Revisão sistemática da acurácia dos testes diagnósticos: uma revisão narrativa

Este artigo tem o objetivo de realizar uma revisão narrativa sobre revisão sistemática da acurácia dos testes diagnósticos. Foi realizada busca na Cochrane Methodology Reviews (Cochrane Reviews of Diagnostic Test Accuracy), Medline e LILACS, bem como busca manual das listas de referências dos artigos incluídos na revisão. As estratégias de busca empregadas foram as seguintes, empregando-se títulos de assuntos e termos livres: 1. na Cochrane Methodology Reviews: accuracy study "Methodology" 2. Na Pubmed "Meta-Analysis "[Publication Type] AND "Evidence-Based Medicine"[Mesh]) AND "Sensitivity and Specificity"[Mesh]; 3. Na LILACS: (revisao sistematica) or "literatura de REVISAO como assunto" [Descritor de assunto] and (sistematica) or "SISTEMATICA" [Descritor de assunto] and (acuracia) or "SENSIBILIDADE e especificidade" [Descritor de assunto]. Em suma, a preparação e o planejamento metodológicos das revisões sistemáticas de testes diagnósticos é ulterior àqueles empregados nas revisões sistemáticas das intervenções terapêuticas. Há muitas fontes de heterogeneidade nos desenhos dos estudos de teste diagnóstico, o que dificulta muito a síntese - metanálise - dos seus resultados. Para contornar esse problema, existem atualmente normas, exigidas pelas principais revistas biomédicas, para a submissão de um manuscrito sobre testes diagnósticos.

Inguinal hernias in patients of 50 years and above. Pattern and outcome

OBJECTIVE: to evaluate a one year experience with inguinal hernia repair, in patients of > 50years, with respect to the type of inguinal hernia, type of surgery, postoperative complications and recurrence. METHODS: a prospective descriptive study of patients (n=57) > 50 years operated for inguinal hernia during a one year period. Tension-free meshplasty and herniorrhaphy, using 3"x6" polypropylene mesh and 2-0 polypropylene suture, were performed in elective and emergency surgery respectively. Follow-up visits were scheduled at six weeks, three and six months postoperatively. RESULTS: the most representative age group was 61-70 years, and all patients were male. 52 (91.22%) patients had unilateral inguinal hernias, while five (8.77%) had bilateral hernias. In 50 (87.71%) patients, the hernia was uncomplicated, while seven (12.28%) patients presented with some complication such as obstruction or strangulation. Elective surgery was performed in 50 (87.71%) patients while seven (12.28%) patients were operated in emergency. Postoperatively, 50 (87.7%) patients had uneventful recovery, while seven (12.28%) patients developed some complications which were treated conservatively. Mean hospital stay was six days. One recurrence was observed and there was no peri/postoperative death. CONCLUSION: tension-free meshplasty and herniorrhaphy are safe, simple and applicable even in elderly patients after adequate pre-operative assessment and optimization. Although associated with longer hospital stay, the mortality rate is nil and complication as well as recurrence rate is low. Hence, timely repair is necessary in elderly patients even in those with comorbid conditions.

Dismenorreia membranosa: uma doença esquecida

OBJETIVO: apresentar uma série de casos de dismenorreia membranosa. MÉTODOS: todas as pacientes foram selecionadas a partir da suspeição diagnóstica, após atendimento clínico em consultório privado por relato de dismenorreia dolorosa associada à eliminação espontânea de material elástico com formato semelhante a útero. Apenas fatos relevantes foram descritos do quadro álgico, história médica atual e pregressa e hábitos de vida. O material eliminado foi encaminhado para laboratório de patologia no qual ocorreu a análise macro e microscópica. Os casos em que não se pode provar a eliminação de material com característica membranácea não foram selecionados. Após a confirmação diagnóstica, realizou-se uma revisão da literatura até o ano de 2008 utilizando o método MeSH com o termo "membranous dysmenorrhea". RESULTADOS: três casos clínicos de dismenorreia foram transcritos. Todos os casos, além do quadro característico de dor e eliminação vaginal de material elástico, foram associados ao uso de métodos anticoncepcionais hormonais. CONCLUSÕES: embora haja apenas escassos relatos de caso de dismenorreia membranosa na literatura científica, sua etiologia deve ser suspeita em casos de dor associada a sangramento vaginal com eliminação de material elástico ou firme. O diagnóstico final é dependente do exame anatomopatológico que nunca deve ser dispensado. Observamos necessidade de mais discussões sobre esta patologia com o objetivo de manter o profissional atualizado para exercer diagnóstico e terapêutica adequados.

Effect of different surface roughnesses on a turbulent boundary layer

The classical treatment of rough wall turbulent boundary layers consists in determining the effect the roughness has on the mean velocity profile. This effect is usually described in terms of the roughness function delta U+. The general implication is that different roughness geometries with the same delta U+ will have similar turbulence characteristics, at least at a sufficient distance from the roughness elements. Measurements over two different surface geometries (a mesh roughness and spanwise circular rods regularly spaced in the streamwise direction) with nominally the same delta U+ indicate significant differences in the Reynolds stresses, especially those involving the wall-normal velocity fluctuation, over the outer region. The differences are such that the Reynolds stress anisotropy is smaller over the mesh roughness than the rod roughness. The Reynolds stress anisotropy is largest for a smooth wall. The small-scale anisotropy and interniittency exhibit much smaller differences when the Taylor microscale Reynolds number and the Kolmogorov-normalized mean shear are nominally the same. There is nonetheless evidence that the small-scale structure over the three-dimensional mesh roughness conforms more closely with isotropy than that over the rod-roughened and smooth walls.

Potential for seed bank formation of two weed species from Brazilian Amazonia

The potential for seed bank formation of two perennial weed species, Ipomoea asarifolia (Desr.) Roem. & Schult. (Convolvulaceae) and Stachytarpheta cayennensis (Rich.) M. Vahl (Verbenaceae), both common in Amazonia , was evaluated in a degraded pasture area in eastern Brazilian Amazonia . Seeds were enclosed in nylon mesh packets and placed at the soil surface or buried at 5 or 10 cm deep. The number of viable seeds was recorded at 6, 10, 14 and 18 months after burial. Results showed that S. cayennensis has the ability to form persistent soil seed bank, while I. asarifolia seeds do not build up in the soil seed bank. For S. cayennensis and, to some extent, for I. asarifolia, seed survival was highest at greater burial depths.

Optimization and validation of the solid-liquid extraction technique for determination of picloram in soils by high performance liquid chromatography

The objective of this study was to optimize and validate the solid-liquid extraction (ESL) technique for determination of picloram residues in soil samples. At the optimization stage, the optimal conditions for extraction of soil samples were determined using univariate analysis. Ratio soil/solution extraction, type and time of agitation, ionic strength and pH of extraction solution were evaluated. Based on the optimized parameters, the following method of extraction and analysis of picloram was developed: weigh 2.00 g of soil dried and sieved through a sieve mesh of 2.0 mm pore, add 20.0 mL of KCl concentration of 0.5 mol L-1, shake the bottle in the vortex for 10 seconds to form suspension and adjust to pH 7.00, with alkaline KOH 0.1 mol L-1. Homogenate the system in a shaker system for 60 minutes and then let it stand for 10 minutes. The bottles are centrifuged for 10 minutes at 3,500 rpm. After the settlement of the soil particles and cleaning of the supernatant extract, an aliquot is withdrawn and analyzed by high performance liquid chromatography. The optimized method was validated by determining the selectivity, linearity, detection and quantification limits, precision and accuracy. The ESL methodology was efficient for analysis of residues of the pesticides studied, with percentages of recovery above 90%. The limits of detection and quantification were 20.0 and 66.0 mg kg-1 soil for the PVA, and 40.0 and 132.0 mg kg-1 soil for the VLA. The coefficients of variation (CV) were equal to 2.32 and 2.69 for PVA and TH soils, respectively. The methodology resulted in low organic solvent consumption and cleaner extracts, as well as no purification steps for chromatographic analysis were required. The parameters evaluated in the validation process indicated that the ESL methodology is efficient for the extraction of picloram residues in soils, with low limits of detection and quantification.

Infestation maps and spatial stability of main weed species in maize culture

A study on the spatial distribution of the major weeds in maize was carried out in 2007 and 2008 in a field located in Golegã (Ribatejo region, Portugal). The geo-referenced sampling focused on 150 points of a 10 x 10 m mesh covering an area of 1.5 ha, before herbicide application and before harvest. In the first year, 40 species (21 botanical families) were identified at seedling stage and only 22 during the last observation. The difference in species richness can be attributed to maize monoculture favouring reduction in species number. Three of the most representative species were selected for the spatial distribution analysis: Solanum nigrum, Chenopodium album and Echinochloa crus-galli. The three species showed an aggregated spatial pattern and spatial stability over both years, although the herbicide effect is evident in the distribution of some of them in the space. These results could be taken into account when planning site-specific treatments in maize.

Sorption and desorption of Suflafenacil in two soils in the state of São Paulo with different physical and chemical attributes

A study was conducted to evaluate the sorption and desorption of 14C herbicide saflufenacil (pyrimidinedione) in two soils in the State of São Paulo, classified as Red Yellow Latosol with clayey texture (LVA-1) and medium texture (LVA-2), using the batch method through isotherms. The soils were air dried and sieved a 2 mm mesh. The radioactivity was determined by liquid scintillation spectrometry in acclimatized room (25 ± 2 °C). Sorption isotherms were conducted for 5 concentrations of saflufenacil (5.0; 2.5; 1.0; 0.5 and 0.05 μg mL-1) and the results were adjusted to the Freundlich equation, thus obtaining the parameters of sorption followed by two extractions with 0.01 M CaCl2 to determine desorption parameters similarly to sorption. The results showed that saflufenacil sorption was low for both soils studied, being greater for the LVA with higher organic matter content. The desorption coefficients were greater than their sorption coefficients, suggesting the occurrence of hysteresis. The sorption and desorption isotherms (classified as type C isotherms), hysteresis and the t-test between the angular coefficient of the respective isotherms showed that both the sorption and desorption occur with equal intensity.

Planktic Cyanobacteria from upper Tietê basin reservoirs, SP, Brazil

Considering the great ecological and sanitary importance of the cyanobacteria and the need of detailed information about these organisms in Brazilian water bodies, the present study aims at contributing towards the knowledge of the cyanobacterial flora of five reservoirs belonging to the upper Tietê Basin, São Paulo: Billings, Guarapiranga, Jundiaí, Pirapora, Ponte Nova and Taiaçupeba. In the past several years, these reservoirs have been submitted to severe environmental deterioration and have repeatedly presented cyanobacterial blooms, including those of toxic species. The samples were collected between 1997 and 2003 either with plankton net (20 µm mesh) or van Dorn's bottle, and preserved with lugol solution or formaldehyde. Some species were isolated and maintained in culture. Forty-eight species of cyanobacteria were identified, with predominance of the order Chroococcales (58%), followed by the orders Oscillatoriales (21%) and Nostocales (21%). Among the 48 studied species, 17 (35%) were considered potentially toxic. The occurrence and biodiversity of the cyanobacteria in each reservoir depend on the environmental conditions. Among the five water bodies, Billings Reservoir presented the most adequate situation for the development of a greater number of species (34), probably due to its high pH values (around 8). Pirapora Reservoir on the other hand, with highest conductivity (445.0 µS cm-1) and lowest Secchi depth values (0.2 m), presented the lowest cyanobacterial biodiversity (14 species).

Cyanobacteria from coastal lagoons of Southern Brazil: coccoid organisms

Considering the great ecological importance of the cyanobacteria and the need for more detailed information about these organisms in Brazilian waters, this paper provides taxonomic information about the unicellular cyanobacteria flora in lagoon systems along the coastal plains of Rio Grande do Sul State. Sampling was performed in different freshwater bodies along the eastern (Casamento Lake area) and western (near the city of Tapes) banks of the Patos Lagoon (30º40' S-30º10' S and 50º30' W-51º30' W). The samples were collected once in the rainy season and once in the dry season (from May 2003 to December 2003) using a plankton net (25 µm mesh) in pelagic and littoral zones, and by squeezing the submerged parts of aquatic macrophytes. Thirty one species belonging to the families Synechoccocaceae (7 taxa), Merismopediaceae (12 taxa), Chamaesiphonaceae (1 taxon), Microcystaceae (4) and Chroococcaceae (7 taxa) were identified. Among these species, five are reported for the first time in Rio Grande do Sul State: Chamaesiphon amethystinus (Rostafinski) Lemmermann, Chroococcus minimus (Keissler) Lemmermann, Coelomoron pusillum (Van Goor) Komárek, Coelosphaerium kuetzingeanum Naegeli, and Cyanodictyon tubiforme Cronberg.

Planktonic diatoms in lotic and lentic environments in the Lago dos Tigres hydrologic system (Britânia, Goiás, Brazil): Coscinodiscophyceae and Fragilariophyceae

A floristic study of Coscinodiscophyceae and Fragilariophyceae in the Lago dos Tigres hydrologic system is presented. Phytoplankton samples were collected with a plankton net (25 µm mesh) at 11 sampling stations, three in lotic areas and eight in lacustrine zones. Eleven species of Coscinodiscophyceae and eight of Fragilariophyceae were identified; descriptions, comments, their geographic distributions for the midwestern region of Brazil, type of environment (lentic/lotic), and illustrations are provided. Among the taxa found, 13 were recorded for the first time in midwestern Brazil: Aulacoseira alpigena, A. distans, A. granulata var. angustissima, A. granulata var. valida, A. muzzanensis, Discostella stelligera var. stelligera, Fragilaria capucina var. fragilarioides, F. delicatissima var. delicatissima, F. javanica, Pleurosira laevis, Staurosira acutirostrata, Staurosirella crassa, and Ulnaria ulna.

Cyanobacteria from coastal lagoons in southern Brazil: non-heterocytous filamentous organisms

This study describes and illustrates non-heterocytous filamentous cyanobacteria found in lagoon systems on the coastal plains of Rio Grande do Sul State. Collections were carried out in different freshwater bodies along the eastern (Casamento Lake area) and western (Tapes City area) margins of the Patos Lagoon (UTM 461948-6595095 and 542910-6645535) using a plankton net (25 µm mesh) in pelagic and littoral zones as well as by squeezing submerged parts of aquatic macrophytes, during both the rainy and dry seasons, from May to December/2003. Twenty two species belonging to the families Phormidiaceae (eight taxa), Pseudanabaenaceae (seven taxa), Oscillatoriaceae (six taxa), and Spirulinaceae (one taxon) were identified. Among these species, five are reported for the first time from Rio Grande do Sul State: Leptolyngbya cebennensis, Microcoleus subtorulosus, Oscillatoria cf. anguina, O. curviceps and Phormidium formosum.

Repair of the anophthalmic cavity of rats with synthetic hydroxyapatite

We placed spheres of synthetic hydroxyapatite (calcium chloride combined with sodium phosphate) in the eviscerated or enucleated orbital cavity of rats in order to evaluate the biocompatibility of this material with the orbital cavity. The study was conducted on 50 albino rats, 25 of which were submitted to enucleation and 25 to evisceration of one eye. The animals were sacrificed 7, 15, 21, 30 and 60 days after surgery and the orbital content was submitted to histopathological examination. A reaction of the young granulation tissue type was observed first. The hydroxyapatite was gradually surrounded by a granulomatous macrophage inflammatory response and covered with dense connective tissue that formed a sort of" mesh" septating and supporting progressively smaller blocks of the substance. The same type of reaction was observed in the enucleated and eviscerated cavities. We conclude that synthetic hydroxyapatite is an inert nonallergenic material which is appropriate for volume replacement in the anophthalmic cavity

A laboratory cage for foster nursing newborn mice

We describe a cage to be used for foster nursing in order to guarantee that original mother's colostrum is not ingested by the newborn mice. A common (30.5 cm x 19.5 cm x 12.0 cm) mouse cage was fitted with a wire net tray with a mesh (1 cm x 1 cm), which divides the cage into an upper and a lower compartment. Mice born to females placed in the upper compartment pass through the mesh and fall into the lower compartment, where another lactating female with one or two of its own pups are. Of a total of 28 newborn mice of C3H/He and Swiss strains, 23 were successfully fostered. Important observations are presented to show that this is a valuable alternative for foster studies without great suffering on the part of the female.

Modulation of fibronectin expression in the central nervous system of Lewis rats with experimental autoimmune encephalomyelitis

Fibronectin (FN), a large family of plasma and extracellular matrix (ECM) glycoproteins, plays an important role in leukocyte migration. In normal central nervous system (CNS), a fine and delicate mesh of FN is virtually restricted to the basal membrane of cerebral blood vessels and to the glial limitans externa. Experimental autoimmune encephalomyelitis (EAE), an inflammatory CNS demyelinating disease, was induced in Lewis rats with a spinal cord homogenate. During the preclinical phase and the onset of the disease, marked immunolabelling was observed on the endothelial luminal surface and basal lamina of spinal cord and brainstem microvasculature. In the paralytic phase, a discrete labelling was evident in blood vessels of spinal cord and brainstem associated or not with an inflammatory infiltrate. Conversely, intense immunolabelling was present in cerebral and cerebellar blood vessels, which were still free from inflammatory cuffs. Shortly after clinical recovery minimal labelling was observed in a few blood vessels. Brainstem and spinal cord returned to normal, but numerous inflammatory foci and demyelination were still evident near the ventricle walls, in the cerebral cortex and in the cerebellum. Intense expression of FN in brain vessels ascending from the spinal cord towards the encephalon preceded the appearance of inflammatory cells but faded away after the establishment of the inflammatory cuff. These results indicate an important role for FN in the pathogenesis of CNS inflammatory demyelinating events occurring during EAE.