Osteonecrose dos maxilares provocada por terapia medicamentosa

Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas MonizA Osteonecrose dos maxilares associada ao uso de medicamentos (MRONJ) é uma entidade clínica que resulta mais frequentemente do uso de fármacos anti-reabsortivos tais como os bifosfonatos e o denosumab, bem como de fármacos antiangiogénicos. O diagnóstico de MRONJ compreende alguns critérios, tais como, ter sido sujeito a alguma terapêutica mencionada anteriormente, a existência de uma exposição óssea há́ mais de 8 semanas com presença de fistula intra ou extra oral com o mesmo tempo de duração, finalmente, que este não tenha sido sujeito a radioterapia na região da cabeça e pescoço e que se confirme a ausência de metástases ósseas na região maxilar. Nos dias de hoje, a sua etiopatogenia não é completamente compreendida, porém, considera-se que inúmeros fatores de risco estejam associados ao seu desenvolvimento. O seu diagnóstico é fundamentalmente clínico, no entanto, exames complementares de diagnostico são a chave para um diagnóstico mais fidedigno. A MRONJ é classificada em estadios, variando de 0 a 3, que dependem da apresentação da patologia. Quando as formas de prevenção falham, devem então ser implementados tratamentos específicos adequados a cada caso. Assim sendo, o objetivo da presente revisão é o de rever as diferentes classes de agentes anti-reabsortivos, as suas indicações, os seus modos de ação, rever os mecanismos propostos na fisiopatologia do desenvolvimento da osteonecrose, sinais e sintomas, fatores de risco, estadios e analisar as diferentes formas de prevenção assim como os tratamentos.Medication-related osteonecrosis of the jaw (MRONJ) is a clinical entity that arises most frequently from the use of antiresorptive drugs, such as bisphosphonates and denosumab, and antiangiogenic drugs. The diagnosis of MRONJ comprises a list of criteria, such as having been subjected to one of the therapies previously mentioned, the existence of bone exposure for more than 8 weeks with the presence of an intra- or extraoral fistula for the same period of time, and finally, that the patient has not been subjected to radiotherapy in the head and neck region with confirmed absence of bone metastasis in the jaw region. Nowadays, its etiopathogenesis is not fully understood, although innumerous risk factors are considered to be associated with its development. Its diagnosis is often clinical, however complementary exams are essential for a reliable diagnosis. MRONJ is divided in stages, from 0 to 3, that depend on the pathology presentation. When prevention strategies fail, it is necessary to implement specific treatments suitable to each case. Therefore, the point of this review is to reassess the different classes of antiresorptive agents, their indications and modes of action, to examine the suggested mechanisms for the pathophysiology of the development of the osteonecrosis, its signals and symptoms, risk factors, staging, and analyze its prevention and treatmen

GESTÃO FISCAL, TRANSPARÊNCIA E ACCOUNTABILITY: QUAIS OS NOVOS DESAFIOS COM A CRISE DA COVID-19?

Two decades ago, Complementary Law 101, of May 4, 2000, the well-known Fiscal Responsibility Act was enacted. It instituted a new and austere fiscal regime in Brazil, for which it was recognized nationally and internationally as an instrument of high normative quality. Especially after the amendments made by Complementary Law 131/2009, the demand for transparency in the provision of public accounts and the wide dissemination of budget data increased. However, the act is not immune to criticism. On the one hand, it failed to establish a control over the quality of public spending; on the other, there are problems in the effectiveness and observance of its rules by the federated entities. Added to this, the act recently had some of its devices suspended due to the public health emergency, whose effects, in the most diverse areas, will be felt for many years. In this context, this paper seeks to understand the impacts and relationships between the LRF public finance rules and the federal government's budget transparency, especially considering the current challenges to fiscal management and accountability with the pandemic. In addition, to identify the barriers that prevent an expansion of fiscal transparency and responsibility and to point out proposals for progress in the area, in the face of the new crisis reality. For this, it uses the case study technique (with the selection and analysis of public policies on the theme) and the content analysis procedure (collection of primary and secondary data).Há duas décadas foi promulgada a Lei Complementar nº 101, de 4 de maio de 2000, a conhecida Lei de Responsabilidade Fiscal (LRF). Instituiu um novo e austero regime fiscal no Brasil, pelo qual foi reconhecida nacional e internacionalmente como um instrumento de alta qualidade normativa. Especialmente após as alterações da Lei Complementar nº 131/2009, aumentou a exigência de transparência na prestação das contas públicas e de ampla divulgação dos dados orçamentários. Não foi, todavia, imune a críticas. De um lado, não conseguiu estabelecer um controle da qualidade dos gastos públicos; de outro, há problemas na efetividade e observância de suas regras pelos entes federados. Soma-se a isso o fato de que recentemente teve alguns de seus dispositivos suspensos em razão da situação de emergência de saúde pública, cujos efeitos, nas mais diversas áreas, serão sentidos por muitos anos. Nesse contexto, este artigo busca compreender os impactos e relações entre as normas de finanças públicas da LRF e a transparência orçamentária do governo federal, especialmente considerando os atuais desafios à gestão fiscal e à accountability com a pandemia. Ademais, identificar as barreiras que impedem uma expansão da transparência e responsabilidade fiscais e apontar propostas para o avanço na área, diante da nova realidade de crise. Para isso, utiliza-se da técnica de estudo de caso (com a seleção e análise de políticas públicas no tema) e do procedimento de análise de conteúdo (levantamento de dados primários e secundários)

Use of health care among the urban poor in Africa: Does the neighbourhood have an impact?

The aim of this paper is to evaluate the relative influence of neighbourhood and individual practices of care utilization in Dakar (Senegal). The data from a research program on urban malaria, made in Dakar, Senegal between 2008 and 2009. The sample was based on a two-stage sampling. A questionnaire survey covered 2952 households, of which we have selected those that have at least one case of fever (n = 1272) with one of their children under ten years two weeks before the passage of investigators. The analytical model of the use of health services developed by R. Andersen has been adapted for our conceptual framework. Our results showed's like many West African cities, self-medication is a common practice among all households in Dakar, especially the poorest. The non-use of health services is positively associated with individual characteristics such as education level, the level of social network and the level of health literacy of the mother / guardian of the sick child (p <1 %). Some characteristics of the neighborhood of residence, however, increase the use of health services among the poor (health care provision is nearest larger and better quality). Similarly, the cost of use is no longer a major obstacle when people perceive a high environmental risk (presence of stagnant water and mosquito abundance). The district of residence may help remove the financial barrier, and reduce inequalities in access, when resource space

Fontes Do Direito E Circulação De Modelos Jurídicos: O Sistema De Precedentes Na Common Law E No Novo Código De Processo Civil*

The new Code of Civil Procedure stipulated the enforcement of judicial precedents in brazilian law, as way to unify and stabilise the Courts decisions. Therefore, this paper retuns to the qualifying background of this institute as a source of law, in order to better comprehend its framework. In a row, the essay recover precedent’s theoretical basis and its functioning within common law tradition, which can contribute greatly to the entrechment of a doctrine of precedent law in Brazil.O novo Código de Processo Civil normatizou a aplicação dos precedentes jurisprudenciais no direito brasileiro, como uma forma de uniformizar e estabilizar a jurisprudência dos Tribunais. Diante disso, este artigo retorna à origem classificatória do instituto enquanto uma fonte do direito para melhor compreensão de sua estrutura. Em sequência, o trabalho resgata o seu embasamento teórico e funcionamento na tradição de common law, que poderá contribuir para a consolidação de uma doutrina do precedente no Brasil. 

Production of edible films based on pea starch with incorporation of active compounds obtained from the purple araçá (Psidium myrtoides)

The aim of this study was to incorporate the active compounds present in purple araçá (Psidium myrtoides) in pea starch-based films and to verify the influence of different plasticizers (glycerol, sorbitol, and polyethylene glycol 400) on film properties. Films were produced and characterized in relation to visual appearance, active compounds, antimicrobial activity, and mechanical and barrier properties. Pea starch has a high amylose content and a final viscosity of 5371.5 RVU, which contributes to the elaboration of films even without the addition of plasticizers. Purple araçá and pea starch formed films with good water vapor barrier characteristics (0.398 g·mm/m2·h·KPa) and low solubility (33.30%). Among plasticizers, sorbitol promoted a lower permeability to water vapor. The selected formulations, 0%, 20%, and 30% sorbitol, presented a high concentration of phenolic compounds (1194.55, 1115.47, and 1042.10 mg GAE 100 g-1, respectively) and were able to inhibit the growth of Staphylococcus aureus. Therefore, films contained the active compounds of purple araçá and potential to be used as food packagingPostprint (published version

Morbidité Des Enfants En Zones Urbaines Africaines. Le Cas De L’observatoire De Population De Ouagadougou (Burkina Faso)

Rapid urbanization and its consequences in regard to access to water, sanitation, and waste management in African cities can be synonymous to health problems. Based on the data obtained from the Ouagadougou Health and Demographic Surveillance System, this paper focuses on characterizing most of those at risk of disease (fever, diarrhea, cough, infections of the skin and eyes). Spatial analysis show that populations in formal (zoned) neighbourhoods, compared to those in informal neighbourhoods, are most at risk of disease. However, in performing multiple correspondence factor analysis and classification, we found that the informal neighbourhoods are mostly at risk of disease. The formal and informal opposition is not absolute, but the differences remain strong despite the existence of atypical neighbourhoods. The contribution of the paper is to provide a new perspective for thinking in regards to the links between environment and children’s health

Micromorphology of the upper anthecium in Mesosetum Steud. and related genera (Poaceae, Arthropogoninae) and its taxonomic applications

Mesosetum is a Neotropical genus with 25 species, and 21 of them occur in Brazil. Mesosetum forms a clade closely related with Keratochlaena rigidifolia and Tatianyx arnacites. The objective of this work was to establish the taxonomic value of the upper anthecium micromorphology for the group. A total of 96 specimens, representing all Mesosetum species (except M. wrightii), K. rigidifolia and T. arnacites were examined under a scanning electron microscope (SEM). PCA and UPGMA analysis were applied using the micromorphologicalcharacters. Fifithteen useful taxonomic characters were identified. We highlight the following characters to distinguish the Mesosetum species: the presence, type and distribution of papillae on the abaxial surface of the upper lemma; the presence of unicellular macrohairs and bicellular microhairs; presence or absence of silica cells and the structure of the germination lid. The present work shows that the micromorphological characters identified are important taxonomically at the specific level, allowing the species identification in many cases

Sr1-xBaxSnO3 system applied in the photocatalytic discoloration of an azo-dye

International audienceSemiconductor materials have received substantial attention as photocatalysts for controlling water pollution. Among these materials, perovskite-structured SrSnO3 is a promising candidate for this application, whereas BaSnO3 exhibits very low activity. In the present work, Sr1−xBaxSnO3 (x = 0, 0.25, 0.50, 0.75 and 1) was synthesized by solid-state reaction and was applied in the photocatalytic discoloration of the organic dye Remazol Golden Yellow. The perovskite structure was obtained for all compositions of the solid solutions with both Sr2+ and Ba2+ present in the lattice. A remarkable change in the short-range symmetry was observed as the amount of Ba2+ increased, and this change led to a decrease in the band gap of the material. Although the BaSnO3 was not active toward water photolysis, the discoloration induced by this perovskite was twice that induced by SrSnO3. The two materials appear to feature different mechanisms of photodegradation: the direct mechanism prevails in the case of BaSnO3, whereas the indirect mechanism appears to play a key role in the case of SrSnO3