Qualidade física de um Latossolo Vermelho submetido a sistemas de manejo avaliado pelo Índice S

O monitoramento da qualidade do solo pelos atributos físicos é importante para a avaliação e manutenção da sustentabilidade dos sistemas agrícolas. Um atributo indicador da qualidade do solo deve ser sensível às variações do manejo ao qual está sendo submetido. Este estudo teve como objetivo avaliar o parâmetro S como indicador da qualidade física do solo e a agregação de um Latossolo Vermelho distrófico, submetido a sistemas de manejo sem ou com a inclusão de plantas de cobertura em pré-safra durante 11 anos. Os tratamentos foram: sistema convencional (SC) e sistemas conservacionistas compostos por plantas de cobertura, crotalária (SDC), milheto (SDM) e lablabe (SDL). O delineamento experimental foi o de blocos casualizados, com quatro tratamentos e seis repetições; as camadas constituíram-se nas parcelas subdivididas. Os sistemas conservacionistas SDC, SDM e SDL apresentaram maior teor de matéria orgânica em relação ao SC nas camadas de 0 a 0,05 m. Maiores valores de diâmetro médio ponderado e geométrico dos agregados foram observados nos sistemas conservacionistas. O solo apresentou boa qualidade física determinada pelo índice S, com valores todos superiores a 0,035.

Different PTH response to oral peptone load and oral calcium load in patients with normocalcemic primary hyperparathyroidism, primary hyperparathyroidism, and healthy subjects.

BACKGROUND: Normocalcemic primary hyperparathyroidism (PHPT-N) is a condition that may have similar long-term implications to primary hyperparathyroidism (PHPT); however, differential diagnosis and treatment for parathyroid disorders are not clearly defined. We investigated the effect of an oral peptone and an oral calcium load on calcium-regulating hormones in PHPT-N compared with PHPT and healthy controls to provide a new potential diagnostic tool. DESIGN: Case-control study. METHODS: We evaluated serum gastrin, PTH, ionized calcium, and phosphate responses to oral calcium (1 g) and peptone (10 g) load in 22 PHPT and 20 PHPT-N patients matched for PTH serum values. Moreover, 30 healthy subjects were enrolled as controls. In 12 patients for each group, we also performed the oral peptone test adding aluminum hydroxide (AH) to suppress phosphate absorption. RESULTS: In PHPT patients, PTH increased significantly 30 min after the oral peptone load, while no significant increase was found in PHPT-N and controls. After oral calcium load, PTH remained stable in PHPT while it decreased dramatically in PHPT-N patients, and ionized calcium increased significantly in each of the three groups. Peptones plus AH induced a blunted PTH increase in the three groups. CONCLUSIONS: Considering the marked difference in PTH response elicited by peptones in PHPT compared with PHPT-N, we suggest that the oral peptone test could be added to the diagnostic evaluation of PHPT patients. In case of absent response to peptones, patients should have their serum calcium levels assessed twice a year in accordance with recent guidelines.

Oral pregabalin as an add-on treatment for status epilepticus.

Oral antiepileptic drugs (AEDs) represent possible add-on options in refractory status epilepticus (SE). In this setting, pregabalin (PGB) has not been reported before. Over the last 42 months, we identified 11 SE episodes (10 patients) treated with PGB in our hospital. Its use was prompted by the favorable pharmacokinetic profile, devoid of drug-drug interactions. The patients mostly had refractory, partial SE. Only two patients were managed in the intensive care unit (ICU). We found a definite electroclinical response in 5 of 11, already evident 24 h after PGB introduction, and a possible response (concomitantly with other AEDs) in 3 of 11 of the episodes; 3/11 did not respond. The treatment was well tolerated. Partial SE appeared to better respond than generalized convulsive SE. PGB appears to be an interesting option as add-on treatment in refractory partial SE.

Índice S para avaliação da qualidade física de solos

O conceito da qualidade física do solo atualmente é bem estabelecido, principalmente pelos índices que avaliam a qualidade do solo. O índice S é um recente indicador da qualidade física do solo relacionado com características importantes do solo. O objetivo deste trabalho foi fazer uma avaliação do método de obtenção do índice S quanto à derivada da função de curva de retenção de água da curva usando ou não a transformação ln(h), bem como avaliar o problema de unidades e da restrição m = 1 - 1/n no cálculo do índice. Concluiu-se que o valor do índice S é superior quando a umidade do solo usada no ajuste da curva de retenção de água proposta por van Genuchten (1980) é expressa na forma volumétrica, quando comparada com a gravimétrica. Para a mesma unidade da umidade do solo, não se observa diferença nos valores do índice S para qualquer unidade de tensão. O valor do índice S difere de acordo com o uso ou não da restrição m = 1 -1/n para estimativa dos parâmetros m e n da curva de retenção proposta por van Genuchten (1980).

Can one or two high doses of oral vitamin D3 correct insufficiency in a non-supplemented rheumatologic population?

We evaluated the effectiveness of supplementation with high dose of oral vitamin D3 to correct vitamin D insufficiency. We have shown that one or two oral bolus of 300,000 IU of vitamin D3 can correct vitamin D insufficiency in 50% of patients and that the patients who benefited more from supplementation were those with the lowest baseline levels. INTRODUCTION: Adherence with daily oral supplements of vitamin D3 is suboptimal. We evaluated the effectiveness of a single high dose of oral vitamin D3 (300,000 IU) to correct vitamin D insufficiency in a rheumatologic population. METHODS: Over 1 month, 292 patients had levels of 25-OH vitamin D determined. Results were classified as: deficiency <10 ng/ml, insufficiency ≥10 to 30 ng/ml, and normal ≥30 ng/ml. We added a category using the IOM recommended cut-off of 20 ng/ml. Patients with deficient or normal levels were excluded, as well as patients already supplemented with vitamin D3. Selected patients (141) with vitamin D insufficiency (18.5 ng/ml (10.2-29.1) received a prescription for 300,000 IU of oral vitamin D3 and were asked to return after 3 (M3) and 6 months (M6). Patients still insufficient at M3 received a second prescription for 300,000 IU of oral vitamin D3. Relation between changes in 25-OH vitamin D between M3 and M0 and baseline values were assessed. RESULTS: Patients (124) had a blood test at M3. Two (2%) had deficiency (8.1 ng/ml (7.5-8.7)) and 50 (40%) normal results (36.7 ng/ml (30.5-5.5)). Seventy-two (58%) were insufficient (23.6 ng/ml (13.8-29.8)) and received a second prescription for 300,000 IU of oral vitamin D3. Of the 50/124 patients who had normal results at M3 and did not receive a second prescription, 36 (72%) had a test at M6. Seventeen (47%) had normal results (34.8 ng/ml (30.3-42.8)) and 19 (53%) were insufficient (25.6 ng/ml (15.2-29.9)). Of the 72/124 patients who receive a second prescription, 54 (75%) had a test at M6. Twenty-eight (52%) had insufficiency (23.2 ng/ml (12.8-28.7)) and 26 (48%) had normal results (33.8 ng/ml (30.0-43.7)). At M3, 84% patients achieved a 25-OH vitamin D level >20 ng/ml. The lowest the baseline value, the highest the change after 3 months (negative relation with a correlation coefficient r = -0.3, p = 0.0007). CONCLUSIONS: We have shown that one or two oral bolus of 300,000 IU of vitamin D3 can correct vitamin D insufficiency in 50% of patients.

Índice de qualidade do solo associado à recarga de água subterrânea (IQS RA) na Bacia Hidrográfica do Alto Rio Grande, MG

A proposição de índices de qualidade do solo tem crescido de forma considerável nos últimos anos para análises de sustentabilidade ambiental e da produção agrícola. No entanto, não há, nas condições brasileiras, o desenvolvimento de qualquer indicador de qualidade do solo vinculado à recarga de água subterrânea. O objetivo deste estudo foi gerar um índice de qualidade do solo, relacionado à recarga de água subterrânea (IQS RA), válido para as condições da Bacia Hidrográfica do Alto Rio Grande e proceder a seu mapeamento por meio de técnicas geoestatísticas. O IQS RA proposto é uma combinação linear de três indicadores relacionados à infiltração de água no solo: densidade do solo, condutividade hidráulica saturada e macroporosidade. Para sua validação, foi considerada a participação do deflúvio base (ou subterrâneo) no deflúvio total para quatro sub-bacias da Bacia Hidrográfica do Alto Rio Grande, analisando o comportamento desses indicadores hidrológicos tendo-se como referência a distribuição espacial do IQS RA. O índice gerado mostrou-se uma ferramenta importante para avaliação do potencial do solo para recarga de água subterrânea, uma vez que ele reflete a influência dos usos da terra no comportamento do deflúvio base e, consequentemente, na dinâmica da produção de água pelas sub-bacias.

Novo índice geoestatístico para a mensuração da dependência espacial

O semivariograma possibilita uma avaliação visual da dependência espacial, mas sem resultar diretamente em um valor numérico único que expresse a mensuração de tal dependência. Contudo, a partir dos parâmetros estimados do modelo teórico ajustado ao semivariograma experimental, é possível construir uma medida dessa dependência espacial. Atualmente, há dois índices na literatura, com uso cada vez mais frequente; porém, há inadequações nesses índices existentes. O objetivo deste trabalho foi propor um novo índice para medir a dependência espacial de dados geoestatísticos, que supere as incipiências dos atuais. Esse novo índice utiliza a relação existente entre o semivariograma e o correlograma, contemplando dessa forma todos os aspectos da dependência espacial. Realizaram-se uma comparação, por simulação, entre o índice proposto e os índices já existentes e também verificação da aplicabilidade do índice proposto utilizando pesquisas reais publicadas, em que ocorreram ajustes dos modelos teóricos esférico, exponencial e gaussiano. Verificou-se que o índice proposto foi melhor que os índices existentes. Além disso, observou-se que os índices existentes podem levar a equívocos nas interpretações do grau de dependência espacial, evidenciando que devem ser evitados. Em decorrência, recomenda-se a utilização do novo índice proposto para medir o grau da dependência espacial.

Prevalence of patients' difficulties in swallowing solid oral dosage forms

Introduction Swallowing difficulties, or dysphagia, can occur in anyage group, although it is most common among elderly people. It canaffect patients' ability to take solid oral dosage forms, thus compromisingmedication adherence. Although literature is poor, availabledata show that prevalence in the general population ranges from 25 to60%. Prevalence in community pharmacies needs to be explored.Materials & Methods Community pharmacies were recruited from arandom selection in three Swiss states: Basel-Stadt (BS), Basel-Landschaft (BL) and Lausanne (LA). Patients' ability to swallowsolid oral medications was enquired with a semi-structured interview;the interviewer spent 4 h in each included pharmacy. Each consecutivepatient (18 years and older) entering the pharmacy with aprescription for at least 3 different solid oral forms was enrolled.Study was approved by the Lausanne ethics committee.Results Sixty pharmacies took part in the study (20 in BS, 10 in BL,30 in LA) between March and May 2010. Patient inclusion rate was77.8% (410/527). Prevalence of swallowing disorders was 22.4% (92/410). Patients with swallowing disorders were older (mean age: 67.5± 16 years vs. 63.0 ± 14 years, range 19-96; p = 0.03) and moreoften women (69.6% vs. 59.1%; Chi2 = 3.3, p = 0.04) than patientswithout swallowing disorders. They had on average 4.6 ± 2.7 drugswith a mean number of 5.5 ± 3.3 tablets or capsules to take daily,which didn't differ from the number of drugs taken by patientswithout swallowing difficulties (4.9 ± 2.5 drugs and 5.9 ± 3.5 tablets;n.s.). The difficulty was mainly related to the big size (63%) orthe quality of pill coating (rough, sticky, 14%). Twenty-one patients(37.5%) stated that their swallowing disorders resulted in nonadherence, rated as rarely (12 patients), sometimes (6 patients), veryoften (1 patient) or always (2 patients). According to patients, nopharmacist and only 2 physicians enquired about patients' swallowingissue.Discussion & Conclusion Swallowing difficulties are frequent amongpatients in community pharmacies in Switzerland with an estimatedprevalence of 22%. The problem resulted in non adherence or partialadherence in at least 35% of these patients. However, pharmacists andphysicians did not routinely inquire about the disorder. Guidelinesshould be developed for promoting systematic approaches of patientsin community pharmacies.

Oral and intravenous methadone use: some clinical and pharmacokinetic aspects.

A sample of 15 patients participating in an injectable methadone trial and of 15 patients in an oral methadone maintenance treatment, who admitted injecting part or all of their methadone take-home doses, were compared to 20 patients in maintenance treatment who use methadone exclusively by mouth. The present study confirms the poorer general health, the higher levels of emotional, psychological or psychiatric problems, the higher use of illicit drugs, and the higher number of problems related to employment and support associated with the use of the intravenous mode of administration of methadone. As expected, due to the shunt of metabolism in the gut wall and of the liver first-pass effect, higher concentration to dose ratios of (R)-methadone, which is the active enantiomer, were measured in the intravenous group (23% increase). This difference reached an almost statistically significant value (P = 0.054). This raises the question whether the effect of a higher methadone dose could be unconsciously sought by some of the intravenous methadone users.

Assessment of driving capability through the use of clinical and psychomotor tests in relation to blood cannabinoids levels following oral administration of 20 mg dronabinol or of a cannabis decoction made with 20 or 60 mg Delta9-THC.

Delta(9)-Tetrahydrocannabinol (THC) is frequently found in the blood of drivers suspected of driving under the influence of cannabis or involved in traffic crashes. The present study used a double-blind crossover design to compare the effects of medium (16.5 mg THC) and high doses (45.7 mg THC) of hemp milk decoctions or of a medium dose of dronabinol (20 mg synthetic THC, Marinol on several skills required for safe driving. Forensic interpretation of cannabinoids blood concentrations were attempted using the models proposed by Daldrup (cannabis influencing factor or CIF) and Huestis and coworkers. First, the time concentration-profiles of THC, 11-hydroxy-Delta(9)-tetrahydrocannabinol (11-OH-THC) (active metabolite of THC), and 11-nor-9-carboxy-Delta(9)-tetrahydrocannabinol (THCCOOH) in whole blood were determined by gas chromatography-mass spectrometry-negative ion chemical ionization. Compared to smoking studies, relatively low concentrations were measured in blood. The highest mean THC concentration (8.4 ng/mL) was achieved 1 h after ingestion of the strongest decoction. Mean maximum 11-OH-THC level (12.3 ng/mL) slightly exceeded that of THC. THCCOOH reached its highest mean concentration (66.2 ng/mL) 2.5-5.5 h after intake. Individual blood levels showed considerable intersubject variability. The willingness to drive was influenced by the importance of the requested task. Under significant cannabinoids influence, the participants refused to drive when they were asked whether they would agree to accomplish several unimportant tasks, (e.g., driving a friend to a party). Most of the participants reported a significant feeling of intoxication and did not appreciate the effects, notably those felt after drinking the strongest decoction. Road sign and tracking testing revealed obvious and statistically significant differences between placebo and treatments. A marked impairment was detected after ingestion of the strongest decoction. A CIF value, which relies on the molar ratio of main active to inactive cannabinoids, greater than 10 was found to correlate with a strong feeling of intoxication. It also matched with a significant decrease in the willingness to drive, and it matched also with a significant impairment in tracking performances. The mathematic model II proposed by Huestis et al. (1992) provided at best a rough estimate of the time of oral administration with 27% of actual values being out of range of the 95% confidence interval. The sum of THC and 11-OH-THC blood concentrations provided a better estimate of impairment than THC alone. This controlled clinical study points out the negative influence on fitness to drive after medium or high dose oral THC or dronabinol.

Risk of falls and major bleeds in patients on oral anticoagulation therapy.

BACKGROUND: The risk of falls is the most commonly cited reason for not providing oral anticoagulation, although the risk of bleeding associated with falls on oral anticoagulants is still debated. We aimed to evaluate whether patients on oral anticoagulation with high falls risk have an increased risk of major bleeding. METHODS: We prospectively studied consecutive adult medical patients who were discharged on oral anticoagulants. The outcome was the time to a first major bleed within a 12-month follow-up period adjusted for age, sex, alcohol abuse, number of drugs, concomitant treatment with antiplatelet agents, and history of stroke or transient ischemic attack. RESULTS: Among the 515 enrolled patients, 35 patients had a first major bleed during follow-up (incidence rate: 7.5 per 100 patient-years). Overall, 308 patients (59.8%) were at high risk of falls, and these patients had a nonsignificantly higher crude incidence rate of major bleeding than patients at low risk of falls (8.0 vs 6.8 per 100 patient-years, P=.64). In multivariate analysis, a high falls risk was not statistically significantly associated with the risk of a major bleed (hazard ratio 1.09; 95% confidence interval, 0.54-2.21). Overall, only 3 major bleeds occurred directly after a fall (incidence rate: 0.6 per 100 patient-years). CONCLUSIONS: In this prospective cohort, patients on oral anticoagulants at high risk of falls did not have a significantly increased risk of major bleeds. These findings suggest that being at risk of falls is not a valid reason to avoid oral anticoagulants in medical patients.

ÍNDICE DE VEGETAÇÃO POR DIFERENÇA NORMALIZADA E PRODUTIVIDADE DE CULTIVARES DE TRIGO SUBMETIDAS A DOSES DE NITROGÊNIO

RESUMO O manejo da adubação nitrogenada na cultura do trigo tem se evidenciado fator limitante à produtividade da cultura na Região Sul do Brasil, e a utilização de novas técnicas como o índice de vegetação por diferença normalizada (NDVI) pode auxiliar na estimativa do potencial produtivo da cultura e, consequentemente, na determinação da adubação nitrogenada. O objetivo deste trabalho foi avaliar o uso do NDVI, obtido por sensores passivo e ativo, como ferramenta para estimar a produtividade de grãos de cultivares de trigo submetidas a doses de nitrogênio. O experimento foi conduzido em Guarapuava, PR, em blocos ao acaso, seguindo o esquema fatorial 4 × 5, com quatro cultivares e cinco doses de N. As avaliações realizadas compreenderam leituras de NDVI, matéria seca (MS) de parte aérea, nos estádios fenológicos de afilhamento, emborrachamento e florescimento, teor foliar de N e produtividade de grãos. Nas leituras de NDVI, constataram-se diferenças significativas entre cultivares em todos os estádios fenológicos e doses, assim como entre as doses e os estádios fenológicos, para ambos os sensores. Verificaram-se efeito da MS e do teor foliar de N nas leituras de NDVI, sendo possível gerar modelos para a estimativa desses atributos com base no NDVI e, ainda, estimar a produtividade no início de desenvolvimento da cultura.