O julgamento simulado do Conselho Regional de Medicina do Estado de São Paulo: processo de ensino da ética médica

O julgamento simulado reproduz a dinâmica de um julgamento em que os envolvidos são substituidos por representações da realidade, podendo tornar-se importante estratégia para o ensino da ética médica.

Eficácia e segurança do uso inalatório da adrenalina-L na laringite pós-intubação utilizada em associação com a dexametasona

Objective: to assess the efficacy and safety of the use of nebulized L-epinephrine associated with dexamethasone in post-intubation laryngitis. Method: we carried out a prospective, randomized, double-blind, placebo controlled study with two cohorts of patients with postintubation laryngitis graded 3 to 6 by Downes and Raphaely score and during two years. Our population was divided into two groups: A and B; both groups received intravenous dexamethasone and nebulized saline with (group B) and without (group A) L-epinephrine. The efficacy was assessed by Downes and Raphaely's score. The side effects of epinephrine were evaluated according to occurrence of arrhythmia, to increased blood pressure, and to average heart rate of group B in comparison to group A. Results: twenty-two patients were included in group A (average score = 4.8) and 19 in group B (average score = 5.2). During treatment, 3 patients in group A presented a score of 8 and were reintubated. This group also showed higher clinical scores than group B during the first two hours of the protocol; these results were not statistically significant. No side effects were observed due to epinephrine. The gasometric parameters were adequate in both groups, but better in the control group. Conclusions: we did not observe increased efficacy for the treatment of post-intubation laryngitis when nebulized L-epinephrine was used simultaneously with intravenous dexamethasone. Some indicators, however, did present a favorable trend when combined therapy was used and should be submitted to further evaluation.

Utilização de índices de estabilidade transitória para a avaliação de segurança dinâmica

Indices that report how much a contingency is stable or unstable in an electrical power system have been the object of several studies in the last decades. In some approaches, indices are obtained from time-domain simulation; others explore the calculation of the stability margin from the so-called direct methods, or even by neural networks.The goal is always to obtain a fast and reliable way of analysing large disturbance that might occur on the power systems. A fast classification in stable and unstable, as a function of transient stability is crucial for a dynamic security analysis. All good propositions as how to analyse contingencies must present some important features: classification of contingencies; precision and reliability; and efficiency computation. Indices obtained from time-domain simulations have been used to classify the contingencies as stable or unstable. These indices are based on the concepts of coherence, transient energy conversion between kinetic energy and potential energy, and three dot products of state variable. The classification of the contingencies using the indices individually is not reliable, since the performance of these indices varies with each simulated condition. However, collapsing these indices into a single one can improve the analysis significantly. In this paper, it is presented the results of an approach to filter the contingencies, by a simple classification of them into stable, unstable or marginal. This classification is performed from the composite indices obtained from step by step simulation with a time period of the clearing time plus 0.5 second. The contingencies originally classified as stable or unstable do not require this extra simulation. The methodology requires an initial effort to obtain the values of the intervals for classification, and the weights. This is performed once for each power system and can be used in different operating conditions and for different contingencies. No misplaced classification o- - ccurred in any of the tests, i.e., we detected no stable case classified as unstable or otherwise. The methodology is thus well fitted for it allows for a rapid conclusion about the stability of th system, for the majority of the contingencies (Stable or Unstable Cases). The tests, results and discussions are presented using two power systems: (1) the IEEE17 system, composed of 17 generators, 162 buses and 284 transmission lines; and (2) a South Brazilian system configuration, with 10 generators, 45 buses and 71 lines.

Eficácia e segurança da atorvastatina no tratamento de pacientes com hipercolesterolemia primária

Introduction: Hypercholesterolemia is an important risk factor for cardiovascular disease, the first cause of death and third reason for hospital admissions in Brazil. The reduction of serum cholesterol levels reduces morbidity and mortality from cardiovascular disease. The present study evaluated the efficacy and safety of atorvastatin in the treatment of Brazilian patients with primary hypercholesterolemia (types IIA and IIB dyslipidemias). Patients and methods: After a 4-week wash-out period, 152 patients were treated with atorvastatin at the initial dose of 10 mg/day. According to treatment efficacy within the first 8 weeks this dose could be increased to 20 mg/day. Treatment lasted for a total of 16 weeks, and its efficacy was evaluated by the reduction of serum levels of LDL-cholesterol, total cholesterol, HDL-cholesterol, and triglycerides, as well as by the propotion of patients that achieved the target levels recommended by the National Cholesterol Education Program - Adult Treatment Panel II (NCEP ATP II) Results: The analysis of efficacy was conducted in 145 patients. Atorvastatin led to significant reductions in the levels of LDL-cholesterol after 8 and 16 weeks of treatment (P<0.001 for both comparisons). The relative reduction of such levels was 38% (P<0.001 after 8 and 16 weeks). Atorvastatin also led to significant reductions of total cholesterol and triglycerides. At the end of the study, 81% of patients achieved the target LDL-cholesterol levels recommended by NCEP ATP II. Treatment was well tolerated, and was interrupted due to creatine phosphokinase elevation in only one patient. Conclusion: Atorvastatina is efficacious and safe in the treatment of patients with primary hypercholesteromia. © Copyright Moreira Jr. Editora. Todos os direitos reservados.

Segurança e defesa no Cone Sul: Transições com transformações?

The new conditions of international security don't only attach importance to sovereignty and interstate relations. This new framework has led to changes in the scope and requirements for Politics of Defense. Countries of the Southern Cone seek to establish new parameters in the definition of their policies, but need to define between dissuasive policies, as in the past, or establish mechanisms for cooperation with their neighbors. Furthermore, these policies, by their nature and size, are not exclusively militaries. The purpose of this article is to examine the definitions constraints on strategic deterrence and cooperation in international security, and identify the degree of autonomy and the nature of the concepts derived from the armed forces in shaping Politics of Defense. Finally, we try to check the level of civil policy direction in defining those policies.

Farmacovigilância no Brasil: A relação entre polimorfismo de fármacos, efetividade e segurança dos medicamentos

In spite of the stated Brazilian policy on medicines that their quality, effectiveness and safety should be ensured at reasonable cost, hospitals in the ANVISA Surveillance Network have been receiving notifications of technical complaints, adverse reactions and suspected therapeutic ineffectiveness (STI) of medicines. The purpose of this study was to identify the medicines notified for suspicion of therapeutic ineffectiveness, at a university hospital participating in the national Surveillance Network, and to investigate the existence of polymorphs of any of the drugs involved, by examining the literature. There were 31 notifications of STI in a period of 18 months, concerning 11 different drugs, all of which were 'similar' drugs (neither original nor licensed by originator); five of these could contain polymorphs, according to the literature. However, this does not mean that the other drugs could not contain some unknown polymorphs, more studies being needed on polymorphism, especially in the cases of reported therapeutic ineffectiveness. Therefore, tests of polymorphism should be made part of the routine quality control of the raw materials during the development of medicines and in the studies of pharmaceutical equivalence to 'reference' medicines (innovative brands). The stability test should also involve a study of polymorphism, in order to confirm the solid state stability of the drug. All these measures will assure the effectiveness of medicines, since the reproducibility in the quality of pharmaceutical products could be monitored, as well as the equivalence of each production batch with the batch selected to determine the bioequivalence with the reference brand.

Ensaios biológicos para avaliação de segurança de produtos cosméticos

Despite efforts to the contrary, some cosmetic products can cause undesirable side effects in the users. These may often be due to individual factors or inappropriate use of the product. Thus, biological assays to assess the safety of a new cosmetic must precede its being placed on the market. Historically, these tests have always been carried out in vivo, in animals, since such tests can be used to evaluate many of the potential risks, such as irritation, allergy or systemic effects; but, recently, some research centers have been adopting in vitro alternatives, in order to replace the animal tests. This review emphasizes the need to employ biological assays to test the safety of cosmetic products, and reviews the main in vivo and in vitro tests used, focusing on the need to develop and use alternatives to the in vivo assays of product safety, so as to offer the consumers the maximum safety with the least possible risk, while ensuring the best conditions of use of the product.

Estudo clínico randomizado, aberto e comparativo para avaliação de segurança, tolerabilidade e eficácia analgésica de duas diferentes apresentações de medicamento tópico na realização de curetagem dermatológica de molusco contagioso em pacientes pediátricos

Aim: This study aimed to compare the safety and analgesic efficacy of a new topical drug (in two different presentations: cream and aerosol) consisting of benzocaine, menthol and triclosan, in the curettage of molluscum contagiosum. Method: The study included 296 volunteers in different stages: 256 healthy adult volunteers for the safety evaluation, and 40 volunteers between 2 and 12 years old who presented Molluscum contagiosum, for the evaluation of tolerability and efficacy. Each volunteer represented two experimental units (left and right) where it was applied randomly the tested products (cream or aerosol) 30 minutes before the dermatological curettage, immediately after and twice a day during 7 days. Dermatological evaluations of safety and efficacy were performed immediately after the procedure, 3 and 7 days after the curettage. Results: During safety evaluation, the tested products showed no irritant, sensitizing, phototoxic or photosensitizing potential. Both presentations, cream and aerosol, were considered safe with no statistically significant differences between them. With respect to analgesic efficacy, the results showed that the medication promoted the reduction of painful symptoms and there was no statistically significant difference (p <0.05) between the two presentations. Conclusion: The tested product, in two different presentations, was considered safe and effective in controlling pain symptoms during and after the curettage of molluscum contagiosum. © Copyright Moreira Jr. Editora.

Avaliação da segurança e eficácia de novo preenchedor à base de ácido hialurônico no tratamento dos sulcos nasolabiais e contorno dos lábios

Introduction: The use of dermal filling techniques for soft tissue augmentation has greatly increased in recent years. Hyaluronic acid is one of the most used temporary dermal fillers in the treatment of facial wrinkles, furrows, and folds due to its effectiveness and safety. Objective: To evaluate the efficacy and safety of Perfectha®, a new hyaluronic acid filler, for nasolabial folds and lip correction. Methods: Open, multicenter study comprising 87 women. Efficacy was evaluated by the Global Aesthetic Improvement Scale and the Wrinkle Severity Rating Scale. Safety was evaluated through observation and the reporting of side effects. Results: One week after the injection of the filler, improvement in nasolabial folds and lips was observed in 86% and 89% of the women, respectively. Mild or moderate transient inflammatory reaction and ecchymoses occurred in 15% and 9% of patients, respectively, mainly in nasolabial folds. Two patients presented labial herpes simplex after treatment of the lips. The good results were maintained in 76% and 57% of women for nasolabial folds and in 72% and 45% of women for lips after 3 and 6 months, respectively. Conclusion: Perfectha® was effective and safe for these indications.

Uso do AHP na avaliação do desempenho do sistema de gestão da qualidade, meio ambiente e segurança e saúde ocupacional integrados

The paper analyses the application of the AHP method together with the attach A of ISO 9004:2000 in order to evaluate the performance of two industrial organizations, both possessing quality management systems with ISO 9001:2000 certifications, based on the specific requirements of quality, environment, occupational health and management systems. The evaluated organizations were a government-owned company from the science and technology sector that works in the nuclear area, and a private company that works in the automotive and railroad area. The open software Web-Hipre version 1.22 from Helsinki University of Technology, Finland, was used. The results demonstrated that the AHP method together with the attach A of ISO 9004:2000 is adequate to evaluate organizational performances. Both organizations presented similar performance levels.

Estudo da segurança de cosméticos: Presente e futuro

Cosmetics have been used since ancient times and, recently, their consumption has increased greatly in many countries, including brazil, which is the third largest consumer market in the world. Thus, concern for the safety and efficacy of these products should be heightened, even though these products are rarely related to adverse reactions that damage the health. Brazilian law requires manufacturers to subject their products to safety testing, to assess the possible reactions that could be caused by them (irritation, sensitization, systemic effects). To this end, in general, animals have been used as the experimental model, but this practice is being increasingly controlled, so that the scientific community is looking for alternative tests that do not require experimental in vivo models. Thus, this review aims to describe the main biological assays used to assess the safety of cosmetics, as well as in vitro assays that can replace them.

Avaliação microbiológica do camarão da Amazônia (Macrobrachium amazonicum) e sua relação com o ambiente de criação na carcinicultura

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Modelação e análise da vida útil (metrológica) de medidores tipo indução de energia elétrica ativa

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Desenvolvimento de hardware e software para tratamento e visualização de dados de descargas atmosféricas aplicados à segurança da navegação hidroviária

Pós-graduação em Engenharia Elétrica - FEIS

Alívio de sobrecargas em redes de transmissão com o auxílio de geradores distribuídos

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)