Current practices in the management of patients with ureteral calculi in the emergency room of a university hospital

OBJECTIVE: Urinary lithiasis is a common disease. The aim of the present study is to assess the knowledge regarding the diagnosis, treatment and recommendations given to patients with ureteral colic by professionals of an academic hospital. MATERIALS AND METHODS: Sixty-five physicians were interviewed about previous experience with guidelines regarding ureteral colic and how they manage patients with ureteral colic in regards to diagnosis, treatment and the information provided to the patients. RESULTS: Thirty-six percent of the interviewed physicians were surgeons, and 64% were clinicians. Forty-one percent of the physicians reported experience with ureterolithiasis guidelines. Seventy-two percent indicated that they use noncontrast CT scans for the diagnosis of lithiasis. All of the respondents prescribe hydration, primarily for the improvement of stone elimination (39.3%). The average number of drugs used was 3.5. The combination of nonsteroidal anti-inflammatory drugs and opioids was reported by 54% of the physicians (i. e., 59% of surgeons and 25.6% of clinicians used this combination of drugs) (p = 0.014). Only 21.3% prescribe alpha blockers. CONCLUSION: Reported experience with guidelines had little impact on several habitual practices. For example, only 21.3% of the respondents indicated that they prescribed alpha blockers; however, alpha blockers may increase stone elimination by up to 54%. Furthermore, although a meta-analysis demonstrated that hydration had no effect on the transit time of the stone or on the pain, the majority of the physicians reported that they prescribed more than 500 ml of fluid. Dipyrone, hyoscine, nonsteroidal anti-inflammatory drugs, and opioids were identified as the most frequently prescribed drug combination. The information regarding the time for the passage of urinary stones was inconsistent. The development of continuing education programs regarding ureteral colic in the emergency room is necessary.

Light vector meson production in pp collisions at root s=7 TeV ALICE Collaboration

The ALICE experiment has measured low-mass dimuon production in pp collisions at root s = 7 TeV in the dimuon rapidity region 2.5 < y < 4. The observed dimuon mass spectrum is described as a superposition of resonance decays (eta, rho, omega, eta', phi) into muons and semi-leptonic decays of charmed mesons. The measured production cross sections for omega and phi are sigma(omega)(1 < p(t) < 5 GeV/c. 2.5 < y < 4) = 5.28 +/- 0.54(stat) +/- 0.49(syst) mb and sigma(phi)(1 < p(t) < 5 GeV/c. 2.5 < y < 4) = 0.940 +/- 0.084(stat) +/- 0.076(syst) mb. The differential cross sections d(2)sigma/dy dp(t) are extracted as a function of p(t) for omega and phi. The ratio between the rho and omega cross section is obtained. Results for the phi are compared with other measurements at the same energy and with predictions by models. (C) 2012 CERN. Published by Elsevier B.V. All rights reserved.

The association between coronary artery calcification progression and loss of bone density in non-dialyzed CKD patients

Background: Coronary artery calcification (CAC) and low bone density are coexisting deleterious conditions commonly shared by chronic kidney disease (CKD) patients. In the present study, we aimed to investigate whether the progression of CAC was associated with overtime reduction in bone density in non-dialyzed CKD patients. Methods: This is a prospective study of 24 months including 72 non-dialyzed CKD patients Stages 2 - 4 (age 57.6 +/- 10.3 years, 62% male, 22% diabetics). CAC and vertebral bone density (VBD) were measured by computed tomography. Results: At baseline, 46% of the patients had CAC (calcified group) and calcification was not identified in 54% of the patients (non-calcified group). The calcified group was older, predominantly male, and had lower VBD in comparison to non-calcified group. CAC progression was observed only in the calcified group (91% of the patients increased calcium score). The multiple regression analysis revealed loss of VBD as the independent determinant of CAC progression in these patients. Conclusion: CAC progression was associated with loss of VBD in non-dialyzed CKD patients.

Increased vertebral morphometric fracture in patients with postsurgical hypoparathyroidism despite normal bone mineral density

Background In human malaria, the naturally-acquired immune response can result in either the elimination of the parasite or a persistent response mediated by cytokines that leads to immunopathology. The cytokines are responsible for all the symptoms, pathological alterations and the outcome of the infection depends on the reciprocal regulation of the pro and anti-inflammatory cytokines. IL-10 and IFN-gamma are able to mediate this process and their production can be affected by single nucleotide polymorphisms (SNPs) on gene of these cytokines. In this study, the relationship between cytokine IL-10/IFN-gamma levels, parasitaemia, and their gene polymorphisms was examined and the participation of pro-inflammatory and regulatory balance during a natural immune response in Plasmodium vivax-infected individuals was observed. Methods The serum levels of the cytokines IL-4, IL-12, IFN-gamma and IL-10 from 132 patients were evaluated by indirect enzyme-linked immunosorbent assays (ELISA). The polymorphism at position +874 of the IFN-gamma gene was identified by allele-specific polymerase chain reaction (ASO-PCR) method, and the polymorphism at position -1082 of the IL-10 gene was analysed by PCR-RFLP (PCR-Restriction Fragment Length Polymorphism). Results The levels of a pro- (IFN-gamma) and an anti-inflammatory cytokine (IL-10) were significantly higher in P. vivax-infected individuals as compared to healthy controls. The IFN-gamma levels in primoinfected patients were significantly higher than in patients who had suffered only one and more than one previous episode. The mutant alleles of both IFN-gamma and IL-10 genes were more frequent than the wild allele. In the case of the IFNG+874 polymorphism (IFN-gamma) the frequencies of the mutant (A) and wild (T) alleles were 70.13% and 29.87%, respectively. Similar frequencies were recorded in IL-10-1082, with the mutant (A) allele returning a frequency of 70.78%, and the wild (G) allele a frequency of 29.22%. The frequencies of the alleles associated with reduced production of both IFN-gamma and IL-10 were high, but this effect was only observed in the production of IFN-gamma. Conclusions This study has shown evidence of reciprocal regulation of the levels of IL-10 and IFN-gamma cytokines in P. vivax malaria, which is not altered by the presence of polymorphism in the IL-10 gene.

Studying the influence of a secondary variable in Collocated Cokriging estimates

In this paper the influence of a secondary variable as a function of the correlation with the primary variable for collocated cokriging is examined. For this study five exhaustive data sets were generated in computer, from which samples with 60 and 104 data points were drawn using the stratified random sampling method. These exhaustive data sets were generated departing from a pair of primary and secondary variables showing a good correlation. Then successive sets were generated by adding an amount of white noise in such a way that the correlation gets poorer. Using these samples, it was possible to find out how primary and secondary information is used to estimate an unsampled location according to the correlation level.

Avaliação da endotelização de hastes de stents em artérias ilíacas de coelhos

FUNDAMENTO: A rápida endotelização pós-implante de stent é ocorrência desejável por teoricamente reduzir a possibilidade de trombose do stent. OBJETIVO: Avaliar a extensão da endotelização de hastes de stents eluidores de sirolimus (liberados da face luminal e abluminal e abluminal exclusivamente) em artérias ilíacas de coelhos. MÉTODOS: Foram implantados em artérias ilíacas de 10 coelhos quatro stents eluidores de sirolimus na face luminal e abluminal, três stents eluidores de sirolimus na face abluminal, seis stents recobertos com polímero e quatro stents sem recobrimento. Após quatro semanas, foi realizada eutanásia e utilizou-se microscopia eletrônica de varredura para quantificação da área de hastes de stent exposta e da porcentagem de endotelização. RESULTADOS: A área (média ± DP) (mm²) de hastes expostas de stent sem recobrimento, stent recoberto com polímero, stent eluidor de sirolimus na face luminal e abluminal e stent eluidor de sirolimus na face abluminal foi de 0,12 ± 0,08; 0,09 ± 0,12; 0,60 ± 0,67 e 0,05 ± 0,04 respectivamente (p = 0,120). A porcentagem de endotelização (média ± DP) (%) de stent sem recobrimento, stent recoberto com polímero, stent eluidor de sirolimus na face luminal e abluminal e stent eluidor de sirolimus na face abluminal foi de 99 ± 01; 99 ± 0; 97 ± 03 e 99 ± 0 respectivamente (p = 0,133). CONCLUSÃO: Após quatro semanas de implante em artérias ilíacas de coelhos, os stents com liberação de sirolimus tanto da face luminal e abluminal quanto da face abluminal exclusivamente apresentaram taxas de endotelização de hastes de stent semelhantes aos apresentados nos demais tipos de stents sem eluição de medicamento.

A sepse como causa de lesão renal aguda: modelo experimental

A sepse associada à falência de múltiplos órgãos como a lesão renal aguda (LRA) demonstra alta taxa de mortalidade no paciente crítico. Este estudo investigou a LRA induzida pela sepse em modelo experimental. Foram utilizados ratos da raça Wistar, adultos e machos divididos nos seguintes grupos: Controle - controle cirúrgico e Sepse - indução da sepse pela ligadura e punção do cécon (LPC). Foram avaliados os parâmetros fisiológicos (temperatura retal, pressão arterial média - PAM, glicemia sérica e fluxo urinário); a função renal (clearance de creatinina); o estresse oxidativo (peróxidos urinários e substâncias reativas com ácido tiobarbitúrico - TBARS) e realizada a análise histológica renal. O estudo conclui que a LRA induzida pela sepse caracteriza-se por lesão endotelial com disfunção hemodinâmica, liberação de mediadores inflamatórios e geração de espécies reativas de oxigênio (EROs) por células tubulares, caracterizando-se como uma associação de vasoconstrição renal de origem hemodinâmica e inflamatória.

Determinação dos parâmetros cinéticos e termodinâmicos da adsorção de L-cisteína em ouro por meio da técnica de microbalança a cristal de quartzo

This article discusses the adsorption kinetics of a L-cysteine monolayer onto a gold surface by means of information obtained through the QCM technique. The results indicate that the adsorption process is rapid and follows the Langmuir isotherm, in which adsorption and desorption are considered. From these measurements the following parameter values were obtained: k d = (4.2 ± 0.4) x 10-3 s-1, k a = 75 ± 6 M-1 s-1, Keq=(1.8 ± 0.3) x 10(4) M-1 and ΔGads = - (5.8 ± 0.2) kcal mol-1.

Resolubilidade da estratégia saúde da família e unidades básicas de saúde tradicionais: contribuições do Pet-Saúde

O Programa de Educação pelo Trabalho para a Saúde (PET-Saúde) materializa uma política indutora de novas relações entre instituições de ensino de nível superior e a rede assistencial à saúde. A Universidade de São Paulo - Campus de Ribeirão Preto e a Secretaria de Saúde do município, selecionadas pelo PET-Saúde/2009, avaliaram a resolubilidade das Unidades Básicas de Saúde (UBS) e das Unidades de Estratégia Saúde da Família (ESF), como forma de contribuir para a qualificação da Atenção Básica. Foi realizado um estudo transversal em 13 Unidades de Saúde (oito ESF e cinco UBS), com a participação de 216 alunos dos cursos da área da saúde, 30 preceptores (profissionais) da rede pública de saúde e cinco tutores (docentes). Foram coletados dados de 12.494 atendimentos, sendo 7.129 (58,9%) em ESF e 4.963 (41,1%) em UBS, compostos por 4.059 (33,6%) pessoas do sexo masculino e 8.035 (66,4%) do feminino.As UBS referenciaram mais pacientes do que as Unidades de ESF (OR = 1,67; IC 95% 1,46 - 1,90; [p < 0,05]). As especialidades com maior demanda por encaminhamentos foram oftalmologia, cardiologia e ortopedia. A ESF apresenta-se como modelo assistencial com maior resolubilidade, e o PET-Saúde é uma iniciativa importante, considerando-se que estimula a ampliação desse modelo.

Sinvastatina e lesão renal aguda isquêmica em ratos

OBJETIVOS: O estudo visou verificar a ação renoprotetora da sinvastatina em modelo animal de isquemia/reperfusão por 30 minutos. MÉTODOS: A isquemia foi obtida por meio do clampeamento dos pedículos renais bilaterais por 30 minutos, seguida de reperfusão. Ratos Wistar, machos foram usados pesando entre 250-300g, distribuídos nos seguintes grupos: SHAM (controle, sem clampeamento renal); Isquemia (isquemia renal por 30 minutos); Isquemia+Estatina (sinvastatina 0,5 mg/kg, via oral durante três dias). A função renal (clearance de creatinina, método de Jaffé), a osmolalidade urinária, os peróxidos urinários foram avaliados. RESULTADOS: Os resultados mostraram que a estatina melhorou a função renal, a osmolalidade urinária e reduziu a excreção de PU. CONCLUSÃO: Em síntese, o estudo confirmou o efeito renoprotetor da estatina, com ação antioxidante de proteção renal.

In vitro expression and antiserum production against the movement protein of Citrus leprosis virus C (CiLV-C)

Citrus leprosis, caused by Citrus leprosis virus C (CiLV-C), is currently considered the most important viral disease in the Brazilian citrus industry due to the high costs required for the chemical control of its vector, the mite Brevipalpus phoenicis. The pathogen induces a non-systemic infection and the disease is characterized by the appearance of localized lesions on citrus leaves, stems and fruits, premature fruit and leaf drop and dieback of stems. Attempts were made to promote in vitro expression of the putative cell-to-cell movement protein of CiLV-C in Escherichia coli and to produce a specific polyclonal antibody against this protein as a tool to investigate the virus-plant-vector relationship. The antibody reacted strongly with the homologous protein expressed in vitro by ELISA, but poorly with the native protein present in leaf lesion extracts from sweet orange caused by CiLV-C. Reactions from old lesions were more intense than those from young lesions. Western blot and in situ immunolocalization assays failed to detect the native protein. These results suggest low expression of the movement protein (MP) in host tissues. Moreover, it is possible that the conformation of the protein expressed in vitro and used to produce the antibody differs from that of the native MP, hindering a full recognition of the latter.

Study of the number of occlusal contacts in maximum intercuspation before orthodontic treatment in subjects with Angle Class I and Class II Division 1 malocclusion

OBJECTIVE: Define and compare numbers and types of occlusal contacts in maximum intercuspation. METHODS: The study consisted of clinical and photographic analysis of occlusal contacts in maximum intercuspation. Twenty-six Caucasian Brazilian subjects were selected before orthodontic treatment, 20 males and 6 females, with ages ranging between 12 and 18 years. The subjects were diagnosed and grouped as follows: 13 with Angle Class I malocclusion and 13 with Angle Class II Division 1 malocclusion. After analysis, the occlusal contacts were classified according to the established criteria as: tripodism, bipodism, monopodism (respectively, three, two or one contact point with the slope of the fossa); cuspid to a marginal ridge; cuspid to two marginal ridges; cuspid tip to opposite inclined plane; surface to surface; and edge to edge. RESULTS: The mean number of occlusal contacts per subject in Class I malocclusion was 43.38 and for Class II Division 1 malocclusion it was 44.38, this difference was not statistically significant (p>0.05). CONCLUSIONS: There is a variety of factors that influence the number of occlusal contacts between a Class I and a Class II, Division 1 malocclusion. There is no standardization of occlusal contact type according to the studied malocclusions. A proper selection of occlusal contact types such as cuspid to fossa or cuspid to marginal ridge and its location in the teeth should be individually defined according to the demands of each case. The existence of an adequate occlusal contact leads to a correct distribution of forces, promoting periodontal health.

Importance of the proportions of dietary polyunsaturated fatty acids and antioxoidants in larval development of marine fish

La acuicultura es uno de los sectores con mayor crecimiento en la producción animal mundial, con una tasa superior al 5% anual en la última década (Izquierdo et al., 2008). En la acuicultura, el éxito del cultivo de cualquier especie de peces marinos está limitado por la cantidad y la calidad de la producción en masa de sus alevines (Izquierdo y Fernández - Palacios, 1997). Por lo tanto, para cubrir las crecientes demandas de la producción de semillas, es necesario mejorar la calidad nutritiva de sus larvas, lo cual todavía constituye una de las principales limitaciones para el desarrollo del cultivo de especies de peces marinos (Watanabe et al., 1983; Yúfera y Pascual, 1984; Sargent et al. 1997; Izquierdo et al., 2000). Aunque la producción Mediterránea del cultivo de peces marinos se ha incrementado en varias especies, la dorada Sparus aurata continúa siendo la especie mas cultivada (Izquierdo, 2005), con una producción anual de alevines que supera los 120 millones/ año. La demanda de alevines de buena calidad está aumentando a un ritmo del 10% anual, pero el éxito de la producción de los juveniles se ve muy afectado por la eficacia de la primera alimentación y la calidad nutricional de la dieta de arranque (Kolkovski et al., 1993; Sargent et al., 1997; Izquierdo et al., 2000). En general, la dorada y la lubina europea (Dicentrarchus labrax) son las especies más importantes de peces marinos criados en la región mediterránea y han caracterizado el desarrollo de la acuicultura marina en esta región en las últimas tres décadas (FAO, 1999). Además, en la producción, de ambas especies, se prevee una mayor expansión (Basurco y Abellán, 1999). Sin embargo, a pesar de que el engorde de estas especies está bien controlado, el conocimiento de sus necesidades nutricionales, en comparación con otras especies como salmónidos y carpas, sigue siendo incompleto (NRC, 1993). Por lo tanto, para obtener un mejor crecimiento y una mayor tasa de supervivencia, es esencial una dieta que responda a las necesidades nutricionales de las larvas, tanto cualitativas como cuantitativas (Kolkovski et al., 1993; Sargent et al., 1997). Además, incluso antes de que comience el desarrollo larvario, los huevos de los peces deben contener todos los nutrientes que cubran los requerimientos adecuados para el desarrollo del embrión (Izquierdo y Fernández - Palacios, 1997). En los últimos años, las investigaciones han prestado gran atención a la importancia de los lípidos dietéticos para larvas de peces marinos (Izquierdo et al., 2003), puesto que son esenciales para el crecimiento y el desarrollo de los mismos (Watanabe, 1982; Sargent et al., 1999a). Como reflejo de esta importancia, la dieta para dorada y lubina se ha convertido en una dieta altamente energética (25% de lípidos) en comparación con la década anterior (12% de lípidos) (Izquierdo et al., 2003). Los lípidos dietéticos proporcionan una fuente rica de energía y fosfolípidos y son fundamentales para la estructura de las biomembranas. Los lípidos dietéticos también sirven como vehículos para la absorción de otros nutrientes, como las vitaminas liposolubles A, D, E, y K, y pigmentos naturales o sintéticos. Los lípidos son componentes de las hormonas y precursores para la síntesis de diversos metabolitos funcionales, como las prostaglandinas y otros eicosonoides. Además, los lípidos dietéticos son reconocidos como uno de los factores nutricionales más importantes que afectan el crecimiento y la supervivencia de las larvas (Watanabe et al., 1983), porque constituyen materiales esenciales para la formación normal de célula, las membranas de los tejidos y el desarrollo de órganos (Izquierdo et al., 1998, 2003; Pousaò et al., 2003). Sin embargo, la utilización de los lípidos dietéticos por las larvas puede verse afectada directa o indirectamente por varios cambios morfológicos y fisiológicos que ocurren durante el desarrollo larvario. En los últimos años ha habido más interés en todos estos aspectos nutricionales de los lípidos en las larvas de peces, debido a la importancia de utilización de los lípidos dieteticos para el óptimo crecimiento y supervivencia larvaria (Izquierdo et al., 2000).

Enhancement of gilthead sea bream (Sparus aurata) and sea bass (Dicentrarchus labrax) larval growth by dietary vitamin E en relation to diffetent levels of essential fatty acids

[EN]Most marine fish larvae require high amounts of n-3 HUFA (highly unsaturated fatty acids) such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) (Watanabe, 1982; Izquierdo, 1996). Fish larvae tissue lipids are also very high in n-3 HUFA, what implies a higher risk of peroxidation (Sargent et al. 1999) and cellular damage (Kanazawa, 1991), requiring then antioxidants to protect them intra- and extra-cellularly from free radical compounds. Vitamin E (Vit E) functions as a chain breaking antioxidant, reacting with the lipid peroxide radical produced and preventing the further reaction with a new PUFA. Hence their requirements are related with the dietary and tissue PUFA contents. The objective of the present study was to determine the effect of dietary Vit E on gilthead sea bream and sea bass survival, growth and stress, at different n-3 HUFA levels.