A brief acconunt of the origin and progress of the patent syringe or stomach pump and lavement apparatus ... /

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Análise da eficácia de um refrigerador doméstico com condensador modificado: revestimento com meio poroso dissipativo

The development of home refrigerators generally are compact and economic reasons for using simplified configuration. The thermodynamic coefficient of performance ( COP ) is limited mainly in the condenser design for reasons of size and arrangement ( layout ) of the project ( design ) and climatic characteristics of the region where it will operate. It is noteworthy that this latter limitation is very significant when it comes to a country of continental size like Brazil with diverse climatic conditions. The COP of the cycle depends crucially on the ability of heat dissipated in the condenser. So in hot climates like the northeast, north, and west-central dispel ability is highly attenuated compared to the south and southeast regions with tropical or subtropical climates when compared with other regions. The dissipation in compact capacitors for applications in domestic refrigeration has been the focus of several studies, that due to its impact on reducing costs and power consumption, and better use of the space occupied by the components of refrigeration systems. This space should be kept to a minimum to allow an increase in the useful storage volume of refrigerator without changing the external dimensions of the product. Due to its low cost manufacturing, wire on tube condensers continue to be the most advantageous option for domestic refrigeration. Traditionally, these heat exchangers are designed to operate under natural convection. Not always, the benefits of greater compactness of capacitors for forced outweigh the burden of pumping air through the external heat exchanger. In this work we propose an improvement in convective condenser changing it to a transfer mechanism combined in series with conductive pipes and wire to a moist convective porous medium and the porous medium to the environment. The porous media used in the coating was composed of a gypsum plaster impregnated fiber about a mesh of natural cellulosic molded tubular wire mesh about the original structure of the condenser , and then dried and calcined to greater adherence and increased porosity. The proposed configuration was installed in domestic refrigeration system ( trough ) and tested under the same conditions of the original configuration . Was also evaluated in the dry condition and humidified drip water under natural and forced with an electro - fan ( fan coil ) convection. Assays were performed for the same 134- refrigerant charge e under the same thermal cooling load. The performance was evaluated in various configurations, showing an improvement of about 72 % compared with the original configuration proposed in humidification and natural convection.

Características psicológicas do paciente obeso grave e suas implicações pós-operatórias na cirurgia bariátrica

Obesity is a chronic disease that has multi-factorial aetiology, characterized by high degree of body fat; the degree of obesity will vary according to the Body Mass Index (BMI=m2 /kg). The severe degree of obesity is characterized by BMI>40 and it is regularly associated to endocrine-metabolic or mechanic clinical alterations, and to psychological disorders. Binge Eating (BE) results were overly high for this population. The Bariatric Surgery has been the treatment chosen by those diagnosed with severe obesity as this intervention provides prompt outcomes for loss of weight and clinical improvement conditions. However, recent research has acquiesced that after two years between 20% and 30% of people subject to this intervention gained weight. The main objective of this research is to assess the psychological and behavioral characteristics of those diagnosed with severe obesity that have been subject to Gastric Bypass Surgery in the past 24 months. Specific aspects were investigated: (1) characteristics of different personalities and diagnose of clinic and personality disorders; (2) BE and its relation with loss of weight; (2) the difference between the groups regarding post-surgery care, e.g. physical activity, psychological and dietician input. Method: 40 adults (women and men) aged 23 and 60 year-old who went through a bariatric surgery in the past 24 months, in the city of Natal-RN (Brazil); they were assembled in two groups n=20, Gain group displaying loss of < 50% of their initial surplus of weight, and the Loss group displaying loss of >50%. The research protocol is made of a socio-demographic questionnaire and 3 psychometric instruments: Rorschach – Comprehensive System; Millon Personality Inventory (MCMI-III); and the Binge Eating Scale (Escala de Compulsão Alimentar Periódica (ECAP). Through Rorschach significant differences between these groups were verified according to the kind of personality (EB) - more EB Extratensivo in Gain group and Intratensivo in Loss group – and the lack of control to express affect, increasing the answer for Color Pure at Group I. Concerning the people standardization, the sample as a whole tends to show psychic pain, denigrated selfperception, high levels of self-criticism, distorted perceptions, vulnerability to develop mood disorders and high scores regarding Suicide. MCMI-III results showed more clinic and personality disorders in Group I: Depressive Disorder and Schizotypal, Anxiety, Dysthymia, Major Depressive Disorder; Thought Disorder, Bipolar- Manic and Posttraumatic Stress Disorder. In relation to ECAP, the results indicated significant differences, showing increased BE results in Gain group. There were found significant differences between BE severity and the presence of clinic and personality disorders. Concerning the post-surgery care, the observed differences are statistically significant regarding physical activities with median-increased differences in Loss group. There is a difference between the initial weight and the time post-surgery, indicating that the higher the initial weight and the time after the surgery the higher the re-gain of weight post-surgery. Finally, the results show that the participants with more than 3 years of surgery will have Clinic and Major Depressive Disorders; Somatoform Disorder; Dysthymia. These results confirm prior studies related to BE post-surgery and re-gain of weight as well as the proneness of clinic disorders in severe obesity people. That means the results reinforce that the surgery process is a facet of the severe obesity treatment. The post-surgery process needs to be the main focus of attention and have a long-term input to sustain the care of the surgery results and the quality of life of the patients.

Obtenção e caracterização de sistemas particulados de quitosana para liberação gástrica de amoxicilina

The infection caused by Helicobacter pylori (H. pylori) is associated with gastroduodenal inflammation can lead to the development of gastritis, gastric or duodenal ulcer and gastric cancer (type 1 carcinogen for stomach cancer). Amoxicillin is used as first-line therapy in the treatment of H. pylori associated to metronidazole or clarithromycin, and a proton pump inhibitor. However, the scheme is not fully effective due to inadequate accumulation of antibiotics in gastric tissue, inadequate efficacy of ecological niche of H. pylori, and other factors. In this context, this study aimed to obtaining and characterization of particulate systems gastrorretentivos chitosan - amoxicillin aiming its use for treatment of H. pylori infections. The particles were obtained by the coacervation method / precipitation using sodium sulfate as precipitating agent and crosslinking and two techniques: addition of amoxicillin during preparation in a single step and the sorption particles prior to amoxycillin prepared by coacervation / precipitation and spray drying. The physicochemical characterization of the particles was performed by SEM, FTIR, DSC, TG and XRD. The in vitro release profile of amoxycillin free and incorporated in the particles was obtained in 0.1 N HCl (pH = 1.2). The particles have higher encapsulation efficiency to 80% spherical shape with interconnected particles or adhered to each other, the nanometric diameter to the systems obtained by coacervation / precipitation and fine for the particles obtained by spray drying. The characterization by FTIR, DSC and XRD showed that the drug was incorporated into the nanoparticles dispersed in the polymeric matrix. Thermal analysis (TG and DSC) indicated that encapsulation provides greater heat stability to the drug. Amoxicillin encapsulated in nanoparticles had slower release compared to free drug. The particles showed release profile with a faster initial stage (burst effect) reaching a maximum at 30 minutes 35% of amoxicillin for the system in 1: 1 ratio relative to the polymer and 80% for the system in the ratio 2: 1. Although simple and provide high encapsulation efficiency of amoxicillin, the process of coacervation, precipitation in one step using sodium sulfate as precipitant / cross-linker must be optimized in order to adjust the release kinetics according to the intended application.

Estratégias tróficas do peixe traíra, Hoplias malabaricus e do peixe cascudo, Hypostomus pusarum do açude Marechal Dutra, Rio Grande do Norte, Brasil

The fish, Hoplias malabaricus (Osteichthyes: Erythrinidae) and armored catfish, Hypostomus pusarum (Loricariidae) are of freshwater origin from the neotropical region, and are considered ecologically and economically of important. This work investigated the trophic strategies, the morphology and histology of the digestive tract of these fish captured from the Marechal Dutra reservoir, Acari, the semiarid region of Rio Grande do Norte, Brazil. A total of 133 individuals of H. malabaricus and 118 specimens of H. pusarum were analyzed. The two study species occupy different levels in the food chain and spatial distribution in the water column of the reservoir. The results of this study are presented in the form of four scientific papers. The first article describes the morphology and histology of the digestive tract and the feeding habits of H. malabaricus (Bloch, 1794). This fish has a short intestine, with an intestinal coefficient of 0.72 ± 0.09. The dietary importance index indicates that H. malabaricus feeds preferentially on animal matter, especially on fish (72.8%) and prawns (27.2%). The histology of its digestive tract confirms the carnivorous feeding habit. The second article discusses about the pioneering work on the feeding strategy and the characterization of anatomy and histology of the digestive tract of H. pusarum. The intestine of this fish is long, with an intestinal coefficient of 10.8±0.7. The dietary importance index indicates that H. pusarum feeds preferentially on organic matter in decomposition (88.7%) and on filamentous microalgae and diatoms (11.3%). The third article compares the morphological aspects of the digestive tract of H. malabaricus and H. pusarum, in relation to their food habits. The arrangement of the digestive organs in both species is directly related to the shape of the peritoneal cavity and the form of the body. The short intestine of H. malabaricus and the long intestine of H. pusarum are associated with their feeding habits. The morphology of the digestive tracts of H. malabaricus and H. pusarum confirm their food habits, carnivorous and detritivorous / herbivorous, respectively. The fourth article discusses the food and reproductive aspects (length and weight, length-weight relationship, type of growth and sex ratio) of H. pusarum. This species has a negatively allometric growth, with the predominance of females in the sampled population. H. malabaricus inhabits the pelagic environment and is a carnivore, while H. pusarum, lives in the benthic environment and is characterized as a detritivore/herbivore. Each species studied shows a very different diet, without trophic competition between them. The morphological and anatomical structures of the digestive tract reflect their feeding strategy.

Análise da expressão dos receptores HER-2 e sua correlação clínica em pacientes com neoplasia gástrica do setor de Oncologia do Hospital de Clínicas da Universidade Federal de Uberlândia-UFU

Introduction: Gastric cancer is currently the fourth higher cancer mortality rate among men in the world and the fifth among women, despite the progressive advances in oncology. The identification of tumor receptors and the development of target-drugs to block them has contributed to increased survival and quality of life of patients, but it becomes important to know the tumor profile of the population being treated, avoiding burdening treatment with examinations and treatments that are not cost-effective. Objective: To evaluate the profile of the population with gastric cancer treated in five years at the Clinical Hospital of the Federal University of Uberlândia and verify the correlation between overexpression of HER-2 receptor with an unfavorable prognosis. Methods: 203 records with gastric cancer were selected through the system database, attending a five-year period, of which 117 paraffin blocks were available for immunohistochemical assessment of HER2 receptor. Results: 2.6% of tumors showed overexpression of HER2, considering for this study two crosses as positive. There was no statistically significant difference in correlation between expression of the HER2 receptor with age, gender, tumor grade, local involvement, Lauren classification, Borrmann classification or staging. Conclusion: For this studied population, we can conclude that there is no need to employ HER2 blockers with high cost as a target-therapy in patients with gastric cancer, since no clinical benefit probably will be obtained due to a low percentage of these patients that demonstrated superexpression of this receptor or even there is no patients with gastric cancer with superexpression of HER2 with more than three crosses of positivity in immunochemistry

Estudio ecográfico del estómago, duodeno proximal y descendente en el perro de raza Bulldog Francés

La exploración ecográfica del tubo digestivo es compleja y debe contemplarse dentro del protocolo diagnóstico de los pacientes con sintomatología digestiva como una técnica complementaria a otras técnicas de diagnóstico por imagen, fundamentalmente de la radiología. Estas técnicas de diagnóstico por la imagen, en un número elevado de casos, serán útiles para la aproximación al diagnóstico de las principales patologías que afectan al tubo digestivo en el perro. La ecografía abdominal requiere una mayor pericia por parte del explorador. La presencia de contenido alimenticio y gas dentro de su luz es una barrera que ha retrasado el uso de esta técnica como herramienta diagnóstica del sistema digestivo. El estudio ecográfico del estómago y duodeno proximal es, por sus características anatómicas y por su posición en abdomen craneal, más compleja que otras estructuras abdominales. Unas condiciones previas adecuadas que preparen el paciente, el desarrollo de protocolos de exploración apropiados y la descripción del patrón ecográfico y establecimiento de las medidas de normalidad para los diferentes pacientes serán imprescindibles para la realización correcta y completa de una ecografía de esta región. El conocimiento de la física del sonido, así como su interacción con las diferentes estructuras del organismo y el reconocimiento de los artefactos ecográficos son fundamentales para poder desarrollar un examen correcto de la cavidad abdominal y más concretamente de esta porción del tubo digestivo...

Investigação experimental das propriedades termofísicas e da convecção forçada de nanofluido de grafeno

This work presents an experimental investigation of thermal hydraulic performance of the nanofluid composed by graphene nanoparticles dispersed in a mixture of water and ethylene glycol at a ratio of 70:30% by volume. The tests were carried out under forced convection inside a circular tube with uniform heat flux on the wall for the laminar-turbulent transition regime. The mass flow rate ranged from 40 to 70 g/s corresponding to Reynolds numbers between 3000 and 7500. The heat flux was maintained constant at values of 11, 16 and 21 kW/m², as well as the inlet temperature of 15, 20 and 25°C. Three samples were produced with the nanofluid volumetric concentration of 0.05%, 0.10% and 0.15%. Thermophysical properties were experimentaly measured for all samples that were critically compared and discussed with theoretical models most commonly used in the literature. Initially, experiments with distilled water confirmed the validity of the experimental equipment for the thermo-hydraulic tests. Therefore, nanofluid samples that showed the highest thermal conductivity, corresponding to the volumetric concentrations of 0.15% and 0.10%, were subjected to the tests. The thermal-hydraulic performance for both samples was unsatisfactory. The heat transfer coefficients for convection of nanofluids reduced 21% in average, for the sample with = 0.15% and 26% and for =0.10%. The pressure drop of the samples was higher than the base fluid. Finally, the pressure drop and heat transfer coefficient by convection of both samples were also compared to theoretical models. The models used for pressure drop showed an excellent agreement with experimental results, which is remarkable considering the transitional flow.

Las estatuas-menhir noroccidentales en contexto: conectividad y conexiones materiales durante el Bronce Tardío/Final

Este artículo analiza las estatuas-menhir noroccidentales que se distribuyen en el área comprendida entre los valles del río Duero y el río Miño, pero que descubrimientos recientes han extendido a regiones fuera de este área nuclear. Partiendo de tres aspectos claves para su interpretación (la cronología, su relación con el paisaje y su sentido iconográfico), se examinan las relaciones entre estas formas materiales y un paisaje socio-material de acción específico (las formas socio-materiales de interacción propias del Bronce final atlántico). Para ello, se tiene en cuenta diferentes conexiones materiales (presencia, encuentro, coexistencia, hibridación, etc.) que permiten contextualizar las estatuasmenhir dentro de un proceso histórico particular: la integración del noroeste de la península Ibérica en un contexto de relaciones mediterráneo-atlánticas, en la segunda mitad del II milenio a.C.

Gestação após gastroplastia para tratamento de obesidade mórbida: série de casos e revisão da literatura

Objetivo: relatar a evolução de uma série de casos de gestação em mulheres previamente submetidas à cirurgia de bypass gástrico para tratamento de obesidade grave. Métodos: cinco casos consecutivos de gravidez após gastroplastia ocorridos entre 2001 e 2004 foram avaliados. As pacientes tinham idade entre 30 e 34 anos e todas haviam sido submetidas à cirurgia de Capella. Aspectos clínicos, laboratoriais e do acompanhamento materno e fetal foram considerados, durante o período gestacional e após o parto. Foi realizada revisão da literatura internacional, por meio das bases de dados MEDLINE e Web of Science, utilizando os seguintes unitermos: gastroplasty, gastric bypass surgery, bariatric surgery e pregnancy. Resultados: todas as gestações observadas foram únicas e não ocorreram complicações obstétricas, durante o seguimento pré-natal e parto. Também não houve registro de recém-nascidos prematuros ou de baixo peso ao nascimento. Conclusão: nossos dados sugerem que a gravidez após gastroplastia é segura para a mãe e feto. Entretanto, em virtude do limitado volume de informação disponível sobre o tema, investigações adicionais são necessárias para estabelecer recomendações apropriadas com relação ao seguimento dessas gestações _________________________________________________ABSTRACT Purpose: we report a small series of pregnant women who underwent gastric bypass surgery for severe obesity, with a review of the literature on this topic. Methods: five consecutive cases of pregnancy after gastroplasty between 2001 and 2004 were evaluated, and clinical, laboratory and therapeutic features were considered. Patients were 30 to 34 years old and all had been submitted to gastroplasty by the Capella technique. The outcomes for both the pregnant woman and the fetus were evaluated. A search of the English language literature was done through MEDLINE and Web of Science databases with the following terms: gastroplasty, gastric bypass surgery, bariatric surgery, and pregnancy. Results: all 5 pregnancies were singleton. No major obstetric complications were observed and there were no premature or lowbirth weight infants. Conclusion: our data suggest that pregnancy following gastroplasty is safe for mother and fetus. However, since information about this topic is limited, further investigations are required to establish appropriate recommendations concerning the follow-up of these pregnancies

Síndromes de polinização ocorrentes em uma área de Mata Atlântica, Paraíba, Brasil

ARAUJO, Afranio Cesar de et al. Síndromes de polinização ocorrentes em uma área de Mata Atlântica, Paraíba, Brasil. Biotemas, Florianopolis, v. 4, n. 22, p.83-94, dez. 2009. Disponível em: . Acesso em: 04 out. 2010.

Ontogenia del sistema digestivo y caracterización de la actividad enzimática de las larvas de chita Anisotremus scapularis (Tschudi, 1846)

La chita Anisotremus scapularis es un pez marino que habita las costas de Perú, es muy valorado para el consumo humano directo, y, es considerada una especie con potencial acuícola. El cultivo larval en muchas especies de peces marinos se considera como uno de los cuellos de botella para el desarrollo de la tecnología de cultivo a escala comercial, este es el caso de la chita. Como primer alimento y durante los primeros días de vida de las larvas se les suministra presas vivas, y posteriormente, cuando poseen un sistema digestivo más desarrollado, se les suministra alimento balanceado. Sin embargo, los alimentos vivos más empleados no satisfacen los requerimientos nutricionales de las larvas convirtiéndose en un punto crítico. Es por ello, que en los últimos años diversas investigaciones han concentrado sus esfuerzos en la sustitución del alimento vivo por alimento balanceado; no obstante, esto exige un buen conocimiento de la organización y funcionalidad del sistema digestivo. En este sentido, en el presente trabajo se investigan algunos aspectos de la fisiología nutricional de las larvas de chita durante los primeros 30 días de vida. Las larvas fueron cultivadas a partir de huevos obtenidos de desoves naturales de un lote de reproductores mantenidos en cautiverio en el Laboratorio de Cultivo de Peces del Instituto del Mar del Perú (IMARPE). El estudio del crecimiento en longitud, los análisis histológicos y la caracterización enzimática se realizaron a partir de muestras de larvas colectadas a los 0, 1, 2, 3, 4, 6, 8, 10, 14, 18, 22, 26 y 30 días después de la eclosión (DDE). Para los análisis histológicos, las larvas fueron sometidas a un proceso de deshidratación e inclusión en parafina, y teñidos utilizando la técnica de hematoxilina-eosina. La cuantificación de las enzimas digestivas de la chita, proteasas totales (ácidas y alcalinas), tripsina, leucina aminopeptidasa, lipasas dependientes de sales biliares y alfa-amilasa se llevó a cabo con técnicas espectrofotométricas. Al momento de la eclosión, las larvas poseen un tubo digestivo recto e histológicamente indiferenciado ubicado dorsalmente con respecto al saco vitelino, que se caracteriza por poseer una gota de aceite. Entre los 2 y 4 DDE, se observaron los mayores cambios en el desarrollo del sistema digestivo, entre los más importantes están la diferenciación de la bucofaringe, esófago e intestino, plegamiento de la mucosa intestinal, la formación de las microvellosidades en los enterocitos y el desarrollo de sus glándulas anexas, hígado y páncreas, los cuales permitieron la ingestión, digestión y absorción de los primeros alimentos exógenos ingeridos por las larvas. El mayor cambio que se observó en días posteriores fue la observación de un estómago en desarrollo, con la diferenciación de las glándulas gástricas (26 DDE). Las enzimas digestivas analizadas, fueron detectadas desde el momento de la eclosión de las larvas, antes de la apertura de la boca, y se incrementaron con la edad de los organismos. En general, se observó incrementos en la actividad total de las enzimas digestivas a partir de los 8 y 10 DDE o a los 4 mm de longitud total (LT), particularmente con aumentos más marcados en la actividad de las lipasas y de la leucina aminopeptidasa. Para la actividad de proteasas alcalinas totales, tripsina y alfa-amilasa, los aumentos fueron evidentes a partir de los 22 DDE o entre 6 y 7 mm de LT. La actividad de las proteasas ácidas se evidenció e incrementó a partir del 26 DDE o a los 9 mm de LT. En cuanto los patrones de actividad específica, en general, se observaron incrementos súbitos de la actividad que se relacionan con los periodos de transición de la alimentación endógena a exógena (3-6 DDE), y con el cambio de alimentación de rotíferos a metanauplios de Artemia (26 DDE). También, exceptuando la actividad de la leucina aminopeptidasa, se observaron estos incrementos súbitos antes de la primera alimentación. Con base al análisis histológico y bioquímico de las larvas de chita, se recomienda iniciar el destete a los 26 DDE.

Biodistribution of technetium-99m pertechnetate after Roux-en-Y gastric bypass (Capella technique) in rats

The biodistribution of sodium pertechnetate, the most used radiopharmaceutical in nuclear medicine, has not been studied in details after bariatric surgery. The objective was to investigate the effect of Roux-en-Y gastric bypass (RYGB) on biodistribution of sodium pertechnetate (Na99mTc-) in organs and tissues of rats. Methods: Twelve rats were randomly divided into two groups of 6 animals each. The RYGB group rats were submitted to the Roux-en-Y gastric bypass and the control group rats were not operated. After 15 days, all rats were injected with 0.1mL of Na99mTc- via orbital plexus with average radioactivity of 0.66 MBq. After 30 minutes, liver, stomach, thyroid, heart, lung, kidney and femur samples were harvested, weighed and percentage of radioactivity per gram (%ATI/g) of each organ was determined by gama counter Wizard Perkin-Elmer. We applied the Student t test for statistical analysis, considering p<0.05 as significant. Results: Significant reduction in mean %ATI/g was observed in the liver, stomach and femur in the RYGB group animals, compared with the control group rats (p<0.05). In other organs no significant difference in %ATI/g was observed between the two groups. Conclusion: This work contributes to the knowledge that the bariatric surgery RYGB modifies the pattern of biodistribution of Na99mTc

Biodistribution of the Radiopharmaceutical Sodium Pertechnetate after Biliopancreatic Bypass with a Duodenal Switch

Study with the purpose to examine the effects of duodenal switch (DS), regularly performed in morbidly obese patients, on biodistribution of sodium pertechnetate in several organs of rats. There was no early or late mortality in either rats groups. The values of percent radioactivity per gram of tissue (%ATI/g), showed no significant difference in liver, stomach, small bowel, duodenum, kidney, heart, bladder, bone and brain, when compared the DS rats with sham and controls rats. A postoperative significant increase (p<0.05) in mean %ATI/g levels was observed in spleen, pancreas and muscle in group DS rats, as compared to group S and C rats. In the lung there was an increase and in thyroid a decrease in mean %ATI/g of DS rats, when compared to sham rats (p<0.05). In conclusion, the biliopancreatic diversion with duodenal switch in rats modified the biodistribution of sodium pertechnetate in thyroid, lung, pancreas, spleen and muscle

Gestação após gastroplastia para tratamento de obesidade mórbida: série de casos e revisão da literatura

relatar a evolução de uma série de casos de gestação em mulheres previamente submetidas à cirurgia de bypass gástrico para tratamento de obesidade grave. Métodos: cinco casos consecutivos de gravidez após gastroplastia ocorridos entre 2001 e 2004 foram avaliados. As pacientes tinham idade entre 30 e 34 anos e todas haviam sido submetidas à cirurgia de Capella. Aspectos clínicos, laboratoriais e do acompanhamento materno e fetal foram considerados, durante o período gestacional e após o parto. Foi realizada revisão da literatura internacional, por meio das bases de dados MEDLINE e Web of Science, utilizando os seguintes unitermos: gastroplasty, gastric bypass surgery, bariatric surgery e pregnancy. Resultados: todas as gestações observadas foram únicas e não ocorreram complicações obstétricas, durante o seguimento pré-natal e parto. Também não houve registro de recém-nascidos prematuros ou de baixo peso ao nascimento. Conclusão: nossos dados sugerem que a gravidez após gastroplastia é segura para a mãe e feto. Entretanto, em virtude do limitado volume de informação disponível sobre o tema, investigações adicionais são necessárias para estabelecer recomendações apropriadas com relação ao seguimento dessas gestações