Gestação após gastroplastia para tratamento de obesidade mórbida: série de casos e revisão da literatura

Objetivo: relatar a evolução de uma série de casos de gestação em mulheres previamente submetidas à cirurgia de bypass gástrico para tratamento de obesidade grave. Métodos: cinco casos consecutivos de gravidez após gastroplastia ocorridos entre 2001 e 2004 foram avaliados. As pacientes tinham idade entre 30 e 34 anos e todas haviam sido submetidas à cirurgia de Capella. Aspectos clínicos, laboratoriais e do acompanhamento materno e fetal foram considerados, durante o período gestacional e após o parto. Foi realizada revisão da literatura internacional, por meio das bases de dados MEDLINE e Web of Science, utilizando os seguintes unitermos: gastroplasty, gastric bypass surgery, bariatric surgery e pregnancy. Resultados: todas as gestações observadas foram únicas e não ocorreram complicações obstétricas, durante o seguimento pré-natal e parto. Também não houve registro de recém-nascidos prematuros ou de baixo peso ao nascimento. Conclusão: nossos dados sugerem que a gravidez após gastroplastia é segura para a mãe e feto. Entretanto, em virtude do limitado volume de informação disponível sobre o tema, investigações adicionais são necessárias para estabelecer recomendações apropriadas com relação ao seguimento dessas gestações _________________________________________________ABSTRACT Purpose: we report a small series of pregnant women who underwent gastric bypass surgery for severe obesity, with a review of the literature on this topic. Methods: five consecutive cases of pregnancy after gastroplasty between 2001 and 2004 were evaluated, and clinical, laboratory and therapeutic features were considered. Patients were 30 to 34 years old and all had been submitted to gastroplasty by the Capella technique. The outcomes for both the pregnant woman and the fetus were evaluated. A search of the English language literature was done through MEDLINE and Web of Science databases with the following terms: gastroplasty, gastric bypass surgery, bariatric surgery, and pregnancy. Results: all 5 pregnancies were singleton. No major obstetric complications were observed and there were no premature or lowbirth weight infants. Conclusion: our data suggest that pregnancy following gastroplasty is safe for mother and fetus. However, since information about this topic is limited, further investigations are required to establish appropriate recommendations concerning the follow-up of these pregnancies

Análise de desempenho sobre redes IEEE 802.3/PM-AH: protoclo multicilos para automação hospitalar

Com a incorporação de conceitos da automação em ambientes hospitalares surge uma série de novos requisitos pertinentes a área médica. Dentre esses requisitos, um que merece destaque é a necessidade do estabelecimento de uma rede de comunicação segura e eficiente entre os elementos do ambiente hospitalar, visto que, os mesmos encontram-se de maneira distribuída. Nesse sentido, existe uma série de protocolos que podem ser utilizados no estabelecimento dessa rede, dentre os quais, um que merece destaque é o PM-AH (Protocolo Multiciclos para Automação Hospitalar) justamente por ser voltado a automatização de ambientes hospitalares tanto no que diz respeito ao cumprimento dos requisitos impostos nesse tipo de ambiente, como pelo fato de ser projetado para funcionar sobre a tecnologia Ethernet, padrão esse que é comumente utilizado pela rede de dados dos hospitais. Em decorrência disso, o presente trabalho aborda uma análise de desempenho comparativa entre redes PM-AH e puramente Ethernet visando atestar a eficiência do primeiro no que diz respeito ao cumprimento dos requisitos impostos pela automação hospitalar

Gestação após gastroplastia para tratamento de obesidade mórbida: série de casos e revisão da literatura

relatar a evolução de uma série de casos de gestação em mulheres previamente submetidas à cirurgia de bypass gástrico para tratamento de obesidade grave. Métodos: cinco casos consecutivos de gravidez após gastroplastia ocorridos entre 2001 e 2004 foram avaliados. As pacientes tinham idade entre 30 e 34 anos e todas haviam sido submetidas à cirurgia de Capella. Aspectos clínicos, laboratoriais e do acompanhamento materno e fetal foram considerados, durante o período gestacional e após o parto. Foi realizada revisão da literatura internacional, por meio das bases de dados MEDLINE e Web of Science, utilizando os seguintes unitermos: gastroplasty, gastric bypass surgery, bariatric surgery e pregnancy. Resultados: todas as gestações observadas foram únicas e não ocorreram complicações obstétricas, durante o seguimento pré-natal e parto. Também não houve registro de recém-nascidos prematuros ou de baixo peso ao nascimento. Conclusão: nossos dados sugerem que a gravidez após gastroplastia é segura para a mãe e feto. Entretanto, em virtude do limitado volume de informação disponível sobre o tema, investigações adicionais são necessárias para estabelecer recomendações apropriadas com relação ao seguimento dessas gestações

Metodologia para avaliação de cinemática de partículas gasosas em fluidos de viscosidade variável com o tempo e sua aplicação na construção de poços de petróleo

Many challenges have been presented in petroleum industry. One of them is the preventing of fluids influx during drilling and cementing. Gas migration can occur as result of pressure imbalance inside the well when well pressure becomes lower than gas zone pressure and in cementing operation this occurs during cement slurry transition period (solid to fluid). In this work it was developed a methodology to evaluate gas migration during drilling and cementing operations. It was considered gel strength concept and through experimental tests determined gas migration initial time. A mechanistic model was developed to obtain equation that evaluates bubble displacement through the fluid while it gels. Being a time-dependant behavior, dynamic rheological measurements were made to evaluate viscosity along the time. For drilling fluids analyzed it was verified that it is desirable fast and non-progressive gelation in order to reduce gas migration without affect operational window (difference between pore and fracture pressure). For cement slurries analyzed, the most appropriate is that remains fluid for more time below critical gel strength, maintaining hydrostatic pressure above gas zone pressure, and after that gels quickly, reducing gas migration. The model developed simulates previously operational conditions and allow changes in operational and fluids design to obtain a safer condition for well construction

Análise in vitro da atividade antifúngica e de toxicidade da anfotericina B pré-aquecida

The aim of this work was to evaluate how an aqueous micellar system containing Amphotericin B (AmB) and sodium deoxycholate (DOC) can be rebuilt after heating treatment. Also a review of the literature about the new physicochemical and biological properties of this new system was carried out. Afterwards, heated (AmB-DOC-H) and unheated (AmB-DOC) micelles were subsequently diluted at four different concentrations (50mg.L-1, 5mg.L-1, 0.5mg.L-1 and 0.05mg.L-1) to perform the physicochemical study and, then, the pharmacotoxicity assay, in which two cell models were used for the in vitro experiments, Red Blood Cells (RBC) from human donors and Candida parapisilosis (Cp). While potassium (K+) and hemoglobin leakage from RBC were the used parameters to evaluate the acute and chronic toxicity, respectively, the efficacy of AmB-DOC and AmB-DOC-H were assessed by K+ leakage and cell survival rate from Cp. The spectral study revealed a slight change on the aggregate peak from 327nm to 323nm for AmB-DOC-H compared to AmB-DOC. Concerning the toxicity, although AmB-DOC and AmB-DOC-H presented different behavior for hemoglobin leakage, AmB-DOC produced higher leakage than AmB-DOC-H at high concentrations (from 5mg.L-1) with values tending to zero. However, concerning K+ leakage, both AmB-DOC and AmB-DOC-H, showed similar profile for both cell models, RBC and Cp (p<0,05). AmB-DOC-H and AmB-DOC also revealed similar profile of activity against Cp with equivalent survival rate. In short, the AmB-DOC-H showed much less toxicity than AmB-DOC, but remained as active as the late one against fungal cell. Therefore, the results highlight the importance of this new procedure as a simple, inexpensive and safe alternative to produce a new kind of micelle system for treatment of systemic fungal infections

Caracterização térmica (TG/DTG, DTA, DSC, DSC-fotovisual) de Hormônios bioidênticos (estriol estradiol)

Bioidentical hormones are defined as compounds that have exactly the same chemical and molecular structure as hormones that are produced in the human body. It is believed that the use of hormones may be safer and more effective than the non-bioidentical hormones, because binding to receptors in the organism would be similar to the endogenous hormone. Bioidentical estrogens have been used in menopausal women, as an alternative to traditional hormone replacement therapy. Thermal data of these hormones are scarce in literature. Thermal analysis comprises a group of techniques that allows evaluating the physical-chemistry properties of a drug, while the drug is subjected to a controlled temperature programming. The thermal techniques are used in pharmaceutical studies for characterization of drugs, purity determination, polymorphism identification, compatibility and evaluation of stability. This study aims to characterize the bioidentical hormones estradiol and estriol through thermal techniques TG/DTG, DTA, DSC, DSC-photovisual. By the TG curves analysis was possible to calculated kinetic parameters for the samples. The kinetic data showed that there is good correlation in the different models used. For both estradiol and estriol, was found zero order reaction, which enabled the construction of the vapor pressure curves. Data from DTA and DSC curves of melting point and purity are the same of literature, showed relation with DSC-photovisual results. The analysis DTA curves showed the fusion event had the best linearity for both hormones. In the evaluation of possible degradation products, the analysis of the infrared shows no degradation products in the solid state

Direito à moradia em cidades sustentáveis: parâmetros de políticas públicas habitacionais Natal 2013

The right to housing is included in several international human rights instruments and in Brazilian legal system integrates the constitutional catalog of fundamental social rights (art. 6) and urban development policy (art. 182 and 183). Besides, it is for all federative governments its effectiveness by building programs and improvement of housing conditions and sanitation (art. 23, IX), which justifies the investment in urban planning and public policy of housing affordability because they are tools for achieving this right. Newer strategies in this area have been based on tax incentives, combined with the mortgage as a way to induce the construction of new housing units or reform those in a precarious situation. However, there is still a deficit households and environmental soundness, compounded with the formation of informal settlements. Consequently, we need constant reflections on the issue, in order to identify parameters that actually guide their housing policies in order to meet the constitutional social functions of the city and ensure well-begins of its citizens (art. 182). On the other hand, the intervention of the government in this segment can not only see the availability of the home itself, but also the quality of your extension or surroundings, observing aspects related to environmental sanitation, urban mobility, leisure and services essential health, education and social assistance. It appears that the smoothness and efficiency of a housing policy condition to the concept of adequate housing, in other words, structurally safe, comfortable and environmentally legally legitimate, viable from the extensive coordination with other public policies. Only to compliance with this guideline, it is possible to realize the right to housing in sustainable cities

Carga de trabalho de enfermagem e infecções relacionadas à assistência à saúde na unidade de terapia intensiva

In recent decades, the search for quality care has been widely discussed by the institutions and health professionals. In this context, it is the nurse coordinator of the process of providing nursing staff, reflecting the commitment to quality of care. In this process, it is the appearance of Infections Related to health care and its potential association with the workload in nursing as a valuable indicator of quality of care. Thus, this research contributes to studies to characterize the demand of nursing work to promote a safe healthcare practice. This study aimed to identify the association of nursing workload with the number of cases of Ventilator-Associated Pneumonia, urinary tract infection and central venous catheter infection in the intensive care unit. This is a quantitative research approach, descriptive, cross-sectional and prospective, held at Unimed Hospital in Natal-RN. The study population consisted of all patients treated in the Intensive Care Unit, Hospital for a period of 90 consecutive days in 2011. The convenience sample was compostapelos patients admitted to the ICU during the period of data collection, a total sample of 286 patients. To perform the data analysis software were used: Statistica 6.0, SPPS (Statistical Package for Social Sciences) version 17.0 (2004) and Excel 2007. In the descriptive analysis, we used Measures of Central Tendency and Measures of Dispersion or Variability and the use of nonparametric tests. Of the 286 patients, 88 were from the ICU and 198 ICU II II. Males predominated in the ICU I (51.1%) and female ICU II (57.6%) patients in the ICU I were aged 61-80 years (39.8%) followed by greater than 80 years (39.8%). In the ICU II, most of the patients were aged 61-80 years (38.9%) and then from 41 to 60 years (24.2%). In relation to the class of TISS inlet predominant class II in the two ICUs (59.1%), followed by Class III also in the two units (34.6%). Most patients (70.6%) out of the ICUs belonging to class II TISS. In the ICU I, the average number of forms of the TISS 28 was 6, has in ICU II this value drops to 3.2 forms. The overall mean was 19.9 TISS points in ICU patients I and ICU II.the 17 points in the average hours required to provide adequate nursing care to patients in the ICU I found that is 10 , 7 hours, and the ICU II 9.2 hours. It was found that the time provided by the nursing staff were higher in ICU II, with an average of 19 hours available for nurses in this sector. In the ICU I, which showed higher need of available hours, it was found that the mean value of 12.7 available hours. It was found that only 2.4% of patients had these units Ventilator-Associated Pneumonia, 1.0% were infected central venous catheter and 1.4% of patients had urinary tract infection. Infection associated with health care occurs, on average, on the tenth day of hospitalization. In the ICU II, this average value extends to the twelfth day with an excess of 2.7 hours of nursing care while in ICU I value decays to the ninth day of hospitalization with a deficiency of 12-hour assistance. It is concluded that patients generally showed a need for classification of semi-intensive care and has been assisted in their need to load. As for his association with the Related Infections Health will assist this analysis could not be performed due to the small number of notifications in this period. It is suggested further study how other factors related to infections me a longer period of analysis

Segurança do paciente no sistema de medicação: análise de enfermeiros de um hospital de ensino

This study aimed to identify and describe the factors related to Patient Safety in a medication system according to the nurses analysis in a teaching hospital from the photographic analysis method. This was a cross-sectional, descriptive study with mixed approach in a teaching hospital in Rio Grande do Norte. The population consisted of 42 nurses from inpatient units, of which 34 composed the study sample. As eligibility criteria, we defined nurses from public service and nurses who agreed to participate. Ethical determinations were observed, the study was submitted to the Ethics and Research of the University Hospital Onofre Lopes, obtaining the assent with ethical assessment certificate (CAAE 0098.0.051.294-11). For data collection, we used the photographic method (Photographic Analysis Technique) by Patricia Marck (Canada). It was developed in two phases: at first, we randomly captured photos from the medication system, resulting in 282 images; then we selected/processed the photographs, which were reduced to 10 images in Microsoft Excel 2010; in the second phase, the nurses answered the questionnaire divided into socio-professional profile and Digital Photography Scoring Tool (questions a and b ). For analysis of the question a , we used the content analysis technique, and for b , we used the Statistical Package for the Social Sciences 20.0 (temporary license). The socio-professional profile revealed the predominance of females; age group 34-43 years; professionals with specialization; 10-18 years of length of service; and nurses working exclusively in the hospital and who know the Patient Safety. The photographic analysis in relation to Patient Safety resulted in specific categories for each stage of the medication system. Regarding disposal, we identified Proper verification ; Improper verification ; Correct identification ; Disposal in single doses ; and Improper Environment , with predominance of that last category. As for storage: Proper storage ; Improper storage ; Risk of exchange/disappearance ; and Poor hygiene , with special reference to improper storage. In preparation: Risk of exchanging medication/patient ; Inappropriate physical space ; and Inadequate 9 preparation of controlled drugs , highlighting the first category. In drug administration: Lack of Personal Protective Equipment ; Use of Personal Protective Equipment ; Improper administration technique ; Proper administration technique ; Correct drug identification ; Incorrect drug identification ; and Peripheral venous access without identification . From the safety assessment of 10 photographs, by adapting the scores (1-10) to the Likert Scale, we identified three Totally Unsafe (Level 1), three Unsafe (Level 2), three Partially Safe (Level 3), one Safe (Level 4), and no photograph considered Totally Safe. This study identified the prevalence of unsafety in the medication system in the nurses opinion. We were also able to understand that, although nurses identify safety aspects, the most prevalent categories characterize an unsafe assessment. Nursing needs to reflect on its practice, identifying gaps in the medication system in order to achieve a proper and safe care

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

Avaliação da incorporação de cinzas de lodo de esgoto como adição mineral em concretos de cimento Portland

O desenvolvimento das grandes cidades tem gerado um dos maiores desafios ambientais enfrentados na atualidade, que é a gestão eficaz de resíduos sólidos. A grande variedade e quantidade dos resíduos produzidos diariamente, tem tornado a destinação ecologicamente correta e sustentável destes materiais cada vez mais difícil. Dentre os vários resíduos produzidos diariamente destacam-se os lodos oriundos de estações de tratamento de esgotos, denominados de lodos de esgoto, cuja destinação final segura tem sido discutida mundialmente em diversos estudos, tendo em vista que a tendência de geração deste tipo de resíduo tende a crescer com o aumento do saneamento das cidades. Uma forma amplamente difundida nos países desenvolvidos para destinação dos lodos de esgoto é a incineração destes materiais para posterior envio das cinzas geradas neste processo a aterros sanitários. Porém, tem-se estudado formas alternativas de disposição, destacando-se a utilização destas cinzas como adição mineral em concretos e argamassas de cimento Portland. Sabe-se que o desempenho de resíduos de incineração como adição mineral em matrizes cimentícias, depende em grande parte da capacidade de atuação destes materiais como elementos pozolânicos ou como fileres, podendo estas características serem influenciadas pela temperatura de queima ao qual estes resíduos foram submetidos. Neste sentido, verificou-se com esta pesquisa a influência da temperatura empregada na queima dos lodos sépticos no índice de atividade pozolânica (IAP) das cinzas geradas como resíduo deste processo, aqui denominadas de cinzas de lodo séptico (CLS), sendo em seguida, avaliadas as implicações técnicas e microestruturais da utilização deste resíduo em teores de 10%, 20% e 30% como adição mineral em concretos de cimento Portland. Os resultados obtidos demonstraram não haver alterações significativas no IAP das CLS em decorrência da temperatura utilizada durante o processo de queima dos lodos de esgoto. Além disso, verificou-se que embora a utilização das CLS tenham provocado diminuição da trabalhabilidade dos concretos para todos os teores de incorporação, estas melhoraram a resistência mecânica à compressão, o índice de vazios, a absorção de água e o comportamento microestrutural dos concretos contendo 10% e 20% de resíduo

Controle de estoques de sal: uma inovação da quantificação e no gerenciamento dos recursos naturais da indústria mineral

The strengthening of the domestic industry in Brazil required the modernization, mechanization and expansion of salt production. Thereafter the production of sea salt started to be made in a process of continuous flow, where the product is constantly stored in yards, with daily movements in and out of salt. Thus far, the major bottleneck found in this production process is the control of production, because due to the large amount produced and variety of losses existing in the various stages of production there are not a regulated and safe way to control inventories with accuracy and speed demanded. In a typical case with a salt marsh company of Rio Grande do Norte state, salt produced is stored in two open courtyards and inventory control of salt made by carrying input / output relationship of salt in each storage yard. This work developed a conceptual model of inventory control, based on topography, adopting surveys into one of the courtyards of the company. There were 25 biweekly survey measurements over a year book to generate digital models representing the stock. For each measurement, results were compared with the values of inventory accounting provided by the salt marsh in order to identify existing losses and mark out the sales department on the actual stock available at each measurement date. Inventories calculated by the model indicated losses of 6,349 tonnes for the period of one year book and 3,279 tonnes for the period between harvests, when compared to the accounting control

Um sistema de visão para navegação robusta de uma plataforma robótica semi-autônoma

Large efforts have been maden by the scientific community on tasks involving locomotion of mobile robots. To execute this kind of task, we must develop to the robot the ability of navigation through the environment in a safe way, that is, without collisions with the objects. In order to perform this, it is necessary to implement strategies that makes possible to detect obstacles. In this work, we deal with this problem by proposing a system that is able to collect sensory information and to estimate the possibility for obstacles to occur in the mobile robot path. Stereo cameras positioned in parallel to each other in a structure coupled to the robot are employed as the main sensory device, making possible the generation of a disparity map. Code optimizations and a strategy for data reduction and abstraction are applied to the images, resulting in a substantial gain in the execution time. This makes possible to the high level decision processes to execute obstacle deviation in real time. This system can be employed in situations where the robot is remotely operated, as well as in situations where it depends only on itself to generate trajectories (the autonomous case)

Projeto e controle de um sistema de aquecimento no Laboratório de Avaliação de Medição em Petróleo

The Oil Measurement Evaluation Laboratory (LAMP), located in the Federal University of Rio Grande do Norte (UFRN), has as main goal to evaluate flow and BS&W meters, where the simulation of a bigger number of operation variable in field, guarantees a less uncertain evaluation. The objective of this work is to purpose a heating system design and implementation, which will control the temperature safely and efficiently in order to evaluate and measure it. Temperature is one of the variables which influence the flow and BS&W accurate measurement, directly affecting the fluid viscosity and density in the experiment. To project the heating system it is of great importance to take the laboratory requirements, conditions and current restrictions into consideration. Three alternatives were evaluated: heat exchanger, internal resistance and external resistance. After the analyses are made in order to choose the best alternative for the heating system in the laboratory, control strategies were determined for it, PID control methods in combination with fuzzy logic were used. Results showed a better performance with fuzzy logic than with classic PID

Implantação de um sistema de detecção de vazamentos em oleodutos com tratamento de alarmes falsos

The pumping of fluids in pipelines is the most economic and safe form of transporting fluids. That explains why in Europe there was in 1999 about 30.000 Km [7] of pipelines of several diameters, transporting millíons of cubic meters of crude oil end refined products, belonging to COCAWE (assaciation of companies of petroleum of Europe for health, environment and safety, that joint several petroleum companies). In Brazil they are about 18.000 Km of pipelines transporting millions of cubic meters of liquids and gases. In 1999, nine accidents were registered to COCAWE. Among those accidents one brought a fatal victim. The oil loss was of 171 m3, equivalent to O,2 parts per million of the total of the transported volume. Same considering the facts mentioned the costs involved in ao accident can be high. An accident of great proportions can bríng loss of human lives, severe environmental darnages, loss of drained product, loss . for dismissed profit and damages to the image of the company high recovery cost. In consonance with that and in some cases for legal demands, the companies are, more and more, investing in systems of Leak detection in pipelines based on computer algorithm that operate in real time, seeking wíth that to minimize still more the drained volumes. This decreases the impacts at the environment and the costs. In general way, all the systems based on softWare present some type of false alarm. In general a commitment exists betWeen the sensibílity of the system and the number of false alarms. This work has as objective make a review of thé existent methods and to concentrate in the analysis of a specific system, that is, the system based on hydraulic noise, Pressure Point Analyzis (PPA). We will show which are the most important aspects that must be considered in the implementation of a Leak Detection System (LDS), from the initial phase of the analysis of risks passing by the project bases, design, choice of the necessary field instrumentation to several LDS, implementation and tests. We Will make na analysis of events (noises) originating from the flow system that can be generator of false alarms and we will present a computer algorithm that restricts those noises automatically