Incidência de parada cardíaca durante anestesia, em hospital universitário de atendimento terciário: estudo prospectivo entre 1996 e 2002

JUSTIFICATIVA E OBJETIVOS: A incidência e causas de parada cardíaca (PC) durante a anestesia variam e são difíceis de comparar diante dos diversos métodos usados nos estudos. A pesquisa teve como objetivo estudar todas as PC ocorridas no intra e pós-operatório, durante um período de sete anos, de 1996 a 2002, em hospital de ensino de atendimento terciário para determinar incidência e causas da PC. MÉTODO: A incidência prospectiva de PC ocorrida durante a anestesia em 40.941 pacientes consecutivos foi identificada, utilizando-se um Banco de Dados. Todos os casos de PC e óbito foram revisados por uma Comissão, para determinar o fator desencadeante da PC ou óbito. A incidência de PC foi calculada em relação à idade, sexo, estado físico, segundo a classificação da ASA, tipo de atendimento, fatores desencadeantes, como alteração do estado físico do paciente e complicações cirúrgicas e anestésicas, tipo de anestesia e evolução para óbito. RESULTADOS: Ocorreram 138 PC (33,7:10.000), sendo a maioria em recém-nascidos, crianças até um ano e idosos, no sexo masculino (65,2%), em pacientes com estado físico ASA III ou superior, em atendimento de emergência e durante anestesia geral. Alterações do estado físico foram o principal fator de PC (23,9:10.000), seguidas de complicações cirúrgicas isoladamente (4,64:10.000) ou associadas a alterações do estado físico (2,44:10.000) e da anestesia isoladamente (1,71:10.000) ou associadas a alterações do estado físico (0,98:10.000). O risco de óbito relacionado à anestesia como fator principal ou contributivo foi igual para ambos (0,49:10.000). As principais causas da mortalidade associada à anestesia foram os problemas ventilatórios (45,4%), eventos relacionados à medicação empregada (27,3%), aspiração pulmonar (18,2%) e hidratação excessiva (9,1%). CONCLUSÕES: A incidência de PC durante a anestesia ainda continua elevada. A maioria das PC e óbitos associados à anestesia foi relacionada ao manuseio das vias aéreas e à administração de medicamentos e anestésicos.

Early rather than delayed administration of lisinopril protects the heart after myocardial infarction in rats

Background: ACE inhibitors have shown beneficial results in several studies after myocardial infarction (MI). However, these studies have shown conflicting results about the ideal starting time of the ACE inhibitors administration after MI and the importance of infarct size.Objectives: This study was designed to assess the long-term effects of lisinopril on mortality, cardiac function, and ventricular fibrosis after MI, in rats.Methods: Lisinopril (20 mg/kg/day) was given on day 1 or 21 days after coronary occlusion in small or large infarctions.Results: the mortality rate was reduced by 39% in early treatment and 30% in delayed treatment in comparison to the untreated rats. Early treatment reduced cardiac dysfunction in small MIs; however, delayed treatment did not. No statistical difference was observed among the groups for large MIs. No statistical difference was observed among the groups with large or small MIs on myocardial hydroxyproline concentration.Conclusions: Both early and delayed treatments with lisinopril increased survival. Treatment exerts no marked effects on fibrosis; early treatment has exerted beneficial influences on cardiac function whereas delayed treatment had no consistent effects. The protective effect of lisinopril is detectable only in small (< 40% of LV) MIs.

Piranha attacks in dammed streams used for human recreation in the State of São Paulo, Brazil

Ataques por piranhas vêm se tornando um problema comum em trechos represados de rios e córregos no estado de São Paulo, Sudeste do Brasil. em dois surtos ocorridos em dois municípios vizinhos no noroeste do estado, 74 banhistas foram mordidos. Uma mordida por pessoa foi registrada, em curto período do ano. As mordidas estão relacionadas a cuidado parental e/ou defesa do território de desova, o que reforça estudos anteriores e desmistifica os ataques por este peixe lendário, da maneira como são popularmente percebidos. A colocação de redes de malha fina e a remoção de vegetação aquática cessaram os ataques.

Gestão Sustentável da água: um estudo da conscientização ambiental em atividades residenciais urbanas

The search for sustainable solutions through an appropriate environmental administration of the available natural resources, that comes from encounter to the aspirations of preservation of the environment and of the human being, in way to diagnose and to solve the environmental and social problems with the smallest possible impact to the nature and the man, it is the great challenge, so much for that generation, as for the future generations. The study of the environmental problems of the water and the participation and the social actors' environmental understanding as a whole, interferes in the field of the thematic environmental international, contemplating the strategic need of an appropriate administration of that very natural one, through a program returned to the diagnosis of the problems and in the search of compatible maintainable solutions, in a social and environmental politics of planning and environmental education, centered above all in the citizen's voice , user of that system. The present thesis she seeks to study the problem of the maintainable administration of the water, focusing the participation and the citizen's environmental understanding in the use of that very natural one for urban residential activities, in what concerns the approach and analyses of variables that treat of the measurement of general knowledge and you adapt, sense of community of the access to the means of information and of the attitudes and environmental behaviors, besides the variables of partner-demographic characterization or personal identification of the interviewed ones of an exploratory research of the type " survey ", accomplished through a stratified aleatory sampling, being the strata each one of the 4 (four) Political-Administrative Areas of the Natal city, having happened the collection of the data in the period of february to april/2002. The methodology used in this work it constitutes in the application of questionnaires with scales of the type Likert to measure the echo-varied of the study, besides a partner-demographic scale for the characterization of the studied sample. For the analysis of the results, it was made an exploratory descriptive study initially, followed by the use of techniques statistical multivariate s, such as, factorial analysis through the application of main components, besides the accomplishment of studies of multiple lineal regression. To complement this study, the accomplishment of Tests of Independence was proceeded through the Qui-square of Pearson, in way to verify the dependence of the associations between the partner-demographic variables and the principal selected variables and presents in the resulting factors of the factorial analysis. The results appear for a low level of environmental knowledge, of access to the information and community's sense, besides the verification that the principal factors resultants send for the need of feeling emphasis in the programs and administration actions addressed for the environmental understanding, the behaviors and attitudes that approach the information and the environmental education, besides the reuse of the water

Cidades pequenas, grandes problemas :perfil urbano do Agreste Potiguar

In view of the diversity and the heterogeneity of the existing cities in Brazil, our approach refers to the urban and non-metropolitan areas. Aiming to foment the studies on small cities e to apprehend the sociospatial configuration of the urban environment in such cities, this piece of work elaborates and analyzes the urban profile of the small cities of the Agreste Potiguar region, using as a theoretical reference landmark the production of the urban and regional space, from the decade of 1970 to 2000. Starting from this reference, this piece of work presents an urban sociospatial characterization of the small cities of the Agreste Potiguar region, with emphasis on the economic framework, on the population dynamics, on the main social data, culminating in the main characteristics of the local daily life. The study of the small cities of the Agreste Potiguar region makes it possible the comprehension of the problems that involve the cities of this size, above all, those inserted in economically fragile regions. In the analyzed period, the changes occurred in the productive structure of the State of Rio Grande do Norte triggered a great crisis in the economy of the Agreste Potiguar region. This aspect, allied to the insufficient performance of the public power, contributed to the sprouting of some sociospatial problems, amongst which may be distinguished: the economic fragility, the generalized unemployment, the lack of security and the urban infrastructure absence sufficient to take care of the social demand. Even facing the existing problems, the small cities must be seen as potential spaces, capable to promote the regional development. To do so, it is necessary a process of democratization of the public administration, an ample popular participation and the establishment of a new urban policy, that aims at the social promotion of the individuals, the guarantee of basic necessities and the access to the necessary services to a dignified life

Administration of single-dose GnRH agonist in the luteal phase in ICSI cycles: a meta-analysis

Background: The effects of gonadotrophin-releasing hormone agonist (GnRH-a) administered in the luteal phase remains controversial. This meta-analysis aimed to evaluate the effect of the administration of a single-dose of GnRH-a in the luteal phase on ICSI clinical outcomes.Methods: The research strategy included the online search of databases. Only randomized studies were included. The outcomes analyzed were implantation rate, clinical pregnancy rate (CPR) per transfer and ongoing pregnancy rate. The fixed effects model was used for odds ratio. In all trials, a single dose of GnRH-a was administered at day 5/6 after ICSI procedures.Results: All cycles presented statistically significantly higher rates of implantation (P < 0.0001), CPR per transfer (P = 0.006) and ongoing pregnancy (P = 0.02) in the group that received luteal-phase GnRH-a administration than in the control group (without luteal-phase-GnRH-a administration). When meta-analysis was carried out only in trials that had used long GnRH-a ovarian stimulation protocol, CPR per transfer (P = 0.06) and ongoing pregnancy (P = 0.23) rates were not significantly different between the groups, but implantation rate was significant higher (P = 0.02) in the group that received luteal-phase-GnRH-a administration. on the other hand, the results from trials that had used GnRH antagonist multi-dose ovarian stimulation protocol showed statistically significantly higher implantation (P = 0.0002), CPR per transfer (P = 0.04) and ongoing pregnancy rate (P = 0.04) in the luteal-phaseGnRH- a administration group. The majority of the results presented heterogeneity.Conclusions: These findings demonstrate that the luteal-phase single-dose GnRH-a administration can increase implantation rate in all cycles and CPR per transfer and ongoing pregnancy rate in cycles with GnRH antagonist ovarian stimulation protocol. Nevertheless, by considering the heterogeneity between the trials, it seems premature to recommend the use of GnRH-a in the luteal phase. Additional randomized controlled trials are necessary before evidence-based recommendations can be provided.

Alterações orofaciais em doenças alérgicas de vias aéreas

OBJETIVO: Apontar as possíveis alterações orofaciais decorrentes do sintoma obstrução nasal em pacientes portadores de doenças alérgicas de vias aéreas superiores, por meio de revisão de literatura. FONTES DE DADOS: Levantamento bibliográfico utilizando bancos de dados eletrônicos, como Medline, Ovid, SciELO e Lilacs, com as palavras-chave asthma, rhinitis e mouth breathing, abrangendo os 30 últimos anos. Foram incluídos artigos de revisão, estudos observacionais e ensaios clínicos. SÍNTESE DOS DADOS: A obstrução nasal é encontrada freqüentemente em doenças alérgicas de vias aéreas, como rinite e asma. A respiração bucal decorrente da obstrução nasal pode interferir de maneira direta no desenvolvimento infantil, com alterações no crescimento do crânio e orofacial, na fala, na alimentação, na postura corporal, na qualidade do sono e no desempenho escolar. CONCLUSÕES: Devido à variedade de alterações orofaciais encontradas na criança respiradora bucal decorrente de obstrução nasal por doenças alérgicas de vias aéreas, é necessário realizar diagnóstico e tratamento precoces por uma equipe multidisciplinar, composta por médico, ortodontista e fonoaudiólogo, contemplando a visão de uma via respiratória única, que traz conseqüências ao crescimento e desenvolvimento do sistema motor oral.

Ballast water: a review of the impact on the world public health

Since the nineteenth century ships have been using ballast water (BW) for safety, stability, propulsion and maneuverability, as well as to redress loss of fuel weight and water consumption, and to maintain structural stress at acceptable levels. Ballast water has been spreading many non-native species around the globe, but little is known about the extent and potential significance of ship-mediated transfer of microorganisms. The global movements of ballast water by ships create a long-distance dispersal mechanism for human pathogens that may be important in the worldwide distribution of microorganisms, as well as for the epidemiology of waterborne diseases. Only a few studies have been carried out on this subject, most of them involving ballast water containing crustacean larvae and phytoplankton. Specialized microbiological studies on these waters are necessary to avoid a repeat of what happened in 1991, when epidemic cholera was reported in Peru and rapidly spread through Latin America and Mexico. In July of 1992, Vibrio cholerae was found in the USA and the Food and Drug Administration (FDA) determined that it came from ballast water of ships whose last port of call was in South America. In Brazil, just a few studies about the subject have been performed. An exploratory study by the Brazilian National Health Surveillance Agency (Agencia Nacional de Vigilancia Sanitaria - ANVISA) found in ballast water different microorganisms, such as fecal coliforms, Escherichia coli, Enterococcus faecalis, Clostridium perfringens, coliphages, Vibrio cholerae O1 and Vibrio cholerae non-O1. Until now, Brazil has been focusing only on organisms transported to its territory from other countries by ballast water, to avoid their establishment and dissemination in Brazilian areas. Studies that can assess the probability that water ballast carries pathogenic microorganisms are extremely important, as is the examination of ships that arrive in the country. Treatment of the human infections caused by BW exists but none is completely safe and efficient.

Ischaemia and reperfusion effects on skeletal muscle tissue: morphological and histochemical studies

This was a study on the oxidative stress due to ischaemia (I) and reperfusion (R) in skeletal muscle tissue. Using a tourniquet, groups of rats were submitted to ischaemia for 4 h, followed by different reperfusion periods. The animals were divided in four groups: control; 4 h of ischaemia (IR); 4 h of ischaemia plus 1 h reperfusion (IR-1 h); 4 h of ischaemia plus 24 h reperfusion (IR-24 h); and 4 h of ischaemia plus 72 h reperfusion (IR-72 h). At the end of the procedures, samples of soleus muscle were collected and frozen in n-hexane at -70 degrees C. Cryostat sections were submitted to haematoxylin-eosin, succinate dehydrogenase (SDH) and nicotinamide adenine dinucleotide-tetrazolium reductase (NADH-TR) stains. An additional muscle sample was processed for electron microscopy. No alterations were found in control animals. IR group showed fibres had normal aspect besides some round, acidophilic and hypertrophic fibres. There were several fibres with angular outlines and smaller diameters in this group compared with control group. NADH-TR/SDH reaction was moderately intense in most fibres. In some fibres, cytoplasm showed areas without activity and other fibres had very intense reactivity. IR-1 h group showed oedema hypercontracted fibres with disorganized myofibrils, mitochondria with focal lesions and dilated sarcoplasmic reticulum. NADH-TR/SDH reaction was moderate to weak. IR-24 h showed intense inflammatory infiltrate in the endomysium and perimysium. NADH-TR/SDH reaction was similar to IR-1 h. IR-72 h showed necrotic fibres, areas with inflammatory infiltrate, reduced muscle fibres at different stages of necrosis and phagocytosis, and many small round and basophilic fibres characterizing a regeneration process. NADH-TR/SDH reaction was weak to negative. Our results suggest that ischaemia and the subsequent 1-, 24- and 72-h reperfusions induced progressive histological damage. Although progressive, it may be reversible because there were ultrastructural signs of recovery after 72-h reperfusion. This recovery could in part be due to the low oxidative stress identified by the morphological and histochemical analysis.

Age-related histopathological lesions in the Mongolian gerbil ventral prostate as a good model for studies of spontaneous hormone-related disorders

The Meriones unguiculatus (Mongolian) gerbil has demonstrated significant prostatic responses to hormonal treatments, and to drugs against human prostatic hyperplasia Spontaneous neoplasia develops in the older animals. Thirty gerbils (age 18 months) were divided into non-affected and prostatic lesion bearers and the prostate lesions were evaluated morphologically, immunohistochemically and quantitatively. The most frequent changes were in epithelial sites and, namely prostatic intraepithelial neoplasias, microinvasive carcinomas and adenocarcinomas. In the stromal compartment, cellular hyperplasia, when verified, was always associated with the sites of anomalous epithelium. Additionally, larger deposition of collagen fibrils, generating stromal fibrosis, was found in all the old gerbils analysed. The quantitative analysis showed that prostatic tissue proportions differed in altered areas, being specific for each lesion type. Isolated nuclear and nucleolar parameters were not effective in diagnosing the malign potential of lesions. However, the cellular proliferation and death indexes indicated larger cellular turnover in invasive lesions such as carcinomas. With these analyses, it could be verified that old gerbils present high propensity to develop spontaneous prostate changes and this may aid in a better understanding of the biological behaviour of human prostate cancer.

Mites (Acari: Mesostigmata, Sarcoptiformes and Trombidiformes) associated to soybean in Brazil, including new records from the cerrado areas

In Brazil, soybean Glycine max (L.) Merril crops are subjected to incidence of several pests, which are mainly insect species. However, the occurrences of other pest species are growing. In this context, outbreaks of phytophagous mites are becoming more frequent. Nevertheless, records of mites in such crop are available only for Maranhao, Mato Grosso, Minas Gerais and Rio Grande do Sul states. Thus, this work gathers all information published about the diversity of mites found in soybean in Brazil, and also new records of mite species made on samplings taken from the central Cerrado area. In the whole, occurrence of 44 species of plant mites in soybean has been recorded in Brazil. Data from prior studies and the results of this work present the tetranychid Mononychellus planki (McGregor) as the mite species most frequently occurring in the Brazilian soybean crops. A large portion of Phytoseiidae species has occurred in crops from Rio Grande do Sul state. In addition, spontaneous soybean has hosted almost half of the phytoseiid species sampled in Cerrado region. High diversity of Tarsonemidae has been found in the cultivated soybean. More studies about soybean mites are needed to clarify the damage potential of phytophagous mites and the biological role of predatory mites in this crop.

O emprego de métodos geofísicos na fase de investigação confirmatória em cemitérios contaminados

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Effects of the administration of a catalase inhibitor into the fourth cerebral ventricle on cardiovascular responses in spontaneously hypertensive rats exposed to sidestream cigarette smoke

OBJECTIVE: ,,,,,Previous studies have demonstrated a relationship between brain oxidative stress and cardiovascular regulation. We evaluated the effects of central catalase inhibition on cardiovascular responses in spontaneously hypertensive rats exposed to sidestream cigarette smoke. ,,,, ,,,, ,,,,,METHODS: ,,,,,Male Wistar Kyoto (WKY) rats and spontaneously hypertensive rats (SH) (16 weeks old) were implanted with a stainless steel guide cannula leading into the fourth cerebral ventricle (4th V). The femoral artery and vein were cannulated for arterial pressure and heart rate measurement and drug infusion, respectively. The rats were exposed to sidestream cigarette smoke for 180 minutes/day, 5 days/week for 3 weeks (CO: 100-300 ppm). The baroreflex was tested using a pressor dose of phenylephrine (8 μg/kg, bolus) and a depressor dose of sodium nitroprusside (50 μg/kg, bolus). Cardiovascular responses were evaluated before and 5, 15, 30 and 60 minutes after injection of a catalase inhibitor (3-amino-1,2,4-triazole, 0.001 g/100 μL) into the 4th V. ,,,, ,,,, ,,,,,RESULTS: ,,,,,Vehicle administration into the 4th V did not affect the cardiovascular response, whereas administration of the central catalase inhibitor increased the basal HR and attenuated the bradycardic peak (p<0.05) to a greater extent in WKY rats exposed to sidestream cigarette smoke than in WKY rats exposed to fresh air. However, in spontaneously hypertensive rats, the effect of the catalase inhibitor treatment was stronger in the fresh air condition (p<0.05). ,,,, ,,,, ,,,,,CONCLUSION: ,,,,,Administration of a catalase inhibitor into the 4th V combined with exposure to sidestream cigarette smoke has a stronger effect in WKY rats than in SH rats.

Hiperalimentação enteral em traumatismos crânio-encefálicos agudos reposição ou dietoterapia?

Os autores apresentam revisão geral sobre a fisiopatogenia do trauma, ressaltando os estados de hipereatabolismo e hipermetabolismo, suas consequências nutricionais, com as particularidades do trauma encefálico. São feitas, também, considerações sobre as vias, composição e volumes das dietas enterais a serem administradas a pacientes com trauma agudo encefálico, assim como são apontadas questões a serem melhor elucidadas.

Effect of zinc administration on thyrotropin releasing hormone-stimulated prolactinemia in healthy men

Previous in vitro studies have demonstrated zinc (Zn++) inhibition of basal and of potassium (K+) or thyrotropin-releasing hormone (TRH)-stimulated prolactin (PRL) secretion, in a selective, reversible, and dose-dependent manner. Thus, Zn++ may regulate physiologically pituitary PRL secretion. Furthermore, studies with patients with uremia, cirrhosis or prolactinoma, have shown the coexistence of hypozincemia and hyperprolactinemia and zinc supplementation did not correct hyperprolactinemia in these patients. In normal individuals Zn++ administration produced controversial results on PRL secretion. Here, we investigated whether zinc administration affects TRH-stimulated PRL in healthy men. We found that Zn++ administration does not change the TRH-stimulated PRL. Therefore, in normal conditions, Zn++ does not inhibit TRH-stimulated prolactinemia. In addition, we found that acute increases of blood PRL and TRH do not alter blood Zn++ levels.