In-office dental bleaching in adolescents using 6% hydrogen peroxide with different application tips: randomized clinical trial

Despite the availability of in-office bleaching gels with a 6% concentration of hydrogen peroxide (HP), these gels have not been evaluated in younger patients. They are commercially available with a tip, associated or not with a brush, where the tip with a brush spreads the gel over the entire surface to have a smaller thickness (thin layer) since the manufacturers indicate the application of a thin layer of gel. Objective: This randomized, split-mouth, double-blind clinical trial evaluated the efficacy of in-office bleaching with 6% HP in adolescents using different application tips, as well tooth sensitivity (TS) and aesthetic self-perception. Methodology: Sixty participants were randomized for 6% HP self-mixing bleaching gel tip design: without brush and with brush. In-office bleaching was performed in 3 sessions of 50 minutes. Color change was evaluated using a digital spectrophotometer (ΔE ab , ΔE 00 , and ΔWI D ) and color guide (ΔSGU), the absolute risk and intensity of TS with a visual analogue scale and aesthetic self-perception with the oral aesthetic scale (a=0.05). Results: The groups achieved similar bleaching regardless of the application tip (p>0.05). However, only for ΔWI D , a significant mean difference (MD) was observed in the third week (MD 2.3; 95% CI 1.2 to 3.3; p < 0.001) and at one month (MD 1.6; 95% CI 0.6 to 2.6; p < 0.03) favoring the tip without brush. Regarding TS, 45% in the tip-without-brush group and 33% in the tip-with-brush group reported TS (odds ratio 0.61; 95% CI 0.29 to 1.28; p<0.02), with low TS intensity (MD 0.05; 95% CI -0.06 to 0.17; p>0.36). All patients reported improved aesthetic self-perception after bleaching (MD -1.3; 95% -1.8 to -0.9; p<0.001). Conclusions: Regardless of the tip used bleaching with 6% HP achieved a bleaching efficacy and improved the aesthetic self-perception. However, a lower risk of TS for application using the tip with brush was observed. &nbsp

Trocador de calor e umidade: proteção contra infecções pulmonares? Estudo piloto

O objetivo deste trabalho foi realizar um estudo bacteriológico comparativo entre os sistemas de umidificação aquoso aquecido (UAA) e filtro trocador de calor e umidade (FTCU) quanto à colonização bacteriana e a incidência de infecção respiratória em pacientes submetidos à ventilação mecânica (VM). Trata-se de uma pesquisa prospectiva, controlada e randomizada, na qual 15 pacientes internados na Unidade de Terapia Intensiva (UTI) foram distribuídos em dois grupos. O primeiro fez uso de UAA (n=7) e o outro de FTCU (n=8). Foram coletadas amostras da secreção traqueal, condensado do circuito e FTCU na admissão do paciente, no quarto e oitavo dias, e realizada análise bacteriológica dos mesmos. Quanto às características antropométricas, não observou-se diferenças entre os grupos estudados. A prevalência de pneumonia associada à ventilação (PAV) foi de 57,1% no UAA e 62,5% no FTCU. Ao realizar a análise bacteriológica quantitativa entre eles, não foram observadas variações, sugerindo não haver diferença na prevenção de PAV entre os sistemas de umidificação; porém a presença das mesmas bactérias na secreção traqueal e no condensado e ausência destas na membrana do FTCU podem indicar que a principal fonte de contaminação é o próprio paciente.The aim of this study was to conduct a bacteriological research comparing the aqueous heated humidification systems (HH) and filter heat and moisture exchanger (FHME) and to bacterial colonization and the incidence of respiratory infection in patients undergoing mechanical ventilation. It is a prospective, controlled trial, in that 15 intensive care unit (ICU) patients were divided into two groups. The first made use of HH (n=7) and the other, FHME (n=8). We collected samples of tracheal secretions, and condensate circuit FHME at admission in the fourth and eighth day and bacteriological analysis of the same place. Regarding the anthropometric characteristics, no differences were observed between the groups. The prevalence of ventilator associated pneumonia (VAP) was 57.1% in the HH and 62.5% in FHME. When performing quantitative bacteriological analysis between the group and HH and FHME, differences were not observed, suggesting no variation in the prevention of VAP between the humidification systems, but the presence of these bacteria in the tracheal and condensate and in the absence of these membrane FHME may indicate that the main source of contamination is the patient himself

Whole-genome sequencing of 1,171 elderly admixed individuals from Brazil

As whole-genome sequencing (WGS) becomes the gold standard tool for studying population genomics and medical applications, data on diverse non-European and admixed individuals are still scarce. Here, we present a high-coverage WGS dataset of 1,171 highly admixed elderly Brazilians from a census-based cohort, providing over 76 million variants, of which ~2 million are absent from large public databases. WGS enables identification of ~2,000 previously undescribed mobile element insertions without previous description, nearly 5 Mb of genomic segments absent from the human genome reference, and over 140 alleles from HLA genes absent from public resources. We reclassify and curate pathogenicity assertions for nearly four hundred variants in genes associated with dominantly-inherited Mendelian disorders and calculate the incidence for selected recessive disorders, demonstrating the clinical usefulness of the present study. Finally, we observe that whole-genome and HLA imputation could be significantly improved compared to available datasets since rare variation represents the largest proportion of input from WGS. These results demonstrate that even smaller sample sizes of underrepresented populations bring relevant data for genomic studies, especially when exploring analyses allowed only by WGS

Efeito da radioterapia profilática para ossificação heterotópica em pacientes com lesão medular traumática

A incidência da ossificação heterotópica (OH) varia de 10 a 53%. Em pacientes com lesão medular (LM), o principal fator de risco associado ao desenvolvimento de OH é gravidade do comprometimento medular de acordo com a American Spinal Injury Association Impairment Scale (AIS).A incidência da ossificação heterotópica (OH) varia de 10 a 53%. Em pacientes com lesão medular (LM), o principal fator de risco associado ao desenvolvimento de OH é gravidade do comprometimento medular de acordo com a American Spinal Injury Association Impairment Scale (AIS)

Perception of primary care doctors and nurses about care provided to sickle cell disease patients

OBJECTIVE: To analyze the perception of primary care physicians and nurses about access to services and routine health care provided to sickle cell disease patients.METHODS: This descriptive exploratory study took a qualitative approach by surveying thirteen primary care health professionals who participated in a focus group to discuss access to services and assistance provided to sickle cell disease patients. The data were submitted to thematic content analysis.RESULTS: Access to primary care services and routine care for sickle cell disease patients were the categories that emerged from the analysis. Interaction between people with sickle cell disease and primary care health clinics was found to be minimal and limited mainly to scheduling appointments. Patients sought care from the primary care health clinics only in some situations, such as for pain episodes and vaccinations. The professionals noted that patients do not recognize primary care as the gateway to the system, and reported that they feel unprepared to assist sickle cell disease patients.CONCLUSION: In the perception of these professionals, there are restrictions to accessing primary care health clinics and the primary care assistance for sickle cell disease patients is affected

Energy Efficiency Analysis of Pumping Systems Impacted by the Golden Mussel: A Case Study in the Brazilian Amazon

Pumping systems, especially those used in the water supply sector and in industrial and hydroelectric facilities, are commonly infested by the golden mussel. This causes an increase in maintenance operations (e.g., system shutdowns for cleaning) that can generate an increased energy cost. The geographical expansion of the golden mussel in Latin America presents an economic risk, not only to the ecosystem in general, but also to the energy sector. The imminence of its spread in the Amazon region, one of the main river basins in South America, is cause for concern with regard to the problems that bioinvasion of this species can cause. Given the absence of studies on the loss of energy efficiency in pumping systems impacted by the golden mussel, this study proposes a methodology to estimate the increase in energy consumption and costs of pumping under such bioinfestation. For the standardization of the methodology and development of mathematical calculations (both novel and improved equations), data from the literature (the growth of the golden mussel as a function of infestation time) and an analysis of the dimensions (length and height) of a sample of mussels available in the laboratory were considered. These data were used to calculate the roughness generated by the mussel infestation in the pumping suction and discharger pipe, which was necessary to determine the loss of energy efficiency (load loss, power consumption, and cost of pumping) resulting from the increase in energy consumption for pumping. This methodology was applied to a pumping station representative of the Brazilian Amazon as a case study. The results show an average increase in economic indicators (consumption and cost of pumping) after the system undergoes bioinfestation. This total increase corresponded to 19% and 44% in the first and second years, respectively, achieving a stabilization of the increase in the cost of pumping at 46%, in the 30 months of operation. Our results demonstrate the pioneering nature of the proposal, since these are the first quantitative data on the energy efficiency of pumping systems associated with bioinfestation by the golden mussel. These results can also be used to estimate the increase in costs caused by golden mussel bioinfestation in the raw water pumping systems of other facilities