Tempo de circulação extracorpórea como fator risco para insuficiência renal aguda

OBJETIVO: A insuficiência renal aguda (IRA) no pósoperatório (PO) de cirurgia cardíaca é complicação grave. O objetivo deste trabalho é avaliar o tempo de circulação extracorpórea (CEC) como fator de risco para IRA. MÉTODO: Foram avaliados 116 pacientes de um único centro, submetidos a cirurgia cardíaca com CEC. Foram avaliados os dados demográficos, características clínicas, variáveis intra e pós-operatórias. A creatinina sérica e o clearance de creatinina foram avaliados até o 5ºPO. IRA foi definida como necessidade de diálise. Os pacientes foram estratificados em dois grupos: grupo CEC< 70 min e grupo CEC> 90min. RESULTADOS: O aumento médio da creatinina sérica no PO foi 0,18+0,41 no grupo CEC<70min e 0,42+0,44 no grupo CEC>90min (p=0,005). Diálise foi necessária em 1,3% dos pacientes do grupo CEC<70min, e em 12,5% do grupo CEC> 90min (p=0,018). O risco relativo para diálise foi 1,12 (IC 95%, 1,00-1,20) para CEC>90min. Não houve diferença para mortalidade (5,2 versus 7,5%, p=0,631). CONSLUSÃO: O desenvolvimento de IRA no pós-operatório de cirurgia cardíaca foi observado em pacientes com tempo de CEC superior a 90 minutos, embora o clearance de creatinina não tenha demonstrado alteração entre os grupos.

Aplicação de exercício isotônico durante a hemodiálise melhora a eficiência dialítica

INTRODUÇÃO: A doença renal crônica (DRC) é decorrente de uma lesão renal e perda progressiva e irreversível da função dos rins. A hemodiálise substitui parcialmente essa função, com o objetivo de corrigir as alterações metabólicas na DRC. Para acompanhar a adequação da diálise, é determinado o Kt/V - índice de depuração da ureia por sessão de hemodiálise. O exercício físico de moderada intensidade tem se mostrado de fundamental importância para melhorar os efeitos adversos ao tratamento dialítico. OBJETIVOS: Avaliar o Kt/V em indivíduos com DRC submetidos ao exercício físico isotônico de baixa intensidade durante a hemodiálise. MATERIAIS E MÉTODOS: Analisados dados de 15 voluntários de ambos os sexos, submetidos à hemodiálise três vezes por semana. Após duas horas do início da diálise, foi aplicado um protocolo de exercícios isotônicos de baixa intensidade de membros superiores e inferiores com duração de 30 minutos, por um período de três meses. Os valores do Kt/V foram comparados no período de três meses anteriores sem exercício e após três meses de exercício. RESULTADOS: A média dos valores do Kt/V nos três meses sem exercício foi de 1,13 ± 0,11 e após aplicação do programa de exercícios foi de 1,29 ± 0,12 (p < 0,05). CONCLUSÃO: O programa de exercício físico isotônico de baixa intensidade em pacientes com DRC, aplicados durante a sessão de diálise mostrou a melhora da eficiência dialítica.

Despatologização do gênero: a politização das identidades abjetas

Apesar das mudanças políticas e sociais em relação às transexualidades e travestilidades, elas ainda são consideradas pela Associação de Psiquiatria Norte-Americana (APA) e pela Organização Mundial da Saúde (OMS) como transtornos mentais. Essas entidades divulgarão em 2013 as novas versões do Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM - APA) e do Código Internacional de Doença (CID - OMS), o que tem mobilizado ativistas trans que reivindicam a retirada da transexualidade do rol das doenças identificáveis como transtornos mentais. A campanha Stop Trans Pathologization (Pare a Patologização!) se internacionalizou e envolvia, até o início de 2012, mais de 29 países. Neste artigo, discutiremos algumas iniciativas dessa campanha, analisaremos a ideologia de gênero presente no DSM e no CID, que incorporam o gênero como uma categoria diagnóstica, e, por fim, apresentaremos argumentos pelo fim do diagnóstico de gênero.

Efeitos do teor de carboidratos solúveis sobre as características da silagem de cana-de-açúcar

Objetivou-se quantificar na cana-de-açúcar o teor de carboidratos solúveis (CHOs) que anula a produção de etanol e avaliar os efeitos desses carboidratos sobre o valor nutritivo e outras características fermentativas da silagem de cana-de-açúcar. Utilizou-se o delineamento inteiramente casualizado com três tratamentos, cada um com quatro repetições. Os tratamentos consistiram da retirada total do caldo da cana-de-açúcar, por meio de prensagem, e de sua reconstituição (0, 50 ou 100%) à cana. No nível de 50% de reconstituição, o caldo foi adicionado à cana juntamente com 50% de água e, no nível 0%, adicionou-se 100% de água à cana. A restituição resultou em concentrações de 41,6; 34,0 e 23,0% de carboidratos solúveis na matéria seca (MS). O material foi ensilado em 12 silos experimentais confeccionados a partir de baldes plásticos. A abertura dos silos foi realizada 85 dias após a ensilagem, quando foram determinados os teores dos ácidos orgânicos e a composição química das silagens. A retirada de carboidratos solúveis da cana-de-açúcar teve efeito linear decrescente sobre os teores de matéria seca, o teor de carboidratos solúveis e a digestibilidade in vitro da matéria seca (DIVMS) das silagens, no entanto, ocasionou aumento dos teores de fibra detergente ácido (FDA), fibra detergente neutro (FDN) e lignina. Observou-se efeito linear decrescente da retirada dos carboidratos solúveis sobre os teores de etanol e ácidos lático e butírico e as perdas de matéria seca das silagens. Não se observaram efeitos de tratamentos sobre os dados de estabilidade aeróbia. A produção de etanol seria nula se a cana-de-açúcar contivesse apenas 12,4% de CHOs com base na matéria seca (MS).

Dietary vitamin or mineral mix removal during the finisher period on broiler chicken performance

The effect of dietary vitamin (VS) and mineral (MS) mix withdrawal between 42 and 49 d of age on broiler chicken performance was evaluated. The diets were formulated based on corn and soybean meal, and the experiments were conducted in floor pens using wood shavings as litter. Trial I evaluated withdrawal of VS and MS mix at 42, 45, and 49 d. The results of this trial showed that VS and MS mix withdrawal at 42 d of age did not impair feed intake (FI) or weight gain (WG), but feed conversion (FC) was improved (P = 0.043) when both mixes were maintained in the diets until 49 d of age. Trial 2 assessed the withdrawal of VS or MS mix at 42 d of age. FI and WG were not affected by withdrawal, but FC was poorer (P = 0.035) for the broilers fed the diet without VS. The relative liver weight was reduced by VS or MS mix withdrawal (P = 0.014 and P = 0.001, respectively). Carcass, breast, and leg yields were not affected by VS or MS mix withdrawals in either trial. The findings of the study suggested that VS mix withdrawal during the final period of broiler chicken growth was more deleterious than the withdrawal of MS mix, because it affected FC ratio. VS or MS withdrawal during this period did not affect carcass yield.

ESTENOSE SUBGLOTICA

In the present study we report the experience of the Department of Otolaryngology-Head and Neck Surgery, University Hospital, Botucatu School in 19 cases of laryngotracheal stenosis. Fifteen cases had subglottic stenosis, one had stenosis of inferior tracheal and subglottic, one had stenosis of trachea and two others had extensive involvement of larynx and trachea due to chronic inflammatory disease. In eleven patients a laryngotracheal reconstrutive technique with costal cartilagem graft was performed with good results. The major technical difficulties, occurring mainly in children, were the withdrawal of the cannula of the tracheostomy due to granulation tissue formation and the subglottic partial stenosis after surgical reconstruction.

Commissural NTS lesions and cardiovascular responses in aortic baroreceptor-denervated rats

Both acute (1 day) lesions of the commissural nucleus of the solitary tract (commNTS) and aortic baroreceptor denervation increase pressor responses to bilateral common carotid occlusion (BCO) during a 60-second period in conscious rats. In this study, we investigated the following: (1) the effects of commNTS lesions on basal mean arterial pressure (MAP) and heart rate (HR) of aortic denervated (ADNx) rats; (2) the effects of acute commNTS lesions on pressor responses to BCO in ADNx rats; and (3) the effects of chronic (10 days) commNTS lesions on the pressor response to BCO. ADNx increased basal MAP and HR in sham-lesioned rats. Acute commNTS lesions abolished the MAP and HR increases observed in ADNx rats. Acute commNTS lesions increased the pressor responses to BCO in rats with intact- baroreceptor innervation but produced no additional change in the pressor response to BCO in ADNx rats. Chronic commNTS lesions did not change the pressor responses to BCO in rats with intact-baroreceptor innervation. The data show that acute commNTS lesions abolish the MAP increase produced by aortic baroreceptor denervation. They also suggest that acute commNTS lesions enhance the pressor response to BCO by partial withdrawal of aortic baroreceptor inputs into the NTS. Chronically, reorganization in the remaining aortic baroreceptor or in the baroreflex function as a whole might produce normalization of the cardiovascular responses to BCO.

Uso e conservação de Piper cernuum Vell. (Piperaceae) na Mata Atlântica: I. Fenologia reprodutiva e dispersão de sementes

The pariparoba (Piper cernuum Vell.), a native plant from the Atlantic Tropical Forest (ATF), has been commonly used in folk medicine. Works seeking the exploitation of P. cernuum natural populations need to be accomplished, seeking compatibility in obtaining income rates and preservation of ATF. The present work aimed to study the reproductive phenology and seed dispersal in P. cernuum natural population in the counties of Sete Barras/SP (Parque Estadual Intervales - PEI). The population of P. cernuum studied in PEI presented continuously bud-inflorescences, green-infrutescences and bud-inflorescence emission, with variation among individuals. Fruit-set average was of 9.1%, varying among individuals. Shading and foliar damage presented negative effect on the fruit-set. Three species of bats were identified as potential dispersors of the P. cernuum seeds: Carollia perspicillata, Anoura geoffroyi and Artibeus sp. The foragement strategy observed was the withdrawal of some seeds per infrutescence per flight. This strategy increases the potential in establishing new plants as well as in increase the potential of gene flow in comparison with the entire infrutescence plant eaten at the night perches. In consequence, the results of reproductive phenology and seed dispersal ecology presented in this work can help to establish management and conservation strategies of P. cernuum natural populations in the ATF.

Síndrome das pernas inquietas: Diagnóstico e tratamento. Opinião de especialistas Brasileiros

This article contains the conclusions of the November 17-18, 2006 meeting of the Brazilian Study Group of Restless Legs Syndrome (GBE-SPI) about diagnosis and management of restless legs syndrome (RLS). RLS is characterized by abnormal sensations mostly but not exclusively in the legs which worsen in the evening and are improved by motion of the affected body part. Its diagnosis is solely based on clinical findings. Therapeutic agents with efficacy supported by Class I studies are dopamine agonists, levodopa and gabapentine. Class II studies support the use of slow release valproic acid, clonazepan and oxycodone. The GBE-SPI recommendations for management of SPI are sleep hygiene, withdrawal of medications capable of worsening the condition, treatment of comorbidities and pharmacological agents. The first choice agents are dopaminergic drugs, second choice are gabapentine or oxycodone, and the third choice are clonazepan or slow release valproic acid.

Postural control under visual and proprioceptive perturbations during double and single limb stances: Insights for balance training

Single Limb Stance under visual and proprioceptive disturbances is largely used in clinical settings in order to improve balance in a wide range of functional disabilities. However, the proper role of vision and proprioception in SLS is not completely understood. The objectives of this study were to test the hypotheses that when ankle proprioception is perturbed, the role of vision in postural control increases according to the difficulty of the standing task. And to test the effect of vision during postural adaptation after withdrawal of the somesthetic perturbation during double and single limb stance. Eleven males were submitted to double (DLS) and single limb (SLS) stances under conditions of normal or reduced vision, both with normal and perturbed proprioception. Center of pressure parameters were analyzed across conditions. Vision had a main effect in SLS, whereas proprioception perturbation showed effects only during DLS. Baseline stability was promptly achieved independently of visual input after proprioception reintegration. In conclusion, the role of vision increases in SLS. After proprioception reintegration, vision does not affect postural recovery. Balance training programs must take that into account. © 2011 Elsevier Ltd.

Planejamento da expansão de sistemas de transmissão considerando a retirada de linhas de transmissão

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Efeitos cardiovasculares e respiratórios da infusão contínua ne naloxona ou tramadol, em coelhos anestesiados com isofluorano e submetidos à hipovolemia aguda

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

Avaliação de um modelo esperimental de diálise peritonial em ratos e efeito da concentração de glicose e da temperatura no peritônio

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Perda de matéria seca em grãos de milho submetidos a sistemas de secagem natural e artificial

Pós-graduação em Agronomia (Energia na Agricultura) - FCA

The Netherlands Antilles: trade and integration with CARICOM

Introduction The Netherlands Antilles is an autonomous entity within the Kingdom of the Netherlands and comprises a federation of five Caribbean islands: Bonaire and Curacao (the Leeward islands) which comprise 80 per cent of the population of 211,000 and Saba, St. Eustatius and the southern part of St. Maarten (the Windward islands). Like the other countries in the Kingdom, it enjoys full autonomy in internal matters as, for example, education, public health, justice and customs. It has a per capita income of about US$ 12,000. The Leeward Islands and the Windward Islands account for about 75 per cent (Curacao (70 per cent) and Bonaire (5 per cent)) and 25 percent respectively of the economy of the Netherlands Antilles. The Netherlands Antilles has its own currency, the Netherlands guilder, which is pegged to the United States dollar at a fixed rate since 1971. The economy has some unique features that stem from its close relations with the Netherlands, its undiversified nature and heavy dependence on tourism, offshore finance, oil refining and shipping, the high share of trade (exports of goods and services of about 75 per cent of GDP), its geographical characteristics, its common border with the French Republic on St. Maarten, its duty-free access for imports from Aruba, its de facto free trade zone (FTZ), partial dollarization, especially for the Windward Islands, and its highly regulated labor market (1). Adverse economic shocks in the last two decades affected particularly the offshore financial sector and the oil refinery and, to a lesser extent, tourism. The repeal of withholding taxes in the United States in the 1980s indirectly caused the collapse of a number of highly profitable offshore financial activities in Curacao, leading to significant drops in government revenue and contributions to foreign exchange earnings. The withdrawal of Shell from Curacao in 1986 and the (temporary) closure of the oil refinery which had been a mainstay of the Curacao economy for almost three quarters of a century was the second major shock. It was subsequently leased to the Venezuelan State Company, Petroleos de Venezuela Sociedad Anonima (PDVSA), which resumed operations and preserved employment. In the 1990s, the Windward Islands were bit by several devastating hurricanes, which destroyed much of the economic infrastructure on the islands, including about half of the number of available hotel rooms in St Maarten. Further negative shocks were related to the discontinuation of certain trade privileges on European markets for Overseas Countries and Territories (OCTs), the withdrawal by the Netherlands of certain tax privileges for Dutch pensioners residing in the Netherlands Antilles and disruptions in the availability of Solidarity Fund resources for the smaller islands. National income has been on the decline since 1997. GDP declined by about 6 per cent between 1997 and 1999. Underlying fiscal imbalances and structural weaknesses have also impacted negatively on the economy. In recent years, with recession high unemployment and migration have been experienced (2). The Netherlands Antilles has been able to survive thanks to additional aid from the Netherlands, large-scale spontaneous emigration (mostly to the Netherlands), some drop in international reserves, an increase in domestic debt and arrears and reduced outlays for the maintenance of public assets. From 1986 onwards, successive efforts at restoring macroeconomic balance, particularly with regard to public finance, were made, but were unsuccessful. Adjustment was also attempted in 1996 and 1997, but failed to meet the desired targets. In 1999, the government launched a new National Recovery Plan" (NRP). The NRP contains important medium-term structural adjustment measures aimed at restoring macroeconomic balance and conditions for revitalizing the economy. The NRP subsequently served as an important input into a comprehensive adjustment plan drawn up with the assistance of the International Monetary Fund (IMF) and reflected in the government's Memorandum of Economic Policies dated 15 September 2000. Beyond restoring macroeconomic balance and reforming the economic incentive framework, the government aims at establishing a Comprehensive Development Framework (CDF) for the formulation and implementation of a sustainable long-term growth strategy. It is against the above background that this study is undertaken. Its main objective is to assess the integration options facing the Netherlands Antilles (3) vis-a-vis the Caribbean Community (CARICOM). A secondary objective is to examine the above taking into account, inter alia, the level of trade between the Netherlands Antilles and CARICOM, the barriers to trade between the two groups of countries and the requirements for increasing trade between the two groups of countries. The Consultant was given an initial Draft Terms of Reference (Annex 1) with the intention of modifying it in the course of the interviews with all the stakeholders. The main idea that emerged from these interviews was a concern with some possible form of association with CARICOM. The Consultant was asked to exam the costs and benefits of various forms of association and to recommend an option. This adjustment of the Terms of Reference (TOR) was substantial and involved the Consultant having to do some interviews and collect documentation in CARICOM. The study essentially revolves around the search for a road map for the Netherlands Antilles. It is tackled in the first instance by describing the existing system of trade of the Netherlands Antilles with a view to determining the import and export structures and the specific nature and extent of trade in goods and services between the Netherlands Antilles and CARICOM. 1 Netherlands Antilles: Elements of a Strategy for Economic Recovery and Sustainable Growth. Interim Report of the World Bank Mission, 5-20 December 2000. 2 IMF, IMF Country Report No. 01/73 Kingdom of the Netherlands-Netherlands Antilles-Recent Development, Selected Issues and Statistical Appendix. May 2001 3 The Netherlands Antilles is a country within the Kingdom of the Netherlands. It contains five islands. Curacao and Bonaire (Leewards) and St Eustatius, Saba and St Maarten (The Windwards)"