Prevalence of broncopulmonary and otorhinolaryngologic symptoms in children under investigation for gastroesophageal reflux disease: retrospective analysis

A Doença do Refluxo Gastroesofágico (DRGE) é uma afecção comum na infância, aumentando as evidências de que o refluxo gastroesofágico seja um cofator importante que contribui para as desordens de vias aéreas, principalmente na população pediátrica. É muito comum serem observadas manifestações em vias aéreas superiores e inferiores. Nosso objetivo é avaliar a presença de sintomas otorrinolaringológicos em crianças com idade de um a 12 anos e suspeita de doença do refluxo gastroesofágico. MATERIAIS E MÉTODO: Foram avaliados dados de prontuários de pacientes de até 12 anos submetidos à pHmetria de 24 horas de um ou dois canais, locados a 2 e 5 cm do EEI para confirmação de diagnóstico de Doença do Refluxo Gastroesofágico. RESULTADOS: Foram analisados 143 prontuários de crianças que realizaram pHmetria de 24 horas para investigação de DRGE; porém 65 foram incluídas. Os sintomas mais prevalentes nas crianças eram os broncopulmonares, encontrados em 89,2%, de sintomas nasossinusais (72,3%) , otológicos (46,1%) e de infecções de VAS de repetição (44,6%). Quando comparada a presença de cada grupo de sintomas com o resultado da pHmetria, não foi encontrada diferença significativa entre os sintomas e o resultado da pHmetria. CONCLUSÃO: DRGE pode se manifestar de diversas maneiras e os sintomas otorrinolaringológicos são frequentes em crianças.

Fatores que influenciam nas complicações das tireoidectomias

O resultado pós-operatório das tireoidectomias é imputado a fatores relativos ao paciente, à tireopatia e ao cirurgião. OBJETIVO: Analisar a experiência de um serviço quanto a complicações com a tireoidectomia. Desenho do estudo: coorte histórica com corte transversal. MATERIAL E MÉTODO: Foram avaliados os prontuários de 228 pacientes submetidos à tireoidectomia, entre 1991 e 2004. Foram estudadas as complicações transitórias, definitivas e totais, persistência e recidiva da tireopatia de base, em relação a fatores clínico-laboratoriais. RESULTADOS: Ocorreram 34,65% de complicações totais, 18,86% de complicações transitórias (9,21% hipocalcemia, 0,44% paralisia de cordas vocais, 4,82% outras), associadas aos primeiros anos de cirurgia no serviço e queixas compressivas, e 17,98% de complicações definitivas (8,77% hipoparatireoidismo, 1,75% paralisia de cordas vocais, 0,44% rouquidão), associadas à malignidade e cirurgias mais radicais. Houve persistência da doença de base em 17,98% dos casos, associada à idade, e recidiva em 10,96%, associada aos primeiros anos de cirurgia, benignidade e cirurgias menos radicais. CONCLUSÃO: Complicações pós-operatórias se associaram a queixas compressivas, história curta, malignidade e cirurgias mais radicais. A recidiva se associou aos primeiros anos de cirurgia no serviço, tireopatias benignas e cirurgias menos radicais. A persistência da doença se associou à maior idade.

Cistos subependimários diagnosticados pelo ultra-som transfontanelar

Objetivos: avaliar a evolução ultra-sonográfica de cistos subependimários (CSE) do ângulo externo dos ventrículos laterais, e a evolução clínica dos pacientes. Comparar os pacientes com CSE isolados e os com CSE associados a outras lesões. Métodos: foram diagnosticados um a vários cistos no ângulo externo de um ou de ambos os ventrículos laterais, por meio de ultra-som transfontanelar (US) de rotina, realizado nos primeiros dias de vida, caracterizando os CSE. Durante o período de 1981-2000, 66 recém-nascidos tiveram CSE evidenciados na UTI neonatal do Hospital de Port-Royal. Foram constituídos dois grupos: G-I, com CSE isolados (n=21), e G-II, com CSE associados a outras lesões (n=45). Resultados: os recém-nascidos do GI apresentaram maior maturidade, melhores condições de nascimento e menor morbidade respiratória em relação a GII. A incidência de malformações congênitas foi elevada em ambos os grupos. Houve baixa taxa de infecção bacteriana e ausência de infecção congênita. Os CSE foram uni ou bilaterais, únicos ou múltiplos (colar de pérolas), sem diferença entre os grupos estudados, e predominaram à esquerda. US seriados foram realizados em 49/66 pacientes (74%), mostrando aumento no tamanho do cisto em 21/49 (45%), no primeiro mês de vida, enquanto 12 CSE (24%) desapareceram. O óbito ocorreu em dez recém-nascidos com lesões neurológica graves (quatro leucomalácias periventriculares, cinco hemorragias peri e intraventriculares), e somente um com hérnia diafragmática não apresentava outras lesões ao US transfontanelar. Conclusões: as características dos CSE não diferiram quando esses estavam associados a outras lesões. O nítido predomínio no lado esquerdo sugere uma etiologia vascular. Foi encontrada uma alta taxa de malformações associadas, alertando para a possibilidade de uma etiologia malformativa. Ambas hipóteses sugerem um desvio de desenvolvimento, e não de uma fetopatia viral.

Skin reactions to drugs

OBJECTIVE - To assess drug reactions and report the drugs involved and the most frequent types of skin reactions.METHODS - A retrospective and descriptive study. Data of inpatients at the Dermatology Ward with initial diagnosis of adverse drug reactions were evaluated from January 1999 to June 2004. Patients with confirmed diagnosis were included in the study based on clinical and histopathological criteria, after analysis of medical charts.RESULTS - Initial diagnosis of adverse drug reactions was confirmed in 121 patients. Forty-three patients were included in the study; 51.2% were females and 86% were caucasians. A total of 48,8% were on one drug only. Antibiotics were the most commonly used drug (20%) and accounted for 33% of the drug eruptions. The second group comprised anti-inflammatory drugs (16 7%), followed by anticonvulsants (13%), analgesic/antipyretic (13%.) agents. Skin eruption manifested as maculopapular exanthema in 41.9% patients, erythrodermia in 25.6%, and urticaria in 23.3%.CONCLUSION - Maculopapular exanthema was the main type of skin reaction triggered by use of drugs, and these reactions were most frequently caused by antibiotics.

Grafico misto de controle da media com amostragem em dois estagios

This paper proposes a new control chart to monitor a process mean employing a combined npx-X control chart. Basically the procedure consists of splitting the sample of size n into two sub-samples n1 and n2 determined by an optimization search. The sampling occur in two-stages. In the first stage the units of the sub-sample n1 are evaluated by attributes and plotted in npx control chart. If this chart signs then units of second sub-sample are measured and the monitored statistic plotted in X control chart (second stage). If both control charts sign then the process is stopped for adjustment. The possibility of non-inspection in all n items may promote a reduction not only in the cost but also the time spent to examine the sampled items. Performances of the current proposal, individual X and npx control charts are compared. In this study the proposed procedure presents many competitive options for the X control chart for a sample size n and a shift from the target mean. The average time to sign (ATS) of the current proposal lower than the values calculated from an individual X control chart points out that the combined control chart is an efficient tool in monitoring process mean.

Analysis of biological tissues in infant chest for the development of an equivalent radiographic phantom

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

Teste tuberculínico em indivíduos com infecção pelo vírus da imunodeficiência humana: relação com número de linfócitos T periféricos e atividade tuberculosa

OBJETIVO: Avaliar os resultados do teste tuberculínico e relacioná-los com a presença ou não de tuberculose em atividade e com a contagem de linfócitos T CD4+/CD8+. MÉTODOS: Foram revisados 802 prontuários de pacientes com síndrome da imunodeficiência adquirida atendidos no período de agosto de 1985 a março de 2003. Cento e oitenta e cinco pacientes realizaram o teste tuberculínico (23,1%) e, destes, 107 eram do sexo masculino (57,8%). A média de idade no grupo de reatores ao teste tuberculínico foi de 30,6 anos, com desvio-padrão de 6,62 anos, e entre os não reatores de 34,45 anos com desvio-padrão de 10,32 anos. Foram constituídos dois grupos de estudo: reatores ao teste tuberculínico, com 28 pacientes, e não reatores ao teste tuberculínico, com 157 pacientes. RESULTADOS: Grande parte dos indivíduos foi pouco responsiva ao teste tuberculínico. Constatou-se, no grupo de reatores, maior porcentagem de indivíduos com tuberculose ativa à época da realização do teste, quando se comparou com os não reatores. Dez pacientes entre os reatores e onze entre os não reatores apresentavam alguma forma clínica de tuberculose em atividade à época da realização do teste, sendo que seis do primeiro grupo e oito do segundo tinham contagem de linfócitos T CD4+ menor que 200 células/mm³. CONCLUSÃO: Indurações maiores do que 5 mm não se relacionaram com contagens absolutas mais altas de células T CD4+.

Geologia e geomorfologia dos recifes de Maracajaú-RN e plataforma rasa adjacente

This work focuses the geological and geomorphological characterization of the inner shelf in the West Coast of the Rio Grande do Norte state, particularly the reef coral barrier offshore of Maracajaú (Maxaranguape district). If developed without the necessary concerns, tourism and entertainment activities that have been widely increased during the last five years can lead to irreversible environmental damages to the biotic and abiotic ecosystems of the region. Regarding these aspects, it is crucial the realization of a detailed study to envisage the achievement of a self-sustainable development, especially with respect to the possibilities of a rational usage of the region. This is the aim of this manuscript, which consisted of an initial stage of digital modeling of the terrain with basis on digitalization and vectorization of the Nautical map number 803 (Naval Service of Brazil, 1971). Information obtained in this phase was improved with the digital processing of small format aerial photos acquired from six flights, which were integrated to form a photomosaic of the area. The refined maps produced with the data from Nautical and aerial photo-interpretations aided to locate 9 bathymetric profiles, which provided information about the sea floor relief of the whole area. This later aided in the choosing of areas to bottom sampling that, in its turn, helped to characterize sediments present in floor of the inner shelf. Sixty-four samples collected during this work were studied by granulometrical and chemical analysis; with the later one developed in order to measure carbonate and organic matter contents. Forty-two of these samples showed carbonate content higher than 80% and organic matter in the range of 0.58% to 24.06%. With respect to grain size, these samples are in the interval between fine- to mid-grained sands. Sands with grain sizes higher than this one are also composed by carbonate carapaces such as pale yellow to red rhodolites with ellipsoidal and spheroidal shapes. During determination of the submerse features, the small format aerial photos demonstrated to be a useful methodology to aid the delineation of the sea floor topography through shallow deep waters. The bathymetry, for its turn, revealed several features at the bottom of the platform, in which the most conspicuous are undulations and morphological details of the São Roque Channel. Examination of bottom, aside from sand, yielded the identification of bivalves, ostracods, fragments of bryozoans, spikes of sponges, spines of echinoderms, operculum of gastropods and foraminifers. From the above it is concluded that the multi-methodological approach developed in this study worked efficiently, permitting the geomorphological and environmental characterization of the inner shelf of the North Maracajaú

Caracterização de processos morfodinâmicos e hidrodinâmicos do cinturão lacustre meridional da Reserva Biológica do Lago Pirituba, Amapá

The Amapá State has an important natural lake system, known as The Amapá Lakes Region . Most of these lakes are on the southern part of Amapá s coastal plain, which has 300 km of extension and it s composed by holocenic sediments deposited at the northern part of Amazon River to the Orange Cape located on the northern part of Amapá state. This region is under influence of the Amazon River discharge which is the largest liquid discharge of about 209.000 m³/s and biggest sediment budget discharged on the ocean in the order 6.108 ton per day. The climate is influenced by the Intertropical Convergence Zone and El Niño Southern Oscillation which act mainly under precipitation, nebulosity, local rivers and tidal hidrology. In this region lake belts are Ocidental, Oriental and Meridional Lake Belts. The last one is formed by the by the lakes Comprido de Cima, Botos, Bacia, Lodão, Ventos, Mutuco and Comprido de Baixo. These lakes are the closest to the Araguari River and are characterized by pelitic sedimentation associated with fluvial and estuarine flood plains under influence of tides. The lakes are interconnected, suffer influence of flood pulses from the Tartarugal, Tartarugalzinho and Araguari rivers and the hydrodynamic and morphodynamic know edge is poor. Volume and area reduction, natural eutrophication, anthophic influence, hidrodynamic alterations, morphological changes and are factors which can contribute to the closing of such lakes on the Meridional Lake Belt. This belt is inside the boundaries of the Biological Reserve of Piratuba Lake, created in 1980 for integral protection. Due to the fragility of the environment together with the poor knowledge of the system and with the study area relevancy it is necessary to know the hydrodynamic and geoenvironmental processes. This work aims the characterization of morphodynamic and hydrodynamic processes in order to understand the geoambiental context of the Meridional Lake Belt, from the Comprido de Baixo Lake to the dos Ventos Lake, including the Tabaco Igarape. Methodology was based on the hydrodynamic data acquisition: liquid discharge (acoustic method), tides, bathymetry and the interpretation of multitemporal remote sensing images, integrated in a Geographic Information System (GIS). By this method charts of the medium liquid discharges of Lake Mutuco and Tabacco Igarape the maximum velocity of flow were estimated in: 1.1 m/s, 1.6 m/s and 1.6 m/s (rainy season) and 0.6 m/s, 0.6 m/s and 0.7 m/s (dry period), the maximum flow in: 289 m³/s, 297 m³/s and 379 m³/s (rainy season) and 41 m³/s , 79 m³/s and 105 m³/s (dry period), respectively. From the interpretation of multitemporal satellite images, maps were developed together with the analysis of the lakes and Tobaco Igarape evolution from 1972 to 2008, and were classified according to the degree of balance in the area: stable areas, eutrophic areas, areas of gain, and eroded areas. Troughout analysis of the balance of areas, it was possible to quantify the volume of lake areas occupied by aquatic macrophytes. The study sought to understand the hydrodynamic and morphodynamic processes occurring in the region, contributing to the elucidation of the processes which cause and/or favor geoenvironmental changes in the region; all such information is fundamental to making the management of the area and further definition of parameters for environmental monitoring and contributing to the development of the management plan of the Biological Reserve of Lake Piratuba. The work activities is a part of the Project "Integration of Geological, geophysical and geochemical data to Paleogeographic rebuilding of Amazon Coast, from the Neogene to the Recent

Sífilis materna e congênita: ainda um desafio

Este estudo descritivo coletou informações sociodemográficas, obstétricas e relacionadas ao diagnóstico e tratamento da gestante/puérpera e parceiro das 67 gestantes/puérperas notificadas no Sistema Nacional de Agravos de Notificação, usuárias de maternidades públicas do Distrito Federal, Brasil, entre 2009 e 2010. As informações do acompanhamento clínico e laboratorial recebido pela criança vieram do prontuário médico hospitalar, fichas de notificação compulsória e Cartão da Criança. Das gestantes, 41,8% foram adequadamente tratadas, o principal motivo para a inadequação foi a ausência (83,6%) ou inadequação do tratamento do parceiro (88,1%). Mais de um terço necessitou de novo tratamento na maternidade por falta de documentação terapêutica no pré-natal. Dos recém-nascidos com sífilis congênita, 48% fizeram estudo radiográfico, 42% passaram por punção liquórica e 36% deles não receberam qualquer tipo de intervenção. Nota-se, assim, que a qualidade do pré-natal recebido pela gestante não é suficiente para garantir o controle da sífilis congênita e o alcance da meta de incidência da doença.

As praças públicas de Natal/RN no âmbito dos problemas socioambientais urbanos

This paper presents the public square as a subsystem of the city for the potential integration of elements 'natural' and built environment. But sometimes the suitability of projects and the social processes involved are not compatible and favorable to their real functions in urban space. The city of Natal, with a population of 803,739 inhabitants has 253 public parks not uniformly distributed in the urban area, but mostly in central areas and their absence in some peripheral neighborhoods. In this sense, the objective of this paper is to analyze the quality and spatiality of the city's public squares within the urban socio-environmental problems. For this, use of simple random sampling to define the sample and the proportional allocation of districts, totaling 168 squares to be raised. We prepared a form to collect data on the field that includes aspects of leisure, infrastructure and environment. For each square sampled was calculated Square Quality Index (PQI), then calculating the average per IQP neighborhood. The rates found were crossed with census data and Municipal Public Administration by neighborhood, using multivariate analysis. We generated maps, charts and tables, considered appropriate to each question format, focused comparison. The public square appears as an indicator of environmental challenges present in intra-urban spaces of the city. Their spatial distribution is not consistent demand population, both by disposition and by how much. In terms of quality are characterized by different levels of inadequacy and degradation aspects of leisure, environmental and infrastructure, often causing disfigurement, abandonment and improper occupation in such spaces. Multivariate analysis point to a central concentration and their problems in certain administrative units, not only as regards the public squares, but also to aspects of education, income, and other violence, perpetuating the problem. The various levels of inadequacy and degradation of public squares have been more blatant in the poorest neighborhoods of the city, pointing to a structural pattern associated with the intrinsic characteristics of the neighborhood and the socioeconomic profile of the local population. These are problems of social and environmental dimensions, threaded in and influenced the political, economic and broader social process of transformation of the city and the urban. Based on an uneven process in which space necessarily reflect the contradictions inherent in the active forces and interests. Thus evidencing the importance of managing the necessary public effectively engaged with the problems that are present there, in order to equate them, without being prioritized certain areas of the city at the expense of others

Orientação geográfica: uma proposta metodológica para o ensino da geografia na 5ª série

Cartographical representations (maps, charters and plans) are taken as didactic resources in Geography classes in the 5th grade of the municipal public schools in São José de Ribamar through a methodological approach taking into consideration the use of those resources is still worries an important part of the teachers of the Maranhão State public schools who teach in this level. Papers related to the theme, most of the time, are non accessible to the teachers of the maranhense public schools, mainly because the education instilutions, which use those resources, do it in a very incipient way. So this research proposes from the drawings of magnetccoursein the school courtyards, together with maps, charts, plans among others representation used in the classroom environment, motivate the students to a deeper interests in participating in Geography learning process in the 5th grade. Interviews, analyses of socialcultural questionnaires of the families involved in the process; observations of classes, trainings, geocartographical orientations, application of pre and posttests, discussions about the usage of cartographic representations, proposed and effectivated tasks in the classroom, as well as around the school, were the basis of the researched population. As a result of this process, it was produced a was complement didatical material showing, among others, the space in which students, for sure, will contribute in an effective way to a better teaching practice in the chain of maranhense public schools, having in mind that these geographic subjects may be taught in the level we focused our study

Vocal Polyps: Clinical, Morphological, and Immunohistochemical Aspects

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

Vocal Cysts: Clinical, Endoscopic, and Surgical Aspects

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

Ptose palpebral: avaliação do posicionamento palpebral por imagens digitais

Objectives: To assess the palpebral position in patients with congenital or acquired ptosis, related to margin, sulcus and eyebrow, trying to identify differences between types of ptosis. Methods: A retrospective evaluation of patients with palpebral ptosis treated at the Ambulatory of Ophthalmic Plastic Surgery - Faculdade de Medicina de Botucatu (UNESP) was conducted, from 1995 to 2006. Data were recovered from electronic medical charts as well as digital image files. Eighty-seven patients were assessed, according to age, gender and data related to ptosis, such as time of appearance and type of palpebral ptosis. Palpebral ptosis was classified in two groups: congenital and acquired ptosis. Measurements were taken of margin-reflex distance (MRD), margin sulcus distance (MSD) and margin eyebrow distance (MED) using digital measurements of photos obtained. The corneal diameter of each individual patients was the unit of measure used. All data was transferred to an Excel Spreadsheet and received statistical treatment. Results: Statistical analysis revealed there is no association between the presence of ptosis and gender, or the type of ptosis and gender. There was a significant difference between eyelid with and without ptosis for MRD. However, in relation to the type of ptosis (congenital or acquired), MRD did not present any significant difference. The MSD and MED measurements were higher in acquired ptosis when compared to congenital ptosis. Conclusion: Assessment of palpebral positioning using digital measures endorse that MRD is smaller in patients with palpebral ptosis and similar in congenital or acquired ptosis, whereas MSD and MED presented higher values in acquired ptosis.