Mapping soil pollution by spatial analysis and fuzzy classification

Spatial analysis and fuzzy classification techniques were used to estimate the spatial distributions of heavy metals in soil. The work was applied to soils in a coastal region that is characterized by intense urban occupation and large numbers of different industries. Concentrations of heavy metals were determined using geostatistical techniques and classes of risk were defined using fuzzy classification. The resulting prediction mappings identify the locations of high concentrations of Pb, Zn, Ni, and Cu in topsoils of the study area. The maps show that areas of high pollution of Ni and Cu are located at the northeast, where there is a predominance of industrial and agricultural activities; Pb and Zn also occur in high concentrations in the northeast, but the maps also show significant concentrations of Pb and Zn in other areas, mainly in the central and southeastern parts, where there are urban leisure activities and trade centers. Maps were also prepared showing levels of pollution risk. These maps show that (1) Cu presents a large pollution risk in the north-northwest, midwest, and southeast sectors, (2) Pb represents a moderate risk in most areas, (3) Zn generally exhibits low risk, and (4) Ni represents either low risk or no risk in the studied area. This study shows that combining geostatistics with fuzzy theory can provide results that offer insight into risk assessment for environmental pollution.

Identificação de dificuldades no início do aleitamento materno mediante aplicação de protocolo

Objetivo: dimensionar o grupo de mães/recém-nascidos com necessidades especiais de apoio para um início bem sucedido do aleitamento materno, mediante aplicação de protocolo preconizado pelo UNICEF, e verificar práticas assistenciais associadas com dificuldades no aleitamento materno. Metodologia: trata-se de um estudo transversal, descritivo. A amostra foi constituída de 50 binômios mãe/recém-nascido, selecionados mediante sorteio, em maternidade que atende ao parto de baixo risco pelo SUS. Utilizando protocolo para observação e avaliação de mamada, foram registrados os comportamentos de cada dupla, computando-se a freqüência de comportamentos desfavoráveis ao aleitamento materno. A seguir, foram criados escores (bom, regular, ruim) para avaliar cada aspecto da mamada observada. Investigou-se também a associação entre determinadas práticas assistenciais e escores desfavoráveis. Adotou-se p < 0,05 como nível crítico. Resultados: a freqüência de binômios que apresentaram comportamentos sugestivos de sérias dificuldades (escore ruim) com o início do aleitamento materno variou entre 2% e 22%, conforme o aspecto da mamada avaliada. As dificuldades mais presentes foram a má posição corporal da mãe e do bebê durante a mamada e a inadequação da interação mãe/neonato. Tais dificuldades foram significativamente mais freqüentes quando o parto foi cirúrgico (p< 0,05). O uso de fórmula láctea e/ou soro glicosado também associou-se com piores escores em alguns aspectos da mamada. Conclusões: a aplicação do protocolo para a observação e avaliação de mamada identificou alta prevalência de binômios mãe/bebê com comportamentos sugestivos de dificuldades com o início da amamentação, em especial quando o parto foi cirúrgico e quando foram oferecidos suplementos ao neonato.

Relevância de exames de rotina em pacientes de baixo risco submetidos a cirurgias de pequeno e médio porte

JUSTIFICATIVA E OBJETIVOS: A avaliação pré-operatória tem como objetivos diminuir a morbimortalidade do paciente cirúrgico, o custo do atendimento perioperatório e a ansiedade pré-operatória. A partir da avaliação clínica deve-se definir a necessidade de exames complementares e estratégias para reduzir o risco anestésico-cirúrgico. O objetivo deste trabalho foi avaliar o benefício de exames de rotina pré-operatório de pacientes de baixo risco em cirurgias de pequeno e médio porte. MÉTODOS: Trata-se de um estudo descritivo, transversal, com 800 pacientes atendidos no consultório de avaliação pré-anestésica do Hospital Santo Antonio, Salvador, BA. Foram incluídos pacientes de 1 a 45 anos, estado físico ASA I, que seriam submetidos a cirurgias eletivas de pequeno e médio porte. Avaliaram-se alterações no hemograma, coagulograma, eletrocardiograma, RX de tórax, glicemia, função renal e dosagem de sódio e potássio e as eventuais mudanças de conduta que ocorreram decorrentes dessas alterações. RESULTADOS: Dos 800 pacientes avaliados, 97,5% fizeram hemograma, 89% coagulograma, 74,1% eletrocardiograma, 62% RX de tórax, 68% glicemia de jejum, 55,7% dosagens séricas de ureia e creatinina e 10,1% dosagens de sódio e potássio séricos. Desses 700 pacientes, 68 (9,71%) apresentaram alteração nos exames pré-operatórios de rotina e apenas 10 (14,7%) dos considerados alterados tiveram conduta pré-operatória modificada, ou seja, solicitação de novos exames, interconsulta ou adiamento do procedimento. Nenhuma das cirurgias foi suspensa. CONCLUSÃO: Observou-se que excessivos exames complementares são solicitados no pré-operatório, mesmo em pacientes jovens, de baixo risco cirúrgico, com pouca ou nenhuma interferência na conduta perioperatória. Exames aboratoriais padronizados não são bons instrumentos de screening de doenças, além de gerar gastos elevados e desnecessários.

Câncer diferenciado da tiróide de baixo risco: revisão do estado atual da literatura e proposta de conduta

A incidência do câncer diferenciado da tiróide vem aumentando há várias décadas no Brasil, assim como em todo o mundo. A popularização de métodos diagnósticos sensíveis e de uso relativamente simples tem contribuído para o diagnóstico cada vez mais freqüente de carcinomas de pequeno tamanho. Uma parte destes tumores ocorre em pacientes denominados de baixo risco, que poderiam se beneficiar de estratégias de conduta menos agressivas. Entretanto, a definição de baixo risco ainda é confusa e não existem meios seguros para distinguir os pacientes que evoluirão de forma pior dos demais. Por outro lado, o uso de novos métodos de acompanhamento vem mudando a maneira de conduzir estes casos. Um grupo multidisciplinar que inclui pesquisadores básicos, endocrinologistas, médicos nucleares, cirurgiões e patologistas endócrinos reviu a literatura pertinente e, com base em sua experiência, propõe algumas normas de conduta no carcinoma diferenciado da tiróide chamado de baixo risco em nosso meio.

Dental abnormalities in children after chemotherapy treatment for acute lymphoid leukemia

The frequency of dental abnormalities, such as delayed dental development, microdontia, hypoplasia, agenesis, V-shaped root and shortened root was evaluated in 76 acute lymphoblastic leukemia (ALL) pediatric patients who had been off chemotherapy for 6 months. These children had been subjected to one of the three Brazilian Protocols or the BFM86 Protocol. The patients were divided into three groups: Group I (GI; high risk) treated with one of the three Brazilian Protocols who received high-dose chemotherapy, intensive maintenance and cranial radiotherapy; Group II (GII; low risk) who were also treated with one of the three Brazilian Protocols using low-intensive chemotherapy with no radiotherapy; and Group III (GIII) based on the BFM86 Protocol.Of 76 children, 13 showed no dental abnormalities (8 were at the age of tooth formation). The remaining 63 children (82.9%) showed at least one dental anomaly.The abnormalities were probably caused by the type, intensity, frequency of the treatment and age of the patients at ALL diagnosis and this might have important consequences for the children's dental development. (C) 2002 Elsevier B.V. Ltd. All rights reserved.

beta-carotene and other carotenoids as antioxidants

Carotenoids are natural pigments which are synthesized by plants and are responsible for the bright colors of various fruits and vegetables. There are several dozen carotenoids in the foods that we eat, and most of these carotenoids have antioxidant activity. beta-carotene has been best studied since, in most countries it is the most common carotenoid in fruits and vegetables. However, in the U.S., lycopene from tomatoes now is consumed in approximately the same amount as beta-carotene. Antioxidants (including carotenoids) have been studied for their ability to prevent chronic disease, beta-carotene and others carotenoids have antioxidant properties in vitro and in animal models. Mixtures of carotenoids or associations with others antioxidants (e.g. vitamin E) can increase their activity against free radicals. The use of animals models for studying carotenoids is limited since most of the animals do not absorb or metabolize carotenoids similarly to humans.Epidemiologic studies have shown an inverse relationship between presence of various cancers and dietary carotenoids or blood carotenoid levels. However, three out of four intervention trials using high dose beta-carotene supplements did not show protective effects against cancer or cardiovascular disease. Rather, the high risk population (smokers and asbestos workers) in these intervention trials showed an increase in cancer and angina cases. It appears that carotenoids (including beta-carotene) can promote health when taken at dietary levels, but may have adverse effects when taken in high dose by subjects who smoke or who have been exposed to asbestos. It will be the task of ongoing and future studies to define the populations that can benefit from carotenoids and to define the proper doses, lengths of treatment, and whether mixtures, lather than single carotenoids (e.g. beta-carotene) are more advantageous.

β-carotene and other carotenoids as antioxidants

Carotenoids are natural pigments which are synthesized by plants and are responsible for the bright colors of various fruits and vegetables. There are several dozen carotenoids in the foods that we eat, and most of these carotenoids have antioxidant activity. β-carotene has been best studied since, in most countries it is the most common carotenoid in fruits and vegetables. However, in the U.S., lycopene from tomatoes now is consumed in approximately the same amount as β-carotene. Antioxidants (including carotenoids) have been studied for their ability to prevent chronic disease. β-carotene and others carotenoids have antioxidant properties in vitro and in animal models. Mixtures of carotenoids or associations with others antioxidants (e.g. vitamin E) can increase their activity against free radicals. The use of animals models for studying carotenoids is limited since most of the animals do not absorb or metabolize carotenoids similarly to humans. Epidemiologic studies have shown an inverse relationship between presence of various cancers and dietary carotenoids or blood carotenoid levels. However, three out of four intervention trials using high dose β- carotene supplements did not show protective effects against cancer or cardiovascular disease. Rather, the high risk population (smokers and asbestos workers) in these intervention trials showed an increase in cancer and angina cases. It appears that carotenoids (including β-carotene) can promote health when taken at dietary levels, but may have adverse effects when taken in high dose by subjects who smoke or who have been exposed to asbestos. It will be the task of ongoing and future studies to define the populations that can benefit from carotenoids and to define the proper doses, lengths of treatment, and whether mixtures, rather than single carotenoids (e.g. β-carotene) are more advantageous.

Peritoneal dialysis in acute renal failure

The definition of adequate dialysis in acute renal failure (ARF) is complex and involves the time of referral to dialysis, dose, and dialytic method. Nephrologist experience with a specific procedure and the availability of different dialysis modalities play an important role in these choices. There is no consensus in literature on the best method or ideal dialysis dose in ARF. Peritoneal dialysis (PD) is used less and less in ARF patients, and is being replaced by continuous venovenous therapies. However, it should not be discarded as a worthless therapeutic option for ARF patients. PD offers several advantages over hemodialysis, such as its technical simplicity, excellent cardiovascular tolerance, absence of an extracorporeal circuit, lack of bleeding risk, and low risk of hydro-electrolyte imbalance. PD also has some limitations, though: it needs an intact peritoneal cavity, carries risks of peritoneal infection and protein losses, and has an overall lower effectiveness. Because daily solute clearance is lower with PD than with daily HD, there have been concerns that PD cannot control uremia in ARF patients. Controversies exist concerning its use in patients with severe hypercatabolism; in these cases, daily hemodialysis or continuous venovenous therapy have been preferred. There is little literature on PD in ARF patients, and what exists does not address fundamental parameters such as adequate quantification of dialysis and patient catabolism. Given these limitations, there is a pressing need to re-evaluate the adequacy of PD in ARF using accepted standards. Therefore, new studies should be undertaken to resolve these problems. Copyright © Informa Healthcare.

Efetividade de um programa de exercícios no condicionamento físico, perfil metabólico e pressão arterial de pacientes hipertensos

Background and objective: It has been shown that aerobic exercise is useful to reduce arterial pressure, however, the effectiveness of an exercise program is still controversial and not very well analyzed among populations with low-income. The objective of the present study was to set up an individualized physical fitness program - Projeto Hipertensão - focused on hypertensive people, patients from a Health Basic Unit (HBU) and, after that, to investigate the effects of this program on physical fitness, metabolic profile and pressure levels. Methods: Sixteen hypertensive women (56 ± 3yrs) under regular pharmacological treatment underwent 4 months of a supervised aerobic and stretching exercise program (3 sessions/wk, 90 min/session, 60% of V̇O 2 max). Several physical and metabolic variables were compared before and after 4 months of training. Results: Training significantly reduced systolic arterial pressure (SAP, -6%), improved cardio-respiratory fitness (+42% of V̇O2max), flexibility (+11%) and plasma glucose content (-4%). BMI and % fat did not change. Besides modifying metabolic profile, it was found that training presented significant correlations between individual initial values of cholesterol total level (CT), high density lipoprotein (HDL-C) and low density lipoprotein (LDL-C) and its responses after exercise. Conclusions: The study shows that exercise programs can be personalized for hypertensive patients from a HBU and confirms the effectiveness of exercise on AP, physical fitness, flexibility and lipid profile on hypertensive patients. The expressive reduction of AP in hypertensive subjects suggests that this exercise intervention should be emphasized on other health centers which assist low-income population.

Prevalence and associated factors for suicidal ideation and behaviors in obsessive-compulsive disorder

Introduction: Patients with obsessive-compulsive disorder (OCD) have historically been considered at low risk for suicide, but recent studies are controversial. Objective: To study the prevalence of suicidal thoughts and attempts in OCD patients and to compare those with and without suicidality according to demographic and clinical variables. Methods: Fifty outpatients with primary OCD (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) from a Brazilian public university were evaluated. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to assess OCD severity, the Beck Depression Inventory to evaluate depressive symptoms and the Alcohol Use Disorders Identification Test to assess alcohol problems. Results: All patients had obsessions and compulsions, 64% a chronic fluctuating course and 62% a minimum Y-BOCS score of 16. Half of the patients presented relevant depressive symptoms, but only three had a history of alcohol problems. Seventy percent reported having already thought that life was not worth living, 56% had wished to be dead, 46% had suicidal ideation, 20% had made suicidal plans, and 10% had already attempted suicide. Current suicidal ideation occurred in 14% of the sample and was significantly associated with a Y-BOCS score ≥16. Previous suicidal thoughts were associated with a Beck Depression Inventory score ≥19. Conclusion: Suicidally has been underestimated in OCD and should be investigated in every patient, so that appropriate preventive measures can be taken.

Seleção de espermatozoides para ICSI

The application of assisted reproduction techniques has provided help to many men seeking to father a child, although the current success of these procedures remains suboptimal. Today some protocols allow sperm to be selected according to their ultrastructural morphology or surface molecular characteristics. On the other hand, successful human reproduction relies partly on the inherent integrity of sperm DNA. Therefore, it is now necessary to improve the safety of the sperm selection method. It is urgent to optimize procedures to isolate spermatozoa for ICSI with low risk of DNA damage. In recent years, two technologies have attracted the attention of specialists as methods capable of identifying a spermatozoon with low risk of DNA damage: Ultrastructural morphology sperm selection at high magnification and sperm head birefringence selection. This review analyses these two technologies. © Todos os direitos reservados a SBRA - Sociedade Brasileira de Reprodução Assistida.

Expression of the nonclassical HLA-G and HLA-E molecules in laryngeal lesions as biomarkers of tumor invasiveness

Introduction: HLA-G and HLA-E are two nonclassical class I molecules, which have been well recognized as modulators of innate and adaptive immune responses, and the expression of these molecules in virus infected cells has been associated with subversion of the immune response. Objective: In this study we performed a cross-sectional study, systematically comparing the expression of HLA-G and HLA-E in benign, premalignant and malignant laryngeal lesions, correlating with demographic and clinical variables and with the presence of high-risk and low-risk HPV types. Materials and methods: Laryngeal lesions were collected from 109 patients and stratified into 27 laryngeal papillomas, 17 dysplasias, 10 in situ laryngeal carcinomas, 27 laryngeal carcinomas without metastases, 28 laryngeal carcinomas with metastasis along with their respective draining cervical lymph nodes, and 10 normal larynx specimens. The expression of HLA-G and HLA-E molecules was determined by immunohistochemistry. HPV DNA detection and typing was performed using generic and specific primers. Results: HLA nonclassical molecules showed a distinct distribution pattern, according to the larynx lesion grade. HLA-G expression increased in benign and premalignant lesions, and gradually decreased in invasive carcinomas and in respective draining cervical lymph nodes. Conversely, HLA-E expression increased as far as lesion grade increased, including increased molecule expression in the draining lymph nodes of malignant lesions. Only 17 (15.6%) patients were HPV DNA positive. Conclusions: Overexpression of HLA-E and underexpression of HLAG appear to be good markers for malignant larynx lesion.

Influence of a preventive training program on lower limb kinematics and vertical jump height of male volleyball athletes

Objective: To examine the influence of a preventative training program (PTP) on sagittal plane kinematics during different landing tasks and vertical jump height (VJH) in males. Design: Six weeks prospective exercise intervention. Participants: Fifteen male volleyball athletes (13 ± 0.7 years, 1.70 ± 0.12 m, 60 ± 12 kg). Interventions: PTP consisting of plyometric, balance and core stability exercises three times per week for six weeks. Bilateral vertical jumps with double leg (DL) and single leg (SL) landings were performed to measure the effects of training. Main outcome measurements: Kinematics of the knee and hip before and after training and VJH attained during both tasks after training. The hypothesis was that the PTP would produce improvements in VJH, but would not generate great changes in biomechanical behavior. Results: The only change identified for the SL was the longest duration of landing, which represents the time spent from initial ground contact to maximum knee flexion, after training, while increased angular displacement of the knee was observed during DL. The training did not significantly alter the VJH in either the SL (difference: 2.7 cm) or the DL conditions (difference: 3.5 cm). Conclusions: Despite the PTP's effectiveness in inducing some changes in kinematics, the changes were specific for each task, which highlights the importance of the specificity and individuality in selecting prevention injury exercises. Despite the absence of significant increases in the VJH, the absolute differences after training showed increases corroborating with the findings of statistically powerful studies that compared the results with control groups. The results suggest that short-term PTPs in low risk young male volleyball athletes may enhance performance and induce changes in some kinematic parameters. © 2012 Elsevier Ltd.

European Ancestry Predominates in Neuromyelitis Optica and Multiple Sclerosis Patients from Brazil

Background: Neuromyelitis optica (NMO) is considered relatively more common in non-Whites, whereas multiple sclerosis (MS) presents a high prevalence rate, particularly in Whites from Western countries populations. However, no study has used ancestry informative markers (AIMs) to estimate the genetic ancestry contribution to NMO patients. Methods: Twelve AIMs were selected based on the large allele frequency differences among European, African, and Amerindian populations, in order to investigate the genetic contribution of each ancestral group in 236 patients with MS and NMO, diagnosed using the McDonald and Wingerchuck criteria, respectively. All 128 MS patients were recruited at the Faculty of Medicine of Ribeirão Preto (MS-RP), Southeastern Brazil, as well as 108 healthy bone marrow donors considered as healthy controls. A total of 108 NMO patients were recruited from five Neurology centers from different Brazilian regions, including Ribeirão Preto (NMO-RP). Principal Findings: European ancestry contribution was higher in MS-RP than in NMO-RP (78.5% vs. 68.7%) patients. In contrast, African ancestry estimates were higher in NMO-RP than in MS-RP (20.5% vs. 12.5%) patients. Moreover, principal component analyses showed that groups of NMO patients from different Brazilian regions were clustered close to the European ancestral population. Conclusions: Our findings demonstrate that European genetic contribution predominates in NMO and MS patients from Brazil. © 2013 Brum et al.

Nucleotide and phylogenetic analysis of human papillomavirus types 6 and 11 isolated from recurrent respiratory papillomatosis in Brazil

There are few studies about the distribution of natural molecular variants of low-risk HPVs. Our aim was to evaluate the E6 early gene variability among HPV-6 and HPV-11 isolates detected in recurrent respiratory papillomatosis (RRP) samples obtained in a cohort of Brazilian patients. We also performed a phylogenetic analysis in order to compare nucleotide sequences identified in our study with previously reported isolates from different anatomic sites (laryngeal papillomas, genital warts, cervical cancer and anal swabs) obtained from other parts of the world to determine the phylogenetic relationships of variants detected in Brazil. The complete coding region of the E6 gene of 25 samples was cloned and sequenced: 18 isolates of HPV-6 (72%) and 7 isolates of HPV-11 (28%). A total of four different HPV-6 genomic variants and two HPV-11 genomic variants was identified. It was not possible to correlate specific variants with disease severity. Phylogenetic trees for both HPV types were constructed enclosing both E6 sequences detected in our study and formerly published sequences. In both phylogenetic trees, the sequences from Brazil did not group together. We could not establish a geographical association between HPV-6 or HPV-11 variants, unlike HPV-16 and HPV-18. © 2013 Elsevier B.V.