Eficiência mastigatória e impacto da saúde oral na qualidade de vida em pacientes reabilitados com próteses totais removíveis implanto-suportadas

Edentulous patients with complaint about mandibular conventional denture might experience poor masticatory function and negative impact of oral health on quality of life. The aim of this controlled clinical trial was to evaluate the effect of mandibular overdenture on oral health-related quality of life and masticatory efficacy in patients wearing mandibular complete dentures. The edentulous patients (n=16) were rehabilitated with new maxillary and mandibular complete dentures and, after 3 months, mandibular overdentures retained by 2 implants (bar-clip system) were fabricated. The Brazilian version of OHIP-Edent questionnaire was used to assess the oral healthrelated quality of life. Masticatory efficacy was evaluated through a colorimetric method with chewing capsules. The mean OHIP-Edent score was 8.5 with conventional dentures and 2.0 with mandibular overdenture, which means a positive impact of oral health on quality of life with overdentures (p=0.001). The mean absorbance for masticatory efficacy was 0.025 for conventional dentures and 0.073 for overdentures. There was statistically significant difference for masticatory efficacy before and after implants rehabilitation (p=0.003). However, there was no correlation between masticatory efficacy and OHIP (p>0.05). So, mandibular overdenture retained by 2 implants improved the quality of life and masticatory efficacy of edentulous patients with complaint about mandibular conventional complete dentures

Uso de confiabilidade na rotulação de exemplos em problemas de classificação multirrótulo com aprendizado semissupervisionado

The techniques of Machine Learning are applied in classification tasks to acquire knowledge through a set of data or information. Some learning methods proposed in literature are methods based on semissupervised learning; this is represented by small percentage of labeled data (supervised learning) combined with a quantity of label and non-labeled examples (unsupervised learning) during the training phase, which reduces, therefore, the need for a large quantity of labeled instances when only small dataset of labeled instances is available for training. A commom problem in semi-supervised learning is as random selection of instances, since most of paper use a random selection technique which can cause a negative impact. Much of machine learning methods treat single-label problems, in other words, problems where a given set of data are associated with a single class; however, through the requirement existent to classify data in a lot of domain, or more than one class, this classification as called multi-label classification. This work presents an experimental analysis of the results obtained using semissupervised learning in troubles of multi-label classification using reliability parameter as an aid in the classification data. Thus, the use of techniques of semissupervised learning and besides methods of multi-label classification, were essential to show the results

Agroindústria canavieira e unidade de conservação: Impactos Sociais na comunidade de pescadores de Baía Formosa (RN)

The conservation unities emerged in response to the environmental damages. In the Atlantic Forest of the Brazilian Northeast, the most of the damages come from the sugar-cane agro-industry, especially by the deforestation for the introduction of sugar-cane fields and installation of the industry structure. Besides the damages over the biodiversity, there are critical social problems that affect the communities which survive using directly or indirectly the biome from the Atlantic Forest. The objective of this research is to analyze the social impacts on the fishermen of Baía Formosa/RN generated by the changes and socio-environmental transformations occurred starting the installation of a sugar-cane factory and the creation of a conservation area in the municipality of Baía Formosa/RN community. The research is based on a qualitative and diachronic perspective, for both approach, it was used the method of oral history in conjunction with the literature search and some technical and research tools such as direct observation, interview, records images and recordings . The results show that social and symbolic practices of the community in the conservation unit Mata Estrela last more strongly presented. Today fewer natural resources are used, due to factors such as limit access to forest and disappearance of some natural resources by deforestation. It is believed that the loss of free access to space for the community is the most significant negative impact, as promoted changes in the relationship of the community with the Star Forest that contributed to the fading of their social and symbolic practices. The loss of free access caused the decline in the practice of agriculture, which resulted in the loss of one of the means of social reproduction of the community

Diagnóstico sorológico da brucelose bovina em animais adultos vacinados com dose reduzida da cepa 19 de Brucella abortus

Com o presente trabalho avaliou-se o uso de dose reduzida da vacina produzida com a amostra 19 de Brucella abortus, em rebanho adulto negativo para a enfermidade, por meio de técnicas de diagnóstico sorológico preconizadas pelo Programa Nacional de Controle e Erradicação da Brucelose e Tuberculose Animal e por um ensaio indireto de imunoadsorção enzimática (ELISA ID). A prova de fixação de complemento detectou 46,77% de positivos, o antígeno acidificado tamponado 67,74%, o 2-mercaptoetanol com soroaglutinação lenta 87,09% e o ELISA ID 100%. A dose reduzida interferiu no diagnóstico sorológico. Nenhuma das técnicas apresentou especificidade adequada para uso em rebanho nestas condições, até 3 meses após a vacinação.

Arcabouço geofísico, isostasia e causas do magmatismo cenozóico da província Borborema e de sua margem continental (Nordeste do Brasil)

The Borborema Province (BP) is a geologic domain located in Northeastern Brazil. The BP is limited at the south by the São Francisco craton, at the west by the Parnaíba basin, and both at the north and east by coastal sedimentary basins. Nonetheless the BP surface geology is well known, several key aspects of its evolution are still open, notably: i)its tectonic compartmentalization established after the Brasiliano orogenesis, ii) the architecture of its cretaceous continental margin, iii) the elastic properties of its lithosphere, and iv) the causes of magmatism and uplifting which occurred in the Cenozoic. In this thesis, a regional coverage of geophysical data (elevation, gravity, magnetic, geoid height, and surface wave global tomography) were integrated with surface geologic information aiming to attain a better understanding of the above questions. In the Riacho do Pontal belt and in the western sector of the Sergipano belt, the neoproterozoic suture of the collision of the Sul domain of the BP with the Sanfranciscana plate (SFP) is correlated with an expressive dipolar gravity anomaly. The positive lobule of this anomaly is due to the BP lower continental crust uplifting whilst the negative lobule is due to the supracrustal nappes overthrusting the SFP. In the eastern sector of the Sergipano belt, this dipolar gravity anomaly does not exist. However the suture still can be identified at the southern sector of the Marancó complex arc, alongside of the Porto da Folha shear zone, where the SFP N-S geophysical alignments are truncated. The boundary associated to the collision of the Ceará domain of the BP with the West African craton is also correlated with a dipolar gravity anomaly. The positive lobule of this anomaly coincides with the Sobral-Pedro II shear zone whilst the negative lobule is associated with the Santa Quitéria magmatic arc. Judging by their geophysical signatures, the major BP internal boundaries are: i)the western sector of the Pernambuco shear zone and the eastern continuation of this shear zone as the Congo shear zone, ii) the Patos shear zone, and iii) the Jaguaribe shear zone and its southwestern continuation as the Tatajuba shear zone. These boundaries divide the BP in five tectonic domains in the geophysical criteria: Sul, Transversal, Rio Grande do Norte, Ceará, and Médio Coreaú. The Sul domain is characterized by geophysical signatures associated with the BP and SFP collision. The fact that Congo shear zone is now proposed as part of the Transversal domain boundary implies an important change in the original definition of this domain. The Rio Grande do Norte domain presents a highly magnetized crust resulted from the superposition of precambrian and phanerozoic events. The Ceará domain is divided by the Senador Pompeu shear zone in two subdomains: the eastern one corresponds to the Orós-Jaguaribe belt and the western one to the Ceará-Central subdomain. The latter subdomain exhibits a positive ENE-W SW gravity anomaly which was associated to a crustal discontinuity. This discontinuity would have acted as a rampart against to the N-S Brasiliano orogenic nappes. The Médio Coreaú domain also presents a dipolar gravity anomaly. Its positive lobule is due to granulitic rocks whereas the negative one is caused by supracrustal rocks. The boundary between Médio Coreaú and Ceará domains can be traced below the Parnaíba basin sediments by its geophysical signature. The joint analysis of free air anomalies, free air admittances, and effective elastic thickness estimates (Te) revealed that the Brazilian East and Equatorial continental margins have quite different elastic properties. In the first one 10 km < Te < 20 km whereas in the second one Te ≤ 10 km. The weakness of the Equatorial margin lithosphere was caused by the cenozoic magmatism. The BP continental margin presents segmentations; some of them have inheritance from precambrian structures and domains. The segmentations conform markedly with some sedimentary basin features which are below described from south to north. The limit between Sergipe and Alagoas subbasins coincides with the suture between BP and SFP. Te estimates indicates concordantly that in Sergipe subbasin Te is around 20 km while Alagoas subbasin has Te around 10 km, thus revealing that the lithosphere in the Sergipe subbasin has a greater rigidity than the lithosphere in the Alagoas subbasin. Additionally inside the crust beneath Sergipe subbasin occurs a very dense body (underplating or crustal heritage?) which is not present in the crust beneath Alagoas subbasin. The continental margin of the Pernambuco basin (15 < Te < 25 km) presents a very distinct free air edge effect displaying two anomalies. This fact indicates the existence in the Pernambuco plateau of a relatively thick crust. In the Paraíba basin the free air edge effect is quite uniform, Te ≈ 15 km, and the lower crust is abnormally dense probably due to its alteration by a magmatic underplating in the Cenozoic. The Potiguar basin segmentation in three parts was corroborated by the Te estimates: in the Potiguar rift Te ≅ 5 km, in the Aracati platform Te ≅ 25 km, and in the Touros platform Te ≅ 10 km. The observed weakness of the lithosphere in the Potiguar rift segment is due to the high heat flux while the relatively high strength of the lithosphere in the Touros platform may be due to the existence of an archaean crust. The Ceará basin, in the region of Mundaú and Icaraí subbasins, presents a quite uniform free air edge effect and Te ranges from 10 to 15 km. The analysis of the Bouguer admittance revealed that isostasy in BP can be explained with an isostatic model where combined surface and buried loadings are present. The estimated ratio of the buried loading relative to the surface loading is equal to 15. In addition, the lower crust in BP is abnormally dense. These affirmations are particularly adequate to the northern portion of BP where adherence of the observed data to the isostatic model is quite good. Using the same above described isostatic model to calculate the coherence function, it was obtained that a single Te estimate for the entire BP must be lower than 60 km; in addition, the BP north portion has Te around 20 km. Using the conventional elastic flexural model to isostasy, an inversion of crust thickness was performed. It was identified two regions in BP where the crust is thickened: one below the Borborema plateau (associated to an uplifting in the Cenozoic) and the other one in the Ceará domain beneath the Santa Quitéria magmatic arc (a residue associated to the Brasiliano orogenesis). On the other hand, along the Cariri-Potiguar trend, the crust is thinned due to an aborted rifting in the Cretaceous. Based on the interpretation of free air anomalies, it was inferred the existence of a large magmatism in the oceanic crust surrounding the BP, in contrast with the incipient magmatism in the continent as shown by surface geology. In BP a quite important positive geoid anomaly exists. This anomaly is spatially correlated with the Borborema plateau and the Macaú-Queimadas volcanic lineament. The integrated interpretation of geoid height anomaly data, global shear velocity model, and geologic data allow to propose that and Edge Driven Convection (EDC) may have caused the Cenozoic magmatism. The EDC is an instability that presumably occurs at the boundary between thick stable lithosphere and oceanic thin lithosphere. In the BP lithosphere, the EDC mechanism would have dragged the cold lithospheric mantle into the hot asthenospheric mantle thus causing a positive density contrast that would have generated the main component of the geoid height anomaly. In addition, the compatibility of the gravity data with the isostatic model, where combined surface and buried loadings are present, together with the temporal correlation between the Cenozoic magmatism and the Borborema plateau uplifting allow to propose that this uplifting would have been caused by the buoyancy effect of a crustal root generated by a magmatic underplating in the Cenozoic

Avaliação do modelo de predição clínica de Wells et al. no diagnóstico da trombose venosa profunda dos membros inferiores

CONTEXTO: A aplicação de uma estratégia baseada em um modelo clínico associado ao mapeamento dúplex (MD) pode permitir um diagnóstico da trombose venosa profunda (TVP) mais seguro, eficaz e custo-efetivo. OBJETIVO: Testar o modelo clínico de Wells et al. associado ao MD e verificar a ocorrência de TVP nos pacientes categorizados quanto à probabilidade de apresentar a doença, e determinar se, a partir dos resultados obtidos, seria possível reduzir o número de exames seriados com o MD. MÉTODOS: Os pacientes com suspeita clínica de TVP foram categorizados quanto à apresentação de TVP em baixa, moderada e alta probabilidade (BP, MP, AP) e, em seguida, submetidos ao MD. Pacientes com MD negativo repetiram o exame em 24-48 horas e em 7 dias. Pacientes com exame positivo para TVP foram tratados. Todos os pacientes sem TVP foram convocados para reavaliação clínica em 3 meses. RESULTADOS: A ocorrência de TVP entre os 489 pacientes avaliados foi de 39,1% (191), sendo 35,6% identificados no exame inicial e 3,5% no exame seriado. Os índices de pacientes que apresentaram TVP foram de 6,1% no grupo de BP, 26,9% no grupo de MP e 79,5% no grupo de AP. No exame seriado, o percentual de TVP foi de 2,4, 7,8 e 15,1% nos grupos BP, MP e AP, respectivamente. Dos pacientes com MD negativo, 62,4% compareceram após 3 meses, e piora dos sintomas foi apresentada por apenas um paciente. Neste, o MD mostrou TVP de veia poplítea. CONCLUSÃO: Os resultados obtidos sugerem que, para os pacientes com BP para TVP e MD negativo, seria possível prescindir do exame seriado, devido à baixa ocorrência de TVP neste grupo, tornando, assim, a abordagem diagnóstica mais simples.

Geologia, Geocronologia, Geoquímica e Petrogênese das Rochas Ígneas Cretácicas da Província Magmática do Cabo e suas Relações com as Unidades Sedimentares da Bacia de Pernambuco (NE do Brasil)

The area studied forms a thin NNE-directed belt situated south of Recife town (Pernambuco state), northeastern Brazil. Geologically, it comprises the Pernambuco Basin (PB), which is limited by the Pernambuco Lineament to the north, the Maragogi high to the south and the Pernambuco Alagoas massif to the west, all of them with Precambrian age. This thesis reports the results obtained for the Cabo Magmatic Province (CMP), aiming the characterization of the geology, stratigraphy, geochronology, geochemistry and petrogenesis of the Cretaceous igneous rocks presented in the PB. The PB is composed of the Cabo Formation (rift phase) at the base (polymictic conglomerates, sandstones, shales), an intermediate unit, the Estiva Formation (marbles and argillites), and, at the top, the Algodoais Formation (monomictic conglomerates, sandstones, shales). The CMP is represented by trachytes, rhyolites, pyroclastics (ignimbrites), basalts / trachy-andesites, monzonites and alkali-feldspar granite, which occur as dykes, flows, sills, laccoliths and plugs. Field observations and well descriptions show that the majority of the magmatic rocks have intrusive contacts with the Cabo Formation, although some occurrences are also suggestive of synchronism between volcanism and siliciclastic sedimentation. 40Ar/39Ar and zircon fission tracks for the magmatic rocks indicate an average age of 102 r 1 Ma for the CMP. This age represents an expressive event in the province and is detected in all igneous dated materials. It is considered as a minimum age (Albian) for the magmatic episode and the peak of the rift phase in the PB. The 40Ar/39Ar dates are about 10-14 Ma younger than published palynologic ages for this basin. Geochemically, the CMP may be divided in two major groups; i) a transitional to alkaline suite, constituted by basalts to trachy-andesites (types with fine-grained textures and phenocrysts of sanidine and plagioclase), trachytes (porphyrytic texture, with phenocrysts of sanidine and plagioclase) and monzonites; ii) a alkaline suite, highly fractionated, acidic volcano-plutonic association, formed by four subtypes (pyroclastic flows ignimbrites, fine-to medium-grained rhyolites, a high level granite, and later rhyolites). These four types are distinguished essentially by field aspects and petrographic and textural features. Compatible versus incompatible trace element concentrations and geochemical modeling based on both major and trace elements suggest the evolution through low pressure fractional crystallization for trachytes and other acidic rocks, whereas basalts / trachy-andesites and monzonites evolved by partial melting from a mantle source. Sr and Nd isotopes reveal two distinct sources for the rocks of the CMP. Concerning the acidic ones, the high initial Sr ratios (ISr = 0.7064-1.2295) and the negative HNd (-0.43 to -3.67) indicate a crustal source with mesoproterozoic model ages (TDM from 0.92 to 1.04 Ga). On the other hand, the basic to intermediate rocks have low ISr (0.7031-0.7042) and positive HNd (+1.28 to +1.98), which requires the depleted mantle as the most probable source; their model ages are in the range 0.61-0.66 Ga. However, the light rare earth enrichment of these rocks and partial melting modeling point to an incompatible-enriched lherzolitic mantle with very low quantity of garnet (1-3%). This apparent difference between geochemical and Nd isotopes may be resolved by assuming that the metasomatizing agent did not obliterate the original isotopic characteristics of the magmas. A 2 to 5% partial melting of this mantle at approximately 14 kbar and 1269oC account very well the basalts and trachy-andesites studied. By using these pressure and temperatures estimates for the generation of the basaltic to trachy-andesitic magma, it is determined a lithospheric stretching (E) of 2.5. This E value is an appropriated estimate for the sub-crustal stretching (astenospheric or the base of the lithosphere?) region under the Pernambuco Basin, the crustal stretching probably being lower. The integration of all data obtained in this thesis permits to interpret the magmatic evolution of the PB as follows; 1st) the partial melting of a garnet-bearing lherzolite generates incompatible-enriched basaltic, trachy-andesitic and monzonitic magmas; 2nd) the underplating of these basaltic magmas at the base of the continental crust triggers the partial melting of this crust, and thus originating the acidic magmas; 3rd) concomitantly with the previous stage, trachytic magmas were produced by fractionation from a monzonitic to trachy-andesitic liquid; 4th) the emplacement of the several magmas in superficial (e.g. flows) or sub-superficial (e.g. dykes, sills, domes, laccoliths) depths was almost synchronically, at about 102 r 1 Ma, and usually crosscutting the sedimentary rocks of the Cabo Formation. The presence of garnet in the lherzolitic mantle does not agree with pressures of about 14 kbar for the generation of the basaltic magma, as calculated based on chemical parameters. This can be resolved by admitting the astenospheric uplifting under the rift, which would place deep and hot material (mantle plume?) at sub-crustal depths. The generation of the magmas and their subsequent emplacement would be coupled with the crustal rifting of the PB, the border (NNE-SSW directed) and transfer (NW-SE directed) faults serving as conduits for the magma emplacement. Based on the E parameter and the integration of 40Ar/39Ar and palynologic data it is interpreted a maximum duration of 10-14 Ma for the rift phase (Cabo Formation clastic sedimentation and basic to acidic magmatism) of the PB

Avaliação da eficiência da técnica de obturação pela compressão hidrùlica vertical após instrumentação automatizada

The purpose of this study was to evaluate through radiographic and microscopic analysis the efficiency of the filling techniques by vertical hidraulic compression after the root canal mechanical instrumentation in vitro as well to evaluate the marginal apical leakage through macroscopic and microscopic analysis. Thirty human mandibular molars were used , they were divided on three groups, these were subdivided on six subgroups with five specimens each, come down to 106 root canals filled. Initially, the teeth were instrumented with Profile system series 29 and filled with two ways: single accessory cone or single cone associated with gutta-percha secundary cone, with Fill Canal sealer or Sealer 26. Completed the filling, the teeth were coated with araldit and finger -nail polish except for the apical 2 mm and dried for 3 hours, thep radiographs were taken of the teeth in orto and disto-radiai directions. Next, the coronal seal was carried out with composite resin photopolymerized and with their process of making impermeable. Teeth of positive controls were used without araldit and finger-nail polish whereas the negative controls were used with total coat of araldit and finger-nail polish. The specimens were placed in 2% Methylene Blue dye for 24 hours and thermocycled for 7 days. Afterwards, sections were made of each tooth at mesial and distal roat, after this the teeth were radiographed at buccolíngual direction for a macroscopic analysis and at buccolingual and mesiodistal directions for assessment of the marginal apical leakage. Cross sections were made 3 mm to 3mm since the tooth apice. The sections obtained for each group were observed with a stereomicroscope to evaluate the quality of the root canal filling and the marginal apical leakage. The results showed that: In the four techniques the marginal dye leakage was present in the apical third; in all groups the quality of the root canal filling in the radiography was better at mesial root canal and the single cone technique showed inefficient when only a single distal root canal was present. In the radiographic evaluation the best quality of the root canal filling was observed in the 1A group (single accessory cone + FiIl Canal), as in the mesial root as in the distal root wich Shcwed twe root canals: when the distaI root had only one canal. the best result was showed by 28 group (single accessory cone associated with secundary cone + Fill Canal) In the macroscopic analysis of longitudinal !eaKage (outside surface). less leakage was showed as In the mesial root as in the distal root in the negative control group (3) followed 2A group (single accessory cone + Sealer 26). When the microscopic analysis of tranversal leakage of both roots (inside surface) was carried out. the groups that showed less dye leakage were the negative control (38) followed the 28 group (single acessory cone associated with secundary cone + Sealer 26). The homogeneity o filling was best noted in the 1 A group (.single accessoty cone + Fill Canal). The groups that showed less dye penetration in the tranversal leakage (total area) were negative control (3B) and 2B

Avaliação da utilização de biópsia transbrônquica em pacientes com suspeita clínica de doença pulmonar intersticial

OBJETIVO: Estudar os padrões clínicos, radiológicos e histopatológicos da biópsia transbrônquica (BTB) utilizados para a confirmação diagnóstica em pacientes com suspeita clinica de doença pulmonar intersticial (DPI) atendidos em um hospital universitário de nível terciário. MÉTODOS: Os prontuários, laudos radiológicos e de biópsias transbrônquicas de todos os pacientes com suspeita de DPI submetidos a BTB entre janeiro de 1999 e dezembro de 2006 no Hospital das Clínicas de Botucatu, localizado na cidade de Botucatu (SP), foram revisados. RESULTADOS: Foram incluídos no estudo 56 pacientes. Desses, 11 (19,6%) apresentaram o diagnóstico definitivo de fibrose pulmonar idiopática (FPI), que foi significativamente maior nos casos nos quais DPI era uma possibilidade diagnóstica em comparação com aqueles nos quais DPI era a principal suspeita (p = 0,011), demonstrando a contribuição da BTB para a definição diagnóstica dessas doenças. O exame histopatológico dessas biópsias revelou que 27,3% dos pacientes com FPI apresentavam o padrão de pneumonia organizante, o que pode sugerir doença mais avançada. O padrão histológico indeterminado foi o mais frequente, refletindo a característica periférica da FPI. Entretanto, o padrão fibrose apresentou alta especificidade e alto valor preditivo negativo. Para os padrões sugestivos de FPI em TC, a curva ROC indicou que a melhor relação entre sensibilidade e especificidade ocorreu com a presença de cinco alterações radiológicas, sendo o aspecto de favo de mel fortemente sugestivo de FPI (p = 0,01). CONCLUSÕES: Nas DPIs, a TC de tórax deve ser sempre realizada e a BTB usada em situações individualizadas, conforme a suspeita e distribuição das lesões.

Espectros fractais em sistemas nanoestruturados e cristais fotônicos

The study of the elementary excitations such as photons, phonons, plasmons, polaritons, polarons, excitons and magnons, in crystalline solids and nanostructures systems are nowdays important active field for research works in solid state physics as well as in statistical physics. With this aim in mind, this work has two distinct parts. In the first one, we investigate the propagation of excitons polaritons in nanostructured periodic and quasiperiodic multilayers, from the description of the behavior for bulk and surface modes in their individual constituents. Through analytical, as well as computational numerical calculation, we obtain the spectra for both surface and bulk exciton-polaritons modes in the superstructures. Besides, we investigate also how the quasiperiodicity modifies the band structure related to the periodic case, stressing their amazing self-similar behavior leaving to their fractal/multifractal aspects. Afterwards, we present our results related to the so-called photonic crystals, the eletromagnetic analogue of the electronic crystalline structure. We consider periodic and quasiperiodic structures, in which one of their component presents a negative refractive index. This unusual optic characteristic is obtained when the electric permissivity and the magnetic permeability µ are both negatives for the same range of angular frequency ω of the incident wave. The given curves show how the transmission of the photon waves is modified, with a striking self-similar profile. Moreover, we analyze the modification of the usual Planck´s thermal spectrum when we use a quasiperiodic fotonic superlattice as a filter.

Comparação entre dois testes de rastreamento do diabetes gestacional e o resultado perinatal

OBJETIVO: comparar dois testes de rastreamento para diabetes e seus resultados com o resultado da gestação. MÉTODOS: no total, 279 pacientes foram submetidas a dois testes de rastreamento do diabetes gestacional - associação glicemia de jejum e fatores de risco (GJ + FR) e o teste de tolerância à glicose simplificado (TTG50g). O rastreamento pela associação GJ + FR caracterizou-se pela dosagem da glicemia de jejum e anamnese para identificação dos fatores de risco na primeira consulta de pré-natal. O TTG50g foi realizado entre a 24ª e a 28ª semana de gestação e caracterizou-se pela dosagem das glicemias plasmáticas em jejum e uma hora após a sobrecarga oral com 50 g de glicose. Os resultados, positivo e negativo, foram relacionados ao resultado da gestação. Foram consideradas variáveis dependentes: via de parto, idade gestacional, peso e índice ponderal ao nascimento, índices de Apgar <7 no 1º e 5º minutos, necessidade de Unidade de Terapia Intensiva (UTI), tempo de permanência hospitalar e óbito neonatal. Empregou-se o teste t de Student, admitindo-se 5% como limite de significância para calcular a diferença de proporção de das médias. RESULTADOS: apenas dois resultados perinatais estudados foram diferenciados pelos testes. O TTG50g alterado esteve associado à maior proporção de cesárea (58,7 versus 34,3%) e a associação GJ + FR positiva, maior taxa de prematuridade (15,4 versus 5,4%). As demais variáveis não foram diferentes nas pacientes com testes de rastreamento positivo e negativo. CONCLUSÕES: Apesar da relação entre a prematuridade e associação GJ + FR positiva e aumento de cesárea e TTG50g alterado, seria falha crítica aceitá-los como definitivos. Entre outras explicações, múltiplos fatores intercorrentes e as características próprias dos testes de rastreamento devem ser consideradas.

Monitoramento da dinâmica costeira da praia de Ponta Negra

This dissertation includes the monitoring of coastal environmental dynamics at three points distinct from Ponta Negra beach, located on the South Coast of Natal, capital of Rio Grande do Norte, in the period June 2012 to May, 2013. For this, the following hypotheses were developed: Which actors morphodynamic and/or anthropogenic responsible for the changes in the study area? And yet, the configuration of the morphodynamic state of the beach, dissipative, reflective or intermediate? Faced with these questions , studies on the beach environment has its relevance as they may clarify the risks and responsibilities of anthropogenic intervention and also assist managers in more targeted action regarding the protection of praiais systems, since once committed, it is very difficult recover the environmental framework of the area, being greatly more feasible the development of multidisciplinary work plans that can guide human actions possible in search of an understanding to the harmonious interaction between society and the beach system. Its main goal is the understanding of the processes of coastal dynamics, methodological procedures that supported the implementation of this research were based on the object of study related literature associated with the collection of data resulting from beach profiles made monthly in spring tides (full moon), the hydrodynamic data and statistical quantification data (%) and size classification of sediment sediment after laboratory analysis. The results obtained from annual comparative tables of beach profiles, associated sedimentological analysis, indicated a positive sediment budget, tending to equilibrium for Point 01 and Point 02 negative. Have to Step 03 were added to the hydrodynamic data, which allowed also on a comparative framework, the perception of a depositional dynamics, with a tendency to decrease the accumulation of material at the end of the annual cycle. These data also allowed for the point 03, the calculation of the volume of material transported by the longshore current was around 104.280 m³/m, plus the Dean parameter which established a morphological state of the dissipative beach with specific prevalences for point 03. Thus, given the results presented in this work in a timely monitoring of coastal dynamics is expected that managers and public authorities can articulate multidisciplinary work plans, always aiming actions that seek understanding and effective commitment to the recovery of the harmonious interaction between society and Ponta Negra beach environment

Associação glicemia de jejum e fatores de risco como teste para rastreamento do diabete gestacional

OBJETIVOS: comparar dois testes de rastreamento do diabete gestacional. MÉTODOS: estudo prospectivo no qual foram avaliadas 356 gestantes, sem diagnóstico prévio do diabete melito, submetidas, de modo independente, a dois testes de rastreamento: associação glicemia de jejum e fator de risco (GJ+FR) e teste oral simplificado de tolerância à glicose (TTG50g). A comparação entre os métodos foi realizada pelos índices de sensibilidade (S), especificidade (E) e valores preditivos positivo (VPP) e negativo (VPN), resultados falsos, positivos (FP) e negativos (FN) e pela diferença dos resultados observados e esperados, avaliada pelo teste do Qui-quadrado (p<0,05). RESULTADOS: a associação GJ+FR determinou a confirmação diagnóstica em maior número de gestantes (187; 52,5%) que o TTG50g (49; 13,8%). Esta diferença foi significativa (p<0,05). A associação GJ+FR apresentou sensibilidade de 83,7% e valor preditivo negativo (VPN) de 95,3% em relação ao TTG50g. CONCLUSÕES: os índices elevados de sensibilidade e VPN da associação GJ+FR em relação ao TTG50g, sua simplicidade, praticidade, baixo custo e fácil replicação permitem sua indicação no rastreamento do diabete gestacional.

Cardiotocografia Anteparto e Prognóstico Perinatal em Gestações Complicadas pelo Diabete: Influência do Controle Metabólico Materno

Objetivo: relacionar a qualidade do controle metabólico com os resultados da cardiotocografia (CTG) anteparto e avaliar sua capacidade preditiva no prognóstico perinatal de gestações associadas ao diabete. Pacientes e Métodos: estudo retrospectivo de 125 gestantes, portadoras de diabete gestacional ou clínico, no qual se relacionou a última CTG anteparto (intervalo máximo de 48 horas) à qualidade do controle metabólico materno e aos resultados perinatais. A qualidade do controle metabólico foi definida pela média glicêmica do dia do exame (MGd) e da gestação (MG) e pelo comportamento da requisição de insulina (R/insulina). Para os resultados perinatais foram analisados os índices de Apgar de 1º e 5º minuto, a classificação peso/idade gestacional, o tempo de internação, a necessidade de cuidados de UTI e a ocorrência de óbito neonatal (ONN) precoce. A capacidade diagnóstica da CTG anteparto foi avaliada pelos índices de sensibilidade, especificidade e valor preditivo positivo e negativo. Resultados: a MGd adequada (<120 mg/dL) associou-se a 2,9% dos resultados de CTG anteparto alterados e a inadequada ( > ou = 120 mg/dL), a 26,1% (p<0,005). A MG mantida inadequada se relacionou a 13,7% de CTG anteparto alterada e a adequada, a apenas 2,7% (p<0,005). O comportamento da requisição de insulina não interferiu nos resultados da CTG anteparto. Os índices de Apgar de 1º e 5º minuto, a necessidade de cuidados de UTI e a ocorrência de ONN precoce não dependeram do último traçado da CTG anteparto. O exame diferenciou o tempo de internação dos recém-nascidos: quando normal, 46,4% tiveram alta hospitalar até o 3º dia de vida e, quando alterado, 62,5% deles ficaram internados por mais de sete dias. Conclusões: os resultados alterados da última CTG anteparto relacionaram-se com níveis inadequados de MG, diária e da gestação, e não dependeram da R/insulina. O resultado normal da CTG anteparto foi adequado para garantir a saúde neonatal. Ao contrário, os resultados alterados indicaram risco de complicações nos filhos de mães diabéticas.

Malformação arteriovenosa uterina após doença trofoblástica gestacional

OBJETIVO: investigar a presença e resultados de malformações vasculares uterinas (MAVU) após doença trofoblástica gestacional (DTG). MÉTODOS: estudo retrospectivo com inclusão de casos diagnosticados entre 1987 e 2004; 2764 pacientes após DTG foram acompanhadas anualmente com ultra-sonografia transvaginal e Doppler colorido no Centro de Neoplasia Trofoblástica Gestacional da Santa Casa da Misericórdia (Rio de Janeiro, RJ, Brasil). Sete pacientes tiveram diagnóstico final de MAVU baseado em análise ultra-sonográfica - índice de pulsatilidade (IP), índice de resistência (IR) e velocidade sistólica máxima (VSM) - e achados de imagens de ressonância nuclear magnética (RNM). Dosagens negativas de beta-hCG foram decisivas para estabelecer o diagnóstico diferencial com DTG recidivante. RESULTADOS: a incidência de MAVU após DTG foi 0,2% (7/2764). Achados ultra-sonográficos de MAVU: IP médio de 0,44±0,058 (extremos: 0,38-0,52); IR médio de 0,36±0,072 (extremos: 0,29-0,50); VSM média de 64,6±23,99 cm/s (extremos: 37-96). A imagem de RNM revelou útero aumentado, miométrio heterogêneo, espaços vasculares tortuosos e vasos parametriais com ectasia. A apresentação clínica mais comum foi hemorragia transvaginal, presente em 52,7% (4/7) dos casos. Tratamento farmacológico com 150 mg de acetato de medroxiprogesterona foi empregado para controlar a hemorragia, após a estabilização hemodinâmica. Permanecem as pacientes em seguimento, assintomáticas até hoje. Duas pacientes engravidaram com MAVU, com gestações e partos exitosos. CONCLUSÃO: presente sangramento transvaginal em pacientes com beta-hCG negativo e história de DTG, deve-se considerar a possibilidade de MAVU e solicitar avaliação ultra-sonográfica com dopplervelocimetria. O tratamento conservador é a melhor opção na maioria dos casos de MAVU pós-DTG.