Conhecimento dos cirurgiões dentistas sobre o uso de anestésicos locais em pacientes: diabéticos, hipertensos, cardiopatas, gestantes e com hipertireoidismo

Anestésicos locais, contendo ou não vasoconstritores, são utilizados para realização da maioria dos procedimentos odontológicos. Porém, seu uso inadequado, principalmente em casos de alteração sistêmica, pode acarretar sérios riscos para a saúde do paciente. O objetivo deste estudo foi avaliar o nível de conhecimento dos cirurgiões dentistas (CDs) com relação à utilização de anestésicos locais, frente à pacientes especiais com diabetes, hipertensão, cardiopatias, gestantes e com hipertireoidismo. O estudo teve um delineamento quantitativo do tipo transversal com dados coletados através de questionário adaptado pela equipe como único instrumento para coleta de dados. Os dados foram submetidos à análise estatística descritiva e inferencial. De 200 participantes, 17% eram acadêmicos formandos em odontologia, e, dentre os formados, a maioria (34 %) tinha de 1 a 5 anos ou de 6 a 10 anos (16%) de formação. Do total de participantes graduados, 43% não possuíam especialização e 57% eram especialistas. Os resultados demostraram baixa taxa de acertos global (62%) entre os participantes. Quanto as categorias de pacientes especiais, observamos bom nível de conhecimento sobre o uso de anestésicos em pacientes diabéticos (79%), hipertensos (73%) e nível razoável para gestantes (65%) e pacientes com hipertireoidismo (62%). Entretanto, 60% erraram as questões relacionadas a cardiopatias. Ademais, foi insuficiente o percentual daqueles que afirmaram aferir a P.A no início dos atendimentos (45%), assim como, daqueles que consideram-se preparados para atender pacientes especiais (36%). Concluiu-se que o nível de conhecimento dos CDs relacionado ao atendimento de pacientes especiais é insuficiente havendo diferença significativa entre especialistas e clínicos

PREVALÊNCIA DE LEUCOSE ENZOÓTICA BOVINA, DIARRÉIA VIRAL BOVINA RINOTRAQUEÍTE INFECCIOSA BOVINA E NEOSPOROSE BOVINA EM 26 PROPRIEDADES LEITEIRAS DA REGIÃO NORDESTE DO RIO GRANDE DO SUL, BRASIL PREVALENCE OF ENZOOTIC BOVINE LEUKOSIS, BOVINE VIRAL DIARRHEA, INFECTIOUS BOVINE RHINOTRACHEITIS AND BOVINE NEOSPOROSIS IN 26 DAIRY CATTLE FARMS FROM THE NORTHEAST REGION OF RIO GRANDE DO SUL , BRAZIL

Objetivou-se investigar a freqüência de aglutininas anti-Brucella abortus em caprinos e ovinos do Sertão do Estado de Pernambuco, Brasil. Foram processadas 700 amostras de soros sangüíneos, das quais 340 eram da espécie caprina (115 machos e 225 fêmeas) e 360 (136 machos e 224 fêmeas) ovina. Empregou-se a técnica do antígeno acidificado tamponado (AAT) corado com rosa bengala (RB). Das 340 amostras de caprinos avaliadas, duas (0,6%) foram reagentes ao AAT. Não se observaram associações significativas para as variáveis faixa etária (p= 0,430), raça (p= 0,936) e sexo (p= 0,562). Das 360 amostras de ovinos, nove (2,5%) foram reagentes. Também não houve associação significativa entre as variáveis analisadas e a soropositividade para brucelose: faixa etária (p= 0,522); raça (p= 0,576) e sexo (p= 0,461). Verificou-se associação significativa (p= 0,042) entre as espécies estudadas e soropositividade para brucelose nos animais investigados. A soropositividade para Brucella abortus em caprinos e ovinos foi descrita pela primeira vez no Sertão de Pernambuco, fato que pode dificultar o sucesso do Programa Nacional de Controle e Erradicação da Brucelose, tendo em vista que nessa região é comum a criação consorciada de pequenos ruminantes com bovinos, além de representar riscos à Saúde Pública.<br /><br />PALAVRAS-CHAVES: Brucelose, ovinos, caprinos, pequenos ruminantes, sorodiagnóstico. The objective was to investigate the frequency of anti-Brucella abortus agglutinins in goats and sheep of the backlands of the State of Pernambuco, Brazil. 700 samples of sanguine serums were processed, of which 340 were of the goat (115 males and 225 females) and 360 (136 males and 224 females) sheep. The technique of the Tamponed Acidified Antigen (AAT) dyed with Bengalese Rose (BR) was used. Of the 340 samples of goat evaluated two (0.6%) were reactive to AAT. Significant associations were not observed for the variable age group (p = 0.430); race (p = 0.936) and sex (p = 0.562). Of the 360 sheep samples, nine (2.5%) were reactive. There also was no significant association between the analyzed variables and the seropositiveness for brucellosis: age group (p = 0.522); race (p = 0.576) and sex (p = 0.461). Significant association was observed (p = 0.042) among the studied species and seropositiveness for brucellosis in the investigated animals. The seropositiveness for Brucella abortus in goats and sheep was traced for the first time in the “Sertão” (dry interior region, backlands) of Pernambuco, fact that can hinder the success of the National Program of Control and Erradication of Brucellosis, due to the fact that it is common to raise small ruminants with bovines in this area, besides representing risks to Public Health. <br /> <br />KEY WORDS: Brucellosis, ovines, caprines, small ruminants, serodiagnosis

Paracoccidioidomycosis: clinical and epidemiological profile of hospitalized patients in Passo Fundo - RS

Paracoccidioidomycosis (PCM) is not a notifiable disease despite its relevance in Latin America, and therefore estimates of the prevalence, incidence, and associated morbidity of this mycosis are based on reports of epidemiological surveys, case series, hospitalization records, and mortality data. The objective of this study was to describe aspects related to the patient, disease evolution, diagnostic confirmation, and treatment of confirmed cases of PCM treated at a teaching hospital in southern Brazil. Information was collected from the medical records of 27 patients diagnosed with PCM, confirmed in the period from 2010 to 2019. The prevalent profile was a male patient, with a mean age of 53 years, who was involved in various work activities, of urban origin, immunocompetent and without comorbidities, and a smoker, but not an alcoholic. For most cases, the initial involvement was pulmonary, with significant involvement of the lymphatic system during the course of the disease. Microscopic observation of pathognomonic fungal structures in biopsy samples, lymph node aspirates, and sputum was the most common method to confirm the clinical suspicion. Itraconazole was the first treatment option, followed by amphotericin B.A paracoccidioidomicose não é uma doença de notificação obrigatória apesar de sua relevância na América Latina, por isso as estimativas de prevalência, incidência e morbidade dessa micose são baseadas em relatórios de levantamentos epidemiológicos, séries de casos, registros de hospitalização e dados de mortalidade. O objetivo desse trabalho foi descrever aspectos relacionados com o paciente, evolução da doença, confirmação diagnóstica e tratamento de casos confirmados de paracoccidioidomicose atendidos em um hospital de ensino do sul do Brasil. Foram coletadas informações de prontuários de 27 pacientes com diagnóstico de paracoccidioidomicose confirmado no período de 2010 até 2019. O perfil prevalente foi de um paciente do sexo masculino, com idade média de 53 anos, envolvido com atividades laborais diversas, de procedência urbana, imunocompetente e sem comorbidades, tabagista, mas não etilista. Para a maioria dos casos o acometimento inicial foi pulmonar, com importante envolvimento do sistema linfático no percurso da doença. A observação microscópica das estruturas fúngicas patognomônicas em amostras de biópsia, aspirado linfonodal e escarro foi o método mais utilizado para confirmar a suspeita clínica. O itraconazol foi a primeira opção de tratamento, seguido da anfotericina B

Neutrophil Extracellular Traps Induce Organ Damage during Experimental and Clinical Sepsis.

Organ dysfunction is a major concern in sepsis pathophysiology and contributes to its high mortality rate. Neutrophil extracellular traps (NETs) have been implicated in endothelial damage and take part in the pathogenesis of organ dysfunction in several conditions. NETs also have an important role in counteracting invading microorganisms during infection. The aim of this study was to evaluate systemic NETs formation, their participation in host bacterial clearance and their contribution to organ dysfunction in sepsis. C57Bl/6 mice were subjected to endotoxic shock or a polymicrobial sepsis model induced by cecal ligation and puncture (CLP). The involvement of cf-DNA/NETs in the physiopathology of sepsis was evaluated through NETs degradation by rhDNase. This treatment was also associated with a broad-spectrum antibiotic treatment (ertapenem) in mice after CLP. CLP or endotoxin administration induced a significant increase in the serum concentrations of NETs. The increase in CLP-induced NETs was sustained over a period of 3 to 24 h after surgery in mice and was not inhibited by the antibiotic treatment. Systemic rhDNase treatment reduced serum NETs and increased the bacterial load in non-antibiotic-treated septic mice. rhDNase plus antibiotics attenuated sepsis-induced organ damage and improved the survival rate. The correlation between the presence of NETs in peripheral blood and organ dysfunction was evaluated in 31 septic patients. Higher cf-DNA concentrations were detected in septic patients in comparison with healthy controls, and levels were correlated with sepsis severity and organ dysfunction. In conclusion, cf-DNA/NETs are formed during sepsis and are associated with sepsis severity. In the experimental setting, the degradation of NETs by rhDNase attenuates organ damage only when combined with antibiotics, confirming that NETs take part in sepsis pathogenesis. Altogether, our results suggest that NETs are important for host bacterial control and are relevant actors in the pathogenesis of sepsis

LPS-induced endotoxic shock leads to NETs deposition in kidney tissue.

<p>Endotoxic shock was induced by LPS injection (15 mg/kg, iv.). In situ immunofluorescence analysis of frozen tissue sections of kidney harvested 12 h after endotoxic shock induction was conducted. (<b>A-B</b>) DNA stained. (<b>C-D</b>) DNA/histones stained. (<b>E-F</b>) MPO stained. (<b>G-H</b>) Tissue structure was visualized by differential interference contrast (DIC) microscopy. NETs were identified by the co-localization of DNA, histone and MPO markers. (<b>I-J</b>) Co-localization of DNA (blue), DNA/histone (green) and MPO (red) indicates intraglomerular NETs formation. n = 5 per experimental group.</p

Serum concentrations of cf-DNA are positively correlated with organ failure in septic patients.

<p>(<b>A</b>) Cf-DNA was quantified in serum samples obtained from healthy control volunteers (n = 8) and septic patients (n = 31). * p < 0.05 compared with healthy control volunteers (Mann-Whitney U test). (<b>B</b>) Correlation of cf-DNA serum concentrations with SOFA scores. Serum cf-DNA concentration according to stages of (<b>C</b>) AKIN score and (<b>D</b>) ARDS, according to the Berlin Definition. *p < 0.05 compared with 0/1 stages (Mann-Whitney U test). (<b>E</b>) Patient serum samples incubated with rhDNase for 30 minutes. *p < 0.05 compared with serum+rhDNase (Paired t-test). AKIN—Acute Kidney Injury Network; ARDS—Acute Respiratory Distress Syndrome; no—no ARDS; rS–Spearman’s rho; SOFA–Sequential Organ Failure Assessment.</p

Degradation of systemic cf-DNA/NET by rhDNase treatment did not prevent organ damage during polymicrobial sepsis.

<p>Mice were subjected to sham surgery or CLP-induced severe sepsis. (<b>A</b>) Blood samples were collected 3, 6, 12 and 24 hours after sepsis induction, and plasma concentrations of cf-DNA/MPO (NET) were determined (white horizontal bar represents the sham group at the indicated times). Blood samples were also collected 6 and 12 hours after sepsis induction in mice treated pre-sepsis (10 min) and post-sepsis (4 h) with rhDNase (10 mg/kg, sc.) * p < 0.05 compared with the sham group, white line; # p < 0.05 compared to the CLP- Sal 6 and 12 h groups (ANOVA followed by Tukey’s test, n = 5 per experimental group). (B) Animals were treated pre-sepsis (10 min) and post-sepsis (4 h) with Sal (control) or rhDNase (10 mg/kg, sc.). Six hours after sepsis induction, the serum levels of CK-MB, BUN (C) and AST (D) were quantified. Blood bacterial levels 6 h (E) were also quantified; # p < 0.05 compared with the CLP-Sal 6 h group (ANOVA followed by Tukey’s test, n = 5 per experimental group). The horizontal bars represent the median (Mann-Whitney U test, n = 5–7 per experimental group). The data are reported as the mean ± SEM. * p < 0.05 compared with the sham group; # p < 0.05 compared with the CLP+Sal group (ANOVA followed by Tukey’s test, n = 5 per experimental group).</p

Systemic degradation of NETs attenuated organ damage during LPS-induced endotoxic shock.

<p>Endotoxic shock was induced by LPS injection (15 mg/kg, iv.) Mice were pre-treated (10 min) and post-treated (8 h) with saline or rhDNase (10 mg/kg, sc.). Twelve hours after endotoxic shock induction, the serum concentrations of cf-DNA (<b>A</b>) and TNF-α (<b>B</b>), serum levels of serum CK-MB (<b>C</b>), BUN (<b>D</b>), AST (<b>E</b>) and MPO in lung tissue (<b>F</b>) were determined. The data are reported as the mean ± SEM. * p < 0.05 compared with the sham group; # p < 0.05 compared with the LPS+Sal group (ANOVA followed by Tukey’s test, n = 5 per experimental group). (<b>G</b>) Survival rates of endotoxemic mice pre-treated (10 min) and post-treated (8/8 h) with saline or rhDNase (10 mg/kg, sc.) until the 48^th hour. * p < 0.05 compared with the LPS+Sal group (Mantel-Cox log-rank test, n = 10 per experimental group).</p

Morphological changes in heart, lungs and liver tissues.

<p>Animals were euthanized 12 h after endotoxic shock induction, and the heart, lungs, and liver were isolated, fixed by immersion in 10% paraformaldehyde, dehydrated and embedded in paraffin wax. Then, 5-μm-thick sections were stained with hematoxylin and eosin for histological examination. The images are representative of heart, lung and liver sections from the CTRL (<b>A, D, G</b>), LPS+Sal (<b>B, E, H</b>) and LPS+rhDNase (<b>C, F, I</b>) groups. Arrows indicate edema. Stars indicate leukocyte infiltration. Arrowheads indicate hyperplasia and hypertrophy of Kupffer cells. n = 5 per each experimental group.</p