Aplicação da metodologia ROC na avaliação de desempenho de índices de gravidade clínica em unidades de neonatologia de Portugal

Tese de Doutoramento em Engenharia Industrial e de Sistemas

Nickel(II) complexes of bidentate N-N′ ligands containing mixed pyrazole, pyrimidine and pyridine aromatic rings as catalysts for ethylene polymerisation

This work describes the synthesis and characterisation of Ni(II) complexes of the following neutral bidentate nitrogen ligands containing pyrazole (pz), pyrimidine (pm) and pyridine (py) aromatic rings: 2-pyrazol-1-yl-pyrimidine (pzpm), 2-(4-methyl-pyrazol-1-yl)-pyrimidine (4-Mepzpm), 2-(4-bromo-pyrazol-1-yl)-pyrimidine (4-Brpzpm), 2-(3,5-dimethyl-pyrazol-1-yl)-pyrimidine (pz*pm), 2-pyrazol-1-yl-pyridine (pzpy) and bis(3,5-dimethylpyrazol-1-yl)phenylmethane (bpz*mph). The complexes [NiBr2(pzpm)] (1), [NiBr2(4-Mepzpm)] (2), [NiBr2(4-Brpzpm)] (3), [NiBr2(pz*pm)] (4), [NiBr2(pzpy)] (5) and [NiBr2(bpz*mph)] (6) were tested as catalysts for ethylene polymerisation, in the presence of the cocatalysts methylaluminoxane (MAO) or diethylaluminium chloride (AlEt2Cl), the catalyst systems 1-3/MAO showing moderate to high activities up to the temperature of 20 °C only in the presence of MAO, whereas 4-6/MAO revealed to be inactive. Other related Pd(II) complexes, already reported in previous works, such as [PdClMe(pzpm)], [PdClMe(pz*pm)], [PdClMe(pzpy)] and [PdClMe(bpz*mph)], also showed to be inactive in the polymerisation of ethylene, when activated by MAO or AlEt2Cl. Selected samples of polyethylene products were characterised by GPC/SEC, 1H and 13C NMR and DSC, showing to be low molecular weight polymers with Mn values ranging from ca. 550 to 1500 g mol−1 and unusually low dispersities of 1.2–1.7, with total branching degrees generally varying between 2 and 12%, melting temperatures from 40 to 120 °C and crystallinities from 40 to 70%.

Nasal trauma due to continuous positive airway pressure in neonates.

PATIENTS: All neonates admitted between January 2002 and December 2007 treated by nCPAP were eligible. METHODS: Patients' noses were monitored during nCPAP. Nasal trauma was reported into three stages: (I) persistent erythema; (II) superficial ulceration; and (III) necrosis. RESULTS: 989 neonates were enrolled. Mean gestational age was 34 weeks (SD 4), mean birth weight 2142 g (SD 840). Nasal trauma was reported in 420 (42.5%) patients and it was of stage I, II and III in 371 (88.3%), 46 (11%) and 3 (0.7%) patients, respectively. Incidence and severity of trauma were inversely correlated with gestational age and birth weight. The risk of nasal trauma was greater in neonates <32 weeks of gestational age (OR 2.48, 95% CI 1.59 to 3.86), weighing <1500 g at birth (OR 2.28, 95% CI 1.43 to 3.64), treated &gt;5 days by nCPAP (OR 5.36, 95% CI 3.82 to 7.52), or staying &gt;14 days in the NICU (OR 1.67, 95% CI 1.22 to 2.28). Most cases of nasal trauma (90%) appeared during the first 6 days of nCPAP. Persistent visible scars were present in two cases. CONCLUSIONS: Nasal trauma is a frequent complication of nCPAP, especially in preterm neonates, but long-term cosmetic sequelae are very rare. This study provides a description of nasal trauma and proposes a simple staging system. This could serve as a basis to develop strategies of prevention and treatment of this iatrogenic event.

Long-term outcome of preterm infants treated with nasal continuous positive airway pressure

RESUME La ventilation en pression positive continue (Continuous Positive Airway Pressure, CPAP), utilisée pour la première fois chez. les prématurés en 1971, est une technique actuellement très largement utilisée dans les unités néonatales. L'utilisation de la CPAP présente de nombreux avantages à court terme: diminution de la fraction maximale inspirée d'oxygène, de la durée de l'oxygénothérapie, du taux d'intubation et donc du recours à une ventilation mécanique, réduction de l'utilisation des amines, des curares et de la morphine, possible prévention de l'apparition d'une bronchodysplasie pulmonaire, et possibles réductions du nombre d'infections postnatales et des entérocolites nécrosantes. Mais peu d'études existent concernant les effets à long terme de la CPAP sur le neurodéveloppement et la croissance, qui constituent l'objectif de la présente étude. L'utilisation systématique de la CPAP comme alternative à la ventilation mécanique a été introduite à Lausanne en 1998. La population cible de cette étude est constituée des prématurés nés à moins de 32 semaines de gestation ou pesant moins de 1500 g à la naissance; ils ont été systématiquement suivis jusqu'en âge préscolaire dans le cadre de l'étude de cohorte «Unité de Développement, CHUV». L'originalité de ce travail réside dans le fait d'évaluer le neurodéveloppement et la croissance à long terme d'enfants prématurés traités préférentiellement avec la CPAP, en comparaison avec un groupe historique contrôle traité par d'autres modes ventilatoires, en tenant compte de nombreux autres paramètres néonataux. Du point de vue du neurodéveloppement, l'usage, de la CPAP montre une tendance à diminuer l'incidence d'hémorragie intraventriculaire et le risque d'avoir un mauvais neurodéveloppement à 6 mois. Ces résultats positifs sur le neurodéveloppement s'estompent à l'âge de 18 mois, où persiste néanmoins une valeur plus élevée du quotient de développement, et disparaissent complètement en âge préscolaire. Du point de vue de la croissance, l'utilisation de la CPAP ne montre aucun effet sur le poids, mais par contre un effet positif sur la taille à 6 et 18 mois et sur le périmètre crânien à 6 mois, 18 mois et en âge préscolaire. Malgré le caractère non randomisé de cette étude, les résultats positifs obtenus ici permettent sans conteste de s'assurer d'une utilisation de la CPAP sans effet négatif sur le neurodéveloppement et la croissance, et fournissent donc un argument supplémentaire pour l'utilisation systématique de la CPAP chez les prématurés.

Whole body protein synthesis and energy expenditure in very low birth weight infants.

The aim of the present work was to study whole body protein synthesis and breakdown, as well as energy metabolism, in very low birth weight premature infants (less than 1500 g) during their rapid growth phase. Ten very low birth weight infants were studied during their first and second months of life. They received a mean energy intake of 114 kcal/kg X day and 3 g protein/kg X day as breast milk or milk formula. The average weight gain was 15 g/kg X day. The apparent energy digestibility was 88%, i.e. 99 kcal/kg X day. Their resting postprandial energy expenditure was 58 kcal/kg X day, indicating that 41 kcal/kg X day was retained. The apparent protein digestibility was 89%, i.e. 2.65 g/kg X day. Their rate of protein oxidation was 0.88 g/kg X day so that protein retention was 1.76 g/kg X day. There was a linear relationship between N retention and N intake (r = 0.78, p less than 0.001). The slope of the regression line indicates a net efficiency of N utilization of 67%. Estimates of body composition from the energy balance, coupled with N balance method, showed that 25% of the gain was fat and 75% was lean tissue. Whole body protein synthesis and breakdown were determined using repeated oral administration of 15N glycine for 60-72 h, and 15N enrichment in urinary urea was measured. Protein synthesis averaged 11.2 g/kg X day and protein breakdown 9.4 g/kg X day. Muscular protein breakdown, as estimated by 3-methylhistidine excretion, contributed to 12% of the total protein breakdown.(ABSTRACT TRUNCATED AT 250 WORDS)

Desenvolvimento e validação de metodologia analítica por CLAE-IR para determinação de artemisinina em Artemisia annua L

The aim of this work was to develop and validate an analytical methodology for determination of artemisinin used as antimalaric. The method was based on high performace liquid chromatography, using a CN column with mobile phase composed of methanol : H2O 50:50 (V/V). The results showed that the method presented linearity from 50 to 1500 µg/mL. It was considered selective, accurate, precise according to the specific resolution from ANVISA, the Brazilian regulatory agency.

Impacto do volume de gordura aspirado na resistência insulínica após lipoaspiração

OBJETIVO: investigar a resistência insulínica imposta pela lipoaspiração, correlacionando sua intensidade com a extensão da operação. MÉTODOS: A amostra foi formada de 20 pacientes do sexo feminino sem comorbidades, com idade entre 21 e 43 anos, índice de massa corporal entre 19 e 27 Kg/m², submetidas à lipoaspiração isolada ou associada à prótese de mamas. Foram coletados os indicadores de resistência insulínica no início e término da cirurgia para o cálculo do Homeostasis Model Assessment (HOMA-IR). As variáveis operatórias foram tempo de lipoaspiração, tempo de prótese de mamas, áreas corporais lipoaspiradas e gordura total aspirada. RESULTADOS: O tempo de lipoaspiração foi 94 a 278 min (média=174 min), tempo de prótese de mamas de 20 a 140 min (média=65 min), gordura total aspirada de 680 a 4280 g (média=1778 g). A análise estatística foi realizada por uma linha de corte de 1500 g de gordura aspirada e revelou uma resistência insulínica pelo índice de HOMA significativamente mais intensa no grupo >1500 g (aumento de 123%) em relação ao grupo d"1500 g (aumento de 53%,) a partir dos dados basais (p=0,02). As demais variáveis operatórias não apresentaram correlação significativa. CONCLUSÃO: A resistência insulínica apresenta aumento significativo na lipoaspiração, correlacionada ao volume de gordura aspirado.

Vaasan saariston suurikasvuinen siika 2011-2012

Suurikokoisen, meressä kutevan siian esiintymistä Vaasan saaristoalueella tutkittiin koekalastamalla verkoilla kutuvalmiita ja kutevia kaloja syksyllä sekä kartoittamalla siianpoikasten esiintymisalueita. Vastakuoriutuneiden poikasten esiintyminen osoittaa, että syksyisen kudun tuottama mäti selviää talven yli tietyillä alueilla. Kutuvalmiita siikoja jäi saaliiksi ainoastaan kivi- ja sorapohjaisilta paikoilta, jotka olivat virtaisilla alueilla. Tällaiset paikat eivät ole alttiita hienojakoisen aineksen sedimentaatiolle, joka tukahduttaisi kehittyvät mätimunat. Koekalastusten perusteella kutuvalmiiden siikojen kasvunopeus on ollut suuri verrattuna muihin Pohjanlahden merikutuisten siikojen kantoihin. Suurimmat saaliiksi jääneet yksilöt painoivat yli 1500 g. Selvityksessä esitetään useita ehdotuksia Vaasan saaristoalueen suurikokoisen merikutuisen siian kantojen vaalimiseksi, mutta päätösten taustalle tarvittaisiin lisää tietoa siikamuodon perusbiologiasta, kuten vaelluskäyttäytymisestä ja levinneisyysalueesta.

Curva de dissipação de imazapyr em água de drenos de irrigação, após aplicação para controle da taboa

O herbicida sistêmico imazapyr foi usado no controle da taboa (Typha subulata Crespo & Peres-Moreau f.) em drenos de irrigação, como alternativa ao controle mecânico. O resíduo do princípio ativo do herbicida na água foi analisado por cromatografia líquida de alta performance (HPLC). A curva de dissipação de imazapyr mostrou que o herbicida pode ser usado para o controle de taboa em drenos de irrigação, sem causar danos a culturas vizinhas, desde que a água seja usada, no mínimo, depois de 1,6 a 3,7 dias da aplicação das doses de 500 a 1500 g ha-1, respectivamente.

Influência do resíduo de colheita de cana-de-açúcar sem queima sobre a eficiência dos herbicidas imazapic e imazapic + pendimethalin

Os resíduos deixados sobre o solo por ocasião da colheita mecanizada da cana-de-açúcar podem constituir-se em uma barreira física para a ação dos herbicidas no controle de plantas daninhas, quando aplicados em pré-emergência destas plantas sobre a palha da cana. Em virtude disso, o presente trabalho teve por objetivos analisar e quantificar a interferência dessa camada de palha sobre o solo na ação dos herbicidas imazapic e imazapic + pendimethalin no controle de plantas daninhas em áreas onde a cana-de-açúcar foi colhida mecanicamente sem a queima da palhada previamente à colheita. Foram realizados dois ensaios simultâneos: um com a retirada da palha dois dias após a aplicação dos herbicidas e o outro com a manutenção desta, ambos conduzidos em casa de vegetação. O imazapic isolado foi aplicado nas dosagens de 0, 122,5 e 147 g i.a.ha-1 e em mistura com pendimethalin na dosagem de 75 + 1500 g i.a.ha-1, com simulação de chuvas nas intensidades de 30, 60 e 90 mm. Após análise dos resultados de biomassa seca, altura e número de folhas das plantas de Sorghum bicolor e Cyperus rotundus, além de nota visual e biomassa seca de Panicum maximum, Brachiaria plantaginea, Digitaria horizontalis, Amaranthus viridis, Ipomoea grandifolia e Brachiaria decumbens, constatou-se eficiência proporcional dos herbicidas à dosagem utilizada, independentemente da presença da palha, à exceção de Ipomoea grandifolia e Brachiaria decumbens, além de haver menor controle nos tratamentos submetidos à chuva de 90 mm. Esses resultados indicam boas perspectivas quanto à aplicação destes herbicidas em áreas de colheita mecanizada de cana-de-açúcar sem queima, para controle de plantas daninhas em condições de pré-emergência.

Application of continuous positive airway pressure in the delivery room: a multicenter randomized clinical trial

This study evaluated whether the use of continuous positive airway pressure (CPAP) in the delivery room alters the need for mechanical ventilation and surfactant during the first 5 days of life and modifies the incidence of respiratory morbidity and mortality during the hospital stay. The study was a multicenter randomized clinical trial conducted in five public university hospitals in Brazil, from June 2008 to December 2009. Participants were 197 infants with birth weight of 1000-1500 g and without major birth defects. They were treated according to the guidelines of the American Academy of Pediatrics (APP). Infants not intubated or extubated less than 15 min after birth were randomized for two treatments, routine or CPAP, and were followed until hospital discharge. The routine (n=99) and CPAP (n=98) infants studied presented no statistically significant differences regarding birth characteristics, complications during the prenatal period, the need for mechanical ventilation during the first 5 days of life (19.2 vs 23.4%, P=0.50), use of surfactant (18.2 vs 17.3% P=0.92), or respiratory morbidity and mortality until discharge. The CPAP group required a greater number of doses of surfactant (1.5 vs 1.0, P=0.02). When CPAP was applied to the routine group, it was installed within a median time of 30 min. We found that CPAP applied less than 15 min after birth was not able to reduce the need for ventilator support and was associated with a higher number of doses of surfactant when compared to CPAP applied as clinically indicated within a median time of 30 min.

Psychological well-being of the parents and child development, behavior, and quality of life in very low birth weight infants

The parents of premature infants, especially the mothers, are at increased risk for distress. Infants born prematurely are at risk for developmental problems. The aim of this study was to investigate whether the psychological well-being of both parents is associated with child development in very low birth weight (VLBW, ≤1500g) children. The burden of prematurity-related morbidity to the children and to the family was also assessed. A cohort of 201 VLBW infants born during 2001–2006 in the Turku University Hospital, Finland, and their parents were studied (I–IV). One study included a control group (n=166) of full-term infants (IV). The psychological well-being of the parents was evaluated by assessments of depressive symptoms, parenting stress, the sense of coherence and general family functioning. Cognitive, behavioral, and socio-emotional development, and the health-related quality of life (HRQoL) of the children were determined when the children were 2 to 8 years old. The psychological well-being of the parents was associated with the cognitive, behavioral and social development of the VLBW children. The VLBW infants with prematurity-related morbidities had a poorer HRQoL and the general functioning of the family was inferior compared to the control children and their families. 64.5% of the VLBW children survived without morbidities. Most of the VLBW children did not have significant behavior problems (93%), had normal social skills (63%), had no emotional problems (64%), and had no problems in executive functioning (62%). Only 3% of the surviving VLBW infants had significant cognitive delay. In conclusion, the depressive symptoms and stress of the parents can be risk factors for disadvantageous child development, while a strong sense of coherence can be protective. Parents of the premature children with developmental delays might also experience more depressive symptoms and stress than other parents. Prematurity-related morbidities were a burden to the VLBW child as well as to the family.

Influência do resíduo de colheita de cana-de-açúcar sem queima sobre a eficiência dos herbicidas imazapic e imazapic + pendimethalin

Os resíduos deixados sobre o solo por ocasião da colheita mecanizada da cana-de-açúcar podem constituir-se em uma barreira física para a ação dos herbicidas no controle de plantas daninhas, quando aplicados em pré-emergência destas plantas sobre a palha da cana. em virtude disso, o presente trabalho teve por objetivos analisar e quantificar a interferência dessa camada de palha sobre o solo na ação dos herbicidas imazapic e imazapic + pendimethalin no controle de plantas daninhas em áreas onde a cana-de-açúcar foi colhida mecanicamente sem a queima da palhada previamente à colheita. Foram realizados dois ensaios simultâneos: um com a retirada da palha dois dias após a aplicação dos herbicidas e o outro com a manutenção desta, ambos conduzidos em casa de vegetação. O imazapic isolado foi aplicado nas dosagens de 0, 122,5 e 147 g i.a.ha-1 e em mistura com pendimethalin na dosagem de 75 + 1500 g i.a.ha-1, com simulação de chuvas nas intensidades de 30, 60 e 90 mm. Após análise dos resultados de biomassa seca, altura e número de folhas das plantas de Sorghum bicolor e Cyperus rotundus, além de nota visual e biomassa seca de Panicum maximum, Brachiaria plantaginea, Digitaria horizontalis, Amaranthus viridis, Ipomoea grandifolia e Brachiaria decumbens, constatou-se eficiência proporcional dos herbicidas à dosagem utilizada, independentemente da presença da palha, à exceção de Ipomoea grandifolia e Brachiaria decumbens, além de haver menor controle nos tratamentos submetidos à chuva de 90 mm. Esses resultados indicam boas perspectivas quanto à aplicação destes herbicidas em áreas de colheita mecanizada de cana-de-açúcar sem queima, para controle de plantas daninhas em condições de pré-emergência.

Influência do teor de água na superfície do solo sobre a eficácia e seletividade do flazasulfuron, na cultura de cana-de-açúcar

Objetivou-se avaliar a eficácia e a seletividade do herbicida flazasulfuron aplicado em pré-emergência de Panicum maximum, Brachiaria plantaginea e Digitaria horizontalis e das plantas de cana-de-açúcar, em solos argilosos com diferentes teores de água na superfície, após os primeiros cinco dias da aplicação. Foram testadas as seguintes doses de flazasulfuron isolado: 37,5; 50,0; e 75,0 g ha-1. O herbicida foi misturado, na menor dose (37,5 g ha-1), com ametrine e diuron, ambos a 1.000 g ha¹, e com acetochlor na dose de 1.536 g ha-1. Esses tratamentos foram comparados aos padrões comerciais: isoxaflutole (112,5 g ha-1), tebuthiuron (1.000 g ha-1), sulfentrazone (800 g ha-1) e diuron + hexazinone (1.500 g ha-1). Mantiveram-se as testemunhas capinada e infestada. Todos os herbicidas foram seletivos aos cultivares de cana-de-açúcar testados (RB 845257 e RB 855536). O herbicida flazasulfuron, bem como alguns padrões comerciais, proporcionou ótimos níveis de controle das plantas daninhas onde o solo se encontrava com bons teores de água nesse período. Os resultados foram insatisfatórios - sobretudo para o flazasulfuron isolado ou em misturas com ametrine, acetochlor e diuron - para o controle de P. maximum e B. plantaginea em solo com menor teor de água na superfície. Com a dose de 37,5 g ha-1 do flazasulfuron, o controle de B. plantaginea aos 90 dias após a aplicação, foi de 42,5% em função da redução do teor de água de 22% (CC) a 7,1%, na camada de 0 a 2,5 cm do solo. O controle aumentou para 97,5% quando a variação foi de 25% a 21%.

Desenvolvimento de cultivares de mamoneiras em relação à profundidade de semeadura e seletividade de herbicidas dinitroanilinas

Three trials were carry out at Garca Municipal County, São Paulo, Brazil in order to study the effects of sowing depth of three castor bean cultivars submitted or not to dinitroaniline herbicides application in pre-emergency. The three cultivars chosen as fllow: AL Guarany 2002 variety and Iris and Savana hybrids. The experiments were disposed in randomized complete blocks, with fifteen treatments and four replications, by using factorial scheme 5x3, composed by sowing in 2,5; 5,0; 10,0; 15,0 and 20,0 cm depths with application in pre-emergency condition of the herbicides: trifluralin (1125 g a.i. ha(-1)), pendimethalin (1500 g a.i. ha(-1)) and check without herbicide (hand-hold check). Only the sowing depths of 2.5 and 20.0 significantly reduced the initial development of castor bean cultivars AL Guarany 2002 and Iris, without interfering in characteristics number of leaves, stem diameter, insertion height of first raceme and yield. Trifluralin application has increased significantly AL Guarany 2002 yield, in sowings from 5.0 cm deep, unlike Iris and Savana hybrids, where most of sowing depths studied, resulted in yield declines. Pendimethalin herbicide presented high selectivity mainly for AL Guarany 2002 and Savana cultivars, characterizing, generally as the safest option castor bean crop.