Caracterização da demanda do pronto socorro do Hospital das Clínicas da Faculdade de Medicina de Botucatu - UNESP

The demand for health services can be understood as an application needs the user has. The inability to use the outpatient services and limited supply of these make it possible for users to browse sites that focus attention on a greater possibility of entry doors, in which first-aid centers and hospital emergency match this profile, distorting the flow of patients in the network through an inverse demand of the movement hierarchy. Added to this, the burden of care in these services results in overcrowding and poor quality of care. Evaluate the demand of the visits occurred in the Emergency Room of the Hospital of the Medical School of Botucatu / UNESP (PS - HC - FMB / UNESP) during June-July 2010. A transversal, descriptive and retrospective. For data collection sheet was used in the proposed Service unit and the data it was filled out the form with the necessary items for the search. Made an exploratory analysis and frequency distributions for categorical variables of the form. Females predominated (56%) and aged 61 years or older with 30%. 96.5% were owned by DRS VI, and 62.5% of Botucatu. The attendance by the physician on duty and corresponded to 57.7% among the 23 medical specialties, Gastric (7.0%), Cardiology (4.5%), Medical (4.4%), urology (4.2%) and Pulmonology (4.1%) were the ones that stood out. The medical procedures performed that stood out were X-ray (46.4%) and electrocardiogram (ECG) (42.3%) and in most specialty care occurred, only the daily consultation with the patient. It was possible to characterize, so the demand for PS - HC - FMB / UNESP for the period June- July 2010, The predominance of the elderly shows that come along with aging diseases and addictions, causing a greater need for health services. Moreover, this study showed that the high number of visits is related to both the daily demands that the tertiary hospital has the same transformation... (Complete abstract click electronic access below)

Achados clínicos, hemodinâmicos e hemogasométricos da infusão contínua de propofol associado ou não ao tramadol em ovelhas submetidas à videolaparoscopia

Pós-graduação em Cirurgia Veterinária - FCAV

Interação entre odontologia restauradora e periodontia - parte 1: planejamento e protocolo cirúrgico

Current dental treatments search for alternatives to achieve restablishment of esthetics and function. The increased demand for high esthetic patterns stimulates an interaction between the dental specialties towards a comprehensive treatment in order to solve slinical cases effectively. Knowing the components involved in the dental smile harmony is essential for treatment planning and implementation. It is also important to be aware of the changes that may impair suck harmony and become a patient's complaint. This article addresses a multidisciplinary treatment that involved the integration between Periodontics and Restorative Dentistry. After the surgical-restorative planning, periodontal procedures were performed to obtain an adequate balance between the teeth and soft tiessues.

Associação de prótese fixa, implantes e estética periodontal para reabilitação de pacientes parcialmente edêntulos

Periodontitis is a chronic inflammatory disease that results in the destruction of teeth and their supporting tissues with subsequent tooth loss. The replacement of missing teeth for implant-supported restorations has proven to be a highly predictable treatment method with good long-term prognosis. However, some consequences of tooth loss prevents dental implant placement in an ideal position, where regenerative procedures are necessary for this type of rehabilitation. Less invasive procedures such as conventional prosthesis emerge as a therapeutic option in cases where there is enough bone structure for implants and patient´s non-acceptance for invasive procedures. Thus, this paper aims to present the resolution of rehabilitation through a noninvasive and multidisciplinary treatment. One female patient referred to the clinic presented maladaptive bilateral mandibular fixed prostheses, endodontic lesions, gingival recession, and root sensitivity. For proper resolution of this case, an association among osseointegrated implants, fixed partial prosthesis, tooth extraction, and aesthetic periodontal procedures with the use of subepithelial connective tissue graft was proposed. After two years, the patient shows excellent aesthetics and chewing. Within the limits of this scenario, this paper discusses the various factors that may affect the choice of a particular treatment modality for the rehabilitation of edentulous single spaces.

Cell therapy in experimental model of inflammatory bowel disease

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Survival rate of osseointegrated implants in atrophic maxillae grafted with calvarial bone: a retrospective study

The aim of this study was to evaluate the clinical survival rate of osseointegrated implants placed in the atrophic maxilla that has been reconstructed by means of autogenous bone grafts harvested from a cranial calvarial site. Further, we sought to analyse the level of pen-implant bone after prosthetic rehabilitation and to determine subjective patient satisfaction with the treatment performed. This study conformed to the STROBE guidelines regarding retrospective studies. Twenty-five patients who had received osseointegrated implants with late loading in the reconstructed atrophic maxilla were included in the study. The survival rate and level of pen-implant bone loss were evaluated. A questionnaire related to the surgical and prosthetic procedures was completed. The observed implant survival rate was 92.35%. The mean bone loss recorded was 1.76 mm in the maxilla and 1.54 mm in the mandible. The results of the questionnaire indicated a high level of patient satisfaction, little surgical discomfort, and that the patients would recommend the procedure and would undergo the treatment again. From the results obtained, it is concluded that the cranial calvarial site is an excellent donor area; calvarial grafts provided stability and maintenance of bone volume over the course of up to 11 years.

Pathotypes and probiotics: response to a commentary on the detection of a Shiga toxin producing Escherichia coli in a Crohn’s disease patient

A recent report on the detection in a Crohn's disease (CD) patient of an adherent and invasive Shiga toxin producing Escherichia coli (STEC) (Gut pathogens 2015, 7:2) prompted a commentary expressing some skepticism on the significance of the paper findings (Gut pathogens 2015, 7:15). Besides focusing on recurrent issues concerning the difficulties in defining a pathogen, the opinion considers recent data demonstrating the presence of virulence factors in a commercial probiotic. In response to the commentary's observations, additional information on the described STEC strain, as well as a short discussion on CD associated E. coli are presented here.

How the fluctuations of water levels affect populations of invasive bivalve Corbicula fluminea (Muller, 1774) in a Neotropical reservoir?

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Protein-energy malnutrition as a consequence of the hospitalization of gastroenterologic patients

The effects of the clinical and dietetics in patient managements on the protein-energy status of hospitalized patients were retrospectively (four yr) investigated in 243 adult (49 +/- 16 yr), male (168) and female (75) patients suffering from chronic liver diseases (42%), intestinal diseases with diarrhea (14%), digestive cancers (11%), chronic pancreatitis (10%), stomach and duodenum diseases (7%), acute pancreatitis (7%), primary protein-energy malnutrition (3%), esophagus diseases (3%), intestinal diseases with constipation 14 (2%) and chronic alcoholism (2%). The protein-energy nutritional status assessed by combinations of anthropometric and blood parameters showed 75% of protein energy malnutrition at the hospital entry mostly (4/5) in severe and moderate grades. The overall average of hospitalization was 20 +/- 15 days being the shortest (13 +/- 5,7 days) for esophagus diseases and the longest (28 +/- 21 days) for the intestinal diseases with diarrhea patients which also received mostly (42%) of the enteral and/or parenteral feedings followed by acute pacreatitis (41%) and digestive cancers (31%) patients. When compared to the entry the protein-energy malnutrition rate at the discharge decreased only 5% despite the increasing of 30% found on the protein-energy intake. The main improvement of the protein-energy nutritional status were attained to those patients showing protein-energy malnutrition milder degrees at the entry which belonged mostly to primary protein-energy malnutrition, acute pancreatitis and intestinal diseases with diarrhea diseases. The later two groups showed protein-energy nutritional status improvement only after the second week of hospitalization. The digestive cancers patients had their protein-energy nutritional status worsened throughout the hospitalization whereas it happened only in the first week for the intestinal diseases with diarrhea and chronic liver diseases patients, improving thereafter up to the discharge. The protein-energy nutritional status improvement found in few patients could be attributed to some complementary factors such as theirs mild degree of protein-energy malnutrition at entry and/or non-invasive propedeutics and/or enteral-parenteral feddings and/or longer hospitalization staying. The institutional causes for the unexpected lack of nutritional responses by the patients were probably the high demand for the few available beds which favour the hospitalization of the most severed patients and the university-teaching pressure for the high rotation of the available beds. Both often resulting in early discharging. In persisting the current physical area and attendance demand one could suggest an aggressive support early at the entry preceding and/or accompanying the more invasive propedeutical procedures.

A new heterologous fibrin sealant as a scaffold to cartilage repair - experimental study and preliminary results

Autologous fibrin gel is commonly used as a scaffold for filling defects in articular cartilage. This biomaterial can also be used as a sealant to control small hemorrhages and is especially helpful in situations where tissue reparation capacity is limited. In particular, fibrin can act as a scaffold for various cell types because it can accommodate cell migration, differentiation, and proliferation. Despite knowledge of the advantages of this biomaterial and mastery of the techniques required for its application, the durability of several types of sealant at the site of injury remains questionable. Due to the importance of such data for evaluating the quality and efficiency of fibrin gel formulations on its use as a scaffold, this study sought to analyze the heterologous fibrin sealant developed from the venom of Crotalus durissus terrificus using studies in ovine experimental models. The fibrin gel developed from the venom of this snake was shown to act as a safe, stable, and durable scaffold for up to seven days, without causing adverse side effects. Fibrin gel produced from the venom of the Crotalus durissus terrificus snake possesses many clinical and surgical uses. It presents the potential to be used as a biomaterial to help repair skin lesions or control bleeding, and it may also be used as a scaffold when applied together with various cell types. The intralesional use of the fibrin gel from the venom of this snake may improve surgical and clinical treatments in addition to being inexpensive and adequately consistent, durable, and stable. The new heterologous fibrin sealant is a scaffold candidate to cartilage repair in this study.

Tratamento cirúrgico comparado ao tratamento clínico na miastenia gravis: revisão sistemática e matanálise

Pós-graduação em Bases Gerais da Cirurgia - FMB

Reconstrução imediata de fenestração peri-implantar com enxerto autógeno em bloco de ramo mandibular

Alveolar wall fenestrations are common during implant placement. The aim of this paper is to report a case where a peri-implant bone fenestration was reconstructed immediately after implant placement by an autogenous mandibular bone block. A male patient was referred to the Department of Surgical and Integrated Clinics to substitute his Kennedy´s Class IV removable partial denture for an implantsupported fixed prosthesis. A peri-implant bone fenestration at the buccal wall was seen at the region of 12, being reconstructed by a mandibular bone block secured by a bicortical screw. Six months later the surgical procedures, an implant-supported complete fixed partial prosthesis was developed. The autogenous bone block harvested from the mandibular ramus was a safe alternative to reconstruct the peri-implant bone defect such as fenestration types.

Técnicas de confecção de prótese total imediata mucossuportada

The immediate complete denture is a prostheses made prior to teeth extraction, that aims to re-establish the patient aesthetics and function immediately after the removal of the remaining teeth. The objective of this paper is to report the technical procedures during the manufacture of immediate prosthesis. The study reports the clinical steps prior to teeth extraction as well as the surgical and maintenance procedures. The immediate complete denture is a viable rehabilitation method, especially to restore patients’ self-esteem, aesthetics and function promptly. An accurate planning and manufactory beholds better results

Binômio mãe-filho: estudo epidemiológico e de base populacional desenvolvido em maternidades de baixo e alto risco

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

P-233-Biodiversity of mucosa associated microbiome of Crohn's disease patients living in middle western São Paulo State, Brazil

Background: The intestinal microbiome (IM) has extensively been studied in the search for a link of bacteria with the cause of Crohn`s disease (CD). The association might result from the action of a specific pathogen and/or an eventual imbalance in bacterial species composition of the gut. The innumerous virulence associated markers and strategies described for adherent and invasive Escherichia coli (AIEC) have made them putative candidate pathogens for CD. IM of CD patients shows dysbiosis, manifested by the proliferation of bacterial groups such as Enterobacteriaceae and reduction of others such as Lactobacillus and Bifidobacterium. The augmented bacterial population comprising of commensal and/or pathogenic organisms super stimulates the immune system, triggering the inflammatory reactions responsible for the clinical manifestations of the disease. Considering the role played by IM in CD and the multiple variables influencing its species composition, resulting in differences among populations, the objective of this study was to determine the bacterial biodiversity in the mucosa associated microbiome of CD patients from a population not previously subject to this analysis, living in the middle west region of Sao Paulo state. Methods: A total of 4 CD patients and 5 controls subjects attending the Botucatu Medical School of the Sao Paulo State University (UNESP) for routine colonoscopy and who signed an informed consent were included in the study. A number of 2 biopsies, one from the ileum and other from any part of the terminal colon, were taken from each subject and immediately frozen at -70[degrees]C until DNA purification. The bacterial biodiversity was assessed by next generation (ion torrent) sequencing of PCR amplicons of the ribosomal DNA 16S V6 region (16S V6 rDNA). The bacterial identification was performed at the genus level, by alignment of the generated DNA sequences with those available at the ribosomal database project (RDP) website. Results: The overall DNA sequence output was based on an average number of 526,427 reads per run, matching 50 bacterial genus 16SrDNA sequences available at the RDB website, and 22 non matching sequences. Over 95% of the sequences corresponded to taxa belonging to the major phyla: Firmicutes, Bacterioidetes, Proteobacteria and Actinobacteria. Irrespective of the intestinal site analyzed, no case-control differences could be observed in the prevalence of Actinobacteria and Firmicutes. The prevalence of Proteobacteria was higher (40%) in the biopsies of control subjects as compared to that of DC patients (16%). For Bacterioidetes, the higher prevalence was observed among DC patients (33% as opposed to 14,5% in controls). The significance for all comparisons considered a p value < 0,05 in a Chi2 test. No mucosal site specific differences could be observed in IM comparisons of CD and control subjects. Conclusions: The rise in the number of Bacterioidetes observed here among CD patients seems to be in agreement with most of studies published thus far. Yet, the reduction in the number of Proteobacteria along with an apparently unaltered population of Actinobacteria and Firmicutes, which include the so called "beneficial" organisms Bifidobacterium and Lactobacillus were rather surprising. These data suggest that the analyses on the role of IM in CD should consider the multiple variables that may influence its species composition.