Avaliação da eficácia analgésica no pós-operatório de revascularização do miocárdio: ensaio clínico randomizado controlado

A analgesia pós-operatória eficaz é especialmente importante após cirurgias torácicas, pois, além de aliviar a dor, facilita a retomada de atividades normais, incluindo a deambulação, a respiração e a tosse. Dessa forma, os objetivos deste estudo são: avaliar a eficácia analgésica da associação entre anestesia geral e raquianestesia com morfina e ropivacaína mais esquema multimodal em relação à anestesia geral e esquema multimodal em cirurgia de revascularização do miocárdio; analisar a eficácia analgésica da injeção subcutânea de lidocaína e analgesia multimodal na remoção de tubos torácicos em cirurgia de revascularização do miocárdio. A metodologia consiste em ensaio clínico randomizado, controlado, envolvendo 58 pacientes, de ambos os sexos, com idade média de 59,8  8,9 anos, estado físico ASA II e III. Os participantes foram alocados em dois grupos, sendo o GI composto por indivíduos submetidos à anestesia geral combinada à raquianestesia com morfina 400μg e 6 ml (30mg) a 8 ml (40mg) de ropivacaína a 0,5% e analgesia multimodal; já o GII foi composto por indivíduos submetidos à anestesia geral associada à analgesia multimodal. Foi avaliada a dor, ao despertar, nas primeiras 24 horas, e ao realizar exercício respiratório, ao retirar drenos de torácicos e o tempo para extubação. A análise estatística foi realizada pelos testes do Qui-quadrado e Teste t de Student e o teste de Fisher. O resultado obtido foi o seguinte: o GI apresentou menor intensidade de dor ao despertar (p= 0,001), nas primeiras 24 horas (p= 0,001) e durante a realização dos exercícios respiratórios (p= 0,004). Houve maior necessidade de analgesia complementar no grupo GII, com maior consumo de morfina (p= 0,05), e os efeitos colaterais leves, como náuseas (p= 0,001), vômito (p= 0,002), prurido (p= 0,030), predominaram no GI. Não houve diferença estatisticamente significante entre os grupos (P= 0,47), em relação à intensidade de dor na remoção dos drenos. Após as observações feitas, o estudo sugere que a anestesia geral combinada à raquianestesia com morfina associada à ropivacaína oferece melhor efeito analgésico no pós-operatório de cirurgia cardíaca. Adicionalmente, o estudo sugere que o efeito analgésico da injeção subcutânea de lidocaína 1% associado à analgesia multimodal não é eficaz

Efeitos da sintomatologia depressiva na mobilidade de idosos de um centro urbano do nordeste brasileiro

O processo de envelhecimento da humanidade é um fenômeno mundial e nas últimas décadas a população brasileira tem acompanhado essa tendência. No entanto, este fenômeno somente pode ser considerado como uma real conquista em termos sócios demográficos na medida em que se agregue qualidade aos anos adicionais de vida para a população. Em populações idosas, a incapacidade funcional e os sintomas depressivos tornaram-se importantes conceitos tanto por suas consequências para a saúde pública, quanto pelo impacto na qualidade de vida dessas populações. Este estudo tem como objetivo verificar se há associação entre os sintomas depressivos e o desempenho funcional de idosos comunitários. Foram avaliados 313 idosos de um centro urbano do nordeste brasileiro através das baterias de testes; Center for Epidemiologic Studies Depression CES-D e Short Physical Performance Battery - SPPB; além de variáveis relacionadas ao estado físico, condições crônicas, função cognitiva e características sócio demográficas. Foram utilizadas medidas de correlação e aplicado método de análise multivariada para construir um modelo explicativo da influência da sintomatologia depressiva no desempenho funcional. Os resultados revelaram que as mulheres apresentaram mais sintomas depressivos (p< 0.01) e pior desempenho funcional (p< 0.01) que os homens. Os indivíduos com sintomatologia depressiva apresentaram pior desempenho funcional, especialmente as mulheres. A idade, o sexo feminino, o estado de saúde percebido, o nível de função cognitiva e o Índice de massa corporal foram identificados como fatores associados ao desempenho funcional na amostra estudada. Os resultados deste estudo permitem inferir a relação de associação entre sintomas depressivos e desempenho funcional em uma população de idosos de um centro urbano no nordeste do Brasil. Estes resultados fornecem informações úteis para intervenções terapêuticas adequadas voltadas para a prevenção do declínio na mobilidade em idosos

Cultura e clima organizacionais: um estudo multicasos em indústrias de laticínios do estado do Rio Grande do Norte

The objective of this study is to investigate if exist relationship between organizational culture and the organizational climate, having as research s locus three dairy industries in the Rio Grande do Norte State. As such, an exploratory-descriptive and conclusive-causal study, with a sample composed of 211 employees of all firms hierarchical levels was undertaken. By way the data collection, the employees personal characteristics, the predominant organizational culture profile and the predominant organizational climate in the industries researched were identified. In order to analyse the organizational culture, the Competing Value Model (CAMERON; QUINN, 2006), with adaptations by Santos (1998, 2000), was used. In order to analyse the organizational climate, the Organizational Climate Measurement Scale, proposed by Martins (et al., 2004, 2008), with modifications, was used. The data were submitted to quantitative statistical analyses, firstly to the set of firms and afterwards to the firms alone, that permitted arrival to the following conclusions: the cultural profiles was met in a balanced way in the researched organizations, with emphasis to clan culture and market culture profiles; the researched organizations have a good organizational climate, based in the Martins (2008) classification, with emphasis to boss and organization s support and physical comfort , being these factors coherent whit the clan culture profile; the personal variables are correlated with the cultural profiles and with the organizational climate factors, however, each organization show its singular form of relation; and the cultural profiles showed influence on organizational climate factors. Thus, the results permitted to conclude that there are relations between the cultural profiles and the organizational climate factors in the researched organizations

Influência do teor de calcário no comportamento físico, mecânico e microestrutural de cerâmicas estruturais

There are ores of clay in Piauí State that are used for red structural ceramics, which are naturally contaminated with calcareous vein. This is one thing that impedes its exploration in an adequate way, especially for tile production. The present work aims at verifying the influence of the calcareous contents in the technological structural ceramics area, seeking to determine a maximum permissible calcareous proportion/contents in the ceramic mass using the patterns of the local industry production. For the consecution of this paper, it was characterized the clay and calcareous material by FRX, DRX, TGA and DTA. It was also configurated by extrusion and burnt in the temperatures of 850°C, 900°C, 950°C and 1000°C pieces of the corpus with 0, 5, 10, 15 e 20% of calcareous proportion. After that, it was carried out technological samples of linear retraction, water absortion, apparent porosity, specific apparent mass and mechanic resistance. The results showed the possibility of using calcareous in the ceramic mass and in some cases the technological properties got better

Tratamento térmico do titânio e suas consequências sobre as propriedades físico-químicas e de biocompatibilidade

The titanium and titanium alloys are widely used as biomaterial in biomedical device and so research have been developed aiming to improve and/or better to understand interaction biomaterial/biological environment. The process for manufacturing of this titanium implants usually involves a series of thermal and mechanical processes which have consequence on the final product. The heat treatments are usually used to obtain different properties for each application. In order to understand the influence of these treatments on the biological response of the surface, it was done, in this work, different heat treatments in titanium and analyzed their influence on the morphology, adhesion and proliferation of the pre-osteoblastic cells (MC3T3-E1). For such heat-treated titanium disks were characterized by optical microscopy, contact angle, surface energy, roughness, microhardness, X-ray diffraction and scanning through the techniques (BSE, EDS and EBSD). For the analysis of biological response were tested by MTT proliferation, adhesion by crystal violet and β1 integrin expression by flow cytometry. It was found that the presence of a microstructure very orderly, defined by a chemical attack, cells tend to stretch in the same direction of orientation of the material microstructure. When this order does not happen, the most important factor influencing cell proliferation is the residual stress, indicated by the hardness of the material. This way the disks with the highest level state of residual stress also showed increased cell proliferation

Estudo de Matérias-Primas do Rio Grande do Norte para Uso em Revestimento Poroso: Influência do teor de dolomita e temperatura de calcinação nas propriedades físico-mecânicas

The state of Rio Grande do Norte presents a great potentiality for the production of ceramic tiles because of having natural raw material in quantity and quality making its economical exploration possible, beyond the great energetic differential of the state, the natural gás. This works aims to study the influence of the dolomite and granulometry concentration and calcinations temperature in the obtaining of formulations for porous coverings which have to be coherent to the project,s specifications. The experiments have involved the physical-chemical and mineralogical characterizations of raw materials and mechanical tests in the dry and burnt proof bodies preceding a mixture experiment planning with the use of the response surface methodology, in order to get the best raw materials combinations to produce a ceramic mass with specific properties. The twelve ceramic masses studied in this work were prepared by the via dry process, characterized, shaped by uniaxial pressing and sinterized in the temperatures of 940ºC, 1000ºC, 1060ºC, 1120ºC and 1180ºC, using a fast burning cycle. The crystalline phases formed during the sintering in the temperatures in study have revealed the presence of anorthite and diopside beyond quartz with a remaining phase. These phases were the main responsible ones by the physical- mechanical properties of the sinterized proof bodies. The proof bodies after the sintering stage have presented water absorption higher than 10% and a good dimensional stability in all studied temperatures. However, the flexural breaking strength results in the temperatures of 940ºC, 1000ºC and 1060ºC, under the temperature zone of the vitrification of ceramic whiteware do not reach the flexural breaking strength specific for the porous wall tile (15 MPa), but in the temperature of 1120ºC next to the vitrification temperature zone, some whiteware ceramic (formulations) has reached the specified value for the porous wall tile. The results of this work have showed that the studied raw materials have great importance for used in the production of porous wall tiles (BIII)

Efeitos das variáveis ambientais locais sobre a abundância, a riqueza e a biomassa da macrofauna de solo em um ecossistema semiárido no estado do rio grande do norte, nordeste do brasil

The soil macrofauna is influenced to several biotic and abiotic environmental factors, from changes in the physical environment to a variety of interactions among the species involved, affecting the patterns of biodiversity of soil fauna. The power and specificity of the mechanisms that act on soil organisms vary greatly depending on environmental conditions at different scales of space and time. The Caatinga has great spatial heterogeneity of vegetation, climate and soil, so the soil macrofauna would follow this local spatial variation in the environment? This study aimed to investigate the effects of local environmental variables on biological parameters (taxa richness, total abundance and biomass) of soil macrofauna in a fragment of caatinga in João Câmara, Rio Grande Norte, Northeast Brazil. The study was conducted in the Cauaçu farm, where a grid of 2000m x 500m was drawn, and later, 30 sampling points were randomly selected. The methodology used to collect the macrofauna was the TSBF method. We tested the effects of 10 environmental variables on macrofauna across the plots and across the layers of soil. The hypothesis that macrofauna soil responds to changes in the environment was not supported throughout the plots, but was confirmed to soil layers. The soil macrofauna shows a pattern of concentration in the surface layer and decreases considerably in the deeper layers. This pattern had significant and positive relationship with the aerial plant biomass and fine root stock. The aerial plant biomass releases plant necromass that accumulates in the surface layer, providing an important source of resource and shelter for soil macrofauna, explaining their greater abundance in this layer. The roots are used as a means for the arrival of nutrients to the soil from the primary production, thus a greater amount of root conditions higher food intake for macrofauna, especially the herbivores

Estudo da produção de pectinase por fermentação em estado sólido utilizando pedúnculo de caju como substrato

Pectinolytic enzymes, or simply pectinases, are complex enzymes that degrade pectic polymers. They have many uses, such as fruit juice extraction and purification, textile fiber treatment and vegetal oil extraction. The aim of this work was to study the kinetics of pectinases production by solid-state fermentation, using dry cashew apple residue as substrate and the microorganism Aspergillus niger CCT 0916. The influence of the initial medium moisture and medium supplementation with a source of nitrogen and phosphorus was evaluated using the factorial experimental planning and response surface methodology. Ammonia sulphate and potassium phosphate were used as nitrogen and phosphorus source, respectively. The variables time of contact (T) and ratio volume solvent/fermented medium (RZ), in systems with and without agitation, were evaluated in order to study the best extraction condition of the produced enzyme. Washed and unwashed cashew apple residues were tested as the growth medium. The unwashed residue was obtained by drying the residue after the extraction of the juice, while the washed residue was obtained by water washing 5 times using the proportion of 1 kg pulp/2 liters of water. Samples were taken every 12 hours for moisture content, pH, protein, reducing sugars, polygalacturonase activity (PG) and viscosity reduction. The physical-chemical composition of the residues had different sugar and pectin levels. For the unwashed residue, the peak activity was reached with 40% of initial moisture content, 1% of nitrogen supplementation without phosphorus addition after 30 hours of process. These conditions led to 16 U/g of PG activity and 82% of viscosity reduction. The calculated models reached similar values to the experimental ones in the same process conditions: 15.55 U/g of PG and 79.57% of viscosity eduction. Similarly, the greatest enzyme production for washed residue was reached with 40% initial moisture content, 1% nitrogen supplementation without phosphorus addition after 22 hours of cultivation. In this condition it was obtained polygalacturonase activity of 9.84 U/g and viscosity reduction of 81.36%. These values are close to experimental values that were of 10.1 U/g and 81%, respectively. The conditions that led to the best PG activity results was the agitated one and the best extraction condition was obtained with 100 minutes of solvent/medium contact and RZ of 5 (mL/g)

Efeito agudo do exercício físico associado a praxias ideomotoras sobre as concentrações séricas de cortisol e memória declarativa em indivíduos com idade entre 51 e 74 anos

Introduction: Several modifications are identified as aging, causing more or less limitation imposed by over the years. Among these, one can highlight the different degrees of cognitive decline, particularly memory that can involve the daily activities and the subject functionality. Studies have shown an association between levels of serum cortisol and stress imposed by the exercise on this. However, there are few studies that references the performance on cognitive aspects of declarative memory and cortisol on the exercise in the water with automatic and práxicos movements and moderate. Objective: Check the effect based on the acute physical exercise and práxicos automatic movements on the performance of visual declarative memory and in serum cortisol in subjects aged between 51 and 74 years. Materials and Methods: It builds a survey characterized as cross with a first sample of 32 physically active subjects aged between 51 and 74 years, divided into two exercise groups (March of Automatic Group - MAG and the March of Praxis Group - MPG). We used a probabilistic and random sampling for sample selection. Used the MMSE (Mini Mental State Examination) to check the general cognitive status, visual acuity test - optotypes chart "E" Rasquin and was even used the declarative visual memory test proposed by Nitrini and collaborators (1994), applying before motor stimulation and immediately after, and the day of blood collection with 2 ml for analysis of cortisol hormone. The normality and homogeneity were verified from the Shapiro-Wilk and Levene tests. Thus we adopted a descriptive statistics to characterize the sample. The Split-Plot ANOVA was used along with the paired t-test to verify the identified differences. We adopted a significance level of p <0.05. Results: It was observed that the groups (MAG and MPG) and the anthropometric variables, perceived exertion, education, cognitive assessment and visual acuity showed no significant differences (p > 0.05), showing that the groups are homogeneous, with variables and similar means. After the stimulation session, lasting 30 min, it was observed that the amount of hits for Δ of declarative memory questionnaire visual images increased, presenting significant for both groups (MAG, p < 0.001; MPG, p = 0.042). The same was observed for cortisol concentration with a reduction in the levels immediately after the stimulus (MAG and MPG, p < 0.001). Conclusion: The results showed that the exercises proposed in its acute effect provide significantly memories of gains and also showed a reduction in cortisol levels.

A responsabilidade civil extracontratual do estado na prestação de serviços públicos de saúde

This study aims to examine the Brazilian legal model for the non-contractual liability of the state in providing public health services, from the perspective of threedimensional theory of law. Up based on bibliographical and documentary research, with emphasis on legislation, doctrine and Brazilian jurisprudence, the following conclusions were reached. The right to health is typified in the Constitution as a social fundamental right, and understands the pretension to obtain from the State, the supply of goods or the provision of services that reduce the risk of disease and other health problems; or promote, protect and recover the physical and mental well-being. Once violated the fundamental right to health, provides the managed, among other fundamental guarantees, the non-contractual liability of the state. The provision of public services by the state can be made directly through the Direct or Indirect Public Administration, or by recourse to private entities. In any case, the provision of public health services is entirely subordinate to the principles of administrative law and should be fully funded by tax revenues. As the provision of public health services is part of the administrative activity of the State, there is no way to exclude the application of the guarantee of non-contractual liability of the state in the face of the damage suffered by administered as users of these services. Therefore, it applies the theory of administrative risk, even in the event of harmful and illegal state failure.

Cultura e clima organizacionais: um estudo multicasos em indústrias de laticínios do estado do Rio Grande do Norte

The objective of this study is to investigate if exist relationship between organizational culture and the organizational climate, having as research s locus three dairy industries in the Rio Grande do Norte State. As such, an exploratory-descriptive and conclusive-causal study, with a sample composed of 211 employees of all firms hierarchical levels was undertaken. By way the data collection, the employees personal characteristics, the predominant organizational culture profile and the predominant organizational climate in the industries researched were identified. In order to analyse the organizational culture, the Competing Value Model (CAMERON; QUINN, 2006), with adaptations by Santos (1998, 2000), was used. In order to analyse the organizational climate, the Organizational Climate Measurement Scale, proposed by Martins (et al., 2004, 2008), with modifications, was used. The data were submitted to quantitative statistical analyses, firstly to the set of firms and afterwards to the firms alone, that permitted arrival to the following conclusions: the cultural profiles was met in a balanced way in the researched organizations, with emphasis to clan culture and market culture profiles; the researched organizations have a good organizational climate, based in the Martins (2008) classification, with emphasis to boss and organization s support and physical comfort , being these factors coherent whit the clan culture profile; the personal variables are correlated with the cultural profiles and with the organizational climate factors, however, each organization show its singular form of relation; and the cultural profiles showed influence on organizational climate factors. Thus, the results permitted to conclude that there are relations between the cultural profiles and the organizational climate factors in the researched organizations

Influência do teor de calcário no comportamento físico, mecânico e microestrutural de cerâmicas estruturais

There are ores of clay in Piauí State that are used for red structural ceramics, which are naturally contaminated with calcareous vein. This is one thing that impedes its exploration in an adequate way, especially for tile production. The present work aims at verifying the influence of the calcareous contents in the technological structural ceramics area, seeking to determine a maximum permissible calcareous proportion/contents in the ceramic mass using the patterns of the local industry production. For the consecution of this paper, it was characterized the clay and calcareous material by FRX, DRX, TGA and DTA. It was also configurated by extrusion and burnt in the temperatures of 850°C, 900°C, 950°C and 1000°C pieces of the corpus with 0, 5, 10, 15 e 20% of calcareous proportion. After that, it was carried out technological samples of linear retraction, water absortion, apparent porosity, specific apparent mass and mechanic resistance. The results showed the possibility of using calcareous in the ceramic mass and in some cases the technological properties got better

Tratamento térmico do titânio e suas consequências sobre as propriedades físico-químicas e de biocompatibilidade

The titanium and titanium alloys are widely used as biomaterial in biomedical device and so research have been developed aiming to improve and/or better to understand interaction biomaterial/biological environment. The process for manufacturing of this titanium implants usually involves a series of thermal and mechanical processes which have consequence on the final product. The heat treatments are usually used to obtain different properties for each application. In order to understand the influence of these treatments on the biological response of the surface, it was done, in this work, different heat treatments in titanium and analyzed their influence on the morphology, adhesion and proliferation of the pre-osteoblastic cells (MC3T3-E1). For such heat-treated titanium disks were characterized by optical microscopy, contact angle, surface energy, roughness, microhardness, X-ray diffraction and scanning through the techniques (BSE, EDS and EBSD). For the analysis of biological response were tested by MTT proliferation, adhesion by crystal violet and β1 integrin expression by flow cytometry. It was found that the presence of a microstructure very orderly, defined by a chemical attack, cells tend to stretch in the same direction of orientation of the material microstructure. When this order does not happen, the most important factor influencing cell proliferation is the residual stress, indicated by the hardness of the material. This way the disks with the highest level state of residual stress also showed increased cell proliferation

Estudo de Matérias-Primas do Rio Grande do Norte para Uso em Revestimento Poroso: Influência do teor de dolomita e temperatura de calcinação nas propriedades físico-mecânicas

The state of Rio Grande do Norte presents a great potentiality for the production of ceramic tiles because of having natural raw material in quantity and quality making its economical exploration possible, beyond the great energetic differential of the state, the natural gás. This works aims to study the influence of the dolomite and granulometry concentration and calcinations temperature in the obtaining of formulations for porous coverings which have to be coherent to the project,s specifications. The experiments have involved the physical-chemical and mineralogical characterizations of raw materials and mechanical tests in the dry and burnt proof bodies preceding a mixture experiment planning with the use of the response surface methodology, in order to get the best raw materials combinations to produce a ceramic mass with specific properties. The twelve ceramic masses studied in this work were prepared by the via dry process, characterized, shaped by uniaxial pressing and sinterized in the temperatures of 940ºC, 1000ºC, 1060ºC, 1120ºC and 1180ºC, using a fast burning cycle. The crystalline phases formed during the sintering in the temperatures in study have revealed the presence of anorthite and diopside beyond quartz with a remaining phase. These phases were the main responsible ones by the physical- mechanical properties of the sinterized proof bodies. The proof bodies after the sintering stage have presented water absorption higher than 10% and a good dimensional stability in all studied temperatures. However, the flexural breaking strength results in the temperatures of 940ºC, 1000ºC and 1060ºC, under the temperature zone of the vitrification of ceramic whiteware do not reach the flexural breaking strength specific for the porous wall tile (15 MPa), but in the temperature of 1120ºC next to the vitrification temperature zone, some whiteware ceramic (formulations) has reached the specified value for the porous wall tile. The results of this work have showed that the studied raw materials have great importance for used in the production of porous wall tiles (BIII)