Seroprevalence of hepatitis E virus in patients with chronic liver disease.

INTRODUCTION: The seroprevalence of hepatitis E virus (HEV) in patients with chronic liver disease (CLD) is little known in Brazil. Studies have suggested that HEV may harmfully influence the course of CLD, with a higher risk of progression to cirrhosis. OBJECTIVE: To estimate the prevalence of the anti-HEV antibody (IgG) in patients with CLD and to describe demographic data and risk factors, as well as clinical-laboratory and ultrasound parameters. PATIENTS AND METHODS: Cross-sectional study that included 227 patients with CLD followed at a referral outpatient clinic from June 2022 to March 2023. The patients were investigated clinically and tested for liver functions, anti-HEV IgG and, in positive cases, for HEV-RNA. Ultrasonography of the upper abdomen was also carried out. RESULTS: Investigation of 227 patients (50 with hepatitis B, 49 with nonalcoholic fatty liver disease, 33 with hepatitis C, 17 with alcoholic liver disease, 16 with schistosomiasis and 62 with mixed disease), 55.5% were female, with an average age of 57 ± 13 years; 37.9% had liver cirrhosis. Seven patients (3.08%) presented anti-HEV positive and HEV-RNA negative. Ultrasound identified association between anti-HEV and contact with pigs, presence of gynecomastia or palmar erythema, lower platelet count, higher APRI and FIB-4 values, and splenomegaly. CONCLUSION: Although the prevalence of anti-HEV in patients with CLD was low in this study, the antibody was observed more frequently in cases with a history of contact with pigs and with clinical-laboratory or imaging evidence of more advanced chronic liver disease.

Air pollution epidemiology: A simplified Generalized Linear Model approach optimized by bio-inspired metaheuristics.

Studies in air pollution epidemiology are of paramount importance in diagnosing and improve life quality. To explore new methods or modify existing ones is critical to obtain better results. Most air pollution epidemiology studies use the Generalized Linear Model, especially the default version of R, Splus, SAS, and Stata softwares, which use maximum likelihood estimators in parameter optimization. Also, a smooth time function (usually spline) is generally used as a pre-processing step to consider seasonal and long-term tendencies. This investigation introduces a new approach to GLM, proposing the estimation of the free coefficients through bio-inspired metaheuristics - Particle Swarm Optimization (PSO), Genetic Algorithms, and Differential Evolution, as well as the replacement of the spline function by a simple normalization procedure. The considered case studies comprise three important cities of São Paulo state, Brazil with distinct characteristics: São Paulo, Campinas, and Cubatão. We considered the impact of particles with an aerodynamic diameter less than 10 µm (PM10), ambient temperature, and relative humidity in the number of hospital admissions for respiratory diseases (ICD-10, J00 to J99). The results showed that the new approach (especially PSO) brings performance gains compared to the default version of statistical software like R.

Efeitos da meditação associada a educação em neurociências da dor em adultos com fibromialgia: ensaio clínico controlado e randomizado / Effects of meditation associated with education in neurosciences of pain in adults with fibromyalgia: A randomized controlled trial / Efectos de la meditación asociada con la educación en neurociencia del dolor en adultos con fibromialgia: un ensayo clínico aleatorio controlado

OBJETIVO: analisar os efeitos do mindfulness associado com educação em neurociências da dor na percepção da dor, sono e capacidade funcional de adultos com fibromialgia. MÉTODO: trata-se de um estudo experimental controlado e randomizado cujos participantes foram divididos em dois grupos: grupo mindfulness e grupo mindfulness e educação em neurociência da dor. RESULTADOS: foram observadas melhorias de algumas variáveis relacionadas à dor, na capacidade funcional, ansiedade, depressão, qualidade do sono e na catastrofização. Não houve diferença na comparação intergrupos, porém existiram diferenças na comparação intra-grupos. CONCLUSÃO: intervenções baseadas na prática de mindfulness e educação em neurociências da dor se mostraram eficazes na melhora do quadro de pacientes com fibromialgia. Registro do Ensaio clínico: REBEC RBR-58pgs4.

OBJECTIVE: to analyze the influence of meditation associated with pain neuroscience education in pain perception, sleep and functional capacity of adults with fibromyalgia. METHOD: this is an experimental, controlled, randomized study whose participants were divided into two groups: mindfulness group and mindfulness group and education in pain neuroscience. RESULTS: improvements were observed in some variables related to pain, functional capacity, anxiety, depression, sleep quality and catastrophization. 270/5000. There was no difference in the intergroup comparison, but there were differences in the intra-group comparison. CONCLUSION: mindfulness-based interventions and education in pain neurosciences proved to be effective in improving the condition of patients with fibromyalgia. Clinical trial register: REBEC RBR-58pgs4

OBJETIVO: analizar los efectos de la atención plena asociada con la educación en neurociencias del dolor sobre la percepción del dolor, el sueño y la capacidad funcional de los adultos con fibromialgia. MÉTODO: este es un estudio experimental, controlado, aleatorizado cuyos participantes se dividieron en dos grupos: grupo de atención plena y grupo de atención plena y educación en neurociencia del dolor. RESULTADOS: se observaron mejoras en algunas variables relacionadas con el dolor, la capacidad funcional, la ansiedad, la depresión, la calidad del sueño y la catastrofización. No hubo diferencias en la comparación intergrupal, pero sí hubo diferencias en la comparación intragrupo. CONCLUSIÓN: las intervenciones basadas en la práctica de la atención plena y la educación en neurociencias del dolor demostraron ser efectivas para mejorar la condición de los pacientes con fibromialgia. Registro del ensayo clínico: REBEC RBR-58pgs4

Qualidade de vida de cuidadoras formais de idosos / Quality of life of formal caregivers of the elderly / Calidad de vida de los cuidadores formales de personas mayores

Pesquisa descritiva e exploratória de abordagem quantitativa realizada em dois serviços de longa permanência para idosos em municípios baianos, com o objetivo de avaliar a qualidade de vida de cuidadores de idosos residentes em Instituições de Longa Permanência. A amostra foi constituída por 18 cuidadores. O instrumento de coleta de dados foi composto por dados sociodemográficos, condições de saúde e o questionário WHOQOL-Bref. Na avaliação da qualidade de vida, constatou-se que os cuidadores de idosos apresentaram menor pontuação no domínio meio ambiente (52,14 pontos) e maior pontuação no domínio psicológico (79,16 pontos). Concluiu-se que a qualidade de vida dos cuidadores formais de idosos avaliados apresenta comprometimento no Domínio Meio Ambiente.

This is a descriptive and exploratory study with a quantitative approach carried out in two long-term care facilities for the elderly in municipalities of Bahia, with the purpose of evaluating the quality of life of the caregivers of the elderly residents in long stay institutions. The sample consisted of 18 caregivers. The data collection instrument consisted of sociodemographic information, health conditions and the WHOQOL-Bref questionnaire. In evaluating the quality of life it was verified that the caregivers had lower scores in the environment domain (52.14 points) and higher scores in the psychological domain (79.16 points). It was concluded that the quality of life of the assessed caregivers demonstrated commitment in the Domain Environment.

Se trata de un estudio descriptivo y exploratorio con enfoque cuantitativo llevado a cabo en dos centros de atención a largo plazo para personas mayores en municipalidades de Bahia, con el objetivo de evaluar la calidad de vida de los cuidadores de ancianos residentes in instituciones de larga estadía. La muestra fue constituida por 18 cuidadores. El instrumento de recolecta de datos consistió en información sociodemográfica, las condiciones de salud y el cuestionario WHOQOL-Bref. En la evaluación de la calidad de vida se encontró que los cuidadores de ancianos tenían puntuaciones más bajas en el campo del medio ambiente (52,14 puntos) y una puntuación más alta en el dominio psicológico (79,16 puntos). Se concluyó que la calidad de vida de los cuidadores formales de ancianos evaluados presenta comprometimiento en el dominio del medio ambiente.

Treatment adherence and life quality of diabetic patients assisted in the primary care division / Aderência ao tratamento e qualidade de vida de pacientes diabéticos assistidos na atenção primária de saúde

BACKGROUND AND OBJECTIVE: This study sought to evaluate the association between treatment adherence and life quality of diabetic patients assisted in Primary Health Care Units of four cities of Alagoas. METHODS: It was an observational study based on a quantitative approach of transversal investigation. Data came from diabetic patients who were helped out in Primary Health Care Units of the Health Public System of Alagoas/Brazil, from December 2009 to July 2010, in four cities of the state and through the application of socioeconomic and demographic questionnaires and the Morisky-Green and World Health Organization Quality of Life BREF (WHOQOL-BREF) tests. For the analysis, it was used the resources of the Epi Info program. RESULTS: The sample consisted of 711 diabetic patients, predominantly female (71%). The mean age was 61.1, the majority declared to be married, having an average of 4.5 live children. Most were of low education and did not perform any paid activity; 43.4% live with a Brazilian minimum wage or less. It was observed that 61.5% of the population studied was diagnosed with the disease for more than five years. The study showed a better life quality in the social domain of WHOQOL-BREF. According to the Morisky-Green test, there was a higher frequency of patients with an intermediate class of adherence. The study also showed a good adherence to the treatment and a satisfactory evaluation for the general life quality of the population and an association between these two factors. CONCLUSION: There was better correlation between adherence and the quality of life in the social...

JUSTIFICATIVA E OBJETIVO: Este estudo procurou avaliar a associação entre a adesão ao tratamento e qualidade de vida de pacientes diabéticos atendidos em Unidades Básicas de Saúde de quatro cidades de Alagoas. MÉTODOS: Foi um estudo observacional com base em uma abordagem quantitativa de investigação transversal. Os dados vieram de pacientes diabéticos que foram ajudados em Unidades Básicas de Saúde do Sistema Público de Saúde de Alagoas/Brasil, de dezembro de 2009 a julho de 2010, em quatro cidades do Estado e por meio da aplicação de questionários socioeconômicos e demográficos e Morisky-Green e testes World Health Organization Quality of Life BREF (WHOQOL-BREF). Para a análise, foram utilizados os recursos do programa Epi Info. RESULTADOS: A amostra foi composta de 711 pacientes diabéticos, predominantemente do sexo feminino (71%). A idade média foi de 61,1 anos, a maioria declarou ser casado, com uma média de 4,5 filhos vivos. A maioria era de baixa escolaridade e não realiza qualquer atividade remunerada: 43,4% vivem com um salário mínimo brasileiro ou menos. Observou-se que 61,5% da população estudada foram diagnosticadas após mais de cinco anos da doença. O estudo mostrou uma melhor qualidade de vida no domínio social do WHOQOL-BREF. De acordo com o teste de Morisky-Green, houve uma maior frequência de pacientes com uma classe intermediária de aderência. O estudo também mostrou uma boa adesão ao tratamento e uma avaliação satisfatória para a qualidade de vida geral da população, e ainda uma associação entre esses dois fatores. CONCLUSÃO: Houve melhor correlação entre adesão ao tratamento e qualidade de vida no campo social...

Fluid overload and changes in serum creatinine after cardiac surgery: predictors of mortality and longer intensive care stay. A prospective cohort study.

INTRODUCTION: Fluid overload is a clinical problem frequently related to cardiac and renal dysfunction. The aim of this study was to evaluate fluid overload and changes in serum creatinine as predictors of cardiovascular mortality and morbidity after cardiac surgery. METHODS: Patients submitted to heart surgery were prospectively enrolled in this study from September 2010 through August 2011. Clinical and laboratory data were collected from each patient at preoperative and trans-operative moments and fluid overload and creatinine levels were recorded daily after cardiac surgery during their ICU stay. Fluid overload was calculated according to the following formula: (Sum of daily fluid received (L)--total amount of fluid eliminated (L)/preoperative weight (kg) × 100). Preoperative demographic and risk indicators, intra-operative parameters and postoperative information were obtained from medical records. Patients were monitored from surgery until death or discharge from the ICU. We also evaluated the survival status at discharge from the ICU and the length of ICU stay (days) of each patient. RESULTS: A total of 502 patients were enrolled in this study. Both fluid overload and changes in serum creatinine correlated with mortality (odds ratio (OR) 1.59; confidence interval (CI): 95% 1.18 to 2.14, P = 0.002 and OR 2.91; CI: 95% 1.92 to 4.40, P <0.001, respectively). Fluid overload played a more important role in the length of intensive care stay than changes in serum creatinine. Fluid overload (%): b coefficient = 0.17; beta coefficient = 0.55, P <0.001); change in creatinine (mg/dL): b coefficient = 0.01; beta coefficient = 0.11, P = 0.003). CONCLUSIONS: Although both fluid overload and changes in serum creatinine are prognostic markers after cardiac surgery, it seems that progressive fluid overload may be an earlier and more sensitive marker of renal dysfunction affecting heart function and, as such, it would allow earlier intervention and more effective control in post cardiac surgery patients.

Infant feeding: the interfaces between interaction design and cognitive ergonomics in user-centered design.

This text presents a discussion on the process of developing interactive products focused on infant behavior, which result was an interactive game for encouraging infant feeding. For that, it describes the use of cognitive psychology concepts added to interaction design methodology. Through this project, this article sustains how the cooperative use of these concepts provides adherent solutions to users' needs, whichever they are. Besides that, it verifies the closeness of those methodologies to boundary areas of knowledge, such as design focused on user and ergonomics.

Avaliação de programa de ensino-aprendizagem sobre metabolismo de cálcio e fósforo para pacientes em hemodiálise / Evaluation of an educational program on calcium and phosphorus metabolism for patients on hemodialysis / Evaluación de programa de enseñanza-aprendizaje sobre metabolismo de calcio y fósforo para pacientes en hemodiálisis

Estudo de corte avaliando efeitos de programa de ensino-aprendizagem sobre o metabolismo e controle de níveis séricos de cálcio (Ca), fósforo (PO4), paratormônio (PTH), produto Ca x PO4, em 33 pacientes estáveis em HD, randomizados para dois grupos: Controle (n=17) e Intervenção (n=16). O grupo Controle recebeu informação sobre acesso vascular: a Intervenção sobre metabolismo de Ca, PO4 e PTH. Mudanças de conhecimento avaliadas por testes pré e pós-classe; adesão à terapia por dosagens laboratoriais seriadas. Não houve mudança significativa de conhecimento em qualquer grupo [Intervenção: 8/17 vs. 14/17 pacientes competentes no pré e pós-teste, respectivamente (P<0.001); Controle: 11/16 vs. 13/16 pacientes competentes, respectivamente (P<0.001)]. Houve redução de PO4 e produto Ca x PO4 entre tempos 0 e 1 em ambos os grupos e entre tempos 1 e 2 no grupo Controle. Concluiu-se que o programa não induziu mudança de conhecimento ou comportamento e que os programas de ensino-aprendizagem para renais crônicos devem ser contínuos.

This cohort study evaluated the effects of an educational program about metabolism and control of serum levels of calcium (Ca), phosphorus (PO4), parathormone (PTH), Ca x PO4 product on 33 stable patients on hemodialysis. Patients were randomized into two groups: control (n=17) and intervention (n=16). The control group received information on vascular access. The intervention group was informed about Ca, PO4 and PTH metabolism. The changes in knowledge were evaluated using tests. Treatment compliance was assessed by serial laboratory tests. No significant change was observed in their knowledge [intervention: 8/17 vs. 14/17 competent patients before and after class, respectively (P<0.001); control: 11/16 vs. 13/16 competent patients, respectively (P<0.001)]. A reduction was observed in PO4 and Ca x PO4 product between time 0 and 1 in both groups and between time 1 and 2 in the control group. The program did not induce changes in knowledge or behavior. In conclusion, chronic renal patients should be offered continuous educational programs.

Estudio de cohorte evaluando efectos de programa de enseñanza-aprendizaje sobre el metabolismo y control de niveles séricos de calcio (Ca), fósforo (PO4), parathormona (PTH), producto Ca x PO4 en 33 pacientes estables en HD, randomizados para dos grupos: Control (n=17) e Intervención (n=16). El grupo Control recibió información sobre acceso vascular; el grupo Intervención, sobre metabolismo de Ca, PO4 y PTH. Cambios de conocimiento evaluadas por pruebas pre y post clases, adhesión a la terapia por dosajes laboratoriales seriados. No existió cambio significativo de conocimiento en cualquier grupo [Intervención: 8/17 vs 14/17 pacientes competentes en las etapas pre y post prueba, respectivamente (P<0,001); Control: 11/16 vs. 13/16 pacientes competentes, respectivamente (P<0,001)]. Existió reducción de PO4 y producto Ca x PO4 entre momentos 0 y 1 en ambos grupos y entre momentos 1 y 2 en el grupo Control. El programa no indujo cambios de conocimiento o comportamiento. Los programas de enseñanza-aprendizaje para enfermos renales crónicos deben ser continuos.

Detecção precoce de carcinoma basocelular: importância da visita domiciliar no contexto da atenção integral à saúde do idoso / Early detection of basal cell carcinoma: importance of the home visit in the context of comprehensive elderly health care

A atenção primária à saúde visa à promoção, à proteção e à recuperação da saúde dos indivíduos e da família continuamente.Através das visitas domiciliares, os profissionais entram em contato com a realidade dos indivíduos assistidos,reconhecendo seus problemas e suas necessidades de saúde.Esse relato de experiência demonstra a importância das visitas domiciliares em detectar precocemente patologias que, muitas vezes, não são evidenciadas em ambulatórios.A detecção do Carcinoma Basocelular se deu durante uma visita domiciliar, vista como estratégia que viabiliza a intermediação entre o domicílio e a Unidade de Saúde da Família. No Brasil, o câncer de pele continua sendo o tipo mais incidente para ambos os sexos, correspondendo acerca de 25% de todos os tumores diagnosticados em todasas regiões geográficas. Quando detectado precocemente,este tipo de câncer apresenta altos percentuais de cura.

Primary health care aims to continuo usly promote, protectand restore the health of individuals and families. Throughhome visits professionals capture the reality of the individual sassisted, recognizing their problems and health needs.This case report demonstrates the importance of homevisits to detect early disease, which is often not found inclinics. Detection of a case of basal cell carcinoma occurred during a home visit, a strategy that liaises the household with the Family Health Unit. In Brazil, skin cancer remainsthe most frequent type of cancer for both sexes, accountingfor about 25% of all tumors diagnosed in all geographic regions. When detected early this type of cancer has a highcure rate.

[Evaluation of an educational program on calcium and phosphorus metabolism for patients on hemodialysis]. / Avaliação de programa de ensino-aprendizagem sobre metabolismo de cálcio e fósforo para pacientes em hemodiálise.

This cohort study evaluated the effects of an educational program about metabolism and control of serum levels of calcium (Ca), phosphorus (PO4), parathormone (PTH), Ca x PO4 product on 33 stable patients on hemodialysis. Patients were randomized into two groups: control (n = 17) and intervention (n = 16). The control group received information on vascular access. The intervention group was informed about Ca, PO4 and PTH metabolism.The changes in knowledge were evaluated using tests. Treatment compliance was assessed by serial laboratory tests. No significant change was observed in their knowledge [intervention: 8/17 vs. 14/17 competent patients before and after class, respectively (P < 0.001); control: 11/16 vs. 13/16 competent patients, respectively (P < 0.001)]. A reduction was observed in PO4 and Ca x PO4 product between time 0 and 1 in both groups and between time 1 and 2 in the control group. The program did not induce changes in knowledge or behavior. In conclusion, chronic renal patients should be offered continuous educational programs.

Perfil epidemiológico da tuberculose entre casos notificados no Município de Pririri, Estado do Piauí, Brasil / Profile epidemiologist of the tuberculosis between cases notified in the City of Pririri, State of the Piauí, Brazil

Embora conhecida desde a Antiguidade, a tuberculose continua preocupando as autoridades sanitárias até os dias de hoje. O presente estudo descreve o perfil clínico e epidemiológico da doença entre casos notificados à Secretaria Municipal de Saude de Piriri, estado do Piauí, no período de junho de 1997 a outubro de 2000. Os dados foram coletados a partir das Fichas de Investigação Individual da doença e do Livro de Registro e Controle de tratamento dos casos de tuberculose e, a seguir, processados pelo software Epi info6.04b. Verificou-se predomínio da doença em pessoas do sexo masculino(61,4 por cento) adultos jovens(40,2 por cento) e analfabetos(68,4 por cento). A incidência foi de 82,4 e 80,2 casos por 100.000 habitantes, respectivamente, nos anos de 1998 e 1999. Com relação aos aspectos clínicos, 93,1 por cento dos doentes apresentaram tuberculose pulmonar. De todos os casos, a baciloscopia foi realizada em 93,1 por cento; destes, 75,5 por cento apresentaram resultado positivo. A radiologia torácica foi empregada em 34,5 por cento dos enfermos. Quanto à evolução dos casos, 91,7 por cento foram curados, ocorreram dez caso de óbito(6,9 por cento) e apenas um caso de abandono(0, 7 por cento) do Programa de Controle da Tuberculose(PCT) do Município. A investigação possibilitou conhecer características da tuberculose na população estudada, além de avaliar, indiretamente, o serviço de saúde dirigido ao controle da doença em Piriri-PI...

Mycophenolic acid pharmacokinetics in stable pediatric renal transplantation.

Mycophenolate mofetil (MMF) is given to children in fixed doses based either on body weight or body surface area. There are data indicating mycophenolic acid (MPA) blood levels should be monitored in the early period of transplantation. However, there is little information regarding MPA pharmacokinetics (PK) in stable pediatric recipients. We evaluated MPA-PK in 20 stable renal transplant children (11.7+/-1.9 years) under long-term (46+/-31 months) MMF (26.1+/-7 mg/kg per day or 785+/-183 mg/m(2) per day) therapy plus prednisone and cyclosporin A (n=16), tacrolimus (n=3), or MMF/prednisone (n=1). Total MPA levels were measured using the EMIT-MPA assay at 0, 1, 2, 3, 4, 6, and 8 h after an oral dose of MMF. The level at 12 h was considered equal to the trough level for AUC(0-12) calculation. Mean C(0), C(max), AUC (0-12), and T(max )were 3.46+/-1.32, 13.5+/-0.58 microg/ml, 63.2+/-24.4 microg x h/ml, and 1.3+/-0.6 h, respectively. Six (30%) children were considered to have an adequate exposure (36-54 microg x h/ml) to MPA, 11 (55%) showed an AUC(0-12 )>54 microg.h/ml, and 3 (15%) showed an AUC(0-12 )<36 microg x h/ml. A C(max )>/=10 microg/ml was seen in 13 (65%) children. MMF dose did not correlate with AUC(0-12) or C(max). The combination of variables C(0), C(1), and C(4 )provided an equation to predict exposure (r(2)=0.75) where AUC(0-12)=12.62+(7.78 x C(0))+(0.90 x C(1))+(1.30 x C(2)) (P<0.001). The use of MMF without monitoring MPA blood levels may cause unnecessary overexposure to the drug in stable pediatric recipients.

A strategy to calculate cyclosporin A area under the time-concentration curve in pediatric renal transplantation.

The complete area under the time-concentration curve (AUC) is considered the gold standard for cyclosporin A (CsA) monitoring, particularly in pediatric kidney graft recipients who have great absorption and drug clearance variability. However, complete AUC is time-consuming and expensive. For this reason, we retrospectively reviewed 131 complete 4-h AUC (AUC0-4) performed in 34 children (mean age 10.6 +/- 2 yr) in order to construct an equation to calculate AUC0-4. The median time after transplantation was 540 (range: 247-1,358) days. Multiple regression analysis was performed either with a single variable or with a combination of two variables. CsA blood concentration at the second hour after the oral morning dose (C2) was the best predictor of AUC0-4, where AUC0-4 = 424 + (2.65 x C2), R2 = 0.81, p < 0.001. Only the combination of C1 and C2 offered mathematical improvement over the C2 equation. The same analysis was made for pharmacokinetic curves performed earlier than 6 months (79 +/- 55 days, range 8-169 days) and after 1 yr of transplantation. In both time-periods, C2 was the best parameter to use to calculate AUC0-4. The equations obtained during these two time-periods were very close to the one for the whole population. Our data shows that C2 can be safely used to estimate AUC0-4. However, for values above 4,000 ng/h/mL, the formula overestimates the trapezoidal AUC0-4. The C2 equation simplifies the CsA monitoring as a result of its high predictive value and clinical feasibility.

Sampling strategy to calculate the cyclosporin-A area under the time-concentration curve.

The complete area under the time-concentration curve (AUC) is considered to be the gold standard for cyclosporin-A (CyA) monitoring. However, complete AUC is time- and cost-consuming. For this reason, we reviewed 259 4-h AUC (AUC0-4) performed in 74 renal transplanted patients in order to construct an equation to calculate AUC0-4. All samples were drawn from one adult population 13 days following transplantation, in order to allow the cyclosporin metabolism to stabilize. Regression analysis was done either with each or with a combination of two variables. Cyclosporin-A blood concentration at the second hour after the oral dose (C2) was the best predictor of AUC0-4, where AUC0-4 = 451 +(2.73 x C2), R2 = 0.87, p<0.001. The combination of C1 and C2 only, offered a better mathematical improvement to the C2 equation. This equation was further validated in 33 other CyA pharmacokinetic profiles performed in eight patients who had not participated in the equation development. In this new population, the C2 equation excellently predicted the trapezoidal AUC0-4 (R2 = 0.81). Our data shows that C2 can be safely used to estimate AUC0-4. The C2 equation simplifies CyA monitoring because of its high-predictive value and clinical feasibility.

Ecocardiografia fetal na avaliaçäo de anormalidades cardíacas estruturais e funcionais / Fetal echocardiography in the evaluation of cardiac structural and functional abnormalities

De julho de 1987 a abril de 1988 foram submetidas à ecocardiografia fetal 75 gestantes entre 18 a 42 semanas. As indicaçöes mais freqüentes para o exame foram diabetes materna (30,6%), seguida de história de filho cardiopata (12%), arritmia fetal (12%), cardiopatia congênita materna (10,6%), retardo de crescimento intra-uterino (6,6%), malformaçöes fetais (5,3%), polidrâmnio (4%). Anormalidades estruturais isoladas foram encontradas em três casos e associadas com arritmia em dois casos (total 6,6%). O diagnóstico foi confirmado pelo ecocardiograma pós-natal, cateterismo ou necropsia. Em apenas um caso, extremamente complexo, de Síndrome do Isomerismo Atrial Esquerdo, näo se diagnosticou presença de dextrocardia e dupla via de saída de ventrículo direito. Arritmias fetais foram encontradas, acompanhadas de anatomia cardíaca normal, em nove casos (12%), sendo a extrassistolia atrial a mais freqüente (55,5%), com retorno para ritmo sinusal em todos os casos. Os achados deste estudo indicam que a anatomia e funçäo cardíaca fetal avaliadas com precisäo teräo um forte impacto no campo do tratamento do feto e recém-nascido portadores de cardiopatia congênita

Proposta de intervenção em adesão ao tratamento de pacientes diabéticos adscritos na unidade de Saúde da Família Cruzeiro II

O presente estudo propõe um plano de intervenção para aumentar a adesão ao tratamento de pacientes diabéticos adscritos na Unidade de Saúde da Família Cruzeiro II do Município de São Sebastião - AL. O estudo usa como método o Planejamento Estratégico Situacional e foi realizado nas seguintes etapas: identificação e priorização dos problemas da USF Cruzeiro II, seleção, descrição e identificação das causas do problema priorizado, pesquisa bibliográfica, revisão de literatura e projeto de intervenção. Nessa ultima etapa, por meio da pesquisa na literatura e do diagnóstico situacional da comunidade Cruzeiro II, foram sugeridas soluções e estratégias que contribuirão para a adesão ao tratamento de diabéticos assistidos na ESF Cruzeiro II