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Humanos , Masculino , Persona de Mediana Edad , Embolia Pulmonar/etiología , Síndrome Respiratorio Agudo Grave/complicaciones , COVID-19/complicaciones , Anticoagulantes/uso terapéutico , Warfarina/uso terapéutico , Síndrome Respiratorio Agudo Grave/tratamiento farmacológico , Inhibidores del Factor Xa/uso terapéutico , COVID-19/tratamiento farmacológicoRESUMEN
This paper reviews the Starfield pillars and the Canadian health system. An objective and subjective evaluation are applied to the system through the lenses of access, longitudinality, integrality, and coordination of care. System vulnerabilities, actions, and proposals that are underway to improve these aspects, both nationally and in the province of Ontario, are discussed. Worth highlighting is the opportunity to establish a national free drug system, and the several challenges to advance the agenda of reforms.
Os pilares Starfield são revistos assim como o sistema de saúde canadense. Avaliação objetiva e subjetiva são aplicadas ao sistema sob as lentes do acesso, longitudinalidade, integralidade e coordenação de cuidados. Discutem-se as vulnerabilidades do sistema e as ações e propostas que estão em curso para tentar melhorar esses aspectos, tanto nacionalmente como na província de Ontário. Destaque para a oportunidade de se criar um sistema gratuito de medicamentos e os diversos desafios para avançar a agenda de reformas.
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Continuidad de la Atención al Paciente , Atención a la Salud , Accesibilidad a los Servicios de Salud , Atención al Paciente , Atención Primaria de Salud , Derivación y Consulta , Brasil , Canadá , Humanos , Ontario , Grupo de Atención al Paciente , Preparaciones Farmacéuticas , Médicos de Familia/estadística & datos numéricosRESUMEN
Resumo Os pilares Starfield são revistos assim como o sistema de saúde canadense. Avaliação objetiva e subjetiva são aplicadas ao sistema sob as lentes do acesso, longitudinalidade, integralidade e coordenação de cuidados. Discutem-se as vulnerabilidades do sistema e as ações e propostas que estão em curso para tentar melhorar esses aspectos, tanto nacionalmente como na província de Ontário. Destaque para a oportunidade de se criar um sistema gratuito de medicamentos e os diversos desafios para avançar a agenda de reformas.
Abstract This paper reviews the Starfield pillars and the Canadian health system. An objective and subjective evaluation are applied to the system through the lenses of access, longitudinality, integrality, and coordination of care. System vulnerabilities, actions, and proposals that are underway to improve these aspects, both nationally and in the province of Ontario, are discussed. Worth highlighting is the opportunity to establish a national free drug system, and the several challenges to advance the agenda of reforms.
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Humanos , Atención Primaria de Salud , Derivación y Consulta , Continuidad de la Atención al Paciente , Atención a la Salud , Atención al Paciente , Accesibilidad a los Servicios de Salud , Ontario , Grupo de Atención al Paciente , Médicos de Familia/estadística & datos numéricos , Brasil , Canadá , Preparaciones FarmacéuticasRESUMEN
Araucaria angustifolia is endemic to southern Brazil. Known as Brazilian pine, A. angustifolia is the only native conifer species with economic and social relevance in this country. Due to massive exploitation, it has suffered a significant population decline and currently is classified as critically endangered. This encouraged the scientific community to investigate genetic features in Brazilian pine to increase resources for management and preservation. In this work, RNA-Seq data was used to determine the complete nucleotide sequence of the A. angustifolia chloroplast genome (cpDNA). The cpDNA is 146,203 bp in length and contains 122 genes, including 80 protein-coding genes, 5 ribosomal RNA genes, and 37 tRNA genes. Coding regions comprise 45.02%, 4.96% correspond to rRNAs and tRNAs, and 50.02% of the genome encompasses non-coding regions. Genes found in the inverted repeat (IR) are present as single copy, with exception of the rrn5 and trnI-CAU loci. The typical LSC, SSC, IRa and IRb organization reported in several land-plant groups is not present in A. angustifolia cpDNA. Phylogenetic analyses using Bayesian and Maximum Likelihood methods clustered A. angustifolia in the Araucariaceae family, with A. heterophylla and A. columnaris as congeneric species. The screening of A. angustifolia cpDNA reveled 100 SSRs, 14 of them corresponding to tetrapolymer loci.
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OBJECTIVE: To compare the outcomes of 2 different bone graft materials: autogenous bone grafts from mandibular symphysis and bovine bone grafts associated with platelet-rich plasma (PRP). METHODS: Twenty individuals met the inclusion criteria and accepted to participate in the study. Group A patients underwent alveolar bone grafting using autologous bone and group B patients using a bovine bone graft associated with PRP. Cone beam computed tomography scans were taken and reconstructed 3-dimensionally for all patients preoperatively and 1 year postoperatively. RESULTS: A significant reduction was detected for area and volume within group A and group B. Between groups, no significant difference was found for area or volume. CONCLUSIONS: Bovine grafts associated with PRP are a good option for the reconstruction of alveolar clefts and provide good results such as autologous bone grafts.
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Trasplante Óseo , Fisura del Paladar , Plasma Rico en Plaquetas , Animales , Bovinos , Fisura del Paladar/cirugía , Humanos , Proyectos PilotoRESUMEN
One of the challenges regarding human motor control is making the movement fluid and at a limited cognitive cost. The coordination between posture and movement is a necessary requirement to perform daily life tasks. The present experiment investigated this interaction in 20 adult men, aged 18-30 years. The cognitive costs associated to postural and movement control when kicking towards a target was estimated using a dual-task paradigm (secondary auditory task). Results showed that addition of the attentional demanding cognitive task yielded a decreased kicking accuracy and an increased timing to perform the movement, mainly during the backswing motion. In addition, significant differences between conditions were found for COP and COM displacement (increased amplitude, mean speed) on the anteroposterior axis. However, no significant differences between conditions were found on the mediolateral axis. Finally, EMG analysis showed that dual-task condition modified the way anticipatory postural adjustments (APAs) were generated. More specifically, we observed an increase of the peroneus longus activity, whereas the temporal EMG showed a decrease of its latency with respect to movement onset. These results suggested a functional adaptation resulting in an invariance of overall APAs, emphasizing that cognitive, postural, and motor processes worked dependently.
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Actividad Motora/fisiología , Movimiento/fisiología , Postura/fisiología , Desempeño Psicomotor/fisiología , Adolescente , Adulto , Electromiografía , Humanos , Masculino , Adulto JovenRESUMEN
Lignobrycon myersi is a threatened freshwater fish species and endemic of a few coastal rivers in northeastern Brazil. Even though the Brazilian laws prohibit the fisheries of threatened species, L. myersi is occasionally found in street markets, being highly appreciated by local population. In order to provide a reliable DNA barcode dataset for L. myersi, we compared mitochondrial sequences of cytochrome c oxidase subunit I (COI) from fresh, frozen, and salt-preserved specimens. Phylogenetically related species (Triportheus spp.) and other fish species (Astyanax fasciatus) commonly mixed with L. myersi in street markets were also included to test the efficiency of molecular identification. In spite of the differences in conservation processes and advanced deterioration of some commercial samples, high-quality COI sequences were obtained and effective in discriminating L. myersi specimens. In addition, while populations from Contas and Almada River basins seem to comprise a single evolutionary lineage, the specimens from Cachoeira River were genetically differentiated, indicating population structuring. Therefore, DNA barcoding has proved to be useful to trace the illegal trading of L. myersi and to manage threatened populations, which should focus on conservation of distinct genetic stocks and mitigation on human impacts along their range.
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BACKGROUND: We hypothesized that pathological N1 (pN1) and N2a (pN2a) nodal disease portend a similar prognosis in patients with oral cancer. METHODS: An international multicenter study of 739 oral squamous cell carcinoma (SCC) patients with pN1 or pN2a stage disease was conducted. Multivariable analyses were performed using Cox proportional hazard models to compare locoregional failure, disease-specific survival (DSS), and overall survival (OS). Institutional heterogeneity was assessed using 2-stage random effects meta-analysis techniques. RESULTS: Univariate analysis revealed no difference in locoregional failure (p = .184), DSS (p = .761), or OS (p = .475). Similar results were obtained in adjusted multivariable models and no evidence of institutional heterogeneity was demonstrated. CONCLUSION: The prognosis of pN2a and pN1 disease is similar in oral SCC suggesting these categories could be combined in future revisions of the nodal staging system to enhance prognostic accuracy. However, these results may reflect more aggressive treatment of N2a disease; hence, we caution against using these data to deintensify treatment.
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Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Neoplasias de la Boca/patología , Neoplasias de la Boca/cirugía , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/cirugía , Anciano , Australia , Brasil , Carcinoma de Células Escamosas/mortalidad , Femenino , Estudios de Seguimiento , Alemania , Humanos , India , Israel , Italia , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/mortalidad , Recurrencia Local de Neoplasia/mortalidad , Estadificación de Neoplasias , Pronóstico , Taiwán , Estados UnidosRESUMEN
Parrotfishes (Labridae, Scarinae) comprise a large marine fish group of difficult identification, particularly during juvenile phase when the typical morphology and coloration of adults are absent. Therefore, the goal of this study was to test cytogenetic markers and DNA barcoding in the identification of bucktooth parrtotfish Sparisoma radians from the northeastern coast of Brazil. Sequencing of cytochrome c oxidase subunit I (COI) confirmed all studied samples as S. radians, and all showed high similarity (99-100%) with Caribbean populations. The karyotype of this species was divergent from most marine Perciformes, being composed of 2n = 46 chromosomes. These consisted of a large number of metacentric and submetacentric pairs with small amounts of heterochromatin and GC-rich single nucleolar organizer regions (NORs) not syntenic to 5S rDNA clusters. These are the first data about DNA barcoding in parrotfish from the Brazilian province and the first refined chromosomal analysis in Scarinae, providing useful data to a reliable genetic identification of S. radians.
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Carlos Ribeiro, one of the directors of the Geological Commission of Portugal, voyaged in 1858 to many countries of Europe to acquire publications, equipment and comparator collections. In Paris he met Paul Deshayes, a well-known conchologist, who gave him access to his personal collections of Tertiary deposits from France and helped him to classify Portuguese fossils. The outcome of the joint work can be seen in the Ribeiro List, which is preserved in the historic archives of the National Energy and Geology Laboratory (Alfragide, Portugal). These classifications served as a basis for a monograph published by Pereira da Costa, Ribeiro's colleague on the Geological Commission, and the definition of the stratigraphy of Portugal's Tertiary deposits.
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Carlos Ribeiro, um dos diretores da Comissão Geológica de Portugal, empreendeu em 1858 viagem por vários países da Europa, para adquirir bibliografia, equipamentos e coleções de comparação. Em Paris, conheceu o reputado conquiliologista Paul Deshayes, que lhe franqueou suas coleções pessoais do Terciário francês e o ajudou na classificação de fósseis portugueses. O trabalho conjunto revela-se na listagem de Ribeiro conservada no arquivo histórico do Laboratório Nacional de Energia e Geologia (Alfragide, Portugal), tendo aquelas classificações servido de base a uma monografia publicada por Pereira da Costa, parceiro de Ribeiro na Comissão Geológica, e à definição da estratigrafia dos depósitos terciários portugueses.
Carlos Ribeiro, one of the directors of the Geological Commission of Portugal, voyaged in 1858 to many countries of Europe to acquire publications, equipment and comparator collections. In Paris he met Paul Deshayes, a well-known conchologist, who gave him access to his personal collections of Tertiary deposits from France and helped him to classify Portuguese fossils. The outcome of the joint work can be seen in the Ribeiro List, which is preserved in the historic archives of the National Energy and Geology Laboratory (Alfragide, Portugal). These classifications served as a basis for a monograph published by Pereira da Costa, Ribeiro's colleague on the Geological Commission, and the definition of the stratigraphy of Portugal's Tertiary deposits.
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Historia del Siglo XIX , Expediciones/historia , Fósiles/historia , Geología/historia , Europa (Continente)RESUMEN
Objetivo: Conhecer o perfil dos usuários que procuram o acolhimento em uma Unidade Básica de Saúde. Identificar as queixas apresentadas pelos usuários e a forma de condução dos casos pelos profissionais de saúde. Metodologia: Foram entrevistados todos os usuários que procuraram acolhimento de janeiro a março de 2007. Foram verificados dados sociodemográficos e o motivo de procura ao acolhimento. Os prontuários foram consultados, registrando o profissional responsável pelo atendimento, diagnóstico e conduta. Resultados: 1.061 participantes foram entrevistados, com predomínio de mulheres, pessoas casadas, com ensino fundamental incompleto e idade entre 21 e 60 anos. Alterações respiratórias foram relatadas por 21% dos participantes, seguindo-se queixas de dor (20%). A maioria (60%) foi atendida por médicos e medicamentos foram prescritos para 86% dos usuários. Hipóteses diagnósticas foram registradas em 24% dos prontuários. Conclusão: A dor foi o principal motivo de busca pelo acolhimento, seguindo-se queixas respiratórias. A maioria dos usuários foi submetida a avaliação médica e o tratamento medicamentoso foi a conduta mais frequente.
Study Objective: To discern the profile of walk-in users of a public primary care unit, to identify their complaints and the health professionals? diagnosis and management of each case. All walk-in users from January to March, 2007, were interviewed. Sociodemographic data and the main reason for the visit were recorded. The consulting professional?s category, diagnosis, and procedures, as registered in the files, were also recorded. 1,061 participants were interviewed, with a predominance of women, married persons, aged 21 to 60 years, and with incomplete primary education. Respiratory complaints were the most prevalent, reported by 21% of the participants, followed by pain complaints, reported by 20% of the participants. The majority (60%) were examined by a medical doctor, and medications were prescribed for 86% of the participants. Specific diagnosis was registered in 24% of the cases. Pain was the main reason for seeking assistance, followed by respiratory complaints. Most of the patients were examined by a doctor, and drug prescription was the treatment most commonly used. It is observed that patient participation in a screening procedure will not suffice in improving care, as expected from this device.
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Centros de Salud , Acogimiento , Servicios de SaludRESUMEN
The aim of this randomized, double-blind clinical trial was to investigate the effect of preemptive analgesia with a combination of tramadol+dexamethasone or tramadol+diclofenac sodium. The study included 30 patients (age range: 16-30 years), who were randomly assigned to 2 groups by the split-mouth method. Postoperative pain was assessed with a visual analogue scale at 4, 6, 12, 24, and 48 h postoperatively (p.o.h.). Swelling was measured at 48 p.o.h. Maximal interincisor distance was measured at 48 p.o.h. and 7 postoperative days (p.o.d.). Significant differences in postoperative pain intensity were detected between the drug combinations at 4, 6, and 12p.o.h., suggesting the importance of preemptive analgesia. Patients treated with tramadol+dexamethasone showed lower pain scores compared to the tramadol+diclofenac sodium combination, larger postoperative mouth opening, and less swelling. The tramadol+dexamethasone combination also was more effective than tramadol+diclofenac sodium at reducing inflammation.
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Analgésicos Opioides/administración & dosificación , Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios/administración & dosificación , Dexametasona/administración & dosificación , Diclofenaco/administración & dosificación , Tercer Molar/cirugía , Premedicación , Tramadol/administración & dosificación , Acetaminofén/administración & dosificación , Administración Oral , Adolescente , Adulto , Analgésicos no Narcóticos/administración & dosificación , Estudios Cruzados , Método Doble Ciego , Combinación de Medicamentos , Edema/prevención & control , Femenino , Estudios de Seguimiento , Humanos , Masculino , Dimensión del Dolor , Dolor Postoperatorio/prevención & control , Complicaciones Posoperatorias/prevención & control , Rango del Movimiento Articular/efectos de los fármacos , Extracción Dental/métodos , Diente Impactado/cirugía , Adulto JovenRESUMEN
PURPOSE OF REVIEW: Laryngeal nerve injuries are among the most important complications of thyroidectomy. Recently, the use of neuromonitoring has been increasingly employed in order to predict and document nerve function at the end of thyroidectomy. RECENT FINDINGS: There is much controversy in recent studies concerning neuromonitoring in thyroid surgery. Some authors believe that the method does not bring any additional reduction in the paralysis rate of the laryngeal nerves. Other researchers defend its use only in selected cases and in very specific situations. Finally, some much respected surgeons advocate the routine use of neuromonitoring in all thyroidectomies. SUMMARY: In this review, we try to present relevant recent publications dealing with this still controversial subject, emphasizing the advantages and disadvantages of neuromonitoring in thyroidectomy.
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Traumatismos del Nervio Laríngeo/prevención & control , Monitoreo Intraoperatorio , Tiroidectomía , Estimulación Eléctrica , Humanos , Traumatismos del Nervio Laríngeo/etiología , Monitoreo Intraoperatorio/efectos adversos , Tiroidectomía/efectos adversosRESUMEN
BACKGROUND: Recurrent nerve injury is 1 of the most important complications of thyroidectomy. During the last decade, nerve monitoring has gained increasing acceptance in several centers as a method to predict and to document nerve function at the end of the operation. We evaluated the efficacy of a nerve monitoring system in a series of patients who underwent thyroidectomy and critically analyzed the negative predictive value (NPV) and positive predictive value (PPV) of the method. METHODS: NIM System efficacy was prospectively analyzed in 447 patients who underwent thyroidectomy between 2001 and 2008 (366 female/81 male; 420 white/47 nonwhite; 11 to 82 years of age; median, 43 years old). There were 421 total thyroidectomies and 26 partial thyroidectomies, leading to 868 nerves at risk. The gold standard to evaluate inferior laryngeal nerve function was early postoperative videolaryngoscopy, which was repeated after 4 to 6 months in all patients with abnormal endoscopic findings. RESULTS: At the early evaluation, 858 nerves (98.8%) presented normal videolaryngoscopic features after surgery. Ten paretic/paralyzed nerves (1.2%) were detected (2 unexpected unilateral paresis, 2 unexpected bilateral paresis, 1 unexpected unilateral paralysis, 1 unexpected bilateral paralyses, and 1 expected unilateral paralysis). At the late videolaryngoscopy, only 2 permanent nerve paralyses were noted (0.2%), with an ultimate result of 99.8% functioning nerves. Nerve monitoring showed absent or markedly reduced electrical activity at the end of the operations in 25/868 nerves (2.9%), including all 10 endoscopically compromised nerves, with 15 false-positive results. There were no false-negative results. Therefore, the PPV was 40.0%, and the NPV was 100%. CONCLUSIONS: In the present series, nerve monitoring had a very high PPV but a low NPV for the detection of recurrent nerve injury.
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Estimulación Eléctrica/métodos , Traumatismos del Nervio Laríngeo Recurrente/diagnóstico , Tiroidectomía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Laringoscopía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Valor Predictivo de las Pruebas , Tiroidectomía/efectos adversos , Parálisis de los Pliegues Vocales/prevención & control , Adulto JovenRESUMEN
BACKGROUND: The Family Health Strategy (FHS) has been implemented as a strategy for primary care improvement in Brazil. Working with teams that include one doctor, one nurse, auxiliary nurses and community health workers in predefined areas, the FHS began in 1994 (known then as the Family Health Program) and has since grown considerably. The programme has only recently undergone assessment of outcomes, in contrast to more routine evaluations of infrastructure and process. METHODS: In 2001, a health survey was carried out in two administrative districts (with 190,000 inhabitants) on the outskirts of the city of São Paulo, both partially served by the FHS. Chronic morbidity (hypertension, diabetes and ischaemic heart disease) of individuals aged 15 or older was studied in areas covered and not covered by the programme. Stratified univariate analysis was applied for sex, age, education, income, working status and social insurance of these populations. Multivariate analysis was applied where applicable. RESULTS: There was a distinct pattern in the morbidity profile of these populations, suggesting differentiated self-knowledge on chronic disease status in the areas served by the FHS. CONCLUSION: The FHS can increase population awareness of chronic diseases, possibly through increasing access to primary care.
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Salud de la Familia , Encuestas de Atención de la Salud , Adolescente , Adulto , Brasil/epidemiología , Enfermedad Crónica/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Atención Primaria de Salud/organización & administración , Evaluación de Programas y Proyectos de Salud , Garantía de la Calidad de Atención de Salud , Adulto JovenRESUMEN
O óxido nitroso, primeiro gás inalatório utilizado na sedação consciente, foi indentificado por Joseph Priestley. Esse composto ficou conhecido como gás hilariante, porém só em 1844 teve sua primeira aplicação em pacientes. Tem como características farmacológicas metabolização lenta no organismo, início e término de ação rápidos, mas alcançando concentrações cerebrais eficientes. Sua técnica baseia-se na administração de O2 seguida de N2O, até alcançar o nível de sedação ideal. Essas técnicas são indicadas para pacientes ansiosos, tensos e situações em que não existam contra-indicações, porém essas são técnicas apenas relativas e não absolutas, e estão relacionadas principalmente ao risco de hipóxia, aumento de volume ou pressão em espaços fechados, alterações hematológicas e neurológicas. Os benzodiazepínicos servem também como método de sedação consciente devido a sua ação ansiolítica: vale destacar o midazolam, diazepam, alprazolam, triazolam e lorazepam. Os efeitos colaterais são variados abrangendo degeneração da medula óssea, náuseas, teratogênese, entre outros. O objetivo deste trabalho é realizar uma revisão da literatura para mostrar a importância da sedação consciente nos procedimentos odontológicos.
Nitrous oxide, the first inhaled gas used in conscious sedation, was identified by Joseph Priestley. This compound was known as laughing gas, but only in 1844 had its first application in patients. Its pharmacological characteristics are don?t be metabolized in the body, beginning and ending of fast action, but reaching effi cient concentrations in the brain. Its technique is based on the administration of O2 followed by N2O, to achieve the optimal level of sedation. Such techniques are indicated for anxious and tense patients, and situations that have no contraindications, but these are only relative and not absolute, and are due mainly to the risk of hypoxia, volume or pressure increase in enclosed spaces, hematological and neurological changes. The benzodiazepines also serve as a conscious sedation method because of their anxiolytic action, highlight the valley midazolam, diazepam, alprazolam, triazolam and lorazepam. Side effects are varied covering bone marrow degeneration, nausea, teratogenesis, among others. The aim of this article is to realize a review in order to show the value of conscious sedation to dental procedures.
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Utilizou-se de um inquérito domiciliar de saúde, realizado em dois distritos administrativos de São Paulo (compreendendo uma população de 190 mil habitantes) em 2001, para se analisar o possível impacto do "Programa de Saúde da Família" (PSF) - QUALIS na morbidade referida e estilo de vida dos maiores de 14 anos. Utilizando-se de análise uni e multivariada, com diversas variáveis sócio-econômicas, mostrou-se que há diferenças na morbidade crônica entre as populações cobertas ou não pelo PSF. Esse fato deve-se, possivelmente, a um maior acesso à Atenção Primária por parte das populações cobertas por essa nova estratégia. Praticamente não houve diferenças em relação a estilo de vida...
A health survey, held in 2001 in two administrative districts of the city of Sao Paulo (inhabited by 190,000 people) was used to measure the impact of the "Family Health Program" - QUALIS in referred morbidity and lifestyle for those 15 and older. Through univariate and multivariate analysis, using several socioeconomic measures, we came to the conclusion that there are differences in chronicle morbidity between the populations attended or not by the program. It is so, possibly, due to a larger access to Primary Health System with this new strategy. There is basically no difference concerning lifestyle...
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Humanos , Masculino , Femenino , Adolescente , Adulto , Estilo de Vida , Encuestas de Morbilidad , Evaluación de Programas y Proyectos de Salud , Estrategias de Salud Nacionales , Consumo de Bebidas Alcohólicas , Actividad Motora , TabaquismoRESUMEN
Numerosas pesquisas adicionam novos conhecimentos sobre as relações funcionais da ATM e enriquecem conceitos e procedimentos classicamente estabelecidos. Os estudos da ATM concluem que o conhecimento anatômico, histológico e funcional detalhado dos integrantes desse sistema formam os fundamentos essenciais na abordagem destas relações. O objetivo do presente estudo foi o de revisar a literatura sobre os aspectos biomecânicos e funcionais da ATM