961 resultados para Índices de gravidade do trauma
Resumo:
Os objetivos deste trabalho foram: testar a adequação de diferentes índices de erosividade das chuvas, comparar duas equações propostas para cálculo da energia cinética das chuvas e estimar o fator K (erodibilidade) da equação universal de perdas de solo (EUPS) para um latossolo vermelho-escuro (LE) álico muito argiloso e um podzólico vermelho-amarelo (PV) álico muito argiloso da região de Sete Lagoas (MG). Não houve diferença significativa entre as duas equações testadas para cálculo da energia cinética das chuvas. O índice EI30 mostrou ser um bom estimador da erosividade da chuva e pode continuar sendo utilizado como fator R (erosividade) da EUPS para a região estudada. Os valores do fator K, para o LE e o PV da região de Sete Lagoas, foram, respectivamente, 0,002 e 0,033 t h (MJ mm)-1.
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Em 29 amostras superficiais (0-20 cm) de solos do estado do Ceará, foram determinadas diferentes frações de boro e estabelecidas relações com algumas propriedades do solo e com o boro solúvel, usado como índice de disponibilidade para as plantas. As frações de boro foram analisadas, seguindo-se um esquema de fracionamento seqüencial. Determinaram-se o boro solúvel em água (B-Sol), o boro não especificamente adsorvido (B-NEsAd), o boro especificamente adsorvido (B-EsAd), o boro associado a óxidos de Mn (B-OxMn), o boro associado a óxidos de Fe e Al amorfo (B-OxFeA) e a óxidos de Fe e Al cristalino (B-OxFeC), e o boro residual (B-Res). Também foram determinados o boro total (B-Total) e o solúvel em três extratores: água quente, HCl 0,05 mol L-1 e manitol 0,05 mol L-1 + CaCl2 0,01 mol L-1. O teor de boro total nos solos variou de 10,5 a 24,0 mg kg-1 (média de 14,4 mg kg-1). As frações B-Sol, B-NEsAd e B-EsAd apresentaram teores entre 0,05 e 0,79 mg kg-1, representando entre 0,3 a 4,4% do B-Total. Dentre os óxidos, houve predominância do B-OxFeC (média de 4,4 mg kg-1) com teores entre 1 a 2 vezes superiores aos de B-OxFeA (média de 2,72 mg kg-1). Na maioria dos solos, a fração predominante foi o B-Res (média de 6,22 mg kg-1), ocluso em minerais silicatados, com teores que variaram de 19,6 a 70,7% do B-Total. Os valores de B disponível, nos três extratores, correlacionaram-se de forma altamente significativa entre si e com as frações B-Sol, B-NEsAd e B-EsAd. A matéria orgânica e a argila foram as propriedades que se correlacionaram melhor com o B-Sol, B-NEsAd e B-EsAd.
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Traumatic brain injury (TBI) is recognized as a cause of hypopituitarism even after mild TBI. Although over the past decade, a growing body of research has detailed neuroendocrine changes induced by TBI, the mechanisms and risk factors responsible for this pituitary dysfunction are still unclear. Around the world, sports-especially combative sports-are very popular. However, sports are not generally considered as a cause of TBI in most epidemiological studies, and the link between sports-related head trauma and hypopituitarism has not been investigated until recently. Thus, there is a paucity of data regarding this important concern. Because of the large number of young sports participants with near-normal life expectancy, the implications of undiagnosed or untreated postconcussion pituitary dysfunction can be dramatic. Understanding the pathophysiological mechanisms and risk factors of hypopituitarism caused by sports injuries is thus an important issue that concerns both medical staff and sponsors of sports. The aim of this paper was to summarize the best evidence for understanding the pathophysiological mechanisms and to discuss the current data and recommendations on sports-related head trauma as a cause of hypopituitarism.
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Con la finalidad de calcular el impacto de una condición cálida o fría sobre la reproducción de la anchoveta, se analiza el comportamiento de las anomalías de los índices reproductivos (Índice gonadosomático (IGS), Fracción desovante (FD), Índice del contenido graso (CG) y Factor de condición (FC) como una manera de visualizar el efecto del ambiente sobre la reproducción de los recursos, lo que se verá reflejado directamente en los índices reproductivos.
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Introduction.- Knowledge of predictors of an unfavourable outcome, e.g. non-return to work after an injury enables to identify patients at risk and to target interventions for modifiable predictors. It has been recently shown that INTERMED; a tool to measure biopsychosocial complexity in four domains (biologic, psychologic, social and care, with a score between 0-60 points) can be useful in this context. The aim of this study was to set up a predictive model for non-return to work using INTERMED in patients in vocational rehabilitation after orthopaedic injury.Patients and methods.- In this longitudinal prospective study, the cohort consisted of 2156 consecutively included inpatients with orthopaedic trauma attending a rehabilitation hospital after a work, traffic or sport related injury. Two years after discharge, a questionnaire regarding return to work was sent (1502 returned their questionnaires). In addition to INTERMED, 18 predictors known at baseline of the rehabilitation were selected based on previous research. A multivariable logistic regression was performed.Results.- In the multivariate model, not-returning to work at 2 years was significantly predicted by the INTERMED: odds-ratio (OR) 1.08 (95% confidence interval, CI [1.06; 1.11]) for a one point increase in scale; by qualified work-status before the injury OR = 0.74, CI (0.54; 0.99), by using French as preferred language OR = 0.60, CI (0.45; 0.80), by upper-extremity injury OR = 1.37, CI (1.03; 1.81), by higher education (> 9 years) OR = 0.74, CI (0.55; 1.00), and by a 10 year increase in age OR = 1.15, CI (1.02; 1.29). The area under the receiver-operator-characteristics curve (ROC)-curve was 0.733 for the full model (INTERMED plus 18 variables).Discussion.- These results confirm that the total score of the INTERMED is a significant predictor for return to work. The full model with 18 predictors combined with the total score of INTERMED has good predictive value. However, the number of variables (19) to measure is high for the use as screening tool in a clinic.
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INTRODUCTION: Oxidative stress is involved in the development of secondary tissue damage and organ failure. Micronutrients contributing to the antioxidant (AOX) defense exhibit low plasma levels during critical illness. The aim of this study was to investigate the impact of early AOX micronutrients on clinical outcome in intensive care unit (ICU) patients with conditions characterized by oxidative stress. METHODS: We conducted a prospective, randomized, double-blind, placebo-controlled, single-center trial in patients admitted to a university hospital ICU with organ failure after complicated cardiac surgery, major trauma, or subarachnoid hemorrhage. Stratification by diagnosis was performed before randomization. The intervention was intravenous supplements for 5 days (selenium 270 microg, zinc 30 mg, vitamin C 1.1 g, and vitamin B1 100 mg) with a double-loading dose on days 1 and 2 or placebo. RESULTS: Two hundred patients were included (102 AOX and 98 placebo). While age and gender did not differ, brain injury was more severe in the AOX trauma group (P = 0.019). Organ function endpoints did not differ: incidence of acute kidney failure and sequential organ failure assessment score decrease were similar (-3.2 +/- 3.2 versus -4.2 +/- 2.3 over the course of 5 days). Plasma concentrations of selenium, zinc, and glutathione peroxidase, low on admission, increased significantly to within normal values in the AOX group. C-reactive protein decreased faster in the AOX group (P = 0.039). Infectious complications did not differ. Length of hospital stay did not differ (16.5 versus 20 days), being shorter only in surviving AOX trauma patients (-10 days; P = 0.045). CONCLUSION: The AOX intervention did not reduce early organ dysfunction but significantly reduced the inflammatory response in cardiac surgery and trauma patients, which may prove beneficial in conditions with an intense inflammation. TRIALS REGISTRATION: Clinical Trials.gov RCT Register: NCT00515736.
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BACKGROUND: The psychological transmission of the noxious effects of a major trauma from one generation to the next remains unclear. The present study aims to identify possible mechanisms explaining this transmission among families of Holocaust Survivors (HS). We hypothesized that the high level of depressive and anxiety disorders (DAD) among HS impairs family systems, which results in damaging coping strategies of their children (CHS) yielding a higher level of DAD. METHODS: 49 CHS completed the Resilience Scale for Adults, the Hopkins Symptom Check List-25, the 13-Item Sense of Coherence (SOC) scale, and the Family Adaptability and Cohesion Scale. We test a mediation model with Family types as the predictor; coping strategies (i.e. Resilience or SOC) as the mediator; and DAD as the outcome variable. RESULTS: Results confirm that the CHS׳ family types are more often damaged than in general population. Moreover, growing in a damaged family seems to impede development of coping strategies and, therefore, enhances the occurrence of DAD. LIMITATIONS: The present investigation is correlational and should be confirmed by other prospective investigations. CONCLUSIONS: At a theoretical level we propose a mechanism of transmission of the noxious effects of a major trauma from one generation to the next through family structure and coping strategies. At a clinical level, our results suggest to investigate the occurrence of trauma among parents of patients consulting for DAD and to reinforce their coping strategies.
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O nitrogênio é um dos elementos de grande impacto na produtividade da batata, e seu efeito nas plantas pode ser avaliado por meio de técnicas de diagnóstico do estado nutricional. Este trabalho teve o objetivo de determinar a dose ótima econômica de N para a produção de tubérculos e estimar o nível crítico de índices do estado de N na folha de duas cultivares de batata. O experimento foi conduzido de maio a agosto de 2008, em delineamento em blocos ao acaso em esquema fatorial 4 x 2, sendo quatro doses de N (0, 100, 200 e 400 kg ha-1 de N, aplicadas em pré-plantio como ureia) e duas cultivares de batata (Ágata e Asterix), com quatro repetições. Aos 21 dias após a emergência foram determinadas a leitura SPAD e os teores de N e de clorofila na quarta folha a partir do ápice (QF). A produtividade de tubérculos comerciais aumentou até 45.065 e 46.500 kg ha-1 com o aumento da dose de N até 297 e 250 kg ha-1 para Ágata e Asterix, respectivamente. Para essas cultivares, a dose para obtenção da máxima eficiência econômica foi de 290 e 245 kg ha-1 de N, respectivamente. Nas duas cultivares, houve efeito positivo de doses de N sobre o índice SPAD e teores de N e de clorofila na QF. Os valores críticos foram de 40,5 e 43,7 para o índice SPAD, de 66,7 e 75,2 g kg-1 para o teor foliar de N e de 6,13 e 6,96 mg g-1 para o teor de clorofila total na matéria fresca das folhas, respectivamente, para Ágata e Asterix. Os valores da leitura do índice SPAD correlacionaram-se com os valores de clorofila total extraível na quarta folha e com a produção de tubérculos de batata, indicando a possibilidade de medir o valor SPAD aos 21 DAE para prognosticar a produtividade de tubérculos de batata.
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This article describes the long-lasting psychological after-effects of a traumatic experience. There is growing lmowledge of the biomedical underpinnings of these phenomena: the underlying mechanisms belong to an implicit learning process whereby the victim remains under the influence of painful past experiences. One of these mechanisms concerns the development of a traumatic bonding which Iioticeably impedes the establishment of interpersona! relationships. The other mechanism, called "contextualisation deficit", is the difficulty of adjusting a person's emotional and behavioural reactivity to the context of present day !ife. This capacity of a traumatic experience to become incrusted long-termina human being's mind, and to haunt the victim with various forms of psychological and physical suffering, can be compared with the presence of a tumour or an abscess in somatic medicine. Th us, severe drug addiction can be conceptualised as a disorder in which the patient tries - in most cases ineffectively - to soothe the pain of today's world in cmmection with the trauma of the past. In conclusion, this article urges the development of psychiatrie care programmes which operate at the centre of the suffering encountered by the se patients, as a complement to the already well-established offers such as harm reduction, substitution therapy and social support.
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Purpose This study aimed to identify self-perception variables which may predict return to work (RTW) in orthopedic trauma patients 2 years after rehabilitation. Methods A prospective cohort investigated 1,207 orthopedic trauma inpatients, hospitalised in rehabilitation, clinics at admission, discharge, and 2 years after discharge. Information on potential predictors was obtained from self administered questionnaires. Multiple logistic regression models were applied. Results In the final model, a higher likelihood of RTW was predicted by: better general health and lower pain at admission; health and pain improvements during hospitalisation; lower impact of event (IES-R) avoidance behaviour score; higher IES-R hyperarousal score, higher SF-36 mental score and low perceived severity of the injury. Conclusion RTW is not only predicted by perceived health, pain and severity of the accident at the beginning of a rehabilitation program, but also by the changes in pain and health perceptions observed during hospitalisation.
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Delayed rupture of the spleen following trauma is an exceedingly rare phenomenon in children. In the case we have experienced, arterial embolization was successfully performed, surgery was avoided, and functional splenic tissue was preserved. Embolization is of value in the management of blunt splenic injuries in hemodynamically stable children, even after delayed rupture. The exact criteria for its use remain to be established.
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Les fractures du bassin, groupe polymorphe, sont liées au mécanisme traumatique. L'enjeu des fractures isolées du cotyle est principalement fonctionnel. Les radiographies standards, les scanner 3D et la classification de Letournel orientent le traitement. Ce dernier visera à rétablir une congruence articulaire prévenant la coxarthrose précoce. Les fractures du pelvis surviennent le plus souvent suite à des traumatismes violents, associés à des lésions viscérales, menaçant le pronostic vital. Le bilan radiologique s'intègre dans une prise en charge pluridisciplinaire grâce au scanner. La classification de Tile/AO permet la description des mécanismes et des lésions et une prise en charge adaptée. En cas de chocs hémodynamiques, la stabilisation externe, suivie si nécessaire de l'embolisation, à une place prépondérante. Pelvic trauma A great variety of very polymorphous lesions of pelvic trauma are deffering from each other by their context, their anatomical aspect and therapeutic implication. In the isolated acetabular fractures, function is mainly at stake. The management consists mainly of re-establishing a joint congruence to prevent early coxarthrosis. Pelvic fractures often occur in violent trauma and are associated with visceral lesions, putting vital prognosis at stake. In case of hemodynamic shock, external fracture stabilization when it is indicated associated to embolisation of pelvic bleeding if necessary and after external fixation are preponderant.
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A produtividade dos pomares de cupuaçu na Amazônia tem experimentado lento declínio, provavelmente devido à diminuição da fertilidade do solo, requerendo adubações. Na ausência de recomendações técnicas para quantificar a demanda por nutrientes por essa cultura, o uso do Sistema Integrado de Diagnose e Recomendação (DRIS) pode representar uma alternativa para suprir essa necessidade. O objetivo deste trabalho foi avaliar os diagnósticos produzidos por diferentes fórmulas e critérios de interpretação dos índices DRIS em pomares de cupuaçu. Amostras foliares de 153 pomares foram analisadas para os nutrientes N, P, K, Ca, Mg, Zn, Mn, Cu e Fe e diagnosticadas por três fórmulas DRIS: Beaufils, Jones e Wadt e colaboradores. Na interpretação dos índices DRIS, utilizaram-se: o método DRIS Matéria Seca (M-DRIS), que separa os nutrientes em limitantes ou não limitantes, e o método do Potencial de Resposta à Adubação, o qual separa os nutrientes no estado nutricional de insuficientes, equilibrados ou em excesso. Foram também adotados níveis críticos para os teores dos nutrientes foliares em cupuaçueiros, oriundos da literatura. Os diagnósticos produzidos pelos diferentes critérios de interpretação dos índices DRIS não foram consistentes entre si ou em comparação com o método do nível crítico. A exceção foi a fórmula de Wadt e colaboradores que mostrou maior consistência entre os diagnósticos, independentemente do critério utilizado para sua interpretação. Os valores sugeridos para avaliação do estado nutricional pelo método do nível crítico não foram satisfatórios.