Avanços em reprodução assistida

Buscou-se, por meio de uma revisão bibliográfica de publicações científicas, atualizar conhecimentos produzidos sobre reprodução assistida. Inicialmente, investigou-se o histórico e, em seguida, foram apresentados conceitos relativos à infertilidade e sobre as técnicas de reprodução assistida, especificando-se ainda alguns temas relacionados a aspectos obstétricos, epidemiológicos e perinatais. Vários artigos que abordam o tema foram apresentados. Foi discutida a situação no Brasil bem como os vários aspectos assinalados

Patterns of viral load in chronic hepatitis B patients in Brazil and their association with ALT levels and HBeAg status

Serum hepatitis B virus (HBV) DNA [eve[ is a predictor of the development of cirrhosis and hepatocellullar carcinoma in chronic hepatitis B patients. Nevertheless, the distribution of viral load levels in chronic HBV patients in Brazil has yet to be described. This cross-sectional study included 564 participants selected in nine Brazilian cities located in four of the five regions of the country using the database of a medical diagnostics company. Admission criteria included hepatitis B surface antigen seropositivity, availability of HBV viral toad samples and age >= 18 years. Mates comprised 64.5% of the study population. Mean age was 43.7 years. Most individuals (62.1%) were seronegative for the hepatitis B e antigen (HBeAg). Median serum ALT level was 34 U/L. In 58.5% of the patients HBV-DNA levels ranged from 300 to 99,999 copies/mL; however, in 21.6% levels were undetectable. Median HBV-DNA level was 2,351 copies/mL. Over 60% of the patients who tested negative for HBeAg and in whom ALT level was less than 1.5 times the upper limit of the normal range had HBV-DNA levels > 2,000 IU/mL, which has been considered a cut-off point for indicating a liver biopsy and/or treatment. In conclusion, HBV-DNA level identified a significant proportion of Brazilian individuals with chronic hepatitis B at risk of disease progression. Furthermore, this tool. enables those individuals with high HBV-DNA levels who are susceptible to disease progression to be identified among patients with normal or stightly elevated ALT.

Treatment of Coronary Artery Disease in Hemodialysis Patients Evaluated for Transplant-A Registry Study

Background. We assessed the results of a noninvasive therapeutic strategy on the long-term occurrence of cardiac events and death in a registry of patients with chronic kidney disease (CKD) and coronary artery disease (CAD). Methods. We analyzed 519 patients with CKD (56+/-9 years, 67% men, 67% whites) on maintenance hemodialysis with clinical or scintigraphic evidence of CAD by using coronary angiography. Results. In 230 (44%) patients, coronary angiography revealed significant CAD (lumen reduction >= 70%). Subjects with significant CAD were kept on medical treatment (MT; n=184) or referred for myocardial revascularization (percutaneous transluminal coronary angioplasty/coronary artery bypass graft-intervention; n=30) according to American College of Cardiology/American Heart Association guidelines. In addition, 16 subjects refused intervention and were also followed-up. Event-free survival for patients on MT at 12, 36, and 60 months was 86%, 71%, and 57%, whereas overall survival was 89%, 71%, and 50% in the same period, respectively. Patients who refused intervention had a significantly worse prognosis compared with those who actually underwent intervention (events: hazard ratio=4.50; % confidence interval=1.48-15.10; death: hazard ratio=3.39; % confidence interval 1.41-8.45). Conclusions. In patients with CKD and significant CAD, MT promotes adequate long-term event-free survival. However, failure to perform a coronary intervention when necessary results in an accentuated increased risk of events and death.

Detection of nosocomial malnutrition is improved in Amazon region by a standard clinical nutrition education program

Background: In Brazil hospital malnutrition is highly prevalent. physician awareness of malnutrition is low, and nutrition therapy is underprescribed. One alternative to approach this problem is to educate health care providers in clinical nutrition. The present study aims to evaluate the effect of an intensive education course given to health care professionals and students on the diagnosis ability concerning to hospital malnutrition. Materials and methods: An intervention study based on a clinical nutrition educational program, offered to medical and nursing students and professionals, was held in a hospital of the Amazon region. Participants were evaluated through improvement of diagnostic ability, according to agreement of malnutrition diagnosis using Subjective Global Assessment before and after the workshop, as compared to independent evaluations (Kappa Index, k). To evaluate the impact of the educational intervention on the hospital malnutrition diagnosis, medical records were reviewed for documentation of parameters associated with nutritional status of in-patients. The SPSS statistical software package was used for data analysis. Results: A total of 165 participants concluded the program. The majority (76.4%) were medical and nursing students. Malnutrition diagnosis improved after the course (before k = 0.5; after k = 0.64; p < 0.05). A reduction of false negatives from 50% to 33.3% was observed. During the course, concern of nutritional diagnosis was increased W = 17.57; p < 0.001) and even after the course, improvement on the height measurement was detected chi(2) 12.87;p < 0.001). Conclusions: Clinical nutrition education improved the ability of diagnosing malnutrition; however the primary impact was on medical and nursing students. To sustain diagnostic capacity a clinical nutrition program should be part of health professional curricula and be coupled with continuing education for health care providers.

Ethical Conflicts over the Management of Transsexual Adolescents-Report of Two Cases

Introduction. The diagnosis and the treatment of transsexualism, particularly during adolescence, generate considerable discussion among specialists. Many health and legal professionals have not yet reached a strong consensus on medical treatment for juvenile transsexuals. Hormonal therapy cannot only represent a medical procedure to adjust the somatic sex to the psychological gender, but can also be a reasonable means of preventing some juvenile transsexuals from engaging in undesirable and risky behavior. Aim. To report the cases of two transsexual adolescents who resorted to prostitution to afford hormonal medications when treatment was denied because of age criteria. Results. Hormonal medications were not recommended by the endocrinology staff because specific laws regulating this medical procedure for juvenile transsexuals in Brazil are lacking. In response, these adolescents chose to use illegally obtained sex hormones to treat themselves. Conclusions. We propose ""harm reduction"" as a means of coping with this dilemma in some cases. Baltieri DA, Cortez FCP, and de Andrade AG. Ethical conflicts over the management of transsexual adolescents-report of two cases. J Sex Med 2009;6:3214-3220.

Percutaneous ultrasound-guided renal biopsy in children - safety, efficacy, indications and renal pathology findings: 14-year Brazilian university hospital

Introduction: Pediatric percutaneous renal biopsy (Bx) is a routine procedure in pediatric nephrology to obtain renal tissues for histological study. We evaluated the safety, efficacy, indications and renal findings of this procedure at a tertiary care pediatric university hospital and compared our findings with the literature. Methods: Retrospective study based on medical records from January 1993 to June 2006. Results: In the study period, 305 Bx were performed in 262 patients, 127 (48.5%) male, aged 9.8 +/- 4.2 years. A 16-gauge needle was utilized in 56/305 Bx, an 18-gauge needle in 252/305 Bx (82.6%). 56.1% Bx were performed under sedation plus local anesthesia, 43.9% under general anesthesia. The number of punctures per Bx was 3.1 +/- 1.3. Minor complications occurred in 8.6% procedures. The 16-gauge needle caused a higher frequency of renal hematomas (p = 0.05). The number of glomeruli per puncture was >= 5 in 96.7% and >= 7 in 92%. Glomeruli number per puncture and frequency of complications were not different according to the type of anesthesia used. A renal pathology diagnosis was achieved in 93.1% Bx. The main indications of Bx were nephrotic syndrome (NS), lupus nephritis (LN) and hematuria (HE). The diagnosis of minimal change disease (MCD) (61.3%), class V (35.6%) and IgA nephropathy (26.3%) predominated in NS, LN and HE patients, respectively. Conclusion: Pediatric real-time ultrasound-guided percutaneous renal biopsy was safe and effective. The main clinical indications for Bx were NS and LN, the predominant renal pathology diagnoses were MCD and class V LN.

Risk factors for dental erosion in a group of 12- and 16-year-old Brazilian schoolchildren

Background. Dental erosion is a multifactorial disease and is associated with dietary habits in infancy and adolescence. Aim. To investigate possible associations among dental erosion and diet, medical history and lifestyle habits in Brazilian schoolchildren. Design. The sample consisted of a random single centre cluster of 414 adolescents (12- and 16-years old) of both genders from private and public schools in Bauru (Brazil). The O`Brien [Children`s Dental Health in the United Kingdom, 1993 (1994) HMSO, London] index was used for dental erosion assessment. Data on medical history, rate and frequency of food and drinks consumption, and lifestyle habits were collected by a self-reported questionnaire. Odds ratios with 95% confidence intervals were used to assess the univariate relationships between variables. Analysis of questionnaire items was performed by multiple logistic regression analysis. The statistical significance level was set at 5%. Results. The erosion present group comprised 83 subjects and the erosion absent group 331. There were no statistically significant correlations among dental erosion and the consumption of food and drinks, medical history, or lifestyle habits. Conclusion. The results indicate that there was no correlation between dental erosion and the risk factors analysed among adolescents in Bauru/Brazil and further investigations are necessary to clarify the multifactorial etiology of this condition.

Information internalisation in internationalising the firm

Internationalisation occurs when the firm expands its selling, production, or other business activities into international markets. Many enterprises, especially small- and medium-size firms (SMEs), are internationalising today at an unprecedented rate. Managers are strategically using information to achieve degrees of internationalisation previously considered the domain of large firms. We extend existing explanations of firm internationalisation by examining the nature and fundamental, antecedent role of internalising appropriate information and translating it into relevant knowledge. Based on case studies of internationalising firms, we advance a conceptualisation of information internalisation and knowledge creation within the firm as it achieves internationalisation readiness. In the process, we offer several propositions intended to guide future research. (C) 2002 Elsevier Science Inc. All rights reserved.

Incidence, characteristics, and predictive factors for dysphagia after pediatric traumatic brain injury

Objective: (1) To establish an incidence figure for dysphagia in a population of pediatric traumatic brain injury (TBI) cases; (2) to provide descriptive data on the admitting characteristics, patterns of resolution, and outcomes of children with and without dysphagia after TBI; and (3) to identify any factors present at admission that may predict dysphagia. Participants: A total of 1, 145 children consecutively admitted to an acute care setting for traumatic brain injury between July 1995 and July 2000. Main outcome measure: Medical parameters relating to dysphagia based on medical chart review. Results: (1) Dysphagia incidence figure of 5.3% across all pediatric head injury admissions. Incidence figures of 68% for severe TBI, 15% for moderate TBI, and only 1% for mild brain injury. (2) Statistically significant differences were found between the dysphagic and nondysphagic subgroups on the variables of length of stay, length of ventilation, Glasgow Coma Scale (GCS), computed tomography classification, duration of speech pathology intervention, supplemental feeding duration, duration until initiation of oral intake (DIOF), duration to total oral intake (DTOF), and period of time from the initiation of intake until achievement of total oral intake (DI-TOF). (3) Significant predictive factors for dysphagia included GCS < 8.5 and a ventilation period in excess of 1.5 days. Conclusion: The provision of incidence data and predictive factors for dysphagia will enable clinicians in acute care settings to allocate resources necessary to deal with the predicted number of dysphagia cases in a pediatric population, and assist in predicting patients who are at risk for dysphagia following TBI. Early detection of patients with swallowing dysfunction will be aided by these data, in turn helping to facilitate effective medical and speech pathology intervention via assisting the reduction of medical complications such as aspiration pneumonia.

Protecção contra descargas atmosféricas: aplicação informática de identificação das vulnerabilidades das edificações e de apoio à concepção da protecção

A concepção de instalações eléctricas deve garantir condições de segurança para as pessoas e equipamentos. Para tal é exigida, quer por força de regulamentação ou de normalização, a instalação de dispositivos que garantam a detecção e a protecção contra os defeitos mais comuns nas instalações eléctricas como, por exemplo, as sobreintensidades e as sobretensões. Susceptíveis de criar sobretensões perigosas nas instalações eléctricas, as descargas atmosféricas podem ainda causar danos estruturais elevados, o que, em algumas actividades económicas, torna fundamental a implementação de medidas de protecção contra este fenómeno natural. A protecção contra descargas atmosféricas directas consiste em identificar as vulnerabilidades das estruturas e, nesses locais, implementar dispositivos de captura, direccionamento e escoamento da descarga atmosférica à terra, em condições de segurança. O presente trabalho, desenvolvido no âmbito da dissertação de Mestrado em Engenharia Electrotécnica, visa desenvolver e implementar uma ferramenta computacional, baseada em programas de desenho assistido por computador (CAD) de utilização corrente na área de projecto de arquitectura e de engenharia, que permita, no âmbito de normas internacionais, a análise e implementação de sistemas de protecção em edifícios contra descargas atmosféricas de uma forma rápida e expedita. Baseado num programa CAD 3D, que permite a modelização tridimensional das estruturas a proteger, a ferramenta desenvolvida tentará identificar as suas vulnerabilidades das estruturas às descargas atmosféricas directas, com o intuito de implementar as medidas de protecção mais adequadas do ponto de vista técnico económico. Prevê-se que a ferramenta resultante deste estudo, o Simulador do Modelo Electrogeométrico (SIMODEL), possibilite aos projectistas e particularmente aos alunos das unidades curriculares na área do projecto de instalações eléctricas da Área Departamental de Engenharia de Sistemas e Potencia e Automação (ADESPA) do ISEL, estudar e implementar sistemas de protecção contra descargas atmosféricas (SPDA) baseados na normalização internacional do CENELEC e da IEC, nomeadamente as normas da série 62305.

Reasoning and proof in classroom (9th grade)

This paper is research oriented and pretends to contribute toward giving empirical evidence about how students develop their reasoning and how they achieved to a proof construction in school context. Its main theme is epistemology. It describes the way in which four students in 9th Grade explored a task related with the discovery of symmetry axes in various geometric figures. The proof constructed by students had essentially an explaining function and it was related with the symmetry axes of regular polygons. The teacher’s role in meaning negotiation of the proof and its need is described through illustrative episodes. The paper presents part of a study which purpose is to analyse the nature of mathematical proof in classroom, its role and the nature of the relationship between the construction of a proof and the social interactions. Assuming a social perspective, attention is focussed on the social construction of knowledge and on the structuring resources that shape mathematical experience. The study’s methodology has an interpretative nature. One outcome of the study discussed here is that students develop first a practical understanding with no awareness of the reasons founding mathematical statements and after a theoretical one leading them to a proof elaboration.

An architecture for an effective usage of data mining in business intelligence systems

Business Intelligence (BI) is one emergent area of the Decision Support Systems (DSS) discipline. Over the last years, the evolution in this area has been considerable. Similarly, in the last years, there has been a huge growth and consolidation of the Data Mining (DM) field. DM is being used with success in BI systems, but a truly DM integration with BI is lacking. Therefore, a lack of an effective usage of DM in BI can be found in some BI systems. An architecture that pretends to conduct to an effective usage of DM in BI is presented.

Avaliação do desempenho de um sistema híbrido de tomografia por emissão de positrões e tomografia computorizada

Mestrado em Medicina Nuclear.

Da escrita do nome à escrita de textos: estratégias de abordagem à escrita na educação Pré-Escolar e 1º ciclo do Ensino Básico

Mestrado (PES II), Educação Pré-Escolar e Ensino do 1º Ciclo do Ensino Básico, 27 de Junho de 2014, Universidade dos Açores.

Resolução do problema do escalonamento da produção de energia eléctrica usando programação lógica por restrições

A operação dos Mercados de Energia Eléctrica passa, actualmente, por uma profunda reestruturação, com o principal foco nas transacções do sistema de transmissão entre os diferentes agentes. Tendo isso em conta, o serviço de transmissão neste novo esquema de funcionamento do Mercado de Energia Eléctrica deve ser provido de máxima eficiência económica, atendendo sempre às restrições de segurança do sistema. Com esta reorganização do sector eléctrico da última década surgiu também a necessidade de rever os modelos tradicionais de optimização económica do Sistema Eléctrico de Energia, como por exemplo o despacho e prédespacho (unit commitment). A reestruturação e liberalização dos mercados de energia eléctrica trouxeram novas restrições a alguns dos problemas tradicionais associados aos Sistemas Eléctricos de Energia. Um desses problemas é o Escalonamento da Produção de Energia Eléctrica, que no contexto actual, implica quase sempre negociação entre os diferentes agentes do mercado e consequentemente reescalonamento. A maioria dos métodos usados para a resolução do problema não permitem reformular o prédespacho, algo para que a Programação Lógica por Restrições é extremamente adequada. O trabalho desenvolvido nesta dissertação visa criar uma aplicação computacional com base na Programação Lógica por Restrições, através da plataforma ECLiPSe, para resolver o problema do Escalonamento da Produção de Energia Eléctrica dos grupos térmicos, demonstrando assim a versatilidade e flexibilidade deste tipo de programação aplicada a problema combinatoriais deste género.