Úlcera de pressão em pacientes internados em um hospital universitário em Natal/RN: condições predisponentes e fatores de risco

The pressure ulcers (PU), also known as decubitus ulcers, are defined as injuries caused by the constant pressure exerted on a particular point of the body, causing impairment of blood supply with a decrease or interruption of tissue irrigation, causing occlusion of blood vessels and capillaries, ischemia and cell death. This is a descriptive study with longitudinal design, and panel type, with quantitative approach that aimed to examine the association between predisposing conditions (PC), intrinsic factors (IF) and extrinsic factors (EF) with the occurrence of PU, in hospitalized patients in the Intensive Care Unit (ICU), pain clinical, surgical clinical and neurology wards of a university hospital. The study population was composed of all patients who were restricted to bed during the period from December 2007 to February 2008. The study was approved by the Ethics Committee of HUOL / UFRN (No 135/07). The data-collection took place through a structured formulary of observation, data from medical records and physical examination of patients skins. The results were organized in SPSS 15.0 software, tabulated, categorized and analyzed by descriptive and inferential statistics. Of the 30 patients studied, 43.3% had been hospitalized in the pain clinical and surgical clinic wards, 20.0% in the ICU, 20.0% in the ICU / ward and 16.7% in neurology, being the length of hospitalization in those units of 7 to 18 days (63.3%) and from 19 to 30 days (36.7%), predominantly female and aged ≥ 60 years (60.0%). 19 PU were diagnosed in 43.3% of patients monitored, being 38.5% with one PU between 7 to 18 days and 46.2% with two or more between 19 to 30 days of hospitalization, showing significant relationship (ρ-value = 0029) between length of hospital stay and the number of PU. Was found an association of 35.7% of the PC (cardio-respiratory, hematological, metabolic and psychogenic), IF (age group, oedema, skin changes in humidity and change of body temperature) and EF (type of mattress and strength of body pressure) for all patients studied, statistically significant (ρ-value = 0001), between the average scores in patients with and without PU, with reason chance to 12.0 for the development of PU and there was moderate correlation ( r = 0618) in the presence of this association. Results show the influence of the multiplicity of factors and conditions on the occurrence of PU, which brings us to reflect on the assistance focused on prevention and reduction of these injuries which will encourage the reduction of hospitalization length, physical and psychological suffering, and the possibility of improving the clinical condition of the patient.

Úlceras de pressão: um estudo com pacientes de unidade de terapia intensiva

To characterize patients according to gender, age category, internment time, diagnostical hypothesis and location of the pressure ulcer; to identify the susceptibility conditions, intrinsical and extrinsical factors present on ICU patients and to verify on the existence of association between the susceptibility conditions and the intrinsecal and extrinsecal factors on the occurrence of PU. Methods: It is a descriptive study, of longitudinal design of the panel type, with quantitative approach, performed on two ICU s of a private hospital located in Natal/RN, with 40 patients interned at these units. The data collection was performed on all three shifts through a structured observation and physical exam of the patients' skin form seeking to identify the presence of PU. Results: The greatest occurence of PU was on individuals of the male gender (70%) when compared to the female gender (30%), that difference being statistically significant (p=0,0267), with the male gender presenting 4,3 times greater chance of developing PU than the female; the predominant age category was from 60 years of age on (85%), 60,0% presented 1 to 2 PU s after 7 (seven) days of permanence in the ICU s, the predominant diagnostical hypothesis on the patients with PU were the respiratory diseases (42,3%) and the most frequent locations of PU were the sacral region (40,0%) and heels (36,0%). 25 PU s of stage I were diagnosed on 50,0% of the followed patients, with general incidence of 50,0% on both ICUs. from the 88 variables researched, 75 were identified on the patients from the study, being the predominant conditions (anemia, hypotension, leukocytosis, other diseases hypertension blood pressure, cardiac insuffience, pneumonia - and ansiolythic), the intrinsecal factors (diminished muscular strenght and/or mass, discrete edema, totally compromised mobile coordination and total inability for movement on the bed) and the extrinsecal factors (inadequate mattress type, permanence on a single position for >2 hours, shearing/friction force, bed clothes with folds that leave marks on the body, pressure force) predominated on patients with PU. The male gender variables (p=0,0267,OR=4,3), sedation (p=0,0006,OR=4,1), psychomotive agitation (p=0,0375,OR=5,8) and leukocytosis (p=0,0285,OR=5,0) presented a significant statistical diference when analyzed independently. We verified an association of 17,3%, statistically significant (p=0,0384), between the susceptibility conditions (anemia, leukocytosis and hypotension), the intrinsecal factors (age equal or above 60 years, diminished/absent pain sensibility and smooth, fine or delicate skin) and the extrinsecal factors (inadequate mattress, pressure forces, shearing/friction force, permanence on a single position for more than 2 hours, elevation between 30 to 45 degrees and inadequate bed clothes' conditions), with a chance ratio of 4,6 times the risk of occurrence of PU on the patients that presented the referred association. Conclusion: The incidence of PU detected on the ICU-interned patients was high and we made evident the existence of association between the susceptibility conditions, the intrinsecal and extrinsecal factors on the occurrence of PU s on the ICUinterned patients, and thus we accept the alternative hypothesis proposed on the study

Modelos para análise e dimensionamento de painéis de alvenaria estrutural

The main objective of this thesis was the study of bracing panels of structural masonry, by applying the Finite Element Method and Strut and Tie Method. It was analyzed the following aspects: the effect of orthotropy on the behavior of the panels; distribution of horizontal forces between panels for buildings; comparison between Equivalent Frame and Finite Elements models; panels design with the Strut and Tie Method. The results showed that one should not disregard the orthotropy, otherwise this can lead to models stiffer than the real. Regarding the distribution of horizontal forces, showed that the disregard of lintels and shear deformation leads to significant differences in the simplified model. The results showed also that the models in Finite Element and Equivalent Frame exhibit similar behavior in respect to stiffness of panels and stress distribution over the sessions requested. It was discussing criteria for designing Strut and Tie Method models in one floor panels. Then, the theoretical strength these panels was compared with the rupture strength of panels tested in the literature. The theoretical maximum strength were always less than the rupture strength of the panels obtained in tests, due to the fact that the proposed model cannot represent the behavior of the masonry after the start of the panel cracking due to plasticization of the reinforcement

Estudo numérico do comportamento de muros de arrimo em alvenaria estrutural de blocos vazados

Usually masonry structures has low tension strength, hence the design to flexural efforts can results in high reinforcement ratio, specification of high unit and prism strength, structural members with larger section dimensions and modification in structural arrangement to be possible to use masonry members. The main objective of this study is to evaluate the stiffness, the efforts distribution and the effect of horizontal elements (girders) and vertical elements (counterforts) distribution on the behavior of masonry blocks retaining walls. For this purpose, numerical modeling was performed on typical retaining wall arrangements by varying the amount and placement of horizontal and vertical elements, beyond includes elements simulating the reactions of the soil supporting the foundation of the wall. The numerical modeling also include the macro modeling strategy in which the units, mortar and grout are discretized by a standard volume that represents the masonry elastic behavior. Also, numerical model results were compared with those ones of simplified models usually adopted in bending design of masonry elements. The results show horizontal displacements, principal and shear stresses distribution, and bending moments diagrams. From the analysis it was concluded that quantity and manner of distribution of the girders are both important factors to the panel flexural behavior, the inclusion of the foundation changed significantly the behavior of the wall, especially the horizontal displacements, and has been proposed a new way of considering the flanges section of the counterforts

Elaboração de um queijo análogo ao pecorino romano produzido com leite de cabra e coalhada congelados

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Simulação numérica da interação entre uma nuvem incidente de vórtices e uma aerofólio através do método dos vórtices

The study of aerodynamic loading variations has many engineering applications, including helicopter rotor blades, wind turbines and turbo machinery. This work uses a Vortex Method to make a lagrangian description of the a twodimensional airfoil/ incident wake vortex interaction. The flow is incompressible, newtonian, homogeneus and the Reynolds Number is 5x105 .The airfoil is a NACA 0018 placed a angle of attack of the 0° and 5°simulates with the Painel Method with a constant density vorticity panels and a generation poit is near the painel. The protector layer is created does not permit vortex inside the body. The vortex Lamb convection is realized with the Euler Method (first order) and Adans-Bashforth (second order). The Random Walk Method is used to simulate the diffusion. The circular wake has 366 vortex all over positive or negative vorticity located at different heights with respect to the airfoil chord. The Lift was calculated based in the algorithm created by Ricci (2002). This simulation uses a ready algorithm vatidated with single body does not have a incident wake. The results are compared with a experimental work The comparasion concludes that the experimental results has a good agrement with this papper

Clones promissores de seringueira para a região do Vale do Ribeira, São Paulo

Este trabalho objetivou apresentar resultados da primeira seleção de clones de seringueira (Hevea brasiliensis (Willd. ex Adr. de Juss.) Muell.Arg.) da série IAC 300, e amazônicos das séries IAN e Fx, em experimento de pequena escala, visando produção, crescimento e resistência ao mal-das-folhas. A produção e o vigor de 20 clones foram avaliados por dois e nove anos, respectivamente, em PariqüeraAçú, no Vale do Ribeira, SP. Os clones IAC 301, IAC 304, IAC 306 e IAC 319 produziram satisfatoriamente nos dois primeiros anos de sangria. Os clones amazônicos IAN 6323, Fx 3864 e IAN 2903, com produções de 1.078 kg, 945 kg e 900 kg/ha/ano, respectivamente, foram superiores à testemunha IAN 873 (878 kg/ha/ano). Os clones selecionados apresentaram crescimento vigoroso, com extremos de perímetro do caule, na abertura do painel, de 37,40 cm (IAN 4493) a 53,75 cm (IAN 6323), e percentual de plantas aptas à sangria de 7,0% (IAN 4493) a 100% (IAN 6323 e IAC 302), exceto os clones Fx 3899 e IAN 3044. O IAC 315, com 7,37 mm, mostrou maior espessura de casca virgem que o IAN 873 (6,44 mm). Os clones IAC 320, IAC 306 e IAC 315 foram os mais resistentes ao Microcyclus ulei.

Estudo da detecção do DNA do papiloma vírus humano (HPV) e da expressão imuno-histoquímica de proteína do ciclo celular no carcinoma epidermóide oral

Oral squamous cell carcinoma (OSCC) is the most common malignancy in oral cavity and human papillomavirus (HPV) may have an important role in its development. The aim of this experiment was to investigate the HPV DNA and viral types in 90 cases of OSCC. Moreover, a comparative analysis between the cases of OSSC with and without HPV DNA was performed by using cell cycle markers p21 and pRb in order to detect a possible correlation of these proteins and HPV infection. DNA was extracted from paraffin embedded tissue and amplified by PCR (polymerase chain reaction) with primers PCO3+ e PCO4+ for a fragment of human β-globin gene. After this procedure, PCR for HPV DNA detection was realized using a pair of generic primers GP5+ e GP6+. Immunohistochemical study was performed by streptoavidin-biotin technique and antibodies against p21 and pRb proteins were employed. Eighty-eight cases were positive for human β-globin gene and HPV DNA was found in 26 (29.5%) of then. It could not be detected significant correlation between HPV and age, sex and anatomical sites of the lesion. The most prevalent viral type was HPV 18 (80.8%). Regarding the immunohistochemical analysis, it was detected significant association between HPV presence and pRb immunoexpression (p=0,044), nevertheless, the same was not observed in relation to p21 protein (p =0,416). It can be concluded that the low detection of HPV DNA in OSCC by the present experiment suggests a possible role of the virus in the development and progression in just a subset of this disease

O afeto além dos muros e portões : o apego a vizinhanças na cidade do Natal

Place Attachment is a positive affective bond between people and environments, and its main characteristic is the desire to maintain closeness to the place of attachment. Neighborhoods, in turn, are spaces close to the dwelling, which varies according to environmental, social and cultural characteristics. Facing the contemporary scenario of diminishment of neighborhood relations and its importance to the understanding of cities social-environmental context, the present work aimed to investigate the attachment to neighborhoods at the city of Natal-RN. This study had two stages. The first stage consisted on investigating, through an experts panel, the main characteristics of attached neighborhoods, aspects that contributes to the development of these neighborhoods, the ones that difficult, as well as look for indications of neighborhoods at the city of Natal that may be identified by these elements. In the following stage I interviewed 11 residents of two indicated neighborhoods at the district of Alecrim, to better comprehend the main characteristics of this attachment and the elements of the context that enable its development. The content of the interviews, categorized and evaluated by judges, indicated that, due to the 10 participant experts, the main characteristics of attached neighborhoods encompass elements of socialization, cooperation, physical space usage, intimacy and identity. According to them, these are characteristics enabled by temporal and rootedness aspects, by spatial contact, familiarity between neighbors, and cultural inheritance. The interviews with residents showed that attachment to the studied neighborhoods is specially grounded on support and cooperation networks between neighbors, on satisfaction with the proximity of services, and on the bond to symbolic aspects and local traditions. In addition to be enabled by spatial organization, by low displacement of residents, and by the district s history, relations at these neighborhoods are fostered by an intention to establish this kind of ties, carried by cultural values

A Praça André de Albuquerque, Natal/RN, na visão de seus frequentadores

The study offers a global and interpretative view of the person-environment inter-action at André de Albuquerque Plaza, in Natal, RN, according to a descriptive-exploratory approach that aimed at learning about the space converted into place, as it is perceived and experienced by users, who attribute meaning to it. The main objective was to critically analyze the relationship person-plaza, based on data collected about users perception, utilization and ascribed meaning. I have employed an Environmental Psychology multi-method approach, including informal observations, interactive poster session, videotaping and interviews. The results indicated that the plaza, besides being a passage point, is also a spot of urban convergence for several groups, particularly taxi drivers, flanelinhas, skate boarders and students. In regard to the perception of the place, an overall positive evaluation of the plaza was verified, since people perceive selectively what interests them. In terms of usage, different groups of users presented diverse patterns of utilization, also observed in the attributed meanings. The plaza is a work place for taxi drivers and flanelinhas and a sports arena for the skate boarders, with a practical meaning for both groups. For students and other users it is a place for meeting and leisure, revealing a stronger affective quality, responsible for feelings of well being, tranquility and relaxation. The data so obtained could contribute for future government projects of intervention in those spaces, aiming at its preservation as an open spot among the concrete of city buildings, offering better quality of life, not only for today, but also for future generations

Adaptação transcultural para o Português/Brasil do instrumento vulnerability to abuse screening scale (VASS)

Esse trabalho objetivou promover a adaptação transcultural para o Brasil da VASS. Os passos para adaptação transcultural seguirão a proposta de operacionalização alicerçado na apreciação de diferentes tipos de equivalência: a conceitual e de itens, a semântica e a de mensuração. Para alcançar as duas primeiras etapas utilizou-se as técnicas de tradução e retrotradução associada ao procedimento intitulado Painel de Especialistas. Para o pré-teste e verificação de equivalência de mensuração, aplicou-se o questionário com uma população de 30 e 66 idosos, respectivamente. Para as análises dos resultados foi utilizada a estatística descritiva e inferencial, em especial o KR-20, teste T de student, correlação de Pearson e ANOVA univariada, bem como o método kappa de Fleiss para verificação do índice de confiabilidade. Verificou-se que o conceito utilizado para construção do instrumento, bem como seus itens se mostram adequados à investigação do fenômeno. Evidenciou-se boa equivalência semântica entre os itens das retrotraduções e do instrumento original, especialmente quanto aos resultados de T1 R1. Os juízes optaram pelo uso de 11 itens de T1 à versão-síntese. A equivalência operacional mostrou-se satisfatória. Em geral, os resultados apresentados mostraram-se aceitáveis. Quanto à etapa da equivalência de mensuração, verificou-se que a idade dos participantes variou entre 60 a 84 anos, prevalecendo respondentes idosas (n = 38), representando 57,6% da amostra estudada. O valor do KR-20 para o escore geral do instrumento foi de 0,688 (IC95%: 0,670). Os valores encontrados para as quatro dimensões propostas pelos autores do estudo inicial do instrumento foram 0,528, 0,289, 0,552 e 0,303, respectivamente. Apenas os valores de consistência interna das subescalas Vulnerabilidade e Coerção mostraram-se aproximados aos encontrados no estudo original, a saber, 0,550 e 0,390, respectivamente. Verificou-se que com a retirada dos itens nº 04, nº 06 e nº 10, houve aumento do índice de consistência interna da escala total. Já quanto aos valores da consistência interna das subescalas, percebeu-se que apenas com a retirada dos itens nº 09, referente à escala que dimensiona o Desânimo, e nº 12, item da subescala Coerção, é que houve acréscimo nesses valores. Destaca-se que esses são resultados preliminares, uma vez que após a verificação da adequabilidade e de padrões psicométricos iniciais acerca do uso do instrumento para a população idosa, ainda há de se dar continuidade à etapa concernente à verificação de propriedades psicométricas robustas do instrumento, que indiquem, por exemplo, evidências de fidedignidade em situação de teste-reteste, validade de constructo e de critério, se possível e aplicável. A principal limitação do estudo é a falta de um instrumento padrão-ouro para testar a fidedignidade, sensibilidade e especificidade do instrumento em questão. Apesar desta limitação, a adaptação transcultural e a verificação de propriedades psicométricas preliminares do instrumento de uma medida de autorrelato que afere indicativo de violência doméstica contra o idoso tem sua relevância e foi satisfatória

A comparative study of the immunoantigenicity of eight Paracoccidioides brasiliensis isolates

Para se detectar diferenças imuno-antigênicas entre 8 amostras de P. brasiliensis isoladas de diferentes áreas endêmicas (Botucatu: Pb 1, 2 e 3; São Paulo: Pb: 18, 192 e 265; Venezuela: Pb 9 e 73), esutdaram-se: 1. A reatividade antigênica de cada amostra nas reações de imunofluorescência indireta (II) e de imunodifusão dupla em gel de agar (ID) contra painel de 20 soros controles positivos para paracoccidioidomicose; 2. A capacidade de induzir resposta imune humoral (medida por imunodifusão) e celular (medida pelo teste de coxim plantar) em camundongos imunizados com an-tígenos de cada amostra. Observamos: 1. As amostras Pb 265 e Pb 9 mostraram-se mais reativas na II; 2. Os antígenos das amostras Pb 192 e Pb 73 foram significativamente mais reativas na ID; 3. Estes dados demonstram diferenças de antigenicidade entre estas amostras; 4. A amostra Pb 18 mostrou baixo poder indutor de resposta imune celular e alta capacidade de indução de resposta imune humoral em camundongos imunizados, revelando dissociação de sua imunogenicidade. Estas diferenças podem indicar a existência de cepas distintas do fungo ou refletir modificações do parasita no hospedeiro ou du rante seu cultivo.

Desempenho de clones de seringueira da série IAC 300 selecionados para a região noroeste do Estado de São Paulo

É apresentado o desempenho de 19 novos clones de seringueira [Hevea brasiliensis (Willd. exAdr. de Juss.) Muell. Arg.], resultantes de hibridações conduzidas no Instituto Agronômico e avaliados em experimento de pequena escala, tendo o clone RRIM 600 como testemunha. O experimento em campo obedeceu ao delineamento em blocos ao acaso, com três repetições. Com relação à produção de borracha seca, o clone IAC 40 apresentou a maior média (62,22 g/árvore/sangria) nos três anos de avaliação, seguido pelo IAC 301 (57,67 g/árvore/sangria) e pelo IAC 300 (50,61 g/árvore/sangria), com produções 154%, 138% e 123% superiores em relação ao RRIM 600 (41,04 g/árvore/sangria). Todos os clones selecionados foram vigorosos, com perímetro do caule na abertura do painel variando de 37,81 cm (IAC 317) a 50,90 cm (IAC 315). A porcentagem de plantas aptas a sangria variou de 20,0% (IAC 317) a 100% (IAC 315). Todos os clones apresentaram baixas incidências de quebra pelo vento e de secamento do painel. Não foi detectada nenhuma doença foliar em caráter epidêmico. Dos clones estudados, 15 apresentaram alta resistência à antracnose do painel, e foram superiores ao RRIM 600; os outros cinco apresentaram resistência moderada semelhante ao RRIM 600.

Desempenho de clones de seringueira de origem amazônica no planalto do Estado de São Paulo

O objetivo deste trabalho foi avaliar a adaptabilidade e expressão fenotípica de caracteres superiores de dez clones amazônicos de seringueira (Hevea spp.) no planalto do Estado de São Paulo em um período de 10 anos, obedecendo ao delineamento de blocos ao acaso com três repetições e parcelas lineares de seis plantas. O clone IAN 3156 foi o mais produtivo, com média de 65,57 g de borracha seca/árvore/sangria, no período de quatro anos, seguido pelo clone RO 45 com 52,29 g de borracha seca/árvore/sangria, enquanto o clone-testemunha, RRIM 600, produziu 41,04 g/árvore/sangria. Todos os clones apresentaram crescimento vigoroso. O perímetro do caule na abertura do painel variou de 37,01 cm (IAN 3193) a 49,41 cm (IAN 4493). A porcentagem de plantas aptas à sangria variou de 30,0% (IAN 3703) a 93,75% (IAN 6323). Exceto os clones IAN 3156 e IAN 4493 com 7,00 mm e 6,32 mm, respectivamente, todos os outros clones apresentaram espessura de casca virgem inferior ao clone RRIM 600, que apresentou 6,18 mm. O clone IAN 3193 apresentou maior incidência de quebra do ponteiro pelo vento. Todos os clones estudados apresentaram baixa incidência de secamento de painel. O bom desempenho dos clones IAN 3156, RO 45, Fx 3899 e IAN 4493 permite que possam ser experimentados em larga escala, envolvendo diferentes ambientes no Estado de São Paulo.

Desempenho de clones de seringueira da série IAC 300 na região do planalto de São Paulo

O objetivo deste trabalho foi selecionar clones de seringueira (Hevea spp.) promissores para a região do planalto do Estado de São Paulo. de uma população de 70 clones, de polinização controlada, integrantes do experimento de avaliação em pequena escala, foram avaliados 16 da série IAC 300. O experimento foi instalado na Estação Experimental de Pindorama, no espaçamento de 7 x 3 m, em delineamento de blocos casualizados, com três repetições, tendo os clones RRIM 600 e GT 1 como testemunhas. Quanto à produção de borracha seca, destacaram-se oito e dez clones superiores ao RRIM 600 e GT 1, respectivamente. Todos os clones avaliados apresentaram-se vigorosos em relação ao perímetro do caule na abertura do painel. Sete deles mostraram alta resistência; sete, resistência moderada, e dois, suscetíveis à antracnose do painel. Sugere-se sua avaliação em experimentos de grande escala, para avaliar, além da produção, os demais caracteres secundários, em diferentes ambientes, para futuras recomendações em larga escala para o Estado de São Paulo.