Incidência de parada cardíaca durante anestesia, em hospital universitário de atendimento terciário: estudo prospectivo entre 1996 e 2002

JUSTIFICATIVA E OBJETIVOS: A incidência e causas de parada cardíaca (PC) durante a anestesia variam e são difíceis de comparar diante dos diversos métodos usados nos estudos. A pesquisa teve como objetivo estudar todas as PC ocorridas no intra e pós-operatório, durante um período de sete anos, de 1996 a 2002, em hospital de ensino de atendimento terciário para determinar incidência e causas da PC. MÉTODO: A incidência prospectiva de PC ocorrida durante a anestesia em 40.941 pacientes consecutivos foi identificada, utilizando-se um Banco de Dados. Todos os casos de PC e óbito foram revisados por uma Comissão, para determinar o fator desencadeante da PC ou óbito. A incidência de PC foi calculada em relação à idade, sexo, estado físico, segundo a classificação da ASA, tipo de atendimento, fatores desencadeantes, como alteração do estado físico do paciente e complicações cirúrgicas e anestésicas, tipo de anestesia e evolução para óbito. RESULTADOS: Ocorreram 138 PC (33,7:10.000), sendo a maioria em recém-nascidos, crianças até um ano e idosos, no sexo masculino (65,2%), em pacientes com estado físico ASA III ou superior, em atendimento de emergência e durante anestesia geral. Alterações do estado físico foram o principal fator de PC (23,9:10.000), seguidas de complicações cirúrgicas isoladamente (4,64:10.000) ou associadas a alterações do estado físico (2,44:10.000) e da anestesia isoladamente (1,71:10.000) ou associadas a alterações do estado físico (0,98:10.000). O risco de óbito relacionado à anestesia como fator principal ou contributivo foi igual para ambos (0,49:10.000). As principais causas da mortalidade associada à anestesia foram os problemas ventilatórios (45,4%), eventos relacionados à medicação empregada (27,3%), aspiração pulmonar (18,2%) e hidratação excessiva (9,1%). CONCLUSÕES: A incidência de PC durante a anestesia ainda continua elevada. A maioria das PC e óbitos associados à anestesia foi relacionada ao manuseio das vias aéreas e à administração de medicamentos e anestésicos.

Primary Pulmonary Choriocarcinoma After Human Chorionic Gonadotropin Normalization Following Hydatidiform Mole A Report of Two Cases

BACKGROUND: Primary pulmonary choriocarcinoma (PPC) is rare and frequently leads to death.CASES: Two young patients presented with previous molar pregnancy and spontaneous serum human chorionic gonadotropin (hCG) normalization. Patient 1 was referred to our center after partial response to chemotherapy. Pulmonary lobectomy was performed, and hCG rapidly declined. During further chemotherapy, liver metastasis was detected by positron emission tomography. Right hepatectomy was performed, and hCG declined for 28 days, but increased again despite chemotherapy. This patient died from hepatic failure 3 years after diagnosis. Patient 2 presented with persistently high hCG, though the affected organ was not identified. Chemotherapy was unsuccessful. Patient reevaluation showed an isolated pulmonary mass. Pulmonary lobectomy was performed; 2 weeks later, hCG was normal and consolidation with 2 cycles of chemotherapy was administered. The patient has been in remission for 24 months. PPC was confirmed by histo pathology and immunohistochemistry in both cases. Gestational origin of the tumor was confirmed by molecular genetic analysis (polymorphic microsatellite markers).CONCLUSION: The possibility of choriocarcinoma cannot be overlooked in young women with an isolated pulmonary mass. Early diagnosis, prompt chemotherapy, and surgical resection in a specialized center improves the prognosis. (J Reprod Med 2010;55:311-316)

POST-MORTEM LESIONS of UROLITHIASIS IN A LESSER SEED FINCH (Sporophila angolensis).

Urolithiasis is a disease that despite being a commonly observed problem in veterinary practice is uncommon in birds. Such disease was not reported in passeriforms to date. Accordingly, the aim of the present article is to describe a case of urolithiasis in an adult female lesser seed finch (Sporophila angolensis) pet bird which presented abdominal distension, respiratory distress, and apathy prior to death. The bird had history of being fed with a diet rich in protein. After the bird death, a necropsy was conducted in order to determine the cause of death. At necropsy, accentuated ascites, hydropericardium, and ureteral stones in the left ureter could be grossly observed. Additional tests related with viral and bacterial microbiological testing and with the determination of calculi composition could not be performed since the owner did not consent with the procedures because of the cost. Since the bird was fed on a high protein diet, a relationship between the ureteroliths and dietary imbalance was suggested with participation of protein in calculi development by providing the organic nuclei. Additionally, we conclude that the presence of calculi in the ureter resulted in urinary flow blockage, ascites, and consequent acute respiratory failure due to filling of air sacs with liquid.

Morphological evidences indicate that the interference of cimetidine on the peritubular components is responsible for detachment and apoptosis of Sertoli cells

Cimetidine, referred as antiandrogenic agent, has caused alterations in the seminiferous tubules, including alterations in the peritubular tissue and death of myoid cells by apoptosis. Regarding the structural and functional importance of the peritubular tissue for the maintenance of Sertoli cells (SC), we purpose to investigate the SC-basement membrane interface, focusing the morphological features of SC and their interaction with the basement membrane in the affected tubules by cimetidine. Ten animals were distributed into two groups, control (CG) and cimetidine (CmG) which received saline solution and 50 mg of cimetidine per kg of body weight, respectively, for 52 days. The testes were fixed, dehydrated and embedded for analyses under light and transmission electron microscopy. Paraffin sections were submitted to the TUNEL method; sections of testes embedded in glycol methacrylate were submitted to PAS method and stained by H&E for morphological and quantitative analyses of Sertoli Cells. In the CmG, the SC nuclei were positive to the TUNEL method and showed typical morphological alterations of cell death by apoptosis (from early to advanced stages). A significant reduction in the number of Sertoli Cells was probably due to death of these cells by apoptosis. A close relationship between SC nuclear alterations (including a high frequency of dislocated nuclei from the basal portion) and damage in the peritubular tissue was observed. The ultrastructural analysis showed a parallelism between the gradual advancement of apoptotic process in SC and detachment of the anchoring sites (hemidesmosomes) of SC plasma membrane from the lamina densa. The presence of portions of lamina densa underlying the detached hemidesmosomes indicates a continuous deposition of lamina densa, resulting in the thickening of the basal lamina. The results indicate a possible disarrangement of the SC cytoskeleton, including the focal adhesion structure. These alterations are related to SC apoptosis and probably result from disturbs induced by cimetidine on the peritubular tissue.

Macromolecular properties of cepacian in water and in dimethylsulfoxide

Cepacian is the exopolysaccharide produced by the majority of the so far investigated clinical strains of the Burkholderia cepacia complex. This is a group of nine closely related bacterial species that might cause serious lung infections in cystic fibrosis patients, in some cases leading to death. In this paper the aggregation ability and the conformational properties of cepacian chain were investigated to understand its role in biofilm formation. Viscosity and atomic force microscopy studies in water and in mixed (dimethylsulfoxide/water) solvent indicated the formation of double stranded molecular structures in aqueous solutions. Inter-residue short distances along cepacian chain were investigated by NOE NMR, which showed that two side chains of cepacian were not conformation ally free due to strong interactions with the polymer backbone. These interactions were attributed to hydrogen bonding and contributed to structure rigidity. (c) 2007 Elsevier Ltd. All rights reserved.

Anti-proliferative and cytotoxic activity of pentadactylin isolated from Leptodactylus labyrinthicus on melanoma cells

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Methylation status of CDH1 gene in samples of gastric mucous from brazilian patients with chronic gastritis infected by Helicobacter pylori

CONTEXTO:O câncer gástrico é uma das principais neoplasias que causam o óbito no Brasil e no mundo. Helicobacter pylori é um carcinógeno do tipo I relacionado à gastrite crônica. Diferenças no grau de virulência de suas cepas levam a maior risco de desenvolvimento de doenças gástricas. A metilação de ilhas CpGs está envolvida com o processo de tumorigênese em diferentes tipos de câncer. CDH1 é um gene supressor tumoral que, quando inativado, pode aumentar as chances de metástase. A metilação deste gene em estágios precoces da carcinogênese gástrica ainda não é totalmente compreendida. OBJETIVO: Investigar o padrão de metilação do gene CDH1 em amostras de gastrites crônicas e correlacionar com a presença do H. pylori. MÉTODOS: Foram usadas 60 biopsias de mucosas gástricas. A detecção de H. pylori foi realizada por PCR para o gene da urease C e a genotipagem com PCR para os genes cagA e vacA (região s e m). O padrão de metilação do gene CDH1 foi analisado usando a técnica de PCR e específica para a metilação e sequenciamento direto dos produtos de PCR. RESULTADOS: A bactéria H. pylori foi detectada em 90% das amostras de gastrites crônicas; destas, 33% portavam o gene cagA e 100% vacA s1. O genótipo vacA s2/m1 não foi detectado nas amostras analisadas. Metilação de CDH1 foi detectada em 63,3% das amostras de gastrites e 95% delas eram portadoras de H. pylori. CONCLUSÃO: Os resultados deste estudo sugerem que a metilação em CDH1 e a infecção pelo H. pylori são eventos frequentes em amostras de pacientes brasileiros com gastrite crônica e reforça a correlação entre infecção por H. pylori e inativação do gene CDH1 em estágios precoces da tumorigênese gástrica.

Análise das condições de saúde e de vida da população urbana de Botucatu, SP (Brasil): II - Conhecimentos e opiniões da população sobre sintomas de doenças, 1983

Com objetivo de verificar o grau de informação da população urbana de Botucatu sobre questões de saúde, foram pesquisados conhecimentos e opiniões a respeito da freqüência e gravidade de treze sintomas e sinais de doenças, em 1.005 famílias amostradas. As respostas foram analisadas segundo idade, sexo, escolaridade e estrato sócio-econômico e mostraram tendência compatível com os conhecimentos da medicina científica. Na comparação dos sexos, por idade, as mulheres (adultas jovens) valorizaram mais do que os homens a freqüência e a gravidade da maioria dos sintomas. Os escores altos conferidos para a gravidade tenderam a diminuir com o aumento da escolaridade para todos os sintomas. Houve variações, entre os sintomas, na valorização da freqüência, de acordo com os estratos sócio-econômicos, com tendência à diminuição dos escores altos para gravidade, com o aumento do nível sócio-econômico. O grau de informação encontrado na população contraria o preconceito ainda existente na área médica, a respeito do conhecimento dos leigos. Foi levantada a hipótese de que a amostra estudada teve acesso a múltiplas fontes de informação, entre as quais a extensa rede local de serviços médicos.

Caso para diagnóstico

A paracoccidioidomicose é enfermidade potencialmente grave podendo levar ao óbito. Lesões cutâneas específicas são freqüentes e propícias ao diagnóstico precoce. A disseminação para órgãos do sistema monocítico-macrofágico corresponde à forma aguda-subaguda da enfermidade. Derrame pleural e ascite, raros na paracoccidioidomicose, no presente caso foram conseqüentes à pancreatite aguda hemorrágica. Nos casos graves a anfotericina B e o suporte hospitalar adequado são decisivos na recuperação.

Interação silício-imidacloprid no comportamento biológico e alimentar de Schizaphis Graminum (Rond.) (Hemiptera: Aphididae) em plantas de trigo

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Psychological evaluation of patients scheduled for orthognathic surgery.

Using a questionnaire, 41 patients scheduled for orthognathic surgery were evaluated pre- and postoperatively to determine some of their psychological characteristics and treatment outcome from the patient's standpoint. Among other conclusions, the results showed that some patients may not fully understand the details of their deformity, despite a full explanation by the orthodontist and surgeon. Expectations regarding treatment outcome may be unrealistic even in patients with valid self-motivation for surgery. Social adjustment usually improves after treatment. Functional changes were noticed by over 80% of the patients and esthetic changes in over 90%.

Les patients atteints d'hypertension artérielle: approche de leur vécu

The study aims at exploring the experience of the patients suffering from high blood pressure, analysing the difficulties they evoke and trying to generate similarities. It is a qualitative study, based on the phenomenological method. The interviews highlight the fact that the patients are preoccupied only by the symptoms of high blood pressure. They also show that all the patients live through the disease with a lot of emotions, with feelings of frustration, stress, anxiety and helplessness. A better understanding of the patients' experience must enable the nurses to have better targeted actions.

Clinical and cardiovascular alterations produced by scorpion envenomation in dogs

Scorpionism is a common problem that occurs in tropical and subtropical countries and assumes great medical-sanitary importance due to its fatal effect on sensitive individuals, being able to lead children and aged people to death. The envenomation lethal potential is responsible for the serious cardiopulmonary alterations the scorpion toxin produces in its victims. The present research evaluated the effects of Tityus serrulatus venom on dogs, using two distinct doses: a dose that simulates natural envenomation (0.4 mg/total dose), and an experimental dose (0.25 mg/kg). General clinical signs were observed at different moments after envenomation, and specific data related to the cardiopulmonary system were evaluated by systemic arterial pressure measurement, CK-MB enzymatic activity dosage, and radiographic, electrocardiographic and echocardiographic examinations. Results demonstrated that the scorpion venom, in experimental doses, was able to cause acute and reversible cardiac injury in few days, and, in the dose that simulated natural accident, it produced clinical signs of light envenomation, such as local pain, hyperesthesia, sialorrhea, vomiting, diarrhea, sneeze and prostration.

A reabilitação psicossocial no atendimento em saúde mental: Estratégias em construção

This study aims to identify the representations about Psychosocial Rehabilitation by Mental Health professionals working in open services, and also the difficulties they have met in the process of turning the care effective for the population. The study uses a qualitative methodology, collecting data by means of semistructured interviews with 15 subjects. The professionals identify the rehabilitation process as complex, meeting several obstacles and requiring their dedication and a flexible attitude to achieve the expected results.

Edentulous patients' knowledge of dental hygiene and care of prostheses

Objective: The aim of this study was to analyse denture users' oral care habits with regard to the use of their prostheses. Background: Rehabilitative treatment is only successful when patients are motivated and aware of correct prosthesis use and hygiene. Materials and methods: Questionnaires were distributed to 150 complete denture users at the Federal University of Bahia School of Dentistry, the Esmeralda Natividade Health Center, the Bahian Science Development Foundation and a Salvador nursing home. The questionnaire included information on gender, age, length of prosthesis use, cleaning methods and materials, etc. The data were analysed using EpiInfo version 6 software. The chi-squared test was used for statistical analysis, with a significance level of 5%. Results: Questionnaire results showed that 78% of the subjects, with an average age of 67.3 years, had used the same complete denture for over 5 years. 64% slept with their prostheses and 44% removed them from the mouth only for cleaning. None of the patients interviewed knew anything about brushes designed specifically for complete dentures. 37.3% had a restricted diet and 44% believed that a complete denture would last for more than 10 years. Conclusion: Within the limitations of this study, it was concluded that the edentulous patients surveyed had limited awareness of prosthetic hygiene and long-term oral care despite extended periods of denture use. © 2008 The Authors.