Tratamento de fístulas enterocutâneas através de sistema a vácuo com alta pressão e dieta oral normal

Enterocutaneous fistulas are associated with prolonged hospital stay, high morbidity/mortality, and increase in hospital costs. This study aims to describe the use of a vacuum system and normal oral diet in dealing with this problem. Methods: Seventy-four consecutive patients with recent and defined external postoperative fistulas were analyzed. Abdominal imaging was used to exclude abscess and distal obstruction. The fistula tract was sealed with Foley catheter, connected to a negative pressure flask, changed daily for 5, 10 or 15 days, as necessary. Normal oral diet was permitted. Results: No patient died. Serum albumin and transferrin showed significantly higher levels at the end of treatment than at the beginning. The moderate and low-output fistulas had the best results (97% closed). Forty-eight (65%) fistulas closed after five days, 16(22%) after 10 days and 4(5%) after 15 days. Treatment failed in 6(8%) patients, who subsequently underwent surgery. Only one patient with low-output did not close her fistula. The cost of the treatment was US$ 41.75/day and it was considered cost effective. Conclusions: The vacuum system demonstrated good results in the treatment of fistulas. It included simplicity, low cost, short hospital stay, absence of skin breakdown, normal eating, good nutrition and activity patterns

Da Barra do Rio aos parrachos: duas realidades sociorganizacionais no litoral Norteriograndense

Observing that social capital is considered crucial for the consolidation of an association, this paper analyzes how different groups associative absorb the concept of membership and how to manage routing in their actions to the social interest. The research aimed to evaluate two central forms of association, based on the concept of Pierre Bourdieu (1980) on social capital, stressing that its distribution and perception are uneven and depends on the ability of ownership of different social groups. Accordingly, took up two organizations community based one in - Barra do Rio and another in Maracajaú - whose main activity is the exploitation in the coastal tourist norteriograndense. Once processed the data, it became clear that, despite the purpose for the association has been motivated by exploration in both organizations, each differently appropriates its capital. While one maintains a feelings of togetherness, trust and satisfaction of group work, the other one, feelings are stifled by individualism, mistrust among their members that although they see the association as something important for the growth and strengthening of the group, working individually

Técnica para avaliação da pressão arterial pulmonar de equinos durante o exercício progressivo em esteira rolante

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

Comportamento da pressão intra-ocular segundo os efeitos cardiorrespiratórios e hemodinâmicos induzidos pela anestesia com desflurano, em cães submetidos à hipovolemia experimental

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

Diversificação evolutiva de gobídeos no litoral brasileiro: padrões citogenéticos e ecomorfológicos

The fishes of the order Perciformes are characterized as an important model for understanding the genetic structure of marine populations, because besides they present examples of conservation chromosomal, also they present the karyotype diversification for some groups. Gobiidae family is the most specious in the marine environment. Among its representatives, many species are part of a cryptic fauna little noticed and studied, a wide distribution with behavioral and reproductive characteristics, that make them conducive to the action of biogeographical barriers. Morphologically this family presents reduced body structures through simplification and regressions. Despite their importance in evolutionary inferences, cytogenetics data are incipient facing their species diversity, especially with western Atlantic species. In order to estimate the evolutionary diversity in Gobiidae, it were developed cytogenetic analysis and the standards body, through geometric morphometrics in five species on the Brazilian coast, Coryphopterus glaucofraenum, Bathygobius mystacium, B. soporator, Ctenogobius smaragdus e C. Boleosoma. The data show significant karyotype and morphological diversity among the species. The pericentric inversions and mergers play an important role in chromosomal evolution of this family, causing karyotypic structural and numerical differences in all species. Karyotypic and morphological comparisons among geographic samples of B. soporator from the coast of Maranhão, Rio Grande do Norte and Bahia showed cytogenetics patterns commons, but different morphological patterns. A sample from the Atol das Rocas revealed conspicuous morphological and karyotypic differentiation of another continental populations, confirming the presence of a new island species. The approaches done reveal diversification consistent with characteristics of a group of low vagile and largely able to environmental selection due from peculiar ecological requirements

Desempenho do trator agrícola no manejo da cultura de cobertura e pressão de inflação do pneu da semeadora

O adequado manejo de culturas de cobertura no plantio direto tem-se mostrado excelente alternativa para melhorar as condições de semeadura. O objetivo do presente trabalho foi avaliar o desempenho do trator agrícola no manejo dos restos culturais do sorgo (rolo-faca e triturador de palhas) e a pressão de inflação (525 e 385 kPa) do pneu da semeadora-adubadora, no estabelecimento da cultura do milho em plantio direto. O experimento foi conduzido na UNESP - Jaboticabal, em delineamento de blocos ao acaso, com parcela subdividida, e os tratamentos consistiram nos manejos da cultura de cobertura do solo e pressões de inflação do pneu da semeadora, com quatro repetições. Foram mensurados nas máquinas: velocidade de deslocamento, capacidade de campo, consumo de combustível e patinhagem do trator; no solo e nas plantas, foi acrescido o tratamento de manejo com herbicida: cobertura inicial, número de dias para emergência das plântulas, população inicial e final de plantas, distribuição longitudinal e produtividade de grãos. No manejo da palhada da cultura do sorgo, o rolo-faca proporcionou maior capacidade de campo e menores consumos de combustível. Os tratamentos manejos e pressão não interferiram na cobertura do solo, no número de dias para emergência do milho e na distribuição longitudinal.

Semeadora-adubadora: exigências em função do preparo do solo, da pressão de inflação do pneu e da velocidade

As semeadoras-adubadoras, responsáveis pela correta adição de semente e adubo ao solo, possuem mecanismos dosadores acionados por suas rodas motrizes, que giram em função do contato com a superfície do solo. Esse contato é influenciado, entre outros fatores, pela pressão de inflação dos pneus. O objetivo do presente trabalho foi estudar o desempenho de uma semeadora-adubadora de precisão em função do preparo do solo (preparo convencional e plantio direto), das velocidades de deslocamento e da pressão de inflação do seu pneu. O trabalho foi realizado na UNESP de Jaboticabal (SP) no ano de 2006. Foram avaliadas as seguintes variáveis: força de tração e potência na barra, consumo de combustível (horário, ponderal, operacional e específico), capacidade de campo operacional, patinagem dos rodados do trator e da semeadora-adubadora, estande inicial e distribuição longitudinal de sementes. O sistema plantio direto demandou maior força (35 %), potência e consumo horário de combustível; o mesmo aconteceu na maior velocidade. A pressão de inflação das rodas da semeadora proporcionou menor patinagem e maior estande inicial de plântulas.

Pressão de aplicação com pulverizador de barra e eficiência de bioinseticidas fúngicos comerciais

Bioinseticidas fúngicos são aplicados com pulverizadores convencionais e algumas características destes equipamentos podem não ser adequadas e afetar a eficiência dos bioinseticidas. O objetivo deste trabalho foi verificar se pressões usuais, em aplicações com o pulverizador de barra, podem afetar a ação inseticida de conídios de Beauveria bassiana e Metarhizium anisopliae, componentes de produtos comerciais brasileiros. Para isso, suspensões aquosas de três bioinseticidas foram submetidas à passagem pelo equipamento em três pressões (20, 40 e 60 lbf pol-2) e avaliadas quanto ao rompimento, à viabilidade e à virulência dos conídios. Avaliou-se a viabilidade em lâminas de microscopia cobertas com meio de cultura, após incubação a 26±0,5ºC e fotoperíodo de 12 horas. A concentração foi determinada por meio de contagens em câmara de Neubauer e a virulência foi avaliada para lagartas de Diatraea saccharalis. Não foram encontradas, nos três produtos, influências significativas em nenhum dos parâmetros. Nas pressões avaliadas, a aplicação com o pulverizador de barra não reduz a viabilidade e nem a virulência dos conídios dos bioinseticidas testados, tampouco provoca destruição dos conídios.

Pressão e temperatura da água de lavagem na população microbiana da superfície de carcaças bovinas

The aimm of this study was to evaluate the influence of washing water temperature and pressure on mesophilic and psycluotrophic aerobic bacterial populations, yeasts and molds, total conforms and fecal coliforms population, whereas the cattle carcass surface may become contaminated during the different slaughter procedures and the final carcass washing may reduce microbial population Samples were taken by sponge swabbing in four areas of carcass surface (flank, neck, chest and rump), from which 20 were washed with write, at 25 degrees C and without artificial pressure, 20 with water under a pressure of 3atm, 20 with water at 40 degrees C and without artificial pressure and 20 with water at 40 degrees C under a pressure of 3atm For control purpose and using the same method to collect more 20 carcasses samples were taken without washing., loading 100 samples The results showed that the water at 25 degrees C undo 3atm pressure was more efficient to remove microorganisms from carcass surface than the heated water, although this latter promoter a mote visible clean carcasses

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.

Assistência de enfermagem e o risco para úlceras de pressão medido pela Escala de Braden em unidade de terapia intensiva

The problem facing the incidence of pressure ulcers (UP) in the hospital environment especially in the intensive care unit (ICU), although it is an old and frequent event in our professional practice, it is not notified in the researches as much as it should be. We observed a tendency to invest in therapeutical and in studies about the production of sophisticated new bandages. Few, however, are the investments in research on preventive measures in order to prevent or at least slow down the development of lesions. In this sense, the study aimed to analyze the correlation between nursing care and the risk of developing UP measured by the Braden scale in ICU patients. This is a descriptive study of longitudinal quantitative approach. The project obtained a favourable opinion from the Ethics Committee of HUOL (no 486/10). Data collection was carried out in the Hospital of Unimed in Natal during six months in 2011. The sample was of 32 patients hospitalized in ICU for over four days. The results were processed in SPSS 15.0 for descriptive statistics and inferential statistics. We identified that, only 9.4% of our sample developed UP, being predominantly male, elderly people aged above 60 years, Caucasian, with diagnostic hypothesis at the time of hospitalization of sepsis, were clinical patients, who presented hemodynamic instability, using orotracheal tube (TOT), enteral probe (SNE), vesical probe delay (SVD) and had values of albumin and hemoglobin levels below normal. In addition, these patients had a longer hospital stay, longer usage of TOT, SNE, SVD, increased use of sedation and drain than those who did not develop UP and were all at risk for developing these injuries second Braden scores. 66.7% of the lesions developed were located in the sacral region, limiting the degree I and all patients that developed were considered serious, 100.0% of them have evolved since the death. Small were the differences between the averages of Braden scores between patients with and without UP, 11,9+2,4 against 12,4+2,6 with p = 0.627. The clinical aspects of the patients in the study were instrumental in the development of UP, once, these findings were statistically significant through the Mann-Whitney test, and appropriateness of nursing conduct was decisive for the prevention of pressure ulcers in critical patients, since many were those classified as at risk (28) and few who have developed lesions (03)

Validação de instrumentos para avaliação da habilidade e do conhecimento acerca da medida da pressão arterial

This study aimed to validate tools for evaluating the ability and knowledge about blood pressure (BP) among nursing students. It is a cross-sectional, descriptive, quantitative and methodological study accomplished at the Universidade Federal do Rio Grande do Norte (UFRN), Universidade do Estado do Rio Grande do Norte (UERN) and a private university of the state. The sample consisted of 27 judges of research selected from the inclusion criteria: nursing, teachers of the semiology and/or semiotics discipline, with at least 1 year of experience, being from UFRN, EEN, UERN and private university of the state and and agree to participate voluntarily with the signing of the consent form. The research was development in three stages: construction of two instruments based on the scientific literature, resulting in a structured checklist consists of 28 items and a knowledge questionnaire with 12 questions; submission of the instruments to the judges, in the period from June to September 2012, which should evaluate each item in appropriate , appropriate with changes and inappropriate , addition to making an overall assessment of each instrument based on 10 requirements; validation and verification to the level of agreement among the judges, through the application of Kappa and Content Validity Index (CVI). Was used the consensus level greater than 0.61 (good) to the Kappa index and greater than 0.75 for CVI. Was approved by the Ethics in Research / HUOL. After being coded and tabulated, the data were analyzed using descriptive statistics. Of the 27 judges who evaluated the instrument, 77.8% are female, with a mean age of 36.6 (± 9.0) years, 63.0% worked in UFRN, 74.1% had academic master and 63.0% worked exclusively on teaching. Average length of teaching experience was 7.9 (± 8.0) years and in the semiology and/or semiotics discipline of 5.5 (± 6.7) years. In the judgment of structured checklist and questionnaire of knowledge about blood pressure mensurement any item/question was considered inappropriate since all obtained level of agreement within the indices established (CVI> 0,75 E Kappa> 0.61). In relation to structured checklist, of those 28 items present, 9 showed perfect concordance index (CVI = 1.00, Kappa = 1.00) and another 19 were considered appropriate with changes, especially with regard to clarity and vocabulary. In the questionnaire of knowledge, among the 12 questions that comprised, 7 had perfect concordance index and the others were considered appropriate with changes as requirements as clarity, vocabulary, and feasible sequence of instructional topics. In terms of a overall evaluating of instruments, the structured checklist got CVI of 0.94 and Kappa of 0.89 and the knowledge questionnaire, CVI of 0.97 and a kappa of 0.94. Both instruments proved to be valid as to their content, configuring it as clear and objective tools of assessment of knowledge and ability on blood pressure, being of nursing students as well as others students and health professionals, since the use of valid measures seeking to reduce the risk of distorting the results

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

Fatores condicionantes na formação de aglomerados no turismo :um estudo da perspectiva dos empresários em região do litoral do Nordeste do Brasil

The tourism has been presented as an alternative of production for determined regions of the Country. In this scene, one perceives that it is necessary to observe where each locality is situated in order to face an highly competitive and globalized world. The data used on this work was collected on a field research with the entrepreneurs of the coast of the City of Parnamirim/RN. The main objective of this research was to analyze the conditioning factors in the formation of clusters on tourism, according to the perception of the entrepreneurs of the Association of the Entrepreneurs of the Coast of Parnamirim AELP, based on the competitive advantages showed on Porter s model, referring to the conditions of the production factors, the demand, the associated and support sector, the strategy and structure of the company. On the statistical treatment, descriptive analysis and crossed analysis were carried through. According to the data, the research suggests the existence of some determinative factors that can generate competitive advantages, that whwn integrated, can congregate attributes that allow the formation of a competitive tourist accumulation in a region of the northeast coast of Brazil. The research also evidenced that the entrepreneurs have a strong dependence of the governmental actions

Proposta de algoritmo para detecção de vazamentos em oleodutos utilizando análise freqüencial de sinais de pressão

Pipeline leak detection is a matter of great interest for companies who transport petroleum and its derivatives, in face of rising exigencies of environmental policies in industrialized and industrializing countries. However, existing technologies are not yet fully consolidated and many studies have been accomplished in order to achieve better levels of sensitivity and reliability for pipeline leak detection in a wide range of flowing conditions. In this sense, this study presents the results obtained from frequency spectrum analysis of pressure signals from pipelines in several flowing conditions like normal flowing, leakages, pump switching, etc. The results show that is possible to distinguish between the frequency spectra of those different flowing conditions, allowing recognition and announce of liquid pipeline leakages from pressure monitoring. Based upon these results, a pipeline leak detection algorithm employing frequency analysis of pressure signals is proposed, along with a methodology for its tuning and calibration. The proposed algorithm and its tuning methodology are evaluated with data obtained from real leakages accomplished in pipelines transferring crude oil and water, in order to evaluate its sensitivity, reliability and applicability to different flowing conditions