompatible and were resorbed during the bone remodeling process. They stimulated the newly formed bone until 30 days after implantation. Conclusion: Bone repair was accelerated in the bone defects treated with HDDM in comparison to the control group.

Citotoxicidade de Styrax camporum Pohl em macrófagos peritoneais e a liberação de H2O2

The immunological response includes wide contexts involving several cells, and the macrophage is crucial in the cellular immune response. Several stimuli to macrophage membrane may induce the liberation of H2O2, contributing to antibacterial and cytotoxicical actions. Nowadays, there is a tendency to study natural products to verify their capacity of acting in the immune system. This study evaluated the citotoxicity of the bulk extract and the hexanic and acetic fractions extracted from Styrax camporum Pohl (Styracaceae) and the production of H2O2, on murine peritonal macrophages cultures exposed to fractions extracted from this plant. The results showed that the fraction HX 2 mg/ml produced the liberation of H 2O2 in high concentrations and to 4 mg/ml was observed high citotoxicity. The fractions AC did not produce the liberation of H 2O2 and EB was produced in low levels. We conclude that this HX is a potent stimulator of macrophage.

Potencial cognitivo P300 em indivíduos com diabetes mellitus

Diabetes Mellitus may lead to alterations in the eyes, kidneys, cranial nerves, peripheral nerves, ears etc. The cognitive function, also, seems to be compromised in subjects presented with Diabetes Mellitus, since the cortical and subcortical structures responsible for this function are hindered in some insulin-dependent patients. The cognitive potential P300 has been used as an objective procedure to assess cerebral cognitive functions. Objective: Analyze the sensitivity of P300 cognitive potential for the detection of alterations on the auditory cortex secondary to Diabetes Mellitus. Study design: transversal cohort. Material and Method: Sixteen diabetic subjects of both genders aged 7 to 71 years, and seventeen non-diabetic individuals at the same age range participated in this study, the evaluation procedures were pure tone audiometry (PTA) and P300 cognitive potential. Glycemia of the group presented with Diabetes was assessed prior to applying the P300. Results: No statistically significant difference was shown for the PTA results. A statically significant difference was observed between groups when analyzing the latency of the P300 component measured in Fz. there was a correlation between glycemia and the latency and amplitude of P300. Conclusion: The investigation of the cognitive potential of P300 is an important procedure for the prevention and early diagnosis of neurological changes in individuals presented with Diabetes Mellitus.

A comparison of human and porcine acellular dermal tissues in the subcutaneous space of a rat model

The study compared the host response to a human and a porcine acellular dermal tissue implanted in the subcutaneous space of a rat model. The human and porcine acellular grafts were surgically implanted in the subcutaneous tissue of rats (5 rats/group) and the materials were evaluated at 7, 15, 30, 60 and 180 postoperative days (PO). The histological immune response was quantified using a digital image analysis system, which evaluated the number of vessels present in the implants and in the surrounding soft tissue, the area of inflammatory cell infiltration in the grafts, the width of the capsular formation present around the tissues and the area of implants absorbed. The data were submitted to statistical analysis. Light microscopy showed mononuclear cellular infiltration, the presence of a capsular formation surrounding the grafts and the presence of vacuolar structures (optically empty spaces) inside the implants. The image analysis comparing both materials showed significant inflammatory cells in the human graft at 15 and 30 PO, thicker capsular formation in the porcine tissue at 60 PO, increased number of vessels inside the implants and in the surrounding tissues in the porcine graft and a similar absorption pattern in both materials at 180 PO. The histological findings showed that both tissues were well-tolerated when implanted in the subcutaneous tissue of rats, allowing us to consider the porcine acellular dermal graft as a provisional alternative material for reconstructive plastic surgery. Copyright © 2005 Taylor & Francis LLC.

Aspirado traqueal de cavalos clinicamente sadios da raça quarto de milha após prova de três tambores

The aim of the present study was to evaluate through endoscopy the tracheal aspiration cytology in twenty seven Quarter Horses from Curitiba and surroundings, following the Three Barrel Competittion. Upper respiratory tract secretion was obtained by tracheal aspiration using a polyethylene catheter introduced through the endoscopic fiberoptic working channel, at the level of tracheal bifurcation. Cytologic slides were prepared by smear and stained by diff-quick technique and the differential was performed in 500 cells counting by 1,000X optic microscopy. None of the horses presented abnormality, including epixtasis, at the clinical examination. However, hemosiderophages were detected at cytology in three animals, suggesting that some may be suffering of subclinical pulmonary hemorrhage. Differential cell counting of tracheal aspiration results were, in average: 44.09 ± 35.68% of epithelial cells; 1.10 ± 2.18% of Globet cells; 23.10 ± 35.93% of neutrophils; 0.13 ± 0.37% of lymphocytes; 0.91 ± 2.81% of eosinophils; 30.57 ± 23.62% of macrophages and 0.13 + 0.93% of hemosiderophages. In conclusion, based in the present study, the evaluation of cellular populations with the tracheal aspiration may offer important additional information to the clinician, particularly about the inflammatory processes of lower respiratory tract and pulmonary bleeding.

Qualidade do álcool produzido a partir de resíduos amiláceos da agroindustrialização da mandioca

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)