Transfusão de concentrado eritrocitário em Recém-Nascidos de Muito Baixo Peso e/ou Idade Gestacional menor ou igual a 32 semanas – experiência de 4 anos de uma Unidade de Cuidados Intensivos Neonatais

Introdução: A anemia é um problema frequente nos recém-nascidos (RN) pré-termo e a transfusão de concentrado eritrocitário (CE) é o tratamento mais rápido e eficaz. Objetivos: Verificar se a política transfusional da unidade de Neonatologia esteve de acordo com os Consensos Nacionais de Anemia da Prematuridade de 2004 e avaliar a morbilidade dos RN transfundidos e não transfundidos. Material e Métodos: Estudo retrospetivo de RN com peso à nascença (PN) ≤1500g e/ou idade gestacional (IG) ≤32 semanas (janeiro 2010-dezembro 2013). Os RN foram agrupados de acordo com a realização de CE durante o internamento (grupo transfundido vs não transfundido). As variáveis demográficas foram: idade gestacional (IG), PN, género e índice de Apgar <7 ao 1º e 5º minuto. A comorbilidade incluiu displasia broncopulmonar (DBP), sépsis, persistência canal arterial (PCA), enterocolite necrosante, hemorragia peri-intraventricular (HPIV), leucomalácia periventricular (LPV) e retinopatia da prematuridade. Resultados: Foram incluídos 160 doentes: 88 realizaram pelo menos uma transfusão e 72 não realizaram transfusões. O grupo transfundido tinha menor IG e PN e maior duração de internamento. As transfusões de CE foram realizadas com valores médios de hemoglobina superiores nas situações de ventilação invasiva e menor idade pós-menstrual. A prevalência de DBP, sépsis, PCA, HPIV e LPV foi estatisticamente maior no grupo transfundido. Discussão e Conclusão: O tratamento da anemia nos prematuros de menor IG e PN associou-se a maior número de transfusões de CE. Os critérios transfusionais aplicados estiveram de acordo com os consensos nacionais de Neonatologia de 2004. O grupo transfundido teve maior prevalência de comorbilidade.

Anemia na doença inflamatória intestinal

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Síndrome torácica aguda : a propósito de um caso clínico

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

A desregulação da homeostase do ferro: base molecular e patologias associadas

A homeostase do ferro requer um rigoroso processo de regulação, uma vez que este é um elemento essencial para alguns dos mecanismos celulares básicos mas, quando se encontra em excesso, origina profundos danos celulares e falha de órgãos. Dado que o organismo humano não possui um mecanismo ativo de excreção de ferro, é essencial que a sua homeostase seja estabelecida através de uma estreita comunicação entre os locais de absorção, utilização e armazenamento. Esta interligação é conseguida, essencialmente, através da ação de uma hormona circulante, a hepcidina. A hepcidina é sintetizada ao nível dos hepatócitos do fígado, sendo a sua expressão aumentada pelos níveis de ferro e inflamação e suprimida pela eritropoiese e hipoxia. A hepcidina regula negativamente a absorção duodenal do ferro proveniente da alimentação, a libertação pelos macrófagos do ferro resultante da fagocitose dos glóbulos vermelhos senescentes, assim como a libertação do ferro armazenado nos hepatócitos. A hemocromatose hereditátria (HH) do tipo 1 é uma doença de transmissão autossómica recessiva associada a mutações no gene HFE (p.Cys282Tyr e p.His63Asp). É a patologia humana mais comum de sobrecarga primária em ferro, apresenta penetrância incompleta, e é um dos distúrbios genéticos mais frequentes em caucasianos de ascendência Norte-Europeia. Na hemocromatose, apesar de haver um excesso de ferro no organismo, este facto não é refletido no nível de expressão da hormona hepcidina (cujos níveis deveriam aumentar). Pelo contrário, o nível de expressão da hepcidina encontra-se diminuído o que perpetua a constante absorção do ferro a nível duodenal. Os sintomas associados à doença iniciam-se geralmente na meia-idade e começam por consistir em sintomas gerais de fadiga e dores articulares. No entanto, a progressiva acumulação do ferro em vários órgãos (tais como fígado, coração e pâncreas) provoca aí graves danos, tais como cirrose, carcinoma hepatocelular, cardiomiopatias e diabetes. Para além da HH do tipo 1, podem ocorrer outros tipos de hemocromatose por mutações noutros genes relacionados com o metabolismo do ferro (tais como TFR2, HJV, HAMP, SLC40A1, etc). Mutações em genes como HAMP e HJV associam-se a hemocromatoses mais graves, de início ainda na juventude (hemocromatose juvenil). A implementação no nosso laboratório da nova metodologia de Next-Generation Sequencing permitiu-nos realizar a pesquisa de variantes simultaneamente em 6 genes relacionados com o metabolismo do ferro, em 88 doentes com fenótipo de hemocromatose hereditária não-clássica. Foram identificadas 54 variantes diferentes sendo algumas delas novas. Estudos in silico e estudos funcionais in vitro (em linhas celulares) permitiram-nos comprovar a patogenicidade de algumas das variantes novas e compreender os mecanismos moleculares subjacentes ao desenvolvimento da sobrecarga em ferro. Pelo contrário, no lado oposto do espetro das patologias relacionadas com o ferro, encontram-se as anemias por falta de ferro (anemias ferropénicas). A Organização Mundial de Saúde define anemia quando os níveis de hemoglobina no sangue são menores do que 12 g/dL na Mulher e 13 g/dL no Homem. A hemoglobina é a proteína existente nos glóbulos vermelhos do sangue, responsável pelo transporte de oxigénio no organismo, e cuja molécula é um tetrâmero formado por 4 cadeias polipeptídicas (as globinas) e 4 grupos heme que contêm 4 átomos de ferro. A falta de ferro impede que se formem as moléculas de hemoglobina a níveis normais em cerca de 20% da população portuguesa e isso é devido a carências alimentares ou a dificuldades na absorção do ferro proveniente da alimentação. Entre os fatores genéticos moduladores desta última situação parecem estar algumas variantes polimórficas no gene TMPRSS6, codificante da proteína Matriptase-2, um dos agentes envolvidos na regulação da expressão da hepcidina. Por outro lado, mutações neste gene dão origem a anemias ferropénicas graves, refratárias ao tratamento oral com ferro (Iron Refractory Iron Deficiency Anaemia - IRIDA). As Hemoglobinopatias são outro tipo de anemia hereditária. Estas não estão relacionadas com o défice de ferro mas sim com defeitos nas cadeias globínicas, constituintes da hemoglobina (α2β2). As hemoglobinopatias que estão relacionadas com um problema quantitativo, ou seja quando há ausência ou diminuição de síntese de uma cadeia globínica, denominam-se talassémias: beta-talassémia, alfa-talassémia, delta-talassémia, etc, consoante o gene afetado. Por outro lado, quando o problema é de carácter qualitativo, ou seja ocorre a síntese de uma cadeia globínica estruturalmente anómala, esta é denominada uma variante de hemoglobina. Enquadra-se neste último grupo a Anemia das Células Falciformes ou Drepanocitose. As hemoglobinopatias são das patologias genéticas mais frequentes no mundo, sendo que nalguns locais são um grave problema de saúde pública. Em Portugal foram realizados estudos epidemiológicos que permitiram determinar a frequência de portadores na população e foi implementado um programa de prevenção.

Alimentacao saudavel em dias de sol

Informação sobre medidas a ter para uma alimentação saudável com o aumento do calor e da exposição solar.

Avaliação da influência de cinza da casca de arroz em cimentos para poços de petróleo submetidos à injeção de vapor

Reservoirs that present highly viscous oils require methods to aid in their recovery to the surface. The elev ated oil viscosity hinders its flow through porous media and conventional recovery methods have not obtained significant efficiency. As such, the injection of steam into the reservoir through an injection well has been the most widely used method of therma l recovery, for it allows elevated volumes of recovery due to the viscosity reduction of the oil, facilitating the oil’s mobility within the rock formation and consequently into the production well where it will be exploited. On the other hand, the injecti on of vapor not only affects the fluids found in the rock pores, but the entire structure that composes the well where it is injected due to the high temperatures used in the process. This temperature increment is conducted to the cement, found in the annu lus, responsible for the isolation of the well and the well casing. Temperatures above 110 ̊C create new fazes rich in calcium in the cement matrix, resulting in the reduction of its permeability and the consequential phenomenon of mechanical resistance ret rogression. These alterations generate faults in the cement, reducing the well’s hydraulic isolation, creating insecurity in the operations in which the well will be submitted as well as the reduction of its economic life span. As a way of reducing this re trograde effect, this study has the objective of evaluating the incorporation of rice husk ash as a mineral additive substitute of silica flour , commercially utilized as a source of silica to reduce the CaO/SiO 2 ratio in the cement pastes submitted to high temperatures in thermal recovery. Cement pastes were formulated containing 20 and 30% levels of ash, apart from the basic paste (water + cement) and a reference paste (water + cement + 40% silica flour) for comparison purposes. The tests were executed th rough compression resistance tests, X - Ray diffraction (XRD) techniques, thermogravimetry (TG), scanning electron microscopy (SEM) and chemical anal ysis BY X - ray fluorescence (EDS) on the pastes submitted to cure at low temperatures (45 ̊C) for 28 days following a cure at 280 ̊C and a pressure of 2,000 PSI for 3 days, simulating vapor injection. The results obtained show that the paste containing 30% r ice shell ash is satisfactory, obtaining mechanical resistance desired and equivalent to that of the paste containing 40% silica flour, since the products obtained were hydrated with low CaO/SiO 2 ratio, like the Tobermorita and Xonotlita fases, proving its applicability in well subject to vapor injection.

Obtenção de extratos da Opuntia fícus-indica L. Mill e suas aplicações em formulações cosméticas: avaliação in vivo do sensorial e da eficácia hidratante

Opuntia fícus - indica (L.) Mill is a cactacea presents in the Caatinga ecosystem and shows in its chemical c omposition flavonoids, galacturonic acid and sugars. Different hydroglicolic (EHG001 and EHG002) and hydroethanolic subsequently lyophilized (EHE001 and EHE002) extracts were developed. The EHE002 had his preliminary phytochemical composition investigated by thin layer chromatography (TLC) and we observed the predominance of flavonoids. Different formulations were prepared as emulsions with Sodium Polyacrylate (and) Hydrogenated Polydecene (and) Trideceth - 6 (Rapithix® A60), and Polyacrylamide (and) C13 - 14 I soparaffin (and) Laureth - 7 (Sepigel® 305), and gel with Sodium Polyacrylate (Rapithix® A100). The sensorial evaluation was conducted by check - all - that - apply method. There were no significant differences between the scores assigned to the formulations, howe ver, we noted a preference for those formulated with 1,5% of Rapithix® A100 and 3,0% of Sepigel® 305. These and the formulation with 3% Rapithix® A60 were tested for preliminary and accelerated stability. In accelerated stability study, samples were stored at different temperatures for 90 days. Organoleptic characteristics, the pH values and rheological behavior were assessed. T he emulsions formulated with 3,0% of Sepigel® 305 and 1,5% of Rapithix® A60 w ere stable with pseudoplastic and thixotropic behavior . The moisturizing clinical efficacy of the emulsions containing 3,0% of Sepigel® 305 containing 1 and 3% of EHG001 was performed using the capacitance method (Corneometer®) and transepidermal water lost – TEWL evaluation ( Tewameter®). The results showed t hat the formulation with 3% of EHG001 increased the skin moisturizing against the vehicle and the extractor solvent formulation after five hours. The formulations containing 1 and 3% of EHG001 increased skin barrier effect by reducing transepidermal water loss up to four hours after application.

Avaliação de compatibilidade entre pasta de cimento e fluido de perfuração não-aquoso utilizados em poços petrolíferos

Compatibility testing between a drilling fluid and a cement slurry is one of the steps before an operation of cementing oil wells. This test allows us to evaluate the main effects that contamination of these two fluids may cause the technological properties of a cement paste. The interactions between cement paste and drilling fluid, because its different chemical compositions, may affect the cement hydration reactions, damaging the cementing operation. Thus, we carried out the study of the compatibility of non-aqueous drilling fluid and a cement slurry additives. The preparation procedures of the non-aqueous drilling fluid, the cement paste and completion of compatibility testing were performed as set out by the oil industry standards. In the compatibility test is evaluated rheological properties, thickening time, stability and compressive strength of cement pastes. We also conducted analyzes of scanning electron microscopy and X-ray diffraction of the mixture obtained by the compatibility test to determine the microstructural changes in cement pastes. The compatibility test showed no visual changes in the properties of the cement paste, as phase separation. However, after the addition of nonaqueous drilling fluid to cement slurry there was an increased amount of plastic viscosity, the yield point and gel strength. Among the major causative factors can include: chemical reaction of the components present in the non-aqueous drilling fluid as the primary emulsifier, wetting agent and paraffin oil, with the chemical constituents of the cement. There was a reduction in the compressive strength of the cement paste after mixing with this drilling fluid. Thickening test showed that the oil wetting agent and high salinity of the non-aqueous fluid have accelerating action of the handle of the cement paste time. The stability of the cement paste is impaired to the extent that there is increased contamination of the cement slurry with the nonaqueous fluid. The X-ray diffraction identified the formation of portlandite and calcium silicate in contaminated samples. The scanning electron microscopy confirmed the development of the identified structures in the X-ray diffraction and also found the presence of wells in the cured cement paste. The latter, formed by the emulsion stability of the drilling fluid in the cement paste, corroborate the reduction of mechanical strength. The oil wetting agent component of the non-aqueous drilling fluid, the modified cement hydration processes, mainly affecting the setting time.

Estudo da influência dos genes LRP5, TGFB1, IGF1 e IGF1R no metabolismo ósseo de pacientes com diabetes mellitus tipo 1

Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq

Influência do tempo de adição do policarboxilato em pastas de cimento Portland para cimentação de poços petrolíferos

Cement pastes used in cementing oil wells operations are prepared according to the specific characteristics of each well. The physical properties requested for each folder formulation depend on the temperature and pressure of the well to be cemented. The rheological properties of the pulp are important control parameter for efficiency in transportation and positioning the folder during the cementing operation. One of the main types of additive used for the adjustment of rheological properties of cement pastes is the dispersant additive. This work aims to study the influence of variation of the time of addition of the polycarboxylate (0, 5, 10 and 15 minutes) in cement pastes, considering the initial periods of hydration of cement particles as fundamental point for better performance dispersant additive. Pastes were prepared with a density set at 15.6 lb/gal (1.87 g/cm3) and polycarboxylate concentrations ranging from 0.01 gpc to 0.05 gpc circulation temperature (BHCT) of 51°C and static temperature (BHST) of 76 C. The pastes were characterized from a rheological measurements, volume filtered, thickening time and resistance to compression formulations. Also were carried out tests Diffraction X-ray (XRD) and Scanning Electron Microscopy (MEV). The results showed that the addition of policaboxilato after 15 minutes decreased by 70% the values of rheological parameters. According to results of DRX and MEV, the addition of dispersant after 15 minutes did not affect the chemical reactions and subsequent formation of cement hydration products. A study of the economic feasibility to realize the financial benefits of the technique, which can be seen only with the use of the technique in this work to reduce the cost of production of cement paste was carried out, can get up to $ 1015.00 for each folder 100 barrels produced with said formulations.

Influência do tempo de adição do policarboxilato em pastas de cimento Portland para cimentação de poços petrolíferos

Cement pastes used in cementing oil wells operations are prepared according to the specific characteristics of each well. The physical properties requested for each folder formulation depend on the temperature and pressure of the well to be cemented. The rheological properties of the pulp are important control parameter for efficiency in transportation and positioning the folder during the cementing operation. One of the main types of additive used for the adjustment of rheological properties of cement pastes is the dispersant additive. This work aims to study the influence of variation of the time of addition of the polycarboxylate (0, 5, 10 and 15 minutes) in cement pastes, considering the initial periods of hydration of cement particles as fundamental point for better performance dispersant additive. Pastes were prepared with a density set at 15.6 lb/gal (1.87 g/cm3) and polycarboxylate concentrations ranging from 0.01 gpc to 0.05 gpc circulation temperature (BHCT) of 51°C and static temperature (BHST) of 76 C. The pastes were characterized from a rheological measurements, volume filtered, thickening time and resistance to compression formulations. Also were carried out tests Diffraction X-ray (XRD) and Scanning Electron Microscopy (MEV). The results showed that the addition of policaboxilato after 15 minutes decreased by 70% the values of rheological parameters. According to results of DRX and MEV, the addition of dispersant after 15 minutes did not affect the chemical reactions and subsequent formation of cement hydration products. A study of the economic feasibility to realize the financial benefits of the technique, which can be seen only with the use of the technique in this work to reduce the cost of production of cement paste was carried out, can get up to $ 1015.00 for each folder 100 barrels produced with said formulations.

Pirometamorfismo em calcários da formação Jandaíra, bacia potiguar, nordeste do Brasil

The present study aims the characterization of thermally affected carbonate rocks from Jandaíra Formation in contact with Paleogene and Neogene basic intrusions in the region of the Pedro Avelino and Jandaíra municipalities (RN), northeastern Brazil. For this study, field, petrographic, x-ray diffraction, electron microprobe, and whole rock litogeochemistry data of carbonates were undertaken. The thermally unaffected limestones are classified like wackstones, grainstones and packstones. They may constitute carbonates grains of benthic foraminifera, echinoderm spines, ostracods, algae, corals, bivalves, gastropods, peloids and intraclasts. The porosities are classified like vug, intraparticle, interparticle, intercrystal and moldic types. The major minerals are calcite, ankerite and dolomite; the detrital are montmorillonite, pyrite, limonite, quartz and microcline. The thermally affected limestones are very coarse to very fine-grained and light to dark gray color. The fossiliferous components totally disappear, and the porosity tends to disappear. With the data obtained, it can be inferred that the carbonate protoliths would be calciferous to dolomitic limestones, both with small amount of clay minerals. Crystalline carbonates from dolomitic protolith have rhombohedral calcite and iron oxides / hydroxides, making the rocks much darker. The carbonates from calciferous protolith have a wide variation of grain size according to the recrystallization degree, increasing toward contact with the basic bodies. In this group, it was identified the minerals lizardite and spinel in weakly to moderately affected samples, and spinel and spurrite in strongly affected rocks, as well as calcite, that occur everywhere. The geological context (shallow level diabase intrusions), the crystallization of the pyrometamorphic minerals spurrite and olivine, and comparison with diagrams from the literature allow estimating temperatures and pressures around 1050-1200 °C and 0.5-1.0 kbar, respectively, for PTOTAL=PCO2. The post-intrusion cooling would have afforded the releasing of metasomatic / hydrothermal fluids, allowing the opening of the metamorphic system, with possible contribution of chemical elements from host units (sandstones, shales) and from basic intrusions. This would induce hydration of previous phases, allowing the formation of serpentine, chlorite and brucite. The results discussed here reveal the strong influence of the heat from basic intrusions within the sedimentary pile. Whereas in the offshore portion of the basin occur sills with up to 1000 m thickness, the understanding of pyrometamorphism might be useful for understanding and measuring the thermally affected rocks.

Pirometamorfismo em calcários da formação Jandaíra, bacia potiguar, nordeste do Brasil

The present study aims the characterization of thermally affected carbonate rocks from Jandaíra Formation in contact with Paleogene and Neogene basic intrusions in the region of the Pedro Avelino and Jandaíra municipalities (RN), northeastern Brazil. For this study, field, petrographic, x-ray diffraction, electron microprobe, and whole rock litogeochemistry data of carbonates were undertaken. The thermally unaffected limestones are classified like wackstones, grainstones and packstones. They may constitute carbonates grains of benthic foraminifera, echinoderm spines, ostracods, algae, corals, bivalves, gastropods, peloids and intraclasts. The porosities are classified like vug, intraparticle, interparticle, intercrystal and moldic types. The major minerals are calcite, ankerite and dolomite; the detrital are montmorillonite, pyrite, limonite, quartz and microcline. The thermally affected limestones are very coarse to very fine-grained and light to dark gray color. The fossiliferous components totally disappear, and the porosity tends to disappear. With the data obtained, it can be inferred that the carbonate protoliths would be calciferous to dolomitic limestones, both with small amount of clay minerals. Crystalline carbonates from dolomitic protolith have rhombohedral calcite and iron oxides / hydroxides, making the rocks much darker. The carbonates from calciferous protolith have a wide variation of grain size according to the recrystallization degree, increasing toward contact with the basic bodies. In this group, it was identified the minerals lizardite and spinel in weakly to moderately affected samples, and spinel and spurrite in strongly affected rocks, as well as calcite, that occur everywhere. The geological context (shallow level diabase intrusions), the crystallization of the pyrometamorphic minerals spurrite and olivine, and comparison with diagrams from the literature allow estimating temperatures and pressures around 1050-1200 °C and 0.5-1.0 kbar, respectively, for PTOTAL=PCO2. The post-intrusion cooling would have afforded the releasing of metasomatic / hydrothermal fluids, allowing the opening of the metamorphic system, with possible contribution of chemical elements from host units (sandstones, shales) and from basic intrusions. This would induce hydration of previous phases, allowing the formation of serpentine, chlorite and brucite. The results discussed here reveal the strong influence of the heat from basic intrusions within the sedimentary pile. Whereas in the offshore portion of the basin occur sills with up to 1000 m thickness, the understanding of pyrometamorphism might be useful for understanding and measuring the thermally affected rocks.

Resposta clínica periodontal e controle glicêmico em pacientes com e sem diabetes tipo II portadores de periodontite crônica ao tratamento periodontal “full mouth desinfection”

There is a bidirectional association between periodontal disease (PD) and diabetes mellitus, in which diabetes favors the development of PD and PD, if left untreated, can worsen the metabolic control of diabetes. Thus, periodontal disease should be treated to restore periodontal health and reduce the complications of diabetes. Therefore, the objective is assess the effect of full mouth periodontal therapy decontamination (Full Mouth Desinfection - FMD) in diabetic type II patients with chronic periodontitis during 12 months. Thirty-one patients in group one (G1) and 12 in group two (G2) were followed at baseline, 03, 06 09 and 12 months. There following clinical parameters were accessed: probing on bleeding (BOP), visible plaque index (PI), probing depth (PD), clinical attachment level (CAL) and gingival recession (GR). For diabetic patients, there were also made laboratory tests to evaluate blood parameters: fasting glucose and glycated hemoglobin. The results had been analyzed in two ways: all sites in the mouth and another with diseased sites. The Mann-Whitney, Friedman and Wilcoxon tests were used with 5% significance. Intergroup analysis of all sites it is clear that there was no significant difference over time concerning PD, BOP, PI, CAL and RG. However, when evaluating the diseased sites, we observed significant difference for CAL and PD, with higher values in G1. The intragroup analysis for all sites showed a statistically significant reduction at PD, PI and BOP in both groups. Intragroup analysis of periodontal affected sites showed a statistically significant reduction in PD, BOP and CAL in both groups. There was also a statistically significant increase in RG values. There was no significant change concerning glycated hemoglobin and fasting glucose in the G1. Therefore, it can be concluded that there were improvements in periodontal parameters over the 12 months of research, but without changes in glycemic levels of diabetic patients. Thus, periodontal therapy proved effective in maintaining oral health.

Efeito do exercício físico na estabilidade de membrana de eritrócitos

CHAPTER II - This study evaluated the effects of two different types of acute aerobic exercise on the osmotic stability of human erythrocyte membrane and on different hematological and biochemical variables that are associated with this membrane property. The study population consisted of 20 healthy and active men. Participants performed single sessions of two types of exercise. The first session consisted of 60 min of moderate-intensity continuous exercise (MICE). The second session, executed a week later, consisted of high-intensity interval exercise (HIIE) until exhaustion. The osmotic stability of the erythrocyte membrane was represented by the inverse of the salt concentration (1/H50) at the midpoint of the sigmoidal curve of dependence between the absorbance of hemoglobin and the NaCl concentration. The values of 1/H50 changed from 2.29 ± 0.1 to 2.33 ± 0.09 after MICE and from 2.30 ± 0.08 to 2.23 ± 0.12 after HIIE. In MICE has occurred an increase in the mean corpuscular volume, probably due to in vivo lysis of older erythrocytes, with preservation of cells that were larger and more resistant to in vitro lysis. The study showed that a single bout of acute exercise affected the erythrocyte osmotic stability, which increased after MICE and decreased after HIIE.