Uso da monitorização hemodinâmica contínua não invasiva na insuficiência cardíaca descompensada

FUNDAMENTO: A avaliação clínico-hemodinâmica à beira do leito e o uso do cateter de artéria pulmonar para a estimativa de dados hemodinâmicos têm sido utilizados na insuficiência cardíaca descompensada. Entretanto, não existem dados com o uso da monitorização hemodinâmica contínua não invasiva. OBJETIVO: Comparar as medidas obtidas com a monitorização hemodinâmica não invasiva com as invasivas em pacientes com insuficiência cardíaca descompensada e refratária ao tratamento. MÉTODOS: As medidas hemodinâmicas não invasivas foram obtidas através da monitorização contínua da pressão arterial sistêmica pelo modelo de ondas de pulso (modelflow) e foram comparadas com as medidas obtidas pela passagem do cateter de artéria pulmonar, simultaneamente. RESULTADOS: Foram realizadas 56 medidas em 14 pacientes estudados em dias e horários diferentes. O índice de correlação entre as medidas da pressão arterial sistólica foi de r = 0,26 (IC 95% = 0,00 a 0,49, p = 0,0492) e da diastólica de r = 0,50 (IC 95% = 0,27 a 0,67, p < 0,0001). A correlação foi de r = 0,55 (IC 95% = 0,34 a 0,71, p 0,0001) para o índice cardíaco e de r = 0,32 (IC 95% = 0,06 a 0,53, p = 0,0178) para a resistência vascular sistêmica. CONCLUSÃO: Houve correlação entre as medidas hemodinâmicas não invasivas quando comparadas às medidas do cateter de artéria pulmonar. A monitorização hemodinâmica contínua não invasiva pode ser útil para pacientes internados com insuficiência cardíaca descompensada.

Fatores de risco para trauma vascular durante a quimioterapia antineoplásica: contribuições do emprego do risco relativo

OBJETIVO: identificar a relação entre os fatores de risco para trauma vascular e o surgimento de eventos adversos de infiltração ou flebite por quimioterapia antineoplásica. MÉTODOS: Estudo de abordagem quantitativa observacional com 30 mulheres com câncer de mama. RESULTADOS: O tipo de material do cateter apresentou associação que sugere risco (RR=2,76; IC=1,199; 6,369); o fator velocidade de infusão apresentou RR=2,22; entretanto, IC= 0,7672; 6,436; os fatores trajetória, número de punção e mobilidade da veia apresentaram RR<1 mas não podem ser considerados como fatores de proteção. Local de inserção e a visibilidade da veia apresentaram risco próximo a 1. CONCLUSÃO: O uso de cateter com metal para punção venosa foi considerado neste estudo como fator para Risco de Trauma Vascular. A análise da associação pelo RR mostrou-se concordante com os dados da literatura pesquisada.

Thrombotic obstruction of the central venous catheter in patients undergoing hematopoietic stem cell transplantation

This is an integrative literature review with the aim of summarizing the prevention measures and treatment of thrombotic obstruction of long-term semi-implanted central venous catheters, in patients undergoing hematopoietic stem cell transplantation. The sample consisted of seven studies, being two randomized controlled clinical trials, three cohort studies and two case series. Regarding the prevention measures, one single study demonstrated effectiveness, which was a cohort study on the oral use of warfarin. In relation to the treatment measures, three studies evidenced effectiveness, one highlighted the efficacy of streptokinase or urokinase, one demonstrated the benefit of using low-molecular-weight heparin and the other treated the obstruction with heparin or urokinase. Catheter patency research shows a restricted evolution that does not follow the evolution of transplantations, mainly regarding nursing care.

Tomografia de coerência óptica broncoscópica

OBJETIVO: Avaliar a viabilidade e o potencial do uso da tomografia de coerência óptica em conjunto com um broncoscópio convencional na avaliação das vias aéreas. MÉTODOS: Estudo piloto baseado em um modelo experimental ex vivo com três animais: um coelho adulto da raça Nova Zelândia e dois suínos da raça Landrace. Um cateter de imagem de tomografia de coerência óptica foi inserido no canal de trabalho de um broncoscópio flexível para alcançarmos a traqueia distal dos animais. As imagens foram obtidas sistematicamente em toda a traqueia ao longo das paredes, partindo da porção distal para a proximal. RESULTADOS: O cateter de imagem se adaptou com facilidade ao canal de trabalho do broncoscópio. Imagens em alta resolução de cortes transversais da traqueia foram obtidas em tempo real, sendo delineadas microestruturas, tais como epitélio, submucosa, cartilagem e camada adventícia nas paredes anteriores e laterais da traqueia. As camadas correspondentes do epitélio, mucosa e cartilagens foram claramente diferenciadas. Na parede posterior, foi possível identificar mucosa, submucosa e musculatura traqueal. CONCLUSÕES: O uso de tomógrafo de coerência óptica em conjunto com um broncoscópio flexível é viável. A tomografia de coerência óptica produz imagens de alta resolução que permitem visualizar a microanatomia da traqueia, inclusive estruturas que normalmente são visualizadas somente na histologia convencional.

Job Burnout in Public Accounting: Understanding Gender Differences

Job burnout is linked to job outcomes in public accounting professionals (Fogarty et al., 2000; Jones et al., 2010; Jones et al., 2012). Although women and men have entered the profession in relatively equal numbers, there is a significantly lower percentage of women partners (AICPA, 2011). Extant research has not sufficiently explored how burnout may affect the genders distinctly and whether these differences may lend insight as to women’s choices to exit. A large participant group with a similar proportion of women (n=836) and men (n=845) allowed examination of the burnout construct on a more profound level than extant studies. The three dimensions of job burnout in women and men public accountants were analyzed, not only in total, but also by functional area and position level. Overall findings are that women report higher levels of reduced personal accomplishment and men report higher levels of depersonalization. In light of these findings, suggestions are made for firm and individual actions that may mitigate the intensity of burnout experienced by both women and men public accountants.

A genome-wide association study of resistance to HIV infection in highly exposed uninfected individuals with hemophilia A.

Human genetic variation contributes to differences in susceptibility to HIV-1 infection. To search for novel host resistance factors, we performed a genome-wide association study (GWAS) in hemophilia patients highly exposed to potentially contaminated factor VIII infusions. Individuals with hemophilia A and a documented history of factor VIII infusions before the introduction of viral inactivation procedures (1979-1984) were recruited from 36 hemophilia treatment centers (HTCs), and their genome-wide genetic variants were compared with those from matched HIV-infected individuals. Homozygous carriers of known CCR5 resistance mutations were excluded. Single nucleotide polymorphisms (SNPs) and inferred copy number variants (CNVs) were tested using logistic regression. In addition, we performed a pathway enrichment analysis, a heritability analysis, and a search for epistatic interactions with CCR5 Δ32 heterozygosity. A total of 560 HIV-uninfected cases were recruited: 36 (6.4%) were homozygous for CCR5 Δ32 or m303. After quality control and SNP imputation, we tested 1 081 435 SNPs and 3686 CNVs for association with HIV-1 serostatus in 431 cases and 765 HIV-infected controls. No SNP or CNV reached genome-wide significance. The additional analyses did not reveal any strong genetic effect. Highly exposed, yet uninfected hemophiliacs form an ideal study group to investigate host resistance factors. Using a genome-wide approach, we did not detect any significant associations between SNPs and HIV-1 susceptibility, indicating that common genetic variants of major effect are unlikely to explain the observed resistance phenotype in this population.

Insulin Action on GLUT4 Traffic Visualized in Single 3T3-L1 Adipocytes by Using Ultra-fast MicroscopyV⃞

A novel imaging technology, high-speed microscopy, has been used to visualize the process of GLUT4 translocation in response to insulin in single 3T3-L1 adipocytes. A key advantage of this technology is that it requires extremely low light exposure times, allowing the quasi-continuous capture of information over 20–30 min without photobleaching or photodamage. The half-time for the accumulation of GLUT4-eGFP (enhanced green fluorescent protein) at the plasma membrane in a single cell was found to be of 5–7 min at 37°C. This half-time is substantially longer than that of exocytic vesicle fusion in neuroendocrine cells, suggesting that additional regulatory mechanisms are involved in the stimulation of GLUT4 translocation by insulin. Analysis of four-dimensional images (3-D over time) revealed that, in response to insulin, GLUT4-eGFP-enriched vesicles rapidly travel from the juxtanuclear region to the plasma membrane. In nontransfected adipocytes, impairment of microtubule and actin filament function inhibited insulin-stimulated glucose transport by 70 and 50%, respectively. When both filament systems were impaired insulin-stimulated glucose transport was completely inhibited. Taken together, the data suggest that the regulation of long-range motility of GLUT4-containing vesicles through the interaction with microtubule- and actin-based cytoskeletal networks plays an important role in the overall effect of insulin on GLUT4 translocation.

Longevity and the genetic determination of collagen glycoxidation kinetics in mammalian senescence.

A fundamental question in the basic biology of aging is whether there is a universal aging process. If indeed such a process exists, one would expect that it develops at a higher rate in short- versus long-lived species. We have quantitated pentosidine, a marker of glycoxidative stress in skin collagen from eight mammalian species as a function of age. A curvilinear increase was modeled for all species, and the rate of increase correlated inversely with maximum life-span. Dietary restriction, a potent intervention associated with increased life-span, markedly inhibited glycoxidation rate in the rodent. On the assumption that collagen turnover rate is primarily influenced by the crosslinking due to glycoxidation, these results suggest that there is a progressive age-related deterioration of the process that controls the collagen glycoxidation rate. Thus, the ability to withstand damage due to glycoxidation and the Maillard reaction may be under genetic control.

Analgesia epidural no tratamento da dor oncológica : caso clínico

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Taquicardia ventricular idiopática : estudo de correlação do ECG com o local de origem

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Single vehicle accident study. Volume II: technical report. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Academic missions of family medicine /

Includes bibliographies and index.

Single vehicle accident study. Volume I: executive summary. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Single vehicle accident study. Volume III: appendices. Final report.

National Highway Traffic Safety Administration, Washington, D.C.