Treatment of atherosclerotic renovascular disease

Treatment of atherosclerotic renovascular disease is controversial and revascularization is not a beneficial approach to all patients. Conditions as progressive deterioration of renal function, refractory hypertension or accelerated cardiovascular disease, especially recurrent pulmonary edema, could profit from renal angioplasty with stent placement. Surgical revascularization is a good option for patients who will need concomitant surgical corrections of abdominal aortic lesions. Treatment of all other patients must be individualized. Medical therapy is indicated for all patients with atherosclerotic renovascular disease. Observational studies pointed out to the beneficial effect of controlling blood pressure (<130/80 mm Hg), glucose and lipids profile, lifestyle modifications, specific use of platelet antiaggregant therapy, Angiotensin Conversion Enzyme Inhibitors (ACEI) and statins. All others cardiovascular risk factors must be controlled. The evaluation and management of other systemic atherosclerotic vascular lesions is important, especially coronary, carotid and abdominal aortic. This paper presents a review of evidences to rationale the atherosclerotic renovascular disease treatment. © 2008 Bentham Science Publishers Ltd.

Ajuste oclusal na Ortodontia: Por que, quando e como?

Introduction: The knowledge of dental occlusion should be considered the basic foundation to an excellent orthodontic practice. The patient's diagnose without the centric relation assessment can take the orthodontist to an unpleasant surprises. The use of rectangular archwires requires occlusal contacts been checked to decide what kind of the dental movement will be necessary to achieve the dental equilibrium and mainly to investigate if the movement will be possible. Considering the occlusal surfaces complexity, the occlusal adjustment by selective grinding should be performed during the orthodontic treatment to allow vertical dental movements reducing treatment's time. Occlusal interferences are responsible not only for biomechanics adverse effects, producing undesirable dental movements, but also for potential side effects such as excessive forces (occlusal trauma), leading to roots reabsorption. The occlusal adjustment is a determinant point on dental balance after the end of orthodontics treatments, where each posterior occlusal tooth contacts A and B, or B and C on buccolingual aspect, as well as the stoppers and equalizers contacts on mesiodistal direction must be achieved and well established. The appropriate role of anterior teeth in mandibular movements must be determined, allowing immediate disclusion of posterior teeth, known as anterior guide, and promoting protecting muscle forces to the stomatognathic system. Selective grinding should not be used. in place of well planned and executed orthodontic movement. Aim: The aim of this article is to present the rationale use of occlusal adjustment in Orthodontics.

Systematic reviews showed insufficient evidence for clinical practice in 2004: What about in 2011? the next appeal for the evidence-based medicine age

Rationale and aim The aims of the Cochrane systematic reviews are to make readily available and up-to-date information for clinical practice, offering consistent evidence and straightforward recommendations. In 2004, we evaluated the conclusions from Cochrane systematic reviews of randomized controlled trials in terms of their recommendations for clinical practice and found that 47.83% of them had insufficient evidence for use in clinical practice. We proposed to reanalyze the reviews to evaluate whether this percentage had significantly decreased. Methods A cross-sectional study of systematic reviews published in the Cochrane Library (Issue 7, 2011) was conducted. We randomly selected reviews across all 52 Cochrane Collaborative Review Groups. Results We analyzed 1128 completed systematic reviews. Of these, 45.30% concluded that the interventions studied were likely to be beneficial, of which only 2.04% recommended no further research. In total, 45.04% of the reviews reported that the evidence did not support either benefit or harm, of which 0.8% did not recommend further studies and 44.24% recommended additional studies; the latter has decreased from our previous study with a difference of 3.59%. Conclusion Only a small number of the Cochrane collaboration's systematic reviews support clinical interventions with no need for additional research. A larger number of high-quality randomized clinical trials are necessary to change the 'insufficient evidence' scenario for clinical practice illustrated by the Cochrane database. It is recommended that we should produce higher-quality primary studies in active collaboration and consultation with global scholars and societies so that this can represent a major component of methodological advance in this context. © 2012 John Wiley & Sons Ltd.

The igapó of the Negro River in central Amazonia: Linking late-successional inundation forest with fluvial geomorphology

Despite important progress on Amazonian floodplain research, the flooded forest of the Negro River igapó has been little investigated. In particular, no study has previously focused the linkage between fluvial geomorphology and the floristic variation across the course of the river. In this paper we describe and interpret relations between igapó forest, fluvial geomorphology and the spatial evolution of the igapó forest through the Holocene. Therefore, we investigate the effect of geomorphological units of the floodplain and channel patterns on tree diversity, composition and structural parameters of the late-successional igapó forest. Our results show that sites sharing almost identical flooding regime, exhibit variable tree assemblages, species richness and structural parameters such as basal area, tree density and tree heights, indicating a trend in which the geomorphologic styles seem to partially control the organization of igapó's tree communities. This can be also explained by the high variability of well-developed geomorphologic units in short distances and concentrated in small areas. In this dynamic the inputs from the species pool of tributary rivers play a crucial role, but also the depositional and erosional processes associated with the evolution of the floodplain during the Holocene may control floristic and structural components of the igapó forests. These results suggest that a comprehensive approach integrating floristic and geomorphologic methods is needed to understand the distribution of the complex vegetation patterns in complex floodplains such as the igapó of the Negro River. This combination of approaches may introduce a better comprehension of the temporal and spatial evolutionary analysis and a logic rationale to understand the vegetation distribution and variability in function of major landforms, soil distributions and hydrology. Thus, by integrating the past into macroecological analyses will sharpen our understanding of the underlying forces for contemporary floristic patterns along the inundation forests of the Negro River. © 2013 Elsevier Ltd.

Mild cognitive impairment (part 2): Biological markers for diagnosis and prediction of dementia in Alzheimer's disease

To present a critical review of publications reporting on the rationale and clinical implications of the use of biomarkers for the early diagnosis of Alzheimer's disease (AD). Methods: We conducted a systematic search of the PubMed and Web of Science electronic databases, limited to articles published in English between 1999 and 2012, and based on the following terms: mild cognitive impairment, Alzheimer's disease OR dementia, biomarkers. We retrieved 1,130 articles, of which 175 were reviews. Overall, 955 original articles were eligible. Results: The following points were considered relevant for the present review: a) rationale for biomarkers research in AD and mild cognitive impairment (MCI); b) usefulness of distinct biomarkers for the diagnosis and prediction of AD; c) the role of multimodality biomarkers for the diagnosis and prediction of AD; d) the role of biomarkers in clinical trials of patients with AD and MCI; and e) current limitations to the widespread use of biomarkers in research and clinical settings. Conclusion: Different biomarkers are useful for the early diagnosis and prediction of AD in at-risk subjects. Nonetheless, important methodological limitations need to be overcome for widespread use of biomarkers in research and clinical settings. © 2013 Associação Brasileira de Psiquiatria.

Desenvolvimento de critério objetivo para a sinalização da ingestão alimentar deficiente de paciente hospitalizado

Pós-graduação em Alimentos e Nutrição - FCFAR

Saúde, meio ambiente e complexidade

Pós-graduação em Serviço Social - FCHS

Democracia, participação e representação - os espaços deliberativos no Brasil: a experiência do Conselho Municipal de Saúde de Araraquara (2001-2007)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Proposta de método para avaliação do sistema de gestão da qualidade, meio ambiente, segurança e saúde ocupacional integrados

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação da proficiência oral em inglês como língua estrangeira: foco na competência lexical e uma proposta para o processo de validação do descritor vocabulário de um teste de proficiência para professores de língua inglesa

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

A psiquiatrização da existência: dos manicômios à neuroquímica da subjetividade

Pós-graduação em Psicologia - FCLAS