Atitude expectante na pré-eclâmpsia moderada tardia

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Encefalopatia tardia da entoxicação por monóxido de carbono : case report e revisão de literatura

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Histórias de adoção tardia: considerações a partir da analítica existencial heideggeriana

Adoption establishes a filiation status, resulting from a legal act, which attributes to the child and parents the rights and obligations associated with such condition, being legally irrevocable. Nevertheless, in practice there are adoptions that do not concretize and the child returns to justice during or even after the legal process is closed. Late adoption is the denomination of the adoption of children over two years and it is still permeated by myths and stigmas, leading to a frequent return of the child to justice in these cases. The late adoption involves a process of building a unique relationship with a child whose backstory is commonly marked by the dissolution of the relationship with the family of origin, due to violation of rights and, in some cases, the experience of institutional care. Given such a scenario, this research, based on the Existential Analytic proposed by Martin Heidegger, seeks to understand the experience of mothers and children in the process of late adoption, in order to obtain subsidies to psychological attention in this context. This is a qualitative, phenomenological study with a comprehensive focus. The participants were two mothers and two children who have gone through late adoption for about two years. The procedures of data generation contemplated narrative interviews with mothers and individual meetings with children, in which ludic resources were used as mediators of expression (free drawings, unfinished children's story and "Story-Drawings" on late adoption). The procedures were audiotaped and transcribed. Data analysis was grounded in Heidegger's hermeneutics. The late adoption process, permeated by historical, social and cultural determinants and the web of meanings that create the historical singularity of each person involved have proved to be complex as seen in the narratives. The construction of the meanings of parenthood and filiation has been developing in the families in the study, from the experience of being-with-the-other, caring and dwelling in their peculiar modes of expression. The family of origin and the adoptive family mingle and differentiate by means of the experience of children, especially because of the existence of biological siblings. Data point to the importance of psychological care to family core in late adoption processes

Impacto na epidemiologia da sepse tardia após a mudança do protocolo de antimicrobianos em uma UTIN de um serviço universitário

Advances in neonatology resulted in reducing the mortality rate and the consequent increase in survival of newborn pre terms (PTN). On the other hand, there was also a considerable increase in the risk of developing health care-related infection (HAI) in its most invasive, especially for bloodstream. This situation is worrying, and prevent the occurrence of it is a challenge and becomes one of the priorities in the Neonatal Intensive Care Unit (NICU). Sepsis is the main cause of death in critical neonates and affects more than one million newborns each year, representing 40% of all deaths in neonates. The incidence of late sepsis can reach 50% in NICUs. Currently the major responsible for the occurrence of sepsis in developed countries is the coagulase negative Staphylococcus (CoNS), followed by S. aureus. The cases of HAIs caused by resistant isolates for major classes of antimicrobial agents have been increasingly frequent in the NICU. Therefore, vancomycin has to be prescribed more frequently, and, today, the first option in the treatment of bloodstream infections by resistant Staphylococcus. The objectives of this study were to assess the impact on late sepsis in epidemiology III NICU after the change of the use of antimicrobials protocol; check the frequency of multiresistant microorganisms; assess the number of neonates who came to death. This study was conducted in NICU Level III HC-UFU. three study groups were formed based on the use of the proposed late sepsis treatment protocol, with 216 belonging to the period A, 207 B and 209 to the C. The work was divided into three stages: Period A: data collected from neonates admitted to the unit between September 2010 to August 2011. was using treatment of late sepsis: with oxacillin and gentamicin, oxacillin and amikacin, oxacillin and cefotaxime. Period B: data were collected from March 2012 to February 2013. Data collection was started six months after protocol change. Due to the higher prevalence of CoNS, the initial protocol was changed to vancomycin and cefotaxime. Period C: data were collected from newborns inteerne in the unit from September 2013 to August 2014. Data collection was started six months after the protocol change, which occurred in March 2013. From the 632 neonates included in this study, 511 (80,8%) came from the gynecology and obstetrics department of the HC-UFU. The mean gestational age was 33 weeks and the prevailing sex was male (55,7%). Seventy-nine percent of the studied neonates were hospitalized at the NICU HC-UFU III because of complications related to the respiratory system. Suspicion of sepsis took to hospitalization in the unit of 1,9% of newborns. In general, the infection rate was 34,5%, and the most frequent infectious sepsis syndrome 81,2%. There was a tendency to reduce the number of neonates who died between periods A 11 and C (p = 0,053). From the 176 cases of late sepsis, 73 were clinical sepsis and 103 had laboratory confirmation, with greater representation of Gram positive bacteria, which corresponded to 67.2% of the isolates and CoNS the most frequent micro-organism (91,5%). There was a statistically significant difference in the reduction of isolation of Gram positive microorganisms between periods A and C (p = 0,0365) as well as in reducing multidrug-resistant CoNS (A and B period p = 0,0462 and A and C period, p = 0,158). This study concluded that: the CoNS was the main microorganism responsible for the occurrence of late sepsis in neonates in the NICU of HC-UFU; the main risk factors for the occurrence of late sepsis were: birth weight <1500 g, use of PICC and CUV, need for mechanical ventilation and parenteral nutrition, SNAPPE> 24 and length of stay more than seven days; the new empirical treatment protocol late sepsis, based on the use of vancomycin associated cefepime, it was effective, since promoted a reduction in insulation CoNS blood cultures between the pre and post implementation of the Protocol (A and C, respectively); just as there was a reduction in the number of newborns who evolved to death between periods A and C.

A Parentalidade tardia : Os pais, os filhos e o amanhã

Dissertação de Mestrado apresentada no Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica

Tecnologia de semeadura cruzada e reduzida na cultura da soja em função de doses de boro e zinco.

O objetivo do trabalho foi o de comparar a resposta de dois sistemas de semeadura nas características agronômicas da cultura da soja. O experimento foi conduzido na safra 2013/2014, no município de Sinop-MT, na Embrapa Agrossilvipastoril. Utilizou-se a cultivar BRS 8381, convencional. Realizou-se semeadura Cruzada a 0,45 m e semeadura Reduzida a 0,23 m entre linhas, mantendo-se a mesma população de plantas por hectare (POP). Os demais fatores experimentais foram constituídos por 3 doses de B (0, 1 e 2 kg ha-1) e 3 doses de Zn (0, 2 e 4 kg ha-1), utilizando-se como fontes o ácido bórico e o sulfato de zinco. Os dados foram submetidos à análise de variância e as médias comparadas pelo teste de Tukey, a 5% de probabilidade. Avaliou-se os seguintes parâmetros: POP, massa de 100 grãos (M100), número de vagens por planta (VAG), altura de plantas (ALT) e a produtividade de grãos (PROD). Para a POP, observou-se diferenças significativas entre os arranjos de planta (arranjos) e também na interação entre B e Zn. Entre os arranjos, o Cruzado foi estatisticamente superior ao Reduzido, com 410.000 pl ha-1 e 315.000 pl ha-1, respectivamente. Entre as doses de B dentro de Zn, observou-se diferenças somente para o tratamento testemunha de Zn, sendo que a menor dose de B proporcionou maior POP (396.000 pl ha-1) que a maior dose (343.000 pl ha-1), porém, semelhantes a dose intermediária (359.000 pl ha-1). Quanto a M100, observou-se diferenças somente entre os arranjos. O arranjo Reduzido (12,8g) proporcionou maior M100 em relação ao arranjo Cruzado (12,3 g). Para a ALT, observouse diferenças somente entre os arranjos avaliados. O Reduzido apresentou maior ALT, com 80 cm, em relação ao Cruzado (74 cm). Esse fato se deve ao próprio arranjo, onde as plantas competem mais por luz entre si, na fileira, em relação ao arranjo cruzado, causando aumento em altura. Em relação ao VAG, observou-se diferenças entre os arranjos e entre as doses de Zn. Entre os arranjos, o sistema Reduzido (45 vag pl-1) foi superior ao Cruzado (38 vag pl-1). Observou-se também redução do VAG com o aumento da POP, o que pode ser explicado pela plasticidade da cultura, que compensou o VAG pela diferença na POP. Em relação as doses de Zn, observou-se que a maior dose proporcionou maior VAG (44 vag pl-1) em relação a testemunha (39 vag pl-1), porém, semelhantes a dose intermediária (41 vag pl-1). Em relação à PROD, somente os rranjos se diferenciaram entre si. A maior PROD foi obtida no arranjo Reduzido (2738 kg ha-1) em relação ao Cruzado (2253 kg ha-1). Conclui-se que nas condições em que se desenvolveu o trabalho, o arranjo Reduzido foi superior. A adubação com B, se mal manejada, pode reduzir a POP e a aplicação adequada de Zn pode proporcionar aumento do VAG.