999 resultados para guías clínicas informatizadas
Resumo:
The acceleration of industrial growth in recent decades on all continents aroused the interest of the companies to counter the impacts produced on the environment, spurred primarily by major disasters in the petroleum industry. In this context, the water produced is responsible for the largest volume of effluent from the production and extraction of oil and natural gas. This effluent has in its composition some critical components such as inorganic salts, heavy metals (Fe, Cu, Zn, Pb, Cd, ), presence of oil and chemicals added in the various production processes. In response to impact, have been triggered by research alternative adsorbent materials for water treatment and water produced, in order to removing oils and acids and heavy metals. Many surveys of diatomaceous earth (diatomite) in Brazil involve studies on the physico-chemical, mineral deposits, extraction, processing and applications. The official estimated Jazi are around 2.5 million tonnes, the main located in the states of Bahia (44%) and Rio Grande do Norte (37,4%). Moreover, these two states appear as large offshore producers, earning a prominent role in research of adsorbents such as diatomite for treatment of water produced. Its main applications are as an agent of filtration, adsorption of oils and greases, industrial load and thermal insulator. The objective of this work was the processing and characterization of diatomite diatomaceous earth obtained from the municipality of Macaíba-RN (known locally as tabatinga) as a low cost regenerative adsorbent for removal of heavy metals in the application of water produced treatment. In this work we adopted a methodology for batch processing, practiced by small businesses located in producing regions of Brazil. The characterization was made by X-ray diffraction (XRD), scanning electron microscopy (SEM) and specific surface area (BET). Research conducted showed that the improvement process used was effective for small volume production of diatomite concentrated. The diatomite obtained was treated by calcination at temperature of 900 oC for 2 hours, with and without fluxing Na2CO3 (4%), according to optimal results in the literature. Column adsorption experiments were conducted to percolation of the in nature, calcined and calcined fluxing diatomites. Effluent was used as a saline solution containing ions of Cu, Zn, Na, Ca and Mg simulating the composition of produced waters in the state of Rio Grande do Norte, Brazil. The breakthrough curves for simultaneous removal of copper ions and zinc as a result, 84.3% for calcined diatomite and diatomite with 97.3 % for fluxing. The calcined fluxing diatomite was more efficient permeability through the bed and removal of copper and zinc ions. The fresh diatomite had trouble with the permeability through the bed under the conditions tested, compared with the other obtained diatomite. The results are presented as promising for application in the petroleum industry
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Oligoplites palometa (Cuvier) and Oligoplites saurus (Bloch & Schneider) (Osteichthyes: Carangidae) are coastal pelagic fish species. The objective of this study was to investigate the effect of parasitism by isopods and the reproductive biology of the leather jack, Oligoplites spp. A total of 113 individuals of Oligoplites spp (35 of O. saurus and 78 of O. palometa) were captured during the period between January, 2005 and July, 2007 from the coastal waters of Natal, RN. The morphometric and meristic characters were registered; macroscopic analyses were done to collect the isopod parasites and the gonads were observed to verify the reproductive aspects. The crustacean isopod parasite, Cymothoa spinipalpa (Isopoda: Cymothidae) was encountered on the tongue in the oral cavity in both fish hosts. The parasitic indices of C. spinipalpa showed high values of prevalance of 51,4% for O. saurus and 64,1% for O. palometa. The host presented significant correlations between body mass and body length of O. palometa and the number of parasites. Body lengths of female C. spinipalpa were small due to the limited space available in the oral cavity of the host. There was a significant difference in the sex ratio of O. palometa, males outnumbered the females. The isopod parasites showed specificity to the oral cavity of hosts. Macroscopic analyses of gonads showed four stages of gonadal development for both sex of O. palometa: immature, maturing, mature and spent
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The marine fish white mullet, Mugil curema Valenciennes, 1836 (Osteichthyes: Mugilidae) exhibits a wide geographical distribution, being common in the Brazilian coast and is an important component of the artisanal fisheries. The objective of this study was to investigate the reproductive biology of M. curema in the coastal waters of Rio Grande do Norte. Fish samples were captured on a monthly basis during August, 2008 to July, 2009. The fish specimens were numbered, weighed, measured, dissected and their gonads were removed, weighed, their sex and gonadal development were identified. The length-weight relationship was determined for males and females. The sex ratio, the size at first gonadal maturation and gonadosomatic index (GSI) were calculated and ovarian development was investigated using macroscopic and histological techniques. The fecundity, spawning type and the reproductive period of the species were determined. A total of 366 specimens (186 males and 180 females) were captured. The sex ratio was 1:1 and the females were heavier than males. The estimated values of the angular coefficient for both sexes suggest that the species has isometric growth. The size at which 50% of the population began the process of maturation was 25.9 cm of total length for grouped sex. The macroscopic characteristics of the ovaries showed four stages of development: immature, maturing, mature and spent. However, the microscopic characteristics of the ovaries showed five stages of development: immature, early maturing, late maturing, mature and spent. The development of oocytes indicated five phases: Chromatin-nucleolus (phase I), initial perinucleolar (phase II), final perinuclear (phase II), formation of vitelline vesicle or yolk (phase III), vitellogenic (phase IV) and complete vitellogenesis (phase V). The species has a prolonged spawning period, with two peaks coinciding with the rainy season.
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Avaliou-se a influência da disposição de mangueiras gotejadoras nos canteiros e a injeção ou não de cloro na água de irrigação, nas condições sanitárias do solo e da alface americana irrigada (Lactuca sativa L.) com águas receptoras de efluentes urbanos. Foram realizadas análises microbiológicas de amostras de água do solo e da alface, no decorrer de todo o ciclo de cultivo. Objetivou-se determinar a possível existência de Salmonella spp. e de formas evolutivas de parasitos humanos e a quantidade de coliformes fecais, em pontos e épocas diferentes do experimento, impedindo assim o consumo da alface. Os resultados não indicaram a presença dos dois primeiros em nenhuma das amostras, mas sim de parasitos não humanos (nematóides) de vida livre no solo. em relação à quantidade de coliformes fecais (NMP ml-1), o valor encontrado na cultura atende às exigências da Secretaria de Vigilância Sanitária do Ministério da Saúde brasileiro, porém a presença dos nematóides em quantidades superiores ao permitido pela Organização Mundial de Saúde (OMS) inviabiliza o seu consumo.
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The occurrence of human cancer in the municipality of Lucrécia (RN, Brazil) has shown high frequencies (INCA, 2007). Tests of micronucleus (MN) and nuclear abnormalities (NA) were performed to assess the genotoxic potential of water from the Lucrécia dam, which is located in a semi-arid region under the influence of crop irrigation and irregular rainfall. Water samples were collected in this source for analyzing the concentration of cyanobacteria, metals and radioactivity. Erythrocytes of Nile tilapia (Oreochromis niloticus) were collected in dam and cells of human oral mucosa in the urban area of this municipality for the bioassays of MN and NA. In fish were also analyzed concentrations of metals in samples of liver and gills. The genotoxicity tests with biological samples of fish and humans have shown significant increases in the frequencies of MN and NA (p ≤ 0.05) and are indicative of increased DNA damage in relation to the control groups. In conclusion, the results obtained from water samples and biological municipality of Lucrécia indicates that the presence of chemical and microbiological pollutants, and increase of genotoxic in human of this municipality. We suggest the implementation of advanced water treatment, to prevent further degradation of the aquatic environment and decrease in the life quality. This research of environmental quality assessment was performed in order to contemplate a multi and interdisciplinary character of this water resource and that can induce genotoxic damage in the organisms in this study region
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No Brasil, a despeito das conquistas obtidas a partir da implantação do Sistema Único de Saúde e dos avanços legais e institucionais na atenção a diversos problemas relacionados ao gênero, a incorporação de temas relacionados aos direitos humanos, sexuais e reprodutivos no contexto da formação profissional em saúde permanece deficiente. Este trabalho teve como objetivos avaliar a inserção da temática saúde sexual e reprodutiva no currículo do curso de graduação em Medicina, por meio do emprego de avaliações de conteúdo cognitivo, procedimental e atitudinal. Trata-se de estudo de intervenção educacional envolvendo alunos do internato do curso de Medicina da UFRN. Foram utilizados os seguintes métodos avaliativos: prova escrita, exame clínico objetivo estruturado (OSCE) e Mini-CEX. Como variáveis explicativas foram consideradas o sexo, idade e participação prévia no componente curricular optativo Saúde Reprodutiva . A avaliação do processo constou da aplicação de questionários de satisfação e entrevistas acerca dos métodos avaliativos utilizados. Considerando os três métodos avaliativos empregados, 183 estudantes participaram do estudo, com média de idade de 24,5 ± 2,2 anos, sendo 52,5% do sexo masculino e 47,5% do sexo feminino. No contexto geral, observamos concordância entre os desempenhos dos estudantes nas avaliações de conteúdo cognitivo, procedimental e atitudinal. A participação dos estudantes no componente curricular eletivo Saúde Reprodutiva mostrou-se associada com melhor desempenho em algumas dimensões da avaliação cognitiva e na avaliação com o Mini-CEX, em relação às competências de anamnese, profissionalismo e qualidades humanísticas, relação médico paciente e desempenho global. A análise da fidedignidade entre os avaliadores na avaliação com o método OSCE mostrou-se adequada (alfa de Cronbach superior a 70%) em relação ao desempenho global e aos aspectos técnicos das competências avaliadas, observando-se baixa confiabilidade na avaliação da comunicação médico-paciente. O presente trabalho constitui-se numa experiência educacional inovadora e pioneira no âmbito da educação médica brasileira no que tange à inserção da temática de saúde sexual e reprodutiva na graduação, sugerindo-se um impacto positivo da iniciativa na formação do médico generalista na UFRN. A avaliação de conhecimentos, habilidades e atitudes em saúde sexual e reprodutiva na graduação de Medicina mostrou-se factível, com alta concordância entre os diferentes métodos empregados. Os métodos OSCE e Mini-CEX podem ser aplicados ao contexto da saúde sexual e reprodutiva, possibilitando a avaliação de competências clínicas relevantes para a formação do médico generalista e que habitualmente não são contempladas nas avaliações rotineiramente realizadas na graduação
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Dental education is going through important changes in preparing workers to meet the needs of the society and the labor market. For that reason, we studied the offering of comprehensive dental care clinics in Brazil with the aim of encouraging future curriculum changes focused on the training of general dental practitioners. An email questionnaire on educational organization and comprehensive care clinics of undergraduate programs was sent to each academic dental affairs dean. Sixty-seven (41.6%) dental schools agreed to participate. We observed that curriculum changes have contributed to modify the format of comprehensive care clinics. This was felt mainly (88,1%) with regards to workload and course offerings in different levels of the dental curriculum, thereby creating a favorable environment for generalist training. Most schools shared the following characteristics: clinical procedures were being prioritized according to level of complexity (95,5%), students were having the chance to attend courses in other programs (37,3%), and attempt to diversify teaching methods was being challenged (58,2%). Although progress in combining teaching and clinical services was reported by 83,6% of schools, most clinical procedures were still being performed intramurally (50,7%) in partnership with public service. There was also improvement in clinical mentorship due to the hiring of instructors qualified to work in comprehensive care clinics and with aptitude to supervise a wider range of dental procedures (58,2%). Further changes to Brazilian comprehensive care clinics should hence be encouraged and intensified to ensure appropriate generalist training for dental practitioners
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The Pitimbu River is located at the oriental portion of the State of Rio Grande do Norte, including three importants cities named Macaíba, Parnamirim e Natal. Although its high importance as a water source, which supplys great part of the South Zone of the Natal city, this river receives a large quantity of domestic and industrial waste water without treatment. The Pitimbu River headhas its river-head located in the city of Macaiba, goes through Parnamirim, then it flowing into at the Jiqui Lake in Natal. The aim of this study was to evaluate, qualitatively and quantitatively, the environmental quality of the Pitimbu River by genotoxicity bio-assays, which are important tools for genetics toxicological evaluation. In this work, five samples sites, distributed along the river, were used to collect water samples. Another point site, located near Jiqui lake, was used to collect drinkable water, which was treated by CAERN, the water treatment entreprise of Rio Grande do Norte. The following assays where used to evaluate the quality of these samples: Allium cepa assay; Comet assay; Micronuclei (MN) assay; and Ames test. For the Allium cepa assay, sixteen specimes where used for each water sample from the sample sites. In this assay both microscopic, like cytogenetic damage, and macroscopic aspects, as morphological variation were evaluated. Red blood cells from periferical blood of the Crenicichla menezesi native specie were used not only for the MN assay, but also for the Comet assay. These fishes were collected at different points on the Pitimbu River and the negative control was developed using fishes of the same species that were bring to the laboratory and maintained for 100 days in the optimal experimental conditions. For the Ames test, TA100, YG1042, TA98 and YG1041 strains were used in the directed method without metabolic activation. The results found by the Allium cepa assay showed that two water sample sites induced increase of mitotic index (IM). Additionally, compared to the control, all the water samples increased the chromossomal aberrations frequency and/or micronucleus. Among the sample sites, two also showed an abnormal growth rate in its root and two samples induced morphological alteration. With the MN test in red blood cells, a high frequence of MN was observed in tree sample. By comparing all the results obtained on the water sample points and with the negative control, a significant variation on the MN frequency was observed. Positive results were also observed for the same sample to water test by the Comet assay. These results allow concluding that the proposed specie Crenicichla menezesi has a good profile as a bio-indicator for the evaluation of environmental water quality and the MN and comet test can be usuful for in situ evaluation. By the Ames test, it was possible to detect the mutagenic activity on the waters from the Pitimbu River in different levels of mutagenicity. This result suggests that this river has several substances that induced changes directly to the DNA. The mechanisms involved to this phenomenon could be by both processes, by changing of the reading frame and by nucleotide substitution. These data set indicate the presence of mutagenic agents, which can represent in risk to biot and human beens
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Introdução: O dano miocárdico na doença de Chagas resulta tanto da ação parasitária quanto da resposta imune do hospedeiro humano. O mimetismo molecular entre proteínas do Trypanosoma cruzi e vários antígenos do hospedeiro tem sido amplamente descrito gerando células T CD8+ e anticorpos autorreativos. Entretanto, a geração dos autoanticorpos e seu papel na imunopatogenia da doença de Chagas ainda não têm sido elucidados, o que nos levou, neste trabalho, a avaliar a produção de imunoglobulina G total (IgGt) e seus isotipos anti-T. cruzi, proteínas cardíacas e sua possível associação com as diferentes formas clínicas da doença de Chagas. Métodos: A produção de IgGt e isotipos foi mensurada pelo método de ELISA no soro de pacientes com as formas clínicas indeterminada (IND, n=72), cardíaca (CARD, n=47) e digestiva/cardio-digestiva (DIG/CARD-DIG, n=12) da doença de Chagas, usando como antígenos as formas epimastigota e tripomastigota do T. cruzi e proteínas cardíacas humana (miosina e troponina T). As amostras de indivíduos não infectados saudáveis (CONT, n= 30) e pacientes com cardiomiopatia isquêmica (ISCH, n=15) foram usadas como controle. Os títulos de autoanticorpos foram correlacionados com parâmetros da função cardíaca obtidos por exames eletrocardiográficos, radiográficos e ecocardiográficos. Resultados: Neste estudo foram incluídos 131 indivíduos sem diferença significativa relativa à idade ou sexo. Destes, 55% foram classificados como IND, 35,9% CARD e 9,1% DIG/CARD-DIG. Os títulos de IgGt foram mais elevados em pacientes com as formas clínicas IND, CARD e DIG/CARD-DIG do que em indivíduos CONT e ISCH usando os antígenos as formas tripomastigotas e epimastigotas do T. cruzi e, proteínas cardíacas humanas. Os pacientes com formas clínicas CARD e DIG/CARD-DIG mostraram a produção mais elevada de IgG total dirigida contra antígenos de tripomastigota e epimastigota do que os IND. Os grupos de pacientes IND e CARD apresentaram uma similar produção de IgG total específica direcionada à miosina e troponina T, e mais elevada do que em indivíduos CONT e ISCH. Há uma correlação negativa entre a produção de anticorpos anti-proteínas cardíacas com a fração de ejeção do ventrículo esquerdo (FEVE) em pacientes chagásicos crônicos. Os pacientes foram agrupados em baixo e alto produtores de autoanticorpos e comparados com a fração de ejeção demonstrando que em pacientes alto produtores de anti-troponina T (p=0.042) e miosina (p=0.013) a FEVE foi mais baixa do que os baixo produtores. A maioria dos pacientes chagásicos produz simultaneamente autoanticorpos direcionados à ambas proteínas cardíacas (r=0.9508, p=0.0001). Conclusões: Estes resultados indicam que os autoanticorpos anti- troponina T e miosina cardíaca parecem induzir redução FEVE e deve ser associado com o desenvolvimento de cardiomiopatia chagásica
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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
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OBJETIVOS: Determinar a frequência de retinopatia da prematuridade no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HCFMRP-USP) e verificar a associação da retinopatia da prematuridade com fatores de risco conhecidos. MÉTODOS: Foi realizada análise prospectiva de 70 pacientes, nascidos no HCFMRP-USP, com peso inferior a 1.500 gramas, no período de um ano. Os pacientes foram divididos em dois grupos (Retinopatia da prematuridade e Normal) para realização de análise estatística com relação a fatores de risco conhecidos. Adotou-se nível de significância de 5%. RESULTADOS: A frequência de retinopatia da prematuridade foi de 35,71% entre os pré-termos estudados. Os fatores pesquisados que apresentaram relação de risco para o desenvolvimento da doença foram: peso (p=0,001), idade gestacional (p=0,001), escore SNAPPE II (p=0,008), uso de oxigenoterapia por intubação (p=0,019) e por pressão positiva de vias aéreas (p=0,0017), múltiplas transfusões sanguíneas (p=0,01) e uso de diuréticos (p=0,01). CONCLUSÃO: A frequência de retinopatia da prematuridade foi de 35,71% entre os prétermos nascidos com menos de 1.500 g. Vários fatores de risco foram identificados nos recém-nascidos do HCFMRP-USP, sendo constatado que crianças mais pré-termos apresentam formas mais graves de retinopatia da prematuridade.
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The demands brought by a society doomed to the constant production of global risks, which whose effects are not immediately noticed effects are not perceived immediately, claim from the Law a new Theory about the Risk, that would offer a broad environmental protection, at the same time it would still be compatible with the idea of economic efficiency, required by the Modern Industry. The expansion of the methods and technologies regarding the exploitation and production of oil causes the constant expansion of the exploitable boundaries, especially in ultra-deep waters with the Pre-salt layer, in Brazil, or the still incipient research about the polymetallic nodules and other mineral sources in international waters, like the Atlântico Sudoeste, by the Programme on Ocean Science in Relation do Non Living Resources (OSNLR), a global study performed in partnership with the Intergovernmental Oceanographic Commission, from UNESCO (IOC UNESCO) and also with the Division of Ocean Affairs and Law of the Sea (UNDOALOS). Thus, we aim to analyze the correlation, and possible collisions between the right to a balanced environment and the free exercise of economic activity and the occurrence of environmental damages from the perspective of the exploitation activities of oil and other natural resources in international waters, specifically in the Area, from the constitutional principle of sustainable development and its legitimacy by the environmental international protection. Therefore, this study also aims to evaluate the legal framework for exploration and production of oil in international waters, particularly in the Area, and appraise how the constitutional instruments and mechanisms for environmental protection can impact on the international environmental protection system in order to ensure the present and future generations an ecologically balanced environment, laid down in Article 225 of the Brazilian Constitution, even with so many risks posed by the activities of exploitation and production of oil in international waters. In the meantime, we intend to also intend to investigate the possibility of future liability for environmental damage in order to ensure that constitutional principle and, consequently, and try to define the concept of environmental damage and its implications on the constitutional principle of environmental protection. Given all that was in summary, this work aims to contribute to the evolution of the new Theory of Environmental Risk, turning the law into something more than a punitive or corrective element in this society, but into a legal risk management, that may be triggered even before the consolidation of the damage
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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
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The objective of this experiments was evaluate the control of Bemisia tabaci and Thrips tabaci, through the use of plant oils associated or not to insecticide in bean plants, besides verifying the consequences on yield. The experiment was carried out in the period of rainy seasons, by utilizing Carioca variety. The statistical design was the randomized blocks, by employing a 6x2 factorial scheme ( plant oil versus insecticide), totalizing 12 treatments and four replications. It was concluded thet application of plant oils without insecticide can be utilized on the control of the B. tabaci biotipo B, since their population and the symptoms of golden mosaic was similar to the treatment plant oils plus insecticide; among the plant oils Agrex (R) plant oil promoted a higher control of white fly. For T. tabaci the application of plant oil associated to insecticide provide with a smaller population index when compared to the treatments without this association. The yield was not affected by the population of B. tabaci biotipo B and T. tabaci when plant oils were utilized, associated or not to the insecticide.
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A adição de fertilizantes foliares à calda acaricida é frequentemente empregada na citricultura com o intuito de reduzir os custos das aplicações. Todavia, as implicações desta prática, na maioria dos casos, são desconhecidas. O objetivo do trabalho foi avaliar o efeito de caldas acaricidas em mistura com fertilizantes foliares e preparadas com diferentes águas no controle do ácaro B. phoenicis. Foram realizados dois experimentos em laboratório, nos anos de 2009 e 2010, utilizando-se de frutos de laranja para conter ácaros Brevipalpus phoenicis. Um dos experimentos constou de três bioensaios, nos quais se procurou verificar o efeito das misturas entre fertilizantes foliares e os acaricidas cyhexatin, propargite e acrinatrhrin sobre B. phoenicis. No outro experimento, além de verificar o efeito das misturas de fertilizantes com os acaricidas propargite e acrinatrhrin, buscou-se também avaliar o efeito de águas coletadas em diferentes fontes utilizadas no preparo das caldas sobre B. phoenicis. Os resultados evidenciaram que a aplicação dos fertilizantes foliares cloreto de zinco, cloreto de manganês, ureia e a mistura de fosfito de potássio + ureia + cloreto de zinco não afetaram a ação dos acaricidas cyhexatin, propargite e acrinathrin sobre o controle de B. phoenicis. As misturas dos cloretos de zinco e de manganês com o sulfato de magnésio e a adição de fosfito de potássio diminuíram a eficiência dos acaricidas propargite e acrinathrin, não devendo, a princípio, ser adicionadas numa mesma aplicação. Águas provenientes dos municípios paulistas de Itápolis, Pirangi e Pirassununga interferiram na ação dos acaricidas propargite e acrinathin sobre B. phoenicis, sendo que a água coletada em Itápolis apresentou resultados superiores em termos de eficiência. Verificaram-se alterações dos valores de pH e da condutividade elétrica após a adição de alguns dos fertilizantes à calda acaricida.