Aplicação da geologia de engenharia na redução de risco geológico urbano em Itapecerica da Serra - SP: estudo de caso

O município de Itapecerica da Serra, Região Metropolitana de São Paulo (RMSP), possui uma população de 162 mil habitantes e cerca de 150 km² de área. As características geológicas e geomorfológicas do seu território e o fato de localizar-se quase inteiramente em área de proteção aos mananciais que abastecem a RMSP implicam restrições ao uso do solo e à expansão da ocupação nos moldes em que vem ocorrendo. O diagnóstico das áreas de risco geológico do município foi uma das atividades implementadas para a execução do Plano Municipal de Redução de Riscos (PMRR) do município. O PMRR tem por objetivo apresentar os resultados da identificação e da análise das situações de risco geológico-geotécnico, criando propostas de intervenções estruturais para a sua eliminação e/ou redução, estimativas de custo e estratégias para a gestão de risco no município. O mapeamento do risco geológico foi realizado em 35 áreas, onde foram identificados 66 setores de risco englobando, 419 moradias, sendo 175 moradias em setores cujo grau de risco foi classificado como alto ou muito alto. As propostas de intervenção estrutural buscaram a aderência entre o processo geodinâmico atuante e a tipologia de intervenção sugerida para estabilização e controle. A definição de critérios para a hierarquização das intervenções propostas contribuiu para a inserção das propostas do PMRR no planejamento plurianual do município de Itapecerica da Serra.

O uso do pneumoperitônio progressivo no pré-operatório das hérnias volumosas da parede abdominal

Context - Correction of voluminous hernias and large abdominal wall defects is a big challenge in surgical practice due to technical difficulties and the high incidence of respiratory and cardiovascular complications. Objectives - To present the authors experience with inducing progressive pneumoperitoneum preoperative to surgical treatment of voluminous hernias of the abdominal wall. Methods - Retrospective study of six patients who presented voluminous hernias of the abdominal wall and were operated after installation of a pneumoperitoneum. The procedure was performed by placing a catheter in the abdominal cavity at the level of the left hypochondrium with ambient air insufflation for 10 to 15 days. Results - Four of the six patients were female and two male. Ages ranged from 42 to 62 years. Hernia duration varied from 5 to 40 years. Four patients had incisional, one umbilical, and one inguinal hernias. Mean pneumoperitoneum time was 11.6 days. There were no complications related to pneumoperitoneum installation and maintenance. All hernias were corrected without technical difficulties. The Lichtenstein technique was used to correct the inguinal hernia, peritoneal aponeurotic transposition for one of the incisional hernias, with the rest corrected using polypropylene mesh. One death and one wall infection were observed post operatively. No recurrences were reported until now, in 4 to 36 months of follow-up. Conclusion - Preoperative progressive pneumoperitoneum is a safe and easy executed procedure, which simplifies surgery and reduces post-operative respiratory and cardiovascular complications. It is indicated for patients with hernias that have lost the right of domain in the abdominal cavity.

Highlights from the I international symposium of thrombosis and anticoagulation in internal medicine, October 23-25, 2008, Sao Paulo, Brazil

The importance of thrombosis and anticoagulation in clinical practice is rooted firmly in several fundamental constructs that can be applied both broadly and globally. Awareness and the appropriate use of anticoagulant therapy remain the keys to prevention and treatment. However, to assure maximal efficacy and safety, the clinician must, according to the available evidence, choose the right drug, at the right dose, for the right patient, under the right indication, and for the right duration of time. The first International Symposium of Thrombosis and Anticoagulation in Internal Medicine was a scientific program developed by clinicians for clinicians. The primary objective of the meeting was to educate, motivate and inspire internists, cardiologists and hematologists by convening national and international visionaries, thought-leaders and dedicated clinician-scientists in Sao Paulo, Brazil. This article is a focused summary of the symposium proceedings. © Springer Science+Business Media, LLC 2009.

Significância clínica de tromboembolismo venoso recorrente

Recurrent venous thromboembolism is a significant problem leading to increased morbidity and mortality. It has a high impact on patients' quality of life and imposes a great financial burden on society. Cumulative recurrence has been reported as 40% at 10 years, while the chance of developing postthrombotic signs and symptoms in the lower extremities almost quadruples when ipsilateral. There is also a higher chance of developing pulmonary hypertension. Important factors for recurrence are unprovoked episodes of deep vein thrombosis, malignancy and older age. The evidence for other factors is controversial. Accurate diagnosis and treatment tailored to the patients' history, thrombotic events and risk factors are necessary to optimize management and prevent recurrence.

Systematic review of randomized controlled trials of new anticoagulants for venous thromboembolism prophylaxis in major orthopedic surgeries, compared with enoxaparin

Background: In the past 10 years, new anticoagulants (NACs) have been studied for venous thromboembolism (VTE) prophylaxis. Objective: To evaluate the risk/benefit profile of NACs versus enoxaparin for VTE prophylaxis in major orthopedic surgery. Methods: A systematic review of double-blind randomized phase III studies was performed. The search strategy was run from 2000 to 2011 in the main medical electronic databases in any language. Independent extraction of articles was performed by 2 authors using predefined data fields, including study quality indicators. Results: Fifteen published clinical trials evaluating fondaparinux, rivaroxaban, dabigatran, and apixaban were included. Primary efficacy (any deep vein thrombosis [DVT], nonfatal pulmonary embolism, or all-cause mortality) favored fondaparinux (relative risk [RR] 0.50; 95% CI, 0.39, 0.63) and rivaroxaban (RR, 0.50; 95% CI, 0.34, 0.73) over enoxaparin, although significant heterogeneity was observed in both series. The primary efficacy of dabigatran at 220 mg, apixaban, and bemiparin were similar, with RRs of 1.02 (95% CI, 0.86, 1.20), 0.63 (95% CI, 0.39, 1.01), and 0.87 (95% CI, 0.65, 1.17), respectively. The primary efficacy of dabigatran at 150 mg (RR, 1.20; 95% CI, 1.03, 1.41), was inferior to enoxaparin. The incidence of proximal DVT favored apixaban (RR, 0.45; 95% CI, 0.27, 0.75) only. Rivaroxaban (RR, 0.45; 95% CI, 0.27, 0,77) and apixaban (RR, 0.38; 95% CI, 0.16, 0.90) produced significantly lower frequencies of symptomatic DVT. The incidence of major VTE favored rivaroxaban (RR, 0.44; 95% CI, 0.25, 0.81), only. Bleeding risk was similar for all NACs, except fondaparinux (RR, 1.27; 95% CI, 1.04, 1.55), which exhibited a significantly higher any-bleeding risk compared with enoxaparin, and apixaban (RR, 0.88; 95% CI, 0.79, 0.99), which was associated with a reduced risk of any bleeding. Alanine amino transferase was significantly lower with 220 mg of dabigatran, (RR, 0.67; 95% CI, 0.79, 0.99) than with enoxaparin. Conclusions: NACs can be considered alternatives to conventional thromboprophylaxis regimens in patients undergoing elective major orthopedic surgery, depending on clinical characteristics and cost-effectiveness. The knowledge of some differences concerning efficacy or safety profile, pointed out in this systematic review, along with the respective limitations, may be useful in clinical practice. © 2013 Elsevier Inc. All rights reserved.

Intervenções educativas com usuários de medicamentos como estratégias terapêuticas

A review and analysis of the literature on educative interventions (EI) for medicine users was carried out. For this purpose, databases were searched by employing descriptors related to pharmaceutical care, education and health, covering the period from 1997 to early 2011. A set of 21 articles related to EI with medicine users were selected, 18 (85.7%) of which referred to studies on basic health care. The EI most commonly reported in the articles were: talks, group discussions and educative material. The positive outcomes reported were: improvement in quality of life (better acceptance of the disease), economic advantages (reduction in number of medical consultations) and clinical improvement (risk reduction, prevention of complications).

Low Concentration H2O2/TiO_N in Office Bleaching: A Randomized Clinical Trial

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

CHARACTERIZATION OF THE BRAZPD II COHORT AND DESCRIPTION OF TRENDS IN PERITONEAL DIALYSIS OUTCOME ACROSS TIME PERIODS

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Juventude, drogas e biopolítica

In this article, we tackle the issue of youth and drugs as something linked to biopower and biopolitics, both concepts developed by Michael Foucault. Youth and drugs are taken and analyzed in situations involving the management of crime linked to the risks and deviations from the law, abuse and dependence. The youth; irreverent, courageous, healthy, idealistic, and that wanted to change the world for the better as we have seen in the past, is now strongly related to violence, dangerous activities, moral and social risks, drug addiction, criminality, and others negative images. To deal with these young people, tolerance and small punishments of yore are not enough anymore. The young people emerge as a segment of the population subject to various actions and programs. The drugs now are seen as matters of security and public health. There is a shifting and repositioning in the discourse about the young - from minor, drugged, and criminal to lawbreaker, user and drug addict. The change is subtle, but represents a modulation in the devices of social control. Beyond the consent of the young to get rid of drugs, there is a search for the creation of a wide area of monitoring of their behavior through the activation of community protection networks. The belief that the young are more impressionable and vulnerable, and that action on the cause of the problem or risk reduction are the most efficient ways of management, taking responsibility away from personal and family sphere and transferring it to the State, contributes to the increasing control of young people nowadays.

A Meta-Analysis of Predation Risk Effects on Pollinator Behaviour

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)