MANEJO DE PACIENTES HEMOFÍLICOS NA CLÍNICA ODONTOLÓGICA - UMA REVISÃO INTEGRATIVA DA LITERATURA

Abstract: Hemophilia is a genetic condition in which there are changes in the quantity and quality of plasma proteins that act in the blood clotting processes in a hereditary way. Objective: to carry out a scientific survey in the current literature on the management of hemophiliac patients in the dental clinic, highlighting aspects of the theme that answered the guiding question of the integrative review. Methodology: A literature search was carried out through the electronic database PubMed, using the search keywords, “MeSHterm”: “Hemophilia” AND “Dentistry”. The articles were evaluated according to the pre-established inclusion and exclusion criteria and the Boolean connector “AND” was used. Results and Discussion: Therefore, based on this search strategy, of the 20 articles that met the criteria, only 10 were selected to compose the study, as 10 articles did not address dental management in hemophiliac patients. Therefore, the dental management of hemophiliac patients is centered on hemostasis of the surgical field and on the administration of coagulation factors that are deficient according to the type of hemophilia. Final Considerations: Furthermore, as this is a disease that can involve systemic involvement, it is important to have a multidisciplinary approach, including dentists, hematologists and oral surgeons. Therefore, this integrative literature review included a detailed analysis of 10 articles, focusing on the dental management of hemophiliac patients. The results obtained successfully answered the research's guiding question.Resumen: La hemofilia es una condición genética en la que se producen cambios en la cantidad y calidad de las proteínas plasmáticas que actúan en los procesos de coagulación sanguínea de forma hereditaria. Objetivo: realizar un relevamiento científico en la literatura actual sobre el manejo de pacientes hemofílicos en la clínica dental, destacando aspectos de la temática que respondieron a la pregunta orientadora de la revisión integradora. Metodología: Se realizó una búsqueda bibliográfica a través de la base de datos electrónica PubMed, utilizando las palabras clave de búsqueda, “MeSHterm”: “Hemofilia” Y “Odontología”. Los artículos fueron evaluados según los criterios de inclusión y exclusión preestablecidos y se utilizó el conector booleano “Y”. Resultados y Discusión: Por lo tanto, con base en esta estrategia de búsqueda, de los 20 artículos que cumplieron con los criterios, solo 10 fueron seleccionados para componer el estudio, ya que 10 artículos no abordaron el manejo dental en pacientes hemofílicos. Por tanto, el manejo odontológico de los pacientes hemofílicos se centra en la hemostasia del campo quirúrgico y en la administración de factores de coagulación deficientes según el tipo de hemofilia. Consideraciones finales: Además, dado que se trata de una enfermedad que puede implicar afectación sistémica, es importante tener un abordaje multidisciplinario, incluyendo dentistas, hematólogos y cirujanos orales. Por lo tanto, esta revisión integradora de la literatura incluyó un análisis detallado de 10 artículos, enfocándose en el manejo dental de pacientes hemofílicos. Los resultados obtenidos respondieron con éxito a la pregunta orientadora de la investigación.Resumo: A hemofilia é uma condição genética em que ocorre alterações na quantidade e qualidade de proteínas plasmáticas que atuam nos processos de coagulação sanguínea de forma hereditária. Objetivo: fazer um levantamento científico na literatura atual sobre o manejo de pacientes hemofílicos na clínica odontológica, evidenciando aspectos da temática que respondessem à pergunta norteadora da revisão integrativa. Metodologia: Foi realizada uma busca da literatura através da base de dados eletrônicas PubMed, utilizando as palavras-chave para pesquisa, “MeSHterm”: “Hemophilia” AND “Dentistry”. Os artigos foram avaliados quanto aos critérios de inclusão e exclusão pré-estabelecidos e utilizou-se do conector booleano “AND’’. Resultados e Discussão: Portanto, a partir dessa estratégia de busca, dos 20 artigos que se adequaram aos critérios, apenas 10 foram selecionados para compor o estudo, já que 10 artigos não abordavam o manejo odontológico frente aos pacientes hemofílicos. Sendo assim, o manejo odontológico dos pacientes hemofílicos é centrado na hemostasia do campo cirúrgico e na administração de fatores de coagulação que se apresentam deficientes de acordo com o tipo de hemofilia. Considerações Finais: Ademais, por se tratar de uma doença que pode envolver comprometimento sistêmico, é importante que haja uma abordagem multidisciplinar incluindo dentistas, hematologistas e cirurgiões orais. Logo, a presente revisão integrativa de literatura contou com a análise detalhada de 10 artigos, com enfoque no manejo odontológico de pacientes hemofílicos. Os resultados obtidos responderam com êxito a pergunta norteadora da pesquisa

O desfecho clinico do paciente obeso submetido a cirurgia / The clinical outcome of the obese patient undergoing

A obesidade se trata de uma doença multifatorial e de caráter crônico, necessitando ser precocemente diagnosticada e tratada. O tratamento do excesso de peso corporal têm a finalidade de evitar exacerbações da doença e as comorbidades com ela associadas. O seguinte artigo objetivou por meio da literatura científica abordar e descrever o quadro clínico do paciente obeso e as opções cirúrgicas e seu prognóstico. O estudo em questão é uma revisão de literatura do tipo narrativa, fundamentada nas plataformas online do SciELo, Pubmed, Google Acadêmico, Brazilian Jornal of Health Review e LILACS. Desta pesquisa foram analisados 50 artigos, nos idiomas português, inglês e espanhol. Foram selecionados 20 estudos por estarem atuais, baseados em evidências e com linguagem clara e direta, descartando-se os demais sem relevância para a temática proposta. Na literatura existem muitas informações. Algumas perspectivas mais restritas classificam as causas da obesidade apenas entre o desequilíbrio entre a ingesta calórica e o gasto metabólico. Ademais, estudos mais atuais abordam a questão em sua perspectiva mais realista, ou seja, sua base multifatorial a qual incluem fatores genéticos, neurológicos, metabólicos e endócrinos, associados a um estilo de vida sedentário e a uma alimentação hipercalórica. O diagnóstico clínico se baseia em métodos simples e de fácil aplicabilidade, e a terapêutica se fundamenta em reeducação alimentar e a inclusão de atividades físicas. No advém, alguns pacientes são resistentes a esses meios e urgem ser submetidos a opção cirúrgica. Atualmente, a cirurgia bariátrica é a opção e esta conta com diversas técnicas promissoras e eficazes no combate ao excesso de peso e suas implicações adjacentes. E está possui benefícios e complicações que consoante o perfil clínico do paciente e o acompanhamento multidisciplinar pode resultar em bom prognóstico

Diretriz da Sociedade Brasileira de Cardiologia sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas

This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.  Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities.   Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.  The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.  The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.     Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou. A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica. Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas. A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica. A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.    Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.&nbsp

The Genome of Anopheles darlingi, the main neotropical malaria vector

Anopheles darlingi is the principal neotropical malaria vector, responsible for more than a million cases of malaria per year on the American continent. Anopheles darlingi diverged from the African and Asian malaria vectors ∼100 million years ago (mya) and successfully adapted to the New World environment. Here we present an annotated reference A. darlingi genome, sequenced from a wild population of males and females collected in the Brazilian Amazon. A total of 10 481 predicted protein-coding genes were annotated, 72% of which have their closest counterpart in Anopheles gambiae and 21% have highest similarity with other mosquito species. In spite of a long period of divergent evolution, conserved gene synteny was observed between A. darlingi and A. gambiae. More than 10 million single nucleotide polymorphisms and short indels with potential use as genetic markers were identified. Transposable elements correspond to 2.3% of the A. darlingi genome. Genes associated with hematophagy, immunity and insecticide resistance, directly involved in vectorhuman and vectorparasite interactions, were identified and discussed. This study represents the first effort to sequence the genome of a neotropical malaria vector, and opens a new window through which we can contemplate the evolutionary history of anopheline mosquitoes. It also provides valuable information that may lead to novel strategies to reduce malaria transmission on the South American continent. The A. darlingi genome is accessible at www.labinfo.lncc.br/index.php/anopheles- darlingi. © 2013 The Author(s)

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

microbeMASST: A Taxonomically-informed Mass Spectrometry Search Tool for Microbial Metabolomics Data

microbeMASST, a taxonomically informed mass spectrometry (MS) search tool, tackles limited microbial metabolite annotation in untargeted metabolomics experiments. Leveraging a curated database of >60,000 microbial monocultures, users can search known and unknown MS/MS spectra and link them to their respective microbial producers via MS/MS fragmentation patterns. Identification of microbe-derived metabolites and relative producers without a priori knowledge will vastly enhance the understanding of microorganisms’ role in ecology and human health

VIII Encuentro de Docentes e Investigadores en Historia del Diseño, la Arquitectura y la Ciudad

Acta de congresoLa conmemoración de los cien años de la Reforma Universitaria de 1918 se presentó como una ocasión propicia para debatir el rol de la historia, la teoría y la crítica en la formación y en la práctica profesional de diseñadores, arquitectos y urbanistas. En ese marco el VIII Encuentro de Docentes e Investigadores en Historia del Diseño, la Arquitectura y la Ciudad constituyó un espacio de intercambio y reflexión cuya realización ha sido posible gracias a la colaboración entre Facultades de Arquitectura, Urbanismo y Diseño de la Universidad Nacional y la Facultad de Arquitectura de la Universidad Católica de Córdoba, contando además con la activa participación de mayoría de las Facultades, Centros e Institutos de Historia de la Arquitectura del país y la región. Orientado en su convocatoria tanto a docentes como a estudiantes de Arquitectura y Diseño Industrial de todos los niveles de la FAUD-UNC promovió el debate de ideas a partir de experiencias concretas en instancias tales como mesas temáticas de carácter interdisciplinario, que adoptaron la modalidad de presentación de ponencias, entre otras actividades. En el ámbito de VIII Encuentro, desarrollado en la sede Ciudad Universitaria de Córdoba, se desplegaron numerosas posiciones sobre la enseñanza, la investigación y la formación en historia, teoría y crítica del diseño, la arquitectura y la ciudad; sumándose el aporte realizado a través de sus respectivas conferencias de Ana Clarisa Agüero, Bibiana Cicutti, Fernando Aliata y Alberto Petrina. El conjunto de ponencias que se publican en este Repositorio de la UNC son el resultado de dos intensas jornadas de exposiciones, cuyos contenidos han posibilitado actualizar viejos dilemas y promover nuevos debates. El evento recibió el apoyo de las autoridades de la FAUD-UNC, en especial de la Secretaría de Investigación y de la Biblioteca de nuestra casa, como así también de la Facultad de Arquitectura de la UCC; va para todos ellos un especial agradecimiento

A Taxonomically-informed Mass Spectrometry Search Tool for Microbial Metabolomics Data

MicrobeMASST, a taxonomically-informed mass spectrometry (MS) search tool, tackles limited microbial metabolite annotation in untargeted metabolomics experiments. Leveraging a curated database of >60,000 microbial monocultures, users can search known and unknown MS/MS spectra and link them to their respective microbial producers via MS/MS fragmentation patterns. Identification of microbial-derived metabolites and relative producers, without a priori knowledge, will vastly enhance the understanding of microorganisms’ role in ecology and human health

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants.

BACKGROUND: Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS: We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS: The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION: Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING: WHO