Redução da morbi-mortalidade na síndrome de hellp completa com o uso de altas doses de dexametasona

Objective: To determine the clinical maternal and neonatal outcomes in HELLP syndrome patients treated with dexamethasone who either developed renal injury or renal insufficiency and to identify predictive values of urea and creatinine for the identification of subjects with HELLP syndrome at risk of developing renal insufficiency. Methods: Non-radomized intervention study of dexamethasone use in HELLP syndrome. A total of 62 patients were enrolled at Maternidade Escola Januário Cicco (MEJC). Patients received a total of 30 mg of dexamethasone IV, in three doses of 10 mg every 12 hours. A clinical and laboratory follow up were performed at 24, 48 and 72 hours. Patients were followed up to 6 months after delivery. Patients were grouped in accordance to renal function, i.e, normal and some type of renal lesion. Renal lesion was considered when creatinine was equal or greater than 1.3 mg/dl and diuresis less than 100 ml in 4 hours period and renal insufficiency was defined when dialysis was needed. Results: A total of 1230 patients with preeclampsia were admitted at MEJC. Of those 62 (5%) developed HELLP syndrome. There was no statistical difference in the groups with renal involvement or normal renal function with respect to the demographics, type of anesthesia used and delivery, and weight of the newborn. An improvement in the AST, ALT, LDH, haptoglobine, antithrombine, fibrinogenen and platelets was observed within 72 hours after dexamethosone use. There was a significant increase in the diuresis within the interval of 6 hours before the delivery and 24 hours after it. Of the 62 patients, 46 (74. 2%) had normal renal function and 16 (25.8%) evolved with renal lesion, with 5 (8.1%) needing dialysis. These 5 patients who received dialysis recovered the xi renal function. The delay in administering dexamethasone increased in 4.6% the risk of development of renal insufficiency. Patients with renal insufficiency had received significantly more blood products than subjects without renal lesion (p=0.03). Diuresis, leukocytes, uric acid, urea, creatinine were significantly different between the groups with normal renal function, renal lesion and renal insufficiency. The levels of creatinine 1.2mg/dl and uric acid 51mg/dl, at admission are predictive of subjects who will evolve with renal lesion (p<0.001). Maternal mortality was 3.2%. None of the subjects with renal insufficiency evolved with chronic renal disease. Conclusions: Dexamethasone in patients with HELLP syndrome seems to reduce significantly the hepatic microthrombosis and normalize hemostasis as seen by improvement of liver function. Renal injury can be considered, in HELLP syndrome, when creatinine levels are greater than 1.3 mg/dl and diuresis less than 100 ml/h in interval of 4 hours. The level of creatinine greater than 1.2 mg/dl and urea greater than 51mg/dl are predictive of subjects with HELLP syndrome who will develop renal injury. Patients who receive more red cell packs develop renal insufficiency. Finally, the delay in administering dexamethasone increases the risk of developing renal insufficiency

Elaboração e validade do teste de rastreio de doença da Alzheimer com provérbios (TRDAP) para indivíduos a partir de sessenta anos

A escassez de instrumentos para a avaliação e a triagem da doença de Alzheimer, (DA), notadamente denominados de rastreio, com características de padronização e validados para o Nordeste, motivou este Estudo. Visando à triagem de uma etapa mais leve da doença e encaminhamento precoce ao tratamento multidisciplinar foi elaborado o Teste de Rastreio da Doença de Alzheimer com Provérbios (TRDAP), a partir de um Jogo de Memória de Provérbios, construído como recurso terapêutico ocupacional. Está composto de três etapas conforme a função neuropsicológica avaliada, a A (memória de curto prazo), B (funções executivas e linguagem) e C (memória episódica), além do reconhecimento de provérbios. O Estudo foi realizado em uma amostra de conveniência, com 91 idosos (28 DA e 63 controles), a partir de 60 anos, com um ou mais anos de escolaridade. Foram controladas as variáveis, como doenças intercorrentes ou déficits sensoriais que pudessem comprometer o desempenho dos pacientes, nos testes. O protocolo constou de oito testes selecionados por especialistas: Miniexame do Estado Mental (para validade convergente), Escala de Depressão Geriátrica EDG (validade discriminante), Lista de Palavras, Fluência Verbal, Span de Dígitos, Figura Neuropsi, Teste do Relógio, Atividade de Vida Diária e Instrumental. Os resultados confirmaram a validade de construto convergente e discriminante, assim como a relação significativa (p<0,005) com todos os testes, exceto com o EDG. Quanto à validade concorrente, não houve discordância com o critério da avaliação médica observou-se consistência interna aceitável, conferindo confiabilidade no instrumento, o que não ocorreu com MEEM. Tais resultados permitem afirmar que o TRDAP possui características psicométricas, adequadas ao rastreio da fase leve da DA para população estudada

Sistemas microemulsionados como carreador lipídico para fármacos insolúveis

Several pharmaceutical products have been developed in recent years aiming to enhance the treatment of diseases by increasing the effectiveness of drugs. Many of these new products are based on new drug delivery systems. Among these, microemulsions, which were first studied in 1943 by Hoar and Schulman, is of great interest. Microemulsion can be defined as a thermodynamically stable, isotropic, translucent and transparent system of two immiscible liquids stabilized by a surfactant film located in the oil / water interface. The aim os this work was the incorporation of Amphotericin B and Simvasatin to a microemulsion system and analyzes its physicochemical properties and their therapeutical activity when incorporated into this system. Some very promising results were achieved as the reduction of the toxicity and maintenance of the efficacy of the Amphotericin B incorpored into a microemulsion, which was demonstrated in the in vitro pharmacotoxicological study. As for the incorporation of Simvastatin in microemulsion, it was observed a significant improvement in the potential antiinflammatory and anti-infective properties when the system was use to treat infected wounds (simvastatin pleiotropic effects). Therefore, it can be concluded that the incorporation of these drugs into microemulsion system reveal the potential of microemulsions as a promising and novel dosage form, qualifying them for future trials in order to make them available in the pharmaceutical market

Emprego dos ácidos graxos de cadeia curta na colite de derivação fecal : estudo em ratos Wistar

Diversion colitis is a chronic inflammatory process affecting the dysfunctional colon, after a colostomy. It is postulated that nutritional deficiency of the colonic epithelium by the absence of short-chain fatty acids (SCFA) is one of the factors responsible for the appearance of DC and that their employment could reverse the morphological changes of the mucosa. The treatment of choice for fecal diversion colitis (DC) is the reconstruction of the intestinal tract, although they suggested therapeutic options using enemas. This study evaluates the effect of SCFA in atrophy and inflammation in excluded colonic segments before and after the installation DC. Forty Wistar rats were divided into four groups (n = 10 for each group), submitted colostomy with distal colon exclusion. Two control groups (A1 and B1) received rectally administered physiological saline, whereas two experimental groups (A2 and B2) received rectally administered short-chain fatty-acids. The A groups were prophylactically treated (5th to 40th days postoperatively), whereas the B groups were therapeutically treated (after postoperative day 40), for 07 days. Histological sections stained with HE were used for histological analysis of the thickness of the colonic mucosa excluded (t- Student p ≤0.05). Inflammatory reaction of the lamina propria and mucosa were measured with scores previously established (Mann Whitney p ≤ 0.05). There was a significant thickness recovery of the colonic mucosa in group B2 animals (p = 0.0001), which also exhibited a significant reduction in the number of eosinophilic polymorphonuclear cells in the lamina propria (p = 0.0126) and in the intestinal lumen (p = 0.0256). Group A2 did not prevent the mucosal atrophy and significant increases in the numbers of lymphocytes (p=0.0006) and 50 eosinophilic polymorphonuclear cells in the lamina propria of the mucosa (p = 0.0022). Therapeutic use of short-chain fatty-acids significantly reduced eosinophilic polymorphonuclear cell numbers in the intestinal wall and in the colonic lumen; it also reversed the atrophy of the colonic mucosa. Prophylactic use did not impede the development of mucosal atrophy

A igreja católica e as novas comunidades: do cosmos ao caos moderno

La discussion des métamorphoses de l'Église Catholique Romaine causés par ses relations avec la modernité est la toile de fond au débat sur l'émergence de nouveaux mouvements religieux, en particulier les nouvelles communautés. Dans le but de comprendre la convergence/ divergence ou conservation/ changement en ce qui concerne la relation entre l'Institution et la Communauté, j'ai choisi de contextualiser l'histoire du christianisme catholique dans la modernité et dans la post-modernité à partir de penseurs classiques et contemporains. J ai évité une vision unilatérale qui met l'accent sur l'aspect objectif ou subjectif et a opté pour une approche dialogique capable de permettre une lecture des deux côtés de la réalité. Cette réflexion a guidé le travail ethnographique réalisé dans deux communautés à Cidade do Natal: Fraternité Éfeso et Communauté Catholique Veni Creator Spiritus. Cette recherche a montré que les nouvelles communautés promeuvent un nouveau catholicisme certainement plus conservateur que réformateur; tantôt elles attirent et rettiennent les croyants dans l'Église, tantôt inquiètent la hiérarchie ecclésiastique - depuis l encadrement de ce nouveau phénomène dans la structure existante jusqu'à sa orientation

Os programas de governo no horário gratuito de propaganda eleitoral:um estudo das eleições governamentais no Rio Grande do Norte em 2006

In Brazil, the Free Political advertising time (HGPE) represents one of the main venues for the contest between political parties, revealing a tool that streamlines the electoral dispute and enables all sectors and social classes of important information about dispute over candidates. In HGPE, political groups have the opportunity to present their programs of government and discuss issues that relate to the demands of the population. This research sought to examine the role played by so-called "government programs" in the electoral race for governor of Rio Grande do Norte in 2006, which had as main candidates, two traditional characters of the political landscape in Natal: Wilma de Faria (PSB) and Garibaldi Alves Filho (PMDB). According to our analysis, discussion of government programs such candidates in HGPE had not meant to enlighten the voters about the political projects designed, not just the desire to build an image of seriousness and competence of candidates, but appeared as a means to meet the schedule imposed by the opponent and as a strategic resource to select a specific segment of the electorate.

Adam Smith visto por Roberto Campos: a (re)criação do mito e as necessidades do capitalismo

This work aims at analyzing how Adam Smith, one of the founders of the liberal regime was seen by Roberto Campos, one of the patriarchs of Brazilian liberalism. In this sense, it will be shown how and why the legacy of Scotland was used to legitimize the new pattern of accumulation necessary to capitalism from the second half of the twentieth century on. So, it is the intention to make explicit that the changes in Campos discursive form are consistent with the requirements of capitalism in crisis and were fundamental in the creation of another common sense. To achieve these goals it will be assessed in what way the liberal rhetoric of the Brazilian, harmonized with foreign authors with the same vision, has become an important weapon to transform Smith into a myth in contrast to the political and economic criteria advocated by the same, but valuable to what Roberto Campos intended

História e educação de mulheres remanescentes indíginas de missão do Sahy.

El estudio Historia y educación de mujeres indígenas que quedan em Missão do Sahy pretende comprender, a través de recerdos y memorias, la transmisión de costumbres y prácticas educativas de un grupo de mujeres en sus relaciones con la familia, la escuela y la religión. El enfoque teórico-metodológico utilizado fue la Historia Oral, un enfoque que oferece la oportunidad de trabajar con la historia de mujeres y la memoria, tratando de reconstruir algunas de las experiencias de estas mujeres que tienen la custodia de las historias y los conocimientos transmitidos por los antepasados, como activistas en las actividades de la Comunidad, los partidos políticos, en la dirección de las asociaciones de la comunidad y los mantenedoras de la iglesia. La encuesta se realizó en el Distrito de Missão do Sahy, un asentamiento franciscano instalado en 1697 y abolida en 1863, em el territorio de Las Jacobinas, la ciudad de Senhor do Bonfim, en el norte de Bahia. El estudio demostró que todavía hay uma fuerte presencia de la práctica de los Padres Franciscanos, los creadores del pueblo, también mostró que las orientaciones religiosas han contribuido significativamente a fortalecer el papel de la mujer en Missão do Sahy como madre y esposa. Este estudio también mostró que el sesgo afecta a las más jóvenes remanescentes que - ni india ni negra - todavia son victimas de discriminación, un hecho que quizás tiene su origen el desconocimiento de la identidad de estas mujeres. Varios autores han contribuido en este estudio: Halbwachs (2006), Bosi (1994) y Pollak (1989) contribuyó a la construcción del estudio de la memoria, Perrot (1988, 2006, 2007) y Del Piore (2007) proporcionaron la base para la historia de la mujer; Machado y otros autores regionales (1993, 2007), Lourenço Pereira da Silva (1906, 1915), Adolfo Silva (1971), Edith Davis (1997), Joseph Davis (2001), Da Paz (2001, 2004), Oro (2008) , Santos (2007), Araujo (2002) y (2008 Vieira Filho) contribuyeron a la construcción de una historiografía de la zona de la investigación. Cronistas Frei Martinho de Nantes (1979) y Frei Venancio Willeke OFM (1994), además de teórico Norbert Elias (1993), de Michel de Certeau (1994) y Philippe Aries (1981), que presentan elementos importantes para el análisis de las pruebas.

Pelos caminhos das idéias e da existência: a propósito das cartografias de J. T. de Moura Filho

The present study aimed to investigate the intellectual, personal and professional tracjetory of José Tavares de Moura Filho. Civil engineer who devoted him self to cartographic cience, though not a cartographer, and to literature. At 65 years old, already with retirement, he devoted his attention to writing his books and see the world, as he said. There were nine books, five of poetry, prose and short stories, and four of cartographic nature. The published his books independently. He wrote and his wife Elza typed. Once ready, he would seek the graphics, later a publisher, to reproduce his writing. He liked to say he would rather to pay for your books than bay a new car, and did so. Died at age of 82 years, leaving a rich material for the young students, those who read, as he always did by dedicating his books. In order to achieve the objectives of this study, we used as a theoretical some authors dealing with historiography, oral history, intellectual intineraries and history of ideas, as Garnica, Nóvoa, Barros, Bosi, Le Goff among others. From this perspective, we constructed an archeology of ideas and the existence of Moura Filho, to point contributions of the teaching of mathematics from his work

Violência contra a mulher : estudo de caso em uma instituição de ensino

The study research case with a quantitative approach and prospective data, carried out between December 2010 and February 2011 with the aim of identifying the profile of women in the study, to characterize the acts of violence in the type, frequency, location occurrence and aggressor, analyze the steps taken after the occurrence of acts of violence and the main consequences on the victims. The population consisted of 285 workers in a tertiary institution in Rio Grande do Norte. The results showed that 99 (34.74%) have between 51 to 60 years of age, 78 (27.37%) of 41 to 50 and 62 (21.75%) between 20 and 30 years, are considered color white, 162 (56.84%) have completed higher education, 171 (60.00%) and of these 97 (56.73%) reported having some post-graduate degrees, are married, 141 (49.47%) and have from zero to one child, 148 (51.93%) reside in the south of the city of Natal, 146 (51.23%) have a monthly income of three to five minimum wages, 171 (60.00%) and are mostly in the Technical Administrative Sciences 152 (53.33%), 77 (27.02%) reported having experienced violence, 60 (62.50%) episodes of verbal aggression, 26 (27.08%) of bullying , 05 (5.21%) of physical abuse and 05 (5.21%) sexual harassment; 05 (100.00%) assaults were made by the spouse or partner of the victims and co-workers is another profession were responsible for 18 (30.00%) verbal aggression, 15 (57.69%) bullying and 03 (60.00%) sexual harassment, 02 (40.00%) of victims of physical aggression and 18 (30.00 %) of verbal abused only once, 10 (38.46%) of bullying and 02 (40.00%) of sexual harassment experienced four or more times 05 (100.00%) assaults occurred at domestic and work stood out with 36 (60.00%), verbal abuse, 22 (84.62%), moral harassment and 04 (80.00%) sexual harassment, 35 (36.46%) told colleagues work and 31 (32.29%) for family and friends in 75 (78.13%) cases there was no intervention, 07 (7.29) were unable to respond if something had been done and 14 (14.58% ) have been reported intervention of these, 09 (64.29%) were taken by the heads of the victims, 26 (32.10%) did not notify the fact on the ground that no action would be taken, 62 (80.52%) felt stress , 5 (1.76%) of women turned away from work after the episode of violence, accounting for 198 days of absenteeism. It is concluded that there is a high rate of violence against women, even when they have a good socioeconomic status, and in this sense is important to establish bases of new proposals for improving control of cases of health professionals, especially nurses, to approach patients with a more investigative, and that by identifying a case of violence, be instructed about the paths to be followed for notification while providing psychological support to victims.

Percepção do pai sobre sua presença no nascimento do filho

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Nascimento de um filho :o significado para o pai

Qualitative study on the meaning of a child s birth to the father. Its general purpose was to comprehend the significance the man attaches to his child s birth and its specific objectives were to identify the man s feelings with regard to his child s birth as well as to verify his attitude toward a child s birth. The study was founded on the theoretical reference system about the man in the gravid-puerperal cycle and the humanization of the assistance. The data were obtained through semistructured interview performed with men accompanying their children s birth whose wives were in the immediate puerperium. This stage occurred in two maternity hospitals in Natal-RN, both of which adopt the principle of safe notherhood in the attendance of women in the process of parturition. The material apprehended from the statements was treated in conformity with the content analysis method in the mode of thematic analysis according to Bardin. Three thematic categories emerged from this process: the father s attitude toward his child s birth, the father s feelings in respect of his child s birth, and the informations received by the father in the course of his child s birth. The speech content was analyzed in accordance with the principles of symbolic interactionism according to Blumer. The results showed that the husbands interact with their respective wives and respond with attitudes of care, help, support, and encouragement within the principles of humanization intermingled with feelings of happiness, restlessness, and suffering leading them to appraise and exalt their consorts. Besides, we verified that the father s attitudes and feelings in the delivery room in the light of symbolic interactionism tend to be influenced by the interaction between him and the attending professionals

Uma contribuição à avaliação dos impactos da gestão de estoque na satisfação e fidelização pós-vendas de clientes de concessionárias de automóveis : um estudo empírico em Natal-RN

This paper aims to conduct a study to evaluate and measure the possible impact that the unavailability of spare parts can have on customer satisfaction for car dealerships in the post-sales. A theoretical-conceptual review on the subject of satisfaction and loyalty, on the backdrop of the reality of the automobile market, allowed the construction of a research tool dedicated to collect opinions of car owners, to allow an analysis empirical relationship between the availability of parts, repairs or scheduled service possible, and change or stay on the mark on the occasion of change of vehicle. 236 forms were applied to car owners in the city of Natal / RN. The results obtained in this survey allowed the identification of the unavailability of parts as a significant factor, among others, the motivation for the customer to switch brands. Collaterally, we could also conclude that the dynamics of change in marks, whatever its motivation, is reflected in the perceived positions of the different brands as the market share both in strictly quantitative terms and in terms of relative positioning, with significant changes in the ranking of consumer preferences for different brands available

Sistema de detecção e isolamento de falhas em sistemas dinâmicos baseado em identificação paramétrica

The present research aims at contributing to the area of detection and diagnosis of failure through the proposal of a new system architecture of detection and isolation of failures (FDI, Fault Detection and Isolation). The proposed architecture presents innovations related to the way the physical values monitored are linked to the FDI system and, as a consequence, the way the failures are detected, isolated and classified. A search for mathematical tools able to satisfy the objectives of the proposed architecture has pointed at the use of the Kalman Filter and its derivatives EKF (Extended Kalman Filter) and UKF (Unscented Kalman Filter). The use of the first one is efficient when the monitored process presents a linear relation among its physical values to be monitored and its out-put. The other two are proficient in case this dynamics is no-linear. After that, a short comparative of features and abilities in the context of failure detection concludes that the UFK system is a better alternative than the EKF one to compose the architecture of the FDI system proposed in case of processes of no-linear dynamics. The results shown in the end of the research refer to the linear and no-linear industrial processes. The efficiency of the proposed architecture may be observed since it has been applied to simulated and real processes. To conclude, the contributions of this thesis are found in the end of the text

Controle adaptativo robusto para um modelo desacoplado de um robô móvel

This thesis presents a new structure of robust adaptive controller applied to mobile robots (surface mobile robot) with nonholonomic constraints. It acts in the dynamics and kinematics of the robot, and it is split in two distinct parts. The first part controls the robot dynamics, using variable structure model reference adaptive controllers. The second part controls the robot kinematics, using a position controller, whose objective is to make the robot to reach any point in the cartesian plan. The kinematic controller is based only on information about the robot configuration. A decoupling method is adopted to transform the linear model of the mobile robot, a multiple-input multiple-output system, into two decoupled single-input single-output systems, thus reducing the complexity of designing the controller for the mobile robot. After that, a variable structure model reference adaptive controller is applied to each one of the resulting systems. One of such controllers will be responsible for the robot position and the other for the leading angle, using reference signals generated by the position controller. To validate the proposed structure, some simulated and experimental results using differential drive mobile robots of a robot soccer kit are presented. The simulator uses the main characteristics of real physical system as noise and non-linearities such as deadzone and saturation. The experimental results were obtained through an C++ program applied to the robot soccer kit of Microrobot team at the LACI/UFRN. The simulated and experimental results are presented and discussed at the end of the text