Comparing Survival Outcomes between Hemodialysis and Hemodiafiltration Using Real-World Data from Brazil.

The CONVINCE trial demonstrates that high-dose hemodiafiltration offers a survival advantage for patients in the high-flux hemodiafiltration group compared to hemodialysis. We compared the outcomes of hemodialysis and hemodiafiltration using real-world data. We conducted an analysis on a cohort of patients who underwent hemodiafiltration therapy (HDF) at a single center, NefroStar Clinics. The results obtained were then compared with data from patients receiving hemodialysis (HD) therapy within the Brazilian Public Health System (SUS). The primary outcome was mortality from any cause. Results: A total of 85 patients undergoing hemodiafiltration were compared with 149,372 patients receiving hemodialysis through the Brazilian Public Health System (SUS). Using a 2:1 propensity score, we compared the 170 best-match HD patients with 85 HDF patients. In the Cox analysis, HDF therapy showed a reduced risk of mortality with an HR of 0.29 [0.11-0.77]. The propensity score analysis showed a HR of 0.32 [95% CI: 0.11-0.91]. This analysis was adjusted for age, type of access, KT/v, hemoglobin, and phosphorus. The Kaplan-Meier analysis showed respective survival rates for HDF and HD at the end of one year, 92.1% and 79.9%, p < 0.001. These results suggest high-flux hemodiafiltration has survival advantages over hemodialysis in a real-world scenario.

The Role of Peritoneal Dialysis in the Treatment of Acute Kidney Injury in Patients With Acute-on-Chronic Liver Failure: A Prospective Brazilian Study.

This study aimed to explore the role of peritoneal dialysis (PD) in acute-on-chronic liver disease (ACLD) in relation to metabolic and fluid control and outcome. Fifty-three patients were treated by PD (prescribed Kt/V = 0.40/session), with a flexible catheter, tidal modality, using a cycler and lactate as a buffer. The mean age was 64.8 ± 13.4 years, model of end stage liver disease (MELD) was 31 ± 6, 58.5% were in the intensive care unit, 58.5% needed intravenous inotropic agents including terlipressin, 69.5% were on mechanical ventilation, alcoholic liver disease was the main cause of cirrhosis and the main dialysis indications were uremia and hypervolemia. Blood urea and creatinine levels stabilized after four sessions at around 50 and 2.5 mg/dL, respectively. Negative fluid balance (FB) and ultrafiltration (UF) increased progressively and stabilized around 3.0 L and -2.7 L/day, respectively. Weekly-delivered Kt/V was 2.7 ± 0.37, and 71.7% of patients died. Five factors met the criteria for inclusion in the multivariable analysis. Logistic regression identified as risk factors associated with Acute Kidney Injury (AKI) in ACLD patients: MELD (OR = 1.14, CI 95% = 1.09-2.16, p = 0.001), nephrotoxic AKI (OR = 0.79, CI 95% = 0.61-0.93, p = 0.02), mechanical ventilation (OR = 1.49, CI 95% = 1.14-2.97, p < 0.001), and positive fluid balance (FB) after two PD sessions (OR = 1.08, CI 95% = 1.03-1.91, p = 0.007). These factors were significantly associated with death. In conclusion, our study suggests that careful prescription may contribute to providing adequate treatment for most Acute-on-Chronic Liver Failure (ACLF) patients without contraindications for PD use, allowing adequate metabolic and fluid control, with no increase in the number of infectious or mechanical complications. MELD, mechanical complications and FB were factors associated with mortality, while nephrotoxic AKI was a protective factor. Further studies are needed to better investigate the role of PD in ACLF patients with AKI.

Dor e lesão de pele no recém-nascido durante a remoção de adesivo / Pain and skin damage in the newborn during patch removal

INTRODUÇÃO: A remoção de adesivo é um procedimento corriqueiramente realizado nas unidades neonatais e além de submeter o recém-nascido (RN) a um processo doloroso também pode provocar lesões de pele, o que aumenta o risco de infecção e consequentemente o tempo de internação desses bebês. OBJETIVO: Identificar a prevalência de dor e lesão de pele durante a remoção de adesivo com a utilização de água destilada, no recém-nascido internado em uma unidade neonatal. MÉTODO: Trata-se de um estudo com abordagem quantitativa, descritivo, do tipo longitudinal prospectivo. A pesquisa teve como campo a área de Atenção Clínica ao Recém-Nascido de uma instituição pública do Rio de Janeiro. Os participantes foram os RN acima de 32 semanas que possuíam fixação adesiva de sonda gástrica. A dor foi avaliada por meio da escala NIPS (Neonatal Infant Pain Scale) e a condição de pele foi avaliada através do NSCS (Neonatal Skin Condition Score). Foram realizadas até cinco avaliações nos primeiros dias de vida do RN. O banco de dados foi criado através do programa Epi info e a análise através do programa SPSS e o modelo utilizado para análise longitudinal foi o Equação de Estruturas Generalizadas (GEE). RESULTADOS: No período de coleta, foram admitidos 162 RN, mas apenas 91 participaram do estudo e destes, 56 tiveram seus dados analisados. A IG dos RN variou com um mínimo de 32 semanas e máximo de 41 semanas, com média e mediana próximas do termo. A média dos pesos foi de 2.675g (DP =767). A maioria dos bebês (60,7%) tinham bolsa rota de até 18 horas, sendo mais de 80% com líquido amniótico claro. Nenhum dos participantes tiveram suas incubadoras umidificadas e nenhum teve diagnóstico de infecção durante o período de coleta de dados. Apenas oito bebês tiveram indicação de fototerapia durante o período avaliado. Das 218 avaliações realizadas, em apenas três (1,4%) destas a pontuação na NIPS não indicou dor. Já em relação à avaliação do estado da pele, foi possível observar uma variação progressiva quanto à piora da pele, mostrando uma tendência dos bebês a apresentarem algum tipo de lesão com o passar dos dias. O tipo de lesão mais frequente foi o eritema. Foi encontrada associação da piora do score médio do estado da pele com a fototerapia. CONCLUSÃO: Um caminho importante para melhorar a assistência oferecida ao RN internado em unidade neonatal é o treinamento contínuo da equipe multidisciplinar quanto aos procedimentos que podem oferecer algum tipo de dano a essa clientela. Essa também é uma maneira de reforçar constantemente os benefícios do cuidado individualizado e sensível ao sofrimento causado não apenas pela patologia do RN, mas pela assistência que pode provocar iatrogenias nessa população.

INTRODUCTION: Adhesive removal is a procedure commonly performed in neonatal units. In addition to subjecting the newborn (NB) to a painful process, it can also cause skin lesions, which increases the risk of infection and consequently the length of stay. OBJECTIVE: To identify the prevalence of pain and skin injury during adhesive removal using distilled water in newborn infants admitted to a neonatal unit. METHOD: This is a quantitative, descriptive, prospective longitudinal study. The research had as field the area of Clinical Care to the Newborn of a public institution of Rio de Janeiro. Participants were infants over 32 weeks who had adhesive fixation of the gastric tube. Pain was assessed using the Neonatal Infant Pain Pain Scale (NIPS) and skin condition was assessed using the Neonatal Skin Condition Score (NSCS). Up to five evaluations were performed in the first days of life of the newborn. The database was created through the Epi info program and the analysis through the SPSS program and the model used for longitudinal analysis was the Generalized Structure Equation (GEE). RESULTS: During the collection period, 162 newborns were admitted, but only 91 participated in the study and 56 of these had their data analyzed. The gestational age of newborns ranged from a minimum of 32 weeks to a maximum of 41 weeks, with a mean and median near term. The average weight was 2,675g (SD = 767). Most babies (60.7%) had ruptured pouch of up to 18 hours, with over 80% having clear amniotic fluid. None of the participants had their incubators humidified and none were diagnosed with infection during the data collection period. Only eight babies had indication of phototherapy during the evaluated period. Of the 218 evaluations performed, in only three (1.4%) of these, the NIPS score indicated no pain. Regarding the assessment of the condition of the skin, it was possible to observe a progressive variation regarding the worsening of the skin, showing a tendency of babies to present some type of injury over the days. The most frequent type of lesion was erythema. An association between worsening of average skin condition score and phototherapy was found. CONCLUSION: An important way to improve the assistance offered to the newborn hospitalized in a neonatal unit is the continuous training of the multidisciplinary team on the procedures that can offer some type of damage to this clientele. This is also a way of reinforcing the benefits of individualized and sensitive care when suffering damage not only due to the pathology of the NB, but also due to the assistance that can cause iatrogenesis in this population.

Procedimentos dolorosos agudos no recém-nascido pré-termo em uma unidade neonatal / Acute painful procedures pain in the preterm newborn in a neonatal unit / Procedimientos dolorosos agudos en el recién nacido pre-término en una unidad neonatal

Objetivo: analisar o número de procedimentos dolorosos agudos e manejo da dor em recém-nascidos pré-termo em uma unidade neonatal. Método: estudo descritivo, transversal. Teve como campo uma unidade neonatal de uma instituição pública de saúde. Os participantes da pesquisa foram recém-nascidos abaixo de 35 semanas. Resultados: foram incluídos 17 recémnascidos. Foi quantificado um total de 729 procedimentos dolorosos. Em média foram realizados 42,9 procedimentos por recém-nascido durante os primeiros 14 dias de vida, sendo aproximadamente três procedimentos realizados por bebê no serviço diurno. Dentre os procedimentos, o mais frequente foi a punção de calcâneo (23,9%). O manejo predominante foi a contenção facilitada (32,7%). A (re)inserção de pronga foi o segundo procedimento mais realizado. Conclusões: O estudo permitiu apreender que o manejo da dor no recém-nascido pré-termo internado em uma unidade neonatal ainda é um desafio

Objective: to analyze the number of acute painful procedures and pain management in preterm infants in a neonatal unit. Method: a cross-sectional and descriptive study. It was conducted in a neonatal unit of a public health institution. The newborns younger than 35 weeks were the participants in the survey. Results: seventeen preterm newborns were included. A total of 729 painful procedures were quantified. On average, 42.9 procedures per newborn were performed during the first 14 days of birth, and approximately three procedures performed per day service by child. The most common procedure was the hell-stick (23.9%). The predominant management was facilitated tucking (32.7%). The CPAP prongs insertion/reinsertion was the second most performed procedure. Conclusions: The present study showed that the management of pain in the preterm newborns in a neonatal unit is strongly neglected by the professionals

Objetivo: analizar el número de procedimientos dolorosos agudos y manejo del dolor en recién nacidos prematuros en una unidad neonatal. Método: estudio descriptivo, transversal. Tuvo como campo una unidad neonatal de una institución pública de salud. Los participantes de la investigación fueron recién nacidos por debajo de 35 semanas. Resultados: se incluyeron 17 recién nacidos. Se cuantificó un total de 729 procedimientos dolorosos. En promedio se realizaron 42,9 procedimientos por recién nacido durante los primeros 14 días de vida, siendo acerca de tres procedimientos realizados por bebé en el servicio diurno. Entre los procedimientos, el más frecuente fue la punción de calcáneo (23,9%). El manejo predominante fue la contención facilitada (32,7%). La (re) inserción de prong fue el segundo procedimiento más realizado. Conclusiones: El estudio permitió aprehender que el manejo del dolor en el recién nacidos prematuros internado en una unidad neonatal se muestra fuertemente descuidado por el equipo.

Acute kidney injury in elderly patients: narrative review on incidence, risk factors, and mortality.

Acute kidney injury (AKI) is characterized by a sudden renal dysfunction with consequent increase of nitrogenous products, hydroelectrolytic and acid-base disorders. Its prevalence is high in hospitalized populations (4.9%-7.2%), especially in intensive care units (ICUs). Despite all the technical and therapeutic advances that have occurred in the last few decades, the overall mortality of AKI patients remains high, reaching 80% in ICU patients. Several conditions predispose a patient to progress with AKI, including age, sepsis, surgeries, and comorbidities, such as systemic arterial hypertension, diabetes mellitus, heart disease, neoplasia, and chronic renal disease. Among these risk factors, age is emphasized, since, due to advances in the health area, there has been an increase in life expectancy, hence an increase in the demand of the elderly population for health services. At the same time, the elderly present a greater predisposition to the development of AKI, either due to kidney senility, or because of the high prevalence of comorbidities present, and medical interventions such as the use of contrasts and medications, which can also trigger AKI. Considering the relevance of the social role of the elderly and the scarcity of studies on AKI in the elderly admitted to the ICU, further studies are needed. This review article was elaborated considering the purpose: to assess incidence, risk factors, and mortality of AKI in elderly patients admitted to ICUs. Published studies were collected using the following inclusion criteria: be accessible in online databases (Lilacs, Scielo, and PubMed), have been published since 2000 and written in English, Portuguese, or Spanish. The descriptors used for the survey were "Acute Kidney Injury", "Aging", and "Elderly". All items that did not fit in the above inclusion criteria were discarded. We have also presented a synthesis of the knowledge acquired during this review.

Urinary Neutrophil Gelatinase-Associated Lipocalin Is Excellent Predictor of Acute Kidney Injury in Septic Elderly Patients.

Elderly is the main age group affected by acute kidney injury (AKI). There are no studies that investigated the predictive properties of urinary (u) NGAL as an AKI marker in septic elderly population. This study aimed to evaluate the efficacy of uNGAL as predictor of AKI diagnosis and prognosis in elderly septic patients admitted to ICUs. We prospectively studied elderly patients with sepsis admitted to ICUs from October 2014 to November 2015. Assessment of renal function was performed daily by serum creatinine and urine output. The level of uNGAL was performed within the first 48 hours of the diagnosis of sepsis (NGAL1) and between 48 and 96 hours (NGAL2). The results were presented using descriptive statistics and area under the receiver operating characteristic curve (AUC-ROC) and p value was 5%. Seventy-five patients were included, 47 (62.7%) developed AKI. At logistic regression, chronic kidney disease and low mean blood pressure at admission were identified as factors associated with AKI (OR=0.05, CI=0.01-0.60, p=0.045 and OR=0.81, CI=0,13-0.47; p=0.047). The uNGAL was excellent predictor of AKI diagnosis (AUC-ROC >0.95, and sensitivity and specificity>0.89), anticipating the AKI diagnosis in 2.1±0.3 days. Factors associated with mortality in the logistic regression were presence of AKI (OR=2.14, CI=1.42-3.98, p=0.04), chronic obstructive pulmonary disease (OR = 9.37, CI =1.79-49.1, p=0.008) and vasoactive drugs (OR=2.06, CI=0.98-1.02, p=0.04). The accuracy of NGALu 1 and 2 as predictors of death was intermediate, with AUC-ROC of 0.61 and 0.62; sensitivity between 0.65 and 0.77 and specificity lower than 0.6. The uNGAL was excellent predictor of AKI in septic elderly patients in ICUs and can anticipate the diagnosis of AKI in 2.1 days.

Prática de episiotomia entre residentes em enfermagem obstétrica / Práctica de la episiotomía entre residentes de enfermería obstétrica / Use of episiotomy among residents in obstetric nursing

RESUMO: Objetivo: identificar a frequência e justificativa para a realização da episiotomia em partos assistidos por residentes em enfermagem obstétrica. Método: estudo descritivo e retrospectivo, realizado no período de outubro a novembro de 2016, em uma maternidade pública do município de São Paulo. A população do estudo foi constituída por 884 parturientes de baixo risco. Para análise estatística, utilizou-se o teste Qui-Quadrado. Resultados: a episiotomia ocorreu em 174 (19,7%) partos e em 512 (59%) houve lacerações perineais. A integridade perineal foi mantida em 187 (21,4%) partos. As principais indicações estiveram relacionadas às condições do períneo: 54 (58,1%) por rigidez perineal, 22 (23,7%) períneo curto e 19 (20,4%) eminência de laceração grave. Conclusão: a prática de episiotomia entre residentes está acima do recomendado pela OMS e, com relação às justificativas apresentadas, há discrepância com as mundialmente utilizadas, trazendo reflexões acerca do modelo de formação e do distanciamento entre teoria e prática.

RESUMEN: Objetivo: Identificar la frecuencia y la razón de ejecución de episiotomía en partos atendidos por residentes en enfermería obstétrica. Método: Estudio descriptivo, retrospectivo, realizado de octubre a noviembre de 2016 en maternidad pública del municipio de São Paulo. Población constituida por 884 parturientas de bajo riesgo. Para análisis estadístico se aplicó test de Chi-cuadrado. Resultados: Se practicó episiotomía en 174 (19,7%) partos, y en 512 (59%) hubo laceraciones perineales. Se mantuvo la integridad perineal en 187 (24,4%) de los partos. Las indicaciones principales se relacionaron con las condiciones perineales: 54 (58,1%) por rigidez perineal, 22 (23,7%) por perineo corto y 19 (20,4%) por inminencia de laceración grave. Conclusión: La práctica de episiotomía entre residentes supera lo recomendado por la OMS y, respecto a las razones presentadas, existe discrepancia con las mundialmente aplicadas, debiéndose reflexionar sobre el modelo de formación y de la distancia entre teoría y práctica.

ABSTRACT: Objective: to identify the frequency of and justification for episiotomy in childbirths attended by residents in obstetric nursing. Method: Descriptive and retrospective study conducted in October-November, 2016, in a public maternity hospital in the city of São Paulo. The study population consisted of 884 low-risk pregnant women. Chi-square testwas used for statistical analysis. Results: Episiotomy was performed in 174 (19.7%) deliveries and in 512 (59%) there were perineal lacerations. Perineal integrity was maintained in 187 (21.4%) deliveries. The main indications were related to perineal conditions: 54 (58.1%) perineal rigidity, 22 (23.7%) short perineum and 19 (20.4%) imminent severe laceration. Conclusion: The frequency of use of episiotomyby residents in obstetric nursingis higher than evidence based recommendations from the WHO, and regarding the reasons for the procedure, they differ from those generally reported worldwide, which leads to reflections about the model of professional training of obstetric nurses and the distance between theory and practice.

Acute kidney injury in elderly intensive care patients from a developing country: clinical features and outcome.

AIM: The elderly are at high risk of acute kidney injury (AKI) because of structural and functional degeneration over time and with the aging of the population, the demand for intensive care unit (ICU) admission for older patients has risen recently. However, data from developing countries are scarce. This study aimed to describe the incidence of AKI in elderly patients admitted to ICU from a developing country, to determine the most frequent etiologies for renal impairment and identify its risk factors and outcome. METHODS: All patients admitted to the ICU at a Brazilian teaching hospital for 12 consecutive months were followed prospectively from the time of admission until ICU discharge. Elderly was defined as aged >60 years and AKI was defined according to the Kidney Disease Improving Global Outcomes 2012 criteria. Multivariable logistic regression was used to adjust confounding and selection bias. RESULTS: Two hundred elderly patients were included in the study. AKI incidence was 27% and the main etiology was sepsis (48.1%). At logistic regression, baseline creatinine (odds ratio [OR]=5.17, p<0.0001), Acute Physiology and Chronic Health Evaluation (APACHE) II (OR=1.20, p<0.0001), sepsis (OR=2.96, p<0.0001), and longer ICU stay (OR=1.68, p<0.0001) were associated with AKI in elderly patients. Baseline creatinine (OR=1.97, p=0.018), APACHE II (OR=1.29, p<0.0001), sepsis (OR=1.87, p<0.0001), and AKI severity (OR=2.57, p=0.027) were identified as predictors of death. CONCLUSION: AKI was frequent in elderly patients admitted to ICU from a developing country, and it was identified as a risk factor for death. Sepsis was an important risk factor for both AKI and mortality, similar to developed countries and in younger populations.

Marca-passos sem eletrodos: o futuro da estimulação cardíaca - o estado da arte / Electroless Pacemakers: The Future of Cardiac Pacing - The State of the Art

A presente monografia propõe-se a fazer um levantamento sobre a história da estimulação cardíaca, desde a era pré marca-passo, início dos marca-passos, até os dias atuais com dispositivos sem eletrodos, tendo como foco o Micra Transcatheter pacing system - Micra TPS (Medtronic, Minneapolis, Minessota) considerado o grande pioneiro no cenário da estimulação cardíaca artificial atual...

The long-term outcome after acute kidney injury: a narrative review.

This review will focus on long-term outcomes after acute kidney injury (AKI). Surviving AKI patients have a higher late mortality compared with those admitted without AKI. Recent studies have claimed that long-term mortality in patients after AKI varied from 15% to 74% and older age, presence of previous co-morbidities, and the incomplete recovery of renal function have been identified as risk factors for reduced survival. AKI is also associated with progression to chronic kidney (CKD) disease and the decline of renal function at hospital discharge and the number and severity of AKI episodes have been associated with progression to CKD. IN the most studies, recovery of renal function is defined as non-dependence on renal replacement therapy which is probably too simplistic and it is expected in 60-70% of survivors by 90 days. Further studies are needed to explore the long-term prognosis of AKI patients.

The long-term outcome after acute kidney injury: a narrative review / Evolução em longo prazo após episódio de lesão renal aguda: revisão narrativa

This review will focus on long-term outcomes after acute kidney injury (AKI). Surviving AKI patients have a higher late mortality compared with those admitted without AKI. Recent studies have claimed that long-term mortality in patients after AKI varied from 15% to 74% and older age, presence of previous co-morbidities, and the incomplete recovery of renal function have been identified as risk factors for reduced survival. AKI is also associated with progression to chronic kidney (CKD) disease and the decline of renal function at hospital discharge and the number and severity of AKI episodes have been associated with progression to CKD. IN the most studies, recovery of renal function is defined as non-dependence on renal replacement therapy which is probably too simplistic and it is expected in 60-70% of survivors by 90 days. Further studies are needed to explore the long-term prognosis of AKI patients.

Esta revisão tem como objetivo focar o prognóstico em longo prazo de pacientes após episódio de lesão renal aguda (LRA). Pacientes sobreviventes à LRA apresentam maior mortalidade tardia quando comparados com aqueles internados sem LRA. Estudos recentes mostram mortalidade em logo prazo após LRA entre 15 e 74% e, de modo geral, são fatores que contribuem para essa mortalidade a idade avançada, a presença de comorbidades preexistentes e a recuperação incompleta da função renal. LRA também está associada com evolução para doença renal crônica, sendo a queda de função renal na alta hospitalar e número e intensidade dos episódios de LRA fatores associados com a evolução para DRC. A recuperação da função renal é definida pela maioria dos estudos como a não dependência de diálise e ocorre em 60 a 70% dos pacientes em até 90 dias. Futuros estudos são necessários para explorar o prognóstico tardio desses pacientes.

Comportamento higroscópico de pós de manga das variedades coité e espada e avaliação das características físico-químicas / Hygroscopic behavior of mango powder of coité and espada cultivar and evaluation of physicochemical characteristics

A manga, embora muito apreciada pelos seus aspectos nutricionais e sensoriais, é altamente perecível e requer técnicas peculiares para sua conservação e comercialização. Nesse contexto, este trabalho teve por objetivos avaliar o comportamento higroscópico dos pós de manga das variedades Coité e Espada por meio das isotermas de adsorção e também analisar as características físico-químicas dessas variedades de manga nas formas in natura e em pó. Os resultados indicaram que os pós de manga não mostraram diferença significativa em relação às características físico-químicas, exceto para o valor de pH. Contrariamente, nas amostras in natura, apenas o pH não apresentou diferença significativa. Entre os modelos matemáticos utilizados para ajuste das isotérmicas de adsorção, o modelo de GAB foi o mais adequado para se ajustar aos dados experimentais, apresentando o teor de água da monocamada (gx100g-1 de matéria seca) de 0,09086 e 0,08857, com erros relativos médios de 6,76 e 2,86 por cento para Coité e Espada, respectivamente. O modelo de Oswin foi o segundo modelo matemático que apresentou valores muito próximos de encaixar o modelo de GAB.

The mango, is much appreciated by its nutritional and sensorial characteristics, but is highly perishable and requires specific techniques for its conservation and marketing. In this sense, this study aimed to evaluate the hygroscopic behavior of powdered mango varieties Coite and Espada cv. using adsorption isotherms and physicochemical characteristics of theses varieties of mango in natura and powder. The results showed that the mango powders didn't show significant difference in relation to physicochemical characteristics, except for the pH value. In contrary, in nature samples only the pH didn´t show significant difference. Among the mathematical models used to fit the adsorption isotherms, the GAB model was the more appropriate to fit the experimental data showing the water content of the monolayer of 0,09086 and 0,08857 (gx100g-1 dry matter) and relative average errors of 6,76 and 2.86 percent for Coité and Espada, respectively. The Oswin model was the second mathematical model that showed very close values to fit the GAB model.

Avaliação sensorial e da rotulagem de refrigerantes comercializados na cidade de Sobral, Ceará / Sensorial evaluation and labeling of soda drinks comercialized in the city of Sobral, Ceará

O Brasil é o terceiro maior mercado mundial de refrigerantes e, hoje em dia, o sabor guaraná é o quarto mais consumido do mundo. Por isso, surgiu o interesse de realizar uma análise sensorial de preferência-ordenação entre refrigerantes “sabor guaranᔠcomercializados na cidade de Sobral, CE. Nesta análise foram verificadas 3 marcas comerciais em embalagens flexíveis (Pet/2 litros), coletadas aleatoriamente no período de maio de 2006, em uma grande rede de supermercado. A análise consistia em ordenar, conforme a preferência, as marcas comerciais analisadas (A, B e C). Após a análise sensorial realizada, ficou constatado que a amostra C foi preferida quando comparada com a amostra B, ao nível de 5 por cento de significância. Não havendo diferença significativa em relação à preferência entre as amostras A e B e entre A e C. Em relação à avaliação da rotulagem podemos observar que 100 por cento das marcas comerciais analisadas estão em desacordo com os parâmetros exigidos pela Legislação, por não apresentarem todos os atributos de Rotulagem Nutricional Complementar.

O laço social na contemporaneidade e a toxicomania

Neste trabalho parte-se da concepção de que o sujeito e seus sintomas se constituem no seio de fatores pulsionais e socioculturais que promovem o laço social. Em seguida, delineia-se o perfil sócio-histórico da modernidade e da contemporaneidade, propondo-se que ambas constituem laços sociais diferentes, respectivamente centrados nos imperativos da interdição e da satisfação. Por último, argumenta-se que o imperativo da satisfação favorece a expansão do sintoma da toxicomania, que pode ser compreendido, tal como o laço social contemporâneo, pelo modelo da perversão (AU)

Shiguelose: diagnóstico e tratamento / Shiguellosis: diagnosis and therapy

É uma doença diarréica aguda infecciosa mundialmente distribuída, causada por um bacilo gram-negativo da família das enterobactérias, transmitido por contato inter-humano, por água e alimentos contaminados, causando diarréia mucopiossanguinolenta, associada à febre, cólicas abdominais, urgência e tenesmo retal. O diagnóstico é baseado na história clínica e exame físico, sendo confirmado principalmente pela coprocultura e, mais raramente, pela hemocultura. Outros exames inespecíficos podem ser usados, como o hemograma e a análise do mucofecal. A sorologia e o PCR podem ser úteis, porém nem sempre facilmente disponíveis. O tratamento visa a correçÝo dos distúrbios hidroeletrolíticos já que a shiguelose costuma ser autolimitada, sendo porém, eventualmente necessário o uso de antimicrobianos. Quando a shiguela isolada se mostra sensível à ampicilina, esta droga tem sido utilizada como primeira escolha; entretanto, nÝo se isolando o agente causal, o sulfametoxazoltrimethopim pode ser indicado. atualmente, os melhores resultados (e com baixos ídices de resistência) têm sido obtidos com o uso das quinolonas, devendo, porém, ser usadas com critério devido ao aparecimento de cepas multirresistentes.