Emergências médicas no consultório dentário: análise dos conhecimentos e atuação do médico dentista e futuro médico dentista

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

A Sazonalidade na Empresa Naturimont

A sazonalidade turística é uma realidade inevitável e permeável à escala global que se traduz num desequilíbrio entre a procura e oferta turística, originando assim flutuações nos padrões de consumo. Apesar de poder assumir diversas causas (naturais, institucionais, por “calendário”, pressões sociais e factores económicos), a sazonalidade pode ser atenuada. No entanto, para poder geri-la, é importante não só conhecer as suas consequências (negativas e também positivas) assim como poder quantificá-la através de métodos de mensuração. O presente estudo pretendeu conhecer o impacto da sazonalidade na empresa Naturimont através da observação participante e do cálculo de duas medidas de concentração: a taxa de sazonalidade e o índice de amplitude sazonal. Sediada na região de Lamego, a Naturimont – Desporto, Aventura e Turismo Lda, foi o local onde decorreu o estágio. Deste modo, foi também possível identificar as ferramentas e estratégias de marketing utilizadas pela empresa para atenuar os desafios inerentes à sazonalidade.

Parâmetros bioquímicos e níveis de IgE total e específicas para aeroalérgenos em mulheres obesas com síndrome dos ovários policísticos

Introduction: Polycystic ovary syndrome (PCOS) whose classic features (menstrual irregularity of oligo/ amenorrhea type, chronic anovulation, infertility and hyperandrogenism clinical and/ or biochemical), is associated with aspects of metabolic syndrome (MS), as obesity and insulin resistance. The level of obesity determines different levels of inflammation, increasing cytokines participants of metabolic and endocrine functions, beyond modulate the immune response. Metabolic changes, added to the imbalance of sex hormones underlying irregular menstruation observed in (PCOS) can trigger allergic processes and elevation of total and specific IgE antibodies indicate that a sensitization process was started. Objective: To evaluate the influence of PCOS on biochemical parameters and levels of total and specific IgE to aeroallergens in obese women. Methods: After approval by the Committee of Ethics in Research, were recruited 80 volunteers with BMI ≥ 30 kg/m2 and age between 18 and 45 years. Among these, 40 with PCOS according to the Rotterdam criteria and 40 women without PCOS (control group). All participants were analysed with regard to anthropometric, clinical, gynecological parameters, interviewed using a questionnaire, and underwent blood sampling for realization of laboratory tests of clinical biochemistry: Total cholesterol, LDL-cholesterol, HDL- cholesterol, Triglycerides, Fasting glucose, Urea, Creatinine, Aspartate aminotransferase (AST), Alanine aminotransferase (ALT) and immunological: total and specific IgE to Dermatophagoides pteronyssinus, Blomia tropicalis, Dermatophagoides farinae and Dermatophagoides microceras.Statistical analysis was performed using SPSS 15.0 software through the chi-square tests, Fisher, Student t test and binary logistic regression, with significance level (p <0.05). Results: It was observed in the group of obese women with PCOS that 29 (72.5%) had menstrual cycle variable and 27 (67.5%) had difficulty getting pregnant. According to waist-hip ratio, higher average was also observed in obese PCOS (0.87). Blood level of HDL (36.9 mg/dL) and ALT (29.3 U/L) were above normal levels in obese women with PCOS, with statistically significant relationship. In the analysis of total and specific IgE to D. pteronyssinus high results were also prevalent in obese PCOS, with blood level (365,22 IU/mL) and (6.83 kU/L), respectively, also statistically significant. Conclusions: Observed predominance of cases with high levels of total IgE in the group of obese women with PCOS, 28 (70%) of the participants, whose mean blood concentration of the group was 365.22 IU/mL. In the analysis of Specific IgE between the groups, the allergen Dermatophagoides pteronyssinus showed greater dispersion and average the results of sensitization in the group of obese PCOS, whose mean blood concentration was 6.83 kU/l. Keywords: Obesity, Allergens and Polycystic Ovary Syndrome

Estudo do domínio segurança/proteção da NANDA internacional em pacientes de unidade de terapia intensiva

The study aimed to analyze the field of nursing diagnoses safety / protection of NANDA International present in patients in the Intensive Care Unit. This is a crosssectional study in intensive care complex of a university hospital in northeastern Brazil. The research took place in two stages. The first step was to collect data through an interview form and physical examination, with 86 patients admitted to the unit, during the months of December 2013 to May 2014. Spreadsheets were built in Microsoft Office Excel 2010 Software in which were marked by the researcher of this study, the presence or absence of defining characteristics, related factors and risk factors of the 31 studied diagnoses. In the second stage, held between July and August 2014, the sheets were sent to three diagnosticians, previously trained to perform the diagnostic inference. Data were analyzed using descriptive and inferential statistics for the diagnoses that showed higher frequencies than 50%, using IBM SPSS version 20.0 for Statistic Windows.O project was approved by the 440/414 and Presentation Certificate for Ethics Assessment number 22955113 .2.0000.5292. The results indicated the presence of 29 field of nursing diagnoses safety / protection in hospital clientele in the Intensive Care Unit, of which five were present in 100% of patients, namely: Risk of contamination, injury risk, falls risk,risk of allergic response and risk of trauma. Diagnoses that presented more frequently than 50% were: Risk of infection, dry eye risk, poisoning risk, vascular trauma risk, impaired skin integrity, impaired dentition, bleeding risk, risk imbalance in body temperature, Risk perioperative positioning injury, impaired tissue integrity, peripheral neurovascular dysfunction Risk, Risk adverse response to contrast media with iodine, shock Hazard and Risk of aspiration. For these analyzes, we identified 35 risk factors, 11 defining characteristics and three related factors showed statistically significant association with the studied diagnoses. For diagnostics: Risk of contamination, injury risk, falls risk, allergic response risk, trauma Risk, Risk of infection, dry eye risk and risk poisoning there was no association with any of their risk factors. We conclude that most of the area of nursing diagnoses safety / protection feature is prevalent in critically ill patients, with special attention to the risk diagnoses. There was a significant association between these diagnoses and its components. It is noteworthy, therefore, that the lifting of this profile contributes relevant clues to the inference of the priority nursing diagnoses domain safety / protection in the study population, supporting the practice of nursing and stimulating knowledge on the subject.

Parâmetros biológicos de Herpsilochmus pectoralis Sclater 1857 (Aves: Thamnophilidae) em fragmentos de mata atlântica do Nordeste do Brasil

The study of birds represents an important tool for the understanding of the processes involved in behavioral and morphological patterns. The species we have studied belongs to Thamnophilidae family, the third largest family restricted to the Neotropic ecozone. They are popularly known as antbirds and comprise 209 species. A large portion of the species has cryptic behavior, making the acoustic communication an important tool for maintaining contact among birds. Herpsilochmus pectoralis Sclater 1857 has evident sexual dimorphism, measured between 10 and 12 cm height and it is found in forest fragments in the Northeast and it is also categorized as vulnerable to extinction process. This study was conducted in three sandbank fragments on the east coast of the state of Rio Grande do Norte, Brazil. With the help of tape recordings between 2006 and 2012 it was possible to describe and characterize the sing of H. pectoralis. The sing from male birds has more and longer length than the female sing (16% of dimorphism). No differences were found in the dominant frequency between the sexes. We describe four types of calls from this species repertoire. Through capturing with ornithological nets between 2009 and 2012 it was possible to describe and compare the morphology of H. pectoralis. The species have shown lower corporal mass in the dry season. The young birds showed morphometric similarities in comparison to adults. The species has no accentuated dimorphism in their morphometric characteristics. The young ones with flying capabilities have morphometric characteristics of adults, even though they do not show a characteristic adult plumage. The moult pattern in the species is a characteristic of tropical birds, but it shows short reproductive period, typical of temperate species. Even being in the tropical region, the species suffers with seasonal rainfall, which influences their reproductive phenology and moult (remex and rectrix) cycle. Thus, this dissertation provides information on the biology of H. pectoralis to support the understanding of the relationship of this species to the environment and also to know the variations of morphology and vocal aspects, in order to understand patterns and general characteristics of Thamnophilidae.

Transporte longitudinal de sedimento na zona costeira de Natal/RN

The longshore sediment transport (LST) is determinant for the occurrence of morphological changes in coastal environments. Understanding their movement mechanisms and transport is an essential source of information for the project design and coastal management plans. This study aims to characterize, initially, the active hydrodynamic circulation in the study area, comprised of four beach sectors from the south coast of Natal, assessing the average annual LST obtained through three proven equations (CERC, Kamphuis and Bayram et al.), defining the best formulation for the study area in question, and analyze the seasonal variability and the decadal transport evolution. The coastal area selected for this work constitutes one of the main tourist corridors in the city, but has suffered serious damage resulting from associated effects of hydrodynamic forcings and their disorderly occupation. As a tool was used the Coastal Modelling System of Brazil (SMC-Brazil), which presents integrated a series of numerical models and a database, properly calibrated and validated for use in developing projects along the Brazilian coastline. The LST rates were obtained for 15 beach profiles distributed throughout the study area. Their extensions take into account the depth of closure calculated by Harllermeier equation, and regarding the physical properties of the sediment, typical values of sandy beaches were adopted, except for the average diameter, which was calculated through an optimization algorithm based on equilibrium profile formulation proposed by Dean. Overall, the results showed an intensification of hydrodynamic forcings under extreme sea wave conditions, especially along the headlands exist in the region. Among the analyzed equations, Bayram et al. was the most suitable for this type of application, with a predominant transport in the south-north direction and the highest rates within the order of 700.000 m3 /year to 2.000.000 m3 /year. The seasonal analysis also indicated a longitudinal transport predominance in the south to north, with the highest rates associated with the fall and winter seasons. In these periods are observed erosive beach states, which indicate a direct relationship between the sediment dynamics and the occurrence of more energetic sea states. Regarding the decadal evolution of transportation, it was found a decrease in transport rate from the 50’s to the 70’s, followed by an increase until the 2000’s, coinciding with the beginning of urbanization process in some stretches of the studied coastline.

When wolves cry: long distance calling by wild maned wolves

The maned wolf (Chrysocyon brachyurus Illiger 1815) is the biggest canid in South America and it is considered a “near threatened” species by IUCN. Because of its nocturnal, territorial and solitary habits, there are still many understudied aspects of their behavior in natural environments, including acoustic communication. In its vocal repertoire, the wolf presents a longdistance call named “roar-bark” which, according to literature, functions for spacing maintenance between individuals and/or communication between members of the reproductive pair inside the territory. In this context, this study aimed: 1) to compare four methods for detecting maned wolf’s roar-barks in recordings made in a natural environment, in order to elect the most efficient one for our project; 2) to understand the night emission pattern of these vocalizations, verifying possible weather and moon phases influences in roarbark’s emission rates; and 3) to test Passive Acoustic Monitoring as a tool to identify the presence of maned wolves in a natural environment. The study area was the Serra da Canastra National Park (Minas Gerais, Brazil), where autonomous recorders were used for sound acquisition, recording all night (from 06pm to 06am) during five days in December/2013 and every day from April to July/2014. Roar-barks’ detection methods were tested and compared regarding time needed to analyze files, number of false positives and number of correctly identified calls. The mixed method (XBAT + manual) was the most efficient one, finding 100% of vocalizations in almost half of the time the manual method did, being chosen for our data analysis. By studying roarbarks’ temporal variation we verified that the wolves vocalize more in the early hours of the evening, suggesting an important social function for those calls at the beginning of its period of most intense activity. Average wind speed negatively influenced vocalization rate, which may indicate lower sound reception of recorders or a change in behavioral patterns of wolves in high speed wind conditions. A better understanding of seasonal variation of maned wolves’ vocal activity is required, but our study already shows that it is possible to detect behavioral patterns of wild animals only by sound, validating PAM as a tool in this species’ conservation.

Um estudo sobre a variabilidade do vento no nordeste do Brasil através de métodos estatísticos e via modelos dinâmicos de meso e micro escala

The objective of this study was to determine the seasonal and interannual variability and calculate the trends of wind speed in NEB and then validate the mesoscale numerical model for after engage with the microscale numerical model in order to get the wind resource at some locations in the NEB. For this we use two data sets of wind speed (weather stations and anemometric towers) and two dynamic models; one of mesoscale and another of microscale. We use statistical tools to evaluate and validate the data obtained. The simulations of the dynamic mesoscale model were made using data assimilation methods (Newtonian Relaxation and Kalman filter). The main results show: (i) Five homogeneous groups of wind speed in the NEB with higher values in winter and spring and with lower in summer and fall; (ii) The interannual variability of the wind speed in some groups stood out with higher values; (iii) The large-scale circulation modified by the El Niño and La Niña intensified wind speed for the groups with higher values; (iv) The trend analysis showed more significant negative values for G3, G4 and G5 in all seasons and in the annual average; (v) The performance of dynamic mesoscale model showed smaller errors in the locations Paracuru and São João and major errors were observed in Triunfo; (vi) Application of the Kalman filter significantly reduce the systematic errors shown in the simulations of the dynamic mesoscale model; (vii) The wind resource indicate that Paracuru and Triunfo are favorable areas for the generation of energy, and the coupling technique after validation showed better results for Paracuru. We conclude that the objective was achieved, making it possible to identify trends in homogeneous groups of wind behavior, and to evaluate the quality of both simulations with the dynamic model of mesoscale and microscale to answer questions as necessary before planning research projects in Wind-Energy area in the NEB

Borboletas no semiárido: sazonalidade e padrões de diversidade de borboletas frugívoras em um ambiente extremo

The spatial and temporal distribution of the population reflects the adjustment of their biological characteristics to environmental conditions and biotic interactions as adaptive and phylogenetic precursors elements. The habitat’s heterogeneity and alternating seasons tend to cause patterns of activity of organisms and species diversity. However, these seasonal and spatial patterns in butterfly communities in dry environments are not yet clear. We studied a community of frugivorous butterflies in ESEC Seridó, in northeastern Brazil, aiming to characterize the guild in semiarid and check the relative contribution of climate and vegetation variables on its composition, diversity and phenofaunistic. The butterflies were sampled monthly during one year, and the distribution of species was associated with structural characteristics of three vegetation types (eg. richness and abundance of tree and shrub species, canopy cover, herbaceous cover, litter) and climatological data (temperature, rainfall and humidity). We captured 9580 individuals of 16 species of butterflies belonging to four subfamilies (Biblidinae, Charaxinae, Nymphalinae and Satyrinae). The richness, abundance and diversity varied in different scales, especially in time, being higher in the rainy season, while the β-diversity and turnover was higher in the dry. The distribution of species mainly followed the changes in humidity, rainfall and vegetation phenology, with no defined boundaries between habitats. The flight period was shared within subfamilies, which should have distinct response to environmental stimuli, as well as respond to the phenology of host plants and have different reproductive strategies. There is even evidence of physiological and behavioral adaptations as seasonal reproduction and aestivation. So there was environmental control over the distribution and diversity of species, with the key role climate Association and vegetation structure in the community of differentiation in the seasons, and the availability and quality of resources on the variation of species abundance in small scales. These results may support the biomonitoring and conservation preserved areas, particularly in environments under human pressure and extreme environmental conditions such as semi-arid.

Escalonando uma aplicação paralela com demanda variável em ambiente de nuvem

This study proposes a solution responsible for scheduling data processing with variable demand in cloud environments. The system built check specific variables to the business context of a company incubated at Digital Metropole Institute of UFRN. Such a system generates an identification strategy machinery designs available in a cloud environment, focusing on processing performance, using data load balancing strategies and activities of parallelism in the software execution flow. The goal is to meet the seasonal demand within a standard time limit set by the company, controlling operating costs by using cloud services in the IaaS layer.

Climatologia da pluviosidade na bacia hidrográfica do Rio Paranaíba

The main aim of this research was to study pluviosity in the Paranaíba Riverbasin, especially concerning the variability frame and trends. For this end, we used data from 22 pluviometric stations of the Agência Nacional da Águas- ANA(National Water Agency)spatially distributed throughout the basin area. The data comprised the years 1979-2013, which is a historical series of 35 years, and was downloaded through the ANA website and tabulated using the Hydro 1.2 software (2015) and Excel. After tabulation process were applied based methodologies for statistical analysis of annual variability, monthly, daily and seasonal rainfall in the basin beyond the trend analysis. Results of this research showed that the annual rainfall averageis 1491 mm. Seasonality is a hallmark and rainfall variability occurs spatially and temporally. Rains are accumulated in the rainy season accumulating 85% of the annual volume in the basin. In daily analysis it was found that the daily rainfall above 30 mm occur in only 3% of the time. Dry season comprises 15% of the rainfall. Trend analysis using linear regression pointed to a downward trend in rainfall in 46% of jobs, stability in 18% of posts and increased rainfall by 36%. As for the analysis using the sign test indicated that 32% of the analyzed rainfall stations showed an increasing trend of rainfall over the time series and 68% of stations showed downward trend. This research is important because shows how rainfall worksin the area of the Paranaiba basin, and may be used to develop better management of natural resources and the area through public policies for this purpose.

Anafilaxia en urgencias: incidencia, diagnóstico y manejo clínico

La anafilaxia fue descrita en 1902, sin embargo, sigue sin existir una definición de anafilaxia universalmente aceptada. La más utilizada, en la actualidad, es la publicada en el documento de consenso del simposio sobre la definición y el manejo de la anafilaxia del año 2005, que la describe como “una reacción alérgica de inicio rápido que puede producir la muerte”. Actualmente, la anafilaxia se clasifica en inmunológica (IgE dependiente o independiente) y no inmunológica (por ejemplo, la originada por algunos contrastes iodados). Sus síntomas están causados por una liberación masiva de mediadores, principalmente de mastocitos y basófilos, que pueden tener como diana cualquier órgano. Los datos epidemiológicos acerca de la anafilaxia son escasos. La prevalencia se estima entre el 0,05% y el 2%, aunque su incidencia parece estar aumentando. En los últimos años, se han publicado varios estudios que han intentado establecer la incidencia de anafilaxia en los servicios de urgencias de diversos hospitales. Los datos publicados en estos estudios oscilan entre el 0,07% y el 0,4%. Esta variabilidad puede deberse a características de la población y zona geográfica, y también a limitaciones metodológicas, condicionadas principalmente por la falta de consenso en cuanto a su definición, las dificultades para la codificación de la anafilaxia mediante códigos CIE y el funcionamiento de los servicios de urgencias. Además, la mayor parte de estos estudios se centran en pacientes adultos, y en menos ocasiones analizan las características de los pacientes en edad pediátrica...

Caracterización fenotípica y bases moleculares de los pacientes con eosinofilia esofágica respondedora a fármacos inhibidores de la bomba de protones

La esofagitis eosinofílica (EEo) es una enfermedad esofágica alérgica de creciente incidencia. Afecta a niños y adultos jóvenes, principalmente hombres (razón 3:1), encontrándose enfermedades atópicas subyacentes (asma y/o rinoconjuntivitis estacional, dermatitis atópica, alergia alimentaria) en el 80%-90% de los casos. Los primeros criterios diagnósticos para la EEo, publicados en el año 2007, se basaban en la conjunción de tres criterios mayores: datos clínicos (síntomas de disfunción esofágica), datos histológicos (infiltración epitelial esofágica por eosinófilos > 15 eos/cga) y ausencia de respuesta a inhibidores de la bomba de protones (IBP) o pHmetría esofágica normal. Sin embargo, la gran mayoría de los pacientes con síntomas de disfunción esofágica e inflamación esofágica eosinofílica eran diagnosticados de EEo sin confirmación de la respuesta a IBP o realización de pHmetría. Por tanto, existía un riesgo evidente de infraestimación de la respuesta a IBP en estos pacientes. Este incumplimiento de las premisas diagnósticas de consenso no sólo impedía cuantificar el porcentaje de pacientes que eran respondedores a IBP, sino que hacía que pacientes potencialmente respondedores a IBP recibieran otros tratamientos específicos para la EEo (corticoides tópicos, dietas de eliminación), los cuales, comparados con los IBP, provocan mayor cantidad de efectos adversos o podían limitar notablemente la calidad de vida de los pacientes. Inmediatamente después de la publicación de las primeras recomendaciones diagnósticas en el año 2007, se comunicaron pequeñas series retrospectivas de pacientes pediátricos con eosinofilia esofágica sintomática que alcanzaron remisión completa con IBP, tanto con pHmetría normal como patológica. Por tanto, estas series iniciales comenzaron cuestionar el papel diagnóstico de la pHmetría y su capacidad para predecir la respuesta a IBP...

Análise da potencialidade turística inexplorada – Caminha, entre a natureza e a história

O presente relatório insere-se no plano curricular do 2º ano de Mestrado de Turismo e Ambiente e consiste no estudo das potencialidades turísticas não exploradas no município. Caminha é um município litoral, onde, existe uma de grande variedade de produtos, sejam eles naturais, culturais ou até mesmo gastronómicos. A procura turística, porém, centra-se bastante no Turismo de Sol & Mar, sendo os produtos acima referidos desvalorizados pelos turistas. Esta problemática verifica-se ao longo do ano, onde por um lado existe uma crescente procura durante os meses de época balnear, e por outro lado uma baixa procura turística nos restantes meses e, consequentemente, pequenos comércios locais são particularmente afetados por esta sazonalidade. Sendo esta região, portanto, uma zona bastante sazonal, é nosso dever combater esta problemática, expandindo a oferta turística do município, através da obtenção de, por exemplo, novos trilhos pedestres que permitam conhecer melhor o património existente e portanto aumentar a oferta turística. Assim, foi desenvolvido um estágio de mestrado, com o objetivo de identificar e caracterizar os recursos que o município de Caminha tem para oferecer, bem como definir as formas sustentadas de exploração destes recursos. Para que estes trabalhos pudessem ser desenvolvidos tendo em conta os objetivos inicialmente delineados, foi feita uma revisão bibliográfica para poder sustentar as várias atividades desenvolvidas durante o estágio, que proporcionaram, ao mesmo tempo, a aquisição e o desenvolvimento de diferentes competências técnicas e científicas, na área de turismo e ambiente. Conclui-se que os resultados alcançados foram positivos, tendo-se percebido, após a identificação dos recursos, quais os que exibem uma má exploração, de forma a ser traçado um plano de gestão sustentada desses recursos. Por último, para uma maior compreensão e ajuste da oferta turística da região, caracterizou-se o perfil do turista que visita o município bem como as suas motivações. Este relatório é, assim, o produto final da aprendizagem das competências obtidas ao longo da licenciatura e consolidadas no mestrado, bem como de nove meses de trabalho de estágio na Câmara Municipal de Caminha, gabinete da Cultura e Turismo, os quais no seu conjunto contribuíram para a realização do presente relatório de estágio.

Contact dermatitis from shoes: an update

Contact dermatitis is a common inflammatory skin condition characterized by erythematous and pruritic skin lesions that occur after contact with a foreign substance. There are two forms of contact dermatitis: irritant and allergic. Irritant contact dermatitis is caused by the non–immune-modulated irritation of the skin by a substance, leading to skin changes. Allergic contact dermatitis is a delayed hypersensitivity reaction in which a foreign substance comes into contact with the skin; skin changes occur after reexposure to the substance. A medical condition referred to as “shoe dermatitis” is a form of contact dermatitis caused by the contact of the foot with parts of the shoe due to these materials. Shoe dermatitis is a diagnostic and therapeutic challenge and is a common type of contact dermatitis. It is imperative the foot and ankle physician become familiar with recognizing signs and symptoms of shoe dermatitis so that their patients can be accurately diagnosis and appropriately treated to avoid secondary infections and disability. This review will first present causative factors for the etiology of shoe contact dermatitis supported by clinical-based evidence as found in the medical literature. Secondly, a description of the signs and symptoms of shoe contact dermatitis will be presented in a narrative fashion. Finally, both treatment options and preventative measures to avoid shoe.