Resultados do tratamento cirúrgico da doença do refluxo gastroesofágico em crianças com e sem afecções neurológicas concomitantes

RACIONAL: Crianças portadoras de distúrbios neurológicos têm maior incidência de refluxo e, em geral, não apresentam melhora da sintomatologia com tratamento clínico, necessitando de intervenção cirúrgica. OBJETIVO: Comparar os resultados da operação antirefluxo em crianças normais e com comprometimento neurológico, identificando as principais complicações e causas de reoperação. MÉTODOS: Cento e vinte crianças portadores de refluxo foram distribuídas em dois grupos de estudo: Grupo I - 60 crianças normais; Grupo II - 60 crianças com comprometimento neurológico. Exame contrastado do esôfago, estômago e duodeno, endoscopia digestiva alta com biópsia, pHmetria esofágica de 24 horas e cintilografia foram os exames utilizados no diagnóstico e na avaliação da eficácia da operação antirefluxo. Todos os pacientes operados eram refratários ao tratamento clínico. O procedimento cirúrgico antirefluxo realizado foi predominantemente a fundoplicatura de Lind, sendo associada à gastrostomia em 55% dos pacientes do Grupo II. RESULTADOS: No Grupo II a indicação cirúrgica foi significantemente mais precoce que no Grupo I. A principal causa de indicação cirúrgica entre neuropatas foi o alto comprometimento do desenvolvimento neuropsíquico-motor e as pneumonias de repetição. O tempo de internação, as reoperações e a necessidade de dilatações esofágicas no pós-operatório foi maior no Grupo II (p<0,01). Ocorreram três óbitos no pós-operatório tardio no Grupo II (sepse e infecção respiratória grave). CONCLUSÃO: O tratamento cirúrgico adotado foi satisfatório para o tratamento cirúrgico do refluxo nos dois grupos de pacientes. Porém, torna-se necessário o aprofundamento dos estudos acerca da população de crianças neuropatas portadoras de refluxo, uma vez que estas respondem de forma menos favorável ao procedimento cirúrgico, principalmente no que se refere às taxas de mortalidade, recorrência dos sintomas respiratórios, índice de reoperações e gravidade das complicações pós-operatórias.

Moral judgment competence of medical students: a transcultural study

The authors conducted a cross-sectional short-term study using Lind's Moral Judgment Test (MJT) to compare moral judgment competence (C-score) among students from a medical school in the Northeast region of Brazil and a medical school in the Northern region of Portugal. This study compares the C-scores of groups in the first and eighth semesters of study within each medical school and groups from corresponding semesters between the two medical schools. This study also evaluates the influence of such factors as age and gender on moral competence. A regression of moral judgment competence among the students in their eighth semester versus the students in the first semester of Brazilian medical school (p < 0.001) and a stagnation of moral competence among students in their eighth semester versus the first semester students in the Portuguese medical school (p = 0.06) were observed. For both the first semester and eighth semester groups, the students in the Portuguese medical school had higher C-scores than the students in the Brazilian medical school. In the analysis of the students' performances in terms of MJT dilemmas, the phenomenon of moral segmentation was observed in all of the groups, and the students performed better on the worker's dilemma than on the doctor's dilemma. Among students in the same semester of study, older students had lower C-scores. There was generally no significant difference between men's and women's C-scores. © 2013 Springer Science+Business Media Dordrecht.

Competência moral e perfil de profissionais que atendem o adolescente em conflito com a lei

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Competência de juízo moral dos estudantes de medicina: um estudo piloto

The authors conducted a cross-sectional short-term study using Lind's Moral Judgment Test (MJT) to compare the moral judgment competence (C-score) among students in the first and eighth semesters from a medical school in the Northeast region of Brazil. This study also evaluated the influence of such factors as age and gender on moral competence. A difference equal to or greater than 5.0 points (absolute effect-size) on the C-score was considered significant. A regression of moral judgment competence among the students in their eighth semester in relation to the students in the first semester (C-score: 20.5 and 26.2 points, respectively) was observed. In the analysis of the students' performances in terms of MJT dilemmas, the phenomenon of moral segmentation was observed in both semesters, and the students performed better on the worker's dilemma than on the doctor's dilemma. Among students in the same semester of study, older students had lower C-scores. When comparing performance by gender, there was no significant difference between men's and women's C-scores. The finding of regression or stagnation in moral competence among the medical students demands deep reflection by those who work with the political-pedagogical projects of medical schools and by the entire faculty, in order to seek strategies to reverse this condition.

Psicologia do trânsito e competência moral: uma intervenção junto a alunos de um curso de especialização

Pós-graduação em Educação - FFC

A relação entre capacidade reflexiva, crenças, valores e ambiente formador: um estudo sobre a competência moral de estudantes da pós-graduação em educação

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

New Optimization Algorithms for Structural Reliability Analysis

Solution of structural reliability problems by the First Order method require optimization algorithms to find the smallest distance between a limit state function and the origin of standard Gaussian space. The Hassofer-Lind-Rackwitz-Fiessler (HLRF) algorithm, developed specifically for this purpose, has been shown to be efficient but not robust, as it fails to converge for a significant number of problems. On the other hand, recent developments in general (augmented Lagrangian) optimization techniques have not been tested in aplication to structural reliability problems. In the present article, three new optimization algorithms for structural reliability analysis are presented. One algorithm is based on the HLRF, but uses a new differentiable merit function with Wolfe conditions to select step length in linear search. It is shown in the article that, under certain assumptions, the proposed algorithm generates a sequence that converges to the local minimizer of the problem. Two new augmented Lagrangian methods are also presented, which use quadratic penalties to solve nonlinear problems with equality constraints. Performance and robustness of the new algorithms is compared to the classic augmented Lagrangian method, to HLRF and to the improved HLRF (iHLRF) algorithms, in the solution of 25 benchmark problems from the literature. The new proposed HLRF algorithm is shown to be more robust than HLRF or iHLRF, and as efficient as the iHLRF algorithm. The two augmented Lagrangian methods proposed herein are shown to be more robust and more efficient than the classical augmented Lagrangian method.

Geology of Iron Deposits at Princeton Montana and Economic Aspects of Iron Ore in Montana

The purpose of this paper is to introduce to the reader, an iron deposit in the Princeton district, about 19 miles northeast by highway from Philipsburg, Montana. Heretofore there has been no written literature on this deposit. It is also intended to investigate the economic possibilities of iron ore in general in the State of Montana.

64Cu- and 68Ga-labelled [Nle(14),Lys(40)(Ahx-NODAGA)NH2]-exendin-4 for pancreatic beta cell imaging in rats.

PURPOSE Glucagon-like peptide-1 receptor (GLP-1R) is a molecular target for imaging of pancreatic beta cells. We compared the ability of [Nle(14),Lys(40)(Ahx-NODAGA-(64)Cu)NH2]-exendin-4 ([(64)Cu]NODAGA-exendin-4) and [Nle(14),Lys(40)(Ahx-NODAGA-(68)Ga)NH2]-exendin-4 ([(68)Ga]NODAGA-exendin-4) to detect native pancreatic islets in rodents. PROCEDURES The stability, lipophilicity and affinity of the radiotracers to the GLP-1R were determined in vitro. The biodistribution of the tracers was assessed using autoradiography, ex vivo biodistribution and PET imaging. Estimates for human radiation dosimetry were calculated. RESULTS We found GLP-1R-specific labelling of pancreatic islets. However, the pancreas could not be visualised in PET images. The highest uptake of the tracers was observed in the kidneys. Effective dose estimates for [(64)Cu]NODAGA-exendin-4 and [(68)Ga]NODAGA-exendin-4 were 0.144 and 0.012 mSv/MBq, respectively. CONCLUSION [(64)Cu]NODAGA-exendin-4 might be more effective for labelling islets than [(68)Ga]NODAGA-exendin-4. This is probably due to the lower specific radioactivity of [(68)Ga]NODAGA-exendin-4 compared to [(64)Cu]NODAGA-exendin-4. The radiation dose in the kidneys may limit the use of [(64)Cu]NODAGA-exendin-4 as a clinical tracer.

Genetic association study of QT interval highlights role for calcium signaling pathways in myocardial repolarization

The QT interval, an electrocardiographic measure reflecting myocardial repolarization, is a heritable trait. QT prolongation is a risk factor for ventricular arrhythmias and sudden cardiac death (SCD) and could indicate the presence of the potentially lethal mendelian long-QT syndrome (LQTS). Using a genome-wide association and replication study in up to 100,000 individuals, we identified 35 common variant loci associated with QT interval that collectively explain ∼8-10% of QT-interval variation and highlight the importance of calcium regulation in myocardial repolarization. Rare variant analysis of 6 new QT interval-associated loci in 298 unrelated probands with LQTS identified coding variants not found in controls but of uncertain causality and therefore requiring validation. Several newly identified loci encode proteins that physically interact with other recognized repolarization proteins. Our integration of common variant association, expression and orthogonal protein-protein interaction screens provides new insights into cardiac electrophysiology and identifies new candidate genes for ventricular arrhythmias, LQTS and SCD.