Fatores preditivos da dor em pacientes submetidos à cirurgia cardíaca

A identificação de fatores que interferem na dor pós-operatória é útil para minimizar o sofrimento desnecessário e favorecer a uma intervenção analgésica adequada, evitando generalizações nas condutas terapêuticas. O propósito dessa investigação foi identificar os fatores preditivos da dor em pacientes submetidos à cirurgia cardíaca e a relação existente entre dor, analgesia e personalidade. Trata-se de um estudo prospectivo e analítico, aprovado pelo comitê de ética da UFRN (175/06), o qual proporcionou uma abordagem multidisciplinar ao envolver áreas distintas como: fisioterapia, psicologia, médica e enfermagem (interdisciplinaridade) na elucidação do objeto de estudo relacionado a fatores preditivos da dor. Para caracterização geral dos pacientes foi utilizada uma ficha de avaliação fisioterapêutica; a dor pós-operatória foi avaliada pela escala numérica de dor e questionário para dor McGill e o Inventário Millon de Estilos de Personalidade (MIPS) foi utilizado para identificar e avaliar as manifestações das características comportamentais e de personalidade. Foram acompanhados, do 1º ao 5º dia de pós-operatório (DPO), 160 pacientes submetidos à cirurgia cardíaca, 57,5% do sexo masculino, com idade média de 56,8±14,4 anos, sendo incluídos no estudo aqueles que se queixaram de dor no pós-operatório em pelo menos um dos dias de avaliação e assinaram termo de concentimento livre e esclarecido (TCLE). Os dados foram submetidos ao teste Qui-quadrado, regressão logística multivariada, teste de correlação de Spearman, teste t e ANOVA. Ao serem submetidos à análise de regressão foram encontrados seis fatores preditivos da dor: tempo cirúrgico > 3 horas, dreno mediastinal e lateral, tosse, vômitos, tempo de dreno > 24 horas e sexo feminino. Estes fatores apresentaram uma correlação positiva e significava com a intensidade dolorosa referida pelos pacientes na escala numérica de dor e os pacientes que apresentaram mais fatores preditivos da dor referiram mais dor. 23 Já em relação ao McGill não se obteve diferença significativa entre os pacientes com mais e menos fatores preditivos. Observou-se que foram administrados diferentes tipos de analgésicos, isolados ou associados, sendo estes: paracetamol, paracetamol associado à codeína, dipirona, tramadol, toradol e tilatil. A percepção dolorosa apresentou magnitudes variando de leve a moderada do 1º ao 5º DPO e ao ser relacionada com as características de personalidade, nos pacientes com menos dor, observou-se os fatores: preservação, individualismo, introversão e os com mais dor foram: proteção, extroversão, retraimento, discrepância, afetividade, acomodação, comunicabilidade e firmeza. Evidenciou-se que o comportamento doloroso pós-cirurgia cardíaca é multifatorial e que a determinação da existência de fatores preditivos da dor permite ao profissional da área de saúde fazer o uso adequado dos analgésicos, haja vista que o alívio da dor é responsabilidade de todos os profissionais da saúde. Os aspectos psicológicos enquanto características de personalidade podem influenciar padrões de comportamento como os observados.

Câncer de boca e orofaringe: tendências e análise de sobrevida em Natal (RN)

Introduction: Mouth cancer is classified as having one of the ten highest cancer incidences in the world. In Brazil, the incidence and mortality rates of oral cancer are among the highest in the world. Intraoral cancer (tongue, gum, floor of the mouth, and other non-specified parts of the mouth), the accumulated survival rate after five years is less than 50%. Objectives: Estimate the accumulated survival probability after five years and adjust the Cox regression model for mouth and oropharyngeal cancers, according to age range, sex, morphology, and location, for the city of Natal. Describe the mortality and incidence coefficients of oral and oropharyngeal cancer and their tendencies in the city of Natal, between 1980 and 2001 and between 1997 and 2001, respectively. Methods: Survival data of patients registered between 1997 and 2001 was obtained from the Population-based Cancer Record of Natal. Differences between the survival curves were tested using the log-rank test. The Cox proportional risk model was used to estimate risk ratios. The simple linear regression model was used for tendency analyses of the mortality and incidence coefficients. Results: The probability after five years was 22.9%. The patients with undifferentiated malignant neoplasia were 4.7 times more at risk of dying than those with epidermoid carcinoma, whereas the patients with oropharyngeal cancer had 2.0 times more at risk of dying than those with mouth cancer. The mouth cancer mortality and incidence coefficients for Natal were 4.3 and 2.9 per 100 000 inhabitants, respectively. The oropharyngeal cancer mortality and incidence coefficients were, respectively, 1.1 and 0.7 per 100 000 87 inhabitants. Conclusions: A low survival rate after five years was identified. Patients with oropharyngeal cancer had a greater risk of dying, independent of the factors considered in this study. Also independent of other factors, undifferentiated malignant neoplasia posed a greater risk of death. The magnitudes of the incidence coefficients found are not considered elevated, whereas the magnitudes of the mortality coefficients are high

Localização de faltas em linhas de transmissão de múltiplos terminais a partir de registros oscilográficos sincronizados via transformada wavelet

The electric energy is essential to the development of modern society and its increasing demand in recent years, effect from population and economic growth, becomes the companies more interested in the quality and continuity of supply, factors regulated by ANEEL (Agência Nacional de Energia Elétrica). These factors must be attended when a permanent fault occurs in the system, where the defect location that caused the power interruption should be identified quickly, which is not a simple assignment because the current systems complexity. An example of this occurs in multiple terminals transmission lines, which interconnect existing circuits to feed the demand. These transmission lines have been adopted as a feasible solution to suply loads of magnitudes that do not justify economically the construction of new substations. This paper presents a fault location algorithm for multiple terminals transmission lines - two and three terminals. The location method is based on the use of voltage and current fundamental phasors, as well as the representation of the line through its series impedance. The wavelet transform is an effective mathematical tool in signals analysis with discontinuities and, therefore, is used to synchronize voltage and current data. The Fourier transform is another tool used in this work for extract voltage and current fundamental phasors. Tests to validate the location algorithm applicability used data from faulty signals simulated in ATP (Alternative Transients Program) as well as real data obtained from oscillographic recorders installed on CHESF s lines.

Dificuldades de aprendizagem em estequiometria: uma proposta de ensino apoiada na modelagem

In order to learn/teach chemistry some themes are relevant, like the stoichiometry, which consists in the study of the weight ratios in the combination of elements and compounds between themselves. This is an underlying subject in the understanding/representation/forethought of chemical reactions. Considering these aspects, our study presents a modeling-based proposal to develop the content of stoichiometry with prospective chemistry teachers. With this aim, we have made a review of literature, which we considered when tried to identify the learning difficulties using both quizzes and pedagogical tests, and then, from those difficulties we could propose a teaching unit for this concept and, consequently the evaluation of our proposal. The participants were chemistry undergraduates at the Universidade Federal do Rio Grande do Norte (UFRN) from assorted levels. As a methodological framework, we rely on the discursive textual analysis to characterize the speech of participants. As main results we observed ideas of appearance or disappearance of matter during chemical transformations, disregard of stoichiometric proportions when using drawings to represent the microscopic level of a reaction and confusion between the magnitude amount of matter and other magnitudes such as mass and volume. The final product is a sequence of instruction, based on the modeling previous research literature , with the goal of improving students ability to articulate the macroscopic and submicroscopic levels of representation of the matter

Parâmetros de fonte de microterremotos em Cascavel-CE

In this dissertation it was studied the rupture characteristic of earthquakes of the Town of Cascavel CE, Northeastern Brazil. Located on the border of the Potiguar Basin, the Town of Cascavel is one of the most seismically active intraplate areas in the country. In this town, on November 20th, 1980 a 5,2mb earthquake occurred. This was the largest earthquake ever reported in Northeast Brazil. Studies of this region using instruments were possible after 1989, with several campaigns being done using seismographic networks. From the beginning of the monitoring to April 2008 more than 55,000 events were recorded. With the data collected by a network with six 3-components digital seismographic stations during the campaigns done from September 29th, 1997 to March 5th, 1998, estimates of source parameters were found fitting the displacement spectra in the frequency domain for each event. From the fitting of the displacement spectra it was possible to obtain the corner frequency ( ) c f and long period amplitude ( ) W0 . Source parameters were determined following Brune (1970) and Madariaga (1976) models. Twenty-one seismic events were analyzed (0.7 £ £ 2.1) b m in order to estimate the source dimension (r ), seismic moment ( ) M0 , static stress drop (Ds ), apparent stress ( ) a s , seismic energy ( ) S E and moment magnitude ( ) W M for each of the events. It was observed that the ratio between radiated seismic energy and moment seismic (apparent stress) increases with increasing moment and hence magnitude at the observed range. As suggested by Abercrombie (1995), also in this work there is a breakdown in the scaling for earthquakes with magnitudes smaller than three ( < 3.0) W M , so that the rupture physics is different for larger events. If this assumption is valid, the earthquakes analyzed in this work are not selfsimilar. Thus, larger events tend to radiated more energy per unit area than smaller ones.

Estudo do potencial da técnica de nanossísmica para o monitoramento de hidrofraturamento em reservatórios de hidrocarbonetos

Hydraulic fracturing is an operation in which pressurised fluid is injected in the geological formation surrounding the producing well to create new permeable paths for hydrocarbons. The injection of such fluids in the reservoir induces seismic events. The measurement of this reservoir stimulation can be made by location these induced microseismic events. However, microseismic monitoring is an expensive operation because the acquisition and data interpretation system using in this monitoring rely on high signal-to-noise ratios (SNR). In general, the sensors are deployed in a monitoring well near the treated well and can make a microseismic monitoring quite an expensive operation. In this dissertation we propose the application of a new method for recording and location of microseismic events called nanoseismic monitoring (Joswig, 2006). In this new method, a continuous recording is performed and the interpreter can separate events from noise using sonograms. This new method also allows the location of seismic sources even when P and S phases onsets are not clear like in situations of 0 dB SNR. The clear technical advantage of this new method is also economically advantageous since the sensors can potentially be installed on the surface rather than in observation well. In this dissertation field tests with controlled sources were made. In the first test small explosives using fire works at 28 m (slant distances) were detected yealding magnitudes between -2.4 ≤ ML ≤ -1.6.. In a second test, we monitored perforation shots in a producing oil field. In this second test, one perforation shot was located with slant distances of 861 m and magnitude 2.4 ML. Data from the tests allow us to say that the method has potential to be used in the oil industry to monitor hydrofracture

Orientação e magnitude de tensões na bacia potiguar: implicações para evolução de bacias em margens passivas

This study presents new stress orientations and magnitudes from the Potiguar basin in the continental margin of Brazil. We analyzed breakout and drilled induced fractures derived from resistivity image logs run in ten oil wells. We also used direct Shmin measurements determined from hydraulic fractures and rock strength laboratory analysis. In addition, we compared these results with 19 earthquake focal mechanisms located in the crystalline basement. We observed that stress directions and magnitudes change across the basin and its basement. In the basin, the SHmax gradient of 20.0 MPa/km and the SHmax/Shmin ratio of 1.154 indicate a normal stress regime from 0.5 to 2.0 km, whereas the SHmax gradient of 24.5MPa/km and the SHmax/Shmin ratio of 1.396 indicate a strike slip stress regime from 2.5 to 4.0 km. The deeper strike-slip stress regime in the basin is similar to the regime in the basement at 1-12 km deep. This stress regime transition is consistent with an incipient tectonic inversion process in the basin. We also noted that the SHmax direction rotates from NW SE in the western part of the Potiguar basin to E W in its central and eastern part, following roughly the shoreline geometry. It indicates that local factors, as density contrast between continental and oceanic crust and sediment loading at the continental shelf influence the stress field. The concentration of fluid pressure in faults of the lowpermeability crystalline basement and its implications to establish a critically stressed fault regime in the basement is also discussed

analise da dispersao de ondas de superficie na provincia borborema, Nordeste do Brasil

The Borborema Province, Northeastern Brazil, had its internal structure investigated by different geophysical methods like gravity, magnetics and seismics. Additionally, many geological studies were also carried out to define the structural domains of this province. Despite the plethora of studies, there are still many important open aspects about its evolution. Here, we study the velocity structure of S-wave in the crust using dispersion of surface waves. The dispersion of surface waves allows an estimate of the average thickness of the crust across the region between the stations. The inversion of the velocity structure was carried out using the inter-station dispersion of surface waves of Rayleigh and Love types. The teleseismic events are mainly from the edges of the South and North American plates. The period of data collection occurred between 2007 and 2010 and we selected 7 events with magnitude above 5.0 MW and up to 40 km depth. The difference between the events back-azimuths and the interstation path was not greater than 10. We also know the depth of the Moho, results from Receiver Functions (Novo Barbosa, 2008), and use those as constrains in inversion. Even using different parameterizations of models for the inversion, our results were very similar the mean profiles velocity structure of S-wave. In pairs of stations located in the Cear´a Central Domain Borborema the province, there are ranges of depths for which the velocities of S are very close. Most of the results in the profile near the Moho complicate their interpretation at that depth, coinciding with the geology of the region, where there are many shear zones. In particular, the profile that have the route Potiguar Bacia in inter-station, had low velocities in the crust. We combine these results to the results of gravimetry and magnetometry (Oliveira, 2008) and receptor function (Novo Barbosa, 2008). We finally, the first results on the behavior of the velocity structure of S-wave with depth in the Province Borborema

Gravidade do olho seco em pacientes internados em unidade de terapia intensiva: análise de conceito e construção de definições

Dry eye syndrome is a multifactorial disease of the tear film, resulting from the instability of the lacrimal functional unit that produces volume change, up or tear distribution. In patients in intensive care the cause is enhanced due to various risk factors, such as mechanical ventilation, sedation, lagophthalmos, low temperatures, among others. The study's purpose is to build an assessment tool of Dry Eye Severity in patients in intensive care units based on the systematization of nursing care and their classification systems. The aim of this study is to build an assessment tool of Dry Eye Severity in hospitalized patients in Care Unit Intensiva.Trata is a methodological study conducted in three stages, namely: context analysis, concept analysis, construction of operational definitions and magnitudes of nursing outcome. For the first step we used the methodological framework for Hinds, Chaves and Cypress (1992). For the second step we used the model of Walker and Avant and an integrative review Whitemore seconds, Knalf (2005). This step enabled the identification of the concept of attributes, background and consequent ground and the construction of the settings for the result of nursing severity of dry eye. For the construction of settings and operational magnitudes, it was used Psicometria proposed by Pasquali (1999). As a result of context analysis, visualized from the reflection that the matter should be discussed and that nursing needs to pay attention to the problem of eye injury, so minimizing strategies are created this event with a high prevalence. With the integrative review were located from the crosses 19 853 titles, selected 215, and from the abstracts 96 articles were read in full. From reading 10 were excluded culminating in the sample of 86 articles that were used to analyze the concept and construction of settings. Selected articles were found in greater numbers in the Scopus database (55.82%), performed in the United States (39.53%), and published mainly in the last five years (48.82). Regarding the concept of analysis were identified as antecedents: age, lagophthalmos, environmental factors, medication use, systemic diseases, mechanical ventilation and ophthalmic surgery. As attributes: TBUT <10s, Schimer I test <5 mm in Schimer II test <10mm, reduced osmolarity. As consequential: the ocular surface damage, ocular discomfort, visual instability. The settings were built and added indicators such as: decreased blink mechanism and eyestrain.