Distúrbio de hiperatividade e déficit de atenção na síndrome de apnéia obstrutuiva do sono: Há melhora com tratamento cirúrgico?

Neuropsychological disorders are frequently associated with obstructive ventilatory disorders (OVD). Aim: To analyze the incidence of neuropsychological disorders in Brazilian children with OVD, using a screening questionnaire and to compare the answers given before and after surgery. Patients and Methods: We studied 30 children with clinical diagnosis of OVD. The children were divided into 3 groups: group I, children aged 4 to 7; group II, from 8 to 10; and group III, children over 11. The applied questionnaires were answered by the parents or tutors, and comprised 30 questions, 10 for each disorder: attention deficit, hyperactivity and impulsivity. The children were diagnosed with one of the disorders when presented 3 or more positive answers. The follow up interview occurred 6 months after adenotonsillectomy. Results: There was a predominance of male gender (60.6%) over female gender (39.4%). Group II presented the highest number of significant changes, with reductions raging from 87.5% to 33.3% of patients with attention deficit, 75% to 50% of the hyperactive patients, and 50% to 33% of the impulsive patients. Conclusion: There was neuropsychological improvement after the surgery, which occurred mainly in the children from group II. More interaction among health professionals is necessary when diagnosing and following up similar cases.

Associação do hidróxido de cálcio e metronidazol no tratamento de dentes de cães com lesão periapical crônica

One of the primary objectives of endodontic treatment of teeth with pulp necrosis is the elimination of microorganisms from the root canal system, as effectively as possible, especially in cases with chronic periapical lesions. AIM: The purpose of this study was to analyze the response of the periapical tissue of dogs' teeth with chronic periapical lesions to endodontic treatment performed with utilization of metronidazole, calcium hydroxide, and an association of both as root canal dressings. METHODOLOGY: Forty root canals were submitted to pulpectomy and the root canals were kept exposed to the oral environment for 6 months. Then, they were submitted to biomechanical preparation and divided into 4 study groups with 10 specimens: group I - no root canal dressing; group II - calcium hydroxide; group III - metronidazole; group IV - calcium hydroxide associated to metronidazole. After 15 days, the root canals were filled with Fill Canal sealer. After 90 days, the animals were killed and the especimens processed for histological analysis. RESULTS: Calcium hydroxide dressing provided a significantly better outcome compared to other experimental groups (α = 0.01). Also, the results of the association of metronidazole and calcium hydroxide were similar to those observed for the metronidazole group. The worst results were obtained by the no root canal dressing group. CONCLUSION: The use of metronidazole alone or associated with Calcium hydroxide, did not improve periapical healing when compared to Calcium hydroxide dressing.

Causas de ambliopia e resultados do tratamento

Objective: to evaluate the causes and the results of occlusion amblyopia treatment. Methods: a retrospective study was done including children under 12 years old. Sex, age of starting treatment, etiology, ocular deviation affection, visual acuity and time for the occlusion treatment were evaluated. Results: 158 children had all the requirements to compose the sample. 50.6% were males. 70.2% had esotropia, 13.2% exotropia, 0.7% hypertropia and 4.4% presented horizontal and vertical strabismus. 11.4% had no ocular deviation. 6.6% presented anisometropia, 0.7% congenital cataract and 6.6% other diagnoses. Visual acuity improved in 85.5%, faster in the ortophoric children. The occlusion treatment time was long in all the deviation types. Conclusion: the treatment was beneficial in improving amblyopia in the majority of the children evaluated.

Comportamento contrátil de barreiras selantes de solo estabilizado para base de lagoas de tratamento

Liners were proposed as subsoil contamination protection devices for waste disposal sites. In the rural environment, they can be used to construct pond bottoms for liquid waste treatment, but the construction needs to be quick and cheap. A good technical solution for these situations is the use of local soil compacted with low quantities of cement or lime, obtaining good properties for this purpose. These barriers need special care about their contraction behavior which may compromise its use. This work shows the results of contraction tests in sandy soil specimens and others stabilized with lime and with cement. Soil structure changes during cure time were checked using electronic scan microscopy. Results show maximum soil contraction of 0.648% for specimen with 14 days cure process. After twenty eight days of cure the contraction values were lower than 0.5%, which classifies the material as of low contraction. Electronic scan image shows significant material structure alteration up to seven days cure. Results show that studied mixtures had appropriate contraction behavior for liner usage.

Sertralina no tratamento de pacientes com depressão maior leve e moderada: Estudo multicêntrico brasileiro

Introduction: To evaluate the efficacy, safety, and tolerability of sertraline for the treatment of Brazilian patients with mild to moderate major depression. Patients and methods: Patients were 18 years old or older treated on an out-patient basis. Previous medications were stopped for a 2-week washout period. Afterwards, patients received sertraline, initial dose of 50 mg/day up to the 4 th week. The dose could then be increased up to 200 mg/day according to the efficacy and tolerability. Therapeutic efficacy was evaluated with the Montgomery-Asberg Depression Rating Scale (MADRS), Hamilton scale for depression (HAM-D), and Clinical Global Impression (CGI). Results: 51 patients (42 women) were evaluated regarding efficacy and safety. Treatment with sertraline significantly decreased scores of MADRS, HAM-D e ICGfrom 15.7 ± 6.1; 12.2 ± 3.9 e 3.5 ± 0.6 to 6.2 ± 6.5; 5.4 ± 4.7 e 2.3 ± 1.0 (P < 0.0001), respectively. Sertraline was well tolerated. Gastro-intestinal upset (N=14; 24.6%), headache (N=7; 12.3%), sleep alterations (H-7; 12.3%), dizziness (N-4; 7.0%), and anorexia (N=4; 7.0%) were the most common adverse events. Six patients discontinued the treatment due to adverse events. Conclusion: Sertraline is efficient and presents a favorable safety and tolerability profile for the treatment of Brazilian patients with mild to moderate major depression. © Copyright Moreira Jr. Editora.

Síndrome das pernas inquietas: Diagnóstico e tratamento. Opinião de especialistas Brasileiros

This article contains the conclusions of the November 17-18, 2006 meeting of the Brazilian Study Group of Restless Legs Syndrome (GBE-SPI) about diagnosis and management of restless legs syndrome (RLS). RLS is characterized by abnormal sensations mostly but not exclusively in the legs which worsen in the evening and are improved by motion of the affected body part. Its diagnosis is solely based on clinical findings. Therapeutic agents with efficacy supported by Class I studies are dopamine agonists, levodopa and gabapentine. Class II studies support the use of slow release valproic acid, clonazepan and oxycodone. The GBE-SPI recommendations for management of SPI are sleep hygiene, withdrawal of medications capable of worsening the condition, treatment of comorbidities and pharmacological agents. The first choice agents are dopaminergic drugs, second choice are gabapentine or oxycodone, and the third choice are clonazepan or slow release valproic acid.

Tratamento de efluentes de carcinicultura por macrófitas aquáticas flutuantes

The efficiency of systems composed of two species of floating aquatic macrophyte (Eichhornia crassipes and Pistia stratiotes) to treat effluents from shrimp culture was evaluated in this research. The effluent originated from a pond populated with Macrobrachium amazonicum. Treatment systems consisted of 12 experimental tanks with aquatic macrophyte and three tanks without plants (control). Water samples were collected from the fresh water supply and before and after passing through the treatment systems. There are no differences in the removal of nutrients between the two species. The higher nutrient removal was observed for total phosphorus (41.9% by control; 71.6% by E. crassipes; 69.9 by P. stratiotes; 72.5% by E. crassipes + P. stratiotes and 72.1 by P. stratiotes + E. crassipes) and turbidity (30.6% by control; 80.2% by E. crassipes; 75.2 by P. stratiotes; 79.8% by E. crassipes + P. stratiotes and 81.5 by P. stratiotes + E. crassipes). The systems containing aquatic macrophytes were efficient in nitrogen and phosphorus removal from M. amazonicum culture. © 2008 Sociedade Brasileira de Zootecnia.

Uso de polinômios segmentados para o estudo da curva de lactação de búfalos da raça Murrah e seus mestiços em sistema de criação semi-intensivo, no estado de São Paulo

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

Análise de econometria de dois sistemas naturais de tratamento de água residuária na suinocultura

The aim of this work was to develop a detailed econometric analysis to compare a constructed wetland system - combined model, and a waste stabilization pond system - facultative pond, as a function of six different sizes of finishing pig farms and two waste management systems - wet and dry. The constructed wetland system using dried waste management showed the best economic results. This finding is due to the low-cost implementation a year both per animal and per kilogram of meat. This system also required the smallest area for waste treatment. The use of stabilization pond with wet waste management system showed a lower implementation cost a year per animal and per kilogram of meat, but it required large areas. The econometric analysis of both systems of wastewater treatment revealed an economy of scale.

Infliximabe no tratamento inicial da retocolite ulcerativa moderada e grave. Terapia top down: Relato preliminar

The first option for the treatment of UC is both: salicylates or corticoids. Recently, in late November of 2006, the Brazilian Ministry of Health has approved infliximab (Remicade c, Mantecorp, Brazil) to treat ulcerative colitis. We report the use of infliximab as a first option for the treatment of two patients with severe ulcerative colitis. Case report: Patient 1: AZF, 52 years-old, female, was first diagnosed with UC after history and clinical examination; colonoscopy showed pancolitis with positive biopsy (crypt microabscess). Her Mayo score was 10 (range: 0 to 12/asymptomatic to severe colitis). She received intra venous infusion of infliximab at a dose of 5mg/Kg of body weigh at week 0, 2, 6 and 14. Then, patient was given mesalazine 4.5 g/day for maintenance therapy. Clinical response was defined as a decreased from baseline in the total Mayo score of at least 3 points. At present, patient is asymptomatic with Mayo score of 3 one moth after the last dose of infliximab. Patient 2: MLA, 45 years-old, female was first diagnosed with bloody diarrhea; colonoscopy showed left colitis and the biopsy was positive for ulcerative colitis. Her Mayo score was 9. She was offered and accepted the step down treatment. She was given infliximab 5mg/Kg of body weight at week 0, 2, 6 and 14. After initial treatment with infliximab, she received mesalazine 4.2 g/day. At present, she is asymptomatic with Mayo score of 2 eighteen days after the last dose of infliximab. At our knowledge, this is the first Brazilian report of the use of infliximab as fist-line therapy in ulcerative colitis. Few days after the begging of the infusion, an impressive clinical and colonoscopy improvement was seen in these two patients. Recently, it has been reported the use of infliximab as first-line therapy in pediatric Crohn disease. Infliximab could be a good option in cases of moderate and severe UC to avoid the side effects of the use of high doses of corticoids in patients with moderate and severe UC. However, the question if step-down therapy in ulcerative colitis is better then conventional therapy with salicylates and corticoids needs to be answered by randomized trials.

Avaliação hematológica de cães naturalmente infectados por Leishmania (Leishmania) chagasi submetidos a tratamento com antimoniato de meglumina

The present research was carried out aiming to assess the hematological response of dogs with visceral leishmaniasis submitted to treatment. For this, seven animals naturally infected by Leishmania sp. were submitted to a treatment with 75 mg/kg meglumine antimoniate subcutaneously, 12-12h/3 weeks. In all animals, a complete blood count and bone marrow aspiration biopsy were carried out for a descriptive evaluation at up to seven moments: before the treatment, 30, 60, 90, 120, 150 and 180 days after the start of the treatment. Before the beginning of the experiment hematological alterations were observed in four of the seven dogs (57.1%), among them, nonregenerative anemia, lymphopenia, lymphocytosis and monocytosis. During the course of the experiment the occurrence of leukocytoses, such as left shift neutrophilia and eosinophilia, were observed in some of the animals. Before the beginning of the treatment (M1), the occurrence of erythrocytic hypoplasia was detected by bone marrow cytology in two of the dogs (28.6%). This was reversed through an increase in the amount of erythroid progenitor cells after the administration of meglumine antimoniate. Thus, it can be concluded that the treatment led to normalization of the hematological alterations and recovery of the bone marrow.

Azul de metileno no tratamento da síndrome vasoplégica em cirurgia cardíaca. quinze anos de perguntas, respostas, dúvidas e certezas

Objective: There is strong evidence that methylene blue (MB), an inhibitor of guanylate cyclase, is an excellent therapeutic option for vasoplegic syndrome (VS) treatment in heart surgery. The aim of this article is to review the MB's therapeutic function in the vasoplegic syndrome treatment. Methods: Fifteen years of literature review. Results: 1) Heparin and ACE inhibitors are risk factors; 2) In the recommended doses it is safe (the lethal dose is 40 mg/ kg); 3) The use of MB does not cause endothelial dysfunction; 4) The MB effect appears in cases of nitric oxide (NO) up-regulation; 5) MB is not a vasoconstrictor, by blocking of the GMPc system it releases the AMPc system, facilitating the norepinephrine vasoconstrictor effect; 6) The most used dosage is 2 mg/kg as IV bolus followed by the same continuous infusion because plasmatic concentrations strongly decays in the first 40 minutes; 7) There is a possible window of opportunity for the MB's effectiveness. Conclusions: Although there are no definitive multicentric studies, the MB used to treat heart surgery VS, at the present time, is the best, safest and cheapest option, being a Brazilian contribution for the heart surgery.

Efetividade dos aparelhos intrabucais de avanço mandibular no tratamento do ronco e da síndrome da apneia e hipopneia obstrutiva do sono (SAHOS): Revisão sistemática

Introduction: The snoring is produced by the vibration of the soft palatum and/or other oropharyngeal tissues, during the air passage, in the breathing function. OSAHS is defined as the closing of 30%, at least, of the nasal/ buccal airway for 10 seconds or more, in spite of existing inspiratory effort, accompanied by oxyhemoglobin de- saturation of 4% or more. Objectives: To evaluate the available scientific evidence about the use of mandibular advancement intraoral appliances in the treatment of the snoring and/or OSAHS. Methodology: Electronic search strategy using predefined key-words and criteria was realized including studies published until October of 2008. It was also used the qualitative evaluation of the articles methodology. Results: Although a significant number of articles has studied this subject, only 7 articles showed methodological quality to be included in this systematic review. Conclusions: The intraoral appliances are widely prescribed for the treatment of snoring and OSAHS as primary therapy and as an alternative to patients who are unable to tolerate the positive airway pressure therapy.

Tratamento hepatoprotetor favorece a resposta leucocitária de ratos wistar intoxicados por CCL4

The aims of this investigation was to evaluate the effect of hepatoprotective treatments with a compound prepared by the association of N-Acetyl DL-Methionine (5%) + Choline chloride (2%) + Caffeine (1%) + Thiamine hydrochloride (1%) + Nicotinamida (0,5%)+ Pyridoxine hydrochloride (0.04%), administered through intramuscular (IM) route, at doses of 0.2, 0.6 and 1.0 mL/kg of BW, through the study of leukocytes responses in rats submitted to acute intoxication with CCl4. 147 females were randomized into 21 groups, performing five different treatments, which were evaluated seven animals in four periods: two, four, six and eight days after CCl4-induced intoxication. In this study, it was observed absolute eosinophilia and monocytosis in animals untreated and treated with the lowest dose of 0.2 mL. These responses were significantly better in animals treated with 0.6 and 1.0 mL/ kg BW. The untreated animals showed thrombocytopenia, when compared to treated animals. Absolute neutropenia and lymphocytosis was observed in all rats intoxicated with CCl4, there is no difference among treatments. The analysis of white blood cells demonstrated that the hepatoprotective treatments favored the leukocyte response, by act beneficially on the population of these cells, supporting the hypothesis that these events may reduce the deleterious effects in liver tissue after intoxication by CCl4.