Gastroschisis: determinants of neonatal outcome

This retrospective study elicits information regarding the dependence of neonatal outcome in gastroschisis upon: (1) the mode of delivery, (2) place of birth, (3) time for birth to surgery, (4) method of closure, (5) time from operation to commencement of first enteral feeds. The neonatal intensive care database from five major tertiary centres was used to identify 181 neonates with gastroschisis from 1990 to 2000. There were 8 deaths. There were no significant differences in outcome for infants delivered vaginally (102) versus Caesarean section (79), those born near the tertiary centre (133) as compared to infants born away (48), ones operated within 7 hours (125) compared with those operated after 7 hours (56), with delayed closure (30) versus primary closure (151). Neonates fed within 10 days of operation (85) had significantly lower incidence of sepsis, duration of TPN and hospital stay when compared to those fed after 10 days (96). Early commencement of feeds decreases the incidence of sepsis, duration of total parenteral nutrition (TPN) and hospital stay. Place of delivery, mode of delivery, time to surgery and type of closure do not influence neonatal outcome.

Control of the endocrine pancreas by gastrointestinal peptides

This thesis concerns the mechanism through which enteral delivery of glucose results in a larger insulin response than an equivalent parenteral glucose load. Preliminary studies in which mice received a glucose solution either intragastrically or intraperitoneally confirmed this phenomenon. An important regulatory system in this respect is the entero-insular axis, through which insulin secretion is influenced by neural and endocrine communication between the gastrointestinal tract and the pancreatic islets of Langerhans. Using an in vitro system involving static incubation of isolated (by collagenase digestion) islets of Langerhans, the effect of a variety of gastrointestinal peptides on the secretion of the four main islet hormones, namely insulin, glucagon, somatostatin and pancreatic polypeptide, was studied. The gastrointestinal peptides investigated in this study were the secretin family, comprising secretin, glucagon, gastric inhibitory polypeptide (GIP), vasoactive intestinal polypeptide (VIP), peptide histidine isoleucine (PHI) and growth hormone releasing factor (GRF). Gastrin releasing peptide (GRP) was also studied. The results showed that insulin release was stimulated by all peptides studied except PHI, glucagon release was stimulated by all peptides tested, except GRF which suppressed glucagon release, somatostatin release was stimulated by GIP and GRF but suppressed by VIP, PHI, glucagon and secretin, and PP release was stimulated by GIP and GRF, but suppressed by PHI. The insulinotropic effect of GRP was investigated further. A perifusion system was used to examine the time-course of insulin release from isolated islets after stimulation with GRP. GRP was shown to be insulinotropic only in the presence of physiologically elevated glucose concentrations and both first and second phases of insulin release were augmented. There was no effect at substimulatory or very high glucose concentrations. Studies using a cultured insulin-secreting islet cell line, the RINm5F cell line, were undertaken to elucidate the intracellular mechanism of action of GRP. This peptide did not enhance insulin release via an augmentation of glucose metabolism, or via the adenylate cyclase/cyclic AMP secondary messenger system. The pattern of changes of cytosolic free calcium in response to GRP, which involved both mobilization of intracellular stores and an influx of extracellular calcium, suggested the involvement of phosphatidylinositol bisphosphate breakdown as a mediator of the effect of GRP on insulin secretion.

Review: bariatric surgery:to treat diabesity

In obese patients bariatric surgery is increasing in popularity as a strategy to promote, and maintain, weight loss. In obese type 2 diabetes bypass, bariatric surgery improves glycaemic control g€" often to a greater extent than would be anticipated by weight loss alone. Surgical bypass procedures appear to initially offer a greater glucose-lowering effect than surgical restriction procedures. This review considers the rationale for bariatric surgery as a treatment for diabesity and the implications of the different procedures on the secretion and action of enteral hormones.

Avaliação da influência de cinza da casca de arroz em cimentos para poços de petróleo submetidos à injeção de vapor

Reservoirs that present highly viscous oils require methods to aid in their recovery to the surface. The elev ated oil viscosity hinders its flow through porous media and conventional recovery methods have not obtained significant efficiency. As such, the injection of steam into the reservoir through an injection well has been the most widely used method of therma l recovery, for it allows elevated volumes of recovery due to the viscosity reduction of the oil, facilitating the oil’s mobility within the rock formation and consequently into the production well where it will be exploited. On the other hand, the injecti on of vapor not only affects the fluids found in the rock pores, but the entire structure that composes the well where it is injected due to the high temperatures used in the process. This temperature increment is conducted to the cement, found in the annu lus, responsible for the isolation of the well and the well casing. Temperatures above 110 ̊C create new fazes rich in calcium in the cement matrix, resulting in the reduction of its permeability and the consequential phenomenon of mechanical resistance ret rogression. These alterations generate faults in the cement, reducing the well’s hydraulic isolation, creating insecurity in the operations in which the well will be submitted as well as the reduction of its economic life span. As a way of reducing this re trograde effect, this study has the objective of evaluating the incorporation of rice husk ash as a mineral additive substitute of silica flour , commercially utilized as a source of silica to reduce the CaO/SiO 2 ratio in the cement pastes submitted to high temperatures in thermal recovery. Cement pastes were formulated containing 20 and 30% levels of ash, apart from the basic paste (water + cement) and a reference paste (water + cement + 40% silica flour) for comparison purposes. The tests were executed th rough compression resistance tests, X - Ray diffraction (XRD) techniques, thermogravimetry (TG), scanning electron microscopy (SEM) and chemical anal ysis BY X - ray fluorescence (EDS) on the pastes submitted to cure at low temperatures (45 ̊C) for 28 days following a cure at 280 ̊C and a pressure of 2,000 PSI for 3 days, simulating vapor injection. The results obtained show that the paste containing 30% r ice shell ash is satisfactory, obtaining mechanical resistance desired and equivalent to that of the paste containing 40% silica flour, since the products obtained were hydrated with low CaO/SiO 2 ratio, like the Tobermorita and Xonotlita fases, proving its applicability in well subject to vapor injection.

Obtenção de extratos da Opuntia fícus-indica L. Mill e suas aplicações em formulações cosméticas: avaliação in vivo do sensorial e da eficácia hidratante

Opuntia fícus - indica (L.) Mill is a cactacea presents in the Caatinga ecosystem and shows in its chemical c omposition flavonoids, galacturonic acid and sugars. Different hydroglicolic (EHG001 and EHG002) and hydroethanolic subsequently lyophilized (EHE001 and EHE002) extracts were developed. The EHE002 had his preliminary phytochemical composition investigated by thin layer chromatography (TLC) and we observed the predominance of flavonoids. Different formulations were prepared as emulsions with Sodium Polyacrylate (and) Hydrogenated Polydecene (and) Trideceth - 6 (Rapithix® A60), and Polyacrylamide (and) C13 - 14 I soparaffin (and) Laureth - 7 (Sepigel® 305), and gel with Sodium Polyacrylate (Rapithix® A100). The sensorial evaluation was conducted by check - all - that - apply method. There were no significant differences between the scores assigned to the formulations, howe ver, we noted a preference for those formulated with 1,5% of Rapithix® A100 and 3,0% of Sepigel® 305. These and the formulation with 3% Rapithix® A60 were tested for preliminary and accelerated stability. In accelerated stability study, samples were stored at different temperatures for 90 days. Organoleptic characteristics, the pH values and rheological behavior were assessed. T he emulsions formulated with 3,0% of Sepigel® 305 and 1,5% of Rapithix® A60 w ere stable with pseudoplastic and thixotropic behavior . The moisturizing clinical efficacy of the emulsions containing 3,0% of Sepigel® 305 containing 1 and 3% of EHG001 was performed using the capacitance method (Corneometer®) and transepidermal water lost – TEWL evaluation ( Tewameter®). The results showed t hat the formulation with 3% of EHG001 increased the skin moisturizing against the vehicle and the extractor solvent formulation after five hours. The formulations containing 1 and 3% of EHG001 increased skin barrier effect by reducing transepidermal water loss up to four hours after application.

Avaliação de compatibilidade entre pasta de cimento e fluido de perfuração não-aquoso utilizados em poços petrolíferos

Compatibility testing between a drilling fluid and a cement slurry is one of the steps before an operation of cementing oil wells. This test allows us to evaluate the main effects that contamination of these two fluids may cause the technological properties of a cement paste. The interactions between cement paste and drilling fluid, because its different chemical compositions, may affect the cement hydration reactions, damaging the cementing operation. Thus, we carried out the study of the compatibility of non-aqueous drilling fluid and a cement slurry additives. The preparation procedures of the non-aqueous drilling fluid, the cement paste and completion of compatibility testing were performed as set out by the oil industry standards. In the compatibility test is evaluated rheological properties, thickening time, stability and compressive strength of cement pastes. We also conducted analyzes of scanning electron microscopy and X-ray diffraction of the mixture obtained by the compatibility test to determine the microstructural changes in cement pastes. The compatibility test showed no visual changes in the properties of the cement paste, as phase separation. However, after the addition of nonaqueous drilling fluid to cement slurry there was an increased amount of plastic viscosity, the yield point and gel strength. Among the major causative factors can include: chemical reaction of the components present in the non-aqueous drilling fluid as the primary emulsifier, wetting agent and paraffin oil, with the chemical constituents of the cement. There was a reduction in the compressive strength of the cement paste after mixing with this drilling fluid. Thickening test showed that the oil wetting agent and high salinity of the non-aqueous fluid have accelerating action of the handle of the cement paste time. The stability of the cement paste is impaired to the extent that there is increased contamination of the cement slurry with the nonaqueous fluid. The X-ray diffraction identified the formation of portlandite and calcium silicate in contaminated samples. The scanning electron microscopy confirmed the development of the identified structures in the X-ray diffraction and also found the presence of wells in the cured cement paste. The latter, formed by the emulsion stability of the drilling fluid in the cement paste, corroborate the reduction of mechanical strength. The oil wetting agent component of the non-aqueous drilling fluid, the modified cement hydration processes, mainly affecting the setting time.

Length of stay in a neonatal intensive care unit and its association with low rates of exclusive breastfeeding in very low birth weight infants

OBJECTIVE: To identify the inpatient maternal and neonatal factors associated to the weaning of very low birth weight (VLBW) infants. METHODS: One hundred nineteen VLBW (<1500 g) infants were monitored from July 2005 through August 2006, from birth to the first ambulatory visit after maternity discharge. This maternity unit uses the Kangaroo Method and the Baby Friendly Hospital Initiative. Out of 119 VLBW infants monitored until discharge, 88 (75%) returned to the facility, 22 (25%) were on exclusive breastfeeding (EB), and 66 (75%) were weaned (partial breastfeeding or formula feeding). RESULTS: Univariate analysis found an association between weaning and lower birth weight, longer stays in the neonatal intensive care unit (NICU), and longer hospitalization times, in addition to more prolonged enteral feeding and birth weight recovery period. Logistic regression showed length of NICU stay as being the main determinant of weaning. CONCLUSION: The negative repercussion on EB of an extended stay in the NICU is a significant challenge for health professionals to provide more adequate nutrition to VLBW infants.

Length of stay in a neonatal intensive care unit and its association with low rates of exclusive breastfeeding in very low birth weight infants

OBJECTIVE: To identify the inpatient maternal and neonatal factors associated to the weaning of very low birth weight (VLBW) infants. METHODS: One hundred nineteen VLBW (<1500 g) infants were monitored from July 2005 through August 2006, from birth to the first ambulatory visit after maternity discharge. This maternity unit uses the Kangaroo Method and the Baby Friendly Hospital Initiative. Out of 119 VLBW infants monitored until discharge, 88 (75%) returned to the facility, 22 (25%) were on exclusive breastfeeding (EB), and 66 (75%) were weaned (partial breastfeeding or formula feeding). RESULTS: Univariate analysis found an association between weaning and lower birth weight, longer stays in the neonatal intensive care unit (NICU), and longer hospitalization times, in addition to more prolonged enteral feeding and birth weight recovery period. Logistic regression showed length of NICU stay as being the main determinant of weaning. CONCLUSION: The negative repercussion on EB of an extended stay in the NICU is a significant challenge for health professionals to provide more adequate nutrition to VLBW infants.

Influência do tempo de adição do policarboxilato em pastas de cimento Portland para cimentação de poços petrolíferos

Cement pastes used in cementing oil wells operations are prepared according to the specific characteristics of each well. The physical properties requested for each folder formulation depend on the temperature and pressure of the well to be cemented. The rheological properties of the pulp are important control parameter for efficiency in transportation and positioning the folder during the cementing operation. One of the main types of additive used for the adjustment of rheological properties of cement pastes is the dispersant additive. This work aims to study the influence of variation of the time of addition of the polycarboxylate (0, 5, 10 and 15 minutes) in cement pastes, considering the initial periods of hydration of cement particles as fundamental point for better performance dispersant additive. Pastes were prepared with a density set at 15.6 lb/gal (1.87 g/cm3) and polycarboxylate concentrations ranging from 0.01 gpc to 0.05 gpc circulation temperature (BHCT) of 51°C and static temperature (BHST) of 76 C. The pastes were characterized from a rheological measurements, volume filtered, thickening time and resistance to compression formulations. Also were carried out tests Diffraction X-ray (XRD) and Scanning Electron Microscopy (MEV). The results showed that the addition of policaboxilato after 15 minutes decreased by 70% the values of rheological parameters. According to results of DRX and MEV, the addition of dispersant after 15 minutes did not affect the chemical reactions and subsequent formation of cement hydration products. A study of the economic feasibility to realize the financial benefits of the technique, which can be seen only with the use of the technique in this work to reduce the cost of production of cement paste was carried out, can get up to $ 1015.00 for each folder 100 barrels produced with said formulations.

Influência do tempo de adição do policarboxilato em pastas de cimento Portland para cimentação de poços petrolíferos

Cement pastes used in cementing oil wells operations are prepared according to the specific characteristics of each well. The physical properties requested for each folder formulation depend on the temperature and pressure of the well to be cemented. The rheological properties of the pulp are important control parameter for efficiency in transportation and positioning the folder during the cementing operation. One of the main types of additive used for the adjustment of rheological properties of cement pastes is the dispersant additive. This work aims to study the influence of variation of the time of addition of the polycarboxylate (0, 5, 10 and 15 minutes) in cement pastes, considering the initial periods of hydration of cement particles as fundamental point for better performance dispersant additive. Pastes were prepared with a density set at 15.6 lb/gal (1.87 g/cm3) and polycarboxylate concentrations ranging from 0.01 gpc to 0.05 gpc circulation temperature (BHCT) of 51°C and static temperature (BHST) of 76 C. The pastes were characterized from a rheological measurements, volume filtered, thickening time and resistance to compression formulations. Also were carried out tests Diffraction X-ray (XRD) and Scanning Electron Microscopy (MEV). The results showed that the addition of policaboxilato after 15 minutes decreased by 70% the values of rheological parameters. According to results of DRX and MEV, the addition of dispersant after 15 minutes did not affect the chemical reactions and subsequent formation of cement hydration products. A study of the economic feasibility to realize the financial benefits of the technique, which can be seen only with the use of the technique in this work to reduce the cost of production of cement paste was carried out, can get up to $ 1015.00 for each folder 100 barrels produced with said formulations.

Pirometamorfismo em calcários da formação Jandaíra, bacia potiguar, nordeste do Brasil

The present study aims the characterization of thermally affected carbonate rocks from Jandaíra Formation in contact with Paleogene and Neogene basic intrusions in the region of the Pedro Avelino and Jandaíra municipalities (RN), northeastern Brazil. For this study, field, petrographic, x-ray diffraction, electron microprobe, and whole rock litogeochemistry data of carbonates were undertaken. The thermally unaffected limestones are classified like wackstones, grainstones and packstones. They may constitute carbonates grains of benthic foraminifera, echinoderm spines, ostracods, algae, corals, bivalves, gastropods, peloids and intraclasts. The porosities are classified like vug, intraparticle, interparticle, intercrystal and moldic types. The major minerals are calcite, ankerite and dolomite; the detrital are montmorillonite, pyrite, limonite, quartz and microcline. The thermally affected limestones are very coarse to very fine-grained and light to dark gray color. The fossiliferous components totally disappear, and the porosity tends to disappear. With the data obtained, it can be inferred that the carbonate protoliths would be calciferous to dolomitic limestones, both with small amount of clay minerals. Crystalline carbonates from dolomitic protolith have rhombohedral calcite and iron oxides / hydroxides, making the rocks much darker. The carbonates from calciferous protolith have a wide variation of grain size according to the recrystallization degree, increasing toward contact with the basic bodies. In this group, it was identified the minerals lizardite and spinel in weakly to moderately affected samples, and spinel and spurrite in strongly affected rocks, as well as calcite, that occur everywhere. The geological context (shallow level diabase intrusions), the crystallization of the pyrometamorphic minerals spurrite and olivine, and comparison with diagrams from the literature allow estimating temperatures and pressures around 1050-1200 °C and 0.5-1.0 kbar, respectively, for PTOTAL=PCO2. The post-intrusion cooling would have afforded the releasing of metasomatic / hydrothermal fluids, allowing the opening of the metamorphic system, with possible contribution of chemical elements from host units (sandstones, shales) and from basic intrusions. This would induce hydration of previous phases, allowing the formation of serpentine, chlorite and brucite. The results discussed here reveal the strong influence of the heat from basic intrusions within the sedimentary pile. Whereas in the offshore portion of the basin occur sills with up to 1000 m thickness, the understanding of pyrometamorphism might be useful for understanding and measuring the thermally affected rocks.

Pirometamorfismo em calcários da formação Jandaíra, bacia potiguar, nordeste do Brasil

The present study aims the characterization of thermally affected carbonate rocks from Jandaíra Formation in contact with Paleogene and Neogene basic intrusions in the region of the Pedro Avelino and Jandaíra municipalities (RN), northeastern Brazil. For this study, field, petrographic, x-ray diffraction, electron microprobe, and whole rock litogeochemistry data of carbonates were undertaken. The thermally unaffected limestones are classified like wackstones, grainstones and packstones. They may constitute carbonates grains of benthic foraminifera, echinoderm spines, ostracods, algae, corals, bivalves, gastropods, peloids and intraclasts. The porosities are classified like vug, intraparticle, interparticle, intercrystal and moldic types. The major minerals are calcite, ankerite and dolomite; the detrital are montmorillonite, pyrite, limonite, quartz and microcline. The thermally affected limestones are very coarse to very fine-grained and light to dark gray color. The fossiliferous components totally disappear, and the porosity tends to disappear. With the data obtained, it can be inferred that the carbonate protoliths would be calciferous to dolomitic limestones, both with small amount of clay minerals. Crystalline carbonates from dolomitic protolith have rhombohedral calcite and iron oxides / hydroxides, making the rocks much darker. The carbonates from calciferous protolith have a wide variation of grain size according to the recrystallization degree, increasing toward contact with the basic bodies. In this group, it was identified the minerals lizardite and spinel in weakly to moderately affected samples, and spinel and spurrite in strongly affected rocks, as well as calcite, that occur everywhere. The geological context (shallow level diabase intrusions), the crystallization of the pyrometamorphic minerals spurrite and olivine, and comparison with diagrams from the literature allow estimating temperatures and pressures around 1050-1200 °C and 0.5-1.0 kbar, respectively, for PTOTAL=PCO2. The post-intrusion cooling would have afforded the releasing of metasomatic / hydrothermal fluids, allowing the opening of the metamorphic system, with possible contribution of chemical elements from host units (sandstones, shales) and from basic intrusions. This would induce hydration of previous phases, allowing the formation of serpentine, chlorite and brucite. The results discussed here reveal the strong influence of the heat from basic intrusions within the sedimentary pile. Whereas in the offshore portion of the basin occur sills with up to 1000 m thickness, the understanding of pyrometamorphism might be useful for understanding and measuring the thermally affected rocks.

Prevenção de úlceras por pressão segundo a perspectiva do enfermeiro intensivista

Analisar a atuação dos enfermeiros de unidade de terapia intensiva na prevenção da úlcera por pressão. Método: trata-se de estudo descritivo desenvolvido com 13 enfermeiros da unidade de terapia intensiva do Hospital Universitário Onofre Lopes (HUOL), em Natal-RN. Foi aplicado um questionário, submetido à análise de conteúdo temática. O estudo foi aprovado pelo Comitê de Ética da Universidade Federal do Rio Grande do Norte (UFRN), sob o CAAE n. 0240.0.051.000-10. Resultados: os enfermeiros reportaram a realização da mudança de decúbito, a avaliação de risco, a discussão com os colegas sobre as medidas adotadas, a higiene e hidratação da pele do paciente através de uso de ácidos graxos essenciais e hidratante corporal, o cuidado com a disposição dos lençóis, de forma a evitar dobras, a utilização de colchão de ar e a aplicação de placas de hidrocoloide nas proeminências ósseas. Conclusão: a prática da prevenção das úlceras por pressão aplicada pelos enfermeiros da unidade de terapia intensiva ocorre sem padronização dos cuidados

Minimally invasive repair of Morgagni hernia - A multicenter case series

Children may benefit from minimally invasive surgery (MIS) in the correction of Morgagni hernia (MH). The present study aims to evaluate the outcome of MIS through a multicenter study. National institutions that use MIS in the treatment of MH were included. Demographic, clinical and operative data were analyzed. Thirteen patients with MH (6 males) were operated using similar MIS technique (percutaneous stitches) at a mean age of 22.2±18.3 months. Six patients had chromosomopathies (46%), five with Down syndrome (39%). Respiratory complaints were the most common presentation (54%). Surgery lasted 95±23min. In none of the patients was the hernia sac removed; prosthesis was never used. In the immediate post-operative period, 4 patients (36%) were admitted to intensive care unit (all with Down syndrome); all patients started enteral feeds within the first 24h. With a mean follow-up of 56±16.6 months, there were two recurrences (18%) at the same institution, one of which was repaired with an absorbable suture; both with Down syndrome. The application of MIS in the MH repair is effective even in the presence of comorbidities such as Down syndrome; the latter influences the immediate postoperative recovery and possibly the recurrence rate. Removal of hernia sac does not seem necessary. Non-absorbable sutures may be more appropriate.

Resistividade elétrica superficial do concreto: influência da cura

A resistividade elétrica superficial do concreto, nos estados fresco e endurecido, pode ser influenciada por alguns fatores, como por exemplo: grau de hidratação, relação água/aglomerante (a/ag), procedimento de cura, teor de agregado e existência de armadura. Este trabalho tem o objetivo de avaliar o desempenho e o comportamento da resistividade elétrica superficial do concreto tendo como base a influência do tempo de cura e relação a/ag. Os concretos dosados foram divididos em três grupos, onde C-0,81 representa o grupo de concretos com relação água/aglomerante de 0,81 e 20 MPa de resistência à compressão; C- 0,50 representa os concretos com relação água/aglomerante de 0,50 e 40 MPa; e C-0,35 representa os concretos com relação água/aglomerante de 0,35 e 60 MPa de resistência à compressão. Os procedimentos de cura aplicados aos três grupos foram: cura seca, cura submersa até os sete dias e cura submersa até os quatorze dias. No presente estudo, os resultados mostraram que quanto maior a relação água/aglomerante, maior será a porosidade da mistura que, por sua vez, eleva a resistividade elétrica. No que tange ao procedimento de cura, os concretos curados a seco apresentaram maiores índices de resistividade que os concretos submersos.