A importância da residência médica em medicina de família e comunidade e a reflexão de seu processo adaptativo frente à pandemia da COVID 19 - relato de experiência / The importance of the medical residency in family and community medicine and the reflection of its adaptive process facing COVID 19 pandemic -an experience report

O objetivo deste trabalho é abordar a transformação que a pandemia do novo coronavírus promoveu em um programa de residência médica em medicina de família e comunidade (MFC) em Goiás e a importância dessa formação médica como ferramenta construtiva para melhor desempenho individual e profissional.  A atenção primária à saúde é a estratégia principal para se atingir uma saúde universal e equilitária, e possui conexão direta com a MFC, para a construção de um sistema de saúde efetivo, coordenado, integral e longitudinal. Para uma funcionalidade harmônica esse sistema de saúde depende de vários fatores, entre eles as ações da gestão municipal e dos profissionais de saúde, que devem ser sinérgicas em busca da melhor oferta de saúde para a população. Crises, como a pandemia, exigem rápida adaptação e reflexão constante para diminuir possibilidades de estagnação ou retrocesso. O saldo dessa experiência para os médicos residentes foi positivo e as ferramentas e princípios da MFC contribuíram fortemente para esse desfecho

Physicochemical and biological properties of novel chlorhexidine‐loaded nanotube‐modified dentin adhesive

A commercially available three‐step (etch‐and‐rinse) adhesive was modified by adding chlorhexidine (CHX)‐loaded nanotubes (Halloysite®, HNT) at two concentrations (CHX10% and CHX20%). The experimental groups were: SBMP (unmodified adhesive, control), HNT (SBMP modified with HNT), CHX10 (SBMP modified with HNT loaded with CHX10%), and CHX20 (SBMP modified with HNT loaded with CHX20%). Changes in the degree of conversion (DC%), Knoop hardness (KHN), water sorption (WS), solubility (SL), antimicrobial activity, cytotoxicity, and anti‐matrix metalloproteinase [MMP‐1] activity (collagenase‐I) were evaluated. In regards to DC%, two‐way ANOVA followed by Tukey’s post‐hoc test revealed that only the factor “adhesive” was statistically significant (p 0.05). For Knoop microhardness, one‐way ANOVA followed by the Tukey’s test showed statistically significant differences when comparing HNT (20.82 ± 1.65) and CHX20% (21.71 ± 2.83) with the SBMP and CHX10% groups. All adhesives presented similar WS and cytocompatibility. The CHX‐loaded nanotube‐modified adhesive released enough CHX to inhibit the growth of S. mutans and L. casei. Adhesive eluates were not able to effectively inhibit MMP‐1 activity. The evaluation of higher CHX concentrations might be necessary to provide an effective and predictable MMP inhibition. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res B Part B, 2018. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 868–875, 2019.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/148225/1/jbmb34183_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/148225/2/jbmb34183.pd

Effect of Traditional Household Processes on Iron, Zinc and Copper Bioaccessibility in Black Bean (Phaseolus vulgaris L.)

Micronutrient deficiencies are a major public health problem. Beans are an important plant-based source of iron, zinc and copper, but their absorption is reduced in the presence of anti-nutrients such as phytates, polyphenols and tannins. Soaking and discarding the soaking water before cooking is unanimously recommended, but this can result in mineral loss. Data on the consequences for mineral bioaccessibility is still limited. This study aimed to evaluate iron, zinc and copper bioaccessibility in black beans cooked (regular pan, pressure cooker) with and without the soaking water. For that, three batches of black beans were investigated in triplicate, each split in nine parts (raw grains and four different household processes in duplicate) and analyzed by applying the quarter technique, resulting in a grand total of 164 samples. Minerals were quantified by ICP-MS (inductively coupled plasma mass spectrometry), myo-inositol phosphates (InsP5, InsP6) by HPLC (high-performance liquid chromatography) ion-pair chromatography, total polyphenols using Folin-Denis reagent and condensed tannins using Vanillin assay. Mineral bioaccessibility was determined by in vitro digestion and dialysis. All treatments resulted in a statistically significant reduction of total polyphenols (30%) and condensed tannins (20%). Only when discarding the soaking water a loss of iron (6%) and copper (30%) was observed, and InsP6 was slightly decreased (7%) in one treatment. The bioaccessibility of iron and zinc were low (about 0.2% iron and 35% zinc), but copper presented high bioaccessibility (about 70%). Cooking beans under pressure without discarding the soaking water resulted in the highest bioaccessibility levels among all household procedures. Discarding the soaking water before cooking did not improve the nutritional quality of the beans

Clindamycin-modified Triple Antibiotic Nanofibers: A Stain-free Antimicrobial Intracanal Drug Delivery System

INTRODUCTION: A biocompatible strategy to promote bacterial eradication within the root canal system after pulpal necrosis of immature permanent teeth is critical to the success of regenerative endodontic procedures. This study sought to synthesize clindamycin-modified triple antibiotic (metronidazole, ciprofloxacin, and clindamycin [CLIN]) polymer (polydioxanone [PDS]) nanofibers and determine in vitro their antimicrobial properties, cell compatibility, and dentin discoloration. METHODS: CLIN-only and triple antibiotic CLIN-modified (CLIN-m, minocycline-free) nanofibers were processed via electrospinning. Scanning electron microscopy, Fourier-transform infrared spectroscopy (FTIR), and tensile testing were performed to investigate fiber morphology, antibiotic incorporation, and mechanical strength, respectively. Antimicrobial properties of CLIN-only and CLIN-m nanofibers were assessed against several bacterial species by direct nanofiber/bacteria contact and over time based on aliquot collection up to 21 days. Cytocompatibility was measured against human dental pulp stem cells. Dentin discoloration upon nanofiber exposure was qualitatively recorded over time. The data were statistically analyzed (P < .05). RESULTS: The mean fiber diameter of CLIN-containing nanofibers ranged between 352 ± 128 nm and 349 ± 128 nm and was significantly smaller than PDS fibers. FTIR analysis confirmed the presence of antibiotics in the nanofibers. Hydrated CLIN-m nanofibers showed similar tensile strength to antibiotic-free (PDS) nanofibers. All CLIN-containing nanofibers and aliquots demonstrated pronounced antimicrobial activity against all bacteria. Antibiotic-containing aliquots led to a slight reduction in dental pulp stem cell viability but were not considered toxic. No visible dentin discoloration upon CLIN-containing nanofiber exposure was observed. CONCLUSIONS: Collectively, based on the remarkable antimicrobial effects, cell-friendly, and stain-free properties, our data suggest that CLIN-m triple antibiotic nanofibers might be a viable alternative to minocycline-based antibiotic pastes

EFEITO DA FRITURA DE ACARAJÉ NA COMPOSIÇÃO DE CAROTENOIDES E ATIVIDADE ANTIOXIDANTE DE ÓLEO DE PALMA BRUTO

O objetivo deste trabalho foi avaliar o efeito da fritura de acarajé nos carotenoides e na atividade antioxidante de óleo de palma bruto (OPB). Foi realizado experimento de fritura de acarajé em OPB, sendo retiradas amostras nos tempos 0, 5, 10, 15, 20 e 25 horas e submetidas à determinação de carotenoides, cor e atividade antioxidante. O óleo inicial apresentou 584,86 mg g-1 de carotenoides reduzindo 96,3% após 25 h de fritura, com decaimento de 96,3% e 96,9% de a- e all-trans-b-caroteno, respectivamente, formação de produtos de degradação e perda da cor alaranjada. A atividade antioxidante reduziu de 52,78 para 16,63% e de 28,06 para 2,48% pelos métodos DPPH e ABTS. Conclui-se que os carotenoides presentes no óleo de palma bruto degradam-se nas primeiras horas de fritura e que a prática de reposição do meio de fritura com óleo usado acentua a inibição da atividade antioxidant

Extrinsic Characterization Sustainability in Zirconia Reinforced Lithium Silicate Ceramics

ABSTRACT OBJECTIVE. To investigate the effect of aging on the surface roughness and the color sustainability of externally characterized zirconia reinforced lithium silicate glass-ceramics treated with different surface protocols. METHODS. Sixty blocks (12-mm X 14-mm; 1.5-mm) of pre-crystalized zirconia reinforced-lithium silicate glass-ceramic (Vita Suprinity, Vita Zahnfabrick, Germany) CAD/CAM were crystalized and treated with different surface protocols, as extrinsic characterization (EC), mechanical polishing (MP), glaze layer (GL), surface adjustment (SA) and no treatment – control group (CG). Experimental groups (n=10) were divided as follow: CG; EC-MP-GZ; EC-GZ; EC-MP; EC-GZ-SA-GZ; EC-GZ-SA-MP and submitted to thermocycling (5,000 cycles, 5-55C) and toothbrushing simulation (5,000 cycles). Surface roughness (Ra and Rq), color change (CIED2000) and biofilm growth were evaluated. Statistical analysis was performed with a two-sided 5% significance level for all tests. RESULTS. For the parameter RaX, the control differed from EC-GZ and EC-MP (p = 0.04). For the parameter RqX, EC-GZ presented higher surface roughness compared than EC-MP-GZ and the group EC-GZ-SA-MP (p=0.02). EC-MP (p<0.01) and the EC-GZ-SA-MP (p<0.01) showed higher color change E00 after aging, while CG and EC-MP-GZ the least. For the biofilm growth, no significant group effect on bacteria counts was found (p=0.089). CONCLUSION. The aging protocol affected the surface roughness, and color of externally characterized zirconia reinforced lithium silicate glass-ceramics submitted to different surface treatment protocols. In the present study, when the mechanical polishing was performed before glaze application, the slightest color change and surface roughness were observed compared to the other surface treatments. Bacteria were not able to grow in the material surface, under the conditions tested in the present study

Mortalidade por suicídio no estado do Pará: uma análise dos casos de 1996 a 2018 / Suicide mortality in the State of Pará: an analysis of cases from 1996 to 2018

O suicídio é uma lesão autodirigida intencional, onde atualmente está entre as dez principais causas de óbito no mundo, com aproximadamente 800 mil vítimas a cada ano. Assim a presente pesquisa tem como objetivo uma breve análise sobre a mortalidade por suicídio no Estado do Pará entre o período de 1996 a 2018, através dos dados coletados pelo departamento de informática do Sistema Único de Saúde do Brasil (DATASUS). A metodologia em questão trata-se de um estudo qualitativo, com análise documental, por meio do DataSus, com referências para as bases populacionais e territoriais do Instituto Brasileiro de Geografia e Estatística (IBGE) no período estudado. Os resultados da pesquisa evidenciaram que no Estado do Pará, o suicídio está cada vez mais presente na vida dos adultos jovens, tanto na capital, Belém, bem como nos municípios do interior, dentre eles, Marabá, Parauapebas, Castanhal, Ananindeua. Na conclusão destaca-se que para prevenir o suicídio, é indispensável à realização do trabalho voltado para ações de promoção da saúde especialmente para aqueles considerados grupos de risco, através de práticas que considerem os aspectos tanto patológicos como ambientais do suicídio

UNATI/FOSJC/UNESP: Promobiendo la ciudadania y la salud de las personas de la tercera edad

Objetivou-se avaliar a autopercepção dos idosos pertencentes à UNATI/FOSJC/UNESP quanto as condições da saúde bucal, por meio da entrevista semidiretiva e da aplicação do Índice de Gohai. O resultado obtido mostra uma condição bucal considerada de “regular” para “boa”. Esse resultado deriva da autopercepção que os entrevistados têm da própria boca, gengivas e dentes, e que justificam pelo fato de 59,26% não usarem próteses totais, apenas 20,40% portarem próteses parciais e 55,56% manterem, por seus critérios, boas condições das gengivas. Quando se relaciona a condição bucal à classe social a qual o idoso pertence, reafirma-se que ela é satisfatória, assim como relatam os diferentes estudos revisados. Apenas 5,26% dos pertencentes à classe média se auto-avaliam como “excelente”, enquanto 34,22% dessa classe e 10,53% dos pertencentes à chamada classe trabalhadora se auto-avaliam com “boa” condição bucal. Quanto ao perfil do entrevistado, 16,67% pertencem ao gênero masculino e 83,33% ao feminino e 51,85% são casados. Com relação à UNATI, 40,74% dos idosos a reconhecem como um centro de convivência, como espaço de atualização do conhecimento e rede de auxílio para novas amizades. Concluiu-se que: (1) o conhecimento sobre a autopercepção dos idosos da UNATI se revela pelo Índice de Gohai como “satisfatória”, segundo os critérios subjetivos, e pela ausência de qualquer incômodo nos últimos meses, devido a bons hábitos bucais, higienização e escolha do creme e da escova dental; (2) é necessário o conhecimento dos fatores epidemiológicos, por meio de exames clínicos, para colaborar na compreensão da auto-avaliação e também para identificar qualquer discrepância entre os critérios subjetivos e os técnicos e, assim, facilitar a elaboração de um programa e de ações educativas direcionando ao autodiagnóstico e autocuidado.The objective was to evaluate the self-perception of the elderly pertaining ones tothe UNATI/FOSJC/UNESP regarding buccal health, by means of the half-directiveinterview and of the application of the Index of Gohai. The result is that the oralhealth was considered as between "regular" and "good". This result comes fromthe self-perception that the interviewed ones have of their own mouths, gingivasand teeth and justified by the fact that 59,26% do not to use complete denture, only20.40% to carry partial dentures; 55,56% to keep, at their discretion, goodcondition of gingiva. Regarding to oral health to the social classroom which theelderly belongs, it is reaffirmed that it is satisfactory, as well as tell the differentrevised studies. But 5.26% of the pertaining ones to the middle classes if selfassessmentas being "excellent", while 34.22% in these classrooms and 10.53% ofpertaining to the calls the diligent classrooms if auto-assessment as having "good"oral health. As of the profile of the interviewed ones, 16.67% are from male genderand 83.33% to the female, and 51.85% are married. With relation to UNATI,40.74% of elder consider it as a aging center, as space of update of theirknowledge and network for new friendships. One concluded that: (1) theknowledge on the self-perception of the aged ones of the UNATI is considered"satisfactory" according to the Index of Gohai, subjective criteria, and for theabsence of any bother in the last months, for the factors as good buccal habits, forthe hygienic cleaning and the choice of the dental cream and the dental brush; (2)the epidemiologistic factors knowledge by means of clinical examinations isnecessary to help understanding of the self-assessment, as well to identify anydiscrepancies between subjective and technician criteria, thus to facilitate theelaboration of a program and educative actions directing to the self-diagnosis andself-care.El objetivo es evaluar la autopercepción de las personas de la tercera edad, pertenecientes a UNATI/FOSJC/UNESP, en relación a las condiciones de la salud bucal, realizado por médio de una entrevista semidirecta y de la aplicación del Índice de Gohai. El resultado obtenido muestra una condición bucal considerada de "regular" para "buena". Ese resultado deriba de la autopercepción que los entrevistados tienen de la propia boca, encias y dientes, y justifican por el hecho de que 59.26% no usaron prótesis total, apenas 20.4% usaron prótesis parcial y 55.56% mantubieron, por sus propios criterios buenas condiciones de las encias. Cuando se relaciona la condición bucal a la clase social a la cual el idoso pertenece, se afirma que ella es satisfactoria, como describen los diferentes estudios analisados. Apenas 5.26% de los pertenecientes a la clase media se autoevaluan como "excelentes", en cuanto que 34.22% de esa clase y 10.53% delos pertenecientes a la llamada clase trabajadora se autoevaluan como condición bucal "buena". En relación al perfil del entrevistado, 16.67% pertenecen al género masculino y 83.33% al femenino y 51.85% son casados. En relación al UNATI, 40,74% de los de la tercera edad lo reconocen como un centro de convivência, como espacio de actualización del conocimiento y red de auxilio para nuevas amistades. Concluimos que: (1) el conocimiento sobre la autopercepción de los dela tercera edad de la UNATI se rebela por el índice de Gohai como "satisfactoria", según los criterios subjetivos, y por la ausencia de cualquier incómodo en los últimos meses, debido a buenos hábitos bucales, higiene y elección de la crema dental y cepillo de dientes; (2) es necesario el conocimiento de los factores epidemiológicos por medio de exames clínicos, para colaborar en la comprensiónde la auto-avaliación y tambien para identificar cualquier conflicto entre los criterios subjetivos y los técnicos y, facilitar la colaboración de un programa y de acciones educativas direccionadas al autodiagnóstico y autocuidado