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Objective  The present study aims to analyze histomorphometrically the repair of a non-critical bone defect after implantation of hydroxyapatite (HA) microspheres substituted by magnesium (Mg). Methods  Thirty rats were distributed into 3 experimental groups, evaluated at 15 and 45 days postoperatively: HAG (bone defect filled with HA microspheres); HAMgG (bone defect filled with HA microspheres replaced with 1 mol% Mg), and CG (bone defect without implantation of biomaterials). Results  After 15 days, the biomaterials filled the entire defect extent, forming a new osteoid matrix between the microspheres. In the CG, this neoformation was restricted to the edges with the deposition of loose connective tissue with reduced thickness. At 45 days, new bone formation filled almost the entire extension of the bone defect in the 3 groups, with statistically significant osteoid deposition in the CG despite the reduced thickness compared with the HAG and HAMgG. The groups with biomaterial implantation displayed a more abundant osteoid matrix than at 15 days. Conclusion  The biomaterials studied showed biocompatibility, osteoconductivity, and bioactivity. The Mg concentration in the substituted HA did not stimulate more significant bone formation than HA without this ion., Competing Interests: Conflito de Interesses Os autores não têm conflito de interesses a declarar., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit ( https://creativecommons.org/licenses/by/4.0/ ).)

Sesquiterpenes (SS) are secondary metabolites formed by the bonding of 3 isoprene (C5) units. They play an important role in the defense and signaling of plants to adapt to the environment, face stress, and communicate with the outside world, and their evolutionary history is closely related to their physiological functions. This review considers their presence and extensively summarizes the 156 sesquiterpenes identified in Vitex taxa , emphasizing those with higher concentrations and frequency among species and correlating with the insecticidal activities and defensive responses reported in the literature. In addition, we classify the SS based on their chemical structures and addresses cyclization in biosynthetic origin. Most relevant sesquiterpenes of the Vitex genus are derived from the germacredienyl cation mainly via bicyclogermacrene and germacrene C, giving rise to aromadrendanes, a skeleton with the highest number of representative compounds in this genus, and 6,9-guaiadiene, respectively, indicating the production of 1.10-cyclizing sesquiterpene synthases. These enzymes can play an important role in the chemosystematics of the genus from their corresponding routes and cyclizations, constituting a new approach to chemotaxonomy. In conclusion, this review is a compilation of detailed information on the profile of sesquiterpene in the Vitex genus and, thus, points to new unexplored horizons for future research.

Objective  To compare the effect of two therapeutic ultrasound protocols, with different times of exposure in the regeneration of critical bone defect. Methods  Forty-five male rats were distributed among three experimental groups: therapeutic ultrasound group 5 minutes (TUG 5); therapeutic ultrasound group 10 minutes (TUG 10); and control group (CG). In all groups, a critical bone defect of 8.5 mm diameter was made in the calvaria region. The protocol was initiated on the 1 st postoperative day in TUGs 5 and 10, with therapeutic ultrasound at the frequency of 1.0 MHz, pulsed mode, five times a week, at periods of 15, 30, and 60 days. Results  Among the experimental groups, the highest volume of neoformation of osteoid matrix took place in the TUG 10 group followed by TUG 5, when compared with the CG group, in which the neoformation was restricted to the border region. The use of ultrasound promoted an increase in the thickness of the conjunctive matrix, proliferation of capillaries, alignment of the collagen fibers, reduction of edema and inflammatory process, being more significant in the 10-minutes time period. Conclusion  Therapeutic ultrasound stimulated the repair of a critical bone defect, and the longer exposure time promoted greater osteogenic stimulation., Competing Interests: Conflito de Interesses Os autores declaram não haver conflito de interesses.

Objective: to describe the sociodemographic and health care characteristics of women dying due to maternal causes in Recife, Pernambuco, Brazil., Methods: this was a descriptive study using the Mortality Information System, case investigation sheets and summary sheets of early and late maternal deaths occurring between 2006 and 2017, with avoidability assessed by the Municipal Maternal Mortality Committee., Results: we identified 171 deaths, of which 133 were in the puerperium; most deaths occurred among Black women (68.4%), women without partners (60.2%), women who had prenatal care (77.2%), during maternity hospital/general hospital delivery (97.1%), women attended to by obstetricians (82.6%);10.4% of women with puerperal complications had no health care; avoidable/probably avoidable deaths corresponded to 81.9%, for indirect causes (n=80), and direct causes (n=79)., Conclusion: deaths occurred mainly in the postpartum period, among Black women; care failures were frequent; improved health service surveillance and follow-up is needed in the pregnancy-puerperal period, in Recife.

Objective: to evaluate the implantation of the Mortality Information System (SIM) in Pernambuco, Brazil., Methods: this was an evaluation study; primary data (questionnaires) and secondary data (SIM) were used for the municipalities to estimate the degree of implantation (DI), comparing structure and process indicators with outcome indicators; data were consolidated by region and state., Results: SIM was partially implanted in the state (70.6%) and its regions (66.3% to 74.8%); 'management' (75.1%), 'issuing and filling in' (79.1%), and 'processing' (71.7%) were partially implanted; 'collection' (80.7%) was implanted; while 'distribution and control' (49.7%) and 'analysis and dissemination' (58.0%) had incipient implantation; more than 90% coverage was found for deaths with defined underlying causes, as well as for municipalities with monthly data transfer, and death certificates typed and sent on a timely basis; consistency was found between DI and outcome indicators, which improved as DI increased., Conclusion: SIM was found to be only partially implanted owing to inadequacies in distribution, control, analysis and dissemination, thus influencing unfavorably the effects observed.

Statement of Problem: Visual shade matching is subjective and a cause of concern for clinicians. Different measurement devices have been developed to assist in tooth color selection and to achieve better esthetic results. However, consensus is lacking as to which method of tooth shade selection provides more predictable results., Purpose: The purpose of this clinical study was to compare the reliability of different visual and instrumental methods for dental shade matching., Material and Methods: Visual shade matching was performed by 3 experienced clinicians using 2 different shade guides (VITA Classical A1-D4 and VITA Toothguide 3D-MASTER with 29 tabs; VITA Zahnfabrik) with and without the aid of a light-correcting device (Smile Lite; Smile Line). An intraoral scanner (TRIOS; 3Shape A/S) and a spectrophotometer (VITA Easyshade Advance 4.0; VITA Zahnfabrik) were also used for color shade matching. The instrumental methods were repeated 3 times to determine repeatability. Shade-matching sessions for each method were performed under controlled lighting on the middle third of the maxillary right central incisor of 28 participants. The Fleiss' kappa statistical test was used to assess the reliability of each method. The weighted kappa statistical test was used to assess the agreement between the shades matched by different methods (α=.05)., Results: Instrumental methods were more accurate than visual methods. The best performance was found for the intraoral scanner configured for the 3D-MASTER scale (Fleiss' kappa value of .874) and for the spectrophotometer configured for the VITA Classical scale (Fleiss' kappa value of .805). The best visual shade-matching method was the VITA Classical scale associated with the light-correcting device (Fleiss' kappa value of .322). The Classical scale without the light-correcting device showed the poorest reliability (Fleiss' kappa value of .177) (P<.05)., Conclusions: Instrumental methods for color shade matching were more reliable than the visual methods tested., (Copyright © 2018 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

The Vitex genus (Lamiaceae) produces a plethora of metabolites that include ecdysteroids and terpenoids, some of which have demonstrated insect repellent properties. The volatile composition of several members of this genus has not been chemically defined, as many taxa are endemic to remote ecosystems. In this study, leaves were collected from the northeast of Brazil from Vitex capitata, V. megapotamica, V. gardneriana , and V. rufescens plants and examined for their chemical profile via GC-MS/FID of essential oil extracts. The analyses showed a diversity of terpenoids. Of particular note were seven-member ring sesquiterpenes which were present in great abundance; a dendrogram showed clades separating by the production of bicyclogermacrene, aromadendrane and 5,10-cycloaromadendrane sesquiterpenoids for the four species. Comparison of volatile metabolite profiles to 13 other Vitex species showed strong similarities in the production of some monoterpenes, but varied by their production of larger terpenes, especially those with gem-dimethylcyclopropyl subunits on seven-member ring compounds. From this work, we suggest that the sesquiterpene skeleton with seven member rings is a good chemosystematic biomarker candidate for the Vitex genus. Separation using this biomarker was then validated using Inter-Simple Sequence Repeat profiling. Lastly, experiments examining the toxicity of these four oils against the coconut mite Aceria guerreronis showed that only the oil of V. gardneriana had strong acaricidal activity, with an LC 50 of 0.85 mg/mL, thus demonstrating its potential for use as a natural pesticide.

Objective: To evaluate the implementation of a programme to provide primary care physicians for remote and deprived populations in Brazil., Methods: The Mais Médicos (More Doctors) programme was launched in July 2013 with public calls to recruit physicians for priority areas. Other strategies were to increase primary care infrastructure investments and to provide more places at medical schools. We conducted a quasi-experimental, before-and-after evaluation of the implementation of the programme in 1708 municipalities with populations living in extreme poverty and in remote border areas. We compared physician density, primary care coverage and avoidable hospitalizations in municipalities enrolled ( n  = 1450) and not enrolled ( n  = 258) in the programme. Data extracted from health information systems and Ministry of Health publications were analysed., Findings: By September 2015, 4917 physicians had been added to the 16 524 physicians already in place in municipalities with remote and deprived populations. The number of municipalities with ≥ 1.0 physician per 1000 inhabitants doubled from 163 in 2013 to 348 in 2015. Primary care coverage in enrolled municipalities (based on 3000 inhabitants per primary care team) increased from 77.9% in 2012 to 86.3% in 2015. Avoidable hospitalizations in enrolled municipalities decreased from 44.9% in 2012 to 41.2% in 2015, but remained unchanged in control municipalities. We also documented higher infrastructure investments in enrolled municipalities and an increase in the number of medical school places over the study period., Conclusion: Other countries having shortages of physicians could benefit from the lessons of Brazil's programme towards achieving universal right to health.

In the last few years, new primary immunodeficiencies and genetic defects have been described. Recently, immunoglobulin products with improved compositions and for subcutaneous use have become available in Brazil. In order to guide physicians on the use of human immunoglobulin to treat primary immunodeficiencies, based on a narrative literature review and their professional experience, the members of the Primary Immunodeficiency Group of the Brazilian Society of Allergy and Immunology prepared an updated document of the 1st Brazilian Consensus, published in 2010. The document presents new knowledge about the indications and efficacy of immunoglobulin therapy in primary immunodeficiencies, relevant production-related aspects, mode of use (routes of administration, pharmacokinetics, doses and intervals), adverse events (major, prevention, treatment and reporting), patient monitoring, presentations available and how to have access to this therapeutic resource in Brazil.

Objective: to describe the first cases of microcephaly possibly related to Zika virus in live born babies reported in the Metropolitan Region of Recife, Pernambuco State, Brazil., Methods: this was a descriptive case series study (cases reported between August 1st and October 31st 2015), using medical record data and data from a questionnaire answered by the mothers of the babies., Results: 40 microcephaly cases were confirmed, distributed in eight municipalities within the Metropolitan Region, with Recife itself having the highest concentration of cases (n=12); median head circumference was 29 cm, median chest girth was 31 cm and median weight was 2,628 grams; 21/25 cases had brain calcification, ventriculomegaly or lissencephaly; 27 of the 40 mothers reported rash during pregnancy, 20 in the first trimester and 7 in the second trimester, as well as itching, headache, myalgia and absence of fever., Conclusion: the majority of the cases bore the characteristics of congenital infection; the clinical condition of the majority of mothers suggested Zika virus infection during pregnancy.

The Mais Médicos (More Doctors) Program is a Brazilian government program that aims to expand access to medical care and thus improve the quality of primary healthcare delivery. This study aims to analyze the perceptions of nondoctor members of the Family Health Strategy teams regarding comprehensiveness of care after the inclusion of doctors from the program. The study encompassed 32 poor municipalities in Brazil's five geographical regions. A total of 78 health workers were interviewed. The interviews were transcribed and analyzed using content analysis and the software Atlas.ti Version 1.0.36. The study found that the program led to: an increase in access to and accessibility of services provided under the Family Health Strategy; humanized care and the establishment of bonds - understanding, partnership, friendship and respect; going back to clinical approaches - dedicated time, listening attentively, and detailed physical examination; the desire and willingness to resolve problems; continuity of care; guarenteeing home visits; and coordination of multidisciplinary teams in networks. It was concluded that the Mais Médicos Program contributed to the enhancement of comprehensiveness, thus leading to improvements in primary health care delivery.

Background: PIDs are a heterogeneous group of genetic illnesses, and delay in their diagnosis is thought to be caused by a lack of awareness among physicians concerning PIDs. The latter is what we aimed to evaluate in Brazil., Methods: Physicians working at general hospitals all over the country were asked to complete a 14-item questionnaire. One of the questions described 25 clinical situations that could be associated with PIDs and a score was created based on percentages of appropriate answers., Results: A total of 4026 physicians participated in the study: 1628 paediatricians (40.4%), 1436 clinicians (35.7%), and 962 surgeons (23.9%). About 67% of the physicians had learned about PIDs in medical school or residency training, 84.6% evaluated patients who frequently took antibiotics, but only 40.3% of them participated in the immunological evaluation of these patients. Seventy-seven percent of the participating physicians were not familiar with the warning signs for PIDs. The mean score of correct answers for the 25 clinical situations was 48.08% (±16.06). Only 18.3% of the paediatricians, 7.4% of the clinicians, and 5.8% of the surgeons answered at least 2/3 of these situations appropriately., Conclusions: There is a lack of medical awareness concerning PIDs, even among paediatricians, who have been targeted with PID educational programmes in recent years in Brazil. An increase in awareness with regard to these disorders within the medical community is an important step towards improving recognition and treatment of PIDs., (Copyright © 2014 SEICAP. Published by Elsevier Espana. All rights reserved.)

Latin America continues to segregate different social groups into separate health-system segments, including two separate public sector blocks: a well resourced social security for salaried workers and their families and a Ministry of Health serving poor and vulnerable people with low standards of quality and needing a frequently impoverishing payment at point of service. This segregation shows Latin America's longstanding economic and social inequality, cemented by an economic framework that predicted that economic growth would lead to rapid formalisation of the economy. Today, the institutional setup that organises the social segregation in health care is perceived, despite improved life expectancy and other advances, as a barrier to fulfilling the right to health, embodied in the legislation of many Latin American countries. This Series paper outlines four phases in the history of Latin American countries that explain the roots of segmentation in health care and describe three paths taken by countries seeking to overcome it: unification of the funds used to finance both social security and Ministry of Health services (one public payer); free choice of provider or insurer; and expansion of services to poor people and the non-salaried population by making explicit the health-care benefits to which all citizens are entitled., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Antiretroviral therapy has greatly extended the lifespan of people living with human immunodeficiency virus (PLHIV). As a result, the long-term effects of HIV infection, in particular those originating in the central nervous system (CNS), such as HIV associated depression, have gained importance. Animal models for HIV infection have proved very useful for understanding the disease and developing treatment strategies. However, HIV associated depression remains poorly understood and so far there is neither a fully satisfactory animal model, nor a pathophysiologically guided treatment for this condition. Here we review the neuroimmunological, neuroendocrine, neurotoxic and neurodegenerative basis for HIV depression and discuss strategies for employing HIV animal models, in particular humanized mice which are susceptible to HIV infection, for the study of HIV depression.

Introduction: In the district of Sobral, for the decade of 2000 at the same time that political measures were implanted towards the decrease of children mortality, discussions have begun about health and educations conditions, as well as life quality of children aged between 5 and 9, which is an age group of lesser vulnerability as far as health goes, although of major importance in the development of healthy habits and for the child's development itself., Objective: Based on such scenario, it was set up a cohort of children aged between 5 and 9 and residents of the urban area of the district in order to study health and education conditions and quality of life which are essential for the future of these children in light of the Social Determinants of Health., Methods: This is a cross-sectional study with a cohort of children born from 1990 to 1994, home interviews, clinical evaluation and lab exams. The structure for the development of the research was elaborated based on the model of attention towards the health of Family Health Strategy. In this report, the results of such home interviews shall be presented in regards to socio-demographic and environmental conditions in general, with a more detailed analysis of life styles, educational levels, child labor, nutrition and the use of health services by children.

Introduction: The Brazilian National Health System may reduce inequalities in access to health services through strategies that can reach those most in need with no access to care services., Objective: To identify factors associated with the use of health service by children aged 5 to 9 years in the city of Sobral, Ceará, northeastern Brazil., Results: Only 558 (17.0%) children used health care services in the 30 days preceding this survey. Children with any health condition (OR = 3.90) who were frequent attenders of primary care strategy of organization (the Family Health Strategy, FHS) (OR = 1.81) and living in the city's urban area (OR = 1.51) were more likely to use health services. Almost 80% of children used FHS as their referral care service. Children from poorer families and with easier access to services were more likely to be FHS users., Conclusion: The study showed that access to health services has been relatively equitable through the FHS, a point of entry to the local health system.

The aim of this study was to make a histomorphometric evaluation of the osteogenic potential of anionic collagen matrix as scaffolds; either crosslinked in glutaraldehyde or not cross-linked and, implanted in critical bone defects in rat calvaria. Seventy-two rats were randomly distributed in three groups: anionic collagen scaffolds treated for 24 h of selective hydrolysis (ACSH); anionic collagen scaffolds treated for 24 h of selective hydrolysis and 5 min of crosslinking in glutaraldehyde 0.05% (ACSHGA); empty bone defect (Control), evaluated at the biological points of 15, 45, 90 and 120 days. The results showed that the biomaterials implanted were biocompatible and showed a high osteogenic potential. These biomaterials presented a speed of biodegradation compatible with bone neoformation, which was shown to be associated with angiogenesis inside the scaffolds at all biological points. The percentage of mineralization of ACSH (87%) differed statistically from that found in ACSHGA (66%). It was concluded that the regeneration of critical bone defect was more evident in anionic collagen without crosslinking (ACSH).

We report the ultrastructure of regenerated bone surrounding two types of biomaterials: hydroxyapatite-alginate composite and sintered hydroxyapatite. Critical defects in the calvaria of Wistar rats were filled with micrometer-sized spherical biomaterials and analyzed after 90 and 120 days of implantation by high-resolution transmission electron microscopy and Fourier transform infrared attenuated total reflectance microscopy, respectively. Infrared spectroscopy showed that hydroxyapatite of both biomaterials became more disordered after implantation in the rat calvaria, indicating that the biological environment induced modifications in biomaterials structure. We observed that the regenerated bone surrounding both biomaterials had a lamellar structure with type I collagen fibers alternating in adjacent lamella with angles of approximately 90°. In each lamella, plate-like apatite crystals were aligned in the c-axis direction, although a rotation around the c-axis could be present. Bone plate-like crystal dimensions were similar in regenerated bone around biomaterials and pre-existing bone in the rat calvaria. No epitaxial growth was observed around any of the biomaterials. A distinct mineralized layer was observed between new bone and hydroxyapatite-alginate biomaterial. This region presented a particular ultrastructure with crystallites smaller than those of the bulk of the biomaterial, and was possibly formed during the synthesis of alginate-containing composite or in the biological environment after implantation. Round nanoparticles were observed in regions of newly formed bone. The findings of this work contribute to a better understanding of the role of hydroxyapatite based biomaterials in bone regeneration processes at the nanoscale., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Introduction: This study was based on a random sample of 3,276 children aged between 5 and 9 years from the urban region of Sobral - CE, Brazil., Objective: The main goal was to describe reported morbidity in children aged between 5 to 9 years and to analyze their conditionings., Methodology: Home interviews were carried out with 3,276 children and clinical exams were conducted in a sub-sample of 2,594. Health problems reported by mothers were classified according to the tenth revision of the International Disease Classification. Analyses were performed using Stata 7.0. Outcomes analyzed were reported morbidity in the past 15 days. The independent variables were grouped into socioeconomic, environmental, health service access, and nutritional status., Results: The most prevalent morbidities were diseases of the respiratory system (DRS), 28.7%; diseases of the skin and subcutaneous tissue, 3.4%; infectious and parasitic diseases, 2.2%. The independent variables that had statistically significant correlations with the prevalence of DRS were related to the children who lived in the main urban center, had a history of malnutrition, and low school attendance, with odds ratio of respectively, 1.48 (1.10-1.9995%CI), 1.30 (1.05-1.6095%CI), 1.54 (1.02-2.3295%CI)., Discussion: A high prevalence of DRS was observed in children in the main urban center. DRS prevalence was about twice higher than that observed in other studies with similar methodology. This observation has raised the hypotheses of over reporting or environmental pollution. Most children had minor health problems. They also had facilitated access to health services, especially to the FHP.