Avaliação da atenção à saúde de portadores de HIV no centro de referência para o tratamento da Aids em Natal/RN por profissionais e usuários do serviço

Objective: The aim of this study was to evaluate the health care of HIV/AIDS Reference Center for treatment of AIDS in Natal/RN for professionals and service users. Methods: This is an evaluative study with a quantitative approach, performed in the outpatient Giselda Trigueiro Hospital, in Natal (RN). The target population consisted of 313 patients with HIV and 34 professionals of the center. Data collection occurred from august 2007 to july 2008, with a structured form of interview, validated through a pilot study. The data were analyzed by descriptive and inferential statistics. Results: The evaluation of the service was considered unsatisfactory by 85.6% users. However, 58.8% of professionals considered it satisfactory. There was difference in the evaluation of the following indicators: the relationship professional users, offering support, timeliness of professional guidelines on the treatment. There was similarity in the following indicators: physical structure, respect for privacy, opportunity to make complaints, hospitality, convenience of schedules, availability of ARVs and laboratory tests, and ease of access. Conclusion: The results point to dissatisfaction of the users and professional satisfaction with the health care of people with HIV / AIDS in the service searched. It was found that the indicators used in this study may be considered relevant to evaluate the service in question, as well as monitoringparameters provide acceptable quality of health care by the National STD/AIDS

Estratégias para ajuste do ciclo vigília-sono de adolescentes aos horários escolares matutinos: a educação sobre o sono e a exposição a luz solar

In adolescents, who tend to sleep and wake-up later, the school schedule in the morning is associated with sleep advancement and shortening besides bedtime and wake-up time irregularity between week and weekend days. As a result, there is an increase in daytime sleepiness and a drop in cognitive performance that interfer in students performance in classroom. These consequences reinforce the need to evaluate alternatives that help the adolescent to adapt their sleep needs to the time of start of classes in the morning. Accordingly, the general aim of this study was to evaluate the effects of a sleep program education and sunlight exposure in early morning on sleep-wake cycle (SWC) and daytime sleepiness of adolescents. The students chronotype were evaluated by the Horne-Ostberg questionnaire and the health and usual sleep habits by "the health and the sleep questionnaire. The SWC patterns were assessed by sleep log, the daytime sleepiness by Karolinska Sleepiness Scale (KSS) and the alertness by the Psychomotor Vigilance Test (PVT). These parameters were compared before and after a sleep education program and before and during the sunlight exposure. The sleep program was effective in increasing sleep knowledge of adolescents, in promoting a reduction of bedtime and wake-up time irregularity and increasing the sleep duration in school days. The sunlight exposure effect was evaluated in the return to classes after vacation due to the difference in sleep patterns between school and vacation days. During the intervention week it was observed an advance of sleep schedules, an increase on sleep duration and alertness at the end of the morning. Assessed separately, sleep education and sunlight exposure should contribute to minimize adolescents partial sleep deprivation, but daytime sleepiness effect must be better investigated. These strategies should be used jointly by school members to improve health and performance of their students

Avaliação do padrão do ciclo sono-vigília e a cognição em estudantes de medicina com diferentes esquemas de horários de aulas

The sleep patterns of students entering the university, is accompanied by many factors that can lead to changes in sleep habits, such as academic demands, new social opportunities, reduced parental care and irregular teaching schedules. The irregular pattern of sleep-wake cycle is usually accompanied by several daytime consequences, for example, reduced levels of motivation, performance, concentration, alertness and mood as well as increased fatigue and sleepiness.Thus, there are numerous reasons to support the fact that these students may suffer damage in their academic performance. The aim of this study was to evaluate the sleep-wake cycle (SWC) and cognition in medical students with different schemes teaching schedules. One group started classes at 08am, while the other started at 07am. We analyzed the data from 88 volunteers, 39 from each group. However, only those who participated in both stages of the study (n = 78) underwent cognitive testing. For subjective evaluation of the SWC was used questionnaires to check the quality of sleep, chronotype, daytime sleepiness and sleep habits. For objective evaluation was used actigraphy. For cognitive assessment was used the test MoCA (Montreal Cognitive Assessment). The results indicate that the group has class earlier had a greater irregularity of the SWC and a worse performance in cognitive testing. There was a difference between the schedules the week and weekend in the subjective variables, bedtime, wake up and sleep duration in both groups. The objective variables, time in bed showed difference between the schedules the week and weekend to the group started class at 08am and the variables bedtime, get up time, actual sleep time, time in bed and wake bouts in the class at 07am. In the cognitive test, there were differences between the groups in overall score and in the areas of executive function and memory recall. Thus, it is suggested that the class starting time may cause irregularity of the SWC and the irregularity may cause mild cognitive impairment. Moreover, cognitive testing MoCA was sensitive to detect differences among students, although the difference between the schedules is small

LCD-OpenPACS: sistema integrado de telerradiologia com auxílio ao diagnóstico de nódulos pulmonares em exames de tomografia computadorizada

Lung cancer is one of the most common types of cancer and has the highest mortality rate. Patient survival is highly correlated with early detection. Computed Tomography technology services the early detection of lung cancer tremendously by offering aminimally invasive medical diagnostic tool. However, the large amount of data per examination makes the interpretation difficult. This leads to omission of nodules by human radiologist. This thesis presents a development of a computer-aided diagnosis system (CADe) tool for the detection of lung nodules in Computed Tomography study. The system, called LCD-OpenPACS (Lung Cancer Detection - OpenPACS) should be integrated into the OpenPACS system and have all the requirements for use in the workflow of health facilities belonging to the SUS (Brazilian health system). The LCD-OpenPACS made use of image processing techniques (Region Growing and Watershed), feature extraction (Histogram of Gradient Oriented), dimensionality reduction (Principal Component Analysis) and classifier (Support Vector Machine). System was tested on 220 cases, totaling 296 pulmonary nodules, with sensitivity of 94.4% and 7.04 false positives per case. The total time for processing was approximately 10 minutes per case. The system has detected pulmonary nodules (solitary, juxtavascular, ground-glass opacity and juxtapleural) between 3 mm and 30 mm.

Retinopatia de Purtscher-like e pancreatite aguda

Retinopatia de Purtscher-like é uma baixa súbita da visão associada à imagem de múltiplas áreas branco-amareladas (manchas algodonosas) e hemorragias no pólo posterior de ambos os olhos. O exato mecanismo da injúria ainda não é claro, mas provavelmente seria de natureza embólica. Tem sido descrita em uma variedade de condições, incluindo pancreatite aguda, síndrome de embolia gordurosa, insuficiência renal,nascimento (parto e pós-parto), desordens do tecido conectivo, entre outras. Serão relatados três casos de pancreatite aguda confirmada pelos exames laboratoriais e história clínica, associadas a alterações no exame do fundo de olho, compatíveis com esta retinopatia

Diagnóstico, estadiamento e tratamento cirúrgico do adenocarcinoma de pâncreas

O adenocarcinoma pancreático é um dos tumores sólidos de pior prognóstico, sendo o tratamento cirúrgico o único potencialmente curativo. Na grande maioria dos pacientes o tumor é diagnosticado em fase avançada, comumente na presença de doença metastática. A introdução de modernos métodos diagnósticos associados ao aperfeiçoamento dos já existentes tem gerado controvérsia quanto à melhor maneira de se estabelecer o diagnóstico e estadiamento do tumor. Da mesma forma, o papel da cirurgia na paliação e aspectos técnicos da ressecção de lesões localizadas estão longe de alcançarem consenso na prática. Método - Revisão da literatura sobre os aspectos controversos relacionados ao tema e um algoritmo para a abordagem dos pacientes com suspeita de tumor de pâncreas são apresentados. Foram utilizados os descritores: “adenocarcinoma” e “pâncreas” para pesquisa no PubMed (www.pubmed.com) e na Bireme (www.bireme.br) e a seguir selecionadas as publicações pertinentes a cada tópico escolhido com atenção especial para metanálises, estudos clínicos controlados, revisões sitemáticas e ainda publicações de grandes centros especializados em doenças pancreáticas. Conclusões - Na suspeita de adenocarcinoma de pâncreas é possível realizar estadiamento muito próximo do real sem a necessidade da exploração cirúrgica sistemática em virtude da disponibilidade na prática de exames modernos e eficientes. Isso permite que paliação menos invasiva seja praticada na maioria dos pacientes com lesões avançadas e incuráveis. Nos em que a cura é possível, a operação deve ser realizada objetivando-se, essencialmente, a remoção da lesão com margens livres e com aceitáveis índices de morbi-mortalidade

O argumento de inclusão enquanto política de acesso à universidade pública

There are a great number of evidences showing that education is extremely important in many economic and social dimensions. In Brazil, education is a right guaranteed by the Federal Constitution; however, in the Brazilian legislation the right to the three stages of basic education: Kindergarten, Elementary and High School is better promoted and supported than the right to education at College level. According to educational census data (INEP, 2009), 78% of all enrolments in College education are in private schools, while the reverse is found in High School: 84% of all matriculations are in public schools, which shows a contradiction in the admission into the universities. The Brazilian scenario presents that public universities receive mostly students who performed better and were prepared in elementary and high school education in private schools, while private universities attend students who received their basic education in public schools, which are characterized as low quality. These facts have led researchers to raise the possible determinants of student performance on standardized tests, such as the Brazilian Vestibular exam, to guide the development of policies aimed at equal access to College education. Seeking inspiration in North American models of affirmative action policies, some Brazilian public universities have suggested rate policies to enable and facilitate the entry of "minorities" (blacks, pardos1, natives, people of low income and public school students) to free College education. At the Federal University of the state Rio Grande do Norte (UFRN), the first incentives for candidates from public schools emerged in 2006, being improved and widespread during the last 7 years. This study aimed to analyse and discuss the Argument of Inclution (AI) - the affirmative action policy that provides additional scoring for students from public schools. From an extensive database, the Ordinary Least Squares (OLS) technique was used as well as a Quantile Regression considering as control the variables of personal, socioeconomic and educational characteristics of the candidates from the Brazilian Vestibular exam 2010 of the Federal University of the state Rio Grande do Norte (UFRN). The results demonstrate the importance of this incentive system, besides the magnitude of other variables

Adequação bioclimática para os espaços urbanos abertos do centro de Fortaleza, CE

This research presents a study investigating the correlation between the environmental-physycal charcateristics of cities and the formation of its micro-climates. The study was conducted in the central area of Fortaleza characterized as a stable and consolidated area, where the city originated and currently faces serious problems in its urban dynamics. The points of measurements were determined by the elaboration and analysis of topography maps, height of buildings, land use, type of surface coating and vegetation, following the methodology of Katzschner (1997). A zoning map was then determined, according to common morphological characteristics of the 12 measurement points, which were based on a set of Romero s (2001) bioclimatic criteria. Air measurements, temperature, humidity, intensity and direction of winds were made in transect form in two different circuits in the study area, with six points of data collection in each area, in three different times: 6:00 am, 1:00pm and 7:00pm, during two periods of the year: August 2008 and March 2009. The results verified the influence of different environmental-physical types in the behavior of the climatic variables that were collected. A verticalização tão condenada em algumas situações se bem equilibrada e controlada pode reduzir as temperaturas do ar através do sombreamento dos espaços urbanos e possibilidade de maior permeabilidade a ventilação natural. The highest average air temperature and lower humidity were recorded at the point I at all times. This situation may have been in result of the high density, poor vegetation and extended paving of the ground. According to the results, it s clear the positive influence vegetation has on easing air temperature. Another indicator observed that areas with a greater variation in building heights tend to present decreased average air temperature. High rise structure, planned in accordance to urban air quality parameters, can reduce air temperatures by the shading of urban spaces and the possibility of greater penetration of natural ventilation

Análise bioclimática e investigação do conforto térmico em ambientes externos: uma experiência no bairro de Petrópolis em Natal/RN

This study was intended to investigate how the urban form has been influencing the changes in the climate of the city and make a correlation between the climate and the thermal sensation of the users of open spaces. The research was developed in the district of Petrópolis in Natal/ RN whose occupation has been almost consolidated. Among other reasons, this district was selected because it was planned considering the environmental aspects of comfort. The methodologies used are based on KATZSCHNER (1997) and OLIVEIRA (1988) studies, which suggest the drawing and analysis of maps of the area under study, including topography, height of the buildings, land use, green areas, and types of soil pavement, as well as measurement of the environmental variables: air temperature, relative humidity, direction and wind speed for a comparative study. As part of this, study local users of the district were interviewed about their thermal sensations in open spaces. For the statistical analysis, data was collected at 10 distinct points characterized by BUSTOS ROMERO (2002), being 8 within the district and 2 at different places (outside the district), at climatologic stations, in 3 periods (August/2000, January/2002 and June/2002), for 4 consecutive days for each measurement (from Sunday to Wednesday) at the time of lower and higher temperatures in the city, 6:00 am and 1:00 pm, respectively. At the same time interviews were carried out with users of the open spaces in the area, totaling 171 valid formularies. The urban form showed a rather leveled topography, great diversity of land use and height of the buildings, with the existence of an area mostly occupied with high buildings, very little green area and soil practically impermeable. The statistical analysis showed high temperature and humidity levels. The wind direction is predominantly Southeast with extremely variable speeds. When the data from this district is compared with the data from other areas in the city and its outskirt, it was observed that this district is hotter and less ventilated than the others; besides, most users said that they felt uncomfortable in the local environmental conditions. The results of the analysis generated a zoning for the district with recommendations for soil occupation. The profile of the user was defined regarding the thermal comfort, as well as some discussion about the comfort parameters, including the proposal of limiting areas of temperature and humidity for the thermal comfort in the open spaces

Análise do comportamento e crescimento do camarão branco Litopenaeus vannamei (Boone, 1931) em diferentes substratos inconsolidados

The aim of this study was to test the sediment preference of L. vannamei shrimp. It was observed shrimp visit frequency, swimming and burying behaviour at different sediment compositions for 24h. Juvenile (0.93 ± 0.29g) and sub-adult shrimps (10.0 ± 1.18g) were obtained from the aquaculture station at Universidade Federal Rural do Semi-Árido UFERSA, and held in a plastic tank (water volume 500 L) supplied with aerated water and kept at constant temperature, pH, and salinity. Shrimp was fed by commercial shrimp dry food. The experimental substrates were composed by A: medium sand + thick sand + very thick sand + gravel; B: very fine sand + fine sand; and C: silt + clay. Thus, six different substrate combinations were tested: A, B, C, A+B, A+C, B+C. To test preference, it was used a cylindrical tank (40 l) divided into six differently substrate compartments. A single shrimp was introduced each tank and the frequency at which this shrimp visited each compartment was recorded over a 24h study period. It was tested 54 shrimp (18 sub-adult males, 18 subadult females and 18 juveniles). For each trial, sediment and water were changed to avoid pheromones and residues influence. Shrimp were weighted and sub-adults were divided by sex: males present petasma and females present thelycum. Data were collected on the experimental day at 19:30; 20:30; 00:30; 1:30; 05:30; 06:30; 13:30 and 14:30 h. At each time point, shrimp were observed for 20-min periods, in which we noted down which compartment the shrimp was occupying at 2-min intervals. Thus, for each period we had eleven observations (88 observations per day). For observations at night, it was used dim red light that did not affect shrimp behaviour. At each 20-min period, it was observed visit frequency in each substrate, if shrimp was burred or not or if it was swimming. There was not significant difference between light and dark burry activity for females. Swimming activity was significantly higher at night, mainly at 00:30 and 01:30 h. All L. vannamei shrimp showed preference for sediment B. This animal presents cyclic activity, spends the day light period buried and swims at night

Avaliação da toxicidade aguda do inseticida metomil e o seu efeito sobre a atividade da acetilcolinesterase do peixe Danio rerio

Methomyl (Lannate®) is an insecticide from the carbamate group, frequently used in pest control in various types of crops. This compound works inhibiting the activity of the enzyme acetylcholinesterase. The use of physicochemical and ecotoxicological analysis is the most efficient strategy for the correct characterization and control of residues of metomil. The main objectives of this study were to evaluate the acute toxicity of methomyl in 96 hours of exposure and, through a sublethal assay of 5 hours, to assess its effect on the activity of acetylcholinesterase present in brain and squeletic dorsal muscle of the Danio rerio fish. The results showed that the LC50-96 found to D. rerio was 3.4 mg/L and it was found through the average of four definitive tests. In vitro assays were used to test the inhibitory action of methomyl directly over soluble AChE, extracted from the squeletic dorsal muscle, with maximum inhibition of 68.57% to the insecticide concentrations of 0.2 mg/L. In sublethal tests with D. rerio, inhibitory effect of methomyl was found over the soluble form of AChE in the squeletic dorsal muscle, both in one and five hours of fish exposure to the insecticide. In both period, the average values of inhibition were around 61%. In the same condition, no significant inhibitory effect of methomyl soluble and membrane AChE of the D. rerio was observed in the 0.42, 0.85, 1.70 and 2.50 mg/L concentrations and in both times of fish exposure

Anticorpos anti-trypanosoma cruzi como preditivos de infecção por leishmania infantum

Leishmania infantum and Trypanosoma cruzi are trypanosomatids of medical importance and are, respectively, the etiologic agents of visceral leishmaniasis (VL) and Chagas disease (CD) in Brazil. People infected with L. infantum or T. cruzi may develop asymptomatically, enabling the transmission of pathogens through blood transfusion and / or organs. The assessment of the infection by T. cruzi is included among the tests performed for screening blood donors in Brazil, however, there is no availability of tests for Leishmania. Serological tests for T. cruzi are very sensitive, but not specific, and may have cross-reactions with other microorganisms. Thus, the aim of this study was to determine the prevalence of Leishmania infection in blood donors and assess whether the serological test for T. cruzi detect L. infantum. Among the 300 blood samples from donors, discarded in 2011, 61 were T. cruzi positive, 203 were from donors with other infections and 36 were from handbags with low blood volume, but without infection. We also assessed 144 samples from donors without infections and able to donate blood, totaling 444 subjects. DNA was extracted from blood samples of all to perform quantitative PCR (qPCR) to detect Leishmania DNA. The buffy coat obtained from all samples was grown in Schneider medium supplemented and NNN. All samples were evaluated for the presence of anti-Leishmania antibody. The serological results indicate a percentage of 22% of Leishmania infection in blood samples obtained from discarded bags. A total of 60% of samples positive in ELISA for T. cruzi were negative by IFI, used as confirmatory test, ie 60% false positive for Chagas. Among these samples false positive for Chagas, 72% were positive by ELISA for Leishmania characterizing the occurrence of cross reaction between serologic assays. Of the 300 cultures performed, 18 grew parasites that were typed by qPCR and specific isoenzymes, found the species Leishmania infantum crops. Among the 18 cultures, 4 were purged from scholarships for low volume and all negative serology blood bank, thus demonstrating that there is a real risk of Leishmania transmission via transfusion. It is concluded that in an area endemic for leishmaniasis in Brazil, serological diagnosis performed to detect infection by T. cruzi among blood donors can identify infection by L. infantum and although cause false positive for Chagas, this cross-reactivity reduces the risk of Leishmania infection via blood transfusion, since tests are not applied specific detection of the parasite. In this way, there remains the need to discuss the implementation of a specific serological screening test for Leishmania in endemic countries such as Brazil

Investigação do papel modulador do Haloperidol sobre os níveis de proteínas relacionadas à plasticidade e preferência por objetos novos em camudongos

Dopamine (DA) is known to regulate both sleep and memory formations, while sleep plays a critical role in the consolidation of different types of memories. We believe that pharmacological manipulation of dopaminergic pathways might disrupt the sleep-wake cycle, leading to mnemonic deficits, which can be observed in both behavioral and molecular levels. Therefore, here we investigated how systemic injections of haloperidol (0.3 mg/kg), immediately after training in dark and light periods, affects learning assessed in the novel object preference test (NOPT) in mice. We also investigated the hippocampal levels of the plasticity-related proteins Zif-268, brain-derived neurotrophic factor (BDNF) and phosphorylated Ca2+/calmodulin-dependent protein kinases II (CaMKII-P) in non-exposed (naïve), vehicle-injected controls and haloperidol-treated mice at 3, 6 and 12 hours after training in the light period. Haloperidol administration during the light period led to a subsequent impairment in the NOPT. In contrast, preference was not observed during the dark period neither in mice injected with haloperidol, nor in vehicle-injected animals. A partial increase of CaMKII-P in the hippocampal field CA3 of vehicle-injected mice was detected at 3h. Haloperidol-treated mice showed a significant decrease in the dentate gyrus of CaMKII-P levels at 3, 6 and 12h; of Zif-268 levels at 6h, and of BDNF levels at 12h after training. Since the mnemonic effects of haloperidol were only observed in the light period when animals tend to sleep, we suggest that these effects are related to REM sleep disruption after haloperidol injection

Simulador radiográfico antropomórfico de mama humana

Mammography is a diagnostic imaging method in which interpretation depends on knowledge of radiological aspects as well as the clinical exam and pathophysiology of breast diseases. In this work a mammography phantom was developed to be used for training in the operation of mammographic x-ray equipment, image quality evaluation, self-examination and clinical examination of palpation. Polyurethane was used for the production of the phantoms for its physical and chemical properties and because it is one of the components normally used in prostheses. According to the range of flexibility of the polyurethane, it was possible to simulate breasts with higher or lower amount of adipose tissue. Pathologies such as areolar necrosis and tissue rejection due to surgery reconstruction after partial mastectomy were also simulated. Calcifications and nodules were simulated using the following materials: polyethylene, poly (methyl methacrylate), polyamide, polyurethane and poly (dimethyl silicone). Among these, polyethylene was able to simulate characteristics of calcification as well as breast nodules. The results from mammographic techniques used in this paper for the evaluation of the phantoms are in agreement with data found in the literature. The image analyses of four phantoms indicated significant similarities with the human skin texture and the female breast parenchyma. It was possible to detect in the radiographic images produced regions of high and low radiographic optical density, which are characteristic of breasts with regions of different amount of adipose tissue. The stiffnesses of breast phantoms were adjusted according to the formulation of the polyurethane which enabled the production of phantoms with distinct radiographic features and texture similar to human female breast parenchyma. Clinical palpation exam of the phantoms developed in this work indicated characteristics similar to human breast in skin texture, areolar region and parenchyma

Nitretação iônica sem efeito de borda :desenvolvimento e avaliação de uma nova técnica

The ionic nitriding process presents some limitations related with the control of the thickness of the layer and its uniformity. Those limitations that happen during the process, are produced due to edge effects, damage caused by arcing arc and hollow cathode, mainly in pieces with complex geometry and under pressures in excess of 1 mbar. A new technique, denominated ASPN (active screen shapes nitriding) it has been used as alternative, for offering many advantages with respect to dc plasma conventional. The developed system presents a configuration in that the samples treated are surrounded by a large metal screen at high voltage cathodic potencials, (varying between 0 and 1200V) and currents up to 1 A. The sample is placed in floting potential or polarized at relatively lower bias voltages by an auxiliary source. As the plasma is not formed directly in the sample surface but in the metal screen, the mentioned effects are eliminated. This mechanism allows investigate ion of the transfer of nitrogen to the substrate. Optical and electronic microscopy are used to exam morphology and structure at the layer. X-ray difration for phase identification and microhardness to evaluate the efficiency of this process with respect to dc conventional nitriding