Referral letters in oral medicine: standard versus non-standard letters

Usually referral letters are the only means of communication between general practitioners and specialists in the health area. However, they are inadequate if important basic data are omitted. The aim of this study was to compare the content of standard and non-standard letters. A total of 1956 files from the Oral Medicine Service were consecutively evaluated (March 1996 to September 2000). Key items were considered for analysis and the results were stored in a database using the Epinfo 6.04 program. The X-2 test (a=0.05) was applied to the results. of the 1956 files examined, 34% (662) had a referral letter, 31% of them being standard letters and 69% non-standard letters. Most standard letters (87%) were from professionals of public health institutions. Most percent discrepancies between standard and non-standard letters were observed for patient address (14.90 vs 1.32%), patient age (54.81 vs 9.47%), chief complaint (32.21 vs 8.37%), fundamental lesion (29.33 vs 13.66%), and symptoms (27.81 vs 15.42%,,). Statistically significant differences were observed for patient age, professional referring the patient, chief complaint, and site of the lesion. The quality and quantity of the information differed significantly between the two types of letters. The standard letters were more complete and contained information commonly absent in the non-standard letters. We suggest the use of standard letters for improving the quality of communication among professionals.

DIAGNOSIS of REGIONAL CEREBRAL BLOOD FLOW ABNORMALITIES USING SPECT: AGREEMENT BETWEEN INDIVIDUALIZED STATISTICAL PARAMETRIC MAPS and VISUAL INSPECTION BY NUCLEAR MEDICINE PHYSICIANS WITH DIFFERENT LEVELS of EXPERTISE IN NUCLEAR NEUROLOGY

INTRODUCTION: Visual analysis is widely used to interpret regional cerebral blood flow (rCBF) SPECT images in clinical practice despite its limitations. Automated methods are employed to investigate between-group rCBF differences in research Studies but have rarely been explored in individual analyses.OBJECTIVES: To compare visual inspection by nuclear physicians with the automated statistical parametric mapping program using a SPECT dataset of patients with neurological disorders and normal control images.METHODS: Using statistical parametric mapping, 14 SPECT images from patients with various neurological disorders were compared individually with a databank of 32 normal images using a statistical threshold of p<0.05 (corrected for multiple comparisons at the level of individual voxels or clusters). Statistical parametric mapping results were compared with Visual analyses by a nuclear physician highly experienced in neurology (A) as well as a nuclear physician with a general background of experience (B) who independently classified images as normal or altered, and determined the location of changes and the severity.RESULTS: of the 32 images of the normal databank, 4 generated maps showing rCBF abnormalities (p<0.05, corrected). Among the 14 images from patients with neurological disorders, 13 showed rCBF alterations. Statistical parametric mapping and physician A completely agreed on 84.37% and 64.28% of cases from the normal databank and neurological disorders, respectively. The agreement between statistical parametric mapping and ratings of physician B were lower (71.18% and 35.71%, respectively).CONCLUSION: Statistical parametric mapping replicated the findings described by the more experienced nuclear physician. This finding suggests that automated methods for individually analyzing rCBF SPECT images may be a valuable resource to complement visual inspection in clinical practice.

Atividade antimicrobiana de extratos brutos de Petiveria alliacea L.

"Antimicrobial activity of crude extratcs of Petiveria alliacea L.". Petiveria alliacea L. (Phytolaccacea) is an herbaceous plant of great importance in traditional medicine. This species have been widely used in several applications such as antirheumatic, anticarcinogenic, anti-flu, antitussive, analgesic, insecticidal, acaricidal, as well as bactericide and fungicide. Currently, the pathogenic microorganisms are acquiring resistence against the traditional antibiotics, and the search for new herbal antimicrobial agents has been intensified. The objective of this study was to evaluate the antifungal and antibacterial activity of several leaf crude extracts of P. alliacea against several strains of bacterias and yeasts namely Bacilus subtilis, Pseudomonas aeruginosa, Escherichia coli, Streptococcus mutans, Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, Candida parapsilosis, Candida kefyr and Candida albicans, using microdilution method. Promising results were observed for the 70% v/v ethanolic extract which presented minimum inhibitory concentration (MIC) from 250 to 760 mu g/mL for yeast. For the bacteria strains tested the MIC ranged between 240 to 3960 mu g/mL, depending of the extractive solution tested.

In vitro Anthelmintic effect of Melia azedarach L. and Triclinia claussenii C. against sheep gastrointestinal nematodes

The control of parasitic diseases in small ruminants is mainly done with the use of synthetic anthelmintics. However, incorrect and indiscriminate use of these products has caused the emergence of parasite resistance. Plants with anthelmintic activity are used in folk veterinary medicine, but it is necessary to investigate and scientifically validate low-cost phytotherapeutic alternatives for future use to control gastrointestinal nematodes in small ruminants by family farmers. Thus, the aim of this study was to evaluate the in vitro anthelmintic effect of plant extracts from Melia azedarach and Trichilia claussenii by the egg hatch test (EHT) and larval development test (LDT) against sheep gastrointestinal nematodes. The hexane extract of M. azedarach fruits was extracted through cold percolation and the methanol extract of T. claussenii leaves was obtained by extraction at room temperature in solvents in order of increasing polarity. The efficacy results were analyzed using the Probit program of SAS. The M. azedarach extract showed a LC50 of 572.2 mu g/mL and LC99 of 1137.8 mu g/mL in the EHT, and LC50 of 0.7 mu g/mL and LC99 of 60.81 mu g/mL in the LDT. In turn, the T. claussenii extract presented a LC50 of 263.8 mu g/mL and LC99 of 522.5 mu g/mL in the EHTand LC50 of 1.11 mu g/mL and LC99 of 26.4 mu g/mL in the LDT. Comparing the extracts of the species from the Meliaceae family, T. claussenii showed greater anti-parasite potential in vitro than M. azedarach. However, studies on the isolated compounds, toxicity and administration forms to animals are also needed to validate low-cost alternative herbal remedies for use to control gastrointestinal nematodes by family farmers. (C) 2011 Elsevier B.V. All rights reserved.

Paracoccidioidomycosis: Survey and clinical aspects from the Department of Dermatology of the School of Medicine of Botucatu (Sao Paulo - Brazil)

Background - Paracoccidioidomycosis is the most frequent among the systemic mycoses in Brazil. Objective: To study the cases of paracoccidioidomycosis diagnosed from 1976 to 1996 at the Department of Dermatology of the School of Medicine of Botucatu. Methods - Descriptive study obtained from specific protocols comprising anamnesis, clinical- dermatological-laboratorial examination, treatment and follow-up of the patients. Results - Paracoccidioidomycosis was diagnosed in 1.04% of the dermatologic outpatients assisted from 1976 to 1996. In 315 cases, 89.8% were male, 61.9% were over forty and 53.7% were rural workers. The complaints were related more to oropharyngolaryngeal (53.6%) or cutaneous (23.8%) lesions or adenopathy (10.2%). Seventy patients had already been treated in other health services. The chronic multifocal clinical from was the most common: 80.6% of the cases, followed by the acute-subacute (juvenile type) 15.5%. The disease was pulmonary in 80.0%, oropharyngolaryngeal in 69.2% and cutaneous in 45.7%. Th treatment: Amphotericin B in 146 patients, Ketoconazole - 88, Itraconazole - 56, Sulfonamide derivatives - 146 and Terbinafine in 3. The lethality index resulting from the disease or its treatment was 2.0%. Conclusions - The high number of cases, showing the regional relevance of the disease and the high percentage of tegumentary complaints and the high number of relapsing are remarkable.

Antimicrobial activity of essential oils from plants used in Brazilian popular medicine

Essential oils from, Salvia officinalis L. (SO), Mentha sylvestris L. (MS), Casearia sylvestris Sw. (CS), Mentha piperita L. (MP), Ocimum micrantum Willd. (OM) and Mentha arvensis L. (MA), plants used in Brazilian popular medicine were extracted using method I, as described in the Brazilian Pharmacopoeia, in order to obtain the phytochemical profile and to evaluate their antimicrobial activity against the following microorganisms: Bacillus subtilis, Staphylococcus aureus, Micrococcus luteus, Escherichia coli, Serratia marcescens, Candida albicans and Aspergilus oryzae. Test was made by means of the disk-plaque diffusion test in liquid medium using 1% essential oil. In the disk-plaque diffusion test, all the essential oils exhibited activity against B. subtilis, but OM showed the greatest inhibition zone and was the only one to show activity against S. aureus. Samples of SO, MS, MP, OM and MA were active against M. luteus, E. coli and S. marcescens, while A. oryzae was sensitive to MS, MP, OM and MA. No sample, however, was active against C. albicans. In the liquid medium test, significant results were observed for OM and MA, which inhibited the growth of all microorganisms for 24 hours, and OM continued active against E. coli and A. oryzae until the last reading.

Brosimum gaudichaudii Trecul (Moraceae): Da planta ao medicamento

The chemical, biological, pharmacological and toxicological study of plants used in medical treatments by different societies around the world has been intensifying over the years, primarily in the search for new herbal, homeopathic or even allopathic medicines. Motivated by this interest, we are investigating some Brazilian plant species, among them a tree, Brosimum gaudichaudii Trecul (Moraceae), found in Brazil's savannah-like prairies and scrub-forest (cerrado) and mesophytic forest. Several extracts have been made and separated into fractions and some compounds have been isolated - principally coumarins - and their respective structures analyzed by spectrophotometric and other methods. By collaborating with researchers in other fields, we have been able to carry out various bioassays and even basic clinical tests, namely: determination of anti-helminthic, anti-microbial, photosensitizing, anticancer and mutagenic activities, toxicological and pathogenic studies, with the aim of discovering a genuinely Brazilian herbal or homeopathic medicine.

Students' preferred teaching techniques for biochemistry in biomedicine and medicine courses

The aim of this study was to investigate the students' preferred teaching techniques, such as traditional blackboard, power-point, or slide-projection, for biochemistry discipline in biomedicine and medicine courses from São Paulo State University, UNESP, Botucatu, São Paulo, Brazil. Preferences for specific topic and teaching techniques were determined from questionnaires on a Liquert scale from 1 to 5 (strongly disagree; disagree; neither agree, nor disagree; agree; strongly agree) distributed at the end of biochemistry discipline to 180 biomedical students (30 students/year) and 540 medical students (90 students/year), during the years 2000-2005. Despite of the different number of hours applied to the course topics for the two groups of students, the majority of undergraduates from biomedicine and medicine preferred metabolic topics. Although the perception of a medical student is expected to be different than that of a biomedical student, as the aims of the two programs are different, 92.4% of students from each course agreed or strongly agreed with the biochemistry topics, and 92.1% thought highly on this subject. The majority of students, a number of 139 undergraduates from biomedicine and 419 from medicine course, preferred traditional blackboard teaching than slide-projection, or power-point class. In conclusion, it is imperative that the health courses reflect on sophisticated technology and data presentation with high density of information in biochemistry discipline. The traditional classes with blackboard presentation were most favored by students from biomedicine and medicine courses. The use of students' preferred teaching techniques might turn biochemistry more easily understood for biomedical and medical students. © 2007 by The International Union of Biochemistry and Molecular Biology.

Ozone therapy in medicine and dentistry

Aim: The purpose of this review is to present the potential for the incorporation of ozone therapy into the practice of dentistry. Background: Ozone gas has a high oxidation potential and is 1.5 times greater than chloride when used as an antimicrobial agent against bacteria, viruses, fungi, and protozoa. It also has the capacity to stimulate blood circulation and the immune response. Such features justify the current interest in its application in medicine and dentistry and have been indicated for the treatment of 260 different pathologies. It can be used for the treatment of alveolitis as a replacement for antibiotic therapy, as a mouthwash for reducing the oral microflora, as well as the adherence of microorganisms to tooth surfaces. Ozone has been shown to stimulate remineralization of recent caries-affected teeth after a period of about six to eight weeks. Conclusion: The future of ozone therapy must focus on the establishment of safe and well-defined parameters in accordance with randomized, controlled trials to determine the precise indications and guidelines in order to treat various medical and dental pathologies. Scientific support, as suggested by demonstrated studies, for ozone therapy presents a potential for an atraumatic, biologically-based treatment for conditions encountered in dental practice.

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.

Annona sp: Plants with multiple applications as alternative medicine - a review

Annona species have been used as a natural remedy for a variety of illnesses with antiparasitic, antispasmodic, antidiarrheal, antiulcer, sedative, analgesic, hypotensive, and vermifugal effects. These properties are due to the presence of a number of bioactive compounds on the leaves, fruit, seeds, and stem. The aim of this review is to show the main species of Annona, their medicinal properties and the chemical constituents that may be related to these effects. In the leaves it is possible to find acetogenins, annopentocins A, B, and C, cis- and trans-annomuricin-D-ones, goniothalamicin, arianacin, and javoricin, related to anticancer properties. Quercetin-3-O-glucoside, also found in the leaves mediates antidiabetic and antioxidative effects. In the fruit are found annonaine, nornuciferine and asimilobine, associated to antidepressive effects. In the seeds are found muricatetrocin A and muricatetrocin B, longifolicin, corossolin, corossolone, uvarigrandin A, bullatacin, squamotatin. These acetogenins are associated with anticancer effects. Cyclosquamosin B, quercetin, and cyclosquamosin from the seeds have respectively vasorelaxant, antithyroidal and, antiinflammatory activity. In the stem parts there are several components as N-trans-feruloyltyramine, N-p-coumaroyltyramine, and N-trans-caffeoyltyramine, lignans, syringaresinol, syringaldehyde, beta-sitosterol and beta-sitosterol-beta-D-glucoside which exhibit antiplatelet aggregation activity. Copaene, patchoulane, 1H-cycloprop (e) azulene and kaur-16-en-19-oic acid found in the barks exhibit significant central as well as peripheral analgesic and antiinflammatory activities. The properties of the biological compounds in Annona species support information that may provide validation for its medicinal uses, but further studies should be performed to establish ideal and safe doses of consumption to ensure the effectiveness of the benefits. © 2012 Bentham Science Publishers.

Characterization of flavonoids and phenolic acids in Myrcia bella cambess. Using FIA-ESI-IT-MSn and HPLC-PAD-ESI-IT-MS combined with NMR

The leaves of Myrcia DC. ex Guill species are used in traditional medicine and are also exploited commercially as herbal drugs for the treatment of diabetes mellitus. The present work aimed to assess the qualitative and quantitative profiles of M. bella hydroalcoholic extract, due to these uses, since the existing legislation in Brazil determines that a standard method must be developed in order to be used for quality control of raw plant materials. The current study identified eleven known flavonoid-O-glycosides and six acylated flavonoid derivatives of myricetin and quercetin, together with two kaempferol glycosides and phenolic acids such as caffeic acid, ethil galate, gallic acid and quinic acid. In total, 24 constituents were characterized, by means of extensive preparative chromatographic analyses, along with MS and NMR techniques. An HPLC-PAD-ESI-ITMS and FIA-ESI-IT-MSn method were developed for rapid identification of acylated flavonoids, flavonoid-O- glycosides derivatives of myricetin and quercetin and phenolic acids in the hydroalcoholic M. bella leaves extract. The FIA-ESI-IT-MS techinique is a powerful tool for direct and rapid identification of the constituents after isolation and NMR characterization. Thus, it could be used as an initial method for identification of authentic samples concerning quality control of Myrcia spp extracts. © 2013 by the authors.

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.

Avaliação in vitro dos possíveis efeitos citotóxicos e genotóxicos do alcalóide julocrotina em linfócitos humanos

A leishmaniose é considerada um problema de saúde pública, principalmente devido à presença de diferentes espécies enzoóticas de Leishmania, envolvendo muitos hospedeiros e diferentes insetos vetores. Os antimoniais pentavalentes permanecem como as drogas de primeira escolha para o tratamento das leishmanioses há mais de 50 anos, no entanto, sua utilização vem sendo comprometida devido, principalmente, a resistência desenvolvida pelo parasita ao medicamento. Assim, a escolha de drogas derivadas de plantas baseada no estudo e utilização de práticas da medicina tradicional devem aparecer como nova estratégia para o controle da leishmaniose. No entanto, é importante verificar que algumas destas drogas podem ser tóxicas ao organismo, podendo inclusive apresentar propriedades genotóxicas, causando alterações no DNA com conseqüente aumento no risco de carcinogênese. A Julocrotina (2-[N-(2-methylbutanolyl)]- N-phenylethylglutarimide) é um alcalóide glutarimida isolado da espécie Croton pullei var. glabrior Lanj. Euphorbiaceae), encontrada amplamente na Floresta Amazônica e conhecido por possuir potente efeito leishmanicida. Desta forma, no presente estudo avaliamos o efeito citotóxico e genotóxico da Julocrotinaa partir do Ensaio do MTT e Ensaio do Cometa (versão alcalina) em cultura de linfócitos humanos. Como resultado, o alcalóide não demonstrou citotoxicidade em linfócitos humanos nas concentrações testadas. No entanto, a julocrotina mostrou-se genotóxica para linfócitos humanos tratados com a maior concentração (632μM) da substância. Apesar dos resultados de citotoxicidade parecem promissores no que diz respeito ao uso da julocrotina no tratamento da leishmaniose, o efeito genotóxico observado reforça a necessidade de se obter as devidas precauções quanto ao seu uso como fitoterápico leishmanicida.