The importance of oral microbiota control and utilization of biomaterial in secondary alveolar bone graft surgeries in patients with cleft lip and palate

A cavidade bucal é uma das portas de entrada ao nosso organismo. Pertencendo ao sistema digestório, também funciona como uma via de acesso às vias respiratórias. A fissura labiopalatina é uma anomalia que pode promover perda de continuidade nos tecidos labiais, alveolares e palatinos da maxila, necessitando de procedimentos cirúrgicos para reabilitação estética e funcional do paciente. Diante disso, o objetivo do presente estudo foi realizar um trabalho de atualização enfatizando a influência da microbiota bucal e o uso de rhBMP-2 em pacientes submetidos a cirurgia de enxerto alveolar secundário, visto que a cirurgia apresenta um período pós-operatório crítico e de grande importância para o sucesso do tratamento, o qual requer muitos cuidados tanto no que diz respeito à alimentação quanto à higienização bucal, esta com o propósito de diminuir os riscos de infecção no respectivo período. O cuidado com a higiene bucal destes pacientes é um fator importante no processo saúde/doença a partir de uma concepção holística, em prevenir não somente as alterações na cavidade bucal como evitar que esses micro-organismos residentes se tornem agentes complicadores do estado geral do paciente.The oral cavity is one of the entrance ways to the body, belonging to the digestive system, and also allows access to the respiratory pathways. Cleft lip and palate is an anomaly that may cause continuity of lip, alveolar and palatal tissues of the maxilla, requiring surgical procedures for the esthetic and functional rehabilitation of the patient. This study conducted a literature review emphasizing the influence of the oral microbiota and utilization of rhBMP-2 in patients submitted to secondary alveolar graft surgery. This surgery presents a critical postoperative recovery that is fundamental for the treatment success and requires much care both concerning feeding and oral hygiene, to reduce the risk of infection in this period. The care with oral hygiene of these patients is an important factor in the health/disease process based on a holistic approach, to prevent not only changes in the oral cavity and avoid that these microorganisms may complicate the overall status of the patient

Fcγ receptors on aging neutrophils

Objective: Neutrophils are key effector cells of the innate immune system. They recognize antigens through membrane receptors, which are expressed during their maturation and activation. Neutrophils express FcγRII (CD32), FcγRIII (CD16), and FcγRI (CD64) after being activated by different factors such as cytokines and bacterial products. These receptors are involved with phagocytosis of IgG-opsonized microbes and enhance defense mechanisms. Based on that, our study seeks to compare the expression of FcγRII, FcγRIII, FcγRI, and CD11b on neutrophils from elderly and young subjects and their expression after in vitro activation with cytokines and LPS. Methodology: Neutrophils were isolated from human peripheral blood and from mice bone marrow by density gradient. After isolation, FCγRs expression was immediately analyzed by flow cytometry or after in vitro stimulation. Results: In freshly isolated cells, the percentage of FcγRIIIb+ and CD11b+ neutrophils were higher in samples from young individuals; FcγRIIIa expression was more prominent on aged neutrophils; FcγRIA expression was similar in all samples analyzed. Exposure to CXCL8 and LPS resulted in a higher percentage of FcγRIa+ neutrophils on elderly individuals’ samples but lower when compared with neutrophils from young donors. We observed that LPS caused an increase in FcγRIIa expression on aging human neutrophils. In contrast, FcγRIIIb expression in response to CXCL8 and LPS stimulation was not altered in the four groups. CD11b expression was lower in neutrophils from elderly individuals even in response to LPS and CXCL8. In mice, we observed differences only regarding CD11b expression, which was increased on aged neutrophils. LPS exposure caused an increase in all FcγRs. Conclusions: Our results suggest that, in humans, the overall pattern of FcγR expression and integrin CD11b are altered during aging and immunosenescence might contribute to age-related infection

ATRIBUIÇÕES DO ENFERMEIRO NO ACOLHIMENTO COM CLASSIFICAÇÃO DE RISCO NOS SERVIÇOS DE URGÊNCIA E EMERGÊNCIA: UM ESTUDO DE REVISÃO INTEGRATIVA

This study aims to describe the duties of nurses during Welcoming with Risk Classification in urgent and emergency services. The present study is an integrative literature review. The bibliographic survey was carried out between October 10th and November 15th, 2023 in the indexed databases: LILACS, SCIELO and PUBMED, using the descriptors “Risk Classification” AND “Nursing”, which are registered in the DECS and which were defined according to the proposed theme. The inclusion criteria for this study were full original articles available in indexed databases, written in Portuguese, and which were recently published in the last six years. After analysis, reading of the studies and application of the inclusion and exclusion criteria, a quantity of 8 articles were selected to compose this integrative review, as they covered the proposed theme. Data analysis was carried out according to the content analysis technique proposed by Bardin. The selected studies were developed in Caruaru, Fortaleza, in the Center West of Goiás, in the interior of Rio Grande do Sul, in João Pessoa, in Santa Catarina, in the Center West region of the state of São Paulo, and in the interior of Rio de Janeiro. The selected studies were displayed in a data table containing the information: title, author, year, study objective, study methodology, and database. In view of the aforementioned aspects, it was possible to observe that the nurse's duties in risk classification are focused on welcoming, dialogue and building a bond with the user and family members, as well as carrying out anamnesis with assessment of vital signs to identify the level of severity and carry out classification according to the Manchester protocol. Furthermore, these professionals carry out a humanized practice, as they evaluate non-severe patients, inform users about the waiting time for care, and notify cases of infectious diseases.Esse estudo tem como objetivo descrever as atribuições dos enfermeiros durante o Acolhimento com Classificação de Risco nos serviços de urgência e emergência. O presente estudo trata-se de uma revisão de literatura do tipo integrativa. O levantamento bibliográfico foi realizado entre o período de 10 de outubro a 15 de novembro de 2023 nas bases de dados indexadas: LILACS, SCIELO e PUBMED, utilizando os descritores “Classificação de Risco” AND “Enfermagem”, que estão registrados nos DECS e que foram definidos conforme a temática proposta. Os critérios de inclusão desse estudo foram os artigos originais na íntegra disponíveis nas bases de dados indexadas, escritos em língua portuguesa, e que foram publicados recentemente nos últimos seis anos. Após a análise, leitura dos estudos e aplicação dos critérios de inclusão e exclusão, foram selecionados um quantitativo de 8 artigos para compor essa revisão integrativa, visto que esses abrangeram a temática proposta. A análise de dados foi realizada conforme a técnica de análise de conteúdo, proposta por Bardin. Os estudos selecionados foram desenvolvidos em Caruaru, Fortaleza, no Centro Oeste de Goiás, no interior do Rio Grande do Sul, em João Pessoa, em Santa Catarina, na região Centro Oeste do estado de São Paulo, e no interior do Rio de Janeiro. Os estudos selecionados foram expostos em um quadro de dados contendo as informações: título, autor, ano, objetivo do estudo, metodologia do estudo, e base de dados. Tendo em vista os referidos aspectos foi possível observar que as atribuições do enfermeiro na classificação de risco estão voltadas ao acolhimento, diálogo e construção de vínculo com o usuário e os familiares, assim como a realização da anamnese com avaliação dos sinais vitais para identificar o nível de gravidade e realizar a classificação segundo o protocolo de Manchester. Além disso, esses profissionais realizam uma prática humanizada, pois avaliam os pacientes não graves, informam os usuários sobre o tempo de espera para o atendimento, e realizam a notificação dos casos de doenças infectocontagiosas

Ageing exacerbates damage of systemic and salivary neutrophils from patients presenting Candida-related denture stomatitis

<p>Abstract</p> <p>Background</p> <p>Ageing leads to a decline in the function of the immune system, increasing the body's susceptibility to infections through the impairment of T-cells, macrophages, neutrophils and dendritic cells Denture stomatitis is a primary oral disease affecting elderly denture wearers. The major etiologic factor involved in this pathology is the infection by <it>Candida albicans</it>, an opportunistic pathogen that causes local and disseminated diseases in immunosuppressed humans. Neutrophils play a critical role in the immune response against <it>C. albicans </it>and are continually present in the salivary fluid and in the blood. The aim of this study was to determine ageing-related changes in salivary and blood neutrophils and their potential implications in <it>Candida</it>-related denture stomatitis.</p> <p>Results</p> <p>Our results showed a lower number of neutrophils in the saliva from patients presenting <it>Candida</it>-related denture stomatitis in comparison to their matched controls. Furthermore, fewer neutrophils were isolated from the saliva of aged control individuals in comparison to matched younger subjects. CXCR1, CD62L and CD11b expression were significantly greater on systemic neutrophils from younger control individuals. Elderly individuals showed more apoptotic salivary neutrophils and lower GM-CSF levels than younger ones, regardless of the occurrence of <it>Candida </it>infection. On the other hand, CXCL-8 concentrations were higher in the saliva from elderly individuals. Besides, TNF-α was detected at elevated levels in the saliva from infected elderly subjects. Salivary neutrophils from elderly and young patients presented impaired phagocytic activity against <it>C. albicans</it>. However, just systemic neutrophils from elderly showed decreased phagocytosis when compared to the younger ones, regardless of the occurrence of infection. In addition, neutrophils from aged individuals and young patients presented low fungicidal activity.</p> <p>Conclusion</p> <p>The data suggests that the <it>Candida </it>related-denture stomatitis is associated to neutrophils function deficiency, and ageing drastically appears to alter important characteristics of such cells, facilitating the establishment of this infection.</p

ASSISTÊNCIA DE ENFERMAGEM AO PACIENTE GRANDE QUEIMADO: UM ESTUDO DE REVISÃO INTEGRATIVA

O estudo tem como objetivo descrever a assistência realizada pelos profissionais de enfermagem frente ao paciente grande queimado. Trata-se de uma revisão de literatura do tipo integrativa, realizada entre o período de 10 de novembro a 28 de dezembro de 2023 nas bases de dados LILACS, Periódico CAPES, e SCIELO, utilizando os descritores “Unidades de Queimados” AND “Enfermagem”, “Enfermagem” AND “Queimaduras”, registrados nos Descritores em Ciências da Saúde. Os critérios de inclusão foram os artigos originais na íntegra disponíveis nas bases de dados indexadas, escritos em língua portuguesa, e que foram publicados recentemente nos últimos seis anos, entre o período de 2018 a 2023. Inicialmente foram encontrados 66 estudos no LILACS, 40 no CAPES e 14 artigos no SCIELO. Após a análise, leitura dos estudos e aplicação dos critérios de inclusão e exclusão, foram selecionados um quantitativo de 7 artigos para compor a revisão integrativa, visto que esses abrangeram a temática proposta. Os estudos selecionados nas bases indexadas foram expostos em um quadro de dados contendo as seguintes informações: título, autor, ano, objetivo, metodologia do estudo e base de dados. Foi possível observar que os profissionais de enfermagem são imprescindíveis frente aos casos de queimaduras, visto que realizam uma assistência humanizada e eficaz, com a adoção de condutas que reduzem a dor e o sofrimento do paciente. Além disso, estes profissionais realizam condutas iniciais de estabilização da vítima, curativos das lesões, administração de analgésicos e antibióticos, e estratégias por meio da tecnologia leve, como o dialógo, incentivo e esclarecimento de dúvidas aos familiares e ao paciente.O estudo tem como objetivo descrever a assistência realizada pelos profissionais de enfermagem frente ao paciente grande queimado. Trata-se de uma revisão de literatura do tipo integrativa, realizada entre o período de 10 de novembro a 28 de dezembro de 2023 nas bases de dados LILACS, Periódico CAPES, e SCIELO, utilizando os descritores “Unidades de Queimados” AND “Enfermagem”, “Enfermagem” AND “Queimaduras”, registrados nos Descritores em Ciências da Saúde. Os critérios de inclusão foram os artigos originais na íntegra disponíveis nas bases de dados indexadas, escritos em língua portuguesa, e que foram publicados recentemente nos últimos seis anos, entre o período de 2018 a 2023. Inicialmente foram encontrados 66 estudos no LILACS, 40 no CAPES e 14 artigos no SCIELO. Após a análise, leitura dos estudos e aplicação dos critérios de inclusão e exclusão, foram selecionados um quantitativo de 7 artigos para compor a revisão integrativa, visto que esses abrangeram a temática proposta. Os estudos selecionados nas bases indexadas foram expostos em um quadro de dados contendo as seguintes informações: título, autor, ano, objetivo, metodologia do estudo e base de dados. Foi possível observar que os profissionais de enfermagem são imprescindíveis frente aos casos de queimaduras, visto que realizam uma assistência humanizada e eficaz, com a adoção de condutas que reduzem a dor e o sofrimento do paciente. Além disso, estes profissionais realizam condutas iniciais de estabilização da vítima, curativos das lesões, administração de analgésicos e antibióticos, e estratégias por meio da tecnologia leve, como o dialógo, incentivo e esclarecimento de dúvidas aos familiares e ao paciente

Microbiota intestinal de crianças com anomalias craniofaciais atendidas em um hospital especializado

O ecossistema gastrintestinal é caracterizado por interações recíprocas e dinâmicas entre o epitélio gastrintestinal, células do sistema imunológico e sua microbiota intestinal (MI), a qual desempenha atividades metabólicas importantes locais (mucosa intestinal) e sistêmicas. Avaliar a MI de crianças com malformação craniofacial atendidas em um hospital especializado e verificar a influência da antibioticoprofilaxia com cefazolina em palatoplastia foi o objetivo desse trabalho. Foram isoladas e quantificadas as bactérias anaeróbias intestinais dos gêneros Bacteroides sp, Bifidobacterium sp e Lactobacillus sp nas fezes de 11 crianças sem fissura de palato (C) e de 50, com fissura de palato (FP), no período compreendido entre maio de 2007 a setembro de 2008. Foi avaliada a MI de 18 crianças com fissura de palato após 24 horas de tratamento, em dose única na indução anestésica, com cefazolina para palatoplastia. Observou-se que a frequência de Bacteroides sp foi maior no grupo FP (p < 0,001). Para Lactobacillus sp, houve tendência a maior quantidade (p = 0,086) no grupo FP. Não houve diferença na frequência de Bifidobacterium sp entre os dois grupos de crianças (p = 0,495). Houve diminuição do número de UFCs de Bacteróides sp (p = 0,031) e Lactobacillus sp (p = 0,004) em crianças com fissura tratadas com cefazolina em cirurgia de palato. Para o gênero Bifidobacterium sp, houve tendência à diminuição nas UFCs (p = 0,063). A dificuldade de ingestão de nutrientes, aleitamento materno insuficiente, otites recorrentes, entre outras ocorrem com frequência em indivíduos com malformação craniofacial, o que pode ter influenciado na composição da MI. A associação da palatoplastia e o uso de antibiótico...The gastrointestinal ecossystem is characterized by reciprocal and dynamic interactions between the host and the intestinal microbiota (IM), which performs local important metabolic (intestinal mucosa) and systemic activities. The purposes of this study are the assessment of the IM in children with craniofacial malformation attended at a specialized hospital and the verification of the influence of the antibiotic prophylaxis with cefazolin on palatoplasty. The intestinal anaerobic bacteria Bacteroides sp, Bifidobacterium sp and Lactobacillus sp were isolated and quantified in the feces of 11 non-cleft children (NC) and 50 cleft children (CP), from May 2007 to September 2008. After a 24-hour treatment, the IM in 18 cleft children was evaluated – in a single dose – by means of anesthetic induction with cefazolin, in palatoplasty. It was observed that the Bacteroides sp occurred more often in the CP group (p < 0.001). Regarding the Lactobacillus sp, the largest quantity (p = 0.086) tended towards the CP group. There was no frequency difference for the Bifidobacterium sp between the two groups of children (p = 0.495). There was a reduction in the number of Colony-Forming Units (CFUs) for the Bacteroides sp (p = 0.031) and the Lactobacillus sp (p = 0.004) in cleft children treated with cefazolin, in palate surgeries. Regarding the Bifidobacterium sp, there was a reduction tendency in the CFUs (p = 0.063). The difficulty to ingest nutrients, the insufficient breastfeeding, the recurrent otitis – among other things – are frequent in individuals with craniofacial malformation, which may have influenced the IM composition. The association between palatoplasty and the use of antibiotics has intensified the IM changes. New investigations must be performed in order to verify which factors related to the craniofacial malformation, the surgical treatment and the use of antimicrobians would... (Complete abstract click electronic access below)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Male individuals with Robin Sequence: emerging significant association with ABO and RhD blood group phenotypes

Background: This study investigated the association of Robin Sequence with ABO and RhD blood group phenotypes. Methods: A retrospective cross-sectional study was performed of a cohort of Robin Sequence patients of the Hospital de Reabilitação de Anomalias Craniofaciais – Universidade de São Paulo (USP), Brazil. The study group was composed of 339 individuals of both genders with Robin Sequence referred for specific treatment. A control group was composed of 1780 individuals without syndromes. The groups were compared using the Pearson’ chi-square test (χ2) with statistical significance being defined for an alpha error of 5% (p-value < 0.05). Results: A comparison of gender found a significant difference for the AB phenotype between groups (p-value = 0.007). Comparing blood type by gender there was no significant difference within the same group (p-value = 0.117 and 0.388 respectively, for Robin Sequence and the control group). When comparing the AB blood type between groups, there was no difference for females (p-value = 0.577), but there was a significant difference for males (p-value = 0.0029). Conclusions: This study showed that the population with Robin Sequence had different patterns related to gender concerning the phenotypic distribution of ABO and RhD blood group phenotypes. Robin Sequence is more common among females. The AB phenotype was significantly higher in males with Robin Sequence than in males of the Control Group. The prevalence of the RhD-negative phenotype is higher in individuals with Robin Sequence. This result suggests a possible association of ABO and RhD phenotypes with Robin Sequence that should be better investigated by molecular studies, as it deserves greater attention. Keywords: Pierre Robin syndrome, ABO Blood-Group System, Rh-Hr Blood-Group Syste

Evaluation of fecal microorganisms of children with cleft palate before and after palatoplasty

This study isolated and quantified intestinal bacteria of children with cleft palate before and after palatoplasty. A prospective study was conducted from May 2007 to September 2008 on 18 children with cleft palate, aged one to four years, of both genders, attending a tertiary cleft center in Brazil for palatoplasty, to analyze the effect of surgical palate repair on the concentration of anaerobes Bacteroides sp, Bifidobacterium sp and microaerophiles Lactobacillus sp in feces of infants with cleft palate before and 24 hours after treatment with cefazolin for palatoplasty. There was significant reduction of Lactobacillus sp (p < 0.002), Bacteroides sp (p < 0.001) and Bifidobacterium sp (p = 0.021) after palatoplasty, revealing that surgery and utilization of cefazolin significantly influenced the fecal microbiota comparing collections before and after surgery. However, due to study limitations, it was not possible to conclude that other isolated factors, such as surgical stress, anesthetics and other medications used in palatoplasty might have a significant influence on the microbiota. Considering the important participation of the intestinal microbiota on both local and systemic metabolic and immunological activities of the host, professionals should be attentive to the possible influence of these changes in patients submitted to cleft repair

The pattern recognition receptors expressed on neutrophils and the associated cytokine profile from different aged patients with Candida-related denture stomatitis

This study evaluated the expression of pattern recognition receptors (PRRs) and activation factors associated with salivary and blood neutrophils from different aged patients diagnosed with Candida-related denture stomatitis (DS). Expression of neutrophil PRRs was determined by flow cytometry and immunofluorescence, and the levels of selected cytokines that influence immune activation were determined by ELISA. The salivary (but not the serum derived) neutrophils of individuals with DS were found to have an increased expression of CD69 regardless of the age of the patient compared to patients without DS. However, these salivary neutrophils had a lower expression of CD66b and CD64. Expression of TLR2 was lower on the salivary-and serum-derived neutrophils from elderly individuals compared to the neutrophils of younger subjects, regardless of whether the individual had DS. Salivary interleukin (IL)-4 was elevated in both of the elderly subject groups (with or without DS). Only elderly DS patients were observed to have increased serum IL-4 levels and reduced salivary IL-12 levels. Younger DS patients showed an increase in salivary IL-10 levels, and both the saliva and the serum levels of IFN-gamma were increased in all of the younger subjects. Our data demonstrated that changes in both the oral immune cells and the protein components could be associated with DS. Furthermore, changes in the blood-derived factors were more associated with age than DS status. (C) 2012 Elsevier Inc. All rights reserved.FAPESPFAPESP [05/60668-9, 06/59612-1