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ABSTRACT Objective: Test if the MRI FAST1.2 protocol can detect extra-pituitary midline structural brain abnormalities in patients with ectopic posterior pituitary (EPP), and highlighting their radiological-laboratory correlations. Subjects and methods: Cross-sectional study of patients with EPP and control group. All individuals were submitted to FAST1.2, which combines the FAST1 protocol developed by our group with 3D T2DRIVE imaging. Results: We evaluated 36 individuals with EPP and 78 as control group. Pituitary stalk (PS) was identified in 7/36 patients in EPP group by FAST1, and in 24/36 patients in FAST1.2 (p < 0.001). FAST1 failed to detect PS in one individual in the control group, while the FAST1.2 defined the PS in all individuals. In EPP group, eleven had interhypothalamic adhesion (IHA), three septo-optic dysplasia, and one cerebellar malformation. We didn't observe higher frequency of panhypopituitarism or developmental delay in patients with IHA. In control group, three had pars intermedia cysts, one hydrocephalus, and one hypothalamic hamartoma. Conclusions: FAST1.2 allows confident recognition of midline structural abnormalities, including the pituitary stalk and IHA, thereby making MRI acquisition faster and with no need for contrast administration. IHA could be associated with defects in neuronal migration, as occur in patients with EPP, with no clinical significance.
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RESUMO A disposição inadequada de resíduos da construção civil (RCC) gera poluição difusa em grande parte do território brasileiro, a despeito da legislação ambiental vigente. A incipiência do planejamento de sistemas de gestão de resíduos, no âmbito municipal, e também de seu monitoramento com vistas à melhoria contínua foi o agente mobilizador desta pesquisa, que se propôs a determinar e validar variáveis para um conjunto de indicadores de efetividade de gestão de RCC e, por meio deles, avaliar a gestão dos RCC no município de São José dos Campos, São Paulo. Trata-se de uma pesquisa aplicada com dados quanti-qualitativos, tendo em vista a utilidade pública. Os 15 indicadores de efetividade foram avaliados com o auxílio de 124 variáveis de diferentes significâncias determinadas pelos gestores municipais. O uso da ferramenta para a avaliação de desempenho em São José dos Campos mostrou que, mesmo sendo o município considerado referência nacional na gestão de RCC, ainda há esforços a serem invitados para que essa gestão possa ser considerada efetiva, principalmente nas dimensões econômica e social. Os indicadores e variáveis apresentados no presente trabalho podem nortear avaliações em outros municípios brasileiros, desde que consideradas as especificidades locais.
ABSTRACT In spite of current environmental legislation, inadequate disposition of construction solid waste (CSW) generates diffuse pollution in a large part of Brazilian territory. Many incipient plans of waste management systems, at the municipal level, and also their monitoring needs for having continuously improved systems were the mobilizing agents of this research, which proposed to determine and validate variables for a set of CSW management effectiveness indicators and through them to evaluate the management of CSW in the municipality of São José dos Campos. It is an applied research with quantitative and qualitative data, with a view to public utility. Fifteen effectiveness indicators were evaluated using 124 variables with different scores determined by the municipal managers. As a result of using the performance evaluation tool, it was showed that, even though São José dos Campos is considered nationwide as reference in the management of CSW, it is still necessary to invite efforts so that its management can be considered effective, mainly in the economic and social dimensions. All indicators and variables presented in this study may guide evaluations in other Brazilian municipalities, as long as respect for local specificities is maintained.
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Abstract Objective: To analyze the impact of vacuum-assisted venous drainage (VAVD) on arterial pump flow in a simulated pediatric cardiopulmonary bypass circuit utilizing a centrifugal pump (CP) with an external arterial filter. Methods: The simulation circuit consisted of a Quadrox-I Pediatric oxygenator, a Rotaflow CP (Maquet Cardiopulmonary AG, Rastatt, Germany), and a custom pediatric tubing set primed with Lactated Ringer's solution and packed red blood cells. Venous line pressure, reservoir pressure, and arterial flow were measured with VAVD turned off to record baseline values. Four other conditions were tested with progressively higher vacuum pressures (-20, -40, -60, and -80 mmHg) applied to the baseline cardiotomy pressure. An arterial filter was placed into the circuit and arterial flow was measured with the purge line in both open and closed positions. These trials were repeated at set arterial flow rates of 1500, 2000, and 2500 mL/min. Results: The use of progressively higher vacuum caused a reduction in effective arterial flow from 1490±0.00 to 590±0.00, from 2020±0.01 to 1220±0.00, and from 2490±0.0 to 1830±0.01 mL/min. Effective forward flow decreased with increased levels of VAVD. Conclusion: The use of VAVD reduces arterial flow when a CP is used as the main arterial pump. The reduction in the forward arterial flow increases as the vacuum level increases. The loss of forward flow is further reduced when the arterial filter purge line is kept in the recommended open position. An independent flow probe is essential to monitor pump flow during cardiopulmonary bypass.
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Humans , Child , Cardiopulmonary Bypass , Drainage , Equipment Design , Hemodynamics , Models, CardiovascularABSTRACT
Abstract Objective: Hemodilution is a concern in cardiopulmonary bypass (CPB). Using a smaller dual tubing rather than a single larger inner diameter (ID) tubing in the venous limb to decrease prime volume has been a standard practice. The purpose of this study is to evaluate these tubing options. Methods: Four different CPB circuits primed with blood (hematocrit 30%) were investigated. Two setups were used with two circuits for each one. In Setup I, a neonatal oxygenator was connected to dual 3/16" ID venous limbs (Circuit A) or to a single 1/4" ID venous limb (Circuit B); and in Setup II, a pediatric oxygenator was connected to dual 1/4" ID venous limbs (Circuit C) or a single 3/8" ID venous limb (Circuit D). Trials were conducted at arterial flow rates of 500 ml/min up to 1500 ml/min (Setup I) and up to 3000 ml/min (Setup II), at 36°C and 28°C. Results: Circuit B exhibited a higher venous flow rate than Circuit A, and Circuit D exhibited a higher venous flow rate than Circuit C, at both temperatures. Flow resistance was significantly higher in Circuits A and C than in Circuits B (P<0.001) and D (P<0.001), respectively. Conclusion: A single 1/4" venous limb is better than dual 3/16" venous limbs at all flow rates, up to 1500 ml/min. Moreover, a single 3/8" venous limb is better than dual 1/4" venous limbs, up to 3000 ml/min. Our findings strongly suggest a revision of perfusion practice to include single venous limb circuits for CPB.
Subject(s)
Humans , Oxygenators/standards , Cardiopulmonary Bypass/instrumentation , Cannula/standards , Pediatrics/instrumentation , Reference Standards , Temperature , Time Factors , Venous Pressure/physiology , Blood Flow Velocity/physiology , Cardiopulmonary Bypass/methods , Reproducibility of Results , Equipment Design , Equipment Safety , Hemodilution , Models, CardiovascularABSTRACT
Malaria is responsible for more deaths around the world than any other parasitic disease. Due to the emergence of strains that are resistant to the current chemotherapeutic antimalarial arsenal, the search for new antimalarial drugs remains urgent though hampered by a lack of knowledge regarding the molecular mechanisms of artemisinin resistance. Semisynthetic compounds derived from diterpenes from the medicinal plant Wedelia paludosa were tested in silico against the Plasmodium falciparum Ca2+-ATPase, PfATP6. This protein was constructed by comparative modelling using the three-dimensional structure of a homologous protein, 1IWO, as a scaffold. Compound 21 showed the best docking scores, indicating a better interaction with PfATP6 than that of thapsigargin, the natural inhibitor. Inhibition of PfATP6 by diterpene compounds could promote a change in calcium homeostasis, leading to parasite death. These data suggest PfATP6 as a potential target for the antimalarial ent-kaurane diterpenes.
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Aged , Female , Humans , Male , Gastrointestinal Neoplasms/physiopathology , Health Promotion/organization & administration , Survivors , Republic of KoreaABSTRACT
BACKGROUND: atopic dermatitis is directly related to psychological stress, reduced quality of life and psychosomatic symptoms. The Psychosomatic Scale for Atopic Dermatitis is the only questionnaire developed specifically for assessment of psychosomatization in atopic dermatitis. OBJECTIVES: the objective of this study was to cross-culturally adapt and validate a Brazilian-Portuguese version of the Psychosomatic Scale for Atopic Dermatitis. METHODS: adaptation consisted of independent translation and backtranslation by three bilingual translators, followed by a pre-test. The Psychosomatic Scale for Atopic Dermatitis and the Dermatology Life Quality Index were self-administered to 47 patients with atopic dermatitis. Disease severity was evaluated using the Eczema Area and Severity Index. Factor analysis was used to identify the dimensions of the Brazilian Portuguese version of the Psychosomatic Scale for Atopic Dermatitis. Internal consistency and convergence validity were also analyzed. Reproducibility was assessed using the Kappa coefficient. RESULTS: factor analysis revealed a two-dimensional structure: stress/laziness/insecurity (I) and maladjustment/social relationships (II), explaining 54.4% of total variance. All dimensions revealed excellent internal consistency. External construct validity was confirmed by positive correlations between the Psychosomatic Scale for Atopic Dermatitis and the Dermatology Life Quality Index. Test-retest reliability was excellent, with k>0.7 for all questions. CONCLUSIONS: the Brazilian Portuguese version of the Psychosomatic Scale for Atopic Dermatitis demonstrated acceptable psychometric properties and can be used for the evaluation of psychosomatic symptoms in patients with atopic dermatitis and as a tool in clinical and epidemiological research. .
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Dermatitis, Atopic/psychology , Psychophysiologic Disorders/diagnosis , Surveys and Questionnaires/standards , Translations , Brazil , Cross-Cultural Comparison , Psychometrics/methods , Quality of Life/psychology , Reference Values , Reproducibility of Results , Stress, Psychological/diagnosisABSTRACT
INTRODUÇÃO: No Brasil, a definição dos parâmetros de pontuação da residência médica fica a critério da coordenação de cada programa. O objetivo deste trabalho foi avaliar os critérios empregados para análise curricular dos editais de residência médica e a distribuição das vagas, por região no Brasil, durante o ano de 2011. MÉTODOS: Foi utilizado como base o Sistema da Comissão Nacional de Residência Médica e foram pesquisados todos os editais abertos em 2011. Os dados foram coletados por meio de uma ficha padronizada pelos autores e utilizou-se o software Epi Info 6.4 para análise. RESULTADOS: Foram selecionadas 362 instituições, com 7.931 vagas distribuídas nas cinco regiões do País. A oferta se concentrou na Região Sudeste, com 42,8% dos editais e 66,7% das vagas. Apenas quatro especialidades concentraram 57,4% das vagas - Clínica Médica (20,0%), Pediatria (13,9%), Cirurgia Geral (13,6%) e Ginecologia/Obstetrícia (10%). As vagas ofertadas à área de saúde da família e comunidade e medicina preventiva e social somaram menos de 6% do total. Publicação de artigos científicos (97,6%), atividades de monitoria (92,3%), apresentação de resumos em congresso (87,9%), estágio em hospitais (80,6%) e conhecimento em línguas estrangeiras (63,7%) foram as atividades mais pontuadas. A participação em capítulos de livros foi bem avaliada em editais da Região Sudeste (51,3%). A participação em ligas acadêmicas foi pontuada em apenas 37,6% dos editais. CONCLUSÕES: Há grande concentração de vagas na Região Sudeste, com poucas vagas para a área de saúde da família, e os critérios utilizados para avaliação do currículo variam bastante de região para região.
INTRODUCTION: In Brazil, Medical Residency Programs have specific criteria to evaluate a student's résumé. The aim of this study was to analyze the main criteria adopted by Medical Residency Centers in their recruitment programs during the year of 2011. METHODS: The requirements of the main Medical Residency Centers were reviewed according to the National Medicine Council. A questionnaire standardized by the authors was used to collect the data. For analysis of the results, EpiInfo version 6.4 was used. RESULTS: A total of 362 institutions, which offer 7,931 vacancies around Brazil, were included in the study. In total, 57.4% of the applications were made for the following medical specialties: Internal Medicine (20%), Pediatrics (13.9%), General Surgery (13.6%), Obstetrics and Gynecology (10%). A small amount of vacancies were offered in Family and Community Health, corresponding to 6% of the total. The activities developed by the students during the course considered most important by the Medical Residency Centers were: publication of papers (97%), tutorial activities (92.3%), submission of abstract to congresses (87.9%), trainee program in hospitals (80.6%) and knowing a foreign language (63.7%). Publishing a chapter of a book was important mainly in the Centers (51.3%) located in the Southeast of Brazil. Participating in academic study groups is only accepted in 37.6% of the programs. CONCLUSIONS: Most of the vacancies for Medical Residency Programs are in the Southeast Centers. There are very few vacancies in the area of in Family and Community Health. The criteria used to evaluate the students CV relies on the Medical Residency Centers it is applying for and the region it is located.
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RACIONAL: Sempre foi muito controversa a escolha de uma operação ideal para portadores de megaesôfago não avançado com recidiva após tratamento prévio. As várias técnicas existentes e os diferentes graus da doença são os maiores fatores para essa dificuldade. OBJETIVO: Avaliar os resultados precoces e tardios da esofagocardioplastia à Serra-Dória em pacientes que apresentaram recidiva dos sintomas de megaesôfago não avançado após terem sido previamente submetidos à cardiomiotomia. MÉTODO: Foram estudados 32 pacientes. A idade variou de 32 a 63 anos. Dezenove apresentavam disfagia moderada e 13 leve, sendo que 14 tinham algum grau de regurgitação. Esses indivíduos foram submetidos à esofagocardioplastia à Serra-Dória e foram avaliadas as complicações sistêmicas e locais ocorridas no pós-operatório. RESULTADOS: Após o procedimento, puderam ser acompanhados 27 pacientes, sendo que 22 passaram a apresentar deglutição normal, cinco disfagia leve e três permaneceram com alguma regurgitação. Nenhum paciente morreu. Três tiveram pneumonia precoce e em um cocorreu fístula anastomótica. CONCLUSÕES: A esofagocardioplastia à Serra-Dória é procedimento adequado para o tratamento cirúrgico do megaesôfago recidivado não avançado.
BACKGROUND: It has always been very controversial to choose an ideal operation for patients with no advanced recurrent megaesophagus after previous treatment. The various existing techniques and the different degrees of disease are the major factors to this difficulty. AIM: To evaluate the early and late results of the Serra-Doria esophagocardioplasty in patients who had recurrence of symptoms in non-advanced megaesophagus after having been submitted to cardiomyotomy. METHODS: Were studied 32 patients. The age ranged from 32 to 63 years. Nineteen had mild and 13 moderate dysphagia, and 14 had some degree of regurgitation. These subjects underwent the Serra-Doria esophagocardioplasty and were evaluated the local and systemic complications occurred postoperatively. RESULTS: After the procedure could be followed 27 patients, 22 began to show normal swallowing, five mild dysphagia and three remained with some regurgitation. No patient died. Three had early pneumonia and in one occurred anastomotic leak. CONCLUSIONS: The Serra-Doria esophagocardioplasty is adequate procedure for the surgical treatment of relapsed non advanced megaesophagus.
Subject(s)
Adult , Female , Humans , Middle Aged , Cardia/surgery , Esophageal Achalasia/surgery , Esophagus/surgery , Anastomosis, Roux-en-Y , Digestive System Surgical Procedures/methods , Gastrectomy/methods , Recurrence , Retrospective StudiesABSTRACT
Este estudo procurou analisar e demonstrar a importância da musculatura flexora e extensora de joelho durante a aplicação de um programa de múltiplos saltos verticais. As mensurações (avaliação e reavaliação) foram realizadas através da utilização do dinamômetr isocinético da marca CYBEX, modelo NORM 7000, no qual foram avaliadas as valências físicas potência, trabalho total e pico de torque. Foi estabelecido um programa (8 sessões- 3 vezes semanais - 3 séries de 30 repetições - intervalo interséries de 5 minutos) de execução de saltos verticais, onde 16 universitários do curso de Fisioterapia da POntifícia Universidade Católica do Paraná, com faixa de 17 a 25 anos, do sexo masculino, sedentários e hígidos. Os voluntários foram divididos em 2 grupos iguais, sendo que o primeiro grupo executou o programa no solo e outro no meio líquido. Houve evolução na maioria das valências avaliadas com destaque na musculatura flexora de joelho. Conhecer qual dos dois meios proporciona maiores ganhos, levando-se em consideração a semelhança com o gesto desportivo e a sobrecarga imposta ao sistema músculo-esquelético, orienta o fisioterapeuta quanto a sua aplicabilidade e adequação em relação à otimização do porcesso reabilitativo.
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Humans , Male , Adult , Knee/physiology , Muscles/physiology , TorqueABSTRACT
Este artigo discute as indicações para tratamento hospitalar total e parcial em transtornos alimentares. A literatura básica sobre o tema é revisada, explicando tipos e locais de tratamento e guias terapêuticos para abordagem de pacientes nestas condições
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Humans , Male , Female , Bulimia , Anorexia Nervosa , Day Care, Medical , HospitalizationABSTRACT
O presente artigo tem como finalidade apresentar os principais tratamentos psicoterapicos testados para bulimia nervosa. A terapia cognitivo-comportamental (TCC) de acordo com recentes publicacoes permanece...
Subject(s)
Psychotherapy , Bulimia , Cognitive Behavioral Therapy , Behavior Therapy , Bulimia , Interpersonal RelationsABSTRACT
Os autores desrevem um caso de bulimia nervosa que se iniciou com episódios bulímicos e elevado ganho de peso na gestaçäo, e discute o impacto deste transtorno no período gravídico-puerperal
Subject(s)
Humans , Female , Pregnancy , Adult , Bulimia , Pregnancy Complications , Weight GainABSTRACT
Sete pacientes com fraturas antigas de calcâneo tratadas pelo método de Essex-Lopresti foram reavaliados e submetidos à tomografia computadorizada do retropé. De maneira geral, os resultados avaliados tanto clinicamente quanto por radiografias convencionais foram maus. Limitaçäo de movimento, dor e artrose subtalar foram os achados mais comuns. A tomografia computadorizada mostrou maior fineza de detalhes das alteraçöes. Geralmente o calcâneo encontrava-se mais baixo, mais largo e com a retificaçäo do varismo fisiológico. No interior do osso havia áreas extensas de rarefaçäo óssea, cavitaçöes esclerose e algumas regiöes das fraturas estavam sem preenchimento ósseo. Destruiçäo das facetas articulares, incongruência articular e alteraçöes degenerativas foram marcantes na articulaçäo subtalar. A tomografia foi também realizada no pé normal e permitiu estudar com minúcias a anatomia do astrálago e calcâneo