Custo-efetividade da terapia compressiva no processo de cicatrização de úlceras venosas

Analytical study of therapeutic nonrandomized intervention type, intra-group controlled, with the aim of analyzing the cost-effectiveness of compression therapy with manipulated Unna boot in relation to conventional therapy in the healing of venous ulcers (VU) of patients treated in ambulatory clinic. The study population was composed by patients with VU treated by angiologists in Surgical Clinic Ambulatory of the Onofre Lopes University Hospital (HUOL) with a sample of 18 patients. It obtained the assent of the HUOL Ethics in Research Committee (Protocol 276/09). Data collection was performed over a period of four months by the own master's student and 34 nursing students, through the application of the research instrument in the admission of patients to the study and in the ten subsequent evaluations, performed at the time of changing Unna boot, weekly, for a maximum period of 10 weeks. The data were analyzed with SPSS 15.0 software, using descriptive and inferential statistics, and presented as tables, charts and graphs. Among those surveyed, prevailed: females, mean age 57.6 years, low education and income levels, most retired, unemployed or off work, with the standing position more than six hours per day and up to eight hours daily of domestic or occupational activities. In health status profile of respondents there were predominantly sleep, rest and inadequate elevation of the lower limbs, no smoking and/or alcohol use, presence of hypertension and no use of drugs. Most presented the first VU for over 10 years, recurrences, present VU for more than five years, involvement of left leg, in malleolar and / or distal leg region, mild edema, hyperpigmentation, lipodermatosclerosis, telangiectasies, reticular and varicose veins, mild pain, serous exudate in moderate quantity, small lesions (up to 50cm2), with predominance of granulation tissue and / or epithelialization and demarcated, elevated and irregular borders, with crusts and macerated. Most patients reported that in the 10 weeks prior to admission, made bandages at home and / or Basic Health Unit and / or ambulatory, with nursing aides or technicians, daily, and on weekends or holidays, performed by patients themselves, using healing ointment on the lesion, being observed granulation / epithelialization and increase in VU prevalent in the 10 weeks of traditional treatment. After follow up with manipulated Unna boot, was observed a decrease of lesions in all study patients, with complete healing in 27.8% of those between 1 and 5 weeks of treatment, with satisfactory evolution of the lesions, pain and ankle and calf circumferences, and unsatisfactory development of the borders of ulcers, edema, sleep, rest and elevation of the lower limbs, especially in more chronic patients. Furthermore, patients who achieved total healing and exhibited the greatest percentage reduction of lesions had a higher number of wound healing factors (ρ = 0.01 and ρ = 0.027, respectively). The manipulated Unna boot showed better results in those patients with shorter duration of injury, leading them to a satisfactory outcome within a short period of treatment. After the cost-effectiveness analysis, we conclude that the manipulated Unna boot is more effective than conventional therapy in the healing process of VU and is more cost-effective in patients with shorter lesions (ρ = 0.001), shorter treatment (ρ = 0.000) and greater number of wound healing factors (ρ = 0.005).

Estruturas tectônicas cenozóicas na porção leste da Bacia Potiguar - RN

This thesis encompasses the integration of geological, geophysical, and seismological data in the east part of the Potiguar basin, northeastern Brazil. The northeastern region is located in South American passive margin, which exhibits important areas that present neotectonic activity. The definition of the chronology of events, geometry of structures generated by these events, and definition of which structures have been reactivated is a necessary task in the region. The aims of this thesis are the following: (1) to identify the geometry and kinematics of neotectonic faults in the east part of the Potiguar basin; (2) to date the tectonic events related to these structures and related them to paleoseismicity in the region; (3) to present evolutional models that could explain evolution of Neogene structures; (4) and to investigate the origin of the reactivation process, mainly the type of related structure associated with faulting. The main type of data used comprised structural field data, well and resistivity data, remote sensing imagery, chronology of sediments, morphotectonic analysis, x-ray analysis, seismological and aeromagnetic data. Paleostress analysis indicates that at least two tectonic stress fields occurred in the study area: NSoriented compression and EW-oriented extension from the late Campanian to the early Miocene and EW-oriented compression and NS-oriented extension from the early Miocene to the Holocene. These stress fields reactivated NE-SW- and NW-SE-trending faults. Both set of faults exhibit right-lateral strike-slip kinematics, associated with a minor normal component. It was possible to determine the en echelon geometry of the Samambaia fault, which is ~63 km long, 13 km deep, presents NE-SW trend and strong dip to NW. Sedimentfilled faults in granite rocks yielded Optically Stimulated Luminescence (OSL) and Single-Aliquot Regeneration (SAR) ages at 8.000 - 9.000, 11.000 - 15.000, 16.000 - 24.000, 37.000 - 45.500, 53.609 - 67.959 e 83.000 - 84.000 yr BP. The analysis of the ductile fabric in the João Câmara area indicate that the regional foliation is NE-SW-oriented (032o - 042o), which coincides with the orientation of the epicenters and Si-rich veins. The collective evidence points to reactivation of preexisting structures. Paleoseismological data suggest paleoseismic activity much higher than the one indicated by the short historical and instrumental record

Estudos sedimentológicos e o contexto estrutural da formação Serra do Martins, nos platôs de Portalegre, Martins e Santana/RN

This dissertation deals with sedimentological and structural framework of the siliciclastic rock of the Serra do Martins Formation (FSM) in the Portalegre, Martins and Santana plateau, located to the south of Potiguar Basin, in the southwest and central Rio Grande do Norte state. This formation, regarded as of Oligo-Miocene age based on intrusive relations of the Miocene Macau volcanics, has a still disputable age due to the lack of appropriate bio and/or chronostratigraphic markers. The FSSM deposits crop out along 650 to 750 m high plateau, as a remanescent sedimentary cover directly overlying topographically uplifted pre-cambrian crystalline rocks. During the last decades, these deposits were interpreted according to a Tertiary paleoclimatic evolutionary model, associated to pedogenetic processes. The sedimentological characterization of the FSM was done through a detailed study of its facies, petrography and diagenetic features. The facies study was based on description of field relations, textures and structures, the piling up of the strata and their lateral variations. The FSM was deposited by an anastomosing to coarse-meandering fluvial system, including deposits of lag, cannel-fill, ouver-bank and flood plain. The petrographic composition of the sediments, coupled to their facies and paleocurrent directions, suggest a rather distal sourcearea, to the south of the present plateau. The diagenetic study identified an incipient grain mechanical compaction, pronounced dissolution of the framework, matrix and/or cement components, intense precipitation of kaolinite, silic and, eventually, iron oxides, besides mechanical infiltration of the clays. Most of these events, regarded in the literature as associated to near-surface conditions (eo or telodiagenesis), indicate the FSM sediments were never deeply buried. Topographic relations along longitudinal and transversal sections reaching the Potiguar Basin to the north identified regional dips that allow to discuss stratigraphic correlations between the FSM and the basin formations. The sedimentological features of the different units and the intrusive relations of the Macau volcanics were also considered in these correlations,which support the Oligo-Miocene age previously accepted for the FSM. Concerning the tectonic framework of the FSM, this work investigated the pre-cambrian to cretaceous heritage and the cenozoic deformation, allowing the recognition of pre-, sin and post-FSM structures. The crystalline basement, belonging to the Seridó Belt, displays NE and WNW foliation trends related to the Brasiliano-age ductile shear zones. In this terrain, brittle-ductile and brittle NE- and NW-trending structures, associated with extensional joints filled with pegmatites and quartz veins, are related to an E-W compression by the end of Brasiliano Cycle. The E-W joints and NE-trending fractures were reactivated by N-S to N-S to NW extension during late Jurassic to Cretaceous times, controlling the emplacement of the Rio Ceará-Mirim basic dyke swarm and the opening of the Potiguar rift basin

Análise da deformação pós-Rifte na Bacia do Araripe, Nordeste do Brasil

The Araripe Basin is located over Precambrian terrains of the Borborema Province, being part of Northeast Brazil inner basins. Its origin is related to the fragmentation of the Gondwana supercontinent and consequently opening of South Atlantic during early Cretaceous. The basin has a sedimentary infill encompassing four distinct evolution stages, comprising Paleozoic syneclisis, pre-rift, rift and post-rift. The target of this study comprises the post-rift section of the basin focusing deformational styles which affect evaporates from Ipubi Member of the Santana Formation, which is composed by gypsum and anidrite layers interbedded with shales. These units occur widespread across the basin. In the central part of the basin, near Nova Olinda-Santana do Cariri, evaporites are affected by an essentialy brittle deformation tipified by fibrous gypsum filled fractures, cutting massive layers of gypsum and anidrite. Veins with variable orientations and dips are observed in the region distributed over three main populations: i) a dominant NWSE with shallow to moderate NE dipping population, consisting of gypsum filled veins in which fibers are normal to vein walls; i) NE-SW veins with moderate SE dips containing subhorizontal growth fibers; and iii) N-S veins with shallow E-W dips with fibers oblique to vein walls. In the west portion of the basin, near Trindade-Ipubi-Araripina towns, evaporate layers are dominantly constituted by gypsum/anidrite finely stratified, showing a minor density of veins. These layers are affected by a unique style of deformation, more ductile, typified by gentle to open horizontal normal folding with several tens of meters length and with double plunging NW-SE or NE-SW hinges, configuring domic features. In detail, gypsum/anidrite laminae are affected by metre to decimeter scale close to tight folding, usually kinked, with broken hinges, locally turning into box folds. Veins show NE-SW main directions with shallow NE dips, growth fibers are parallel to vein walls, constituting slickenfibers. This region is marked by faults that affect Araripina Formation with NW-SE, NE-SW and E-W directions. The main structural styles and general orientations of structures which affected the post-rift section of Araripe Basin yielded important kinematic information analysis which led us to infer a E-W to NE-SW extension direction to the northeastern part of the Basin, whereas in the southeastern part, extension occurred in N-S direction. Thus, it was possible to determine a regional kinematic setting, through this analysis, characterizing a NE-SW to ENE-WSW system for the post-rift section, which is compatible with the tension settings for the Sout American Plate since Albian. Local variations at the fluid pressure linked (or not) to sedimentary overload variation define local tension settings. This way, at the northeastern portion of the basin, the post-rift deformation was governed by a setting which σ 1 is sub-horizontal trending NE-SW and, σ 3 is sub-vertical, emphasizing a reverse fault situation. At the southwestern portion however there was characterized a strike slip fault setting, featuring σ 1 trending ENEWSW and σ3 trending NNW-SSE

Correlação entre contexto morfoestrutural e sismicidade nas regiões de João Câmara e São Rafael (RN)

This MSc thesis describes brittle deformation in two seismic zones located in north-eastern Brazil: João Câmara and São Rafael, Rio Grande do Norte State. Both areas show seismogenic faults, Samambaia and São Rafael, indicated by narrow zones of epicentres with a strike of 040o, a lenght of 30 km and 4 km, and a depth of 1-12 and 0,5-4 km, respectively. The first seismological and geological studies suggested blind faults or faults that were still in the beginning of the nucleation process. The region is under E-W-oriented compression and is underlain by Precambrian terrains, deformed by one or more orogenic cycles, which generated shear zones generally marked by strong pervasive foliation and sigmoidal shapes. The crystalline basement is capped by the Cretaceous Potiguar basin, which is also locally capped by Pliocene continental siliciclastic deposits (Barreiras Formation), and Quaternary alluvium. The main aim of this study was to map epicentral areas and find whether there are any surface geological or morphotectonic expression related to the seismogenic faults. A detailed geological map was carried out in both seismic areas in order to identify brittle structures and fault-related drainage/topographic features. Geological and morphotectonic evidence indicate that both seismogenic faults take place along dormant structures. They either cut Cenozoic rocks or show topographic expression, i.e., are related to topographic heights or depressions and straight river channels. Faults rocks in the Samambaia and São Rafael faults are cataclasite, fault breccia, fault gouge, pseudotachylyte, and quartz veins, which point to reactivation processes in different crustal levels. The age of the first Samambaia and the São Rafael faulting movement possibly ranges from late Precambrian to late Cretaceous. Both fault cut across Precambrian fabric. They also show evidence of brittle processes which took place between 4 and 12 km deep, which probably have not occurred in Cenozoic times. The findings are of great importance for regional seismic hazard. They indicate that fault zones are longer than previously suggested by seismogenic studies. According to the results, the methodology used during this thesis may also be useful in other neotectonic investigation in intraplate areas

Petrologia das fraturas associadas a feições típicas de dissolução hipogênica na Formação Salitre, Bacia de Irecê, Bahia, Brasil

The recognition of karst reservoirs in carbonate rocks has become increasingly common. However, most karst features are small to be recognized in seismic sections or larger than expected to be investigated with borehole data. One way forward has been the study of analogue outcrops and caves. The present study investigates lithofacies and karst processes, which lead to the generation of the largest system of caves in South America. The study area is located in the Neoproterozoic Una Group in central-eastern Brazil. This province comprises several systems of carbonate caves (Karmann and Sanchéz, 1979), which include the Toca da Boa Vista and Barriguda caves, considered the largest caves in South America (Auler and Smart, 2003). These caves were formed mainly in dolomites of the Salitre Formation, which was deposited in a shallow marine environment in an epicontinental sea (Medeiros and Pereira, 1994). The Salitre Formation in the cave area comprises laminated mud/wakestones, intraclastic grainstones, oncolitic grainstones, oolitic grainstones, microbial laminites, colunar stromatolites, trombolites and fine siliciclastic rocks (marls, shales, and siltites). A thin layer and chert nodules also occur at the top of the carbonate unit. Phosphate deposits are also found. Our preliminary data indicate that folds and associated joints control the main karstification event at the end of the Brasiliano orogeny (740-540 Ma). We recognized five lithofacies in the cave system: (1) Bottom layers of grainstone with cross bedding comprise the main unit affected by speleogenesis, (2) thin grainstone layers with thin siltite layers, (3) microbial laminites layers, (4) layers of columnar stromatolites, and a (5) top layer of siltite. Levels (1) to (3) are affected by intense fracturing, whereas levels (4) and (5) seal the caves and have little fracturing. Chert, calcite and gipsite veins cut across the carbonate units and play a major role in diagenesis. Our preliminary study indicate that hypogenic spelogenesis is the main process of karst development and contributed significantly to the generation of secondary porosity and permeability in the carbonate units.