Objective:To assess the level of knowledge and difficulties concerning hospitalized patients regarding preventive oral health measures among professionals working in Intensive Care Units (ICUs).Study Population and Methods:A cross-sectional survey was conducted among 71 health professionals working in the ICU. A self-administered questionnaire was used to determine the methods used, frequency, and attitude toward oral care provided to patients in Brazilian ICUs. The variables were analyzed using descriptive statistics (percentages). A one-sample t-test between proportions was used to assess significant differences between percentages. t-statistics were considered statistically significant for P < 0.05. Bonferroni correction was applied to account for multiple testing.Results:Most participants were nursing professionals (80.3%) working 12-h shifts in the ICU (70.4%); about 87.3% and 66.2% reported having knowledge about coated tongue and nosocomial pneumonia, respectively (P < 0.05). Most reported using spatulas, gauze, and toothbrushes (49.3%) or only toothbrushes (28.2%) with 0.12% chlorhexidine (49.3%) to sanitize the oral cavity of ICU patients (P < 0.01). Most professionals felt that adequate time was available to provide oral care to ICU patients and that oral care was a priority for mechanically ventilated patients (80.3% and 83.1%, respectively, P < 0.05). However, most professionals (56.4%) reported feeling that the oral cavity was difficult to clean (P < 0.05).Conclusion:The survey results suggest that additional education is necessary to increase awareness among ICU professionals of the association between dental plaque and systemic conditions of patients, to standardize oral care protocols, and to promote the oral health of patients in ICUs.

O atendimento odontológico domiciliar direcionado aos idosos semi e dependentes é conjunto de ações preventivas e de mínima intervenção que visam promover a saúde bucal e orientar familiares e cuidadores. É considerada uma estratégia educativa e assistencial de saúde cuja finalidade é intervir, de maneira multidisciplinar, no processo saúde-doença de idosos vulneráveis. Este estudo tem como objetivo abordar a prática odontológica domiciliar, enfatizando as principais alterações sistêmicas e possíveis repercussões na cavidade bucal, a necessidade de participação efetiva do cirurgião-dentista e orientações de promoção de saúde bucal que possam auxiliar nas condutas dos familiares, cuidadores e profissionais envolvidos com esse tipo de atendimento. Foram realizadas busca e análise de artigos científicos e bases de dados bibliográficos sobre a prática odontológica domiciliar em idosos. Na estratégia de busca foram empregados os termos: assistência domiciliar, odontogeriatria, odontologia domiciliar, idoso fragilizado e saúde bucal. Adotaram-se como critérios de inclusão: artigos publicados em português; artigos indexados nas bases de dados LILACS e SciELO; artigos publicados no período de 2000 a 2011 e legislação federal sobre o assunto, totalizando 36 referências. Concluiu-se que existe grande necessidade dessa atividade odontológica em domicílio a ser executada de maneira capacitada por odontogeriatras com formação gerontológica que possam contribuir na humanização do atendimento e promoção do bem-estar e qualidade de vida desses idosos.

Key Clinical MessageOral hygiene deficiency is common in patients treated in ICUs and it enables biofilm colonization by microorganisms that lead to respiratory infections. A 30‐year‐old female patient with chronic renal failure was hospitalized. Dental procedures were performed in the ICU and contributed to the patient's health after a few days.

The objective of the study was to evaluate, through quantitative methods, the structural alterations in the corpora cavernosa of rats submitted to orchiectomy as well as the role of late hormone replacement in overturning the possible structural alterations. Twenty-five male rats were assigned into 5 groups with 5 animals each and treated as follows: ORCHIEC-1 5 submitted to orchiectomy and sacrificed after 1 month; C-1 5 control group sacrificed after 1 month; ORCHIEC-2 5 submitted to orchiectomy and sacrificed after 2 months; C-2 5 control group sacrificed after 2 months; and T 5 submitted to orchiectomy, underwent testosterone replacement with testosterone undecanoate (100 mg/kg) after 1 month, and sacrificed after 1 month of hormonal replacement. Smooth muscle, collagen, and elastic system fibers of penile corpora cavernosa were quantified. There was a significant decrease in the absolute values of smooth muscle, sinusoidal space, and total area of corpora cavernosa after 2 months in the castrated group when compared with controls. Overall, regarding density, no significant differences were observed among the groups. The hormonal replacement with testosterone was able to reverse the alterations observed. The method used for this research allowed demonstrating that absolute values are reliable to quantify the structural alterations of corpora cavernosa structures. The results suggest that hormonal replacement, even when instituted at a late stage, is effective in reversing the corpora cavernosa's structural alterations produced by castration.

The purpose of this statement is to debate the recommendations of the American Heart Association (AHA) for the prevention of infective endocarditis through an antibiotic prophylaxis protocol and its relation with bacterial resistance to antibiotics. Since dental infections involve biofilms that include several bacterial species (Gram‐negative and Gram‐positive), it is essential, from the dental point of view, to consider the frequency, magnitude, and duration of bacteremia associated with active dental infections before applying antibiotic prophylaxis. The actual guidelines for antibiotic prophylaxis should be revised according to recent evidence of bacterial resistance. Amoxicillin/clavulanic acid and moxifloxacin should be considered due to their effectiveness against bacteria associated with oral, GU, and GI infections and the low rates of antibiotic resistance associated with these antibiotics, instead of the actual protocol, which includes amoxicillin (2 g) or clindamycin (600 mg) administered an hour before the dental procedures. The breaking point to test the antibiotic bacterial resistance (ABR) had a wide range in the different studies that were analyzed, which could explain the widely varied ABR percentages reported for the various antibiotics used for antibiotic prophylaxis.

Objetivo: avaliar a incidência de saburra lingual em pacientes atendidos em unidade de terapia intensiva (UTI) de um hospital do Distrito Federal, Brasil. Material e Métodos: estudo descritivo e prospectivo com coorte de conveniência aprovado pelo Comitê de Ética em Pesquisa. Um único examinador conduziu exames clínicos com foco na avaliação da incidência de saburra lingual em pacientes internados em UTI por cinco semanas, às vezes programadas pelo conselho de administração da UTI. Os dados foram registrados em uma folha de dados padronizada. Resultados: foram avaliados 152 pacientes do sexo masculino e feminino (57% mulheres e 42% homens), com idade média de 64 anos. Os pacientes foram internados na UTI, principalmente sob condições normais (p <0,001); o período mais longo na UTI foi de 48 horas (p <0,001). A maioria dos pacientes (56) apresentou revestimento em suas línguas (p <0,001). Associações entre o tempo de internação hospitalar e a incidência de saburra lingual não foram estatisticamente significantes. Conclusão: a incidência de saburra lingual permanece alta nos pacientes tratados na UTI investigada. Assim, faz-se necessário o desenvolvimento de estratégias educativas e clínicas, bem como a implementação de protocolos de capacitação específica e profissional.

We evaluated, by qualitative and quantitative methods, the structural alterations in the bladder wall of rats submitted to surgical castration, as well as the role of hormone replacement in reversing the possible structural alterations. Twenty-four 12-week-old male Sprague-Dawley rats were used. The animals were divided into 3 groups comprising 8 animals each and treated as follows. Members of group CONTR (control) underwent a sham operation only and were sacrificed after 2 months. Members of group ORCH (orchiectomy) underwent bilateral orchiectomy and were sacrificed after 2 months. Members of group ORCH+TEST (testosterone) underwent orchiectomy, received testosterone replacement after 1 month, and were sacrificed 1 month later. We performed a qualitative and quantitative analysis of collagen by light microscopy, scanning electron microscopy, biochemistry, and a histomorphometric analysis of smooth muscle and elastic fibers in the 3 groups. The results showed a significant decrease in absolute values of elastic fibers in the castrated group. The histomorphometric analysis of epithelial height did not show differences among the groups. There was no statistical difference in quantitative analysis of collagen, either by histomorphometry or by biochemistry. Also, there was no difference in the smooth muscle cells. However, the qualitative analysis revealed differences in collagen (castrated group) when compared with controls and with rats submitted to hormone replacement. Hormone replacement with testosterone was able to revert the alterations observed. The findings suggest that hormone replacement, even when instituted at a late stage, is effective in reversing the bladder wall alterations produced by secondary hypogonadism.

Introduction A surgical approach with plaque incision and graft (PIG) to correct Peyronie's disease is the best method for complex, large deviations. However, the geometric and mechanical consequences of this intervention are poorly understood. Aim The aim of this study was to analyze the geometric and mechanical consequences of PIG on penile straighten surgery. Method A tridimensional penile simile model with a curvature of 85° was created to test all of the most common PIG techniques. PIG with double-Y, H-shape, and Egydio techniques were used to rectify the curved penile model. Main Outcome Measurements The results that differed from a rectified cylinder shape were highlighted. Results All of the analyzed techniques created a geometric distortion that could be linked to poor surgical results. We suggest a new technique to resolve these abnormalities. Conclusion Current techniques designed to correct penile deviation using PIG present geometric and mechanical imperfections with potential consequences to the postoperative success rate. The new technique proposed in this report could be a possible solution to solve the geometric distortion caused by PIG.