Mortes evitáveis em menores de um ano, Brasil, 1997 a 2006: contribuições para a avaliação de desempenho do Sistema Único de Saúde

Os óbitos de menores de um ano foram classificados em causas evitáveis, mal definidas e não evitáveis empregando a Lista Brasileira de Mortes Evitáveis, entre 1997-2006. Foram calculados tendências dos coeficientes de mortalidade infantil por causas de morte e se usou regressão não linear para avaliação de tendência. As causas evitáveis e as causas mal definidas apresentaram significativa redução (p < 0,001). As causas reduzíveis de mortalidade apresentaram redução de 37%. A mortalidade por causas reduzíveis por adequada atenção ao parto declinou em 27,7%; adequada atenção ao recém-nascido, 42,5%; e por adequada atenção à gestação cresceu 28,3%. Concluiu-se que os serviços de saúde contribuíram para a redução da mortalidade infantil. O declínio das causas mal definidas de morte indica ampliação do acesso aos serviços de saúde. O aumento do acesso e atenção ao parto e aos cuidados com recém-nascido contribuíram para a redução de óbitos infantis. O aumento da mortalidade por adequada atenção à gestação revela a necessidade de aprimoramento da atenção pré-natal.

A urbanização crítica na metrópole de São Paulo, a partir de fundamentos da geografia urbana

Over time the city has been involved in constant changes related with its diversity, processes and internal structure. As urban reality, the concepts of urban geography as a discipline shows a metamorphosis based on the agitation of urban reality. This investigation aims to update the geographical literature, without extreme simplifications and including as much perspectives as possible. Pierre George gives and extraordinary example about the extension of that knowledge, abruptly become obsolete.

Characterization of Dengue Virus Type 2: New Insights on the 2010 Brazilian Epidemic

Dengue viruses (DENV) serotypes 1, 2, and 3 have been causing yearly outbreaks in Brazil. In this study, we report the reintroduction of DENV2 in the coast of Sao Paulo State. Partial envelope viral genes were sequenced from eighteen patients with dengue fever during the 2010 epidemic. Phylogenetic analysis showed this strain belongs to the American/Asian genotype and was closely related to the virus that circulated in Rio de Janeiro in 2007 and 2008. The phylogeny also showed no clustering by clinical presentation, suggesting that the disease severity could not be explained by distinct variants or genotypes. The time of the most recent common ancestor of American/Asian genotype and the Sao Paulo and Rio de Janeiro (SP/RJ) monophyletic cluster was estimated to be around 40 and 10 years, respectively. Since this virus was first identified in Brazil in 2007, we suggest that it was already circulating in the country before causing the first documented outbreak. This is the first description of the 2010 outbreak in the State of Sao Paulo, Brazil, and should contribute to efforts to control and monitor the spread of DENVs in endemic areas.

FAM5C Contributes to Aggressive Periodontitis

Aggressive periodontitis is characterized by a rapid and severe periodontal destruction in young systemically healthy subjects. A greater prevalence is reported in Africans and African descendent groups than in Caucasians and Hispanics. We first fine mapped the interval 1q24.2 to 1q31.3 suggested as containing an aggressive periodontitis locus. Three hundred and eighty-nine subjects from 55 pedigrees were studied. Saliva samples were collected from all subjects, and DNA was extracted. Twenty-one single nucleotide polymorphisms were selected and analyzed by standard polymerase chain reaction using TaqMan chemistry. Non-parametric linkage and transmission distortion analyses were performed. Although linkage results were negative, statistically significant association between two markers, rs1935881 and rs1342913, in the FAM5C gene and aggressive periodontitis (p = 0.03) was found. Haplotype analysis showed an association between aggressive periodontitis and the haplotype A-G (rs1935881-rs1342913; p = 0.009). Sequence analysis of FAM5C coding regions did not disclose any mutations, but two variants in conserved intronic regions of FAM5C, rs57694932 and rs10494634, were found. However, these two variants are not associated with aggressive periodontitis. Secondly, we investigated the pattern of FAM5C expression in aggressive periodontitis lesions and its possible correlations with inflammatory/immunological factors and pathogens commonly associated with periodontal diseases. FAM5C mRNA expression was significantly higher in diseased versus healthy sites, and was found to be correlated to the IL-1 beta, IL-17A, IL-4 and RANKL mRNA levels. No correlations were found between FAM5C levels and the presence and load of red complex periodontopathogens or Aggregatibacter actinomycetemcomitans. This study provides evidence that FAM5C contributes to aggressive periodontitis.

Mechanical vibration preserves bone structure in rats treated with glucocorticoids

Glucocorticoids are an important cause of secondary osteoporosis in humans, which decreases bone quality and leads to fractures. Mechanical stimulation in the form of low-intensity and high-frequency vibration seems to be able to prevent bone loss and to stimulate bone formation. The objective of this study was to evaluate the effects of mechanical vibration on bone structure in rats treated with glucocorticoids. Thirty 3-month-old adult male Wistar rats were randomized to three groups: control (C), glucocorticoid (G), and glucocorticoid with vibration (CV). The G and GV groups received 3.5 mg/kg/day of methylprednisolone 5 days/week for a duration of 9 weeks, and the C group received vehicle (saline solution) during the same period. The CV group was vibrated on a special platform for 30 min per day, 5 days per week during the experiment. The platform was set to provide a vertical acceleration of 1 G and a frequency of 60 Hz. Skeletal bone mass was evaluated by total body densitometry (DXA). Fracture load threshold, undecalcified bone histomorphometry, and bone volume were measured in tibias. Glucocorticoids induced a significantly lower weight gain (-9.7%) and reduced the bone mineral content (-9.2%) and trabecular number (-41.8%) and increased the trabecular spacing (+98.0%) in the G group, when compared to the control (C). Vibration (CV) was able to significantly preserve (29.2%) of the trabecular number and decrease the trabecular spacing (+ 26.6%) compared to the G group, although these parameters did not reach C group values. The fracture load threshold was not different between groups, but vibration significantly augmented the bone volume of the tibia by 21.4% in the CV group compared to the C group. Our study demonstrated that low-intensity and high-frequency mechanical vibration was able to partially inhibit the deleterious consequences of glucocorticoids on bone structure in rats. (C) 2010 Elsevier Inc. All rights reserved.

Highlights from the III International Symposium of Thrombosis and Anticoagulation (ISTA), October 14-16, 2010, Sao Paulo, Brazil

To discuss and share knowledge around advances in the care of patients with thrombotic disorders, the Third International Symposium of Thrombosis and Anticoagulation was held in So Paulo, Brazil, from October 14-16, 2010. This scientific program was developed by clinicians for clinicians, and was promoted by four major clinical research institutes: the Brazilian Clinical Research Institute, the Duke Clinical Research Institute of the Duke University School of Medicine, the Canadian VIGOUR Centre, and the Uppsala Clinical Research Center. Comprising 3 days of academic presentations and open discussion, the symposium had as its primary goal to educate, motivate, and inspire internists, cardiologists, hematologists, and other physicians by convening national and international visionaries, thought-leaders, and dedicated clinician-scientists. This paper summarizes the symposium proceedings.

Aerobic training reverses airway inflammation and remodelling in an asthma murine model

Aerobic training (AT) decreases dyspnoea and exercise-induced bronchospasm, and improves aerobic capacity and quality of life; however, the mechanisms for such benefits remain poorly understood. The aim of the present study was to evaluate the AT effects in a chronic model of allergic lung inflammation in mice after the establishment of airway inflammation and remodelling. Mice were divided into the control group, AT group, ovalbumin (OVA) group or OVA+AT group and exposed to saline or OVA. AT was started on day 28 for 60 min five times per week for 4 weeks. Respiratory mechanics, specific immunoglobulin (Ig)E and IgG(1), collagen and elastic fibres deposition, smooth muscle thickness, epithelial mucus, and peribronchial density of eosinophils, CD3+ and CD4+, IL-4, IL-5, IL-13, interferon-gamma, IL-2, IL-1ra, IL-10, nuclear factor (NF)-kappa B and Foxp3 were evaluated. The OVA group showed an increase in IgE and IgG1, eosinophils, CD3+, CD4+, IL-4, IL-5, IL-13, NF-kappa B, collagen and elastic, mucus synthesis, smooth muscle thickness and lung tissue resistance and elastance. The OVA+AT group demonstrated an increase of IgE and IgG(1), and reduction of eosinophils, CD3+, CD4+, IL-4, IL-5, IL-13, NF-kappa B, airway remodelling, mucus synthesis, smooth muscle thickness and tissue resistance and elastance compared with the OVA roup (p < 0.05). The OVA+AT group also showed an increase in IL-10 and IL-1ra (p < 0.05), independently of Foxp3. AT reversed airway inflammation and remodelling and T-helper cell 2 response, and improved respiratory mechanics. These results seem to occur due to an increase in the expression of IL-10 and IL-1ra and a decrease of NF-kappa B.

An ex vivo comparison of root canal length determination by three electronic apex locators at positions short of the apical foramen

Objective. The aim of this study was to evaluate the precision of working length determination of 3 electronic apex locators (EALs): Root ZX, RomiApex D-30, and Ipex at 0.0 mm, at the apical foramen (AF), and at 1.0 mm short of the AF. Methodology. Thirty-eight mandibular premolars had their real lengths previously determined. Electronic measurements were determined at 1.0 mm, followed by measurements at 0.0 mm, performed in triplicate. Results. Precision of devices at 1.0 mm and 0.0 mm were: 94.7% and 97.4%, respectively (Root ZX); 78.9% and 97.4% (RomiApex D-30); and 76.3% and 97.4% (Ipex). Although no statistical differences were observed between the EALs at 0.0, at 1.0 mm Root ZX performed significantly better than the others. Conclusion. The EALs had acceptable precision when measuring the working length at the AF. However, when used at levels short of the AF, only Root ZX did not suffer a significant negative effect on precision. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110:e57-e61)