University of São Paulo

About: University of São Paulo is a education organization based out in São Paulo, Brazil. It is known for research contribution in the topics: Population & Context (language use). The organization has 136513 authors who have published 272320 publications receiving 5127869 citations. The organization is also known as: USP & Universidade de São Paulo.

Evaluation and treatment of chagas disease in the United States : A systematic review

Abstract: ContextBecause of population migration from endemic areas and newly instituted blood bank screening, US clinicians are likely to see an increasing number of patients with suspected or confirmed chronic Trypanosoma cruzi infection (Chagas disease).ObjectiveTo examine the evidence base and provide practical recommendations for evaluation, counseling, and etiologic treatment of patients with chronic T cruzi infection.Evidence AcquisitionLiterature review conducted based on a systematic MEDLINE search for all available years through 2007; review of additional articles, reports, and book chapters; and input from experts in the field.Evidence SynthesisThe patient newly diagnosed with Chagas disease should undergo a medical history, physical examination, and resting 12-lead electrocardiogram (ECG) with a 30-second lead II rhythm strip. If this evaluation is normal, no further testing is indicated; history, physical examination, and ECG should be repeated annually. If findings suggest Chagas heart disease, a comprehensive cardiac evaluation, including 24-hour ambulatory ECG monitoring, echocardiography, and exercise testing, is recommended. If gastrointestinal tract symptoms are present, barium contrast studies should be performed. Antitrypanosomal treatment is recommended for all cases of acute and congenital Chagas disease, reactivated infection, and chronic T cruzi infection in individuals 18 years or younger. In adults aged 19 to 50 years without advanced heart disease, etiologic treatment may slow development and progression of cardiomyopathy and should generally be offered; treatment is considered optional for those older than 50 years. Individualized treatment decisions for adults should balance the potential benefit, prolonged course, and frequent adverse effects of the drugs. Strong consideration should be given to treatment of previously untreated patients with human immunodeficiency virus infection or those expecting to undergo organ transplantation.ConclusionsChagas disease presents an increasing challenge for clinicians in the United States. Despite gaps in the evidence base, current knowledge is sufficient to make practical recommendations to guide appropriate evaluation, management, and etiologic treatment of Chagas disease.

Toward a unified view of the American monsoon systems

Abstract: An important goal of the Climate Variability and Predictability (CLIVAR) research on the American monsoon systems is to determine the sources and limits of predictability of warm season precipitation, with emphasis on weekly to interannual time scales. This paper reviews recent progress in the understanding of the American monsoon systems and identifies some of the future challenges that remain to improve warm season climate prediction. Much of the recent progress is derived from complementary international programs in North and South America, namely, the North American Monsoon Experiment (NAME) and the Monsoon Experiment South America (MESA), with the following common objectives: 1) to understand the key components of the American monsoon systems and their variability, 2) to determine the role of these systems in the global water cycle, 3) to improve observational datasets, and 4) to improve simulation and monthly-to-seasonal prediction of the monsoons and regional water resources. Among the recent observational advances highlighted in this paper are new insights into moisture transport processes, description of the structure and variability of the South American low-level jet, and resolution of the diurnal cycle of precipitation in the core monsoon regions. NAME and MESA are also driving major efforts in model development and hydrologic applications. Incorporated into the postfield phases of these projects are assessments of atmosphere–land surface interactions and model-based climate predictability experiments. As CLIVAR research on American monsoon systems evolves, a unified view of the climatic processes modulating continental warm season precipitation is beginning to emerge.

Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis.

Abstract: Context Lung-protective mechanical ventilation with the use of lower tidal volumes has been found to improve outcomes of patients with acute respiratory distress syndrome (ARDS). It has been suggested that use of lower tidal volumes also benefits patients who do not have ARDS. Objective To determine whether use of lower tidal volumes is associated with improved outcomes of patients receiving ventilation who do not have ARDS.

A Consensus on Criteria for Cure of Acromegaly

Abstract: Objective: The Acromegaly Consensus Group met in April 2009 to revisit the guidelines on criteria for cure as defined in 2000. Participants: Participants included 74 neurosurgeons and endocrinologists with extensive experience of treating acromegaly. Evidence/Consensus Process: Relevant assays, biochemical measures, clinical outcomes, and definition of disease control were discussed, based on the available published evidence, and the strength of consensus statements was rated. Conclusions: Criteria to define active acromegaly and disease control were agreed, and several significant changes were made to the 2000 guidelines. Appropriate methods of measuring and achieving disease control were summarized.