Structural effects and hydrogen bonds on N,N `-di(methoxycarbonylsulfenyl)urea, [CH(3)OC(O)SNH](2)CO, studied by experimental and theoretical methods

Pure N,N`-di(methoxycarbonylsulfenyl)urea, [CH(3)OC(O)SNH](2)CO, is quantitatively prepared by the hydrolysis reaction of CH(3)OC(O)SNCO and characterized by (1)H NMR, GC-MS and FTIR spectroscopy techniques. Structural and conformational properties are analyzed using a combined approach with data obtained from X-ray diffraction, vibrational spectra and theoretical calculation methods. The IR and Raman spectra for normal and deuterated species are reported. The crystal structure of [CH(3)OC(O)SNH](2)CO was determined by X-ray diffraction methods. The substance crystallizes in the orthorhombic P2(1)2(1)2 space group with a = 9.524(2), b = 12.003(1), c = 4.481 (1) angstrom, and Z = 2 moieties in the unit cell. The molecule is sited on a twofold crystallographic axis (C(2)) parallel to c and shows the anti-anti conformation (S-N single bonds antiperiplanar with respect to the opposite C-N single bonds in sulfenyl-urea-sic group). Neighboring molecules are arranged in a chain motif that extends along the C(2)-axis and is held by bifurcated NH center dot center dot center dot O center dot center dot center dot HN intermolecular bonds. A local planar symmetry is observed in the crystal for the central -SN(H)C(O)N(H)S- skeleton. Experimental and calculated data allow to trace this structural feature to the occurrence of N-H center dot center dot center dot O=C hydrogen bonding interactions. Calculated vibrational and structural properties are in good agreement with the experimentally determined features. (C) 2008 Elsevier B.V. All rights reserved.

Synthesis and structure of the dimeric copper(II) complex tetrakis[N-thiazol-2-yl-(4-methylphenyl)sulfonamidate]dicopper(II)

The coordination chemistry of the ligand N-thiazol-2-yl-toluenesulfonamidate towards the copper(II) ion has been investigated using an electrochemical synthesis method. The X-ray structure of this complex was elucidated and is discussed. The compound crystallised in the monoclinic crystal system, P2(1)/c space group with a = 17.3888(9), b = 16.3003(9), c = 18.3679(9) angstrom and beta = 114.3640(10)degrees. Four bidentate sulfathiazolato anions bridge two metal centers in a paddle-wheel fashion, with the nitrogen atoms as donors to give a dimeric species with a Cu center dot center dot center dot Cu distance of 2.7859(5) angstrom.

Vibrational properties, crystal X-ray diffraction structure and quantum chemical calculations on a divalent sulfur substituted phthalimide: 1H-Isoindole-1,3(2H)-dione, 2-[(methoxycarbonyl)thio]

Structural and conformational properties of 1H-Isoindole-1,3(2H)-dione, 2-[(methoxycarbonyl)thio] (S-phthalimido O-methyl thiocarbonate) are analyzed using a combined approach including X-ray diffraction, vibrational spectra and theoretical calculation methods. The vibrational properties have been studied by infrared and Raman spectroscopies along with quantum chemical calculations (B3LYP and B3PW91 functional in connection with the 6-311++G** and aug-cc-pVDZ basis sets). The crystal structure was determined by X-ray diffraction methods. The substance crystallizes in the monoclinic P2(1)/c space group with a = 6.795(1), b = 5.109(1), c = 30.011(3) angstrom, beta = 90.310(3)degrees and Z = 4 molecules per unit cell. The conformation adopted by the N-S-C=O group is syn (C=O double bond in synperiplanar orientation with respect to the N-S single bond). The experimental molecular structure is well reproduced by the MP2/aug-cc-pVDZ method. (C) 2010 Elsevier B.V. All rights reserved.

Experimental and theoretical investigation of molecular structure and conformation of the 4-isopropylthioxanthone

In this study, the molecular structure and conformational analyses of the 4-isopropylthioxanthone (4-ITX) are reported according to experimental and theoretical results. The compound crystallizes in the centrosymmetric P (1) over bar space group with only one molecule in the asymmetric unit, presenting the most stable conformation, in which the three fused-rings adopt a planar geometry, and the isopropyl group assumes a torsional angle with less sterical hindrance. The structural and conformational analyses were performed using theoretical calculations such as Hartree-Fock (HF), DFT method in combination with 6-311G(d,p) and 6-31++G(d,p) and the results were compared with infrared spectroscopy (FT-IR) and X-ray diffraction (XRD). The supramolecular assembly of 4-ITX is kept by non-classical C-H center dot center dot center dot O hydrogen bonds and weak interactions such as pi-pi stacking. 4-ITX was also studied by (1)H and (13)C NMR spectroscopy. UV-Vis absorption spectroscopic properties of the 4-ITX showed the long-wavelength maximum shifts towards high energy when the solvent polarity increases. (C) 2011 Elsevier B.V. All rights reserved.

Structure and thermal reactivity of Zn(II) salts of isocinchomeronic acid (2,5-pyridinedicarboxylic acid)

The synthesis, an improved refined crystal and molecular structure re-determination, and the thermal decomposition behavior of two Zn(II) derivatives of isocinchomeronic acid (2,5-pyridinedicarboxylic acid or H(2)2,5-pydc) are presented. [Zn(2,5-pydc)(H(2)O)(3)Zn(2,5-pydc)(H(2)O)(2)](2) (1) crystallizes in the triclinic P-1 space group with a = 7.106(2), b = 11.450(2), c = 11.869(1) angstrom, alpha = 107.29(1), beta = 104.08(1), gamma = 90.32(2)degrees, and Z = 2. [Zn(2,5-pydc)(H(2)O)(2)] center dot H(2)O (2) is orthorhombic (P2(1)2(1)2(1) space group), with a = 7.342(1), b = 9.430(1), c = 13.834(2) angstrom, and Z = 4. The structures were refined to agreement R(1)-factors of 0.0315 (1) and 0.0336 (2). Complex (1) is arranged as molecular Zn(4)(2,5-pydc)(4)(H(2)O)(10) tetramers, the cages of which define channels that remain unblocked by anions. Compound (2) is polymeric with Zn(2,5-pydc)(H(2)O)(2) and Zn(2,5-pydc)(H(2)O)(3) units linked through bridging ligands. Both compounds were synthesized under mild conditions in aqueous media, without need to resort to hydrothermal media. Changing the pH from 4.51 to 5.75 suffices to direct the chemical processes toward the orthorhombic compound rather than to the triclinic one.

False-positive results of a rapid K39-based strip test and Chagas disease

Background: The definitive diagnosis of visceral. leishmaniasis (VL) requires invasive procedures with demonstration of amastigotes in tissue or promastigotes in culture. Unfortunately, these approaches require laboratory materials not available in poor countries where the disease is endemic. The correct diagnosis of VL is important, and made more difficult by the fact that several common tropical diseases such as malaria, disseminated tuberculosis, and enteric fever share the same clinical presentation. Serological tests have been developed to replace parasitological diagnosis in the field. A commercially available K39-based strip test for VL has been developed for this purpose. The endemic area of leishmaniasis in Brazil overlaps the endemic area of Chagas disease, a disease that can cause false-positive serological test results. The aim of this study was to evaluate the incidence of false-positive exams using a rapid test for VL in patients with Chagas disease. Methods: A rapid test based on the recombinant K39 antigen of Leishmania was used in: (1) 30 patients with confirmed Chagas disease, (2) 30 patients with a serological diagnosis of Chagas disease by ELISA, indirect immunofluorescence, indirect hemagglutination, and chemiluminescence, (3) 30 healthy patients from a non-endemic area as the control group, (4) 30 patients with confirmed VL, and (5) 20 patients with proved cutaneous leishmaniasis. Results: The sensitivity and specificity of the rapid strip test were 100% when compared with healthy volunteers and those with confirmed Chagas disease. One false-positive result occurred in the group with Chagas disease diagnosed by serological tests (specificity of 96%). Conclusion: The rapid test based on recombinant K39 is a useful diagnostic assay, and a false-positive result rarely occurs in patients with a serological diagnosis of Chagas disease. (C) 2008 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

THE LOWER CENTRAL AND DERIVED SERIES OF THE BRAID GROUPS OF THE FINITELY-PUNCTURED SPHERE

Motivated in part by the study of Fadell-Neuwirth short exact sequences, we determine the lower central and derived series for the braid groups of the finitely-punctured sphere. For n >= 1, the class of m-string braid groups B(m)(S(2)\{x(1), ... , x(n)}) of the n-punctured sphere includes the usual Artin braid groups B(m) (for n = 1), those of the annulus, which are Artin groups of type B (for n = 2), and affine Artin groups of type (C) over tilde (for n = 3). We first consider the case n = 1. Motivated by the study of almost periodic solutions of algebraic equations with almost periodic coefficients, Gorin and Lin calculated the commutator subgroup of the Artin braid groups. We extend their results, and show that the lower central series (respectively, derived series) of B(m) is completely determined for all m is an element of N (respectively, for all m not equal 4). In the exceptional case m = 4, we obtain some higher elements of the derived series and its quotients. When n >= 2, we prove that the lower central series (respectively, derived series) of B(m)(S(2)\{x(1), ... , x(n)}) is constant from the commutator subgroup onwards for all m >= 3 (respectively, m >= 5). The case m = 1 is that of the free group of rank n - 1. The case n = 2 is of particular interest notably when m = 2 also. In this case, the commutator subgroup is a free group of infinite rank. We then go on to show that B(2)(S(2)\{x(1), x(2)}) admits various interpretations, as the Baumslag-Solitar group BS(2, 2), or as a one-relator group with non-trivial centre for example. We conclude from this latter fact that B(2)(S(2)\{x(1), x(2)}) is residually nilpotent, and that from the commutator subgroup onwards, its lower central series coincides with that of the free product Z(2) * Z. Further, its lower central series quotients Gamma(i)/Gamma(i+1) are direct sums of copies of Z(2), the number of summands being determined explicitly. In the case m >= 3 and n = 2, we obtain a presentation of the derived subgroup, from which we deduce its Abelianization. Finally, in the case n = 3, we obtain partial results for the derived series, and we prove that the lower central series quotients Gamma(i)/Gamma(i+1) are 2-elementary finitely-generated groups.

The electronic delocalization in para-substituted beta-nitrostyrenes probed by resonance Raman spectroscopy and quantum-chemical calculations

The electronic (UV-vis) and resonance Raman (RR) spectra of a series of para-substituted trans-beta-nitrostyrenes were investigated to determine the influence of the electron donating properties of the substituent (X = H, NO2, COOH, Cl, OCH3, OH, N(CH3)(2), and O-) on the extent of the charge transfer to the electron-withdrawing NO2 group directly linked to the ethylenic (C=C) unit. The Raman spectra and quantum chemical calculations show clearly the correlation of the electron donating power of the X group with the wavenumbers of the nu(s)(NO2) and nu (C=C)(sty) normal modes. In conditions of resonance with the lowest excited electronic state, one observes for X = OH and N(CH3)2 that the symmetric stretching of the NO2. nu(s)(NO2), is the most substantially enhanced mode, whereas for X = O-, the chromophore is extended over the whole molecule, with substantial enhancement of several carbon backbone modes. Copyright (c) 2008 John Wiley & Sons, Ltd.

Digital spiral analysis for objective assessment of fine motor timing variability in Parkinson's disease

OBJECTIVES: To develop a method for objective assessment of fine motor timing variability in Parkinson’s disease (PD) patients, using digital spiral data gathered by a touch screen device. BACKGROUND: A retrospective analysis was conducted on data from 105 subjects including65 patients with advanced PD (group A), 15 intermediate patients experiencing motor fluctuations (group I), 15 early stage patients (group S), and 10 healthy elderly subjects (HE) were examined. The subjects were asked to perform repeated upper limb motor tasks by tracing a pre-drawn Archimedes spiral as shown on the screen of the device. The spiral tracing test was performed using an ergonomic pen stylus, using dominant hand. The test was repeated three times per test occasion and the subjects were instructed to complete it within 10 seconds. Digital spiral data including stylus position (x-ycoordinates) and timestamps (milliseconds) were collected and used in subsequent analysis. The total number of observations with the test battery were as follows: Swedish group (n=10079), Italian I group (n=822), Italian S group (n = 811), and HE (n=299). METHODS: The raw spiral data were processed with three data processing methods. To quantify motor timing variability during spiral drawing tasks Approximate Entropy (APEN) method was applied on digitized spiral data. APEN is designed to capture the amount of irregularity or complexity in time series. APEN requires determination of two parameters, namely, the window size and similarity measure. In our work and after experimentation, window size was set to 4 and similarity measure to 0.2 (20% of the standard deviation of the time series). The final score obtained by APEN was normalized by total drawing completion time and used in subsequent analysis. The score generated by this method is hence on denoted APEN. In addition, two more methods were applied on digital spiral data and their scores were used in subsequent analysis. The first method was based on Digital Wavelet Transform and Principal Component Analysis and generated a score representing spiral drawing impairment. The score generated by this method is hence on denoted WAV. The second method was based on standard deviation of frequency filtered drawing velocity. The score generated by this method is hence on denoted SDDV. Linear mixed-effects (LME) models were used to evaluate mean differences of the spiral scores of the three methods across the four subject groups. Test-retest reliability of the three scores was assessed after taking mean of the three possible correlations (Spearman’s rank coefficients) between the three test trials. Internal consistency of the methods was assessed by calculating correlations between their scores. RESULTS: When comparing mean spiral scores between the four subject groups, the APEN scores were different between HE subjects and three patient groups (P=0.626 for S group with 9.9% mean value difference, P=0.089 for I group with 30.2%, and P=0.0019 for A group with 44.1%). However, there were no significant differences in mean scores of the other two methods, except for the WAV between the HE and A groups (P<0.001). WAV and SDDV were highly and significantly correlated to each other with a coefficient of 0.69. However, APEN was not correlated to neither WAV nor SDDV with coefficients of 0.11 and 0.12, respectively. Test-retest reliability coefficients of the three scores were as follows: APEN (0.9), WAV(0.83) and SD-DV (0.55). CONCLUSIONS: The results show that the digital spiral analysis-based objective APEN measure is able to significantly differentiate the healthy subjects from patients at advanced level. In contrast to the other two methods (WAV and SDDV) that are designed to quantify dyskinesias (over-medications), this method can be useful for characterizing Off symptoms in PD. The APEN was not correlated to none of the other two methods indicating that it measures a different construct of upper limb motor function in PD patients than WAV and SDDV. The APEN also had a better test-retest reliability indicating that it is more stable and consistent over time than WAV and SDDV.

”När man kollar på bilden tänker man så här” : en receptionsstudie av gymnasieelevers uppfattning om bilder som kunskapskällor i historieundervisningen

Images are used in history education for a variety of reasons, not least to generate interest through a better understanding of historical events and people. The aim of this study was to investigate how historical pictures, either illustrated or documentary/photographic, can be used as a resource for activating and improving pupils' historical empathy, in the way described by Stéphane Lévasque. I conducted a reception study on five different focus groups consisting of pupils from different upper secondary schools in Sweden. The pupils varied with regard to number of credits for admission to upper secondary school. A sixth group of pupils was interviewed as a contrasting control group in order to add perspective to the results. The discussions were based on the pupils' interpretations of 34 selected pictures, all of which were taken from the most common history textbooks. Each pupil was asked to choose the picture he/she felt was the most representative historical image. On the basis of the strategies used by the pupils when interpreting the pictures and discussing them, the material was analysed in accordance with Lévesque's categories: imagination, historical contextualisation and morals. The last category, morals, was further divided into three sub-categories: sense of justice, sympathy and progression. The reflections of the pupils and the degree of contextualisation varied. It appeared that the pupils were less inclined to discuss assumptions about the persons in the pictures; instead they chose to discuss the historical context in question. The pictures in this study did not seem to trigger the pupils to fabricate anachronistic reasoning about history; when they did produce lengthy reasoning, it was contextual, structural and metahistorical. In this context, the pupils who belonged to the group with the highest average of credits showed some signs of reflection on the basis of historical context and some criticism about the historical sources. On no occasion did any of the pupils choose a picture as a concrete expression of injustice. One of the questions this study aimed to explore was whether a lack of historical context affects how pictures trigger emotions and reasoning on the basis of moral aspects. Some of the pupils displayed moral standpoints, primarily the degree of morals concerning injustice. One possible interpretation could be that the feeling of being unfairly treated and subjected to insulting behaviour and social injustice was something the pupils could relate to. The group of pupils who had not yet studied history at upper secondary school, the control group, generally made reflections using this sort of reasoning when they discussed the historical aspects of the pictures.

Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to improve neonatal survival in the Quang Ninh province, Vietnam

BACKGROUND: Annually, 2.8 million neonatal deaths occur worldwide, despite the fact that three-quarters of them could be prevented if available evidence-based interventions were used. Facilitation of community groups has been recognized as a promising method to translate knowledge into practice. In northern Vietnam, the Neonatal Health - Knowledge Into Practice trial evaluated facilitation of community groups (2008-2011) and succeeded in reducing the neonatal mortality rate (adjusted odds ratio, 0.51; 95 % confidence interval 0.30-0.89). The aim of this paper is to report on the process (implementation and mechanism of impact) of this intervention. METHODS: Process data were excerpted from diary information from meetings with facilitators and intervention groups, and from supervisor records of monthly meetings with facilitators. Data were analyzed using descriptive statistics. An evaluation including attributes and skills of facilitators (e.g., group management, communication, and commitment) was performed at the end of the intervention using a six-item instrument. Odds ratios were analyzed, adjusted for cluster randomization using general linear mixed models. RESULTS: To ensure eight active facilitators over 3 years, 11 Women's Union representatives were recruited and trained. Of the 44 intervention groups, composed of health staff and commune stakeholders, 43 completed their activities until the end of the study. In total, 95 % (n = 1508) of the intended monthly meetings with an intervention group and a facilitator were conducted. The overall attendance of intervention group members was 86 %. The groups identified 32 unique problems and implemented 39 unique actions. The identified problems targeted health issues concerning both women and neonates. Actions implemented were mainly communication activities. Communes supported by a group with a facilitator who was rated high on attributes and skills (n = 27) had lower odds of neonatal mortality (odds ratio, 0.37; 95 % confidence interval, 0.19-0.73) than control communes (n = 46). CONCLUSIONS: This evaluation identified several factors that might have influenced the outcomes of the trial: continuity of intervention groups' work, adequate attributes and skills of facilitators, and targeting problems along a continuum of care. Such factors are important to consider in scaling-up efforts.

Efeito do exercício aeróbio moderado em gestantes com sobrepeso avaliado através de teste de exercício submáximo : um ensaio clínico randomizado

Objetivo: Avaliar os efeitos de um programa de exercício aeróbio sobre o condicionamento cardiorrespiratório em gestantes hígidas, de baixo risco, com sobrepeso. Métodos: 92 mulheres gestantes com sobrepeso (índice de massa corporal 26-31kg/m2), idade ≥ 20 anos, idade gestacional ≤ 20 semanas, com ausência de diabetes e hipertensão, foram alocadas aleatoriamente para realizar exercício aeróbio três vezes por semana com uma hora de duração ou para realizar sessões de relaxamento no grupo controle. Foram realizados dois testes de exercício submáximo em esteira, utilizando protocolo de rampa na entrada do estudo e outro teste após 12 semanas. Resultados: Em teste de exercício submáximo 12 semanas após randomização, o consumo de oxigênio (VO2) no limiar anaeróbio aumentou 17% (± 3) no grupo intervenção enquanto reduziu 16% (± 3) no grupo controle, de modo que após 12 semanas de exercício ajustado através da análise de covariância pelo o VO2 no limiar na linha de base, idade gestacional e idade materna foi de 2,68ml/kg/min (IC 95% 1,32-4,03) maior, P = 0,002. Conclusão: Exercício aeróbio realizado em gestantes com sobrepeso produz um aumento no limiar anaeróbio, sobrepondo os efeitos negativos da gestação sobre o condicionamento cardiorrespiratório em mulheres com estilo de vida sedentário.

Utilização da frutose-1, 6-Bisfosfato como um protetor celular na preservação de fígados para transplante

A solução de preservação da Universidade de Wisconsin (UW) é considerada a solução padrão para preservação de fígados, rins e pâncreas. A frutose-1,6-bisfosfato (FBP) é uma substância que apresenta efeito protetor do fígado contra injúrias provocadas por agentes químicos e ocorridas durante o período de isquemia-reperfusão. O objetivo deste estudo foi avaliar os efeitos da FBP na composição de soluções para preservação de fígados para transplante. Neste estudo experimental, a perfusão e a preservação dos fígados foram realizadas em cada grupo com as soluções de UW, UW contendo 10 mmol/L de FBP (UWM) e FBP 10 mmol/L (FBPS), respectivamente. Os fígados foram armazenados em um recipiente plástico contendo solução de preservação a 4oC por 24 horas. As mensurações bioquímicas de AST, ALT, LDH e TBARS foram realizadas em amostras das soluções de preservação nos tempos de 0, 12, 18 e 24 horas. A análise histológica foi realizada em fígados preservados por 24 horas. O grau de preservação observado com as soluções de UW e FBPS foi similar até 18 horas de armazenamento. A adição de 10 mmol/L de FBP à solução de UW provocou um aumento das injúrias ocorridas e uma pior preservação quando comparado ao grupo armazenado em UW. A FBP protegeu os fígados contra danos causados pelos radicais livres por tempos de preservação inferiores a 18 horas. Não houve diferença significativa entre os grupos na análise histológica dos fígados preservados no tempo de 24 horas. A FBP utilizada em solução foi eficaz na preservação de fígados, podendo ser um importante constituinte para outras formulações.

O exame direto do lavado broncoalveolar para o diagnóstico precoce de pneumonia nosocomial : um modelo experimental em ratos

A pneumonia nosocomial é a principal causa de infecção nosocomial em unidades de tratamento intensivo e possui alta morbi/mortalidade. A incidência cumulativa varia, conforme os autores, entre limites amplos desde 8% até 51%, dependendo do tipo de paciente e do uso de instrumentação das vias respiratórias. Nos casos específicos das pneumonias de má resolução e da pneumonia associada à ventilação mecânica, o diagnóstico é problemático devido à ausência de uma padronização definitiva, decorrente não só da grande variabilidade fisiopatológica como também da pouca acurácia dos critérios clínicos, microbiológicos e radiológicos. Estes fatos ensejaram a utilização progressiva de técnicas invasivas sofisticadas para coleta de amostras respiratórias endobrônquicas. Entretanto, a validação dessas técnicas para uso sistemático depende ainda de estudos que avaliem não só o seu custo/benefício em cenários clínicos diversos como também a comparação de seu desempenho para o diagnóstico com um padrão-ouro histopatológico. Além disso, o rendimento das técnicas invasivas é freqüentemente limitado quando são aplicadas em pacientes sob antibioticoterapia, que constituem a maioria dos casos em unidades de cuidados intensivos. A otimização desses testes, discutindo suas indicações e avaliando sua capacidade técnica para a confirmação ou exclusão de pneumonia, é justificada pela necessidade da instituição precoce e correta do tratamento, pois disto resulta menor mortalidade, redução de custos e permanência no hospital. Entre os testes que podem auxiliar no diagnóstico encontra-se o exame direto do lavado broncoalveolar, que proporciona resultados precoces e úteis para a tomada de decisão, mas não suficientemente testados em diferentes situações clínicas ou experimentais. Com o objetivo de avaliar o rendimento diagnóstico do exame direto precoce e das culturas quantitativas obtido por lavado broncoalveolar, estudou-se sua utilização em um modelo experimental de pneumonia provocada através de inoculação bacteriana intrabrônquica em ratos. O estudo comparou a acurácia do exame direto e dos exames culturais em três grupos de animais: Grupo A com pneumonia pneumocócica (37 animais); Grupo P com pneumonia por P. aeruginosa (26 animais) e Grupo B controle (10 animais), utilizando a histopatologia dos pulmões como teste de referência para o diagnóstico. Os Grupos A e P foram ainda randomizados em dois subgrupos cada, para tratamento ou não com antibióticos, usando penicilina no grupo pneumococo e amicacina no grupo Pseudomonas. Como resultado, observou-se que nos animais com pneumonia e ausência de antibióticos a pesquisa de bactéria fagocitada (BIC) no exame direto mostrou um rendimento elevado para o diagnóstico, sendo superior ao das culturas quantitativas. No grupo com pneumonia pneumocócica a BIC mostrou: S:94,4% a 100%, E:100%, VPP:100% e VPN:100%; e as culturas quantitativas mostraram: S:77,8%, E:100%, VPP:100%, VPN:40%. Nos com pneumonia por Pseudomonas a BIC obteve: S: 69%, E:100%; VPP:100% e VPN:71,4%); e as culturas quantitativas mostraram valores muito baixos: S:28,6%, E:100%, VPP:100% e VPN:50%). Nos animais com pneumonia pneumocócica sob tratamento antibiótico havia uma queda acentuada de sensibilidade das culturas quantitativas (S:21%) e, em menor grau da BIC (S:57,9%), mas sem perda da especificidade de ambos os exames. Ao contrário, nos animais com pneumonias por Pseudomonas sob tratamento não havia alteração no rendimento dos dois exames, cujos resultados foram semelhantes aos dos animais sem tratamento. Não havia diferenças de leitura da BIC para o diagnóstico, contando a sua positividade em macrófagos ou em neutrófilos infectados. A avaliação global dos casos estudados, reunindo todos os grupos (tratados e não-tratados) em ambos os modelos de pneumonia, mostrou que a acurácia do exame direto, representado pela pesquisa da BIC, foi superior (66%) ao das culturas quantitativas (53%). As conclusões principais do estudo foram: 1) o exame direto do lavado broncoalveolar (LBA) mostrou-se um teste útil e de alto rendimento para o diagnóstico de pneumonia quando realizado na ausência de antibióticos; 2) o LBA feito na vigência de antibióticos efetivos para a pneumonia perde mais de 50% de sua acurácia, mas não é afetado quando o antibiótico for ineficaz ou houver resistência ao mesmo; 3) a pesquisa de BIC no LBA é um exame de resultado precoce, de alta especificidade e com melhor rendimento do que as culturas quantitativas.

Características clínicas e da saturação transcutânea de oxigênio em lactentes hospitalizados com diagnóstico de bronquiolite viral aguda em oxigenoterapia por cateter extranasal

Objetivos – Descrever as características clínicas de crianças entre 1 e 12 meses hospitalizadas com diagnóstico de bronquiolite viral aguda (BVA), nos primeiros dias de internação, e verificar se o tempo de dessaturação de oxigênio (TD) tem valor prognóstico nesses pacientes. Metodologia – Estudo de coorte realizado de maio a outubro de 2001 com 111 pacientes entre 1 e 12 meses de idade internados no Hospital da Criança Santo Antônio, de Porto Alegre (RS), com diagnóstico de BVA na admissão, com saturação transcutânea de oxigênio da hemoglobina (SatHb) menor que 95% e em oxigenoterapia por cateter extranasal há menos de 24 horas. A gravidade foi verificada através do tempo de internação, tempo de oxigenoterapia e tempo para saturar 95% em ar ambiente (desfechos). Foram realizadas avaliações clínicas duas vezes ao dia (manhã e tarde), durante o período em que o paciente necessitou de oxigênio suplementar (até atingir saturação transcutânea de oxigênio de 95% em ar ambiente), com limite de dez avaliações. Os pacientes tiveram o oxigênio adicional retirado. Foi verificado, então, o tempo necessário para a saturação decrescer até 90% (TD90) e 85% (TD85), limitando-se a medida em no máximo cinco minutos. Foi constituído um escore de gravidade com os sinais clínicos anotados. Utilizou-se o teste do qui-quadrado ou teste exato de Fischer para comparar entre si os grupos de variáveis categóricas e o teste t ou MannWhitney para variáveis numéricas. Foi utilizada a correlação de Spearman para avaliar associações entre variáveis contínuas de distribuição assimétrica (escore de gravidade, tempo de internação, tempo de oxigenoterapia total e tempo para saturar acima ou igual a 95% em ar ambiente). Considerou-se alfa crítico de 5% em todas as comparações, exceto nas correlações em que foi utilizada a correção de Bonferroni para comparações múltiplas (30 correlações: p= 0,002; 10 correlações: p= 0,005). Os dados relativos ao peso e estatura para a idade foram digitados e analisados no programa específico do EpiInfo que utiliza o padrão NCHS (EpiNut). Resultados – Houve leve predomínio do sexo masculino (54%), predominância de idade inferior a quatro meses (61,3%), prevalência maior nos meses de junho e julho, freqüência elevada de história de prematuridade (23%) e de baixo peso de nascimento (14%). As manifestações clínicas prévias à hospitalização (falta de ar, chiado no peito, febre e parar de respirar) ocorreram, na sua maioria, nos três dias anteriores. Da população estudada, 45% tinha história de sibilância prévia, a maioria com um ou dois episódios relatados (31,5%). Esses pacientes foram analisados separadamente e tiveram resultados semelhantes ao grupo com BVA. A freqüência de desnutrição moderada e grave, excluídos os pacientes com história de prematuridade, foi de 26 pacientes (23%). Todos os pacientes utilizaram broncodilatador inalatório; 20% do grupo com BVA receberam corticosteróides sistêmicos e 47% de toda população, antibióticos. A mediana do uso de oxigênio em pacientes com BVA foi de 4,4 dias (IIQ 70,2-165,2) e o tempo de oxigenoterapia até saturar 95% em ar ambiente foi de 3,4 dias (IIQ 55-128). A mediana do tempo de internação hospitalar foi de 7 dias (IIQ 5-10,5) entre os pacientes com BVA; neste aspecto, apresentou diferença (p = 0,041) em relação ao grupo com sibilância prévia, que teve um tempo de internação mais longo (9 dias, IIQ 5-12). Observou-se pouca variabilidade clínica no período estudado, através da aplicação do escore clínico. Não se encontraram correlações estatisticamente significativas entre os escores clínicos e os TDs com os desfechos. Conclusões – Os TDs como elementos auxiliares na avaliação de pacientes em oxigenoterapia não foram clinicamente úteis neste estudo. É possível, no entanto, que, avaliando pacientes com maiores diferenças clínicas entre si, essas aferições possam mostrar-se importantes.