Comparison between intermittent mandatory ventilation and synchronized intermittent mandatory ventilation with pressure support in children

Objective: To compare intermittent mandatory ventilation (IMV) with synchronized intermittent mandatory ventilation plus pressure support (SIMV+PS) in terms of time on mechanical ventilation, duration of weaning and length of stay in a pediatric intensive care unit (PICU).Methods: This was a randomized clinical trial that enrolled children aged 28 days to 4 years who were admitted to a PICU between October of 2005 and June of 2007 and put on mechanical ventilation (MV) for more than 48 hours. These patients were allocated to one of two groups by drawing lots: IMV group (IMVG; n = 35) and SIMV+PS group (SIMVG; n = 35). Children were excluded if they had undergone tracheotomy or had chronic respiratory diseases. Data on oxygenation and ventilation were recorded at admission and at the start of weaning.Results: There were no statistical differences between the groups in terms of age, sex, indication for MV, PRISM score, Comfort scale, use of sedatives or ventilation and oxygenation parameters. The median time on MV was 5 days for both groups (p = 0.120). There were also no statistical differences between the two groups for duration of weaning [IMVG: 1 day (1-6) vs. SIMVG: 1 day (1-6); p = 0.262] or length of hospital stay [IMVG: 8 days (2-22) vs. SIMVG: 6 days (3-20); p = 0.113].Conclusion: Among the children studied here, there was no statistically significant difference between IMV and SIMV+ PS in terms of time on MV, duration of weaning or time spent in the PICU.ClinicalTrials.govID: NCT00549809.

The Fulling-Davies-Unruh effect is mandatory: the proton's testimony

We discuss the decay of accelerated protons and illustrate how the Fulling-Davies-Unruh effect is indeed mandatory to maintain the consistency of standard Quantum Field Theory. The confidence level of the Fulling-Davies-Unruh effect must be the same as that of Quantum Field Theory itself.

Eficácia de herbicidas aplicados nas épocas seca e úmida para o controle de Merremia aegyptia na cultura da cana-de-açúcar

Objetivou-se estudar o efeito de herbicidas aplicados em pré e pós-emergência, isolados e em combinações nas épocas seca e úmida, para o controle de corda-de-viola (Merremia aegyptia) na cultura de cana-de-açúcar colhida mecanicamente sem queima. O experimento foi desenvolvido no período de julho de 2008 a maio de 2009, em área de produção comercial de cana-de-açúcar localizada no município de Pradópolis, SP. O delineamento experimental foi o de blocos ao acaso, com quatro repetições, em esquema de parcela subdividida. Foram avaliados na época seca os herbicidas amicarbazone (1.400 g ha ¹), clomazone + hexazinone (800 + 200 g ha-1) e imazapic (147 g ha-1), aplicados em 16/7/2008 após a colheita da cana, e o tratamento sem manejo prévio das plantas daninhas nessa época. Os herbicidas estudados na época úmida foram: mesotrione isolado (192 g ha-1) e em mistura (120 g ha-1) com atrazine (1.500 g ha-1), metribuzin (960 g ha-1) ou diuron + hexazinone (702 + 198 g ha-1), aplicados em 6/11/2008, além de testemunha capinada e outra sem manejo das plantas daninhas. Dos herbicidas utilizados na época seca, o amicarbazone promoveu o melhor controle de M. aegyptia. No entanto, para todos eles, a complementação de manejo com a aplicação de herbicidas na época úmida mostrou-se obrigatória. Nesta época, a associação de mesotrione aos herbicidas atrazine, metribuzin e diuron + hexazinone foi mais eficaz no controle de M. aegyptia do que quando aplicado sozinho. Nenhum dos tratamentos com herbicidas interferiu no número de colmos por metro linear, diâmetro e altura de colmos de cana-de-açúcar (variedade SP 81-3250).

Implantação de Reservas Legais: uma nova perspectiva na conservação dos recursos naturais em paisagem rural

According to the Forest Code of 1965, it is mandatory that every rural property destine part of its land to the establishment of Legal Reserves. When a diagnosis is made over all Brazil, the reality is quite different from what is demanded by law. Therefore, this work, as a general objective, proposes ways of establishing Legal Reserves based on the analysis of the environmental deterioration in a river basin. For this purpose, the environmental deterioration was detected based on three diagnoses: physical-conservational, socioeconomical, and environmental quality. In this way, from a quantitative and qualitative diagnosis, it was possible to identify the main aggressive factors in the studied river basin and to indicate the main vulnerabilities that the area is subjected. According to such diagnosis, some proposals for the establishment of Legal Reserves are discussed here based on scientific arguments aimed at the conservation of water resources, soil and biodiversity. It is hoped, that from this study, the environment receives a new tool for diagnosis, pollution control, recovery and conservation of natural resources.

What Role Should Government Regulation Play in Ecological Restoration? Ongoing Debate in São Paulo State, Brazil

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Infrared spectroscopy: a tool for determination of the degree of conversion in dental composites

Infrared spectroscopy is one of the most widely used techniques for measurement of conversion degree in dental composites. However, to obtain good quality spectra and quantitative analysis from spectral data, appropriate expertise and knowledge of the technique are mandatory. This paper presents important details to use infrared spectroscopy for determination of the conversion degree.

Meningeal tumor: A rare extrahepatic association in patients with polycystic liver disease enrolled for liver transplantation

In the present study, we described a rare association of polycystic liver disease (PCLD) with intracranial meningiomas in patients included on a liver transplant list, focusing on the diagnosis, treatment and possible association with any genetic alterations. Two female patients, aged 39 and 49 years were included on a liver transplant list due to extensive PCLD, with symptoms related to an abdominal compartmental syndrome. Screening for extrahepatic manifestation revealed a right frontal meningioma in the first patient, and a parietal posterior calcified meningioma in the second patient, measuring 1 and 7x3x2 cm in diameter, respectively. Following tumor removal, the histological pattern was compatible with fibrous and transitional meningioma, respectively. Cytogenetic studies conducted following surgery did not reveal any changes in metaphase chromosomes. The postoperative follow-up for the two patients was uneventful, without complications, with the patients remaining on a liver transplant waiting list. We conclude that screening for extrahepatic manifestations of PCLD is mandatory, as certain lesions require treatment prior to liver transplantation. The lack of a genetic or familial association between these two cases show they are likely to have occurred by chance, rather than representing a previously unrecognized association between polycystic liver disease and cranial meningioma.

Folic acid supplementation during early hepatocarcinogenesis: cellular and molecular effects

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Hipotireoidismo congênito: recomendações do Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia

O hipotireoidismo congênito (HC) é o distúrbio endócrino congênito mais frequente, com incidência variando de 1:2.000 a 1:4.000 crianças nascidas vivas e uma das principais causas de retardo mental que pode ser prevenida. Os Programas de Triagem Neonatal para a doença permitem a identificação precoce dos afetados e seu tratamento de modo a evitar as complicações da falta do hormônio. A maioria dos casos de hipotireoidismo congênito é decorrente de disgenesias tireoidianas (85%), entre elas a ectopia, hipoplasia ou agenesia tireoidianas, e os demais resultam de defeitos de síntese hormonal. As crianças afetadas (> 95%) geralmente não apresentam sintomas sugestivos da doença ao nascimento. Os sintomas e sinais mais comuns são: icterícia neonatal prolongada, choro rouco, letargia, movimentos lentos, constipação, macroglossia, hérnia umbilical, fontanelas amplas, hipotonia e pele seca. Várias estratégias são utilizadas para a triagem do HC. No Brasil, esta é obrigatória por lei e geralmente é feita com a dosagem de TSH em sangue seco coletado do calcanhar. A idade recomendada para sua realização é após as 48 horas de vida até o quarto dia. A confirmação diagnóstica é obrigatória com as dosagens de TSH e T4 livre ou T4 total.

The first reported case of human tick paralysis in Brazil: a new induction pattern by immature stages

Tick paralysis (TP) is a rare disease with rapid progression and potential fatal evolution. Immediately after the diagnosis, removal of all ticks from the body of the patient is mandatory. The present study reports for the first time a human case of the disease in Brazil. The patient had loss of muscle strength, decreased reflexes and marked palpebral ptosis. Six hours after removal of the last tick, the ptosis improved and on the following day, the patient had near total regression of the symptoms. This report emphasizes the possible presence of similar cases that should be promptly diagnosed and quickly treated. A new induction pattern for TP in humans associated with immature stages of ticks is also presented.

Sexo, peso e conformação anatômica do olho sobre cálculode poder dióptrico de lentes intra-oculares no cão

A catarata, especialmente na espécie canina, é uma doença oftálmica importante. Seu tratamento é eminentemente cirúrgico, mas a perda do cristalino resulta em alta hipermetropia, e a visão fica comprometida. A correção pode ser feita com a utilização de lente intra-ocular (LIO). Este estudo teve por objetivo colher dados que pudessem fornecer subsídios métricos para a produção de LIOs a serem aplicadas em cães facectomizados, visando a restauração de visão adequada nos animais acometidos por catarata. Foram selecionados 120 cães de ambos os sexos, sadios ao exame clínico e sem evidência de doença ocular ao exame oftálmico de rotina. Foram realizados estudos ceratométrico e biométrico, pela ultra-sonografia modo-A. Uma fórmula específica foi utilizada para a determinação do poder dióptrico de uma LIO utilizada para substituir o cristalino extraído. O poder dióptrico da LIO foi correlacionado com o peso e o sexo dos animais, e entre os olhos direito e esquerdo. Baseado nestas correlações, concluiu-se que o poder dióptrico adequado para uma LIO a ser implantada em um cão facectomizado é influenciado principalmente pelo peso do animal, apesar de apresentar discretas diferenças quando comparado entre os olhos direito e esquerdo e entre machos e fêmeas.

Responsabilidade do profissional de saúde sobre a notificação de casos de violência doméstica

A notificação da violência doméstica pelos profissionais de saúde contribui para o dimensionamento epidemiológico do problema, permitindo o desenvolvimento de programas e ações específicas. O objetivo do trabalho foi verificar a responsabilidade desses profissionais em notificar a violência, especialmente a doméstica e as possíveis implicações legais e éticas a que estão sujeitos. Assim, foi realizada pesquisa na legislação brasileira e códigos de ética da medicina, odontologia, enfermagem e psicologia. Quanto à legislação, as sanções estão dispostas na Lei das Contravenções Penais, Estatuto da Criança e Adolescente, Estatuto do Idoso e na lei que trata da notificação compulsória de violência contra a mulher. Também existem penalidades em todos os códigos de ética analisados. Conclui-se que o profissional de saúde tem o dever de notificar os casos de violência que tiver conhecimento, podendo inclusive responder pela omissão.

pH-cycling models for in vitro evaluation of the efficacy of fluoridated dentifrices for caries control: strengths and limitations

Despite a plethora of in situ studies and clinical trials evaluating the efficacy of fluoridated dentifrices on caries control, in vitro pH cycling models are still broadly used because they mimic the dynamics of mineral loss and gain involved in caries formation. This paper critically reviews the current literature on existing pH-cycling models for the in vitro evaluation of the efficacy of fluoridated dentifrices for caries control, focusing on their strengths and limitations. A search was undertaken in the MEDLINE electronic journal database using the keywords "pH-cycling", "demineralization", "remineralization", "in vitro", "fluoride", "dentifrice". The primary outcome was the decrease of demineralization or the increase of remineralization as measured by different methods (e. g.: transverse microradiography) or tooth fluoride uptake. Inclusion of studies, data extraction and quality assessment were undertaken independently and in duplicate by two members of the review team. Disagreements were solved by discussion and consensus or by a third party. One hundred and sixteen studies were included, of which 42 addressed specifically the comparison of dentifrices using different pH-cycling models. The other studies included meta-analysis or reviews, data about the effect of different fluoride sources on de-remineralization, different methods for analysis de-remineralization and chemical variables and characteristics of dental hard tissues that might have influence on de-remineralization processes. Generally, the studies presented ability to detect known results established by clinical trials, to demonstrate dose-related responses in the fluoride content of the dentifrices, and to provide repeatability and reproducibility between tests. In order to accomplish these features satisfactorily, it is mandatory to take into account the type of substrate and baseline artificial lesion, as well as the adequate response variables and statistical approaches to be used. This critical review of literature showed that the currently available pH-cycling models are appropriate to detect dose-response and pH-response of fluoride dentifrices, and to evaluate the impact of new active principles on the effect of fluoridated dentifrices, as well as their association with other anti-caries treatments.

Closing the SU(3)(L)circle times U(1)(X) symmetry at the electroweak scale

We show that some models with SU(3)(C)circle times SU(3)(L)circle times U(1)(X) gauge symmetry can be realized at the electroweak scale and that this is a consequence of an approximate global SU(2)(L+R) symmetry. This symmetry implies a condition among the vacuum expectation value of one of the neutral Higgs scalars, the U(1)(X)'s coupling constant, g(X), the sine of the weak mixing angle sin theta(W), and the mass of the W boson, M-W. In the limit in which this symmetry is valid it avoids the tree level mixing of the Z boson of the standard model with the extra Z(') boson. We have verified that the oblique T parameter is within the allowed range indicating that the radiative corrections that induce such a mixing at the 1-loop level are small. We also show that a SU(3)(L+R) custodial symmetry implies that in some of the models we have to include sterile (singlets of the 3-3-1 symmetry) right-handed neutrinos with Majorana masses, since the seesaw mechanism is mandatory to obtain light active neutrinos. Moreover, the approximate SU(2)(L+R)subset of SU(3)(L+R) symmetry implies that the extra nonstandard particles of these 3-3-1 models can be considerably lighter than it had been thought before so that new physics can be really just around the corner.

O uso de geotecnologias no planejamento ambiental: o plano diretor municipal de Tambaú - SP

A Lei Federal 10.257, de 10 de julho de 2001, regulamentou os artigos 182 e 183 da Constituição Federal de 1988 no que trata da política urbana, especialmente da propriedade, sendo obrigatório para municípios com mais de 20.000 habitantes. Até então, os planos diretores municipais vinham sendo feitos levando em conta apenas as respectivas áreas urbanas, A partir desta lei, tais planos tiveram de levar em conta também as áreas rurais, integrando-as no processo do planejamento municipal sustentado. Analisando-se os planos diretores municipais recentes, elaborados a partir dessas novas diretrizes, nota-se que a maioria ainda enfatiza a área urbana, em detrimento da área rural. O objetivo deste trabalho foi, a partir de um estudo de caso, avaliar e validar metodologias e tecnologias rotineiramente empregadas em Geociências e Ciências Agrárias.