Adequacy of venous thromboembolism risk stratification and prophylaxis in a tertiary university hospital.

Background: Venous thromboembolism is the third most common cardiovascular disease and the main cause of preventable death in hospitalized patients. Prophylaxis is still underused, despite well-established guidelines in the literature. Studies show a worldwide prophylaxis adequacy rate close to 50%. Objectives: To assess the adequacy of risk stratification and prophylactic measures for venous thromboembolism in a tertiary university hospital. Methods: A cross-sectional observational study was carried out, collecting data from medical records. Adult patients hospitalized by different specialties were enrolled and divided into surgical and clinical groups. The risk stratification of venous thromboembolism performed by the attending physicians was compared with stratification based on recent guidelines performed by the research physicians. Prophylaxis measures prescribed by the attending physicians were compared with guideline recommendations, thus obtaining the prophylaxis adequacy rate. Results: 400 patients were analyzed, 169 (42.3%) surgical and 231 (57.7%) clinical. The overall stratification adequacy rate was 50.8%. Adequacy rates were 39.1% and 59.3% in the surgical and clinical groups respectively (P < 0.0001). The overall prophylaxis adequacy rate was 71.5%, with 78.1% in the surgical group and 66.7% in the clinical group (P=0.0137). Conclusions: Risk stratification adequacy is low, demonstrating a low awareness among prescribing physicians of the need for adequate stratification for prescription of prophylaxis. However, the prophylaxis prescription adequacy rates are higher than those in global data.

Coagulation disorders in patients with femoral head osteonecrosis.

OBJECTIVE: To compare the occurrence of thrombophilic disorders in patients with idiopathic osteonecrosis of the femoral head and patients with secondary osteonecrosis of the femoral head. METHODS: Twenty-four consecutive patients were enrolled, with eight of them presenting idiopathic osteonecrosis and 16 presenting secondary osteonecrosis. The tests for detection of thrombophilic disorders were measurements of protein C, protein S and antithrombin levels and detection of prothrombin and factor V gene mutations. We compared the results using the odds ratio statistics for the thrombophilic disorders between the two groups. RESULTS: The odds ratio for the protein S deficiency and protein C deficiency between the idiopathic and secondary groups were 5 and 2.14, respectively. Thus, an individual with idiopathic osteonecrosis has 5 times more chance of presenting protein S deficiency and 2.14 times more chance of presenting protein C deficiency than an individual with secondary osteonecrosis. CONCLUSION: Patients with idiopathic osteonecrosis have more chances of presenting thrombophilias than those with secondary osteonecrosis, suggesting these coagulation disorders can play an important role in the pathogenesis of the osteonecrosis in cases where there was no initial risk factor recognized. Level of Evidence III, Case-Control Study.

Progress in animal experimentation ethics: a case study from a Brazilian medical school and from the international medical literature.

PURPOSE: This study describes in Brazil and in the global biomedical community the time course of the development of animal research welfare guidelines. METHODS: The database of the Ethics Committee of the Faculty of Medicine of Ribeirao Preto (EC/FMRP-USP), Brazil, was surveyed since its inception in 2002 as the regulations became more stringent to provide better protection of animal research welfare at this institution. Medline database was evaluated to identify the number of publications in the period between 1968 and 2008 that used research animals and were in compliance with established ethics guidelines. RESULTS: The EC/FMRP-USP evaluated 979 projects up until 2009. Most of the applications came from Department of Physiology and the most frequently requested species was the rat. In 2004, national research funding agencies started to request prior approval from institutional review ethics committees prior to application review and this requirement became federal law in Brazil in 2008. The analysis of international publications revealed a relative reduction in studies involving research animals (18% in 1968 to 7.5% in 2008). CONCLUSIONS: The present work showed that in the last four decades major changes occurred in the guidelines dictating use of research animals occurred and they are being adopted by developing countries. Moreover, animal welfare concern in the scientific community preceded the introduction of journal guidelines for this purpose. Furthermore, in Brazil it was anticipated that laws were needed to protect animal research welfare from being not upheld.

Absence of arteriosclerosis in intramyocardial coronary arteries: a mystery to be solved?

Several studies show that portions of intramyocardial coronary arteries are spared of arteriosclerosis, involving morphological, embryological, biochemical and pathophysiological aspects. Endothelial function is significantly affected in the segment of transition, as estimated by the vasoactive response to Ach. These findings suggest that myocardial bridge can provide protection against arteriosclerosis by counteracting the negative effects of endothelial dysfunction. The intramyocardial portion's protection phenomenon deserves further scientific research on all research fronts. Improved morphological, biomechanical and especially physiological and embryological knowledge may be the key to a future window of opportunity for chronic arterial disease therapy and prevention. In addition, this review discusses possible therapeutic approaches for symptomatic coronary ischemia caused by myocardial bridges.

Espaço nasofaringeano: avaliação pela telerradiografia / Nasopharyngeal airway: Roentgencephalometric evaluation

A amídala faringeana, comumente conhecida como adenóide é uma estrutura de tecido linfóide, localizada na parede posterior na nasofaringe. A adenóide faz parte do anel linfático de Waldeyer que circunda a região posterior da cavidade bucal e nasal, representando a primeira linha de defesa do organismo durante os primeiros anos de vida até que outras estruturas, como o baço, o timo e a medula óssea, ligadas à formação e manutenção do sistema imunológico, se desenvolvam. Em seu desenvolvimento normal, a amídala faringeana exibe um aumento em massa do nascimento à puberdade e, após este período, sofre um processo de atrofia, provavelmente devido à ação dos hormônios sexuais. Dependendo do volume que adquire durante seu desenvolvimento a adenóide provoca diferentes graus de obstrução da via respiratória nasal superior podendo nos casos mais graves interferir no processo normal de crescimento e desenvolvimento dentofacial da criança. O objetivo deste trabalho é apresentar um método fácil e objetivo para a avaliação do espaço respiratório nasofaringeano, por meio da telerradiografia cefalométrica em norma lateral, de acordo com vários graus de hipertrofia da amídala faringeana ou adenóide

Comparison between cephalometrics measure using anatomic and metallicporion point

The aim of this study was to compare the cephalometric measures involving FMA (Frankfurt Mandibular Plane Angle), FMIA (Frankfurt Mandibular Incisor Angle), and occlusal plane angles (Frankfurt horizontal plane - occlusal plane) for cephalometric tracing by using anatomic and metallic porion points. Cephalometric tracingwas performed in thirty head lateral teleradiographs divided into two groups. The anatomic porion point was marked in group 1, whereas metallic porion point was marked regarding the Frankfurt horizontal Plane (FHP). All measures were analysed. The mean values for FMA(32.33o) and occlusal plane angles (10.77o) in group 2 were statistically higher than those found in group 1 (FMA - 27.57o); occlusal plane angle - 6.23o). The mean value for FMIA angle (62.73o) in group 1 was statistically higher when compared to group 2 (57,80°). According to these results, one can conclude that cephalometric tracing of porion points (either anatomic or metallic) alter the values for FMA, FMIA, and occlusal plane angles, thus resulting in different treatment plans

Comparison between cephalometrics measure using anatomic and metallicporion point%Comparação entre medidas cefalométricas usando ponto pório metálico e anatômico

The aim of this study was to compare the cephalometric measures involving FMA (Frankfurt Mandibular Plane Angle), FMIA (Frankfurt Mandibular Incisor Angle), and occlusal plane angles (Frankfurt horizontal plane - occlusal plane) for cephalometric tracing by using anatomic and metallic porion points. Cephalometric tracingwas performed in thirty head lateral teleradiographs divided into two groups. The anatomic porion point was marked in group 1, whereas metallic porion point was marked regarding the Frankfurt horizontal Plane (FHP). All measures were analysed. The mean values for FMA(32.33o) and occlusal plane angles (10.77o) in group 2 were statistically higher than those found in group 1 (FMA - 27.57o); occlusal plane angle - 6.23o). The mean value for FMIA angle (62.73o) in group 1 was statistically higher when compared to group 2 (57,80°). According to these results, one can conclude that cephalometric tracing of porion points (either anatomic or metallic) alter the values for FMA, FMIA, and occlusal plane angles, thus resulting in different treatment plans

Análise in vitro da resistência ao cisalhamento de braquetes metálicos colados em incisivos bovinos e humanos / Analysis in vitro of shear bond strength of brackets bonded on bovine and human incisors

O objetivo deste trabalho foi comparar a resistência ao cisalhamento de braquetes metálicos fixados em esmalte bovino e humano e observar o índice de remanescentes de adesivo(IRA). A amostra consistiu de 30 dentes divididos em três grupos, formados por incisivos inferiores permanentes humanos, incesivos inferiores permanentes bovinos e incisivos inferiores decíduos bovinos. Foi realizada profilaxia com pedra-pome e água, seguida de condicionamento do esmalte com ácido fosfórico a 37%, em todos os dentes. Foram colados braquedes metálicos com compósito Concise Ortodôntico de acordo com instruções do fabricante e os mesmos foram submetidos ao ensaio de cisalhamento com velocidade de 0,5 mm por minuto. O valor médio de resistência à colagem em incisivos inferiores humanos foi de X=12,96 MPa, em incisivos permanentes bovinos de x=15,05 MPa e em incisivos decíduo bovinos de x=17,03 MPa. Não foram encontradas diferenças estatísticas significantes entre os grupos, tanto nos valores de resistência ao cisalhamento quanto na avaliação do IRA

Extraçäo seriada, uma alternativa / Serial extraction, an alternative procedure

A extraçäo seriada é um procedimento ortodôntico que visa harmonizar a diferença entre o volume dos dentes e bases ósseas maxilares deficientes, por meio da extraçäo seqüencial de dentes decíduos e pré-molares. Apresenta resultados satisfatórios desde que sejam observados os princípios básicos de diagnóstico ao ser realizado o plano de tratamento. Será relatado um caso clínico na qual uma paciente com severa discrepância entre o tamanho dos dentes e maxilares foi submetida a uma seqüencia de extraçöes seriadas de dentes decíduos e primeiros pré-molares permanentes