Use of automated external defibrillators in a Brazilian airline. A 1-year experience

After the incorporation of automated external defibrilators by other airlines and the support of the Brazilian Society of cardiology, Varig Airlines Began the onboard defibrilation program with the initial purpose of equiping wide-body aircrafts frequently used in international flights and that airplanes use in the Rio - São Paulo route. With all fight attendants trained, the automated. External defibrilation devides were incorporated to 34 airplanes of a total pleet of 80 aircrats. The devices were intalled in the bagage compartments secured with velero straps and 2 pairs of electrods, one or which pre-conected to the device to minimize application time. Later, a portable monitor was addres to the ressocitation kit in the long flights. The expansion of the knowledge of the basic life support fundamentors and the correted implantation of the survival chain and of the automated external defibrilators will increase the extense of recovery of cardiorespiratory arrest victins in aircrafts.

Trends in death from circulatory diseases in Brazil between 1979 and 1996

OBJECTIVE: To analyze the trends in mortality due to circulatory diseases in men and women aged > or = 30 years in Brazil from 1979 to 1996. METHODS: We analyzed population count data obtained from the IBGE Foundation and mortality data obtained from the System of Information on Mortality of the DATASUS of the Ministry of Health. RESULTS: Circulatory diseases, ischemic heart disease, and cerebrovascular disease were the major causes of death in men and women in Brazil. The standardized age coefficient for circulatory disease in men aged > or = 30 years ranged from 620 to 506 deaths/100,000 inhabitants and in women from 483 to 383 deaths/100,000 inhabitants for the years 1979 and 1996, respectively. In men, the mean coefficient for the period was 586.25 deaths with a significant trend towards a decrease (P<0.001) and a decline of 8.25 deaths/year. In women, the mean coefficient for the period was 439.58 deaths, a significant trend towards a decrease (P<0.001) and a rate of decline of 7.53 deaths/year. The same significant trend towards a decrease in death (P<0.001) was observed for ischemic heart disease and cerebrovascular disease. Risk of death from these causes was always higher for men of any age group (P<0.001). Cerebrovascular disease was the primary cause of death in women. CONCLUSION: Although circulatory diseases have been the major cause of mortality in men and women in the Brazilian population, with a greater participation by cerebrovascular diseases, a trend towards a decrease in the risk of death from these causes is being observed.

Do cardiologists at a university hospital adopt the guidelines for the treatment of heart failure?

OBJECTIVE: To verify whether the guidelines for the treatment of heart failure have been adopted at a university hospital. The guidelines recommend the following: use of angiotensin-converting enzyme inhibitors for all patients with systolic ventricular dysfunction, use of digitalis and diuretics for symptomatic patients, use of beta-blockers for patients in functional classes II or III, use of spironolactone for patients in functional classes III or IV. METHODS: We analyzed the prescriptions of 199 patients. All these patients had ejection fraction (EF) <=0.50, their ages ranged from 25 to 86 years, and 142 were males. Cardiomyopathy was the most frequent diagnosis: 67 (33.6%) patients had dilated cardiomyopathy, 65 (32.6%) had ischemic cardiomyopathy. RESULTS: Angiotensin-converting enzyme inhibitors were prescribed for 93% of the patients. 71.8% also had a prescription for digitalis, 86.9% for diuretics, 27.6% for spironolactone, 12% for beta-blockers, 37.2% for acetylsalicylic acid, 6.5% for calcium channel antagonists, and 12.5% for anticoagulants. In regard to vasodilators, 71% of the patients were using captopril (85.2mg/day), 20% enalapril (21.4mg/day), 3% hydralazine and nitrates. In 71.8% of the cases, the dosages prescribed were in accordance with those recommended in the large studies. CONCLUSION: Most patients were prescribed the same doses as those recommended in the large studies. Brazilian patients tolerate well the doses recommended in the studies, and that not using these doses may be a consequence of the physician's fear of prescribing them and not of the patient's intolerance.

Use of oral antihypertensive medication preceding blood pressure elevation in hospitalized patients

OBJECTIVE: To evaluate the frequency of oral antihypertensive medication preceding the increase in blood pressure in patients in a university hospital, the drug of choice, and the maintained use of antihypertensive medication. METHODS: Data from January to June 1997 from the University Hospital Professor Edgard Santos Pharmacy concerning the prescriptions of all inpatients were used. Variables included in the analysis were: antihypertensive medication prescription preceding increase in blood pressure, type of antihypertensive medication, gender, clinical or surgical wards, and the presence of maintained antihypertensive medication. RESULTS: The hospital admitted 2,532 patients, 1,468 in surgical wards and 818 in medical wards. Antihypertensive medication prescription preceding pressure increase was observed in 578 patients (22.8%). Nifedipine was used in 553 (95.7%) and captopril in 25 (4.3%). In 50.7% of patients, prescription of antihypertensive medication was not associated with maintained antihypertensive medication. Prescription of antihypertensive drugs preceding elevation of blood pressure was significantly (p<0.001) more frequent on the surgical floor (27.5%; 405/1468) than on the medical floor (14.3%; 117/818). The frequency of prescription of antihypertensive drugs preceding elevation of blood pressure without maintained antihypertensive drugs and the ratio between the number of prescriptions of nifedipine and captopril were greater in surgical wards. CONCLUSION: The use of antihypertensive medication, preceding elevation of blood pressure (22.8%) observed in admitted patients is not supported by scientific evidence. The high frequency of this practice may be even greater in nonuniversity hospitals.

Assessment of splanchnic perfusion with gastric tonometry in the immediate postoperative period of cardiac surgery in children

OBJECTIVE - A prospective, nonrandomized clinical study to assess splanchnic perfusion based on intramucosal pH in the postoperative period of cardiac surgery and to check the evolution of patients during hospitalization. METHODS - We studied 10 children, during the immediate postoperative period after elective cardiac surgery. Sequential intramucosal pH measurements were taken, without dobutamine (T0) and with 5mcg/kg/min (T1) and 10 (T2) mcg/kg/min. In the pediatric intensive care unit, intramucosal pH measurements were made on admission and 4, 8, 12, and 24 hours thereafter. RESULTS - The patients had an increase in intramucosal pH values with dobutamine 10mcg/kg/min [7.19± 0.09 (T0), 7.16±0.13(T1), and 7.32±0.16(T2)], (p=0.103). During the hospitalization period, the intramucosal pH values were the following: 7.20±0.13 (upon admission), 7.27±0.16 (after 4 hours), 7.26±0.07 (after 8 hours), 7.32±0.12 (after 12 hours), and 7.38±0.08 (after 24 hours), (p=0.045). No deaths occurred, and none of the patients developed multiple organ and systems dysfunction. CONCLUSION - An increase in and normalization of intramucosal pH was observed after dobutamine use. Measurement of intramucosal pH is a type of monitoring that is easy to perform and free of complications in children during the postoperative period of cardiac surgery.

Predição do potencial genético de populações segregantes de arroz de terras altas

O objetivo deste trabalho foi avaliar o método de Jinks &amp; Pooni na predição do potencial genético de populações segregantes de arroz e estudar o efeito da interação populações segregantes x ambiente na seleção destas populações. Utilizaram-se 23 populações segregantes de arroz de terras altas e duas testemunhas, avaliadas em um látice 5x5, com três repetições, no ano agrícola de 1996/97. O estudo foi conduzido em dois locais em Minas Gerais, Lavras e Patos de Minas, em três épocas distintas de semeadura. Os resultados encontrados em relação à probabilidade de extrair linhagens superiores a um determinado padrão indicaram como mais promissoras as populações CNAx 5496 e CNAx 6001, e menos promissoras, CNAx 6063 e CNAx 6102. A previsão do potencial genético das populações segregantes a partir do método de Jinks &amp; Pooni mostrou-se uma alternativa viável na escolha das populações mais promissoras, permitindo ao melhorista concentrar maiores esforços na avaliação das famílias superiores. A ocorrência das interações populações segregantes x épocas e locais x épocas mostraram a importância de se avaliar as populações em mais de um ambiente. A escolha das populações que apresentam um comportamento estável frente às oscilações ambientais é importante dentro de um programa de melhoramento.

Controle genético e tolerância ao estresse de calor em populações híbridas e em cultivares de trigo

O objetivo deste trabalho foi obter informações sobre o controle genético da produtividade de grãos de trigo sob condições de estresse de calor, o grau de tolerância ao estresse de calor de algumas cultivares e linhagens e a identificação de populações segregantes promissoras para a obtenção de linhagens adaptadas às condições da região central do Brasil. Foram avaliados 13 parentais e 40 populações provenientes de um dialelo parcial, nas gerações F1 e F2 em condições de campo, em Lavras e Patos de Minas, MG, com as semeaduras feitas no verão (fevereiro) e no inverno (maio). Houve diferença de tolerância ao calor entre os parentais e entre as populações híbridas quanto ao caráter produção de grãos, e ambos os efeitos aditivos e não-aditivos foram importantes no controle genético deste caráter na presença ou ausência de calor. Apesar da ocorrência de interações populações x épocas de semeadura, a alta repetibilidade dos efeitos da capacidade geral de combinação permite inferir a possibilidade de acelerar os programas de melhoramento na região, efetuando-se a seleção tanto na época de verão quanto no inverno.

MUTANTES DE LARANJA - 'PÊRA' COM NÚMERO REDUZIDO DE SEMENTES, OBTIDOS ATRAVÉS DE MUTAÇÕES INDUZIDAS

A obtenção de cultivares de citros com pequeno número de sementes é importante quando o objetivo é a produção de frutas para o consumo in natura. O objetivo deste trabalho foi o de avaliar, por três anos (1997, 1998 e 1999), o número médio de sementes e 15 outras características agronômicas, de 127 mutantes putativos de laranja-'Pêra', selecionados após irradiação de borbulhas com raios-gama e 8 plantas selecionadas do controle não irradiado. Os mutantes foram divididos em 16 grupos baseados nos tipos de mutações observados e em cada grupo, como controle comum, foram incluídas plantas de laranja-'Pêra' comercial. Observou-se que 46 mutantes putativos e uma planta do controle não irradiado (PSC) apresentaram redução significativa no número de sementes por fruto, nos três anos consecutivos, sendo que 15 mutantes apresentaram frutos com média entre uma e duas sementes e 9 mutantes, frutos com média inferior a uma semente. Dentre estes 9 mutantes, os de número 27, 28 e 58, que apresentaram também alterações significativas no diâmetro de copa ou na altura de planta, além do 59 e 101, que não apresentaram alterações nas outras 15 características avaliadas, possuem um maior potencial para serem lançados como novos mutantes de laranja-'Pêra' com pequeno número de sementes.

AVALIAÇÃO DE SETE PORTA-ENXERTOS MONO E POLIEMBRIÔNICOS SOB QUATRO CULTIVARES DE MANGUEIRA NO CERRADO BRASILEIRO

O melhoramento, visando à seleção de porta-enxertos com tendência ananicante para mangueira nas condições dos Cerrados, é de grande importância. As cultivares de manga para exportação Tommy Atkins e Haden, embora muito produtivas e com frutas de coloração excelente e polpa sem fibras, são muito vigorosas e de porte muito elevado, o que dificulta os tratos culturais e a colheita. O objetivo do trabalho foi obter o efeito interativo da copa x porta-enxerto sobre a altura da planta, sua produtividade e qualidade de frutas.

Implantação de um mini-pacs (sistema de arquivamento e distribuição de imagens) em hospital universitário

Este trabalho apresenta a implementação de um mini-PACS (sistema de arquivamento e comunicação de imagens) que está sendo estruturado junto ao Serviço de Radiodiagnóstico do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, como parte do projeto de um serviço de radiologia digital ("filmless").

La cultura contemporánea del sufrimiento

Puesto que el título elegido para este artículo es poco preciso, conviene advertir al lector qué se encontrará en las siguientes páginas. Lo que sigue forma parte de un estudio en curso sobre la experiencia contemporánea del sufrimiento. De los distintos aspectos de dicho estudio se han seleccionado aquí dos cuestiones: la distribución social del sufrimiento y la construcción de la experiencia del sufrimiento en las sociedades tardocapitalistas. La razón última de la combinación de estas dos cuestiones es explicar la percepción que hoy se tiene del sufrimiento ajeno y, también, del sufrimiento propio.

Pneumopericárdio após traumatismo penetrante: relato de três casos

Pneumopericardium after penetrating wound represents a high suspicion for cardiac wound. Some authors recommend thoracotomy to discharge a cardiac lesion. We present three cases of post-traumatic pneumopericardium one following a gunshot wound and two following a stab wound and discuss about diagnosis and treatment. None showed clinical signs of cardiac tamponade. Diagnosis was made by chest x-ray. Pneumopericardium was identified at the initial evaluation in two patients, who had concomitant hemothorax and underwent chest drainage. The patient with penetrating thoracic wound by gunshot pneumopericardium developed 24h after trauma. Treatment was directed to the associated lesions without specific measurements for pneumopericardium. This aproach was safe in these patients.

Pressure Drop in Vertical Core-Annular Flow

An experimental apparatus for the study of core annular flows of heavy oil and water at room temperature has been set up and tested at laboratory scale. The test section consists of a 2.75 cm ID galvanized steel pipe. Tap water and a heavy oil (17.6 Pa.s; 963 kg/m³) were used. Pressure drop in a vertical upward test section was accurately measured for oil flow rates in the range 0.297 - 1.045 l/s and water flow rates ranging from 0.063 to 0.315 l/s. The oil-water input ratio was in the range 1-14. The measured pressure drop comprises gravitational and frictional parts. The gravitational pressure drop was expressed in terms of the volumetric fraction of the core, which was determined from a correlation developed by Bannwart (1998b). The existence of an optimum water-oil input ratio for each oil flow rate was observed in the range 0.07 - 0.5. The frictional pressure drop was modeled to account for both hydrodynamic and net buoyancy effects on the core. The model was adjusted to fit our data and shows excellent agreement with data from another source (Bai, 1995).