Osteonecrose dos maxilares associada ao uso de medicamentos

A osteonecrose pode ser definida como lesão de osso exposto ou fístula em pacientes sem histórico de doença metastática ou de radioterapia, que estão sob tratamento com agentes antirreabsortivos e/ou antiangiogênicos, tendo suas lesões persistindo por mais de oito semanas. Este estudo tem por objetivo descrever a osteonecrose associada ao uso de medicamentos, relatando sua etiologia e suas formas de tratamento. Esta pesquisa é uma revisão narrativa de Literatura, feita por meio de levantamento bibliográfico nas bases de dados Biblioteca Virtual em Saúde (BVS), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Biblioteca Eletrônica Científica Online (SciELO) e no PubMed. A osteonecrose relacionada ao uso de medicamentos é uma patologia desafiadora, tendo áreas de tecido ósseo não vital que favorecem a colonização de bactérias e aumento da necrose óssea. Na literatura não há um protocolo especifico de tratamento, contudo, o uso de terapia fotodinâmica antimicrobiana vem se mostrado uma alternativa promissora no combate a essa patologia

Impacto da cirurgia bariátrica no prognóstico de pacientes portadores de Diabetes Mellitus tipo 2 / Impact of bariatric surgery on prognosis of patients with type 2 diabetes mellitus

Objetivo: avaliar as possíveis alterações que a cirurgia bariátrica pode gerar no prognóstico do diabetes mellitus tipo 2 e, além disso, atuar na diminuição dos fatores de risco cardiovasculares. Revisão Bibliográfica: Após 2 anos de realização da cirurgia bariátrica, foi visto que houve uma remissão do DM2 em 72,3% dos pacientes, enquanto que naqueles que utilizaram apenas a terapia médica intensiva, a remissão ocorreu em 16,4%, de acordo com o estudo SOS 2014. Também houve melhora dos fatores de risco cardiovasculares, incluindo redução da taxa de mortalidade.  A diminuição do peso ocasionada após a realização da cirurgia bariátrica melhora a resistência insulínica presente no DM2. Além disso, o desvio anatômico feito no procedimento culmina com o efeito incretina, secreção de insulina pelo pâncreas e elevação dos hormônios da saciedade. Com isso, há melhora dos índices glicêmicos e manutenção do peso a longo prazo. Considerações finais: A cirurgia bariátrica apresenta melhores resultados em relação ao prognóstico da doença. Também gera benefícios no controle da hipertensão e hiperlipidemia, reduzindo assim os fatores de risco cardiovasculares

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Apropriações sociais do patrimônio cultural: exclusão ou inclusão?

A preservação do patrimônio cultural no Brasil construiu sua história como instrumento de vanguarda em termos de políticas públicas e, desde sempre, utilizando o conceito de função social da propriedade, o qual só se consolidou no país a partir da Constituição de 1988. O que vemos hoje, no entanto, na área patrimonial, em alguns casos, é uma prática que pode ameaçar esta função social do bem cultural pelo excessivo zelo de retirá-lo do cotidiano e protegê-lo em redomas, como se fossem excepcionalidades extraídas do tempo presente, com compromisso apenas com o passado e o futuro. Para ilustrar e problematizar esta questão, apresentamos o caso da Praça da Estação em Belo Horizonte, na qual a discrepância entre o que é concebido pelos planejadores e o que é vivido pelos transeuntes causa fragmentações no uso da praça e dificulta a existência de uma mistura social

Therapeutic use of cannabidiol: the lawsuit in the state of Pernambuco, Brazil

Cannabis sativa L. has been used since before the Christian Era to treat numerous diseases, but in the early 20th century, its use has been banned in several countries, including for medicinal purposes, for being considered illicit drug. However, the need to obtain alternatives to conventional treatments increased the interest for the therapeutic use of this plant, reason why several studies have been carried out, which verified that Cannabidiol (CBD), one of the main compounds of the plant, has great therapeutic potential. In Brazil, its internal commercialization is prohibited, but since 2015 the compassionate use and importation of the substance has been authorized by the Federal Council of Medicine (CFM) and by the National Health Surveillance Agency (Anvisa); however, the demand for CBD continues to be judicialized. The objective of this interdisciplinary research was precisely in this aspect, which was to analyze the constitutive exterior of the problem of access to the referred drug. For that, a documentary and exploratory research was performed, using the qualitative approach, in addition to the bibliographic review. The case study was carried out with the Judicial Processes of the Court of Justice of Pernambuco (TJ/PE) on the subject, located from the grouped insertion of the keywords “supply” and “Cannabidiol” in the field “jurisprudence” of the virtual site of this Court. As a result, it was found that individuals who file a lawsuit meet the requirements of regulatory agencies, which allows to conclude that the administrative refusal to provide the drug by the state of Pernambuco characterizes violation of their right to health.A Cannabis sativa L. vem sendo utilizada, antes mesmo da Era Cristã, para tratar inúmeras enfermidades, mas, no início do século 20, seu uso passou a ser proibido em vários países, inclusive com escopo medicinal, por ser considerada droga ilícita. Entretanto, a necessidade de obter alternativas aos tratamentos convencionais aumentou o interesse pelo uso terapêutico dessa droga vegetal, razão por que diversos estudos passaram a ser realizados, constatando que o Canabidiol (CBD), um dos principais compostos da planta, possui grande potencial terapêutico. No Brasil, a comercialização do CBD permanece proibida, mas, a partir de 2015, o uso compassivo e importação da substância foram autorizados pelo Conselho Federal de Medicina (CFM) e pela Agência Nacional de Vigilância Sanitária (Anvisa), porém, a demanda por CBD continua sendo judicializada. Justamente neste aspecto residiu o objetivo da pesquisa interdisciplinar, que foi analisar o exterior constitutivo do problema do acesso ao referido fármaco para tratamento de doenças. Para tanto, foi realizada pesquisa documental e exploratória, utilizando a abordagem qualitativa, além da revisão bibliográfica. O estudo de caso foi realizado com os processos judiciais do Tribunal de Justiça de Pernambuco (TJ/PE) sobre o assunto, localizados a partir da inserção agrupada das palavraschave “fornecimento” e “Canabidiol” no campo “jurisprudência” do sítio virtual desse Tribunal. Como resultado, constatou-se que os sujeitos que ingressam com ação judicial atendem aos requisitos exigidos pelos órgãos reguladores, o que permite concluir que a negativa administrativa de fornecimento do medicamento pelo estado de Pernambuco caracteriza violação ao direito à saúde deles

Effect of gingival barrier brands on operator perception, cervical adaptation, and patient comfort during in-office tooth bleaching: a randomized clinical trial

Abstract Background Light-cured resins are widely used as gingival barriers to protect the gums from highly concentrated peroxides used in tooth bleaching. The impact of barrier brand on clinical outcomes is typically considered negligible. However, there is limited evidence on the effects of different brands on operator experience, barrier adaptation, and patient comfort. Objective This clinical trial assessed the impact of four commercial gingival barrier brands (Opaldam, Topdam, Lysadam, and Maxdam) on operator perception, adaptation quality, and patient comfort. Methods Twenty-one undergraduate students placed gingival barriers in a randomized sequence using blinded syringes. Photographs of the barriers were taken from frontal and incisal perspectives. After bleaching procedures, operators rated handling features and safety using Likert scale forms. Two experienced evaluators independently assessed barrier adaptation quality on a scale from 1 (perfect) to 5 (unacceptable). The absolute risk of barrier-induced discomfort was recorded. Data were analyzed using Friedman and Chi-square tests (α = 0.05). Results Opaldam and Topdam received the highest scores in most handling features, except for removal, which was similar among all brands. No significant difference was observed in barrier adaptation quality between the evaluated brands. Discomforts were mainly reported in the upper dental arch, with Maxdam having the highest absolute risk (35% for this arch and 24% overall). Conclusions This study suggests that gingival barrier brands can influence operator perception and patient comfort. Opaldam and Topdam were preferred by operators, but all brands demonstrated comparable adaptation quality. Clinical trial registration The study was nested in a randomized clinical trial registered in the Brazilian Clinical Trials Registry under identification number RBR-9gtr9sc