Predictors of Right Ventricle Dysfunction After Anterior Myocardial Infarction

Background: Regardless significant therapeutic advances, mortality and morbidity after myocardial infarction (MI) are still high. For a long time, the importance of right ventricle (RV) function has been neglected. Recently, RV dysfunction has also been associated with poor outcomes in the setting of heart failure. The shape, location, and contraction conditions make the RV chamber assessment technically challenging.Methods: Our study identified clinical characteristics and left ventricle (LV) echocardiographic data performed 3-5 days after MI that could be associated with RV dysfunction (RV fractional area change [FAC] < 35%) 6 months after MI.Results: The RV dysfunction group consisted of 11 patients (RV FAC 29.4% +/- 5.2) and the no RV dysfunction group of 71 patients (RV FAC 43.7% +/- 5.1); (P < 0.001). Both groups presented the same baseline clinical characteristics. Left atrium (LA), interventricular septum (IVS), and left ventricular posterior wall (LVPW) were larger in RV dysfunction than in no RV dysfunction. Conversely, E wave deceleration time (EDT) was lower in RV dysfunction when compared with no RV dysfunction. Left atrium(adj) (adjusted by gender, age, infarct size, and body mass index) (odds ratio [OR], 1.22; confidence interval [CI], 1.016-1.47; P = 0.032), interventricular septum(adj) (OR, 1.49; CI, 1.01-2.23; P = 0.044), and E wave deceleration time(adj) (OR, 0.98; CI, 0.97-0.98; P = 0.029) assessed soon after MI predicted RV failure after 6-months.Conclusions: LV diastolic dysfunction, resulting from anterior MI and assessed 3-5 days after the event, may play an important role in predicting RV dysfunction 6 months later.

Eosinófilos e proteína catiônica eosinofílica na urina: uma nova abordagem para o diagnóstico da inflamação renal no lúpus eritematoso sistêmico

Universidade Estadual do Rio Grande do Norte

On Fuzzy Implication Classes - Towards Extensions of Fuzzy Rule-Based Systems

Atualmente, há diferentes definições de implicações fuzzy aceitas na literatura. Do ponto de vista teórico, esta falta de consenso demonstra que há discordâncias sobre o real significado de "implicação lógica" nos contextos Booleano e fuzzy. Do ponto de vista prático, isso gera dúvidas a respeito de quais "operadores de implicação" os engenheiros de software devem considerar para implementar um Sistema Baseado em Regras Fuzzy (SBRF). Uma escolha ruim destes operadores pode implicar em SBRF's com menor acurácia e menos apropriados aos seus domínios de aplicação. Uma forma de contornar esta situação e conhecer melhor os conectivos lógicos fuzzy. Para isso se faz necessário saber quais propriedades tais conectivos podem satisfazer. Portanto, a m de corroborar com o significado de implicação fuzzy e corroborar com a implementação de SBRF's mais apropriados, várias leis Booleanas têm sido generalizadas e estudadas como equações ou inequações nas lógicas fuzzy. Tais generalizações são chamadas de leis Boolean-like e elas não são comumente válidas em qualquer semântica fuzzy. Neste cenário, esta dissertação apresenta uma investigação sobre as condições suficientes e necessárias nas quais três leis Booleanlike like — y ≤ I(x, y), I(x, I(y, x)) = 1 e I(x, I(y, z)) = I(I(x, y), I(x, z)) — se mantém válidas no contexto fuzzy, considerando seis classes de implicações fuzzy e implicações geradas por automorfismos. Além disso, ainda no intuito de implementar SBRF's mais apropriados, propomos uma extensão para os mesmos

On rich modal logics

I thank to my advisor, João Marcos, for the intellectual support and patience that devoted me along graduate years. With his friendship, his ability to see problems of the better point of view and his love in to make Logic, he became a great inspiration for me. I thank to my committee members: Claudia Nalon, Elaine Pimentel and Benjamin Bedregal. These make a rigorous lecture of my work and give me valuable suggestions to make it better. I am grateful to the Post-Graduate Program in Systems and Computation that accepted me as student and provided to me the propitious environment to develop my research. I thank also to the CAPES for a 21 months fellowship. Thanks to my research group, LoLITA (Logic, Language, Information, Theory and Applications). In this group I have the opportunity to make some friends. Someone of them I knew in my early classes, they are: Sanderson, Haniel and Carol Blasio. Others I knew during the course, among them I’d like to cite: Patrick, Claudio, Flaulles and Ronildo. I thank to Severino Linhares and Maria Linhares who gently hosted me at your home in my first months in Natal. This couple jointly with my colleagues of student flat Fernado, Donátila and Aline are my nuclear family in Natal. I thank my fiancée Luclécia for her precious a ective support and to understand my absence at home during my master. I thank also my parents Manoel and Zenilda, my siblings Alexandre, Paulo and Paula.Without their confidence and encouragement I wouldn’t achieve success in this journey. If you want the hits, be prepared for the misses Carl Yastrzemski

Changes in apoptosis and Bcl-2 expression in human hyperglycemic, term placental trophoblast

Apoptosis and its associated regulatory mechanisms are physiological events crucial to the maintenance of placental homeostasis; imbalance of these processes, however, such as occurs under various pathological conditions, may compromise placenta function and, consequently, pregnancy success. Increased apoptosis occurs in the placentas of pregnant women with several developmental disabilities, while increased Bcl-2 expression is generally associated with pregnancy-associated tumors. Herein, we tested the hypothesis that apoptosis-associated disturbs might be involved in the placental physiopathology subjected to different maternal hyperglycemic conditions.Thus, in the present study we investigated and compared the incidence of apoptosis using TUNEL reaction and Bcl-2 expression, in term-placentas of normoglycemic, diabetic and daily hyperglycemic patients. Tissue samples were collected from 37 placentas, being 15 from healthy mothers with normally delivered healthy babies, and 22 from mothers with glucose disturbances. From these latter 22 patients, 10 showed maternal daily hyperglycemia and 12 were clinically diabetics. Both Bcl-2 expression and apoptotic DNA fragmentation were established and quantified in the trophoblasts of healthy mothers. Compared to these reference values, a higher apoptosis index and lower Bcl-2 expression were disclosed in the placentas of the diabetic women, while in the daily hyperglycemic group, values were intermediate between the diabetic and normoglycemic patients. The TUNEL/Bcl-2 index ratio in the placentas varied from 0.02 to 0.09 for pregnant normoglycemic and diabetic women, respectively, revealing a predominance of apoptosis in the diabetic group. Our findings suggest that hyperglycemia may be a key factor evoking apoptosis in the placental trophoblast, and therefore, is relevant to diabetic placenta function. (c) 2006 Elsevier B.V.. All rights reserved.

Características clínicas associadas à evolução desfavorável na miocardiopatia periparto

OBJETIVOS: Avaliar as características clínicas de mulheres com diagnóstico prévio de miocardiopatia periparto e verificar as características associadas à evolução desfavorável. MÉTODOS: Variáveis clínicas, obstétricas e ecocardiográficas foram estudadas em 12 pacientes com miocardiopatia periparto, avaliadas no momento do diagnóstico e em consulta atual, quando foram divididas em dois grupos: GF (n= 6, sem alterações cardíacas) e GD (n= 6, com cardiomegalia e disfunção ventricular persistentes). As comparações foram feitas com o teste t de Student e exato de Fisher (p<0,05). RESULTADOS: No diagnóstico, a idade média das pacientes (8 brancas e 4 negras/pardas) foi de 24±7,4 anos; todas em classe funcional IV (NYHA) e 8 relataram hipertensão gestacional ou pré-eclâmpsia. A mediana do tempo de seguimento foi de 25 meses. Dez pacientes evoluíram para classe funcional I/II. A comparação entre os grupos mostrou GD com menor fração de ejeção do ventrículo esquerdo (0,30±0,05 vs. 0,58±0,09; p<0,001) e maior diâmetro sistólico do VE (58±5mm vs. 46±3mm; p<0,001), no momento do diagnóstico. A evolução desfavorável foi mais frequente entre as pardas (p=0,01). Na avaliação atual o GD apresentou menor espessura relativa da parede (0,13±0,02 vs. 0,17±0,02; p< 0,05) e maior massa do VE (283±90g vs. 186±41g; p<0,05). CONCLUSÃO: Pacientes com miocardiopatia periparto prévia apresentam evolução desfavorável associada à raça negra e alterações cardíacas iniciais mais acentuadas e a evolução favorável está associada à redução da massa miocárdica e aumento da espessura relativa da parede ventricular.

Dysglycemias in pregnancy: from diagnosis to treatment. Brazilian consensus statement

There is an urgent need to find consensus on screening, diagnosing and treating all degrees of DYSGLYCEMIA that may occur during pregnancies in Brazil, considering that many cases of DYSGLYCEMIA in pregnant women are currently not diagnosed, leading to maternal and fetal complications. For this reason the Brazilian Diabetes Society (SBD) and the Brazilian Federation of Gynecology and Obstetrics Societies (FEBRASGO), got together to introduce this proposal. We present here a joint consensus regarding the standardization of clinical management for pregnant women with any degree of Dysglycemia, on the basis of current information, to improve medical assistance and to avoid related complications of Dysglycemia in pregnancy to the mother and the fetus. This consensus aims to standardize the diagnosis among general practitioners, endocrinologists and obstetricians allowing the dissemination of information in basic health units, public and private services, that are responsible for screening, diagnosing and treating disglycemic pregnant patients.

Evaluation of Cell Proliferation and Apoptosis in Placentas of Rats with Severe Diabetes

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Respiratory Parameters and Exercise Functional Capacity in Preeclampsia

Objective: To evaluate maximal respiratory pressures, pulmonary volumes and capacities and exercise functional capacity in pregnant women with preeclampsia. Method: Primigravid women with preeclampsia and healthy primigravid women were evaluated by means of manovacuometry, spirometry and the 6-minute walk test. Results: The group with preeclampsia showed higher minute ventilation and lower forced vital capacity and exercise tolerance. The presence of preeclampsia and forced vital capacity were predictors in the six-minute walk test. Conclusion: Preeclampsia showed significant alterations in the respiratory system and was associated with lower exercise tolerance; however, it did not affect respiratory muscle functions.

Bioimpedance in Pregnant Women with Preeclampsia

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Short- and long-term reproductive effects of prenatal and lactational growth restriction caused by maternal diabetes in male rats

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

Vocal evaluation in teachers with or without symptoms

The aim of this study was to perform voice evaluation in teachers with and without vocal symptoms, identifying etiologic factors of dysphonia, voice symptoms, vocal qualities, and laryngeal lesions. Eighty teachers were divided into two groups: GI (without or sporadic symptoms, 40) and GII (with frequent vocal symptoms, 40). They answered a specific questionnaire, and were subject to a perceptual vocal assessment (maximum phonation time, glottal attack, resonance, coordination of breathing and voicing, pitch, and loudness), GIRBAS scale, and to videolaryngoscopy. Females were predominant in both groups, and the age range was from 36 to 50 years. Elementary teachers predominated, working in classes with 31-40 students. Voice symptoms and alterations in the perceptual vocal analysis and in the GIRBAS scale were more frequent in GII In 46 teachers (GI-16; GII-30), videolaryngoscopy exams were abnormal with the vocal nodules being the most frequent lesions. These results indicate that a teacher's voice is compromised, and requires more attention including control of environmental factors and associated diseases, preventive vocal hygiene, periodic laryngeal examinations, and access to adequate specialist treatment.

Dysphonia in Children

Introduction. Vocal symptoms are common among the pediatric population and are often caused by vocal abuse. Laryngoscopy is essential for their diagnosis because it helps differentiate several laryngeal lesions, leading to a decision for suitable treatments considering each case.Objectives. This study aims to present the clinical characteristics, and the laryngoscopic diagnosis of a dysphonic child population.Methods. The parents of 304 children, aged from 4 to 18 years and presenting prolonged hoarseness, answered a questionnaire about their children's voice, and all children were subjected to videolaryngostroboscopy.Results. Male children aged from 7 to 12 years (64%) were predominant. Vocal abuse (n-162) and nasal obstruction symptoms (n-10) were the most frequent associated symptoms. The vocal symptoms had a chronic evolution (over 1 year) and were reported by most parents (n-200). The most commonly diagnosed lesions in the laryngoscopic exams were vocal nodules (n-175) and epidermal cysts (n-47). Furthermore, there was an association of some lesions, especially minor structural alterations.Conclusion. In the present study, dysphonia occurred mainly in children aged from 7 to 12 years, predominantly males. Vocal abuse and nasal obstruction symptoms were frequently reported. Vocal nodules and cysts were the most commonly diagnosed laryngeal lesions in the laryngoscopic exams.

Consequences of Chronic Nasal Obstruction on the Laryngeal Mucosa and Voice Quality of 4- to 12-Year-Old Children

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