Avaliação da função endotelial em pacientes com hipertensão arterial resistente

A hipertensão arterial resistente (HAR) é definida pela persistência da pressão arterial (PA)≥140/90mmHg a despeito do uso de 3 anti-hipertensivos em doses plenas, incluindo diurético. Revisão recente da literatura mostra poucos estudos avaliando o perfil e o comportamento da função endotelial em pacientes com HAR. Objetiva avaliar a função endotelial em pacientes hipertensos resistentes. Estudo transversal com 60 pacientes que foram avaliados em uma visita (V3) de um estudo longitudinal, onde numa primeira fase todos pacientes tiveram padronização do tratamento anti-hipertensivo. Foram incluídos pacientes (V0) com PA>160/100mmHg e <220mmHg e todos receberam clortalidona 25mg/dia e enalapril 20mg 2x/dia ou losartana 50mg 2x/dia (intolerantes ao enalapril). Visita 1: se PA>140/90mmHg acrescentou-se anlodipino 5mg/dia, foi realizado avaliação laboratorial de rotina do hipertenso e monitorização ambulatorial da PA-24h (MAPA). Visita 2: se PA>140/90mmHganlodipino foi titulado para 10mg/dia. Visita 3: todos os pacientes receberam avaliação clínica, da pressão arterial por MAPA, laboratorial de rotina e da função endotelial. Formaram-se dois grupos: os que controlaram a PA, grupo hipertensão arterial controlada (HAC); e os que permaneceram com PA de consultório>140/90mmHg e PA na MAPA-24h>130/80mmHg, foram considerados resistentes. O grupo HAR recebeu aleatoriamente espironolactona ou clonidina por mais 12 semanas para tentar controlar a PA e o grupo HAC teve assistência farmacológica mantida no mesmo período. A PA foi avaliada por método oscilométrico com aparelho digital semi-automático Microlife modelo BP3AC1-1PC e MAPA por aparelho SpaceLabs 90207. A função endotelial avaliada através de tonometria arteriolar periférica (PAT) pelo Endo-PAT2000 e por biomarcadores (I-CAM-1, V-CAM-1, VEGF, MCP-1, IL-6, adiponectina) através da técnica LuminexTMxMAP. Dos 60 pacientes avaliados, 36 controlaram a PA, grupo HAC, e 24 permaneceram resistentes ao tratamento, grupo HAR, na visitaV3. Na avaliação da PA pela MAPA-24h observamos que no grupo HAC a PAS-24h foi de 121,1+1,7mmHg e no grupo HAR 147+3,3mmHg, enquanto a PAD-24h no grupo HAC foi de 76,64+1,5mmHg e no grupo HAR 88,58+2,4mmHg (p<0,0001). O descenso noturno, apesar de maior no grupo HAC, não apresentou significância estatística entre os dois grupos (p> 0,05). A função endotelial avaliada através do PAT mostrou índice de hiperemia reativa de 1,850,056 e 1,65+0,074 nos grupos HAC e HAR respectivamente (p= 0,036) e quando avaliada através dos biomarcadores observamos: ICAM-1 (HAC= 186,6+12,65 vs HAR= 240,9+23,76ng/ml, p= 0,038), VCAM-1 (HAC= 627,137,09vs HAR= 706,086,10ng/ml, p= 0,372),VEGF (HAC= 403,394,91 vs HAR= 612,788,27pg/ml, p= 0,123) e MCP-1 (HAC= 694,969,09 vs HAR= 787,052,80pg/ml, p= 0,315). Na avaliação dos biomarcadores inflamatórios, observamos IL-6 no grupo HAC= 1,8970,2165pg/mle no HAR= 9,7934,421pg/ml (p= 0,027) e adiponectina no grupo HAC= 105701516pg/ml e HAR= 84221295pg/ml (p=0,301). A razão de prevalência do comprometimento da função endotelial no grupo HAR foi de 54% (OR= 3,55; 95% IC 1,18- 10.67; p= 0,029). No presente trabalho, as análises das variáveis estudadas na visita V3, mostraram que os pacientes com HAR têm maior comprometimento da função endotelial que os pacientes com HAC.

Cuidados paliativos na insuficiência cardíaca: o conforto como desfecho do cuidar em enfermagem

O objetivo geral deste estudo foi: Verificar se a introdução dos princípios da teoria do conforto de Katherine Kolcaba na consulta de enfermagem para pacientes com IC sob cuidados paliativos a partir da sistematização da assistência utilizando as taxonominas NANDA-NOC-NIC promove maior conforto. Trata-se de um ensaio clínico aberto, tipo antes e depois, realizado em hospital federal localizado no Rio de Janeiro com amostra de 20 pacientes. Para avaliação do conforto, utilizou-se o questionário End of life comfort questionnaire patient e o resultado de enfermagem (NOC - Estado de Conforto). As avaliações do questionário ocorreram nas primeira, terceira e sexta consultas de enfermagem e o NOC em todas as consultas. A coleta de dados foi realizada entre os meses de novembro de 2012 e maio de 2013. Utilizou-se o programa SPSS 19.0 para análise dos dados. Foram utilizados os Testes Qui-Quadrado, Exato de Fisher e Mann-Whitney para verificar a associação dos diagnósticos e intervenções de enfermagem com o conforto aferido pelo questionário nos três tempos aplicados. Foi utilizado o Teste ANOVA (análise de variância) para avaliar a melhora na condição de conforto dos sujeitos através do questionário já descrito e também pela NOC Estado de Conforto verificada nas seis consultas. Como resultado encontrou-se três diagnósticos de enfermagem e duas intervenções de enfermagem relacionadas à maior conforto dos pacientes (p <0,05). Já associados ao menor conforto foram encontrados 08 diagnósticos e 12 intervenções. O conforto verificado pelo questionário e o resultado de enfermagem aumentaram significativamente (p <0,001) durante os 06 meses de acompanhamento. A aceitação da hipótese alternativa (a introdução dos princípios da teoria de Katherine Kolcaba na consulta de enfermagem está associada ao maior conforto dos pacientes com insuficiência cardíaca sob cuidados paliativos), se confirmou. O estudo contribuiu para reafirmar que quando se utiliza uma teoria de enfermagem para sustentar a prática/pesquisa da profissão, o desenvolvimento da sistematização da assistência se torna mais claro. A implementação da teoria faz com que o desfecho do cuidar em enfermagem se torne visível a outras profissões e à sociedade em geral.

Tudo isso é inovação: mediação e criatividade no encontro entre o designer e as artesãs

O objetivo deste trabalho trata-se de explorar o papel do designer quando em relação à contextos de produção artesanal, partindo de pesquisa etnográfica realizada em uma oficina de design, conduzida por Lars Diederichsen, para as artesãs da Cooperativa Lã Pura. Inserida no programa Talentos do Brasil, do Ministério do Desenvolvimento Agrário, a oficina de design tem como propósito a geração de novos produtos para a cooperativa e configura-se como a visita de um designer ao grupo. As bases teóricas para a análise das relações entre o designer e artesãs estão amparadas no conceito de mediação (Velho, 2001; 2003). Ao relacionarem-se esses sujeitos negociam seus projetos, transitam entre diversos domínios e reconstroem as suas realidades e a si mesmos, criando e recriando as suas identidades como mulheres artesãs e como designer, contribuindo para a conceituação do que significa ser mulher artesã e ser designer. Ao mesmo tempo, a ideia de criatividade permeia todo o processo da oficina de design, tendo sido problematizada a partir de Ingold e Hallam (2007) que sugerem os conceitos de inovação e improvisação.

Role of fisheries extension officers in FFDA at Balasore

The first FFDA in Orissa state was established in the year 1976. The study was conducted in Balasore district of the State. The findings revealed that all of the FEOs were not well qualified but trained and experienced. The duration of training obtained varied from 3 to 10 months. An FEO has a large area under his jurisdiction. Cycle was used by most of the FEOs to visit the fish farmers which resulted in infrequent visits. The FEOs were not satisfied with the working conditions, promotion avenues and conveyance facilities. There was interference of political bodies in leasing out ponds. The amount of loan sanctioned was not adequate to start fish farming. They also revealed that marketing aspects were totally neglected by the FFDA.

Reports of the ICSF seminar / workshop on the conditions of fishworkers on distant water vessels, Manila, Philippines, 1-3 February 1991

This ICSF Exchange Programme held in Manila is an offshoot of the Bangkok Conference on “Global Fisheries Trends and Future of Fishworkers” held on January 22–27, 1990. One of the issues raised in that conference was about the operation of Taiwanese fishing vessels outside its territorial waters and the impact of such operations on small fishermen from the countries concerned. The presence of a Taiwanese fishworker as well as an NGO supporter contributed to an enlightening discussion as the former shed light on the sad plight of Taiwanese fishworkers who are the victims of such structural problems. This meaningful exchange between groups of fishermen, particularly Taiwanese and Filipinos, resulted in the plan of the Taiwanese delegation to have some Taiwanese fishermen visit the Philippines and immerse in fishing communities.

Coulomb blockade double-dot Aharonov-Bohm interferometer: Giant fluctuations

Electron transport through two parallel quantum dots is a kind of solid-state realization of double path interference We demonstrate that the inter-clot Coulomb correlation and quantum coherence would result in strong current fluctuations with a divergent Fano factor at zero frequency. We also provide physical interpretation for this surprising result, which displays its generic feature and allows us to recover this phenomenon in more complicated systems. (C) 2009 Elsevier B.V. All rights reserved.

Interannual fluctuations in floral longevity, pollinator visitation and pollination limitation of an alpine plant (Gentiana straminea Maxim., Gentianaceae) at two altitudes in the Qinghai-Tibetan Plateau

Prolonged floral longevity and bumblebees as dominate pollinators in alpine ecosystem have been suggested to overcome pollination limitation of alpine plants arising from the decrease of pollinator activity with increasing altitude. However, this conclusion has never been examined in the Qinghai-Tibetan Plateau (QTP), the highest and largest plateau in the world. In this study, we intended to test year-to-year correlations between floral longevity, visiting frequency and pollen limitation of this species between two populations (at 3200 m and 4000 m) of Gentiana straminea in this plateau. Pollinator exclusion elongated both male and female phases greatly at both sites, and durations of both male and female phases in natural condition varied greatly over three years. The visiting frequency of bumblebees varied greatly at the higher altitude, but seemed to be stable at the lower altitude. Seed production was pollination limited in both populations in most studied years. The floral durations, pollinator frequency and pollination limitation showed no significant and consistent variations with the increase of altitude. The previous hypothesis that the prolonged floral longevity of alpine plants can compensate for low levels of pollinator visitation therefore could not be confirmed, and our results further suggested that in the QTP platform, the altitude shows no consistent effect on the reproductive performance of this species, despite that the fluctuation of visit frequency intensified at the higher altitude.

Pollinator shift and reproductive performance of the qinghai-tibetan plateau endemic and endangered Swertia przewalskii (Gentianaceae)

Reproductive failure results in many plant species becoming endangered. However, little is known of how and to what extent pollinator shifts affect reproductive performance of endangered species as a result of the artificial introduction of alien insects. In this study we examined breeding systems, visitor species, visiting frequency and seed set coefficients of Swertia przewalskii in two years that had different dominant pollinator species (native vs. alien). Flowers of this species were protandrous and herkogamous and insects were needed for the production of seeds. The stigmatic receptivity of this species was shorter than for other gentians. No significant difference in seed set coefficient was found for hand-pollinated plants between the two years, indicating that pollinator shift only had a minor effect on this plant's breeding system. The commonest pollinators in 2002 were native bumblebees, alien honeybees and occasional solitary bees, however, only alien honeybees were observed in 2004. The flower visitation rate in both years was relatively high, although the total visit frequency decreased significantly in 2004. The control flowers without any treatment produced significantly fewer seed sets in 2004 than in 2002. In the past decade the seed production of this species may have partly decreased due to pollination by alien honeybees, however, we suggest that they might have acted as alternative pollinators ensuring seed production of S. przewalskii when native pollinators were unavailable. The main reason that this plant is endangered is probably the result of habitat destruction, but changes in land use, namely intensified agricultural practice and unfavorable animal husbandry have also contributed to its decline. We recommend that in-situ conservation, including the establishment of a protected area, is the best way to preserve this species effectively.

Social and ecological influences on dispersal and philopatry in the plateau pika (Ochotona curzoniae)

Benefits and costs of dispersal and philopatry of the social plateau pika (Ochotona curzoniae) were studied on the Tibetan plateau for 3 years. Although short-lived, plateau pikas live in cohesive family groups that occupy burrow systems in sedge meadow habitat Most (57.8%) plateau pikas were philopatric, and dispersal movements were extremely restricted. No juvenile females or adult pikas moved more than two family ranges between years; the greatest observed dispersal distances were by two juvenile males that moved five family ranges from the family of their birth. Traversing unfamiliar habitat was not a cost of pika dispersal because most dispersers settled in families that they could easily visit before dispersal. Dispersal movements appeared to result in equalization of density among pika families, an expected result if competition for environmental resources influenced dispersal. Males did not disperse to gain advantages in competition for mates, as evidenced by their moving to families with significantly fewer females. Females, however, moved to families with significantly more males. Males provide abundant paternal care, and significantly more offspring per female survived to become adults from families with more adult males per adult female. Evidence concerning the influence of inbreeding avoidance on natal dispersal was indirect. Some males exhibited natal philopatry; thus some families had opportunity for close inbreeding. Males and females that dispersed had no opposite-sex relatives in their new families. Philopatric pikas may have benefited by remaining in families that exhibited low local densities, and philopatric females might have benefited from social cooperation with relatives.

The use of transvaginal synthetic mesh for anterior vaginal wall prolapse repair: a randomized controlled trial

The aim of the study was to compare the efficacy and safety of transvaginal trocar-guided polypropylene mesh insertion with traditional colporrhaphy for treatment of anterior vaginal wall prolapse.This is a randomized controlled trial in which women with advanced anterior vaginal wall prolapse, at least stage II with Ba a parts per thousand yenaEuro parts per thousand+1 cm according to the Pelvic Organ Prolapse Quantification (POP-Q) classification, were randomly assigned to have either anterior colporrhaphy (n = 39) or repair using trocar-guided transvaginal mesh (n = 40). the primary outcome was objective cure rate of the anterior compartment (point Ba) assessed at the 12-month follow-up visit, with stages 0 and I defined as anatomical success. Secondary outcomes included quantification of other vaginal compartments (POP-Q points), comparison of quality of life by the prolapse quality of life (P-QOL) questionnaire, and complication rate between the groups after 1 year. Study power was fixed as 80 % with 5 % cutoff point (p < 0.05) for statistical significance.The groups were similar regarding demographic and clinical preoperative parameters. Anatomical success rates for colporrhaphy and repair with mesh placement groups were 56.4 vs 82.5 % (95 % confidence interval 0.068-0.54), respectively, and the difference between the groups was statistically significant (p = 0.018). Similar total complication rates were observed in both groups, with tape exposure observed in 5 % of the patients. There was a significant improvement in all P-QOL domains as a result of both procedures (p < 0.001), but they were not distinct between groups (p > 0.05).Trocar-guided transvaginal synthetic mesh for advanced anterior POP repair is associated with a higher anatomical success rate for the anterior compartment compared with traditional colporrhaphy. Quality of life equally improved after both techniques. However, the trial failed to detect differences in P-QOL scores and complication rates between the groups.

Wokół pierwszego pobytu Apostoła Pawła w Efezie (Dz 18,18-22)

One of the crucial stages of the Apostle Paul’s ministry was his stay at Ephesus. However, considering the fact that the reliability of some data in the Acts of the Apostles on the time of Paul’s arrival to Ephesus is nowadays frequently put into question, it has become necessary to investigate the issue. In the present article the author assesses the relevant source material and takes a stand on the particular opinions of contemporary interpreters of the subject. Based on an analysis of the text of the Acts of the Apostles he is led to conclude that Luke’s account of Paul’s first short visit to Ephesus reveals traits of historicity.

Saúde oral na gravidez

Monografia apresentada à Universidade Fernando Pessoa para obtenção do grau de Licenciado em Medicina Dentária

Carpintería y trabajos en tagua. Chiquinquirá (Boyacá). Desarrollo de producto.

139 hojas : ilustraciones.

Diagnóstico de desarrollo artesanal : departamento de Arauca, municipios de Arauca, Arauquita, Saravena, Tame y Cravo Norte.

64 hojas : ilustraciones, fotografías.

Diagnóstico de desarrollo artesanal : departamento de Risaralda municipios de Apia, Quinchia, Balboa, Santa Rosa de Cabal y zona indígena (Mistrato y Pueblo Rico - Santa Cecilia).

49 hojas : ilustraciones, fotografías.