O USO DA MATRIZ DE COLÁGENO SUÍNA (FIBRO-GIDE®) NO RECOBRIMENTO DE MÚLTIPLAS RECESSÕES GENGIVAIS

The use of autogenous connective tissue graft is considered the gold standard for the treatment of gingival recessions (GR), both in terms of aesthetics and percentage of root coverage and predictability. However, this technique has some disadvantages, such as the need for a second surgical site, in addition to the limited amount of graft to be made available. Therefore, a suitable substitute would reduce these limitations, in addition to being able to provide a post-operative period with greater comfort and a greater scope in the total number of teeth treated in a single session. Based on this information, recently a new xenogeneic collagen matrix of porcine origin (Fibro Gide®) was created by Geistlich Pharma AG (Wolhusen, Switzerland, Switzerland). The objective of this case report was the clinical evaluation of the use of this new collagen matrix as a viable substitute for autogenous connective tissue in the treatment of GR. Female patient, 58 years old, without diagnosed systemic changes and non-smoker, sought care in a private office with aesthetic complaints and fear of losing her teeth, in the region of teeth 13 to 17. On oral clinical examination, multiple GR. Root coverage was planned and performed on teeth 13, 14, 15, 16 and 17 using the coronally positioned flap technique associated with the use of Fibro-Gide ®. PO follow-up took place at 7, 15 and 21 days until now. The use of the Fibro-Gide® xenogeneic collagen matrix proved to be quite satisfactory, covering the entire area of the GR between 70 and 100% in the immediate PO and over the course of the days. Furthermore, an excellent PO was evidenced, which presented adjacent tissues similar in color, shape and texture. Based on the above, it was concluded that Fibro-Gide® is an excellent option of choice as a substitute material for autogenous connective tissue for root coverage of multiple RG and gain of keratinized tissue in thickness and height.El uso de injerto autólogo de tejido conectivo se considera el estándar de oro para el tratamiento de las recesiones gingivales (RG), tanto en términos de estética como de porcentaje de cobertura radicular y previsibilidad. Sin embargo, esta técnica tiene algunas desventajas, como la necesidad de un segundo sitio quirúrgico, además de la cantidad limitada de injerto disponible. Por tanto, un sustituto adecuado reduciría estas limitaciones, además de poder proporcionar un postoperatorio con mayor comodidad y un mayor alcance en el número total de dientes tratados en una sola sesión. Basándose en esta información, Geistlich Pharma AG (Wolhusen, Suiza, Suiza) creó recientemente una nueva matriz de colágeno xenogénico de origen porcino (Fibro Gide®). El objetivo de este reporte de caso fue la evaluación clínica del uso de esta nueva matriz de colágeno como sustituto viable del tejido conectivo autógeno en el tratamiento del RG. Paciente femenina, 58 años, sin diagnóstico de cambios sistémicos y no fumadora, acudió a consultorio particular por molestias estéticas y temor a perder los dientes, en la región de los dientes 13 al 17. Al examen clínico intraoral, RG múltiples. Se planificó y realizó la cobertura radicular en los dientes 13, 14, 15, 16 y 17 utilizando la técnica de colgajo posicionado coronalmente asociada con el uso de Fibro-Gide ®. El seguimiento PO se realizó a los 7, 15 y 21 días hasta el momento. El uso de la matriz de colágeno xenogénico Fibro-Gide® resultó bastante satisfactorio, cubriendo toda el área del GR entre 70 y 100% en el PO inmediato y a lo largo de los días. Además, se evidenció una excelente PO, que presentó tejidos adyacentes similares en color, forma y textura. Con base en lo anterior, se concluyó que Fibro-Gide® es una excelente opción de elección como material sustituto del tejido conectivo autógeno para la cobertura radicular de múltiples RG y ganancia de tejido queratinizado en espesor y altura.A utilização de enxerto de tecido conjuntivo autógeno é considerado o padrão ouro para o tratamento das recessões gengivais (RG), tanto no aspecto estético quanto na porcentagem de cobertura radicular e de previsibilidade. Entretanto, essa técnica apresenta algumas desvantagens como a necessidade de um segundo sítio cirúrgico, além da quantidade limitada de enxerto a ser disponibilizado. Sendo assim, um substituto adequado reduziria essas limitações, além de poder proporcionar um pós-operatório com maior confortabilidade e uma maior abrangência no número total de dentes tratados em uma única sessão. Com base nessas informações, recentemente uma nova matriz de colágeno xenógena de origem suína (Fibro Gide®) foi criada pela Geistlich Pharma AG (Wolhusen, Switzerland, Suíça). O objetivo do presente relato de caso foi a avaliação clínica do emprego dessa nova matriz de colágeno como um substituto viável de tecido conjuntivo autógeno no tratamento das RG. Paciente do sexo feminino, 58 anos de idade, sem alterações sistêmicas diagnosticadas e não fumante, procurou atendimento no consultório particular com queixa estética e medo de perder os dentes, na região dos dentes 13 ao 17. Ao exame clínico intraoral, se pode observar múltiplas RG. Foi planejado e realizado nos dentes 13, 14, 15, 16 e 17 o recobrimento radicular se utilizando a técnica do retalho posicionado coronalmente associado ao uso do Fibro-Gide ®. O acompanhamento PO aconteceu com 7, 15 e 21 dias até o presente momento. A utilização da matriz de colágeno xenógena Fibro-Gide® se mostrou bastante satisfatória, recobrindo toda a área das RG entre 70 a 100% no PO imediato e no transcorrer dos dias. Ademais, foi evidenciado um excelente PO que se apresentou com tecidos adjacentes semelhantes na cor, formato e textura. Mediante o exposto, concluiu-se que o Fibro-Gide® é uma excelente opção de escolha como material substituto ao tecido conjuntivo autógeno para o recobrimento radicular de múltiplas RG e ganho de tecido queratinizado em espessura e altura

Microbial culture in minimal medium with oil favors enrichment of biosurfactant producing genes

The waste produced by petrochemical industries has a significant environmental impact. Biotechnological approaches offer promising alternatives for waste treatment in a sustainable and environment-friendly manner. Microbial consortia potentially clean up the wastes through degradation of hydrocarbons using biosurfactants as adjuvants. In this work, microbial consortia were obtained from a production water (PW) sample from a Brazilian oil reservoir using enrichment and selection approaches in the presence of oil as carbon source. A consortium was obtained using Bushnell-Haas (BH) mineral medium with petroleum. In parallel, another consortium was obtained in yeast extract peptone dextrose (YPD)-rich medium and was subsequently compared to the BH mineral medium with petroleum. Metagenomic sequencing of these microbial communities showed that the BH consortium was less diverse and predominantly composed of Brevibacillus genus members, while the YPD consortium was taxonomically more diverse. Functional annotation revealed that the BH consortium was enriched with genes involved in biosurfactant synthesis, while the YPD consortium presented higher abundance of hydrocarbon degradation genes. The comparison of these two consortia against consortia available in public databases confirmed the enrichment of biosurfactant genes in the BH consortium Functional assays showed that the BH consortium exhibits high cellular hydrophobicity and formation of stable emulsions, suggesting that oil uptake by microorganisms might be favored by biosurfactants. In contrast, the YPD consortium was more efficient than the BH consortium in reducing interfacial tension. Despite the genetic differences between the consortia, analysis by a gas chromatography-flame ionization detector showed few significant differences regarding the hydrocarbon degradation rates. Specifically, the YPD consortium presented higher degradation rates of C12 to C14 alkanes, while the BH consortium showed a significant increase in the degradation of some polycyclic aromatic hydrocarbons (PAHs). These data suggest that the enrichment of biosurfactant genes in the BH consortium could promote efficient hydrocarbon degradation, despite its lower taxonomical diversity compared to the consortium enriched in YPD medium. Together, these results showed that cultivation in a minimal medium supplemented with oil was an efficient strategy in selecting biosurfactant-producing microorganisms and highlighted the biotechnological potential of these bacterial consortia in waste treatment and bioremediation of impacted areas

Contracepção hormonal e lesões cervicais pelo Papilomavírus Humano: uma revisão de literatura / Hormonal contraception and cervical injuries by Human Papillomavirus: a literature review

Introdução: A infecção pelo papilomavírus humano (HPV) é a doença sexualmente transmissível (DST) mais comum, afetando 50% da população mundial. Estima-se que entre 75 e 80% da de indivíduos sexualmente ativos adquirirão algum subtipo de HPV ao longo da vida. No Brasil, a taxa de prevalência de HPV varia de 13,7 a 54,3%, de acordo com a população e as regiões estudadas. Assim, este artigo tem como objetivo analisar a associação entre os hormônios contracepção e o aparecimento de lesões induzidas por HPV em o colo uterino. Metodologia: O presente estudo foi elaborado por meio de uma pesquisa bibliográfica, realizada eletronicamente, procurando registros sobre o desenvolvimento de lesões induzidas por HPV em colo uterino e hormônios de contracepção. Objetivando com isso identificar através da literatura a associação entre os hormônios de contracepção e o aparecimento de lesões induzidas por HPV em colo uterino. Para a realização do mesmo foram analisados artigos publicados em revistas científicas, utilizando as bases de dados da BVS (Biblioteca Virtual da Saúde), como: Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde) e Scielo (Scientific Electronic Library Online). Resultados: Após a seleção, restaram nove artigos para a discussão. Podemos observar os artigos escolhidos no quadro, composto pelos autores, título, metodologia, resultados e conclusão que cada um encontrou. Em seguida foi realizada uma discussão acerca destes artigos. Conclusão: Muitos estudos relataram que os mecanismos envolvidos na persistência e incidência de lesões de HPV estão longe de ser esclarecidas, e que novas estudos são necessários para elucidar melhores abordagens em relação ao tipo de contracepção, via de administração e doses hormonal que não estão associadas a lesões induzidas por HPV

Relato de experiência: adolescentes, drogadição e como o ensino em saúde pode contribuir

A Educação em saúde pode ser definida como um processo de construção de conhecimentos e visa a promoção de saúde e desenvolvimento de autonomia dos sujeitos. A drogadição é considerada um problema de saúde pública, com relevância na adolescência e objeto de abordagem a este púbico. Este trabalho tem por objetivo relatar a experiência dos acadêmicos do terceiro período do Curso de Medicina em uma ação de Educação em Saúde realizada com o público-alvo adolescente. Trata-se de um relato de experiência de uma ação educativa proposta pelo módulo de Medicina de Família e Comunidade, da Universidade Evangélica de Anápolis, UniEVANGÉLICA. A ação foi desenvolvida em uma escola municipal em Anápolis, Goiás (GO), na perspectiva da metodologia do Arco de Maguerez. Tratou da temática “Promoção à Saúde e Prevenção quanto ao uso de drogas na adolescência” Participaram do trabalho cerca de 25 adolescentes, das turmas de 7º e 8º ano do ensino fundamental II. A intervenção foi realizada por meio de uma roda de conversa. A ação despertou o interesse do público-alvo, possibilitou o compartilhar de experiências e identificação de fatores que contribuem para o uso de drogas, bem como as possibilidades de prevenção e superação. A Educação em Saúde participativa contribui para a prevenção do uso de drogas na adolescência ao possibilitar reflexão e incentivar a aquisição de habilidades para a vida

Development of Ag-ZnO/AgO Nanocomposites Effectives for Leishmania braziliensis Treatment

Tegumentary leishmaniasis (TL) is caused by parasites of the genus Leishmania. Leishmania braziliensis (L.b) is one of the most clinically relevant pathogens that affects the skin and mucosa, causing single or multiple disfiguring and life-threatening injuries. Even so, the few treatment options for patients have significant toxicity, high dropout rates, high cost, and the emergence of resistant strains, which implies the need for studies to promote new and better treatments to combat the disease. Zinc oxide nanocrystals are microbicidal and immunomodulatory agents. Here, we develop new Ag-ZnO/xAgO nanocomposites (NCPs) with three different percentages of silver oxide (AgO) nanocrystals (x = 49%, 65%, and 68%) that could act as an option for tegumentary leishmaniasis treatment. Our findings showed that 65% and 68% of AgO inhibit the extra and intracellular replication of L.b. and present a high selectivity index. Ag-ZnO/65%AgO NCPs modulate activation, expression of surface receptors, and cytokine production by human peripheral blood mononuclear cells toward a proinflammatory phenotype. These results point to new Ag-ZnO/AgO nanocomposites as a promising option for L. braziliensis treatment

Lycopene from Red Guava (<i>Psidium guajava</i> L.): From Hepatoprotective Effect to Its Use as Promising Self-Emulsifying Drug Delivery System for Anti-Inflammatory and Antioxidant Applications

Lycopene is a carotenoid with potential use in the treatment of chronic illnesses. Here, different formulations of lycopene were studied: lycopene-rich extract from red guava (LEG), purified lycopene from red guava (LPG) and a self-emulsifying drug delivery system loaded with LPG (nanoLPG). The effects of administering orally various doses of LEG to hypercholesterolemic hamsters were evaluated regarding the liver function of the animals. The cytotoxicity of LPG in Vero cells was analyzed by a crystal violet assay and by fluorescence microscopy. In addition, nanoLPG was employed in stability tests. LPG and nanoLPG were tested for their cytotoxic effect on human keratinocytes and antioxidant capacity on cells in an endothelial dysfunction model in an isolated rat aorta. Finally, the effect of different nanoLPG concentrations on the expression of immune-related genes (IL-10, TNF-α, COX-2 and IFN-γ) from peripheral blood mononuclear cells (PBMC) using real-time PCR was also analyzed. Results suggest that LEG, despite not being able to improve blood markers indicative of liver function in hypercholesterolemic hamsters, reduced hepatic degenerative changes. Additionally, LPG did not show cytotoxicity in Vero cells. In relation to nanoLPG, the effects produced by heat stress evaluated by Dynamics Light Scattering (DLS) and visually were loss of color, texture change and phase separation after 15 days without interfering with the droplet size, so the formulation proved to be efficient in stabilizing the encapsulated lycopene. Although LPG and nanoLPG showed moderate toxicity to keratinocytes, which may be related to cell lineage characteristics, both revealed potent antioxidant activity. LPG and nanoLPG showed vasoprotective effects in aortic preparations. The gene expression assay indicates that, although no significant differences were observed in the expression of IL-10 and TNF-α, the PBMCs treated with nanoLPG showed a reduction in transcriptional levels of IFN-γ and an increased expression of COX-2. Thus, the work adds evidence to the safety of the use of lycopene by humans and shows that tested formulations, mainly nanoLPG due to its stability, stand out as promising and biosafe products for the treatment of diseases that have oxidative stress and inflammation in their etiopathology

On the future of the giant South American river turtle Podocnemis expansa

There is a long history of exploitation of the South American river turtle Podocnemis expansa. Conservation efforts for this species started in the 1960s but best practices were not established, and population trends and the number of nesting females protected remained unknown. In 2014 we formed a working group to discuss conservation strategies and to compile population data across the species' range. We analysed the spatial pattern of its abundance in relation to human and natural factors using multiple regression analyses. We found that > 85 conservation programmes are protecting 147,000 nesting females, primarily in Brazil. The top six sites harbour > 100,000 females and should be prioritized for conservation action. Abundance declines with latitude and we found no evidence of human pressure on current turtle abundance patterns. It is presently not possible to estimate the global population trend because the species is not monitored continuously across the Amazon basin. The number of females is increasing at some localities and decreasing at others. However, the current size of the protected population is well below the historical population size estimated from past levels of human consumption, which demonstrates the need for concerted global conservation action. The data and management recommendations compiled here provide the basis for a regional monitoring programme among South American countries. © Fauna & Flora International 2019

Portuguese guidelines for the use of biological agents in rheumatoid arthritis - March 2010 update.

The authors present the revised version of the Portuguese Society of Rheumatology (SPR) guidelines for the treatment of rheumatoid arthritis (RA) with biological therapies. In these guidelines the criteria for introduction and maintenance of biological agents are discussed as well as the contraindications and procedures in the case of non-responders. Biological treatment should be considered in RA patients with a disease activity score 28 (DAS 28) superior to 3.2 despite treatment with 20mg/week of methotrexate (MTX) for at least 3 months or, if such treatment is not possible, after 6 months of other conventional disease modifying drug or combination therapy. A DAS 28 score between 2.6 and 3.2 with a significant functional or radiological deterioration under treatment with conventional regimens could also constitute an indication for biological treatment. The treatment goal should be remission or, if that is not achievable, at least a low disease activity, characterized by a DAS28 lower than 3.2, without significative functional or radiological worsening. The response criteria, at the end of the first 3 months of treatment, are a decrease of 0.6 in the DAS28 score. After 6 months of treatment response criteria is defined as a decrease of more than 1.2 in the DAS28 score. Non-responders, in accordance to the Rheumatologist's clinical opinion, should try a switch to another biological agent (tumour necrosis factor antagonist, abatacept, rituximab or tocilizumab).publishersversionpublishe

Revisão sistematizada da literatura e opinião de peritos

Objective: The 3E (Evidence, Expertise, Exchange) Initiative is a multinational effort of rheumatologists aimed at developing evidence-based recommendations addressing specific questions relevant to clinical practice. The objective of the Portuguese contribution for the 3E Initiative was to develop evidence-based recommendations on how to investigate, follow-up and treat undifferentiated peripheral inflammatory arthritis (UPIA) adapted to local reality and develop additional recommendations considered relevant in the national context. Methods: An international scientific committee from 17 countries selected a set of questions concerning the diagnosis and monitoring of UPIA using a Delphi procedure. Evidence-based answers to each question were sought by a systematic literature search, performed in Medline, Embase, the Cochrane Library and ACR/EULAR 2007-2009 meeting abstracts. Relevant articles were reviewed for quality assessment, data extraction and synthesis. In a national meeting, a panel of 63 Portuguese rheumatologists used the evidence which was gathered to develop recommendations, and filled the gaps in the evidence with their expert opinion. Finally, national recommendations were formulated and agreement among the participants was assessed. Results: A total of 54754 references were identified, of which 267 were systematically reviewed. Thirteen national key recommendations about the investigation, follow-up and treatment of UPIA were formulated. One recommendation addressed differential diagnosis and investigations prior to the established operational diagnosis of UPIA, eight recommendations were related to the diagnostic and prognostic value of clinical and laboratory assessments in established UPIA (history and physical examination, acute phase reactants, serologies, autoantibodies, radiographs, magnetic resonance imaging and ultrasound, genetic markers and synovial biopsy), one recommendation highlighted predictors of persistence (chronicity), one addressed monitoring of clinical disease activity in UPIA, one aimed to find an useful method/score to predict a definitive diagnosis and the last one was related to treatment. Conclusion: Portuguese evidence-based recommendations for the management of UPIA in everyday practice were developed. Their dissemination and implementation in daily clinical practice should help to improve practice uniformity and optimize the management of UPIA patients.publishersversionpublishe

Portuguese guide lines for the use of biological agents in rheumatoid arthritis - october 2011 update

The authors present the revised version of the Portuguese Society of Rheumatology (SPR) guidelines for the treatment of Rheumatoid Arthritis (RA) with biological therapies. In these guidelines the criteria for introduction and maintenance of biological agents are discussed as well as the contraindications and procedures in the case of non-responders. Biological treatment (with a tumour necrosis factor antagonist, abatacept or tocilizumab) should be considered in RA patients with a disease activity score 28 (DAS 28) equal to or greater than 3.2 des pite treatment with at least 20mg-weekly-dose of methotrexate (MTX) for at least 3 months or, if such treatment is not possible, after 3 months of other conventional disease modifying drug or combination therapy. A DAS 28 score between 2.6 and 3.2 with a significant functional or radiological deterioration under treatment with conventional regi -mens could also constitute an indication for biological treatment. The treatment goal should be remission or, if that is not achievable, at least a low disease activity, defined by a DAS28 lower than 3.2,without significative functional or radiological worsening. The response criteria, at the end of the first 3 months of treatment, are a decrease of at least 0.6 in the DAS28 score. After 6 months of treatment res ponse criteria is defined as a decrease greater than 1.2 in the DAS28 score. Non-responders, in accordance to the Rheumatologist's clinical opi -nion, should try a switch to another biological agent (tumour necrosis factor antagonist, abatacept, rituxi mab or tocilizumab).publishersversionpublishe