Are submarine groundwater discharges affecting the structure and physiological status of rocky intertidal communities?

This study evaluated the impacts of submarine groundwater discharges (SGD) on a rocky intertidal community of South Portugal, during April-November 2011. Chlorophyll-a concentration was higher at the SGD site in respect to the Reference site. Epibenthic community structure differed between sites, with an increase in Chthamalus spp. and a decrease in macroalgae coverage at the SGD site. The abundance and body size of Mytilus galloprovincialis were consistently higher at the SGD site. During mid-spring, under potentially higher SGD and less favorable conditions for coastal phytoplankton, the ecophysiological condition of M. galloprovincialis and G. umbilicalis was also higher at the SGD site. These beneficial effects on filter-feeders and herbivores probably resulted from local increases in prey availability, supported by SGD-driven nutrient inputs. Conversely, P. depressa was not favoured by SGD, probably due to a lower dependency on algae as food. The analysis of epibenthic community structure and ecophysiological condition represents a promising approach to disentangle the ecological impacts of SGD on intertidal ecosystems.

CPAP and survival in moderate-to-severe obstructive sleep apnoea syndrome and hypoxaemic COPD.

Obstructive sleep apnoea syndrome (OSAS) often coexists in patients with chronic obstructive pulmonary disease (COPD). The present prospective cohort study tested the effect of OSAS treatment with continuous positive airway pressure (CPAP) on the survival of hypoxaemic COPD patients. It was hypothesised that CPAP treatment would be associated with higher survival in patients with moderate-to-severe OSAS and hypoxaemic COPD receiving long-term oxygen therapy (LTOT). Prospective study participants attended two outpatient advanced lung disease LTOT clinics in São Paulo, Brazil, between January 1996 and July 2006. Of 603 hypoxaemic COPD patients receiving LTOT, 95 were diagnosed with moderate-to-severe OSAS. Of this OSAS group, 61 (64%) patients accepted and were adherent to CPAP treatment, and 34 did not accept or were not adherent and were considered not treated. The 5-yr survival estimate was 71% (95% confidence interval 53-83%) and 26% (12-43%) in the CPAP-treated and nontreated groups, respectively (p<0.01). After adjusting for several confounders, patients treated with CPAP showed a significantly lower risk of death (hazard ratio of death versus nontreated 0.19 (0.08-0.48)). The present study found that CPAP treatment was associated with higher survival in patients with moderate-to-severe OSAS and hypoxaemic COPD receiving LTOT.

Development of Schistosoma mansoni in the laboratory rat analyzed by light and confocal laser scanning microscopy.

The kinetic of maturation (schistogram) of Schistosoma mansoni worms grown in laboratory rats was studied by light and confocal laser scanning microscopy. Infected rats with the BH strain were weekly euthanized 3-9weeks pi. Recovered flukes stained with hydrochloric carmine were preserved as whole-mounts and analyzed by confocal and brightfield microscopy. Worms displayed varying degrees of maturation of the reproductive system at weeks 3-6. Male worms showed complete maturation of the reproductive system at week 6, while female worms completed their maturation at week 7. Males presented few tubercles in tegument in all weeks. Despite the presence of a developing embryo within the ootype, no uterine egg was found. The schistogram in rats follows a pattern similar to that observed in mice hosts.

CA-125 AUC as a new prognostic factor for patients with ovarian cancer.

OBJECTIVE: The aim of the present study was to investigate the usefulness of the CA-125 area under the curve (AUC) as a new kinetic parameter for predicting overall survival in patients with ovarian cancer. In addition, the relationship of CA-125 AUC with other prognostic factors of ovarian cancer was evaluated. METHODS: Ninety-two patients that underwent primary line chemotherapy within 4 months after submission to cytoreductive surgery were included. For each patient, CA-125 AUC was calculated and a statistical analysis was conducted to compare CA-125 AUC behavior among patients according to several covariates. RESULTS: The mean age at diagnostic time was found to be 55.5 (16.1-82.4) years with a mean survival of 39.2 (3.5-100.1; SE = 2.6) months. Across FIGO stage I, II, III, and IV patients had a mean CA-125 AUC of 18.2, 24.6, 147.8, and 574.6 IU/ml*days, respectively (P < 0.05). At the evaluation date, living patients had a mean CA-125 AUC of 40.1 in contrast to 234.1 IU/ml*days (P < 0.05) for deceased ones. Patients with a complete response to primary chemotherapy had a mean CA-125 AUC of 48.8, while patients with a partial response had a mean of 251.7 IU/ml*days, and patients with no response or disease progression had a mean of 316.5 IU/ml*days (P < 0.05). The best CA-125 AUC performance is in predicting patient complete response to chemotherapy with a cut-off of 100 IU/ml*days and an accuracy of 82%. CONCLUSIONS: Despite CA-125 AUC high correlation with the FIGO stage, residual disease, and patient final outcome, the main interest of CA-125 AUC calculation is to evaluate the treatment efficacy and to foresee a full chemotherapy response. Further studies should be carried out before extrapolating these results to other data sets.

[Monitoring serum levels of gentamicin in neonates]. / Recém-nascidos e monitorização sérica de gentamicina.

Newborn infants in intensive care units demonstrated a higher incidence of gestational age below 31 week. Obstetrical and neonatal diseases procedures required for the management of critically ill neonates are associated with an increased risk of infections. Gentamicin is an aminoglycoside antibiotic often used to treat gram-negative bacillary infections and suspected sepsis in neonates. The risk of toxicity or poor efficacy is further increased due to the recognised wide intra and interpatient variability of the newborn. The present work involved 49 infants of 31.3 +/- 4.1 (mean +/- SD) weeks of gestational age, weighing 1.7 +/- 0.8 kg and were treated with standard doses of gentamicin (3.8 +/- 0.9 mg/kg/day). Routine clinical care data were retrospectively collected from the medical records in the neonatal intensive-care unit at Coimbra University Hospital. Data analysis demonstrated that potentially toxic serum levels were observed in 49% of newborn infants (trough > 2 mg/L). Additionally, the obtained results also showed that 7.5% of peak concentrations were found to be higher than 10 mg/L. Potentially sub-therapeutic concentrations were observed in 15% of the patients (peak > 6 mg/L).

The kinetic profile of gentamicin in premature neonates.

The kinetic profile of gentamicin in premature infants has been studied to enable the development of optimized dosage schedules for neonatal intensive-care units and to stress the relationship between the pharmacokinetic parameters and several demographic, developmental and clinical factors which might be associated with changes in gentamicin disposition. Sixty-eight newborn patients of 24- to 34-weeks gestational age and 600-3,100 g current weight in their first week of life, undergoing routine therapeutic drug monitoring of their gentamicin serum levels, were included in this retrospective analysis. Gentamicin pharmacokinetic parameters were determined through non-linear regression by using a single-compartment open model. By regression analysis the current weight (g) was shown to be the strongest co-variate, and both gentamicin clearance (L h(-1)) and volume of distribution (L) had to be normalized. Additionally, gentamicin clearance depended on gestational age with a cut-off at 30 weeks, which allowed the division of the overall population into two subsets (< 30 weeks and between 30-34 weeks of gestational age). The younger neonates (<30 weeks of gestational age) showed a lower gentamicin clearance (0.0288 vs 0.0340 L h(-1) kg(-1)), a slightly higher volume of distribution (0.464 vs 0.435 L kg(-1)), and a longer half-life (11.17 vs 8.88 h) compared with the older subgroup (30-34 weeks of gestational age). On the basis of the pharmacokinetic parameters obtained, we suggest loading doses of 3.7 and 3.5 mg kg(-1) for the two subgroups of neonates (<30 weeks and 30-34 weeks of gestational age), respectively. The appropriate maintenance doses in accordance with the characteristics of the patients should be 2.8 mgkg(-1)/24h and 2.6 mg kg(-1)/18 h for neonates < 30 weeks and between 30-34 weeks of gestational age, respectively. Finally, when compared with previous studies, the information obtained on the pharmacokinetics and determinants of the pharmacokinetic variability of gentamicin in neonates was shown to be consistent.

[Diagnosis of cerebellum-pontine angle tumors using artificial intelligence techniques]. / Diagnóstico de tumores do angulo ponto-cerebelar com o auxílio de técnicas de inteligência artificial.

We are concerned in this paper with learning classification procedures from known cases. More precisely, we provide a diagnostic model that discriminate between cerebellum-pontine angle (CPA) tumors and otorhinolaryngological (ENT) disorders. Usually, in order to distinguish between CPA tumors and ENT disorders one must perform clinical-neurological examination together with expensive radiological imagery (CT and MRI). The proposed model was obtained through artificial intelligence methods and presented a good accuracy level (88.4%) when tested against new cases, considering only clinical examination without radiological imagery results.

Predictive capacity of carbamazepine pharmacokinetic parameters in a Portuguese outpatient population.

The individualization of anticonvulsant therapy regimens can contribute to the implementation of appropriate carbamazepine (CBZ) maintenance doses in epileptic patients. An accurate method for the prediction of concentrations based on a determination of parameters and serum concentrations could be of clinical relevance in the management of epilepsy. In this study, we retrospectively evaluated the predictive performance in an adult outpatient population of six different methods, representing six sets of CBZ pharmacokinetic parameters selected according to the literature using a Bayesian computer program (PKS System; Abbott Laboratories, Abbott Park, IL, USA). The study involved 50 patients with two or more available concentrations selected under several inclusion criteria. The patients were taking CBZ (between 200 and 1600 mg/d) in monotherapy or polytherapy regimens and had no hepatic or renal disease. Steady state concentrations were predicted according to the use of prior information and using one and two feedback patient concentrations. Accuracy and precision were assessed by mean prediction error (ME), mean squared prediction error (MSE) and root mean squared prediction error (RMSE). The analysis showed CL = 0.067 L/hour/kg and Vd = 1.19 L/kg as the most accurate and precise set of pharmacokinetic parameters, presenting the highest percentage of clinically acceptable estimates (error < 2 microg/mL). Additionally, predictions based on one measured feedback concentration were found to be more accurate and precise than prior population-based predictions; the use of two previous patient concentrations further improved predictive capacity but failed to show a significant difference when compared with predictions based on one measured feedback concentration. In conclusion, the adoption of the previously mentioned set of parameters as population estimates and the use of at least one feedback concentration through the Bayesian approach seems to be essential for a better CBZ use in clinical practice. Finally, despite the obtained results, we believe that the Portuguese pharmacokinetic parameter determination of antiepileptics should be carried out to improve the rationale and cost-effectiveness of anticonvulsant therapy.

Kinetic profile of carbamazepine in an adult Portuguese outpatient population.

OBJECTIVE: The aim of our work was to define the kinetic profile of carbamazepine (CBZ), in order to improve on dosing schedules through a Bayesian approach. METHOD: Carbamazepine dose/steady-state trough concentrations data pairs and associated information were collected retrospectively on a population of adult epileptic patients. RESULTS: Fifty patients (index population) with two or more available concentrations (total of 174 determinations) met our inclusion criteria. Patients were taking CBZ (200-1800 mg/day) in mono- or polytherapy regimens. The analysis assumed a one-compartmental model with first-order absorption and elimination. Due to the data source (only trough concentrations were measured as part of hospital routine), the volume of distribution was fixed at 1.19 l/kg. The final estimates for CL were: 0.075 +/- 0.027 (mono- and polytherapy), 0.069 +/- 0.020 (monotherapy), and 0.106 +/- 0.037 l/h/kg (polytherapy). In order to validate these results, we assessed their predictive capacity using 18 new patients (validation population), submitted to the same inclusion criteria and using Prediction-Error analysis. The results suggested a different CL value for our population compared to earlier published clearance values. The results also pointed to an increased metabolic rate associated with polytherapy. The prediction capacity of the optimization method derived from a Portuguese population made in an a priori evaluation indicated a low error (-0.04 microg/ml), close to the theoretical zero value. CONCLUSION: Our results provide specific data on CBZ disposition in a Portuguese population and given the wide variability in the literature values, our data may help improve dosing of CBZ in Portuguese patients.

[Accidents and acts of violence in Brazil: IV--Report of an experiment related to traffic accident prevention: a model used by the Pan American Health Organization]. / Relato de experiência quanto à prevenção de acidentes de trânsito: um modelo usado pela Organização Panamericana de Saúde.

The report of a program related to the prevention of traffic accidents in Bogotá, Columbia, in 1983, is presented. The methodology applied showed that ostensive and preventive policing produced immediate results and its adoption was relatively simple: the number of accidents declined from 414 to 48 within on year of the launching of the Program.

Insulin sensitivity and insulin secretion in lean and obese normal pregnant women.

An insulin-modified frequently sampled intravenous glucose tolerance test with minimal model analysis was performed in normal pregnant women between 28-32 weeks of gestation, to assess insulin sensitivity and insulin secretion. Insulin sensitivity in the pregnant group (no. 26) was reduced to approximately 50% that of nonpregnant group (no. 27) (p < 0.05). This increased insulin resistance was compensated by an enhancement of the first phase of insulin secretion, which was increased more than twofold in the pregnant women when compared with the nonpregnant women (p < 0.05). There was a trend toward greater insulin resistance and insulin secretion in the obese pregnant women (no. 7) as compared with the lean pregnant women (no. 19) although this difference was not statistically significant. Our findings confirm that late pregnancy is a state of physiologic insulin resistance compensated by an increase of insulin secretion.

Metabolic responses to cholecystectomy: open vs. laparoscopic approach.

Laparoscopic cholecystectomy is considered a minor surgical procedure. In a prospective, randomized study, we compared the metabolic responses to surgery in two groups of patients submitted to open or laparoscopic cholecystectomy. The aim of the study was to verify if the latter caused less metabolic changes. Blood samples were drawn before the operation (basal), 1 h and 2 h after skin incision, and on the first and second postoperative days. The following parameters were studied: cortisol, renin, and leukocytes, including subpopulations. The mean values for age, weight, height, basal neutrophil and lymphocyte counts, basal values of cortisol and renin of patients, and sex distribution of group 1 patients (open, n = 20) matched with those for group 2 (laparoscopic, n = 20), with the exception of age (p < 0.05). No differences were detected between the two groups in terms of cortisol and renin values. However, the neutrophil count 1 h after skin incision was statistically significantly higher with the laparoscopic approach (p < 0.05). The lymphocyte count on the second postoperative day was also statistically significantly higher in group 2 (p < 0.05). We conclude that when a cholecystectomy is performed, the laparoscopic approach has no advantage over the open approach from the standpoint of the metabolic responses we studied. It appears that leukocytes have a more rapid return to normal values after laparoscopic cholecystectomy. Although pneumoperitoneum is known to be responsible for important cardiorespiratory changes, no worse response was found in the laparoscopic group than in the open group.

[The teaching of resuscitation and intensive care medicine]. / Ensino da reanimação e medicina intensiva.

The authors analyze the relationship between development of anesthesiology as a specialty and cardiopulmonary resuscitation in the last decades, pointing out to the link between them. In this context, the anesthesiologist is seen as a professional particularly suited to take care of emergency cases. Training programs, both at graduate and postgraduate levels, that are carried on at the Anesthesiology Department of the University of São Paulo are presented. The main goal of these programs is the full training of the anesthesiologist rescuer physician.

[Patient cooperation with his therapeutic regimen]. / Cooperação do paciente com seu regime terapêutico.

The common failure of patients to follow medical instructions creates a problem for the physicians who need to know whether or not their patient are following advice. Lack of patient compliance with prescribed regimens is an important and fascinating problem in medical care. Reports indicate that patients do not follow medical instructions faithfully and that physicians are unable to determine their patient's cooperation levels. Medication compliance has been defined in terms of agreement between the prescription and the behaviour of those who will be taking medicines. The conclusion that can be drawn is that more research in the cited field is quite necessary.

Processamento dos dados vitais da sala de recuperaçäo pós-anestésica / Processing vital signs in the post-anesthetic recuperation room

Na Sala de Recuperaçäo Pós-Anestésica (SRPA), o aacompanhamento do doente, quanto a observaçäo dos sinais vitais, fornece dados de grande valor, quando comparados aqueles do período intra-anestésico. Permitem, assim, uma avaliaçäo adequada da evoluçäo do doente, sevindo, mesmo, como orientaçäo para o estabelecimento de condutas anestésicas. Sendo muito numerosos, estabelecemos um sistema de computadorizaçäo para avaliaçäo de 27 itens referentes a problemáticas respiratória, cardiovascular, neurológica, renal, digestiva, metabólica, hidroeletrolítica, etc. Comparados entre si, contribuem para análises retro e prospectiva da evoluçäo pós-anestésica

[Anesthesia for transsternal thymectomy in myasthenia gravis]. / Anesthésie pour thymectomie trans-sternale dans la myasthénie grave.

Twenty-seven patients with generalized myasthenia gravis (moderate, severe and acute fulminating forms) who underwent thymectomy were studied. The effects of several anesthetic agents were analyzed with special attention being given to immunologic considerations. The authors conclude that the association of ketamine, tiapride, droperidol, fentanil and nitrous oxide allowed fast recovery of consciousness and spontaneous respiration, and made safe extubation possible before leaving the operating room.

Efeito analgesico do fentanil administrado no espaco peridural de pacientes politraumatizados. / Analgesic effect of fentanyl injection in the epidural space in patients with multiple trauma

Foi estudada a acao analgesica do fentanil adminsitrado no espaco peridural de 18 pacientes politraumatizados. A puncao foi feita em L2 - L3 introduzindo-se um cateter por 3 cm em direcao cefalica, mantendo-se todos os pacientes decubito dorsal, em aclive de 45o. por trinta minutos, apos cada dose; receberam a 1 a 6 doses de acordo com as necessidades.Foram analisados a frequencia do pulso, a pressao arterial, a frequencia ventilatoria, os limites da faixa da dor (superior e inferior) e a duracao de analgesia.O resultado mais importante foi a diminuicao da faixa da dor, o que contribuiu para um melhor comportamento dos pacientes frente a fisioterapia ventilatoria