As pr��ticas de leitura e a sua rela����o com a compreens��o leitora nas aulas de l��nguas

Relat��rio de est��gio de mestrado em Ensino de Portugu��s no 3�� Ciclo do Ensino B��sico e no Ensino Secund��rio e de Espanhol nos Ensinos B��sico e Secund��rio

Effectiveness of primary angioplasty in the treatment of acute myocardial infarction. Analysis of in-hospital and late outcomes in 135 consecutive cases

OBJECTIVE: Evaluate early and late evolution of patients submitted to primary coronary angioplasty for acute myocardial infarction. METHODS: A prospective study of 135 patients with acute myocardial infarction submitted to primary transcutaneous coronary angioplasty (PTCA). Success was defined as TIMI 3 flow and residual lesion <50%. We performed statistical analyses by univariated, multivariated methods and survival analyze by Kaplan-Meier. RESULTS: PTCA success rate was 78% and early mortality 18,5%. Killip classes III and IV was associated to higher mortality, odds ratio 22.9 (95% CI: 5,7 to 91,8) and inversely related to age <75 years (OR = 0,93; 95% CI: 0.88 to 0.98). If we had chosen success flow as TIMI 2 and had excluded patients in Killip III/IV classes, success rate would be 86% and mortality 8%. The survival probability at the end or study, follow-up time 142 �� 114 days, was 80% and event free survival 35%. Greater survival was associated to stenting (OR = 0.09; 0.01 to 0.75) and univessel disease (OR = 0.21; 0.07 to 0.61). CONCLUSION: The success rate was lower and mortality was higher than randomized trials, however similar to that of non randomized studies. This demonstrated the efficacy of primary PTCA in our local conditions.

A avalia����o da flu��ncia oral em crian��as do 3�� ano do ensino b��sico com e sem necessidades educativas especiais: um estudo explorat��rio quantitativo

Disserta����o de mestrado em Educa����o Especial (��rea de especializa����o em Dificuldades de Aprendizagem Espec��ficas)

One-year follow-up after primary coronary intervention for acute myocardial infarction in diabetic patients: a substudy of the STENT PAMI trial

OBJECTIVE - This analysis was undertaken to determine the composite incidence of cumulative adverse events (death, reinfarction, disabling stroke, and target vessel revascularization) at the end of the first year after acute myocardial infarction, in diabetic patients who underwent coronary stenting or primary coronary balloon angioplasty. METHODS - From the STENT PAMI trial, we analyzed the 6-month angiographic and 1-year clinical outcomes of 135 diabetic (112, noninsulin dependent) patients who underwent the randomization process of the trial and compared them with 758 nondiabetic patients. RESULTS - Coronary stenting did not significantly reduce the primary composite clinical end point when compared with PTCA (20 vs. 30%, p=0.2). A significant benefit from stenting was observed in patients with noninsulin dependent diabetes, with a trend toward a lesser need for new revascularization procedures (10 vs. 21%, p<.001), with a significant reduction in the primary composite clinical end point at 1 year (12 vs. 28%, p=. 04). At 6 months, the restenosis rate were significantly reduced only in nondiabetic patients (18 vs. 33%, p<. 001). Diabetic patients had the same restenosis rate (38%) either with stenting or balloon PTCA. CONCLUSIONS - Coronary Stenting in diabetics noninsulin dependent offered a significant reduction in the composite incidence of major clinical adverse events compared with balloon PTCA.

The use of abciximab associated with primary angioplasty for treating acute myocardial infarction

OBJECTIVE: To assess the benefit resulting from the use of abciximab associated with primary angioplasty. The following parameters were analyzed in-hospital, at 30 days, and 6 months: (a) flow in the culprit artery; (b) ventricular function; (c) combined outcome of death, acute myocardial infarction, and aditional revascularization. METHODS: From November 1997 to June 1999, a longitudinal nonrandomized study with historical data of 137 patients with acute myocardial infarction within the first 12 hours. Patients undergoing primary angioplasty and were divided into 2 groups: those receiving (A) abciximab (26) or (B) conventional therapy (111). TIMI flow and regional ventricular function estimated by the standard deviation (SD)/chordis index were analyzed. RESULTS: At the end of angioplasty, TIMI 3 flow was observed in 76.9% and 83.8% of the patients in groups A and B, respectively (P=0.58). In the reevaluation, patients with TIMI flow <3 showed a 100% improvement in group A and a 33% in group B (P<0.0001). A significant improvement (P<0.0001) in regional ventricular function, by SD/chordis index, occurred in each group; no significant difference between groups however, was observed (29.9% x 20.2%; P=0.58). A nonsignificant reduction in the combined outcome in the in-hospital phase (3.85% A x 9.0% B; P=0.34) and on the 30th day (4.0% x 12.0%; P=0.22) was observed in group A. CONCLUSION: Abciximab improved blood flow. Primary angioplasty improved regional ventricular function independent of antithrombotic therapy. Abciximab showed a trend toward reducing the combined outcome in the in-hospital phase and on the 30th day.

Primary coronary angioplasty in a nonagenarian

A woman aged 98 years entered the tertiary hospital service with a picture of acute myocardial infarction of the extensive anterior wall, which began 4 hours earlier. Due to the large myocardial risk area suggested by the electrocardiogram, the patient was taken to the hemodynamics laboratory for the performance of emergency coronary arteriography, which revealed occlusion in the proximal third of the anterior descending artery. Primary angioplasty followed by stent grafting was successfully performed. The patient had a satisfactory evolution (Killip I) and was discharged from the hospital on the seventh postinfarction day. We discuss here aspects of thrombolysis and coronary percutaneous interventions in the aged.

Pericardial Effusion with Cardiac Tamponade as a Form of Presentation of Primary Hypothyroidism

The authors describe a case of pericardial effusion accompanied by cardiac tamponade caused by primary hypothyroidism. Diagnosis was made by exclusion, because other causes of cardiac tamponade are more frequent. Emergency treatment of cardiac tamponade is pericardiocentesis (with possible pericardial window), and, after stabilization, performance of hormonal reposition therapy with L-thyroxin.

Primary Cardiac Angiosarcoma: A Therapeutical Dilemma

Cardiac angiosarcomas are malignant tumors that almost invariably have a short and fatal evolution. The therapeutic approach includes surgery, chemotherapy, and radiation therapy, alone or in combination. Heart transplantation is an attractive option in nonresectable tumors, even though the current experience is still limited. However, in most patients, the diagnosis is still established late, and survival is only slightly altered by the proposed treatments, mainly due to previously existing and undetected metastases. We report a case that illustrates the therapeutic dilemma faced with this neoplasia, and we discuss the case based on a literature review.

Primary coronary angioplasty in 9,434 patients during acute myocardial infarction: predictors of major in- hospital adverse events from 1996 to 2000 in Brazil

OBJECTIVE: To verify the results after the performance of primary coronary angioplasty in Brazil in the last 4 years. METHODS: During the first 24 hours of acute myocardial infarction onset, 9,434 (12.2%) patients underwent primary PTCA. We analyzed the success and occurrence of major in-hospital events, comparing them over the 4-year period. RESULTS: Primary PTCA use increased compared with that of all percutaneous interventions (1996=10.6% vs. 2000=13.1%; p<0.001). Coronary stent implantation increased (1996=20% vs. 2000=71.9%; p<0.001). Success was greater (1998=89.5% vs. 1999=92.5%; p<0.001). Reinfarction decreased (1998=3.9% vs. 99=2.4% vs. 2000=1.5%; p<0.001) as did emergency bypass surgery (1996=0.5% vs. 2000=0.2%; p=0.01). In-hospital deaths remained unchanged (1996=5.7% vs. 2000=5.1%, p=0.53). Balloon PTCA was one of the independent predictors of a higher rate of unsuccessful procedures (odds ratio 12.01 [CI=95%] 1.58-22.94), and stent implantation of lower mortality rates (odds ratio 4.62 [CI=95%] 3.19-6.08). CONCLUSION: The success rate has become progressively higher with a significant reduction in reinfarction and urgent bypass surgery, but in-hospital death remains nearly unchanged. Coronary stenting was a predictor of a lower death rate, and balloon PTCA was associated with greater procedural failure.

Influence of balloon pressure inflation in patients undergoing primary coronary stent implantation during acute myocardial infarction: a quantitative coronary angiography analysis

OBJECTIVE:To verify the influence of moderate- or high-pressure balloon inflation during primary coronary stent implantation for acute myocardial infarction. METHODS: After successful coronary stent implantation, 82 patients were divided into 2 groups according to the last balloon inflation pressure: group 1 (<FONT FACE=Symbol>&sup3;</FONT>12 to <16 atm) and group 2 (<FONT FACE=Symbol>&sup3;</FONT>16 to 20 atm), each with 41 cases. All patients underwent late coronary angiography. RESULTS: In group 1, the mean stent deployment pressure was 13.58��0.92 atm, and in the group 2 it was 18.15��1.66 atm. Stents implanted with moderate pressures (<FONT FACE=Symbol>&sup3;</FONT>12 to <16 atm) had a significantly smaller postprocedural minimal lumen diameter, compared to with those with higher pressure, with lesser acute gain (2.7�� 0.4 mm vs 2.9��04 mm; p=0.004), but the late lumen loss (0,9��0,8 mm vs 0,9��0,6 mm) and the restenosis (22% vs. 17.1%) and target-vessel revascularization rates (9.8% vs 7.3%) were similar between the groups. CONCLUSION: During AMI stenting, the use of high pressures (<FONT FACE=Symbol>&sup3;</FONT>16 atm) did not cause a measurable improvement in late outcome, either in the late loss, its index, and the net gain, or in clinical and angiographic restenosis rates.

Malignant hypertension and hypertensive encephalopathy in primary aldosteronism caused by adrenal adenoma

Two cases are reported as follows: 1) 1 female patient with accelerated-malignant hypertension secondary to an aldosterone-producing adrenal adenoma; and 2) 1 female patient with adrenal adenoma, severe hypertension, and hypertensive encephalopathy. This association is a rare clinical finding, and malignant hypertension may modify the hormonal characteristic of primary aldosteronism, making its diagnosis more difficult. The diagnosis of primary aldosteronism should be considered in patients with malignant hypertension or hypertensive encephalopathy if persistent hypokalemia occurs. Identification of primary aldosteronism is of paramount importance for the patient's evolution, because the surgical treatment makes the prognosis more favorable.

Caracterizaci��n zoot��cnica y gen��tica de poblaciones primarias de ovinos productores de lana. Zoothechnical and genetic characterization of primary populations of producing wool ovines.

Desde el tiempo de la conquista y colonizaci��n en siglo XVI, el territorio argentino fue poblado por especies ex��ticas entre ellas ovinos. El tipo de animal introducido al territorio determin�� la formaci��n poblaciones locales del tipo criollo donde en el caso de los ovinos pertenec��an al tipo lanero. Actualmente dichas poblaciones se encuentran relegadas y la mayor��a en manos de peque��os productores. En base a estudios previos se puede afirmar que constituir��an un material gen��tico de importante variabilidad y de un potencial textil importante. El proyecto pretende realizar una caracterizaci��n zoot��cnica y gen��tica mediante relevamientos poblacionales en regiones donde a��n se conserva material aut��ctono o local del tipo criollo. El relevamiento comprende un posicionamiento geogr��fico y breve descripci��n del sistema de producci��n, la toma de informaci��n biol��gica, morfol��gica y zoom��trica de los animales de la majada y la correspondiente obtenci��n de muestras de lana. Estas muestras son remitidas al Laboratorio de Fibras Animales de la Red SUPPRAD para su evaluaci��n. Para determinar la variabilidad zoot��cnica y gen��rica de las poblaciones se confeccionan ��ndices de arca��smo o primariedad basados en marcadores fenot��picos, bioqu��micos y moleculares. A ello se propone incorporar estudios sobre desempe��o productivo y reproductivo de las poblaciones para poner analizar los factores que afectan la producci��n de lana y dise��ar estrategias de manejo que la optimicen. Ello posibilitar�� evaluar la variabilidad de las poblaciones y proponer estrategias de conservaci��n y/o mejoramiento. Paralelamente se podr�� establecer el destino del producto textil producido por dichas poblaciones ovinas.

REVISANDO LOS CONTENIDOS EN LENGUA: Hacia una sem��ntica integradora. Transferencia y capacitaci��n. REVIEWING CONTENTS IN LANGUAGE: Toward an integrative semantics. Transference and training.

En el trabajo se sistematiza la informaci��n sem��ntica a fin de que ella sea la articuladora y eje de otros contenidos abordados en la ense��anza de la lengua materna. As��, en primer lugar se sistematizar��n conceptos y perspectivas sem��nticas, para luego establecer relaciones con otros niveles ling����sticos, como lo son la Morfolog��a y la Sintaxis, sin descuidar los aportes de la sem��ntica a los procesos de producci��n y comprensi��n textuales. Realizaremos estudios para sistematizar y asignar al contenido un lugar dominante e integrador en el proceso de ense��anza-aprendizaje de la lengua materna, sin pretender desdibujar otras tem��ticas. Planteamos tareas cuyo punto culminante es la capacitaci��n de docentes y experimentaci��n de las propuestas did��cticas en tres cursos de lengua en una instituci��n educativa de la ciudad de C��rdoba, cuyo examen, de ser positivo, permitir�� la replicaci��n y transferencia de esas pr��cticas a otras instituciones. Como objetivos generales, destacamos colaborar con la integraci��n de los contenidos que se dictan en Lengua Materna, tomando como eje la naturaleza sem��ntica del lenguaje; contribuir con la formaci��n de los estudiantes en las dimensiones de la comprensi��n y producci��n textuales; promover la reflexi��n y el incremento del caudal l��xico -y del lenguaje en general-, por parte de los estudiantes; contribuir con la capacitaci��n y formaci��n de los docentes en las tem��ticas abordadas, a trav��s de acciones concretas; corroborar que la formaci��n de los alumnos podr�� tornarse m��s significativa en la medida en que se trabajen 'formas' ling����sticas atravesadas por contenidos. El marco te��rico est�� constituido por los aportes de diferentes l��neas, los que, compatibilizados, permitir��n acceder a un abordaje integral del 'contenido' ling����stico. M��s precisamente, consideramos las conceptualizaciones de autores tales como Coseriu (1986) para la delimitaci��n sem��ntica, sus conceptos y operaciones, al que completamos con la perspectiva de Lyons (1986, 1997); para las relaciones entre Morfolog��a, seguimos a Ram��rez S��inz (2008) ; el v��nculo sintaxis- sem��ntica ser�� abordado desde la perspectiva de la Gram��tica Generativa (Demonte,V. 1991; D'Introno, 2001; Fern��ndez Lagunilla, M y Anula Rebollo,A, 1995; los aportes de la comprensi��n ser��n considerados desde De Beaugrande-Dresller (1997). Otros autores de referencia son Lakoff y Jhonsson (1998).

Tradu����o e valida����o do Walking Impairment Questionnaire em brasileiros com claudica����o intermitente

FUNDAMENTO: O Walking Impairment Questionnaire (WIQ) tem sido utilizado para a obten����o de informa����es sobre a percep����o de locomo����o dos indiv��duos com claudica����o intermitente (CI). Entretanto, esse question��rio ainda n��o foi traduzido para o idioma portugu��s, o que limita sua utiliza����o em amostra brasileira. OBJETIVO: Traduzir e verificar a validade e reprodutibilidade do WIQ em brasileiros com CI. M��TODOS: Participaram deste estudo 42 indiv��duos com CI, diagnosticados pelo ��ndice tornozelo-bra��o < 0,90. Ap��s os procedimentos de tradu����o e retradu����o do question��rio, realizado por dois tradutores independentes, a validade de constructo do WIQ foi analisada correlacionando os escores do WIQ com os escores do Medical Outcome Study Questionnaire Short Form 36 (SF-36) e com o desempenho em testes de aptid��o f��sica (marcha e de for��a m��xima). A reprodutibilidade foi analisada em duas aplica����es do WIQ com 7 dias de intervalo. RESULTADOS: Foi encontrada correla����o significativa entre os dom��nios do WIQ, os dom��nios do SF-36 (capacidade funcional, aspectos f��sicos, dor e aspectos emocionais) e o desempenho nos testes de aptid��o f��sica (marcha e for��a m��xima). Al��m disso, verificaram-se coeficientes de correla����o intraclasse que variaram de 0,72 a 0,81, e n��o houve diferen��a entre os escores do WIQ entre as duas aplica����es do question��rio. CONCLUS��O: A vers��o em portugu��s do WIQ �� v��lida e reprodut��vel em brasileiros com CI.

Prevalencia de Trastornos Mentales en consultantes de Centros de Atenci��n Primaria de la Ciudad de C��rdoba, Argentina.Prevalence of Mental Disorders among Consultants in Primary Health Care Centers of the City of C��rdoba, Argentina

El informe de la Organizaci��n Mundial de la Salud (2001), refiere que en un plazo de 20 a��os los trastornos mentales pasar��n a ser la segunda causa dentro de la carga de morbilidad a nivel mundial, y en la actualidad una de cada cuatro personas padece de alg��n trastorno mental en alguna etapa de su vida. Los estudios realizados en diversos pa��ses revelan que una proporci��n importante de los consultantes de la atenci��n primaria en salud presentan alg��n tipo de trastornos mentales. Desde esta perspectiva, la atenci��n primaria de la salud ofrece una oportunidad de intervenir en el manejo de los trastornos mentales de forma temprana y eficaz. En Argentina, es limitada la informaci��n acerca del registro epidemiol��gico en salud mental, no contando con estudios abordados desde la Atenci��n Primaria en la provincia de C��rdoba. El objetivo general del proyecto es estimar la prevalencia de trastornos mentales entre los consultantes de atenci��n primaria por problemas de salud general. Para ello se propone: Estimar la prevalencia de trastornos mentales en una muestra representativa de consultantes adultos por problemas de salud general, de centros de atenci��n primaria de la ciudad de C��rdoba, identificar y describir los tipos de trastornos mentales que presentan estos consultantes adultos de centros de atenci��n primaria y analizar la prevalencia de los trastornos mentales por sexo y edad de la poblaci��n en estudio. Metodolog��a: el estudio se realizar�� en consultorios de Atenci��n Primaria de Salud distribu��dos en todo el ��jido de la ciudad, teniendo en cuenta la representaci��n de las 12 zonas de CPC. La muestra es probabil��stica, estratificada, poliet��pica de pacientes que consultan en el primer nivel de atenci��n. Se entrevistar��n 1200 pacientes utilizando la versi��n computorizada del CIDI 3.0, que proporciona diagn��stico de acuerdo a la DSM IV y la CIE-10. La confiabilidad y la validez del instrumento ha sido ampliamente documentada y la traducci��n de la encuesta al espa��ol fue realizada conforme a las recomendaciones de la OMS. El an��lisis efectuado ser�� de prevalencia de Trastornos Mentales y del Comportamiento (TMC),asociaci��n entre factores sociodemogr��ficos y TCM estimados calculando las razones de disparidad (odds ratio), regresi��n log��stica a fin de ajustar los resultados por la posible interacci��n entre variables, an��lisis de la asociaci��n de todas las variables con los TMC, an��lisis univariado de la asociaci��n de cada variable con los TMC, controlando sexo y edad, se construir�� un modelo de regresi��n log��stica. En todos los casos el nivel de significaci��n ser�� de 0,05. El equipo de trabajo, de cooperaci��n internacional entre profesionales de la UNC y de la Universidad de Chile, y con la participaci��n en colaboraci��n de los profesionales dependientes de la Secretar��a de Salud de la municipalidad de C��rdoba, representa un avance para trabajar en los centros de salud de esta ciudad, constituy��ndose en un avance, cualitativo y cuantitativo de la actividad cient��fica en Atenci��n Primaria en salud mental con abordaje epidemiol��gico. Se espera contribuir al conocimiento acerca de la prevalencia de los problemas de salud mental de esta poblaci��n en la ciudad de C��rdoba, proporcionando informaci��n a los funcionarios y responsables por la gesti��n de las ��reas vinculadas a la salud mental, aportando conocimiento que promueva una temprana identificaci��n de riesgos iniciales en salud mental y conductas de cuidado en la poblaci��n como potencial de bienestar.As�� mismo, se espera sistematizar una experiencia que pueda ser replicada en otros sitios geogr��ficos. Por todo lo anterior, esta propuesta permitir�� conocer por primera vez en la ciudad de C��rdoba la frecuencia y caracter��sticas de los problemas de salud mental entre consultantes de Atenci��n Primaria, informaci��n fundamental para el desarrollo posterior de estrategias que busquen mejorar la detecci��n y el tratamiento de estos problemas. According to the WHO Report (2001), in 20 years, mental health disorders (MHDs) will be the world���s second most frequent cause of morbidity. Primary care offers the opportunity to handle MHDs efficiently at an early stage. In Argentina, the epidemiologic data on mental health (MH) is limited, and there are no records for C��rdoba. The aim of this project is to assess the prevalence of MHDs among consultants who resort to primary health centers (PHCCs) in the city of C��rdoba for common health problems, by using a representative sample of adult consultants, identifying and describing the types of MHDs evinced, and analysing prevalence by sex and age group under study. Methodology:the study will be carried out in PHCCs located in the municipal area of C��rdoba, covering the 12 zones corresponding to the CPCs (municipal branch offices for each zone). A multi-stage stratified random sample of 1200 patients will be interviewed using the program CIDI 3.0 to produce a diagnostic according to DSM IV and CIE-10, a tool with proven reliability and validity.The aspects to be analysed are prevalence of mental and behavior disorders, their association with socio-demographic factors estimated by odds ratios, logistic regression for adjustment of potential interaction among variables, association with all variables, and univariate analysis for association with each variable. Significance level will be 0.05 in all cases. The international teamwork including professionals from the Universities of C��rdoba, Chile and the Public Health Department of the Municipality of C��rdoba constitutes a qualitative and quantitative step forward in the field of primary health care studies with an epidemiologic approach. This project aims at providing administrators in the MH area with data for the early detection of initial risks in MH and the promotion of prevention habits. This will be the first study conducted in C��rdoba, and is aimed at facilitating replication in other geographical areas.