UTILIZAÇÃO DE CORTICOSTEROIDE TÓPICO OCLUSIVO NO TRATAMENTO DO PENFIGOIDE CICATRICIAL DAS MEMBRANAS MUCOSAS EM PACIENTE APRESENTANDO GENGIVITE DESCAMATIVA

Pemphigoid of the mucous membranes is an autoimmune, vesiculobullous, chronic disease characterized by the presence of suprabasal or subepithelial blisters on mucous membranes. It predominantly affects a fixed older age, generally from the fourth decade of life. Ocular involvement is common, with the formation of scars characteristic of this type of pemphigoid, and when the conjunctiva is affected, it can lead the patient to blindness. Those with this alteration may have involvement of the oral mucous membranes, with the inserted gingiva being the most affected site, triggering a condition of desquamative gingivitis, as well as painful and bleeding bullous lesions with deep cleavage. The etiology is unknown, but some authors associate pemphigoid with the use of certain drugs such as Captopril, Furosemide and Amoxicillin. Diagnosis is based on clinical history, perilesional biopsy and direct immunofluorescence. Histopathological examinations show the separation of the basal epithelial layer from the connective tissue itself, vacuolation in the basal lamina under an intact epithelium, and deposits of IgG and C3 in the basal membrane, which can be identified through direct immunofluorescence. The treatment is done in a multidisciplinary way, through topical or systemic corticosteroid therapy, depending on the severity of the disease, in addition to laser therapy and drug associations. The present work aims to present a case of pemphigoid of the mucous membranes, where the patient presented lesions in the eyes and in the oral mucosa, with a diagnosis confirmed through histopathology, in concomitant treatment of stomatology with other medical specialties, such as ophthalmology, presenting satisfactory evolution of the mouth injuries.Penfigoide das membranas mucosas, é uma doença autoimune, vesiculobolhosa, de caráter crônico, que se caracteriza pela presença de bolhas suprabasais, ou subepiteliais, em membranas mucosas. Acomete predominantemente fixa etária mais elevada, geralmente, a partir da quarta década de vida. O envolvimento ocular é costumaz, ocorrendo a formação de cicatrizes característica desse tipo de penfigoide, e quando afetada a conjuntiva, pode levar o paciente à cegueira. Os portadores desta alteração podem apresentar envolvimento das mucosas orais, sendo a gengiva inserida o sítio mais afetado, desencadeando um quadro de gengivite descamativa, além de lesões bolhosas de clivagem profunda, doloridas e sangrantes. A etiologia é desconhecida, mas alguns autores associam o penfigoide ao uso de certos fármacos como Captopril, Furosemida e Amoxicilina. O diagnóstico é baseado na história clínica, biópsia perilesional e imunofluorescência direta. Nos exames histopatológicos, observa-se a separação da camada basal epitelial do tecido conjuntivo propriamente dito, vacuolização na lâmina basal sob um epitélio íntegro, e, depósitos de IgG e C3 na membrana basal, que podem ser identificados através de imunofluorescência direta. O tratamento é feito de forma multiprofissional, através de corticosteroideterapia, tópica ou de forma sistêmica, a depender da gravidade da doença, além de laserterapia e associações medicamentosas. O presente trabalho tem por objetivo apresentar um caso de penfigoide das membranas mucosas, onde o paciente apresentava lesões oculares e em mucosa oral, tendo diagnóstico confirmado através de histopatologia, em tratamento concomitante da estomatologia com outras especialidades médicas, como oftalmologia, apresentando evolução satisfatória das lesões bucais

A EQUIPE MULTIPROFISSIONAL E O DEBATE ACERCA DO ATENDIMENTO HUMANIZADO

The provision of health services permeates the interaction between professionals from different areas, highlighting the importance of the multidisciplinary team. Humanized care emerges as a crucial element in this context, aiming to provide a patient-centered approach, respecting their individuality and promoting comprehensive care. This study seeks to analyze the relationship between the performance of the multidisciplinary team and the implementation of humanized care, exploring the available literature to understand the practices, challenges and benefits associated with this approach in the healthcare setting. The methodology adopted consists of an integrative literature review, allowing a comprehensive analysis of relevant studies on the intersection between the multidisciplinary team and humanized care. The search and selection of articles were carried out systematically in scientific databases. The results reveal that the integrated action of the multidisciplinary team is essential to promote humanization in health care. The exchange of knowledge and collaboration between different professionals contribute to a more holistic and effective approach, meeting the physical, emotional and social needs of patients. Discussions address challenges faced by the multidisciplinary team, such as interdisciplinary communication and overcoming hierarchical barriers. Furthermore, the benefits of humanized care stand out, including greater patient satisfaction, improved adherence to treatment and strengthening of the therapeutic bond. This study highlights the importance of the multidisciplinary team in the context of humanized care, highlighting the need for policies and practices that encourage interdisciplinary collaboration. Promoting an organizational culture that values ​​humanization in care contributes to the quality and effectiveness of health services.A prestação de serviços de saúde permeia a interação entre profissionais de diversas áreas, destacando a importância da equipe multiprofissional. O atendimento humanizado emerge como um elemento crucial nesse contexto, visando proporcionar uma abordagem centrada no paciente, respeitando sua individualidade e promovendo a integralidade do cuidado. Este estudo busca analisar a relação entre a atuação da equipe multiprofissional e a implementação do atendimento humanizado, explorando a literatura disponível para compreender as práticas, desafios e benefícios associados a essa abordagem no cenário da saúde. A metodologia adotada consiste em uma revisão integrativa da literatura, permitindo a análise abrangente de estudos relevantes sobre a interseção entre a equipe multiprofissional e o atendimento humanizado. A busca e seleção dos artigos foram realizadas de forma sistemática em bases de dados científicas. Os resultados revelam que a atuação integrada da equipe multiprofissional é fundamental para promover a humanização no atendimento em saúde. A troca de conhecimentos e a colaboração entre diferentes profissionais contribuem para uma abordagem mais holística e eficaz, atendendo às necessidades físicas, emocionais e sociais dos pacientes. Discussões abordam desafios enfrentados pela equipe multiprofissional, como a comunicação interdisciplinar e a superação de barreiras hierárquicas. Além disso, destacam-se os benefícios do atendimento humanizado, incluindo maior satisfação do paciente, melhoria na adesão ao tratamento e fortalecimento do vínculo terapêutico. Este estudo ressalta a importância da equipe multiprofissional no contexto do atendimento humanizado, evidenciando a necessidade de políticas e práticas que incentivem a colaboração interdisciplinar. A promoção de uma cultura organizacional que valorize a humanização no cuidado contribui para a qualidade e efetividade dos serviços de saúde

Repercussão da terapia de suplementação de proteína em detrimento das alterações na composição muscular de idosos: uma revisão: Repercussion of protein supplementation therapy to the detriment of changes in muscle composition in the elderly: a review

INTRODUÇÃO: O ato de envelhecer traz consigo inúmeras mudanças fisiológicas, dentre elas, destaca-se a sarcopenia, que por vezes pode levar a perda da capacidade funcional, podendo prejudicar a mobilidade e por fim acarretar em acidentes graves ou mortes. A atual concentração diária recomendada de proteína por quilograma não foi projetada para uma população em fase de envelhecimento, o que pode levar a uma concentração de proteína insuficiente. A suplementação proteica surgiu como forma alternativa de preservar a manutenção muscular. OBJETIVO: Analisar os efeitos da suplementação proteica na manutenção da capacidade funcional muscular na população idosa. METODOLOGIA: Para tanto, foi realizada uma revisão integrativa da literatura de aspecto qualitativo, no qual, a partir de uma pesquisa em bases de dados selecionadas, baseou-se em estudos que apresentaram efeitos da suplementação proteica na manutenção da capacidade funcional muscular de idosos. Ao final foram selecionados seis estudos que contemplavam o tema em questão. RESULTADOS E DISCUSSÃO: A melhora do estado nutricional está relacionada ao desempenho muscular, com base nisso, foram analisados nos estudos os seguintes aspectos: ganho de massa muscular, exercício físico em jejum, membros inferiores, velocidade da marcha e outros parâmetros funcionais e 25-hidroxivitamina D, todos colocando-se em comparação com a suplementação proteica como forma intervencionista e de manutenção da capacidade funcional muscular. Ainda, foi realizada uma análise da suplementação dietética com aminoácidos de cadeia ramificada (BCAAs) em relação a desnutrição. CONCLUSÃO: A análise dos dados supracitados revelou a relevância da busca pela melhoria na qualidade de vida e bem-estar da população senil, de maneira que o consumo diário recomendado de proteína seja preconizado como principal medida para manutenção da massa muscular nesta parcela populacional. Deve-se estimular o consumo diário de alimentos ricos em proteínas, tais como carnes, ovos, leite e derivados e suplementos alimentares, quando sua prescrição se faz necessária. Diante da corroboração da sarcopenia no aumento da incidência de quedas em idosos, se faz necessário orientar e estimular a população senil para a prática regular de exercício físico resistido, além do acompanhamento de equipe multidisciplinar

AI is a viable alternative to high throughput screening: a 318-target study

: High throughput screening (HTS) is routinely used to identify bioactive small molecules. This requires physical compounds, which limits coverage of accessible chemical space. Computational approaches combined with vast on-demand chemical libraries can access far greater chemical space, provided that the predictive accuracy is sufficient to identify useful molecules. Through the largest and most diverse virtual HTS campaign reported to date, comprising 318 individual projects, we demonstrate that our AtomNet® convolutional neural network successfully finds novel hits across every major therapeutic area and protein class. We address historical limitations of computational screening by demonstrating success for target proteins without known binders, high-quality X-ray crystal structures, or manual cherry-picking of compounds. We show that the molecules selected by the AtomNet® model are novel drug-like scaffolds rather than minor modifications to known bioactive compounds. Our empirical results suggest that computational methods can substantially replace HTS as the first step of small-molecule drug discovery

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.

BACKGROUND: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. METHODS: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. FINDINGS: Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. INTERPRETATION: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

Background A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. Methods This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. Findings Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0–75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4–97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8–80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3–4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. Interpretation ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials

Development of nanocomposite materials and the infrared laser stereolithography process

Orientadores: Rubens Maciel Filho, André Luiz Jardini MunhozTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Engenharia QuímicaResumo: A tendência atual na área de desenvolvimento de materiais aponta significantemente para o desenvolvimento de nanocompósitos. Várias pesquisas mostram que as características das propriedades que estes materiais apresentam ampliam de forma bastante promissora suas possíveis aplicações. Levando-se isso em consideração, este projeto tem como objetivo o estudo e desenvolvimento de materiais compósitos (polímero/carga) nanoestruturados para utilização no processo da Estereolitografia Laser no Infravermelho (CO2). Para tanto, o estudo envolve a mistura física de nanopartículas de sílica dispersas em uma matriz polimérica, composta por resina epóxi (diglicidil éter bisfenol A - DGEBA) e dietilenotriamina (DETA) como agente de cura. A determinação das propriedades térmicas e análise dos principais fenômenos e mecanismos gerais de cura do material nanocompósito foram realizadas utilizando a técnica de Calorimetria Exploratória Diferencial (DSC). Simulação computacional, utilizando um modelo matemático determinístico resolvido por volumes finitos através do programa ANSYS CFX®, foi realizada com o objetivo de avaliar os perfis da distribuição da temperatura espacial e temporal (análise térmica transiente), na amostra (modelo físico), durante a aplicação do laser nos materiais nanocompósitos com diferentes composições. A validação física das simulações foi feita utilizando o processo de Estereolitografia Laser no Infravermelho (CO2), avaliando o efeito dos parâmetros do processo (velocidade de varredura e potência do laser). Os resultados obtidos comprovaram que, dentre os sistema estudados, o sistema nanocompósito DGEBA/DETA/NS A apresenta características de viscosidade e cura localizada adequadas à utilização no processo de Estereolitografia Laser no Infravermelho (CO2). Os testes experimentais mostraram que quanto maior a velocidade de varredura do feixe laser (?), menor a difusão de calor para as regiões vizinhas ao ponto irradiado e, consequentemente, menor a espessura da camada curada. Outro fator observado na realização dos testes é que quanto menor a quantidade de pulsos incidentes no material e maior a ?, melhores são as condições de obter a cura localizada, com pouca difusão de calor para regiões vizinhas ao volume irradiado. Com base nesses resultados conclui-se que a cura localizada depende do material utilizado e do controle dos parâmetros operacionais do processoAbstract: The current trend in materials development points significantly to the development of nanocomposites. Several researches show that the characteristic properties of these materials present, compared to similar macrocystaline, a broad range of promising possible applications. Taking this into consideration, this project aims to study and develop nanostructured composite materials (polymer/filler) to use in the process of Infrared Laser Stereolithography (CO ). 2 Thus, this study involves the physical mixture of silica nanoparticles dispersed in a polymer matrix composed of epoxy resin (diglycidyl ether bisphenol A - DGEBA) and diethylenetriamine (DETA) as curing agent. The determination of thermal properties and analysis of major general phenomena and mechanisms of nanocomposite materials cure were carried out using the Differential Scanning Calorimetry (DSC) technique. Computer simulation using a deterministic mathematical model solved by finite volume through the ANSYS CFX program, was performed ® to evaluate the profiles of the temperature spatial and temporal (transient thermal analysis) distribution in the sample (physical model) during laser application in nanocomposite materials. The simulation validations were made using the Infrared Laser Stereolithography (CO ) process, evaluating the effect of process parameters 2 (laser scan rate and laser power). The results obtained proved that among the studied systems, the DGEBA/DETA/NS A nanocomposite system have characteristics of viscosity and localized cure suitable for use in the Infrared Laser Stereolithography (CO ) process. 2 The experimental tests showed that the higher the scan rate of laser beam (?), lower the heat diffusion to the neighboring regions to irradiated point, and lower the thickness of the layer cured. Another observed aspect in the test refers to the fact that the smaller number of pulses incident on the material and the higher the scan rate of laser beam, better are the conditions to obtain localized cure, with little heat diffusion to neighboring irradiated volume regions. Based on these results it may be concluded that the localized cure depends on the material used and the control of operational parameters processDoutoradoDesenvolvimento de Processos QuímicosDoutor em Engenharia Químic

Microstructural characteristics and performances of Cr2O3 and Cr2O3-15%TiO2 S-HVOF coatings obtained from water-based suspensions

Cr2O3-based coatings offer high hardness, excellent sliding wear performance, and corrosion resistance. Therefore, they are widely applied in the paper industry, as well as for pumps and mechanical sealing systems. Compared to the conventional spray processes, the technology of suspension-HVOF spraying (S-HVOF) allows the production of dense, finely structured coatings with smoother surfaces and improved mechanical properties by using submicron-scaled raw materials. This work investigates the microstructure and performances of Cr2O3 and Cr2O3-15%TiO2 coatings obtained by S-HVOF starting from water-based suspensions. For the development of the suspensions with binary composition, two routes were used to produce ready-to-spray suspensions: (a) mixture of two stable suspensions in the desired ratio, and (b) dispersion of an appropriate alloyed material in the solvent. In order to evaluate the potential of suspension spraying over the conventional APS and HVOF processes, the mechanical properties, corrosion, and sliding wear resistances of the S-HVOF coatings were compared with those of the coatings produced from feedstock spray powders. From the experimental results, it was observed that, in most of the cases, the suspension-sprayed coatings showed denser microstructures, enhanced mechanical properties, wear resistance, and superior corrosion performances