911 resultados para DROP ATTACKS


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Dissertação de Mestrado apresentada ao ISPA - Instituto Universitário

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

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The Strait of Melaka is the longest strait in the world, stretching for about 800 km from the northern tip of Sumatra to Singapore. It exhibits a dual character like no other, being simultaneously a privileged linking passage of two seas and two knots of human civilization – India and China – and a »bottleneck« that constrains the maritime connections between them. Today, the latter aspect is globally dominant. The strait is considered and analysed mostly as an obstacle rather than a linking point: how to reach China from the West or elsewhere is no longer an issue, but securing the vital flows that pass into the strait on a daily basis undoubtedly is. Accidents, natural catastrophes, political local crises or terrorist attacks are permanent dangers that could cut this umbilical cord of world trade and jeopardize a particularly sensitive and vulnerable area; piracy and pollution are the most common local threats and vulnerabilities.

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Rheumatic fever is still the most commonly seen rheumatic disease in Brazilian pediatric rheumatology clinics. It remains a significant health problem since subsequent cardiac sequelae represent one of the most important causes of chronic heart disease in children. We reviewed the clinical manifestations of rheumatic fever in 786 patients, followed at seven pediatric rheumatology clinics in the state of São Paulo, Brazil. All patients were diagnosed according to revised Jones' criteria. Regarding major criteria, 396 (50.4%) children exhibited carditis, 453 (57.6%) polyarthritis, 274 (34.8%) chorea, 13 (1.6%) erythema marginatum, and 12 (1.5%) subcutaneous nodules. Valvular lesions documented by echocardiography in the absence of accompanying auscultatory findings were found in 144 (18.3%) patients. Migratory polyarthritis was observed in 290 (64.0%) patients with articular involvement. Documented previous streptococcal infection assessed by serum antistreptolysin (ASO) titers occurred in 531 (67.5%) patients. Even though prophylaxis with benzathine penicillin was recommended to all patients, recurrent attacks were observed in 147 (18.7%). We emphasize the high frequency of chorea, silent carditis and recurrences in our series as well as the variable clinical presentation of arthritis in rheumatic fever. Multicenter studies should be encouraged to improve our understanding of the clinical features of rheumatic diseases in children and adolescents.

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A 7-year-old white boy was referred to us with a history of 3 attacks of hypogastric pain over the previous 2 years and persistently elevated serum amylase concentrations. At physical examination, he was well with no evidence of clinical abnormalities. His weight and height were normal. Laboratory diagnostic investigations were all normal except for the presence of Ascaris lumbricoides in the feces and persistently elevated serum amylase levels. Serum amylase determinations in the family members were normal in his father and maternal grandmother but elevated in his mother, sister, maternal aunt, and uncle, all of whom asymptomatic. Macroamylasemia was excluded in the child and in the mother. The finding of persistently elevated amylasemia in the child and in the other family members spanning 3 generations, and the exclusion of diseases that lead to hyperamilasemia are consistent with the diagnosis of familial hyperamylasemia. Until now, only 1 similar case has been reported. Familial hyperamylasemia must be considered in the differential diagnosis of hyperamylasemias in childhood.

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BACKGROUND: The pharmacological treatment of migraine may be acute or preventive. Frequent, severe and long-lasting migraine attacks require prophylaxis. Multiple threads of research over the last 15 years have led to the concept that migraine is generated from a hyperexcitable brain. A variety of causes for hyperexcitability of the brain in migraine have been suggested. These causes include low cerebral magnesium levels, mitochondrial abnormalities, dysfunctions related to increased nitric oxide or the existence of a P/Q type calcium channelopathy. The better knowledge about migraine pathophisiology led us to discuss new treatment options. OBJECTIVES: The aim of the present study is to present an evidence-based review of some new drugs or some agents that even though available for a long time, are not frequently used. METHODS/RESULTS: We present a review of anticonvulsants with various mechanisms of action such as lamotrigine, gabapentin, topiramate, tiagabine, levetiracetam and zonisamide. We also review natural products, like riboflavin and magnesium, botulinum toxin A, a specific CGRP antagonist and the anti-asthma medication montelukast, with pathophysiological discussion. CONCLUSIONS: We aimed to present an update of newer or less frequently used preventive migraine therapies, drugs that might reduce the burden and the costs of a disease that should be considered as a public health problem all around the world.

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PURPOSE: The purpose of this study was to assess portal hemodynamics in patients with portal hypertension due to hepatosplenic schistosomiasis as well as to assess the contribution of splanchnic hyperflow to the pathophysiology of the portal hypertension. METHODS: Sixteen patients with schistosomal portal hypertension and previous history of upper digestive bleeding due to esophageal varices rupture underwent elective esophagogastric devascularization and splenectomy and were prospectively studied. All patients underwent intraoperative invasive hemodynamic portal monitoring with a 4F-thermodilution catheter. The intraoperative portal hemodynamic assessment was conducted after laparotomy (initial) and after esophagogastric devascularization (final). RESULTS: The initial portal pressure was elevated (mean 28.5 ± 4.5 mm Hg), and a significant drop of 25% was observed at the end of the surgery (21.9 ± 4.9 mm Hg). The initial portal flow was elevated (mean 1766.9 ± 686.6 mL/min). A significant fall (42%) occurred at the end of the surgical procedure (1025.62 ± 338.7 mL/min). Fourteen patients (87.5%) presented a portal flow of more than 1200 mL/min, and in 5 cases, values greater than 2000 mL/min were observed. CONCLUSIONS: Esophagogastric devascularization and splenectomy promote a significant reduction of the elevated portal pressure and flow in schistosomal portal hypertension. These data favor the hypothesis of portal hyperflow in the physiopathology of portal hypertension of schistosomiasis.

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PURPOSE: To investigate the impact of alcohol intoxication and withdrawal on the course of social phobia and panic disorder. METHOD: A group of 41 alcoholic inpatients undergoing detoxification therapy were interviewed using the SCID-I (DSM-IV) and questions to detect fluctuations in the course of social phobia and panic disorder as a function of the different phases in alcohol dependence (intoxication, withdrawal, and lucid interval). RESULTS: Only 1 (2.4%) patient presented panic disorder throughout life, and 9 (21.9%) had panic attacks during alcohol intoxication or during the withdrawal syndrome. Sixteen (39%) alcoholic patients showed social phobia with onset prior to drug use. However, drinking eventually became unable to alleviate social phobia symptoms or worsened such symptoms in 31.2% of social-phobic patients. While patients with social phobia reported a significant improvement in psychiatric symptoms during alcohol intoxication, patients experiencing panic attacks worsened significantly during intoxication. In the withdrawal phase, patients with social phobia tended to have more and more intense phobic symptoms. CONCLUSION: Our findings indicate that the impact of alcohol intoxication is different for social phobia as compared to panic disorder, at first decreasing the social-phobic symptoms but later aggravating them. In panic disorder, the impact of intoxication by alcohol is more harmful, at least in the short term.

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Research literature and clinical experience shows that panic patients are often able to identify stressors that preceded the onset of their first attacks. In this study we investigated the relation between life events, coping skills, and panic disorder. METHODS: Forty-tree panic patients were compared with 29 control subjects regarding the occurrence and the impact of stressful life events in a 1-year period preceding the onset of panic attacks using the Social Readjustment Rating Scale and London Life Event and Difficulty Schedule. Coping skills were measured using the Ways of Coping Questionnaire. RESULTS: No differences were observed between panic patients and controls regarding the number of reported stressful life events in the previous year. Panic patients compared to controls reported loss of social support as the most meaningful class of events significantly more often. In response to stressful situations, panic patients more often used coping skills judged as ineffective. CONCLUSIONS: The present study suggests that the type of life event and the coping skills used in response to them, more than the occurrence of stressful events itself, may be associated with the onset of panic disorder.

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O fim da Guerra Fria é um caso inédito de mudança pacífica da estrutura internacional, em que os Estados Unidos e a União Soviética transcendem a divisão bipolar para decidir os termos da paz no quadro das instituições que definem o modelo de ordenamento multilateral, consolidando a sua legitimidade. Nesse contexto, ao contrário dos casos precedentes de reconstrução internacional no fim de uma guerra hegemónica, o novo sistema do post-Guerra Fria, caracterizado pela unipolaridade, pela regionalização e pela homogeneização, forma-se num quadro de continuidade institucional. A ordem política do post-Guerra Fria é um sistema misto em que as tensões entre a hierarquia unipolar e a anarquia multipolar, a integração global e a fragmentação regional e a homogeneidade e a heterogeneidade política, ideológica e cultural condicionam as estratégias das potências. As crises internacionais vão pôr à prova a estabilidade da nova ordem e a sua capacidade para garantir mudanças pacíficas. A primeira década do post-Guerra Fria mostra a preponderância dos Estados Unidos e a sua confiança crescente, patente nas Guerras do Golfo Pérsico e dos Balcãs, bem como na crise dos Estreitos da Formosa. A reacção aos atentados do "11 de Setembro" revela uma tentação imperial da potência unipolar, nomeadamente com a invasão do Iraque, que provoca uma crise profunda da comunidade de segurança ocidental. A vulnerabilidade do centro da ordem internacional é confirmada pela crise constitucional europeia e pela crise financeira global. Essas crises não alteram a estrutura de poder mas aceleram a erosão da ordem multilateral e criam um novo quadro de possibilidades para a evolução internacional, que inclui uma escalada dos conflitos num quadro de multipolaridade regional, uma nova polarização entre as potências democráticas conservadoras e uma coligação revisionista autoritária, bem como a restauração de um concerto entre as principais potências internacionais.

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The residual power of deltametrine FW (25 mg 1 .a/m2) was evaluated and compared to that of DDT (2 g i.a./m2) by means of biological tests. The different kinds of material used in constructing houses in Amazonia, such as: masonry, wood, and wattle and daub, were used. Data from logistic regression showed that the drop in mortality, the inclination of the curve in relation to time, was similar for the two insecticides in the first samples. The negative coeficient for the variable, months after application, confirmed a reduction in the activity of both insecticides. Wooden and wattle walls showed positive and negative coeficiencies respectively from the beginning. The wooden walls retained a residual effect but the wattle walls were shown to be the least indicated for the application of insecticides The experiments demonstrated a more prolonged residual effect for deltametrine as compared to DDT, and that insecticides work better on brick and cement and wooden walls than they do on wattle and daub constructions. For these reasons, it would be necessary to spray brick and cement walls every 8 months, wooden ones every 9 months and wattle constructions every 7 months to control the vectors of malaria.

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Security risk management is by definition, a subjective and complex exercise and it takes time to perform properly. Human resources are fundamental assets for any organization, and as any other asset, they have inherent vulnerabilities that need to be handled, i.e. managed and assessed. However, the nature that characterize the human behavior and the organizational environment where they develop their work turn these task extremely difficult, hard to accomplish and prone to errors. Assuming security as a cost, organizations are usually focused on the efficiency of the security mechanisms implemented that enable them to protect against external attacks, disregarding the insider risks, which are much more difficult to assess. All these demands an interdisciplinary approach in order to combine technical solutions with psychology approaches in order to understand the organizational staff and detect any changes in their behaviors and characteristics. This paper intends to discuss some methodological challenges to evaluate the insider threats and its impacts, and integrate them in a security risk framework, that was defined according to the security standard ISO/IEC_JTC1, to support the security risk management process.

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Information security is concerned with the protection of information, which can be stored, processed or transmitted within critical information systems of the organizations, against loss of confidentiality, integrity or availability. Protection measures to prevent these problems result through the implementation of controls at several dimensions: technical, administrative or physical. A vital objective for military organizations is to ensure superiority in contexts of information warfare and competitive intelligence. Therefore, the problem of information security in military organizations has been a topic of intensive work at both national and transnational levels, and extensive conceptual and standardization work is being produced. A current effort is therefore to develop automated decision support systems to assist military decision makers, at different levels in the command chain, to provide suitable control measures that can effectively deal with potential attacks and, at the same time, prevent, detect and contain vulnerabilities targeted at their information systems. The concept and processes of the Case-Based Reasoning (CBR) methodology outstandingly resembles classical military processes and doctrine, in particular the analysis of “lessons learned” and definition of “modes of action”. Therefore, the present paper addresses the modeling and design of a CBR system with two key objectives: to support an effective response in context of information security for military organizations; to allow for scenario planning and analysis for training and auditing processes.

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The distinction between convective and stratiform precipitation profiles around various precipitating systems existent in tropical regions is very important to the global atmospheric circulation, which is extremely sensitive to vertical latent heat distribution. In South America, the convective activity responds to the Intraseasonal Oscillation (IOS). This paper analyzes a disdrometer and a radar profiler data, installed in the Ji-Paraná airport, RO, Brazil, for the field experiment WETAMC/LBA & TRMM/LBA, during January and February of 1999. The microphysical analysis of wind regimes associated with IOS showed a large difference in type, size and microphysical processes of hydrometeor growth in each wind regime: easterly regimes had more turbulence and consequently convective precipitation formation, and westerly regimes had a more stratiform precipitation formation.

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The role of vitamin C on physiological responses of matrinxã (Brycon amazonicus) submitted to air exposure was analyzed. Nine hundred fish (70.15 g) were distributed in fifteen 500 l boxes (60 fish.box-1) and fed five rations (treatments): Control (no vitamin C); T100 (100 mg); T200 (200 mg); T400 (400 mg) and T800 (800 mg of vitamin C kg.ration-1). Each ration was offered to fish of three boxes during 60 days before the stress challenge that consisted of exposing fish to air for two minutes. Samplings were carried out for 5, 15, 30 and 60 minutes after the air exposure. Blood was collected for glucose, cortisol, total protein, sodium, chloride, hematocrit, hemoglobin determination, and white and red cell count. Liver was removed for hepatosomatic index (HSI) calculation and glycogen determination. Vitamin C did not affect the levels of cortisol, chloride, total protein, hemoglobin, leukocytes, hepatic glycogen or HSI in air exposed fish. Blood glucose levels elevation observed 60 minutes after the challenge did not depend on the levels of vitamin C, nor did the drop in serum sodium levels verified 60 minutes after stressor. In general, hematocrit did not change by effect of vitamin C but it was lower at 15 and 30 minutes after the challenge. The number of erythrocytes decreased in fish after 5 minute sampling in all treatments, especially at 30 and 60 minutes. The air exposure evoked alterations in stress indicators of matrinxã, and the vitamin C did not alter the responses.