Determinant factors for mortality of patients receiving mechanical ventilation and effects of a protocol muscle training in weaning

Introduction: Prognostic factors are used in the Intensive Care Unit (ICU) to predict morbidity and mortality , especially in patients on mechanical ventilation (MV ) . Training protocols are used in MV patients with the aim of promoting the success of the weaning process. Objective: To assess which variables determine the outcome of patients undergoing mechanical ventilation and compare the effects of two protocols for weaning. Method: Patients under MV for more than 48 hours had collected the following information: sex, age , ideal weight, height , Acute Physiology and Chronic Health Evaluation (APACHE II), risk of mortality, Glasgow Coma Scale (GCS) and index Quick and perfunctory (IRRS) breathing. Patients with unsuccessful weaning performed one of weaning protocols: Progressive T - tube or tube - T + Threshold ® IMT. Patients were compared for outcome (death or non- death in the ICU ) and the protocols through the t test or Mann-Whitney test was considered significant when P <0.05. Results: Of 128 patients evaluated 56.25% were men, the mean age was 60.05 ± 17.85 years and 40.62 % patients died, and they had higher APACHE II scores, mortality risk, time VM and IRRS GCS and the lower value (p<0.05). The age, initial and final maximal inspiratory pressure, time of weaning and duration of MV was similar between protocols. Conclusion: The study suggests that the GCS, APACHE II risk of mortality, length of MV and IRRS variables determined the evolution of MV patients in this sample. Not found differences in the variables studied when comparing the two methods of weaning.

Embolization of splenorenal shunt associated to portal vein thrombosis and hepatic encephalopathy

Hepatic encephalopathy (HE) is a cognitive disturbance characterized by neuropsychiatric alterations. It occurs in acute and chronic hepatic disease and also in patients with portosystemic shunts. The presence of these portosystemic shunts allows the passage of nitrogenous substances from the intestines through systemic veins without liver depuration. Therefore, the embolization of these shunts has been performed to control HE manifestations, but the presence of portal vein thrombosis is considered a contraindication. In this presentation we show a cirrhotic patient with severe HE and portal vein thrombosis who was submitted to embolization of a large portosystemic shunt. Case report: a 57 years-old cirrhotic patient who had been hospitalized many times for persistent HE and hepatic coma, even without precipitant factors. She had a wide portosystemic shunt and also portal vein thrombosis. The abdominal angiography confirmed the splenorenal shunt and showed other shunts. The larger shunt was embolized through placement of microcoils, and the patient had no recurrence of overt HE. There was a little increase of esophageal and gastric varices, but no endoscopic treatment was needed. Since portosystemic shunts are frequent causes of recurrent HE in cirrhotic patients, portal vein thrombosis should be considered a relative contraindication to perform a shunt embolization. However, in particular cases with many shunts and severe HE, we found that one of these shunts can be safely embolized and this procedure can be sufficient to obtain a good HE recovery. In conclusion, we reported a case of persistent HE due to a wide portosystemic shunt associated with portal vein thrombosis. As the patient had other shunts, she was successfully treated by embolization of the larger shunt. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.

Mecânica quântica e sua relação com terapias alternativas

Este trabalho propôs uma discussão crítica sobre os conceitos e fenômenos da Mecânica Quântica (MQ) empregados na explicação cientifíca que dá suporte quanto ao princípio de funcionamento de algumas terapias alternativas ou sobre a elaboração de seus respectivos medicamentos, em especial, Homeopatia e Cura Quântica. Essa discussão se faz importante para munir o leitor com argumentos sólidos calcados na teoria quântica e confrontá-los coma as ideias de simpatizantes leigos dessas terapias. Portanto, o trabalho visou descrever fatos históricos que tornaram possível a construção teórica da Mecânica Quântica, elaborou um resumo da loso a dominante que norteava o pensamento imediatamente anterior a MQ e o conflito que se seguiu em decorrência das implicações deste novo ramo da Física. Explorou o paradoxo EPR e o consequente teorema de John Bell sobre as desigualdades até chegar no experimento de Alain Aspect envolvendo laser para responder de forma prática e definitiva o paradoxo EPR. Finalmente, o trabalho apresentou um resumo das abordagens e argumentações defendidas pelos proponentes das terapias alternativas e confrontou com os conceitos da Mecânica Quântica, para enfim apresentar ao público um estudo científico sobre Homeopatia e Cura Quântica, e compreender os limites e equívocos empregados a essas terapias

Lipidose hepática felina

Feline hepatic lipidosis or fatty liver disease is a cholestatic syndrome that affects domestic cats and is characterized by excess fat accumulation in the liver of cats. Symptoms commonly seen with this syndrome are anorexia, weight loss, lethargy, vomiting, jaundice, and occasionally behavioral or neurologic signs such as excessive drooling, blindness, coma, and seizures. The diagnosis is based on the patient history, clinical examination, complementary examination, and the definitive diagnosis is obtained by cytology and/or histopathology of hepatic tissue. In serum biochemistry, the main findings include increased serum alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate amino transferase (AST) and bilirubin. The gamma glutamyl transferase (GGT) is normal or slightly increased. The cornerstone of therapy is aggressive feeding to supply the cat full caloric requirements. Without aggressive nutritional support and intensive monitoring the fatty liver disease can be fatal

Simulação de modelagem qualitativa para avaliação preliminar da qualidade da água na Bacia do Ribeirão das Perdizes em Campos do Jordão/SP, como subsídio ao enquadramento

The purpose of this research was to present the principles for the implementation of a future water body classification program at the UGRHI-1 (Management Unit of Water Resources-1/São Paulo, Brazil) using qualitative and quantitative water modeling. Our study area was in Campos do Jordão, a city in the state of São Paulo, specifically in the Perdizes river watershed, which is included in the UGRHI-1. The water quality assessment used a modeling mehtodology that can support a future study for the classification of water bodies in the region. The behavior of DO and BOD parameters was assessed in the water quality scenarios, considering the variations of flows, loads, reductions in withdrawals and different efficiencies in sewage treatment. The model used was QUAL2E developed by USEPA (United States Environmental Protection Agency) that received a new graphic interface named QUAL2R model. The reference flows Q7,10, Q95% and Qm used were obtained through the DAEE (Department of Water and Electric Energy) hydrologic regionalization method. It was noted that of the 9 proposed scenarios, only scenario 6 that was predicted in the flow regime Qm with the existence of a treatment system capable of removing 93% of the BOD, in the Perdizes River remained 67.5% of the time in class 2. Scenario 8 predicted a 50% reduction in In scenario 8 a reduction of 50% in the flow captured in CA-04, associated with the efficiency of 93% of BOD removal keeping the river in class 2. In scenario 9 the minimum required efficiency in sewage treatment in the flow regime Q95% for keeping the river in class 2 was also calculated and the value of 94.7% was obtained.

Predicting vasospasm after aneurismal subarachnoid hemorrhage with C reactive protein levels

Aim: The interest of inflammatory marker increased in the last years, even in preventing clinical outcome after subarachnoid hemorrhage (SAH). Our objective was to study the relationships between C-reactive protein levels and clinical outcome and the development of cerebral vasospasm after aneurismal SAH. Methods: One hundred adult patients with aneurismal SAH were prospectively evaluated. Glasgow Coma Scale (GCS) score, Hunt and Hess grade, Fisher grade, CT scans, digital subtraction angiography studies, transcranial doppler (TCD) and daily neurological examinations were recorded. Serial serum CRP measurements were obtained on daily between admission and 10th days. Glasgow Outcome Scale (GOS) and the modified Rankin Scale (mRS) were used to predict outcome. Results: A progressive increase in the CRP levels from the admission to the 3rd postictal day was observed, followed by a slow decrease until the 9th day. Hemodynamic changes in TCD were associated with higher serum CRP levels. Patients with lower GCS scores presented with increased CRP levels. Patients with higher Hunt and Hess grades on admission developed significantly higher CRP serum levels. Patients with higher admission Fisher grades showed increased levels of CRP. A statistically significant inverse correlation was established in our series between CRP serum levels and GOS and mRS scores on discharge and CRP levels. Conclusion: Increased CRP levels were strongly associated with poor clinical outcome. CRP levels can predict cerebral vasospasm and delayed ischemic deficits with higher statistic significance. There are relationships between hemodynamic chances in TCD and higher CRP levels.

Plantas de cobertura, adubação nitrogenada e produção de sementes de feijoeiro

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Using the National Institute of Health Stroke Scale to Predict Dysphagia in Acute Ischemic Stroke

Background and Purpose: Oropharyngeal dysphagia is a common manifestation in acute stroke. Aspiration resulting from difficulties in swallowing is a symptom that should be considered due to the frequent occurrence of aspiration pneumonia that could influence the patient's recovery as it causes clinical complications and could even lead to the patient's death. The early clinical evaluation of swallowing disorders can help define approaches and avoid oral feeding, which may be detrimental to the patient. This study aimed to create an algorithm to identify patients at risk of developing dysphagia following acute ischemic stroke in order to be able to decide on the safest way of feeding and minimize the complications of stroke using the National Institutes of Health Stroke Scale (NHISS). Methods: Clinical assessment of swallowing was performed in 50 patients admitted to the emergency unit of the University Hospital, Faculty of Medicine of Ribeirao Preto, Sao Paulo, Brazil, with a diagnosis of ischemic stroke, within 48 h after the beginning of symptoms. Patients, 25 females and 25 males with a mean age of 64.90 years (range 26-91 years), were evaluated consecutively. An anamnesis was taken before the patient's participation in the study in order to exclude a prior history of deglutition difficulties. For the functional assessment of swallowing, three food consistencies were used, i.e. pasty, liquid and solid. After clinical evaluation, we concluded whether there was dysphagia. For statistical analysis we used the Fisher exact test, verifying the association between the variables. To assess whether the NIHSS score characterizes a risk factor for dysphagia, a receiver operational characteristics curve was constructed to obtain characteristics for sensitivity and specificity. Results: Dysphagia was present in 32% of the patients. The clinical evaluation is a reliable method of detection of swallowing difficulties. However, the predictors of risk for the swallowing function must be balanced, and the level of consciousness and the presence of preexisting comorbidities should be considered. Gender, age and cerebral hemisphere involved were not significantly associated with the presence of dysphagia. NIHSS, Glasgow Coma Scale, and speech and language changes had a statistically significant predictive value for the presence of dysphagia. Conclusions: The NIHSS is highly sensitive (88%) and specific (85%) in detecting dysphagia; a score of 12 may be considered as the cutoff value. The creation of an algorithm to detect dysphagia in acute ischemic stroke appears to be useful in selecting the optimal feeding route while awaiting a specialized evaluation. Copyright (C) 2012 S. Karger AG, Basel

Serum C-reactive protein levels predict neurological outcome after aneurysmal subarachnoid hemorrhage

Objectives: Our aim was to evaluate the relationship between serum C-reactive protein (CRP) levels and the neurological prognosis and development of vasospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods: Eighty-two adult patients with aSAH diagnoses were prospectively evaluated. Glasgow Coma Scale (GCS) score, Hunt and Hess grade, Fisher grade, cranial CT scans, digital subtraction angiography studies and daily neurological examinations were recorded. Serial serum CRP measurements were obtained daily between admission and the tenth day. Glasgow Outcome Scale (GOS) and the modified Rankin Scale (mRS) were used to assess the prognosis. Results: Serum CRP levels were related to severity of aSAH. Patients with lower GCS scores and higher Hunt and Hess and Fisher grades presented statistically significant higher serum CRP levels. Patients with higher serum CRP levels had a less favorable prognosis. Conclusions: Increased serum CRP levels were strongly associated with worse clinical prognosis in this study.

Whole-body computerized tomography and concomitant spine and head injuries A study of 355 cases

The authors present a prospective study on the coexistence of spinal injury (SI) and severe traumatic brain injury (TBI) in patients who were involved in traffic accidents and arrived at the Emergency Department of Hospital das Clinicas of the University of Sao Paulo between September 1, 2003 and December 31, 2009. A whole-body computed tomography was the diagnostic method employed in all cases. Both lesions were observed simultaneously in 69 cases (19.4%), predominantly in males (57 individuals, 82.6%). Cranial injuries included epidural hematoma, acute subdural hematoma, brain contusion, ventricular hemorrhage and traumatic subarachnoid hemorrhage. The transverse processes were the most fragile portion of the vertebrae and were more susceptible to fractures. The seventh cervical vertebra was the most commonly affected segment, with 24 cases (34.78%). The distribution of fractures was similar among the other cervical vertebrae, the first four thoracic vertebrae and the lumbar spine. Neurological deficit secondary to SI was detected in eight individuals (11.59%) and two individuals (2.89%) died. Traumatic subarachnoid hemorrhage was the most common intracranial finding (82.6%). Spinal surgery was necessary in 24 patients (34.78%) and brain surgery in 18 (26%). Four patients (5.79%) underwent cranial and spinal surgeries. The authors conclude that it is necessary a judicious assessment of the entire spine of individuals who presented in coma after suffering a brain injury associated to multisystemic trauma and whole-body CT scan may play a major role in this scenario.

Corneal wavefront-guided photorefractive keratectomy with mitomycin-C for hyperopia after radial keratotomy: Two-year follow-up

PURPOSE: To assess corneal wavefront-guided photorefractive keratectomy (PRK) to correct hyperopia after radial keratotomy (RK). SETTING: Sadalla Amin Ghanem Eye Hospital, Joinville, Santa Catarina, Brazil. DESIGN: Case series. METHODS: Excimer laser corneal wavefront-guided PRK with intraoperative mitomycin-C (MMC) 0.02% was performed. Main outcome measures were uncorrected (UDVA) and corrected (CDVA) distance visual acuities, spherical equivalent (SE), corneal aberrations, and haze. RESULTS: The mean time between RK and PRK in the 61 eyes (39 patients) was 18.8 years +/- 3.8 (SD). Before PRK, the mean SE was +4.17 +/- 1.97 diopters (D); the mean astigmatism, -1.39 +/- 1.04 D; and the mean CDVA, 0.161 +/- 0.137 logMAR. At 24 months, the mean values were 0.14 +/- 0.99 D (P<.001), -1.19 +/- 1.02 D (P=.627), and 0.072 +/- 0.094 logMAR (P<.001), respectively; the mean UDVA was 0.265 +/- 0.196 (P<.001). The UDVA was 20/25 or better in 37.7% of eyes and 20/40 or better in 68.9%. The CDVA improved by 1 or more lines in 62.3% of eyes. Two eyes (3.3%) lost 2 or more lines, 1 due to corneal ectasia. Thirty eyes (49.2%) were within +/- 0.50 D of intended SE and 45 (73.8%) were within +/- 1.00 D. From 6 to 24 months, the mean SE regression was +0.39 D (P<.05). A significant decrease in coma, trefoil, and spherical aberration occurred. Three eyes developed peripheral haze more than grade 1. CONCLUSION: Corneal wavefront-guided PRK with MMC for hyperopia after RK significantly improved UDVA, CDVA, and higher-order corneal aberrations with a low incidence of visually significant corneal haze.

Fatores associados ao óbito de motociclistas nas ocorrências de trânsito

Para identificar fatores associados ao óbito em motociclistas envolvidos em ocorrências de trânsito, em Maringá-PR, foi realizado estudo retrospectivo incluindo os motociclistas envolvidos em acidentes no ano de 2004. As fontes de dados foram os registros da Polícia Militar, do SIATE e do Instituto Médico Legal. Foram realizadas análises bivariadas e regressão logística binária. Identificaram-se 2.362 motociclistas nos Boletins de Ocorrência e, destes, 1.743 tinham registros nos Relatórios de Atendimento do Socorrista. As vítimas fatais diferiram das demais quanto à faixa etária, ao local de residência, ao tempo de habilitação e as suas condições fisiológicas na cena da ocorrência. No modelo final permaneceram as seguintes variáveis: Escala de Coma de Glasgow (ECGl), Revised Trauma Score (RTS), pulso e saturação de O2 no sangue. As condições fisiológicas das vítimas na cena do acidente se destacaram no modelo final e a ECGl superou o RTS na associação com óbito.

Amnésia pós-traumática e qualidade de vida pós-trauma

Este estudo compara a qualidade de vida das vítimas que apresentaram amnésia pós-traumática de longa duração com as demais e analisa a relação entre qualidade de vida e duração da amnésia pós-traumática, computando ou não o período de coma. Estudo de coorte prospectivo, com coleta de dados durante a internação hospitalar e avaliação da qualidade de vida no período de estabilidade da recuperação pós-traumática. Participaram desta investigação vítimas de trauma crânio-encefálico contuso, maiores de 14 anos, sem antecedentes de demência ou trauma crânio-encefálico, internadas em hospital de referência para atendimento de trauma nas primeiras 12 horas pós-evento. Os resultados referentes à qualidade de vida foram mais desfavoráveis em três domínios do grupo com amnésia de longa duração. Correlações entre duração da amnésia e domínios de qualidade de vida foram mais expressivas quando excluído o período de coma, indicando que este tempo não deve ser computado na duração da amnésia pós-traumática.

¿Qué he hecho yo para merecer esto?

Seis videos a color. I Jornadas de Enfermería celebradas en Lanzarote entre los días 8 al 10 de octubre de 1992, bajo el título de ¿Qué he hecho yo para merecer esto?, con sedes en el Auditorio de los Jameos del agua y en Sala de Audiencia del Fondeadero del Puerto del Carmen ?Tías, se presentaron distintas ponencias y comunicaciones a las mismas, con títulos tan sugerentes como: Dos enfermeras y un programa, ¿Me dejas que te coma el coco?, Yo soy esa, Y yo con estos pelos, ¿Quién, cómo, cuándo y dónde?, La bien pagá, Suave que me estás matando, Ha nacido una estrella, Nena, tu vales mucho, Lo que era, lo que soy, que seré, Quiéreme aunque te duela, Si tú me dices ven, Cuentos inmorales entre otras. Organizadas por la Dirección de Enfermería Hospital General de Lanzarote, la Escuela Universitaria de Enfermería Lanzarote de la Universidad de Las Palmas de Gran Canaria y el Ilustre Colegio Oficial de Enfermería de Las Palmas. En el acto de apertura se contó con la Coral San Ginés y se cerraron con una mesa redonda. Es una grabación de Producciones Nandi.

Come città dell'infanzia. Architettura, educazione e immagine in due colonie per i figli degli Italiani all'estero a Cattolica e Tirrenia

The present doctoral dissertation deals with two significant case studies of Italian holiday camps which appear as interesting architectural experiences that reflect both the pedagogic and educational programmes of the fascist regime, and the discussion on the constructive and expressive principles that characterize the Italian architecture during the Thirties. The research explains the colony "XXVIII October for the sons of the Italian workers living abroad", today known as "Le Navi" ("The Ships"), built in Cattolica in 1934 and projected by the Roman architect Clemente Busiri Vici, and the feminine colony "for the sons of the Italian workers living abroad" built in 1934 in Tirrenia and projected by the architects Mario Paniconi and Giulio Pediconi. These holiday camps are the sole buildings commissioned directly by the Department in the Italian Foreign Office with the aim of offering a seaside stay to the sons of the Italians living in the colonies who, probably, could visit Italy only one time in their life. Firstly, the work illustrates the most relevant themes concerning these holiday camps, such as the representative intents that the buildings evoked to the children attending the places. Sun-bathing and group gymnastics were some of the rituals in the communal life, where order and discipline gave a precise internal organization to the spaces. Over the correspondence to practical functions, the figures and the forms of the different spaces of the buildings involve the children in an educational dimension. Subsequently, the function of the Department in the Italian Foreign Office and the planning and constructive ideas of the two colonies will be introduced. These colonies were conceived by a precise social project with educational, welfare and therapeutic aims. The elements, the spaces and the volumes create a fixed and theatrical scene of the life, full of ideological, political and celebratory overtones. Finally, the research shows that the relation between the architectural shape of the buildings and the rituals performed by fascist tutors produces an ideal space, extraneous to the external world that could influence the behavior of the children. The plan is to transmit to the children an image of Italy that will remain engraved in their minds once they have returned to their countries. In these projects there is the intent to transmit the image of "italianity" abroad. The way to do this was to plan for them a scenery which contains all the architectural elements of Italian cities. The holiday camps are proposed a sort of microcosm that appears as an "evocation" of the places and the spaces of Italian cities. The buildings appear as veritable "cities of childhood".