Agregação familiar e resultados maternos e perinatais da pré-eclâmpsia severa em população do Rio Grande do Norte

To determine whether there is familiar aggregation of severe preeclampsia in a Brazilian population from Rio Grande do Norte and to characterize the maternal and perinatal outcomes in the studied population. Methods: A case control study was performed with 412 participants who were admitted at Maternidade Escola Januário Cicco (MEJC) for medical care. Of these, 264 subjects presented normal blood pressure and 148 were cases. Cases were composed of eclampsia (n=47), HELLP Syndrome (n=85) and Eclampsia associated with HELLP syndrome (n=16). The diagnosis of these illness were based on the citeria developed by National High Blood Pressure Education Program Working (2000). An interview was performed with each subject and questions related to personal and familiar history of hypertension, preeclampsia, HELLP syndrome and eclampsia. Statistical analysis was performed and comparison of median and mean between cases and controls were performed, with the level of significance of 5%. The Odds-Ratio was determined to estimate the risk of preeclampsia within the families. Results: There were no difference in the demographic data between cases and controls. Previous history of chronic hypertension and preeclampsia was more frequent in the case group. Headaches were more frequent in eclampsia and epigastric pain in the HELLP syndrome cases. Bleeding and oliguria were more frequently found in the eclampsia associated with HELLP syndrome cases. Acute Renal insufficiency was a common complication in the case group, but these cases did not evolve to chronic renal insufficiency. The maternal mortality was 0.4% and the perinatal mortality was high, 223 per 1,000 live births. The 111 risk of a woman to develop preeclampsia whose mother has hypertension or had preeclampsia was respectively 2.5 and 3.5. This risk was increased 5 times, when a sibling has hypertension and 6 times when both sibling and mother had previous history of preeclampsia. Conclusions: This study confirms that there is familiar aggregation of preeclampsia in this Brazilian population. The potential for cardiovascular complications due to development of chronic hypertension indicates the need of closely follow up of women who develop preeclampsia

Fatores de risco individuais e familiares no desenvolvimento da pré-eclâmpia

Preeclampsia is a spectral disease, with different clinical forms which can evolve with severe multisystemic complications. This present study aimed to determine the risk factors associated with preeclampsia (PE); to validate the existence of aggregation of hypertensive disease in families of women with preeclampsia and verify the existence of association between polymorphisms in the VEGF gene and level of VEGF and its soluble receptor (sFlt1). A case-control study was performed (n = 851). Genotyping of VEGF was performed and serum levels of VEGF and sFlt1 were measured by ELISA. It was observed that 38% of mothers (173, 455) of a case of preeclampsia and 30.8% (78 of 361) of controls had history of hypertension (p <0.0001). Similarly, when examining the history of maternal preeclampsia, we observed that 14.6% (48 of 328) of mothers of women with preeclampsia and 9.6% (12 of 294) of mothers of controls had a history of preeclampsia (p = 0.0001). As for maternal history of preeclampsia, we found that 5.1% (15 of 295) of cases and 3.6% (7 of 314) of controls had a history of preeclampsia (p = 0.0568). Sisters of women with preeclampsia also had a history of hypertensive disease in 9% (41 of 455) versus 6.6% (13 of 361), p = 0.002. Similarly when examining the history of preeclampsia in sisters, it was observed that 22.7% (57 of 251) of a sister of case versus 11.4% (26 of 228) of controls had a history of preeclampsia (P = 0.0011). We observed a decrease in free VEGF in the serum of patients (P <0.05) and increased soluble VEGF receptor. There was no association between polymorphisms in the VEGF gene and preeclampsia. The data obtained in this work validate that hypertensive disease in mothers and sisters with preeclampsia are risk factors for preeclampsia. The risk of illness in the family is higher according to disease severity. High incidence of preeclampsia can be assumed by the high incidence of this disease among the controls. Significant differences between the frequency of preeclampsia in mothers of cases and controls indicate familial factors. Work is being conducted with the to eventually perform genome wide association studies to identify susceptibility loci

Risco de doença cardiovascular em mulheres com história de distúrbio hipertensivo da gravidez

OBJECTIVE: Preeclampsia is a disease that can lead to a high maternal and infant morbidity. Worldwide, the incidence of this disease is highly variable and there is no data on this disorder in the Brazilian population. This study aimed at determining incidence and risk factors in the hypertensive disorders during pregnancy in a neighborhood of Natal, in addition to observing the evolution of these disorders one year and five years after delivery. METHODS: Prospective cohort study to assess the outcome of pregnancies of 242 women who became pregnant between 2004-2007 in the neighborhood of Bom Pastor in the city of Natal, state of RN, Brazil. Five years after delivery, there was an active search of thirty-nine (39) women who became pregnant and had a hypertensive disorder during pregnancy and/or pré-eclâmpsia, out of the total of 242 participants in the initial study. We administered a structured questionnaire to obtain basic information about the current clinical situation of patients and occurrences of subsequent pregnancy and presence of hypertensive disorders during pregnancy. We also searched for information on the use of hypotensive drugs and contraceptives. The following characteristics were checked and recorded: a) current weight, b) blood pressure c) body mass index - BMI, and we collected biological samples (blood and urine) for measurement of biochemical parameters and evaluation of microalbuminúria. Finally, we monitored the ambulatory blood pressure (ABP), which uses the method of automatic measurement of heart rate, systolic and diastolic blood pressure and an average of the two for the period of 24 hours. RESULTS: Out of 218 women who completed the study, the incidence of hypertensive disorders was of 16.9% (37 out of 218), while the incidence of preeclampsia was 13.8% (30 of 218). Women with preeclampsia had a BMI (body mass index) averaged of 25.3 (± 4.8) while this ratio in normotensive women was of 23.5 (± 3.7), p = 0.02. The risk of preeclampsia rises with age (OR 1084 p = 0.0034) and with a family history of hypertension (OR 2.6 p = 0.01). The follow-up one year after delivery revealed that 50% of women with hypertensive disorders in pregnancy remained hypertensive. High BMI was also observed after 5 years of delivery. CONCLUSIONS: an elevated BMI, age above 35 years and excessive weight gain during pregnancy were associated with hypertension in the long term in patients with prior preeclampsia. History of preeclampsia increases the risk of chronic hypertension

Educação tecnológica e pré-sal: necessidades e urgências

The purpose of this dissertation is whether the demand for manpower trained in technical school for the sector of Oil and Gas (O&G) is in balance with the offer of that training in the Brazilian education system. The methodology used to obtain such information was based on School Census 2000 and 2008 where data were worked out in order to clarify the numbers of enrollments in secondary technical level demanded by the sector of O&G. The demand for manpower with that qualification as a data source was the 2010-2014 Business Plan Program for Mobilization of the National Oil and Natural Gas (PROMINP). This Program identified the future demand for manpower for the Sector of the O&G until 2014 where the occupational categories are mapped prerequisite training and experience. In order to better understand the object of this study was dome a review of the literature with regard to technical education in Brazil but also the importance of the education to economic growth and the peculiarities of the oil economy in different countries possessors of those mines, or that is, developed and underdeveloped countries. Analysis showed that enrollment in technical education in Brazil had a significant increase between the dates 2000 and 2008. It also don´t bring balance with the characteristic of the dynamics of the productive sectors of the economy mainly due to heating of the economy before the global growth especially in the Construction Industry as well as in the Oil and Natural Gas Engineering and a Naval account of the discovery of oil in the Pre-Salt. Another important aspect is that one of the major problems of qualification of manpower in Brazil is due to a bad quality of the student´s school and high school which makes difficult a good performance in office work and also this ability to learn new functions. The rapprochement between the supply of the education system and the demand for manpower with training mid-level technical support for the sector O&G showed that most technical courses demanded or had no enrollment in 2008, had few enrollment in 15 states with demand expect to occur and those enrollment were unevenly distributed among states. The analysis therefore signalize the needed of a public policy that enables the adequacy of the education system (Secondary Technical Education) to Sector of O&G in terms of enrollment and its distribution between the oil producing states and in relation to technical expertise offered

Educação tecnológica e pré-sal: necessidades e urgências

O objetivo desta dissertação de mestrado é verificar se a demanda de mão-de-obra com formação no ensino médio técnico para o setor de Petróleo e Gás (P&G) está em consonância com a oferta daquela formação no sistema educacional brasileiro. A metodologia aplicada para obter tal informação foi baseada no Censo Escolar 2000 e 2008, em que os dados foram trabalhados de maneira a explicitar o número de matrículas nos cursos de nível médio técnico, demandados pelo setor de P&G. A demanda de mão-de-obra com aquela qualificação teve como fonte de dados o Plano de Negócios 2010-2014 do Programa de Mobilização da Indústria Nacional de Petróleo e Gás Natural (PROMINP). Este Programa identificou a demanda futura de mão-de-obra para o setor de P&G até 2014, onde as categorias ocupacionais mapeadas possuem pré-requisitos de formação e experiência. Com o intuito de entender melhor o objeto deste estudo foi feita uma revisão de literatura no que diz respeito ao ensino técnico no Brasil, como também a importância da educação para o crescimento econômico e as peculiaridades da economia do petróleo nos diferentes países possuidores daquelas jazidas, ou seja, países subdesenvolvidos e desenvolvidos. As análises demonstraram que as matrículas no ensino técnico no Brasil apresentaram um significativo aumento entre as datas de 2000 a 2008. Traz também como característica a desarmonia com a dinâmica dos setores produtivos da economia, devido principalmente ao aquecimento da economia antes da crise mundial de 2008, e a retomada recente do crescimento notadamente no Setor de Construção Civil, bem como no setor de Petróleo e Gás Natural e Engenharia Naval por conta da descoberta de petróleo na camada Pré-sal. Outro aspecto relevante é que um dos grandes problemas da qualificação de mão-de-obra no Brasil se deve a má qualidade do ensino fundamental e médio, que dificulta para o futuro profissional um bom desempenho nas suas funções laborais e na capacidade de aprender novas funções. A aproximação entre a oferta no sistema educacional e a demanda de mão-de-obra com a formação de nível médio técnico para o setor de P&G, demonstraram que a maioria dos cursos técnicos demandados não apresentava matrículas em 2008, ou possuíam poucas matrículas nos 15 estados com demanda prevista, e aquelas matrículas estavam mal distribuídas entre os estados. A análise aponta para a necessidade de uma política pública que possibilite a adequação do sistema educacional (Ensino Médio Técnico) ao setor de P&G, tanto no que se refere ao número de matrículas e a sua distribuição entre os estados produtores de petróleo quanto no que se refere à especialidade técnica oferecida

História das mulheres idosas do Grupo Aurora da Vida Campina Grande-PB (1940-1950)

La recherche intitulée l Histoire des femmes agées du group Aurore de La Vie: Campina Grande-PB (1940-1950) a surgit comme consequence de mon observation sur les interêts de femmes en retrouner à l école aprés qu elles étaient arrivées aux soixante ans, um moment de la vie que malgré son importance est encore considerée par trop de gens comme des moments d être seul jusqu à la fin de la vie. Alors, nous avons formulé la question la plus importante de ce travail: Quel est l histoire de l éducation des femmes agées du group Aurore de La Vie, dans le période de son education d enfant? Un group de 25 femmes qui ont étudié le projet Digna, on a fait une seletion de treize agées, entre 65 et 80 ans, qui s appellent: Perpétua, Florinda, Benta, Ambrósia, Celestine, Cordélia, Circe, Filomena, Desdêmona, Dorotéia, Ofelia, Martítius e Nausica. Beaucoup d intelectuels nous ont aidé avec la base theórico-methodologique et nous ont presenté l histoire des excludées comment une histoire en construction. Parmis ces intelectuelles on rencontre Chartier, Halbwachs, Elias, Perrot, Bosi, Bezerra, Morais et Machado. Pendant notre recherche nous avons employés des narrations, des entrevues, des questions ouvertes ou les femmes puissent parler sur l histoire de leur vie. Nous avons regardé aussi le fiche des agées, le arquive de La Secretarie Municipale de Assistence Social (SEMAS) du Hôtel de Ville de Campina Grande-PB. Nous avons aussi étudié sur la legislation relié à la tematique de la Constituition Brésilienne dans l estatute et dans la Politique Nacional de l age. Notre étude nous a donné des analises sur les themas: pauvresse, travail, sourvenirs, jeux e aussi punitions scolaires. Nous sommes arrivés à la conclusion qu à l époque de son enfance, l éducation formale était déjá determinée pour le mariage, la pró-création la famille. Enfim toujours dédans de la maison excludées du reste du monde. Nous avons compris que pesquiser cet object d étude est un contribut avec l histoire des excludées en cassant le silence des femmes lesqueles on été ignorées par presque toute la prodution historiographique

Tuberculose ativa em pacientes cirúrgicos com baciloscopia negativa no pré-operatório

OBJETIVO: Verificar a proporção de pacientes com baciloscopia negativa no pré-operatório e que apresentaram TB ativa na peça cirúrgica. MÉTODOS: Estudo retrospectivo de pacientes com diagnóstico histopatológico de TB ativa ou sequelar e operados entre os anos de 2003 e 2006 em um hospital universitário. Foram pesquisados antecedentes e aspectos clínicos relativos à doença, pesquisa de bacilos álcool-ácido resistentes (BAAR), tipo de cirurgia realizada e exame histopatológico da peça cirúrgica. RESULTADOS: Foram incluídos 43 pacientes, com média de idade de 44 ± 19 anos, sendo 27 do sexo masculino. Apresentavam história prévia de TB com tratamento adequado 28 pacientes, e 15 não referiam antecedentes para TB. O principal motivo da procura pelo serviço foi infecção de repetição, seguida por achados em exames de imagem. Dos 43 pacientes, foi pesquisado BAAR no pré-operatório em 35: 32 apresentaram resultados negativos e 3, resultados positivos. Dos 35 pacientes pesquisados, 26 apresentavam diagnóstico histopatológico de TB ativa e 9 de TB sequelar na peça cirúrgica; os outros 8 também foram diagnosticados com TB sequelar. A proporção de TB ativa em doentes com baciloscopia negativa foi de 72% (23/32), e o de baciloscopia negativa em TB ativa foi de 88% (23/26), sendo a pesquisa de BAAR positiva somente em 11,5% (3/26). CONCLUSÕES: A baciloscopia direta tem rendimento muito baixo, e muitos pacientes mesmo já tratados podem permanecer com TB em atividade com baciloscopia negativa. A TB ativa pode ser confundida com infecções secundárias ou com câncer.

Avaliação da intensidade de dor e da funcionalidade no pós-operatório recente de cirurgia cardíaca

OBJETIVO: Avaliar a intensidade de dor e o nível de funcionalidade em pacientes submetidos à cirurgia cardíaca nos períodos pré-operatório, 7º pós-operatório e alta hospitalar, relacionando-os entre si. Relacionar funcionalidade com: sexo, faixa etária, primeira cirurgia cardíaca ou reoperação, uso de circulação extracorpórea (CEC), tipo de cirurgia e acompanhamento fisioterapêutico. MÉTODO: Foram estudados 41 pacientes que realizaram cirurgia cardíaca eletiva por toracotomia médio-esternal (TME) no HC da Faculdade de Medicina de Botucatu/UNESP. A intensidade de dor foi avaliada pela escala de VAS e a funcionalidade, pela escala MIF (medida de independência funcional) no domínio físico. RESULTADOS: A intensidade de dor mais elevada foi no 7º pós-operatório comparado com os momentos pré-operatório e alta. No pré-operatório, não houve índice de dor; na alta, a intensidade mediana foi 3 (dor moderada). Os níveis mais elevados de perda funcional ocorreram no 7º pós-operatório, quando comparados com os escores totais do pré-operatório e da alta. Verificou-se correlação significativa entre dor e funcionalidade, demonstrando que o decréscimo do nível de dor entre o 7º pós-operatório e a alta contribuiu para a elevação dos níveis funcionais. CONCLUSÃO: As avaliações realizadas no pré-operatório proporcionaram resultados preditivos a serem alcançados. As avaliações realizadas no 7º pós-operatório e na alta possibilitaram a classificação dos pacientes de acordo com perdas e ganhos, indicando aqueles que necessitavam de maior cuidado e treinamento em suas capacidades.

Arquitetura deposicional e evolução tectono-estratigráfica das sequências pré-rifte e rifte, na porção central do Vale do Cariri, Bacia do Araripe, NE do Brasil

A complex depositional history, related to Atlantic rifting, demonstrates the geological evolution during the late Jurassic and early Neocomian periods in the Araripe Basin NE Brazil. Based on outcrop, seismic and remote sensing data, a new model of the tectono-stratigraphic evolution of the section that covers the stages Dom João, Rio da Serra and Aratu (Brejo Santo, Missão Velha and Abaiara formations) is presented in this paper. In the stratigraphic section studied, ten sedimentary facies genetically linked to nine architectural elements were described, representing depositional systems associated with fluvial, aeolian and deltaic environments. Based on the relationship between the rates of creation of accommodation space and sediment influx (A / S) it was possible to associate these depositional systems with High and Low accommodation system tracks. These system tracks represent two tectono-sequences, separated by regional unconformities. The Tectono-sequence I, which includes lithotypes from the Brejo Santo Formation and is related to the pre-rift stage, is bounded at the base by the Paleozoic unconformity. This unit represents only a High Accommodation System Track, composed by a succession of pelitic levels interbedded with sandstones and limestones, from a large fluvial floodplain origin, developed under arid climatic conditions. The Tectono-sequence II, separated from the underlying unit by an erosional unconformity, is related to the rift stage, and is composed by the Missão Velha and Abaiara Formation lithotypes. Changes in depositional style that reflect variations in the A / S ratio, and the presence of hydroplastic deformation bands, make it possible to divide this tectonosequence into two internal sequences. Sequence IIA, which includes the lower portion of the Missão Velha Formation and sequence IIB, is composed by the upper section of the Missão Velha and Abaiara Formations The Sequence IIA below, composed only by the Low Accommodation System Track, includes crossbedding sandstones interbedded with massive mudstones, which are interpreted as deposits of sandy gravel beds wandering rivers. Sequence IIB, above, is more complex, showing a basal Low Accommodation System Track and a High Accommodation System Track at the top, separated by an expansion surface. The lower System Track, related to the upper portion of the Missão Velha Formation, is composed by a series of amalgamated channels, separated by erosion surfaces, interpreted as deposits of a belt of braided channels. The High Accommodation System Track, correlated with the Abaiara Unit, is marked by a significant increase in the A / S, resulting in the progradation of a system of braided river deltas with aeolic influence. Regarding tectonic evolution, the stratigraphic study indicates that the Tectonosequence Rift in the Araripe basin was developed in two phases: first characterized by a beginning of rifting, related to Sequence IIA, followed by a phase of syndepositional deformation, represented by sequence IIB. The first phase was not influenced by the development of large faults, but was influenced by a sharp and continuous decrease of accommodation space that permitted a change in depositional patterns, establishing a new depositional architecture. In turn, the stage of syndepositional deformation allowed for the generation of enough accommodation space for the preservation of fluvial-lacustrine deposits and conditioned the progradation of a braided river-dominated delta system.

Concepção de roubo em pré-escolares

Partindo do trabalho pioneiro de J. Piaget, O julgamento moral da criança, revisamos as contribuições para este estudo sobre a concepção de roubo em crianças. Usando uma história que envolve um pequeno roubo examinamos como pré-escolares respondem a questões sobre o roubo ser certo ou errado, o porquê dessa resposta, assim como avaliamos a percepção da criança à presença, à contingência e à relatividade de regras. Tendo como sujeitos 80 crianças de duas pré-escolas, uma pública e outra particular, cada escola dividida em duas turmas, encontramos que todas as crianças têm noção da regra de o roubo ser errado e ao justificarem essa resposta apresentam cinco tipos de argumentos, assim como já apresentam julgamentos em função da intenção. Resultados são discutidos em termos da teoria de desenvolvimento moral de Piaget.

Avaliação das atividades antioxidante, anti e pró-hemolítica do extrato etanólico das folhas de Pterogyne nitens Tul. (Fabaceae-Caesalpinioideae)

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

Uma brasileira: a outra história de Julia Mann

O texto parte da recente valorização da origem brasileira de Julia Mann, a matriarca da célebre família de escritores alemães, para discutir o tema da nacionalidade associado às categorias de gênero e raça. Discutimos a historicidade de categorias sociais e como estas determinam a auto-compreensão dos indivíduos. A sociedade alemã do século XIX caracterizou Julia como brasileira e, apesar do estigma que isto representava, ela utilizou-se desta origem exótica como forma de autocompreensão e resistência.

Espaços ibero-americanos: a uma nova arquitetura do Estado para o desenvolvimento

Incluye Bibliografía

História natural das serpentes dos gêneros Echinanthera e Taeniophallus (Echinantherini)

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)