Internato regional e forma����o m��dica: percep����o da primeira turma p��s-reforma curricular

As escolas m��dicas brasileiras priorizam o ambiente hospitalar para o ensino e acabam formando profissionais carentes de compromisso social. O curso de Medicina da Universidade Federal de Santa Maria implantou, em 2004, um novo curr��culo que inclui o Internato Regional (IR), em que o interno permanece dois meses em munic��pio conveniado, atuando em aten����o prim��ria em sa��de. Este estudo transversal e quanti-qualitativo teve por objetivo conhecer a percep����o dos acad��micos da primeira turma que realizou o IR sobre o impacto desse modelo de est��gio em sua forma����o, mediante a aplica����o de um question��rio semiestruturado. Mais de 75% das respostas apontaram ter havido contribui����o para maior conhecimento da realidade social e profissional, aprimoramento da rela����o m��dico-paciente e desenvolvimento de autoconfian��a no exerc��cio da profiss��o. O principal ponto negativo ressaltado foi o despreparo dos m��dicos-preceptores para atuar como docentes. No atual contexto de mudan��as, o IR surge como uma proposta satisfat��ria de amplia����o dos cen��rios de pr��tica-ensino-aprendizagem e contribui com a forma����o humana e pessoal dos futuros m��dicos, apesar de ainda carecer de preceptoria qualificada.

Estrutura da vegeta����o de um cerrad��o e a heterogeneidade regional do Cerrado no Maranh��o, Brasil

A estrutura de um Cerrad��o no nordeste do Maranh��o foi avaliada visando contribuir para a caracteriza����o da heterogeneidade da vegeta����o no Estado. O m��todo de quadrantes foi utilizado na amostragem de 399 pontos em tr��s transectos paralelos, distribu��dos sistematicamente a cada 200 m. O ponto de in��cio do primeiro transecto foi sorteado. O crit��rio de inclus��o m��nimo foi de 1 cm de di��metro ao n��vel do solo. Os 1.596 indiv��duos amostrados representaram 69 esp��cies e 32 fam��lias. Plathymenia reticulata (Candeia) foi a esp��cie com maior ��ndice de Valor de Import��ncia (IVI), diferindo de outras regi��es maranhenses. A diversidade (H'= 3,31) e a eq��abilidade (J= 0,78) foram altas e est��o dentro da varia����o conhecida nos Cerrados do Maranh��o. A compara����o flor��stica entre sete ��reas de Cerrado no Estado mostrou elevada heterogeneidade e baixa similaridade. As localidades com maior proximidade geogr��fica apresentaram maior similaridade flor��stica apenas nas an��lises com valores de abund��ncia das esp��cies.

Produ����o, qualidade dos frutos e estado nutricional da laranja val��ncia sob fertirriga����o e aduba����o convencional

O objetivo deste trabalho foi comparar os efeitos de doses de nitrog��nio, f��sforo e pot��ssio aplicadas via ��gua de irriga����o em compara����o �� aplica����o convencional de fertilizantes, com irriga����o e sem irriga����o. O experimento foi conduzido em um pomar de laranja 'Val��ncia' (Citrus sinensis Osbeck) localizado em Prat��nia - SP, durante tr��s anos consecutivos, e analisados os dados do ��ltimo ano de observa����o. As diferentes formas de aplica����o dos fertilizantes e a redu����o das doses fornecidas via ��gua de irriga����o n��o resultaram em diferen��as significativas sobre o n��mero m��dio de frutos e produtividade. Tamb��m n��o foram constatadas diferen��as estat��sticas dos tratamentos sobre a qualidade do suco e o estado nutricional das plantas, com exce����o do teor de f��sforo.

Variabilidade local e regional da evapotranspira����o estimada pelo algoritmo SEBAL

Em face da import��ncia em conhecer a evapotranspira����o (ET) para uso racional da ��gua na irriga����o no contexto atual de escassez desse recurso, algoritmos de estimativa da ET a n��vel regional foram desenvolvidos utilizando-se de ferramentas de sensoriamento remoto. Este estudo objetivou aplicar o algoritmo SEBAL (Surface Energy Balance Algorithms for Land) em tr��s imagens do sat��lite Landsat 5, do segundo semestre de 2006. As imagens correspondem a ��reas irrigadas, floresta nativa densa e a Caatinga do Estado do Cear�� (Baixo Acara��, Chapada do Apodi e Chapada do Araripe). Este algoritmo calcula a evapotranspira����o hor��ria a partir do fluxo de calor latente, estimado como res��duo do balan��o de energia na superf��cie. Os valores de ET obtidos nas tr��s regi��es foram superiores a 0,60 mm h-1 nas ��reas irrigadas ou de vegeta����o nativa densa. As ��reas de vegeta����o nativa menos densa apresentaram taxa da ET hor��ria de 0,35 a 0,60 mm h-1, e valores quase nulos em ��reas degradadas. A an��lise das m��dias de evapotranspira����o hor��ria pelo teste de Tukey a 5% de probabilidade permitiu evidenciar uma variabilidade significativa local, bem como regional no Estado do Cear��.

Ovo recep����o: perfil das pacientes em lista de espera no programa do Hospital Regional da Asa Sul, Bras��lia, Distrito Federal

OBJETIVO: descrever o perfil epidemiol��gico das pacientes inscritas em lista de espera e principais indica����es para o programa de ovo recep����o do Hospital Regional da Asa Sul (HRAS) em Bras��lia, Distrito Federal. M��TODOS: estudo descritivo prospectivo em que foram pesquisadas 330 mulheres inscritas na lista de espera do programa, das quais foram inclu��das 67 mulheres independente do fator de infertilidade e que ainda n��o tinham sido contempladas com o tratamento. Foram exclu��das 30 mulheres que moravam em outras cidades, 50 pacientes com idade superior ou igual a 50 anos, 24 pacientes que n��o desejavam participar do trabalho, nove pacientes que pediram exclus��o do programa e 150 pacientes n��o localizadas por contato telef��nico. As pacientes inclu��das foram chamadas a responder a um question��rio e tiveram seus prontu��rios recuperados para confirmar a realiza����o da proped��utica necess��ria, a fim de estabelecer a causa da infertilidade. Os dados foram registrados e analisados pelo programa SPSS vers��o 12.0. RESULTADOS: o perfil epidemiol��gico das pacientes inclui faixa et��ria de 40 a 49 anos (82%), n��o brancas (77,6%), cat��licas (71,6%), casadas (59,7%), com escolaridade de primeiro ou segundo grau (76,1%), com infertilidade secund��ria (53,6%) por laqueadura tub��ria (40,3%) e que come��aram a tentar engravidar at�� 35 anos (91%). Para estas mulheres, a principal indica����o para ovo recep����o foi idade no momento da inscri����o no programa, seguida por baixa reserva ovariana. CONCLUS��O: os resultados encontrados demonstram a realiza����o indiscriminada de laqueadura tub��ria. O programa de ovo recep����o beneficia mulheres com progn��stico reprodutivo reservado.

Validation of transit-time flowmetry for chronic measurements of regional blood flow in resting and exercising rats

The objective of the present study was to validate the transit-time technique for long-term measurements of iliac and renal blood flow in rats. Flow measured with ultrasonic probes was confirmed ex vivo using excised arteries perfused at varying flow rates. An implanted 1-mm probe reproduced with accuracy different patterns of flow relative to pressure in freely moving rats and accurately quantitated the resting iliac flow value (on average 10.43 �� 0.99 ml/min or 2.78 �� 0.3 ml min-1 100 g body weight-1). The measurements were stable over an experimental period of one week but were affected by probe size (resting flows were underestimated by 57% with a 2-mm probe when compared with a 1-mm probe) and by anesthesia (in the same rats, iliac flow was reduced by 50-60% when compared to the conscious state). Instantaneous changes of iliac and renal flow during exercise and recovery were accurately measured by the transit-time technique. Iliac flow increased instantaneously at the beginning of mild exercise (from 12.03 �� 1.06 to 25.55 �� 3.89 ml/min at 15 s) and showed a smaller increase when exercise intensity increased further, reaching a plateau of 38.43 �� 1.92 ml/min at the 4th min of moderate exercise intensity. In contrast, exercise-induced reduction of renal flow was smaller and slower, with 18% and 25% decreases at mild and moderate exercise intensities. Our data indicate that transit-time flowmetry is a reliable method for long-term and continuous measurements of regional blood flow at rest and can be used to quantitate the dynamic flow changes that characterize exercise and recovery

Short-lasting systemic and regional benefits of early crystalloid infusion after intravenous inoculation of dogs with live Escherichia coli

We investigated the systemic and regional hemodynamic effects of early crystalloid infusion in an experimental model of septic shock induced by intravenous inoculation with live Escherichia coli. Anesthetized dogs received an intravenous infusion of 1.2 x 10(10) cfu/kg live E. coli in 30 min. After 30 min of observation, they were randomized to controls (no fluids; N = 7), or fluid resuscitation with lactated Ringer's solution, 16 ml/kg (N = 7) or 32 ml/kg (N = 7) over 30 min and followed for 120 min. Cardiac index, portal blood flow, mean arterial pressure, systemic and regional oxygen-derived variables, blood lactate, and gastric PCO2 were assessed. Rapid and progressive cardiovascular deterioration with reduction in cardiac output, mean arterial pressure and portal blood flow (~50, ~25 and ~70%, respectively) was induced by the live bacteria challenge. Systemic and regional territories showed significant increases in oxygen extraction and in lactate levels. Significant increases in venous-arterial (~9.6 mmHg), portal-arterial (~12.1 mmHg) and gastric mucosal-arterial (~18.4 mmHg) PCO2 gradients were also observed. Early fluid replacement, especially with 32 ml/kg volumes of crystalloids, promoted only partial and transient benefits such as increases of ~76% in cardiac index, of ~50% in portal vein blood flow and decreases in venous-arterial, portal-arterial, gastric mucosal-arterial PCO2 gradients (7.2 �� 1.0, 7.2 �� 1.3 and 9.7 �� 2.5 mmHg, respectively). The fluid infusion promoted only modest and transient benefits, unable to restore the systemic and regional perfusional and metabolic changes in this hypodynamic septic shock model.

Systemic and regional hemodynamic effects of enalaprilat infusion in experimental normotensive sepsis

Angiotensin-converting enzyme inhibitors have been shown to improve splanchnic perfusion in distinct shock states. We hypothesized that enalaprilat potentiates the benefits of early fluid resuscitation in severe experimental sepsis, particularly in the splanchnic region. Anesthetized and mechanically ventilated mongrel dogs received an intravenous infusion of live Escherichia coli over a period of 30 min. Thereafter, two interventions were performed: fluid infusion (normal saline, 32 mL/kg over 30 min) and enalaprilat infusion (0.02 mg kg-1 min-1 for 60 min) in randomized groups. The following groups were studied: controls (fluid infusion, N = 4), E1 (enalaprilat infusion followed by fluid infusion, N = 5) and E2 (fluid infusion followed by enalaprilat infusion, N = 5). All animals were observed for a 120 min after bacterial infusion. Mean arterial pressure, cardiac output (CO), portal vein blood flow (PVBF), systemic and regional oxygen-derived variables, and lactate levels were measured. Rapid and progressive reductions in CO and PVBF were induced by the infusion of live bacteria, while minor changes were observed in mean arterial pressure. Systemic and regional territories showed a significant increase in oxygen extraction and lactate levels. Widening venous-arterial and portal-arterial pCO2 gradients were also detected. Fluid replacement promoted transient benefits in CO and PVBF. Enalaprilat after fluid resuscitation did not affect systemic or regional hemodynamic variables. We conclude that in this model of normotensive sepsis inhibition of angiotensin-converting enzyme did not interfere with the course of systemic or regional hemodynamic and oxygen-derived variables.

Intravenous regional block is similar to sympathetic ganglion block for pain management in patients with complex regional pain syndrome type I

Sympathetic ganglion block (SGB) or intravenous regional block (IVRB) has been recommended for pain management in patients with complex regional pain syndrome type I (CRPS-I). Forty-five patients were initially selected but only 43 were accepted for the study. The present study evaluated the efficacy of IVRB produced by combining 70 mg lidocaine with 30 ��g clonidine (14 patients, 1 male/13 females, age range: 27-50 years) versus SGB produced by the injection of 70 mg lidocaine alone (14 patients, 1 male/13 females, age range: 27-54 years) or combined with 30 ��g clonidine (15 patients, 1 male/14 females, age range: 25-50 years) into the stellate ganglion for pain management in patients with upper extremity CRPS-I. Each procedure was repeated five times at 7-day intervals, and pain intensity and duration were measured using a visual analog scale immediately before each procedure. A progressive and significant reduction in pain scores and a significant increase in the duration of analgesia were observed in all groups following the first three blocks, but no further improvement was obtained following the last two blocks. Drowsiness, the most frequent side effect, and dry mouth occurred only in patients submitted to SGB with lidocaine combined with clonidine. The three methods were similar regarding changes in pain intensity and duration of analgesia. However, IVRB seems to be preferable to SGB due to its easier execution and lower risk of undesirable effects.

MMP-1/PAR-1 signal transduction axis and its prognostic impact in esophageal squamous cell carcinoma

The matrix metalloprotease-1 (MMP-1)/protease-activated receptor-1 (PAR-1) signal transduction axis plays an important role in tumorigenesis. To explore the expression and prognostic value of MMP-1 and PAR-1 in esophageal squamous cell carcinoma (ESCC), we evaluated the expression of two proteins in resected specimens from 85 patients with ESCC by immunohistochemistry. Sixty-two (72.9%) and 58 (68.2%) tumors were MMP-1- and PAR-1-positive, respectively, while no significant staining was observed in normal esophageal squamous epithelium. MMP-1 and PAR-1 overexpression was significantly associated with tumor node metastasis (TNM) stage and regional lymph node involvement. Patients with MMP-1- and PAR-1-positive tumors, respectively, had poorer disease-free survival (DFS) than those with negative ESCC (P = 0.002 and 0.003, respectively). Univariate analysis showed a significant relationship between TNM stage [hazard ratio (HR) = 2.836, 95% confidence interval (CI) = 1.866-4.308], regional lymph node involvement (HR = 2.955, 95%CI = 1.713-5.068), MMP-1 expression (HR = 2.669, 95%CI = 1.229-6.127), and PAR-1 expression (HR = 1.762, 95%CI = 1.156-2.883) and DFS. Multivariate analysis including the above four parameters identified TNM stage (HR = 2.035, 95%CI = 1.167-3.681), MMP-1 expression (HR = 2.109, 95%CI = 1.293-3.279), and PAR-1 expression (HR = 1.967, 95%CI = 1.256-2.881) as independent and significant prognostic factors for DFS. Our data suggest for the first time that MMP-1 and PAR-1 were both overexpressed in ESCC and are novel predictors of poor patient prognosis after curative resection. The MMP-1/PAR-1 signal transduction axis might be a new therapeutic target for future therapies tailored against ESCC.

Estudo comparativo do resfriamento de laranja val��ncia com ar for��ado e com ��gua

Este trabalho apresenta um estudo para comparar o resfriamento r��pido de laranja Val��ncia (Citrus sinensis O.), com ar for��ado e com ��gua gelada. O sistema de resfriamento r��pido com ar for��ado operou com um fluxo de ar de 1.933m��/h (3 l/s por kg de produto resfriado), a uma temperatura de 1��C e UR=88,4 �� 2,0%, com uma velocidade do ar em torno de 1m/s. Nos experimentos com ��gua gelada foi utilizado um sistema de imers��o, com uma capacidade de 0,23m�� de ��gua a uma temperatura de aproximadamente 1��C. Foi determinando o tempo meio e de sete oitavos do resfriamento, partindo das leituras de temperatura, perfazendo-se duas repeti����es em cada experimento. Os resultados mostraram que, o resfriamento do leito de frutas com ar for��ado n��o �� homog��neo, obtendo-se um tempo de sete oitavos do resfriamento que variaram de 107min a 170min, dependendo da posi����o do fruto no interior da embalagem. J�� no sistema com ��gua gelada, o resfriamento acontece uniformemente em todo em todo o leito de frutos, sendo o tempo m��dio de resfriamento de 57min.

Processamento do queijo coalho regional empregando leite pasteurizado e cultura l��tica end��gena

O objetivo deste trabalho foi estabelecer uma proposta para o processamento do queijo Coalho regional seguindo-se os procedimentos adequados para a obten����o de um produto final de qualidade. Empregou-se leite de vaca padronizado e pasteurizado e culturas l��ticas end��genas. Foram isoladas, identificadas e caracterizadas culturas l��ticas end��genas de leite de vaca cru e de queijos Coalho artesanais. Algumas culturas foram avaliadas para a fabrica����o do queijo Coalho, seguindo-se o fluxograma de fabrica����o estabelecido neste estudo. O produto final foi submetido a an��lises f��sico-qu��micas, teste de aceita����o e teste de fritura. Os resultados obtidos mostraram que �� vi��vel a padroniza����o do produto tradicional, proporcionando redu����o de custos, qualidade microbiol��gica e a manuten����o das caracter��sticas sensoriais do queijo Coalho regional, com o uso de culturas l��ticas nacionais.

Brazilian, Chinese, and Indian exports: is the regional market really a source of learning?

In some Latin American countries the exporting activity starts at a regional level, with producers only later venturing into more competitive markets. The implicit risk is that a country might never progress from the regional stage to a more global market. This article compares the experiences of Brazil, China and India. It is shown that Brazil relied on the regional market far more intensely than these Asian countries. There were clear gains accruing to China and India for having exploited more sophisticated markets from the very beginning of their export drive.