Predictive value of capnography for severity of acute gastroenteritis in the emergency department.

OBJECTIVE: This study first aims to assess the utility of ETCO2 levels in evaluating the severity of dehydration in adult patients that present to the ED with acute gastroenteritis. AGE. Second, it intends to evaluate the correlation between ETCO2 and several metabolic parameters: creatinine, pH, bicarbonate (HCO3), and bases excessive (BE). METHOD: This prospective study was conducted with AGE patients in the ED of a training and research hospital between June 2018 and April 2019 after approval of the local ethical-committee. The two groups were defined according to the severity of AGE: mild and non-mild groups. For both groups, ETCO2 levels were measured and recorded on admission of the patients. RESULTS: 87 patients were included in the analyses. The median of ETCO2 values was found as lower in non-mild group than mild group; 30 (25-35) & 39 (33-34), respectively (p < 0.001). In ROC analysis for distinguishing between the both groups, the AUC value was found to be 0.988 and the best cut-off level was found as 33.5 with 95% sensitivity and 93% specificity. In addition, strong negative correlation between ETCO2 and creatinine (p < 0.001, r: -0.771) were found. CONCLUSION: ETCO2 levels decreased in the non-mild group of AGE patients; it could be useful to distinguish the mild group from the non-mild group. ETCO2 could be a reliable marker in predicting AKI in the management of AGE patients.

Mild Dehydration Identification Using Machine Learning to Assess Autonomic Responses to Cognitive Stress.

The feasibility of detecting mild dehydration by using autonomic responses to cognitive stress was studied. To induce cognitive stress, subjects (n = 17) performed the Stroop task, which comprised four minutes of rest and four minutes of test. Nine indices of autonomic control based on electrodermal activity (EDA) and pulse rate variability (PRV) were obtained during both the rest and test stages of the Stroop task. Measurements were taken on three consecutive days in which subjects were "wet" (not dehydrated) and "dry" (experiencing mild dehydration caused by fluid restriction). Nine approaches were tested for classification of "wet" and "dry" conditions: (1) linear (LDA) and (2) quadratic discriminant analysis (QDA), (3) logistic regression, (4) support vector machines (SVM) with cubic, (5) fine Gaussian kernel, (6) medium Gaussian kernel, (7) a k-nearest neighbor (KNN) classifier, (8) decision trees, and (9) subspace ensemble of KNN classifiers (SE-KNN). The classification models were tested for all possible combinations of the nine indices of autonomic nervous system control, and their performance was assessed by using leave-one-subject-out cross-validation. An overall accuracy of mild dehydration detection was 91.2% when using the cubic SE-KNN and indices obtained only at rest, and the accuracy was 91.2% when using the cubic SVM classifiers and indices obtained only at test. Accuracy was 86.8% when rest-to-test increments in the autonomic indices were used along with the KNN and QDA classifiers. In summary, measures of autonomic function based on EDA and PRV are suitable for detecting mild dehydration and could potentially be used for the noninvasive testing of dehydration.

Analysis of 2009⁻2012 Nutrition Health and Examination Survey (NHANES) Data to Estimate the Median Water Intake Associated with Meeting Hydration Criteria for Individuals Aged 12⁻80 in the US Population.

In 2005, US water intake recommendations were based on analyses of Nutrition Healthand Examination Surveys (NHANES) III data that examined if hydration classification varied bywater intake and estimated the median water intake associated with hydration in persons aged 19⁻30. Given the upcoming 2020⁻2025 Dietary Guidelines review, this analysis addresses the same twoaims with the 2009⁻2012 NHANES data. Methods were updated by defining hydration criteria interms of multiple measures (serum sodium 135⁻144 mmol/L and urine osmolality < 500 mmol/kg),expressing water intake as ml/kg, distinguishing plain water intake (PWI) from total water intake(TWI), using weighted age- and sex-specific multivariable models to control for determinants ofwater intake requirements, and selecting two study samples (non-acutely ill US population and asub-group without selected chronic disease risk factors). In the US population and sub-group, therelative risk (RR) of meeting the hydration criteria was significantly greater for individuals withTWI ≥ 45 mL/kg or PWI ≥ 20 mL/kg (for the US population 19⁻50 years of age: adjusted RR (RRrepresents Relative Risk, which is a very standard term that probably does not need to be spelledout) = 1.36, 95% CI: 1.10⁻1.68 for males; adjusted RR = 1.70, 95% CI: 1.49⁻1.95 for females. For thesub-group 51⁻70 years of age: adjusted RR = 2.20, 95% CI: 1.15⁻4.18 for males; adjusted RR = 2.00,95% CI: 1.18⁻3.40 for females). The median (SE, which stands for Standard Error, which is also verywell known. Up to you if your journal prefers to spell it out in the abstract) TWI and PWI associatedwith meeting the hydration criteria for males and females 19⁻50 years of age were 42 (2) mL/kg and14 (1) mL/kg and 43 (2) mL/kg and 16 (1) mL/kg, respectively. The significant association betweenwater intake and hydration classification differs from the null association, underlying the 2005 waterintake recommendations, and may lead to different reasoning and inferences for the 2020⁻2025Dietary Guidelines.

Relógio circadiano em eucariotos fotossintetizantes (Archaeplastida) e adaptação ao estresse / Circadian clock in photosynthetic eukaryotes (Archaeplastida) and stress adaptation

Relógios endógenos controlam grande parte de processos biológicos através de osciladores bioquímicos que coordenam a sinalização de pistas ambientais até vias metabólicas, permitindo a percepção do tempo e adaptação a mudanças rítmicas. Comportamentos cíclicos diários foram primordialmente descritos em plantas e, mais recentemente, têm fornecido informações valiosas sobre os ciclos de retroalimentação da transcrição e tradução de genes que controlam estes osciladores. O florescimento é um exemplo bem conhecido da importância da percepção do comprimento do dia através do relógio, processo intimamente regulado por fotorreceptores e pelos genes centrais e periféricos do relógio biológico. Em organismos multicelulares há uma combinação específica de genes mais expressa em cada tecido, podendo ter funções, fases e períodos diferentes, o que aumenta a complexidade desse mecanismo. Devido a isso, tem-se buscado modelos alternativos mais simples dentro dos eucariotos fotossintetizantes relacionados às plantas terrestres. Modelos simplificados facilitam, por exemplo, a avaliação da combinação de fatores que induzem o estresse e como o relógio biológico se altera, permitindo a antecipação de mudanças ambientais e sincronização da fisiologia com o meio ambiente. Neste trabalho, verificou-se como o relógio circadiano se ajusta ao estresse em 3 diferentes modelos: Gracilaria tenuistipitata (Rhodophyta), Ostreococcus tauri (Chlorophyta) e Saccharum sp (Embryophyta). Para isso, estabeleceu-se em G. tenuistipitata métodos para avaliação de crescimento e da fluorescência da clorofila de modo automático, comprovando da existência de ritmos circadianos. Além disso, após padronização de genes de referência para normalização das RT-qPCRs, o gene TRX ficou superexpresso durante a primeira hora após o déficit hídrico. Já em O. tauri, onde os genes centrais do relógio são conhecidos, mudanças na expressão de LOV-HK e TOC1 estão relacionadas com maior crescimento em baixa e alta temperatura, respectivamente. Uma combinação específica de luz, temperatura e salinidade pode ser um importante indutor de eflorescências que reflete mudanças transcricionais no oscilador central, o que pode ser comparado às florescências de plantas terrestres. Já em Saccharum sp tolerante à seca, ritmos de fotossíntese e de expressão de CCA1 sofrem mudanças de fase em suas oscilações e transcritos de HVA-22 e DRP são significativamente mais expressos sob dessecação. Em suma, o estresse em Saccharum sp reseta o relógio, aumentando o período de oscilação da fotossíntese. Em O. tauri induz maior crescimento, mantendo as características do relógio. Não foi possível avaliar o efeito do estresse no relógio de G. tenuistipitata, mas ferramentas foram desenvolvidas visando este objetivo. Estudos de respostas do relógio podem fornecer informações valiosas para o entendimento da reprodução e crescimento de organismos com elevado potencial de aplicações biotecnológicas

Endogenous clocks control a large range of biological processes through biochemical oscillators that coordinate the signaling of environmental cues to metabolic pathways, allowing the perception of time and adjust to rhythmic changes. Cyclical daily behaviors were first noticed in plants and, more recently, revealed information about the transcriptional-translational feedback loops of genes that control these oscillators. Flowering is a well-known process where the perception of day length by the clock is intimately regulated by photoreceptors and by the central and peripheric genes of the biological clock. Multicellular organisms have a tissue-specific combination of expressed clock genes that may have different phase and period, increasing the complexity of this mechanism. Due to this reason, alternative models have been proposed for land plants-related photosynthetic eukaryotes. New models can simplify, for example, which combination of factors induce stress and how the biological clock is altered, allowing the anticipation of environmental changes and synchronization of physiology and environmental factors. This work aimed to verify how the biological clock adjusts to different kinds of stresses in 3 species: Gracilaria tenuistipitata (Rhodophyta), Ostreococcus tauri (Chlorophyta) and Saccharum sp (Embryophyta). Automated measurement techniques for growth rate and photosynthesis were stablished for the red alga. This alga also showed, after establishment of reference genes for RT-qPCRs normalization, an overexpression of TRX during the first hour under water deficit. In O. tauri, where the central clock genes are known, changes in LOV-HK and TOC1 gene expression are related to a higher growth rate under low and high temperatures, respectively. Besides, a specific combination of light, temperature and salinity can be an important trigger of seasonal blooms that causes important transcriptional changes at the central oscillator, what is similar to land plants. In Saccharum sp tolerant to drought, photosynthesis rhythms and CCA1 expression change their phase under simulated water deficit and drought responsive transcripts like HVA-22 and DRP are significantly up-regulated. In short, stress resets the clock in Saccharum sp, increasing the period of photosynthesis oscillation. In O.tauri, it induces a higher growth, keeping clock features. It was not possible to verify clock responses to stress in G.tenuistipitata, but methods to do so were stablished. The biological clock responses to stress can provide invaluable information for the better understanding about the growth and reproduction of organisms with a high biotechnological potential

[THE MODES OF EVALUATION OF TYPE OF DEHYDRATION IN CHILDREN HOSPITALIZED BECAUSE OF ACUTE INTESTINAL INFECTION].

Every year about 800,000 cases of intestinal infections end in lethal outcome due to dehydration. The different types of dehydration acquire differential approach to correction. Everywhere there is no application of routine detection of osmolarity of blood plasma under exicosis in children in view of absence of possibility of instrumental measurement. The search of techniques is needed to make it possible to indirectly detect types of dehydration in children hospitalized because of acute intestinal infection with purpose to apply rationale therapy of water-electrolyte disorders. The sampling of 32 patients with intestinal infections accompanied with signs of exicosis degree I-III was examined. The detection of osmolarity of blood was implemented by instrumental technique using gas analyzer ABL 800 Flex (Radiometer; Denmark) and five estimate techniques according to results of biochemical analysis of blood. The differences in precision of measurement of osmolarity of blood plasma by instrumental and estimate techniques were compared using Bland-Altman graphic technique. It is established that formula: 2x[Na+kp] + [glucosekp] (mmol/l) is the most recise. Its application provided results comparable with values detected by instrumental mode.

Mild to moderate dehydration combined with moderate alcohol consumption has no influence on simulated driving performance.

OBJECTIVE: Many people consume alcoholic beverages following a period of physical activity that results in fluid loss through sweating (e.g., after sports, work). Adequate rehydration following physical activity may not occur, consequently resulting in the consumption of alcohol in a dehydrated state. This may have serious implications for the safety of individuals operating motor vehicles. Therefore, this study investigated the impact of mild-moderate dehydration in combination with moderate alcohol consumption on simulated driving performance. METHODS: Fourteen healthy males participated in a placebo-controlled crossover design study involving 4 experimental trials (separated by 4 days or more). In each trial, participants were dehydrated by ∼2 percent body mass through exercise. After a 30-min recovery, participants completed a 15-min computerized simulated driving task (drive 1). In 2 of the trials, participants were provided with water equivalent to either 50 or 150 percent body mass loss and also received salt capsules (NaCl, 50 mmol/L). A set volume of alcohol or placebo was then consumed in each trial, incorporating the conditions: dehydration-placebo (DP), dehydration-alcohol (DA), partial rehydration-alcohol (PA), and full rehydration-alcohol (FA). The volume of the alcoholic beverage was individually calculated and intended to raise the blood alcohol content (BAC) to ∼0.05 percent. The same driving task was then readministered (drive 2). Primary outcome measures of driving consisted of standard deviation of lateral position (SDLP), number of side and center line crossings (LC), number of failures to stop at red traffic signals (FTS), number of impacts/collisions with other vehicles or objects (IMP), and time to collision with a specified lead vehicle (TTC). In addition, reaction time (RT) and incorrect inhibition response (IIR) behavior to critical events were collected throughout each experimental drive. Subjective ratings of mood and estimates of alcohol intoxication and driving impairment were also recorded in each trial. RESULTS: No effects of trial condition were observed on any of the driving performance measures or on subjective ratings of mood, alcohol intoxication, and driving impairment. SDLP was higher following the consumption of alcohol compared to the placebo trial. However, no differences in SDLP were recorded between the alcohol trials, indicating that hydration level had no observable interaction with alcohol to influence SDLP performance. CONCLUSIONS: Overall, it appears that dehydration does not exacerbate impairment in driving performance caused by mild-moderate alcohol intoxication. Further research is required to clarify the effects of alcohol and dehydration at various alcohol doses.

Relações fisiológicas em mudas de pata-de-vaca (Bauhinia forficata Link) / Physiologic relationships in Brazilian Orchid Tree (Bauhinia forficata Link) seedlings

Os fatores ambientais, tais como: temperatura do ar, umidade relativa do ar e radiação solar, influenciam no comportamento fisiológico dos vegetais refletindo no seu crescimento e desenvolvimento. O objetivo do trabalho foi avaliar o comportamento fisiológico em mudas de pata-de-vaca ao longo do dia e constatar qual o melhor horário para a realização de determinações de trocas gasosas. Para tanto, foram realizadas avaliações de temperatura da folha, radiação fotossinteticamente ativa, resistência estomática e transpiração, utilizando-se um porômetro, das 8:00 às 17:00 horas, em intervalos de uma hora entre as medidas. A espécie apresenta oscilações no seu mecanismo fisiológico em função do horário de avaliação e das condições climáticas, sendo o intervalo mais indicado para a realização de determinações das trocas gasosas das 10:00 às 13:00 horas.

Environmental elements, such as air temperature, relative humidity and solar radiation, affect the physiological behavior of plants, which is reflected in their growth and development. The objective of this study was to evaluate the physiological changes of Brazilian Orchid Tree seedlings over a typical day and find the best time to carry out determinations of gas exchanges. For this end, we evaluated temperature of the leaf, photosynthetically active radiation, stomatal resistance and perspiration, using a porometer, from 8:00 a.m. to 05:00 p.m., in intervals of one hour between measurements. The species presents oscillations in its physiologic mechanism in function of the time of evaluation and climatic conditions, being the most suitable interval to determine gas exchanges from 10:00 a.m. to 01:00 p.m.

Thermoanalytical studies of carbamazepine: hydration/dehydration, thermal decomposition, and solid phase transitions

Carbamazepine (CBZ), a widely used anticonvulsant drug, can crystallize and exhibits four polymorphic forms and one dihydrate. Anhydrous CBZ can spontaneously absorb water and convert to the hydrate form whose different crystallinity leads to lower biological activity. The present study was concerned to the possibility of recovering the hydrated form by heating. The thermal behavior of spontaneously hydrated carbamazepine was investigated by TG/DTG-DTA and DSC in dynamic atmospheres of air and nitrogen, which revealed that the spontaneous hydration of this pharmaceutical resulted in a Form III hydrate with 1.5 water molecules. After dehydration, this anhydrous Form III converted to Form I, which melted and decomposed in a single event, releasing isocyanic acid, as shown by evolved gas analysis using TG-FTIR. Differential scanning calorimetry analyses revealed that Form III melted and crystallized as Form I, and that subsequent cooling cycles only generated Form I by crystallization. Solid state decomposition kinetic studies showed that there was no change in the substance after the elimination of water by heating to 120 °C. Activation energies of 98 ± 2 and 93 ± 2 kJ mol-1 were found for the hydrated and dried samples, respectively, and similar profiles of activation energy as a function of conversion factor were observed for these samples.

A carbamazepina (CBZ) é um anticonvulsivante frequentemente utilizado no Brasil e em vários países. Ela apresenta quatro formas polimórficas e um diidrato. Todas as formas são ativas farmacologicamente, porém a Forma III é a preferível do ponto de vista farmacêutico, em função de suas propriedades físico-químicas. Entretanto, essa forma é altamente higroscópica, podendo converter-se ao diidrato, menos ativo biologicamente. Nesse trabalho propõe-se avaliar o comportamento térmico da forma hidratada, visando à recuperação da forma ativa, por aquecimento. Para tanto, foi feito um estudo do comportamento térmico por TG/DTG-DTA e DSC em atmosfera dinâmica de ar e nitrogênio, que evidenciou hidratação espontânea da Forma III, gerando um hidrato contendo 1,5 moléculas de água. Essa forma sofre desidratação, seguida de fusão e conversão para a Forma I. Segue-se a decomposição em uma única etapa, na qual ocorre liberação do ácido isociânico, conforme análise de gases evolvidos, por termogravimetria acoplada ao infravermelho (TG-FTIR). Estudos por calorimetria exploratória diferencial mostraram que a Forma III se funde e se cristaliza imediatamente na Forma I, durante o aquecimento. A Forma I também se funde e ciclos de aquecimento/resfriamento posteriores evidenciaram que a substância se cristaliza apenas na Forma I por resfriamento. Estudos cinéticos da decomposição, em estado sólido, mostraram que não há alteração na substância pela eliminação da água por aquecimento, sendo determinados valores de energia de ativação da ordem de 98 ± 2 e 93 ± 2 kJ mol-1, respectivamente, para a amostra hidratada e submetida à secagem, assim como perfis semelhantes nas curvas de energia de ativação em função do fator de conversão.

Study of thermal behavior of phytic acid

Phytic acid is a natural compound widely used as depigmenting agent in galenic cosmetic emulsions. However, we have observed experimentally that phytic acid, when heated to 150 ºC for around one hour, shows evidence of thermal decomposition. Few studies investigating this substance alone with regard to its stability are available in the literature. This fact prompted the present study to characterize this species and its thermal behavior using thermal analysis (TG/DTG and DSC) and to associate the results of these techniques with those obtained by elemental analysis (EA) and absorption spectroscopy in the infrared region. The TG/DTG and DSC curves allowed evaluation of the thermal behavior of the sample of phytic acid and enabled use of the non-isothermal thermogravimetric method to study the kinetics of the three main mass-loss events: dehydration I, dehydration II and thermal decomposition. The combination of infrared absorption spectroscopy and elemental analysis techniques allowed evaluation of the intermediate products of the thermal decomposition of phytic acid. The infrared spectra of samples taken during the heating process revealed a reduction in the intensity of the absorption band related to O-H stretching as a result of the dehydration process. Furthermore, elemental analysis results showed an increase in the carbon content and a decrease in the hydrogen content at temperatures of 95, 150, 263 and 380 °C. Visually, darkening of the material was observed at 150 °C, indicating that the thermal decomposition of the material started at this temperature. At a temperature of 380 °C, thermal decomposition progressed, leading to a decrease in carbon and hydrogen. The results of thermogravimetry coupled with those of elemental analysis allow us to conclude that there was agreement between the percentages of phytic acid found in aqueous solution. The kinetic study by the non-isothermal thermogravimetric method showed that the dehydration process occurred in two stages. Dehydration step I promoted a process of vaporization of water (reaction order of zero), whereas dehydration step II showed an order of reaction equal to five. This change in reaction order was attributed to loss of chemically bonded water molecules of phytic acid or to the presence of volatile substances. Finally, the thermal decomposition step revealed an order of reaction equal to one. It was not possible to perform the kinetic study for other stages of mass loss.

O ácido fítico é um composto natural muito utilizado como despigmentante em emulsões cosméticas magistrais. No entanto, observou-se experimentalmente que o ácido fítico, quando aquecido a 150 °C durante cerca de uma hora, mostra evidências de decomposição térmica e que poucos estudos envolvendo essa espécie, isoladamente quanto a sua estabilidade, estão disponíveis na literatura. Esse fato motivou o estudo de caracterização e de comportamento térmico dessa espécie, empregando a análise térmica (TG/DTG e DSC) e associando os resultados obtidos com aqueles de análise elementar (AE) e espectroscopia de absorção na região do infravermelho. As curvas TG/DTG e DSC permitiram avaliar o comportamento térmico da amostra de ácido fítico e, com isso, foi possível estudar, pelo método termogravimétrico não isotérmico, a cinética dos três principais eventos de perda de massa, o de desidratação I, desidratação II e de decomposição térmica. A associação das técnicas de espectroscopia de absorção no infravermelho e análise elementar permitiu avaliar os produtos intermediários da decomposição térmica do ácido fítico. Os espectros no infravermelho de amostras isoladas durante o aquecimento evidenciaram a diminuição de intensidade da banda de absorção relativa ao estiramento do grupo O-H como consequência do processo de desidratação. Também, os resultados de análise elementar indicaram que nas temperaturas de 95, 150 e 263 ºC houve aumento no teor de carbono e diminuição do teor de hidrogênio. Visualmente, observou-se o escurecimento do material a 150 ºC, indicando que a decomposição térmica do material iniciou-se nessa temperatura. Na temperatura de 380 ºC, a diminuição do teor de carbono e hidrogênio foi devido ao avanço do processo de decomposição térmica. Os resultados da termogravimetria juntamente com aqueles da análise elementar permitiram concluir que há concordância entre as percentagens de ácido fítico encontrado na solução aquosa. O estudo cinético pelo método termogravimétrico não isotérmico mostrou que o processo de desidratação ocorreu em duas etapas. Na etapa I da desidratação ocorreu um processo de vaporização de água (ordem de reação igual a zero). Na etapa II da desidratação foi encontrada uma ordem de reação igual a cinco. Essa mudança na ordem de reação foi atribuída à perda de moléculas de água quimicamente ligada, ao ácido fítico ou à presença de substâncias voláteis. Finalmente, na etapa de decomposição térmica foi observado que a ordem da reação foi igual a um. Para as outras etapas de perda de massa não foi possível a realização do estudo cinético.

Evaluation of a clinical dehydration scale in children requiring intravenous rehydration.

OBJECTIVES: To evaluate the reliability and validity of a previously derived clinical dehydration scale (CDS) in a cohort of children with gastroenteritis and evidence of dehydration. METHODS: Participants were 226 children older than 3 months who presented to a tertiary care emergency department and required intravenous rehydration. Reliability was assessed at treatment initiation, by comparing the scores assigned independently by a trained research nurse and a physician. Validity was assessed by using parameters reflective of disease severity: weight gain, baseline laboratory results, willingness of the physician to discharge the patient, hospitalization, and length of stay. RESULTS: Interobserver reliability was moderate, with a weighted κ of 0.52 (95% confidence interval [CI] 0.41, 0.63). There was no correlation between CDS score and percent weight gain, a proxy measure of fluid deficit (Spearman correlation coefficient = -0.03; 95% CI -0.18, 0.12). There were, however, modest and statistically significant correlations between CDS score and several other parameters, including serum bicarbonate (Pearson correlation coefficient = -0.35; 95% CI -0.46, -0.22) and length of stay (Pearson correlation coefficient = 0.24; 95% CI 0.11, 0.36). The scale's discriminative ability was assessed for the outcome of hospitalization, yielding an area under the receiver operating characteristic curve of 0.65 (95% CI 0.57, 0.73). CONCLUSIONS: In children administered intravenous rehydration, the CDS was characterized by moderate interobserver reliability and weak associations with objective measures of disease severity. These data do not support its use as a tool to dictate the need for intravenous rehydration or to predict clinical course.

Prolina livre em alecrim-pimenta sob estresse hídrico antes da colheita / Free proline in Lippia sidoides Cham. under water stress before harvest

O estresse hídrico é considerado um dos fatores limitantes para o desenvolvimento das plantas, com isso, os vegetais desenvolvem mecanismos para tolerar a deficiência hídrica do solo. Entre esses mecanismos, está o acúmulo de prolina livre nos tecidos, tendo como função a regulação osmótica dos tecidos. A influência do estresse hídrico em plantas medicinais ainda é pouco estudado, principalmente em plantas nativas, como é o caso do alecrim-pimenta Lippia sidoides Cham. Assim, o trabalho teve por objetivo avaliar a prolina livre e o teor de flavonoides totais na referida espécie sob condições de estresse hídrico antes da colheita. O trabalho foi realizado no Instituto de Ciências Agrárias da UFMG, Campus Montes Claros, delineamento em blocos casualizados, com 5 tratamentos e 4 repetições, sendo eles 8, 6, 4, 2 e 0 dias de supressão da irrigação antes da colheita. Os teores encontrados de prolina variaram entre 0,2489 a 3,2421 ìM.g-1 de matéria seca e de flavonoides entre 0,0139 a 0,008 g.g-1. Os resultados observados indicam que a planta diminui seu teor de flavonoides e aumenta o teor de prolina com o aumento do período de estresse.

Water stress is considered a limiting factor for plant growth, thus, the plants develop mechanisms to tolerate the soil water deficit. Among these mechanisms is the accumulation of free proline in tissues, with the poke the osmotic regulation of tissues. The influence of water stress in medicinal plants is still poorly studied, mainly on native plants such as rosemary-pepper Lippia sidoides Cham. Thus, the study aimed to evaluate the free proline and total flavonoid content in that species under conditions of water stress before harvest. The study was conducted at the Institute of Agricultural Sciences, UFMG, Campus Montes Claros, randomized block design with 5 treatments and 4 replicates, and they 8, 6, 4, 2 and 0 days of withholding irrigation before harvest. The content of proline ranged from 0.2489 to 3.2421 ìM.g-1 of dry matter and flavonoids from 0.0139 to 0.008 gg-1. The results indicate that the plant reduces its content of flavonoids and proline content increases with increasing stress time.

Emergency department management of gastro-enteritis in Australia and New Zealand.

OBJECTIVE: Comparison of clinical practice guideline (CPG) recommendations and reported physician management of gastro-enteritis at Paediatric Research in Emergency Departments International Collaborative (PREDICT) network sites as a baseline for further randomised controlled trials. METHODS: Two part survey comprising: (i) review of CPGs from PREDICT sites for gastro-enteritis; and (ii) survey of senior emergency department physicians regarding the management of gastro-enteritis. RESULTS: All 11 PREDICT sites participated. Nine CPGs were available with three sites using a common CPG. For moderate dehydration, eight CPGs advocated nasogastric (NG) rehydration in preference to intravenous (IV) rehydration. The IV route was reserved for severe dehydration or failed NG rehydration. In the second component of the survey, 78 of 83 (94%) physicians responded. In moderate dehydration, 82% of respondents used NG rehydration. In severe dehydration, 86% used IV fluids; 12% used NG and 3% an initial IV bolus followed by NG fluid. Serum electrolytes were measured universally with IV fluid use and by 22% using NG rehydration. The IV fluid bolus was with normal saline (86%). Fifty-four per cent used anti-emetics 'rarely' or 'sometimes'. The commonest agents were ondansetron (60%) and metoclopramide (29%). CONCLUSIONS: CPG recommendations and physician practice for the management of gastro-enteritis were similar across PREDICT sites with a focus on NG for moderate dehydration and IV for severe dehydration. A variety of fluids and administration rates were used. Anti-emetics were used infrequently. The efficacy and safety of newer anti-emetics should be explored in collaborative studies. Collaborative development of new CPGs should be considered to simplify fluid regimens.

La neonatología en la atención primaria de salud / The neonatology in primary health care

Este libro es una experiencia única en el país y en Latinoamérica, el haber contado con cerca de cien profesionales involucrados en la atención neonatal (médicos, enfermeras, y otros profesionales de la salud), todos ellos prestadores de servicios de los principales establecimientos de salud materna e infantil de Bolivia. El libro pretende ser un texto de consulta, no es normativo pero se encuadra en la publicaciones científicas y técnicas del Ministerio de Salud y Deportes, de manera que pueda dar un valor agregado en conocimientos a las normas de atención del Seguro Universal Materno Infantil (SUMI) y conforme a lo estipulado en la Ley del Ejercicio Profesional

Crisis de Cianosis / Cyanosis of crisis

La crisis de cianosis son eventos hallados casi exclusivamente en la tetralogía de Fallot. Se caracterizan por irritabilidad, cianosis aguda y taquipnea. En situaciones más graves puede llevar a la hipotonía, pérdida de conocimiento, convulsiones, accidente cerebrovascular y muerte. Es el evento más grave de laTetralogía de Fallot. Se observa en 30 por ciento de estos pacientes, mayormente entre los 3 y 5 meses de edad. Se basa fisiopatológicamente en una disminución brusca del flujo pulmonar (generalmente por espasmos infundibular) y aumento del cortocircuito derecha izquierda, con paso de la sangre insaturada al circuito sistémico. Puede ser desencadenado por disminución de la resistencia vascular periférica (hipotensiónarterial, deshidratación), irritación, aumento de la presión pulmonar, etc

Crisis de Cianosis / Cyanosis of crisis

La crisis de cianosis son eventos hallados casi exclusivamente en la tetralogía de Fallot. Se caracterizan por irritabilidad, cianosis aguda y taquipnea. En situaciones más graves puede llevar a la hipotonía, pérdida de conocimiento, convulsiones, accidente cerebrovascular y muerte. Es el evento más grave de laTetralogía de Fallot. Se observa en 30 por ciento de estos pacientes, mayormente entre los 3 y 5 meses de edad. Se basa fisiopatológicamente en una disminución brusca del flujo pulmonar (generalmente por espasmos infundibular) y aumento del cortocircuito derecha izquierda, con paso de la sangre insaturada al circuito sistémico. Puede ser desencadenado por disminución de la resistencia vascular periférica (hipotensiónarterial, deshidratación), irritación, aumento de la presión pulmonar, etc

Value of laboratory studies in assessment of dehydration in children.

BACKGROUND: Due to the lack of a reliable way of clinically measuring dehydration, laboratory tests are usually used to improve the accuracy of clinical assessment of dehydration in children. The purpose of this study was to compare the relationship between clinical and laboratory parameters in the assessment of dehydration and to evaluate the improvement of those parameters over time. METHODS: We conducted a retrospective study to assess the relationship between clinical assessment of dehydration and laboratory findings. RESULTS: Three hundred children were eligible for the study. Twenty-six per cent of those with mild dehydration had serum urea concentrations greater than 14.3 mmol/L, compared with 38% and 5% of those with moderate or no dehydration, respectively. Urea concentration showed a good specificity, 95%. Creatinine concentrations and mean pH were similar whether or not dehydration was present. Bicarbonate and base excess concentrations decreased with the increasing severity of dehydration and were significantly greater in subjects with moderate dehydration than in those without. The sensitivity (71%) and specificity (74%) of both tests were rather poor. All groups had an abnormal anion gap, which was significantly greater in those with mild or moderate dehydration. CONCLUSION: This study confirms that there is a discrepancy between clinical assessment and laboratory parameters of dehydration. Urea showed good specificity, and anion gap was the most sensitive laboratory parameter for assessment of dehydration. These findings need further validation.

Physician misdiagnosis of dehydration in older adults.

INTRODUCTION: Dehydration is a difficult clinical diagnosis in older adults because the physical signs of dehydration are often confusing. The clinical consequences of a diagnosis of dehydration are critical, since dehydration implies increased morbidity and mortality and aggressive rehydration can improve clinical outcome. The diagnosis is a sentinel event for nursing homes, and often is made at transfer to a hospital. OBJECTIVE: To define the accuracy of the clinical diagnosis of dehydration during hospital admission, and to observe persons admitted from long-term care. METHODS: A total of 102 consecutive medical admissions in persons older than 65 years with a diagnostic coding for dehydration either on admission or during the course of hospitalization over a 3-month period at a university teaching hospital were reviewed. The diagnosis of dehydration was considered confirmed if the calculated serum osmolarity was greater than 295 milliosmols (mOsmol). Subjects were considered to have intravascular volume depletion if the ratio of blood urea nitrogen (BUN) to serum creatinine was greater than 20 or the serum sodium was greater than 145 milligrams per deciliter. Subjects were considered to have hypovolemia if the serum osmolarity was greater than 295 and the BUN/creatinine ratio was greater than 20. RESULTS: Among subjects with a clinical diagnosis of dehydration, only 17% had a serum osmolarity >295 mOsm, and only 11% had a serum sodium greater than 145. A BUN/creatinine ratio greater than 20 was present in 68% of the subjects. Clinicians appear to be using the term dehydration synonymously with intravascular volume depletion. Even so, at least a third of the diagnoses of intravascular volume depletion in older adults were incorrect based on laboratory data. CONCLUSION: Physicians who diagnose dehydration during hospital admission may be relying more on physical signs than laboratory data. Little change in laboratory markers for hydration status occurs from the time of diagnosis to hospital discharge, suggesting that the clinical diagnosis does not affect fluid management. The data suggest a need for improvement in the differential diagnosis and management of volume changes in older persons.