Redução da mortalidade após implementação de condutas consensuais em pacientes com infarto agudo do miocárdio

OBJETIVO: Comparar a mortalidade em 30 dias com a utilização de determinados grupos de medicamentos por pacientes, entre 1992-1997, quando não se dispunham de condutas consensuais para tratamento do infarto agudo do miocárdio, e de 2000-2002, após a padronização dessas condutas em nosso serviço. MÉTODOS: Avaliados, retrospectivamente, no 1º e 2º períodos, 172 e 143 pacientes respectivamente, admitidos com diagnóstico de infarto agudo do miocárdio: foram realizados os testes estatísticos: c² para comparar proporções, teste t de Student e o de Mann-Whitney para comparação de médias ou medianas. RESULTADOS: A análise não mostrou diferença em relação aos homens, brancos e a idade média de 61 anos, nos dois períodos. Com relação aos fatores de risco clássicos, foi observada diferença apenas na incidência de dislipidemia (17 e 29%) e, quanto à estratégia terapêutica, aumento significativo do uso de: trombolíticos (39 e 61,5%), ácido acetilsalicílico (70,9 e 96,5%), betabloqueadores (34,8 e 67,8%), inibidor da enzima conversora da angiotensina (45,9 e 74,8%), nitratos (61 e 85,3%) e a redução significativa de bloqueadores de cálcio (16,8 e 5,3%), antiarrítmicos (29,1 e 9,7%) e diuréticos (50,6 e 26,6%). O uso de inotrópicos não diferiu entre os períodos (29,6 e 32,1%). A mortalidade em 30 dias apresentou redução estatisticamente significante de 22,7 para 10,5%. CONCLUSÃO: A implementação das condutas consensuais para o tratamento do infarto agudo do miocárdio foi acompanhada por significante redução da taxa de mortalidade em 30 dias.

A produção de biodiesel no assentamento Canudos RN: perspectivas e limites da inclusão social

The need to become energy self-sufficient a country with which Brazil has sought renewable energy sources due to the possibility of depletion of oil in coming decades. This paper will examine the perspective of social inclusion the latest energy plan developed by the Federal Government: the National Program of Biodiesel Production and Use - PNPB. It aims to find out whether that work with family farmers who participated in the PNPB socially included and what limits its inclusion. Secondly, the objective is to analyze the Brazilian biodiesel production and its uses. The methodology used for the preparation of this study was to examine the literature, visits to the study area, conducting interviews with the leadership of the settlement, questionnaires and semi-structured interviews with families producing sunflower. Finally, the research dealt with the statistical data. After analyzing the data was verified that the instrument PNPB is able to promote the social inclusion of family farmers, but this occurred in the initial stages because the families involved need a minimum framework of organization and infrastructure to develop activities related to biodiesel

Educomunicação: uma estratégia para promover o ambiente em uma área de proteção ambiental costeira

This study aimed to evaluate the potential of two public schools in Educommunication related to Environmental Protection Area Jenipabu (APAJ) located in Rio Grande do Norte / Brazil, based on perceptions of educommunicatives practices on the environment as well as perform an action included in the school APAJ. In the first phase of the research were three separate questionnaires designed to identify the actions, practices and experiences of three sets of audiences: teachers, students and parents from both schools. In the second phase, activities were carried out as educomunicatives class actions involving ride, maps of environmental design and construction of a mural on the school newspaper APAJ. We opted for the participant, making the observation in a previous visit to knowledge of the schools, where they made the first contacts with the administrative team, teachers and students, and then the application of semi-structured questionnaire to teachers, students and parents of the 4th and 5 years of elementary school the morning hours. The results showed the detachment of these actors in the knowledge, participation and involvement with APAJ, caused by the absence of actions and actions involving teaching practices educomunicatives students to interact with the environment, taking as its starting point the living space.

Usos potenciais de moringa oleifera lam., uma matriz para produção de biodiesel e tratamento de água no semiárido nordestino

The current environmental crisis demands transformations in the relations among society, nature and development, considering sustainability. In this context, an important theme is replacing fossil fuels with biofuels, such as biodiesel. Moringa oleifera Lam. is a species that can be used as a raw material to produce biodiesel. Besides, it is a multiple purposes plant, which can be used also in water treatment. Thus, the aims of this work were to analyze the anatomical adaptations found in the stem and in the leaf and the seed s oil stores of M. oleifera., to investigate chemical characteristics of M. oleifera s seed oil, considering biodiesel production, and to evaluate the coagulation activity of these seeds in water treatment. Semipermanent histological laminas were made and it follows that the stem has thick cuticle, stomata whose cells guard are below the epidermis line, hollow medulla, druses and tector trichomes as adaptations to climate and soil conditions in which the species is found and the leaf is dorsiventral and it has thick cuticle, tector trichomes and druses. The seed has great reserves of oil. These features favor the use of Moringa oleifera Lam. as a raw material to produce biodiesel in Brazil s Northeast semiarid region. Chemical analysis were made through oil solvent extraction using mechanic stirrer. The oil was analyzed in UV spectrophotometer. A transesterification was made and biodiesel was analyzed in gas chromatography. Oil yield was high and good quality biodiesel was obtained. To evaluate seeds coagulantion activity, coagulation and flocculation essays in jartest were made, using seed extract to treat raw water. Seeds were efficient in cogulation process to treat water. So, they can be used in rudimentary systems or as a raw material to coagulant proteins extraction, as an alternative to traditional coagulants. M. oleifera has characteristics that favor its use to biodiesel production and water treatment

Diretrizes para conservação da espécie Mimosa Caesalpiniifolia Benth., Macaíba-RN

About 40% of the earth is occupied by tropical and subtropical forests, including 42% of dry forests, where there is Caatinga Bioma, contemplating tree forests and shrubs, with xerophytic characteristics. Study and conservations of Caatinga biologic diversity is one of the greatest challenges of Brazilian science because those are, proportionally, the less studied among natural areas, with most of the scientific effort centered in very few points around the main cities in the area and also because it is the less protected natural Brazilian area. The environmental degradation is constantly increasing and has its rhythm accelerated by the men appropriation to meet or not their own needs. Therefore, species conservation should be based in three principles: the use of natural resources by present generation, waste prevention and use of the natural resources to benefit the majority of the citizens. Among the strategies to species conservation, we can mention the ex situ conservation , in which the conservation of genetic resources may be realized outside of the natural environment in which the species occur, and in situ conservation , or, in other words, in the places where the species occur. In ex situ conservation, the germplasm collections are maintained in the field and/or in laboratories (conservation chambers), and this mainly conserves intraspecific diversity (genetic variance), the ex situ collections are continuously enriched by collection activities, introduction and germplasm interchange; the in situ conservation preserving ecosystems and habitats, maintaining and recovering native population of species of interest. So, the objective of this paper is the search for strategies to the conservation of Mimosa caesalpiniifolia B. (sabiá) using instruments of environmental perception and plant biotechnology, as mechanisms of in situ and ex situ conservation. To environmental perception, were realized open, semi-structured and qualitative interviews. The questions included socioeconomic data and knowledge of Sabiá specie. To plant biotechnology, Sabiá seed collection were realized in different location to formation of a germplasm bank. The specie micropropagation was made from nodal segment of plants from the matrizeiro. About the knowledge of rural populations and the use of Sabiá plant, some preferences occurred from speeches that the plant possesses a firm wood, not attacked by termites, legalized for exploration by the Brazilian environmental organ (IBAMA), and is a native specie. This research found the rural population has knowledge about Sabiá specie and the natural resources are exhausting. The proposal that the rural community brought was the donation of the Sabiá specie seeding initiating on the rain season, in which the seeding would be plated between the lots, in individual plantations. To the formation of a matrix bank, plant biothecnology brought answers favorable to Sabiá specie seeding, with the formation of multiple shoots

Percepção de riscos ambientais de populações vulneráveis a inundações e deslizamentos de dunas em Natal-RN

In urban, flooding and landslides are among the troubles that most bring human and material loss. Therefore, this study objected to perform an analysis on the risk perception on the population living in social environmental vulnerable places in order to understand what is the way this population realize the risks they are exposed to and what are the outbrave strategies the develop. The first analyzed area was Complexo Passo da Pátria for the flooding risk problematic and then the Cidade Nova neighborhood threatened by the dunes slides. The areas locate, respectively, in the West and East zones of Natal-RN. Using an interview screenplay adapted from risk perception researches from different brazilian cities, it was collected primarily data on the variables: perception, evaluation and choice, safety threshold, adjustment, decision and participation. Due to the studied areas characteristics the qualitative approach adjusted itself to the difficulties for accessing the areas. The studied places characterize for its insecure situation like selling/using drugs, robbery and murder among others. Due to this situation the interviewed individuals were the ones that could be found more accessibly and available in the moment and the interviews were made in the community leader presence of each area. Through the discourse of the respondents analysis it was able to conclude that the interviewed population is exposed to a high vulnerability grade and risks. However it was identified substantial differences between the perception and risks of Complexo Passo da Pátria and bairro Cidade Nova, because in the first area the intervied ones can recognize the high risk they are exposed to in a more emphatic way to the interviewed ones for the Cidade Nova neighborhood. Furthermore, there is a heavy dissatisfaction for the population of the two places about the city hall positions relating to the present problems in the studied areas. It was also identified the strategy development of acquaintanceship with the risk in the research places beyond a feeling of belonging and affection between the dwellers and the places, yet it was more evident for Complexo Passo da Pátria. Though this analysis it was possible to understand and perceptions and the behavior of the individuals or social groups facing the risks as acceptance and rejection of determined risks beyond adaptation measures of living together with the persistence presence of risks. Therefore, qualitative nature researches emphasizing the perception approach are in the fundamental importance in the studies about risks making it possible to offer aids to the urban planning and management in the implement of effective preventive measures and compatible with the population aims

Early initiation of dialysis: mortality and renal function recovery in acute kidney injury patients

INTRODUÇÃO: A decisão de quando iniciar a diálise em pacientes com lesão renal aguda (LRA) que apresentam síndrome urêmica está bem estabelecida, entretanto, com ureia < 200 mg/dl o melhor momento para iniciar a diálise torna-se incerto. OBJETIVO: Este estudo teve como objetivo avaliar a mortalidade e a recuperação da função renal em pacientes com LRA, cujo início da diálise ocorreu em diferentes níveis de ureia. MÉTODOS: Estudo retrospectivo desenvolvido em hospital escola, no estado de São Paulo, Brasil, envolvendo 86 pacientes submetidos à diálise. RESULTADOS: A diálise foi iniciada com uréia > 150 mg/dl em 23 pacientes (grupo I) e uréia > 150 mg/dl em 63 pacientes (grupo II). Hipervolemia e mortalidade foram mais frequentes no grupo I que no grupo II (65,2 x 14,2% - p < 0,05; 39,1 x 68,9% - p < 0,05, respectivamente). Entre os sobreviventes, a recuperação renal foi maior no grupo I (71,4 e 36,8%, respectivamente, p < 0,05). A análise multivariada mostrou risco independente de mortalidade relacionado à sepse, idade > 60 anos, diálise peritoneal e uréia > 150 mg/dl no início da diálise. CONCLUSÃO: Menor mortalidade e maior recuperação renal estão associadas com o diálise iniciada precocemente, conforme baixos níveis de ureia, em pacientes com LRA.

Variability of the conserved V3 loop tip motif in HIV-1 subtype B isolates collected from Brazilian and French patients

The diversity of the V3 loop tip motif sequences of HIV-1 subtype B was analyzed in patients from Botucatu (Brazil) and Montpellier (France). Overall, 37 tetrameric tip motifs were identified, 28 and 17 of them being recognized in Brazilian and French patients, respectively. The GPGR (P) motif was predominant in French but not in Brazilian patients (53.5% vs 31.0%), whereas the GWGR (W) motif was frequent in Brazilian patients (23.0%) and absent in French patients. Three tip motif groups were considered: P, W, and non-P non-W groups. The distribution of HIV-1 isolates into the three groups was significantly different between isolates from Botucatu and from Montpellier (P < 0.001). A higher proportion of CXCR4-using HIV-1 (X4 variants) was observed in the non-P non-W group as compared with the P group (37.5% vs 19.1%), and no X4 variant was identified in the W group (P < 0.001). The higher proportion of X4 variants in the non-P non-W group was essentially observed among the patients from Montpellier, who have been infected with HIV-1 for a longer period of time than those from Botucatu. Among patients from Montpellier, CD4+ cell counts were lower in patients belonging to the non-P non-W group than in those belonging to the P group (24 cells/µL vs 197 cells/µL; P = 0.005). Taken together, the results suggest that variability of the V3 loop tip motif may be related to HIV-1 coreceptor usage and to disease progression. However, as analyzed by a bioinformatic method, the substitution of the V3 loop tip motif of the subtype B consensus sequence with the different tip motifs identified in the present study was not sufficient to induce a change in HIV-1 coreceptor usage.

Conservação de espécies nativas em um assentamento rural do município de Apodi-RN: impactos socioambientais e econômicos e o uso da biotecnologia como alternativa promissora

The Caatinga biome has a high diversity of potential and their conservation constitutes one of the greatest challenges of Brazilian science. The sustainable management of the Caatinga emerges as an alternative that through the formation of systems agrossilvipastoris, enables the use of forest resources sustainably, ensuring their conservation, regeneration and recovery. In RN this technique has been developed mainly in settlements of Agrarian Reform, such as P. A. Moaci Lucena, and their impacts go beyond the environmental aspect and reverberate socially and economically on the quality of life of family farmers. Despite the efficiency of the Sustainable Management of the Caatinga in the conservation of native species, many forests species of this biome faces serious problems of propagation and for this reason have become vulnerable to extinction, as is the case of Mimosa caesalpiniifolia Benth . Thus , it is evident the need to use sustainable alternatives to overcome the difficulties of propagation of this species and enable their replacement in areas where their existence is threatened. The Plant Biotechnology is considered as a promising alternative in this sense, considering that by micropropagation enables the large-scale production of seedlings with high health genetics status. This work has the following objectives: evaluate the perception of family farmers of P. A. Moaci Lucena in relation to social, environmental and economic impacts of the Sustainable Management of the Caatinga and check the conditions of germination and in vitro propagation of Mimosa caesalpiniifolia Benth that enabling the production of seedlings of this specie on a large scale. To achieve the first objective, semi-structured interviews showed that in the perception of farmers PA Moaci Lucena, the Sustainable Management of the Caatinga was responsible for generating many social, environmental and economic impacts that affected directly in the improvement in the quality of life of the families of the Settlement Project Moaci Lucena. Have to achieve the second objective, were investigated the influence of different substrates and concentrations of growth regulator BAP in the germination and shoot induction in vitro of Mimosa caesalpiniifolia Benth. The vermiculite was presented as the most suitable substrate for germination of this species, because it provided a more rapid germination, higher growth rates and higher dry matter accumulation. Regarding micropropagation, the concentration of 17.76 μmol/L of BAP presented a more responsive in relation to multiplication rate and the number of shoots in M. caesalpiniifolia, thus constituting the most suitable concentration for the in vitro propagation of this specie

Avaliação de intervenção educativa sobre aleitamento materno dirigida a agentes comunitários de saúde

OBJETIVOS: avaliar ação educativa visando à capacitação de agentes comunitários de saúde em promoção e apoio ao aleitamento materno. MÉTODOS: estudo do processo e adequação de intervenção, com comparação de conhecimentos e práticas de 54 agentes, antes e dois meses após a ação. A intervenção, quatro oficinas teórico-práticas com oito horas cada, fundamentou-se em princípios da Educação Crítico-Reflexiva e em dois cursos de capacitação de equipes de maternidade. Os resultados foram expressos pelas diferenças dos escores médios de conhecimentos, práticas e total, adotando-se p<0,05 como nível crítico. RESULTADOS: houve aumento do escore médio de conhecimentos (21,0 para 26,6; p<0,001) e de escores de conhecimentos classificados como bons (37,0% para 88,8%, p<0,001). Não houve mudanças no escore de participação dos agentes em específicas ações de saúde, como grupos. O efeito da intervenção mais apontado pelos agentes foi sentir-se mais aceito e em melhores condições de participar da equipe multiprofissional em situações envolvendo cuidados com crianças. Mais da metade relatou melhora na qualidade e quantidade das orientações prestadas nas visitas domiciliarias. CONCLUSÕES: a intervenção tem efeitos positivos sobre conhecimentos e a prática dos agentes junto às famílias, mas não promove aumento da sua participação em específicas ações de saúde.

Effect of fractional urea clearance on survival of hemodialysis patients in relation to gender

Many studies have demonstrated the relationship between dialysis dose and survival. Global mortality is similar among men and women; however, the influence of dialysis dose in the survival could be more intensive between women. Therefore, we conduct an observational study to evaluate the gender-related impact of single pool Kt/V (spKt/V) on the survival of patients submitted to hemodialysis in a university hospital. We found that survival was lower in groups with spKt/V smaller than 1.2 than in those with Kt/V between 1.2 and 1.4. Among female patients, spKt/V smaller than 1.2 had a more adverse effect in survival than among men with a comparable Kt/V. Otherwise, among women, the dialysis dose had an impact in survival even with Kt/V greater than 1.4. Thus, fractional urea clearance more heavily influenced the survival of females than males in hemodialysis patients.

Can Delivery Dialysis Dose Affect Survival of Acute Kidney Injury Patients?

Intensity of dialysis dose in acute kidney injury (AKI) might benefit critically ill patients. The aim of this study was to evaluate the effect of intermittent hemodialysis (IHD) dose on mortality in patients with AKI. Methods: Prospective observational study was performed on AKI patients treated with IHD. The delivered dialysis dose per session was calculated based on single-pool Kt/V urea. Patients were allocated in two groups according to the weekly delivered median Kt/V: higher intensity dialysis dose (HID: Kt/V higher than median) and lower intensity dialysis dose (LID: Kt/V lower than median). Thereafter, AKI patients were divided according to the presence or absence of sepsis and urine output. Clinical and lab characteristics and survival of AKI patients were compared. Results: A total of 121 AKI patients were evaluated. Forty-two patients did not present with sepsis and 45 did not present with oliguria. Mortality rate after 30 days was lower in the HID group without sepsis (14.3% x 47.6%; p = 0.045) and without oliguria (31.8% x 69.5%; p = 0.025). Survival curves also showed that the HID group had higher survival rate when compared with the LID group in non-septic and non-oliguric patients (p = 0.007 and p = 0.003, respectively). Conclusion: Higher dialysis doses can be associated with better survival of less seriously ill AKI patients.

When is dialysis indicated in acute kidney injury?

The indications for dialysis in patients with acute kidney injury (AKI), as well as the dose and timing of initiation, remain uncertain. Recent data have suggested that early initiation of renal replacement therapy (RRT) may be associated with decreased mortality but not with the recovery of kidney function. A blood urea nitrogen (BUN) level of 75 mg/dL is a useful indicator for dialysis in asymptomatic patients, but one that is based on studies with limitations. Different parameters, including absolute and relative indicators, are needed. Currently, nephrologists should consider the trajectory of disease, and the clinical condition and prognosis of the patient are more important than numerical values in the decision to initiate dialysis.

Uma abordagem dialógica para a utilização de atividades experimentais em sala de aula

The belief of using experimental activities in the teaching of Physics as a strategy to produce a more efficient teaching-learning process is great among teachers and the school community. However, there are many difficulties for their implementation and when it happens they do not contribute for an improvement in class efficiency due to the method used. In this work, we developed a proposal for using these activities in Physics classes in high school, from a critical-reflexive approach in which the constant dialogue between the participants in the teaching-learning process is fundamental. The work was developed in two ways. The first, where the author/writer created an educational material and applied it in classroom and a second one, where he presented the idea to other teachers and undergraduate students from the Physics course at UFRN and IFRN (former CEFET-RN) through an extended workshop entitled "The role of experimental activities in the Physics teaching". This workshop had the duration of 60 hours and was implemented in 4 steps: i) sensitization and formation, ii) material development, iii) material implementation and iv) evaluation by teachers and students from the classes where the material was applied. The goal of this workshop was to present the approach, evaluate how the participants received the idea and how they would apply it in real situations. The results of the application in classroom allowed us to reach some conclusions. This approach was well received by the students as well as by the workshop participants. Despite some difficulties in relation to the handling of the implementation results by the workshop participants, they indicated changes in these professionals teaching practice and the introduction of experimental activities has been an important subsidy to assist them in Physics class in high school

Could a high-fat diet rich in unsaturated fatty acids impair the cardiovascular system?

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