Elevation of cardiac troponin I during non-exertional heat-related illnesses in the context of a heatwave

International audienc

AVALIAÇÃO DO EFEITO DE UM DESSENSIBILIZANTE DENTINÁRIO NA REMINERALIZAÇÃO DE LESÕES INICIAIS DE CÁRIE EM ESMALTE DE DENTES HUMANOS E BOVINOS

O objetivo deste estudo foi avaliar o potencial de remineralização de lesões iniciais de cárie dentária de um novo dessensibilizante dentinário (Desensibilize NANO P®, DentsCare/FGM, Joinville, Brasil). Foi realizado estudo in vitro com blocos de 4x4x2mm de esmalte bovino e 3x3x2mm de esmalte permanente e decíduo. As amostras foram embutidas individualmente em resina cristal e lixadas e polidas em politriz. Em seguida, foi determinada a dureza de superfície inicial dos blocos em microdurômetro. As lesões iniciais de cárie foram induzidas em 10 blocos de cada substrato em solução desmineralizadora por 16h a 37°C, e novamente a dureza de superfície foi determinada. As amostras receberam 3 ciclos de tratamento com o material dessensibilizante e posteriormente uma nova medição de dureza de superfície. Com a média das durezas iniciais, após desmineralização e após tratamento, foi calculada a porcentagem de recuperação (ganho) de dureza de superfície para cada bloco de esmalte. A maioria dos blocos ganharam dureza após o tratamento com o dessensibilizante. A % GDS apresentou grande variação sendo em média de 136,5% para dentes bovinos, 104,3% para dentes permanentes e 244,2% para dentes decíduos. O dessensibilizante dentinário avaliado possui potencial para favorecer a remineralização dos três tipos de substrato dentário

CLAREAMENTO DENTAL: UMA ALTERNATIVA ESTÉTICA E CONSERVADORA

Diante de uma cultura que valoriza a estética e de técnicas odontológicas cada vez mais avançadas, há uma maior exigência quanto ao sorriso perfeito. Deste modo, a forma, o alinhamento e principalmente a cor dos dentes são muito valorizados. As causas das alterações de cor nos dentes são variáveis. A indicação e eficiência do procedimento clareador dependerão da causa do escurecimento, que pode ser causado por fatores extrínsecos ou intrínsecos. Dentre as técnicas de clareamento existem 2 modalidades: clareamento interno, para dentes com tratamento endodôntico e externo, que pode ser utilizada tanto para dentes polpados como despolpados. O clareamento externo inclui as técnicas: caseira ou em consultório; sendo que em ambas os principais agentes clareadores são o peróxido de carbamida a 10% e o peróxido de hidrogênio a 35%, respectivamente. O clareamento não é um tratamento milagroso, pois depende da colaboração, hábitos e coloração dos dentes do paciente. É importante ressaltar a possibilidade de alguns efeitos colaterais como hipersensibilidade dentinária, irritação nos tecidos moles, gosto desagradável na cavidade bucal, os quais desaparecem com a interrupção do tratamento. Considerando que o sucesso do tratamento clareador depende de um correto diagnóstico da alteração de cor, bem como da técnica empregada, o objetivo deste trabalho é apresentar e discutir a etiologia das descolorações bem como a efetividade das técnicas atualmente empregadas para o clareamento de dentes vitalizados, salientando os principais riscos e cuidados a serem tomados durante o procedimento clínico

AJUSTE ESTÉTICO EM FACETA DIRETA DE RESINA COMPOSTA

A realização de facetas vestibulares em resina composta tem sido uma alternativa rotineiramente utilizada na clínica odontológica quando há a necessidade de se restaurar dentes anteriores com alteração de cor ou forma anatômica. Para a sua confecção, o profissional deve realizar um correto diagnóstico e plano de tratamento. Também é necessário possuir habilidade manual, a fim de reproduzir detalhes anatômicos, nuances de cor e textura naturais, o que exige boa experiência clínica. O objetivo deste relato é apresentar um caso clínico de confecção de faceta direta em resina composta, salientando a etapa de ajuste estético (textura de superfície) para a reprodução dos detalhes anatômicos superficiais a fim de favorecer a estética e de forma que esta etapa possa ser realizada mesmo por profissionais iniciantes na área de estética

Risk stratification of early admission to the intensive care unit of patients with no major criteria of severe community-acquired pneumonia: development of an international prediction rule

Introduction: To identify risk factors for early (< three days) intensive care unit (ICU) admission of patients hospitalised with community-acquired pneumonia (CAP) and not requiring immediate ICU admission, and to stratify the risk of ICU admission on days 1 to 3. Methods: Using the original data from four North American and European prospective multicentre cohort studies of patients with CAP, we derived and validated a prediction rule for ICU admission on days 1 to 3 of emergency department (ED) presentation, for patients presenting with no obvious reason for immediate ICU admission (not requiring immediate respiratory or circulatory support). Results: A total of 6560 patients were included (4593 and 1967 in the derivation and validation cohort, respectively), 303 (4.6%) of whom were admitted to an ICU on days 1 to 3. The Risk of Early Admission to ICU index (REA-ICU index) comprised 11 criteria independently associated with ICU admission: male gender, age younger than 80 years, comorbid conditions, respiratory rate of 30 breaths/minute or higher, heart rate of 125 beats/minute or higher, multilobar infiltrate or pleural effusion, white blood cell count less than 3 or 20 G/L or above, hypoxaemia (oxygen saturation < 90% or arterial partial pressure of oxygen (PaO2) < 60 mmHg), blood urea nitrogen of 11 mmol/L or higher, pH less than 7.35 and sodium less than 130 mEq/L. The REA-ICU index stratified patients into four risk classes with a risk of ICU admission on days 1 to 3 ranging from 0.7 to 31%. The area under the curve was 0.81 (95% confidence interval (CI) = 0.78 to 0.83) in the overall population. Conclusions: The REA-ICU index accurately stratifies the risk of ICU admission on days 1 to 3 for patients presenting to the ED with CAP and no obvious indication for immediate ICU admission and therefore may assist orientation decisions

Diferentes sistemas de terminação e seus efeitos na carcaça e carne de novilhos angus superprecoces

O objetivo deste trabalho foi avaliar características da carcaça, qualidade e atributos sensoriais da carne de novilhos Angus terminados em diferentes sistemas. Foram avaliadas três dietas de terminação: confinamento convencional (CC) baseado em silagem de milho e um concentrado comercial; confinamento alto grão (AG) composto de 85% milho grão + 15% de concentrado proteico-vitamínico-mineral; a pasto (AP) com suplementação energética de milho a 0,8% do peso vivo (PV), com pastagens de aveia, azevém, festuca e trevo mais 0,8% do peso vivo de milho grão durante 30 dias pré-abate. Foram utilizados 31 bovinos Aberdeen Angus castrados, com média de 12±2 meses de idade e peso inicial de 315±5 kg. A carne dos animais confinados (CC e AG) apresentou maior maciez (p&lt;0,0064) e intensidade de cor vermelha (p&lt;0,0001); os animais apresentaram maior área de olho de lombo (p&lt;0,036); na análise sensorial, maior suculência (p=0,0021), maciez (p&lt;0,0001) e aceitabilidade geral (p=0,0054) foram relatadas. Animais do tratamento AG apresentaram maior rendimento de carcaça (p&lt;0,001) e espessura de gordura subcutânea (p&lt;0,001). A coloração amarela da gordura (0h) foi maior nos tratamentos CC e AP (p&lt;0,0426). Houve variação entre os valores de pH no abate (0h), após resfriamento (24h) e da carne (48h) entre os tratamentos, entretanto dentro dos padrões. Foi produzida uma carne com maior qualidade, principalmente em termos de rendimento de carcaça, maciez e coloração da carne na terminação em confinamento. Na análise sensorial, consumidores preferiram a carne de animais confinados, CC ou AG, frente à carne de animais terminados a pasto com suplementação energética

Anatomomopathological and immunohistochemical analyses of the spleen and lymph node of dogs seropositives for leishmaniasis in serological tests

Canine leishmaniasis (CanL) is a zoonosis caused by the protozoan of the species Leishmania infantum. The spleen and lymph nodes undergo morphological changes during CanL. This research aimed to perform an anatomopathological and immunohistochemical study of these organs in dogs reactive to leishmaniasis in the Dual-path Platform chromatographic immunoassay (DPP®) and Enzyme Immunoabsorption Assay (ELISA). Twenty-seven dogs were evaluated for anatomopathological examination with 92.6% having clinical signs. Splenomegaly and lymphadenomegaly were the main macroscopic changes. All dogs showed changes in the spleen, unrelated to the parasitic load, with granulomatous splenitis being the most severe change. Diffuse cortical and paracortical hyperplasia and spinal cord hyperplasia and hypertrophy were observed in the lymph nodes. Amastigote forms of Leishmania spp. were found in the spleen and lymph node during histopathological and immunohistochemical evaluations, with good agreement between these evaluations (k = 0.55, p = 0.00124), but no difference was observed in the parasitic intensity of these organs (p = 0.23) . Thus, the spleen and lymph node reactive to leishmaniasis on the DPP® and ELISA tests show histomorphological changes resulting from the disease. In addition, the spleen and lymph node have a parasitic load similar to those found by direct diagnostic methods

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Time trends and social inequalities in infant and young child feeding practices: national estimates from Brazil’s Food and Nutrition Surveillance System, 2008–2019

Abstract Objective: To describe the time trends and socio-economic inequalities in infant and young child feeding practices in accordance with the Brazilian deprivation index (BDI). Design: This time-series study analysed the prevalence of multiple breast-feeding and complementary feeding indicators based on data from the Brazilian Food and Nutrition Surveillance System, 2008–2019. Prais–Winsten regression models were used to analyse time trends. Annual percent change (APC) and 95 % CI were calculated. Setting: Primary health care services, Brazil. Participants: Totally, 911 735 Brazilian children under 2 years old. Results: Breast-feeding and complementary feeding practices differed between the extreme BDI quintiles. Overall, the results were more favourable in the municipalities with less deprivation (Q1). Improvements in some complementary feeding indicators were observed over time and evidenced such disparities: minimum dietary diversity (Q1: Δ 47·8–52·2 %, APC + 1·44, P = 0·006), minimum acceptable diet (Q1: Δ 34·5–40·5 %, APC + 5·17, P = 0·004) and consumption of meat and/or eggs (Q1: Δ 59·7–80·3 %, APC + 6·26, P < 0·001; and Q5: Δ 65·7–70·7 %, APC + 2·20, P = 0·041). Stable trends in exclusive breast-feeding and decreasing trends in the consumption of sweetened drinks and ultra-processed foods were also observed regardless the level of the deprivation. Conclusions: Improvements in some complementary food indicators were observed over time. However, the improvements were not equally distributed among the BDI quintiles, with children from the municipalities with less deprivation benefiting the most