Anestesia em paciente obstétrica portadora de anemia falciforme e traço talassêmico após plasmaféresis: relato de caso

JUSTIFICATIVA E OBJETIVOS: A plasmaféresis é a técnica de tratamento de escolha para pacientes com anemia hemolítica grave. Uma de suas conseqüências é a depleção de colinesterase plasmática, o que interfere na metabolização de alguns bloqueadores neuromusculares de uso corrente na prática anestesiológica. RELATO do CASO: Paciente com 26 anos, estado físico ASA IV, gestação de 30 semanas e 3 dias, portadora de anemia falciforme, traço talassêmico e alo-imunização para antígenos de alta freqüência. Apresentou crise de falcização, sendo transfundida com derivado sangüíneo incompatível. Evoluiu com hemólise maciça, sendo admitida com hemoglobina de 3 g/dL e hematócrito de 10%, icterícia intensa, taquicardia, apatia e descoramento. Na avaliação hematológica concluiu-se ser situação de inexistência de sangue compatível para transfusão. Foi tratada com corticoterapia, imunoglobulinas e plasmaféresis. No segundo dia de internação, evoluiu com insuficiência renal aguda e edema pulmonar agudo, piora do estado geral e instabilidade hemodinâmica. Indicada a resolução da gestação em decorrência do quadro clínico da paciente e do sofrimento fetal agudo que se sobrepôs. A paciente foi admitida na sala de operações consciente, dispnéica, pálida, ictérica, SpO2 de 91% em ar ambiente, freqüência cardíaca de 110 bpm e pressão arterial de 110 x 70 mmHg, em uso de dopamina (1 µg.kg-1.min-1) e dobutamina (10 µg.kg-1.min-1). Optou-se por anestesia geral balanceada, com alfentanil (2,5 mg), etomidato (14 mg) e atracúrio (35 mg) e isoflurano. Não se observou intercorrências anestésico-cirúrgicas. Ao final, a paciente foi encaminhada à UTI, sob intubação orotraqueal, e em uso de drogas vasoativas, tendo sido extubada após 3 horas. CONCLUSÕES: Este caso mostrou-se um desafio para a equipe, visto que a paciente apresentava instabilidade hemodinâmica e alteração do coagulograma, condições que contra-indicam a anestesia regional; além disto, a plasmaféresis potencialmente depleta os estoques de colinesterases plasmáticas, o que interfere na anestesia. Entretanto, o arsenal medicamentoso disponível permitiu o manuseio seguro desta situação.

Efeitos da dexmedetomidina sobre o sistema renal e sobre a concentração plasmática do hormônio antidiurético: estudo experimental em cães

JUSTIFICATIVA E OBJETIVOS: A insuficiência renal aguda peri-operatória é responsável por elevada taxa de morbidade e mortalidade. Os fármacos alfa2-agonistas aumentam o débito urinário e promovem boa estabilidade hemodinâmica nesse período. O objetivo desta pesquisa foi estudar os efeitos renais e sobre a concentração plasmática do hormônio antidiurético (HAD) provocados pela dexmedetomidina no cão anestesiado. MÉTODO: Trinta e seis cães adultos, anestesiados com propofol, fentanil e isoflurano, foram divididos aleatoriamente em três grupos que receberam, de modo encoberto: G1 - injeção de 20 mL de solução de cloreto de sódio a 0,9%, em 10 minutos, seguida de injeção de 20 mL da mesma solução em uma hora; G2 - injeção de 20 mL de solução de cloreto de sódio a 0,9% contendo dexmedetomidina (1 µg.kg-1), em 10 minutos, seguida de injeção de 20 mL da mesma solução, com a mesma dose de dexmedetomidina (1 µg.kg-1), em uma hora e G3 - injeção de 20 mL de solução de cloreto de sódio a 0,9% contendo dexmedetomidina (2 µg.kg-1) em 10 minutos, seguida de injeção de 20 mL da mesma solução, com a mesma dose de dexmedetomidina (2 µg.kg-1), em uma hora. As variáveis renais, hemodinâmicas e a concentração plasmática do HAD foram estudadas em quatro momentos: M1 (controle) - imediatamente após o período de estabilização; M2 - após a injeção inicial de 20 mL da solução em estudo, em 10 minutos, coincidindo com o início da injeção da mesma solução, em uma hora; M3 - 30 minutos após M2 e M4 - 30 minutos após M3. RESULTADOS: A dexmedetomidina reduziu a freqüência cardíaca e promoveu estabilidade hemodinâmica, mantendo constante o débito cardíaco. Houve elevação do débito urinário no G2 e G3, em comparação com o G1. A osmolalidade urinária no G2 e G3 foi menor no M3 e M4 em relação ao M1 e M2. A depuração de água livre aumentou no G3. A concentração plasmática do HAD diminuiu no G3, apresentando valores mais baixos que os observados no G1 e G2 em M2 e M4. CONCLUSÕES: Os cães anestesiados com baixas doses de dexmedetomidina promovem diurese hídrica por inibir a secreção do hormônio antidiurético, havendo potencial para proteção renal em eventos isquêmicos.

RR3D: Uma solução para renderização remota de imagens médicas tridimensionais

The visualization of three-dimensional(3D)images is increasigly being sed in the area of medicine, helping physicians diagnose desease. the advances achived in scaners esed for acquisition of these 3d exames, such as computerized tumography(CT) and Magnetic Resonance imaging (MRI), enable the generation of images with higher resolutions, thus, generating files with much larger sizes. Currently, the images of computationally expensive one, and demanding the use of a righ and computer for such task. The direct remote acess of these images thruogh the internet is not efficient also, since all images have to be trasferred to the user´s equipment before the 3D visualization process ca start. with these problems in mind, this work proposes and analyses a solution for the remote redering of 3D medical images, called Remote Rendering (RR3D). In RR3D, the whole hedering process is pefomed a server or a cluster of servers, with high computational power, and only the resulting image is tranferred to the client, still allowing the client to peform operations such as rotations, zoom, etc. the solution was developed using web services written in java and an architecture that uses the scientific visualization packcage paraview, the framework paraviewWeb and the PACS server DCM4CHEE.The solution was tested with two scenarios where the rendering process was performed by a sever with graphics hadwere (GPU) and by a server without GPUs. In the scenarios without GPUs, the soluction was executed in parallel with several number of cores (processing units)dedicated to it. In order to compare our solution to order medical visualization application, a third scenario was esed in the rendering process, was done locally. In all tree scenarios, the solution was tested for different network speeds. The solution solved satisfactorily the problem with the delay in the transfer of the DICOM files, while alowing the use of low and computers as client for visualizing the exams even, tablets and smart phones

Tvoice :um sistema de manipulação de linguagens para auxiliar portadores de necessidades especiais através da web

This work presents the tVoice, software that manipulates tags languages, extracting information and, being integral part of the VoiceProxy system, it aids bearers of special needs in the access to the Web. This system is responsible for the search and treatment of the documents in the Web, extracting the textual information contained in those documents and preceding the capability of generating eventually through translation techniques, an audio script, used by the of interface subsystem of VoiceProxy, the iVoice, in the process of voice synthesis. In this stage the tVoice, besides the treatment of the tag language HTML, processes other two formats of documents, PDF and XHTML. Additionally to allow that, besides the iVoice, other interface subsystems can make use of the tVoice through remote access, we propose distribution systems techniques based in the model Client-Server providers operations of the fashion of a proxy server treatment of documents

Potencialidade à degradação na microbacia Riacho Passagem/RN

A degradação dos recursos naturais é talvez o principal problema da região do semiárido brasileiro, e essa degradação é principalmente resultante das perdas de solo, decorrente do processo erosivo. Na busca de melhor conhecer esta problemática vem sendo empregado o processo de modelagem ambiental, cujo objetivo é identificar e propor soluções para a degradação dos solos. Nesse sentido, o trabalho aplica o modelo da Equação Universal de Perda de Solos (EUPS), desenvolvido nos Estados Unidos ao longo da década de 1950, agregado as ferramentas de geoprocessamento, informações de sensoriamento remoto e Sistemas de Informações Geográficas (SIGs). A área de estudo é a Microbacia Riacho Passagem localizada na região oeste do Estado do Rio Grande do Norte, a microbacia tem uma área de 221,7Km² e esta inserida no semiárido, região Nordeste do Brasil. A metodologia utilizada consiste: em agrupar as variáveis da EUPS no ambiente SIG utilizando imagens de satélite, levantamentos bibliográficos e trabalhos de campo. Para determinação das extensões das vertentes foi empregado o Modelo RAMPA, e para adequar a EUPS as condições da área de estudo, foram realizados ajuste através de modelos estatísticos, aperfeiçoando o trabalho e os resultados gerados pelo modelo. Ao fim do processo foi desenvolvida uma pseudo linguagem no aplicativo Linguagem Espacial para Geoprocessamento Algébrico (LEGAL) disponível no software SPRING versão 5.1.2 servindo de suporte para o processamento das informações contidas no banco de dados, base da EUPS. Os resultados demonstram que inicialmente é necessário delimitar com precisão o período seco e chuvoso, informação fundamental para a EUPS, uma vez que o trabalho busca identificar a perda de solo por erosão hídrica. O modelo RAMPA apresentou-se satisfatório e com elevado potencial de aplicação na determinação dos comprimentos de vertentes utilizando imagens de radar. Quanto ao comportamento das extensões de vertentes, na microbacia, o mesmo apresentou uma pequena variação na porção leste, maiores vertentes, área próxima a desembocadura. Após a aplicação do modelo o valor máximo de perda de solo foi 88 ton/ha.ano com núcleos localizados no NEOSSOLOS LITÓLICOS e o mínimo 0,01 ton/ha.ano localizado no domínio dos LATOSSOLOS e NEOSSOLOS FLÚVICOS. A erosão provoca diminuição do perfil de solo, principalmente nos NEOSSOLOS LITÓLICOS, resultando em alteração no balanço hídrico e conseqüentemente aumento da temperatura do solo, podendo desencadear a desertificação. Os resultados e a metodologia do presente trabalho poderão ser aplicados na busca pelo desenvolvimento sustentável, na região do semiárido brasileiro, auxiliando na compreensão do binômio uso do solo e capacidade de suporte do meio natural.

Diagnóstico da degradação ambiental no município de Areia Branca-RN por geotecnologias

The municipality of Areia Branca is within the mesoregion of West Potiguar and within the microregion of Mossoró, covering an area of 357,58 km2. Covering an area of weakness in terms of environmental, housing, together with the municipality of Grossos-RN, the estuary of River Apodi-Mossoró. The municipality of Areia Branca has historically suffered from a lack of planning regarding the use and occupation of land as some economic activities, attracted by the extremely favorable natural conditions, have exploited their natural resources improperly. The aim of this study is to quantify and analyze the environmental degradation in the municipality. Thus initially was performed a characterization of land use using remote sensing, geoprocessing and geographic information system GIS in order to generate data and information on the municipal scale, which may serve as input to the environmental planning and land use planning in the region. From this perspective, were used a Landsat 5 image TM sensor for the year 2010. In the processing of this image was used SPRING 5.2 and applied a supervised classification using the classifier regions, which was employed Bhattacharya Distance method with a threshold at 30%. Thus was obtained the land use map that was analyzed the spatial distribution of different types of the use that is occurring in the city, identifying areas that are being used incorrectly and the main types of environmental degradation. And further, were applied the methodology proposed by Beltrame (1994), Physical Diagnosis Conservationist under some adaptations for quantifying the level of degradation or conservation study area. As results, the indexes were obtained for the parameters in the proposed methodology, allowing quantitatively analyze the degradation potential of each sector. From this perspective, considering a scale of 0 to 100, sector A and sector B had value 31.20 units of risk of physical deterioration. And the C sector, has shown its value - 34.64 units degradation risk and should be considered a priority in relation to the achievement of conservation actions

Evolução da paisagem do baixo curso do rio de Piranhas-Assu (1988-2024): uso de autômatos celulares em modelo dinâmico espacial para simulação de cenários futuros

The lower course of Piranhas-Assu river, located in the north coast of Rio Grande do Norte, Brazil, arouses a keen interest as a study field, once it concentrates, besides petroleum and gas exploration, activities related to shrimp culture, salt and horticulture, factors that also deserve special attention. Thus, the awareness of the study field environmental stage demands studies from researchers and discernment from society, as a way of understanding the inter-relation between environment and men. Therefore, this work attempts at understanding and studying the dynamics of land use in the lower course of Piranhas-Assu river, through a multitemporal analysis of present and past, accomplishing future projections through simulation models. The work is divided in stages that include the research, analysis, interpretation of results, and the generation of simulation models, to analyze the landscape tendencies, making possible to identify indicators which cause such changes in the lower course of the river. From Geographical Database, the necessary exploratory analyses were accomplished to the following items: land use evolution, natural and environmental vulnerability, multiple geodiversity indexes, and preparation of the data to be used in the simulation model. Later, the construction of the landscape simulation model was conducted. Sequentially, simulations of future sceneries were accomplished through the execution of the model in a specific software environment. Last, the analyses of landscape tendencies in the study field were carried out. The lower course of Piranhas-Assu River didn't show any intense dynamics in landscape changing, once in the period taken into account (from 1988 to 2004) class stability proved to be superior to its transformations. Activities related to agriculture and livestock are the ones that influence, mostly, the landscape dynamics. The production of sea shrimp and petroleum also infers in the landscape, although in smaller proportion. INCRA s public policies excessively determined the dynamics of the landscape in the lower course of Piranhas-Assu River, RN. In respect to its natural vulnerability, the lower course of Piranhas-Assu River, RN, features more vulnerable than stable areas. The landscape simulation, in the first taken period (2004-2009), indicated considerable increases and decreases of antropic activities, if compared to its sequent periods (2009-2014, 2014-2019 and 2019-2024). The simulation, in a wider analysis, showed that the determining factors for the space mobility of antropic activities, in the focused area, are related to the pre-existence of communities with agricultural capability and to the existence of access routes and drainage. Considering the area that features fixed and mobile dunes, located in Porto do Mangue district, we recommend its conversion into a conservation area

Evolução geodinâmica e condicionamento estrutural dos terrenos Piancó-Alto Brígida e Alto Pajeú, domínio da zona transversal, NE do Brasil

This thesis aims to advance in the geological knowledge of the region comprising the Piancó-Alto Brígida (TPAB) and Alto pajeú (TAP) terranes, in the Transversal Zone Domain (Borborema Province, NE Brazil), with the main objective of understanding the geodynamic evolution and the structural framework of these units. To reach this objective, and besides field work and interpretation of traditional aerial photographs, other tools were employed like of remote sensing products (Landsat 7 ETM+, aeroradiometrics, aeromagnetics and topographical images), lithogeochemical (whole rock) analyses and geochronological dating (U-Pb in zircon), besides integration with literature data. In the area, several precambrian geological units outcrop, represented in the TAP by the paleoproterozoic Serra Talhada and Afogados da Ingazeira complexes, Riacho Gravatá Complex (metavolcano-sedimentary sequence of Stenian-Tonian age) and Cariris Velhos orthogneisses (of Tonian age). The TPAB comprises the Santana do Garrote (lower unit) and Serra do Olho d'Água (upper unit) formations of the Cachoeirinha Group (Neoproterozoic III), besides the Piancó orthogneisses and Bom Jesus paragneisses; the latter correspond to an older (basement ?) block and a possible high grade equivalent of the Cachoeirinha Group (or Seridó Group ?), respectively. Several Brasiliano-age plutons occur in both terranes.The aeromagnetic data show the continuity, at depth, of the main shear zones mapped in the region. The Patos, Pernambuco, Boqueirão dos Cochos, Serra do Caboclo, Afogados da Ingazeira/Jabitacá and Congo-Cruzeiro do Nordeste shear zones reach depths greater than to 6-16 km. The aeromagnetic signature of other shear zones, like the Juru one, suggests that these structures correspond to shallower crustal features. The satellite images (Landsat 7 ETM+) and aerogamaspectrometric images discriminate different geological units, contributing to the mapping of the structural framework of the region. The Serra do Caboclo Shear Zone was characterized as the boundary/suture between the TPAB and TAP. This structure is an outstanding, pervasive feature that separates contrasting geological units, such as the Neoproterozoic III Cachoeirinha Group in the TPAB and the Riacho Gravatá Complex and the Cariris Velhos metaplutonics, of Stenian-Tonian age, in the TAP. Occupying different blocks, these units are not found in authoctonous relations, like unconformities and intrusive contacts. Concerning the Cariris Velhos (ca. 1,0 Ga old) event is recorded by radiometric ages of the Riacho Gravatá Complex metavolcanics and intrusive augen and orthogneisses, all of them displaying geochemical affinities of arc or collisional settings. A structural signature of this event was not recorded in the region, possibly due to its low grade/low strain style, obliterated by the overprinting of younger, higher grade/high strain Brasiliano-age fabrics.The first tectonic event (D1) observed in the Cariris Velhos lithotypes presents contractional kinematics with transport to the NW. Neoproterozoic III geochronologic dates, obtained in late-D1 granitoids, imply a Brasiliano age (ca. 610-600 Ma) for this deformation event. The second tectonic event (D2) characterized in the region corresponds to the Brasiliano transcurrent kinematics of the outstanding shear zones and associated granitoid plutons. The geochronological (U-Pb in zircon) data obtained during this thesis also confirms the occurrence of the Cariris Velhos magmatic suite in the TAP, as well as the Neoproterozoic III age to the Cachoeirinha Group in the TPAB. The TAP (Riacho Gravatá Complex, augen and orthogneisses) is interpreted as a continental arc possibly accreted to a microcontinent during the Cariris Velhos (Stenian-Tonian) event. Later on, this terrane collided with the TPAB at the beginning of the Brasiliano orogeny (D1 contractional deformation), and both domins were reworked by the transcurrent shear deformation of the D2 event

Morfologia e sedimentologia da plataforma continental brasileira adjacente a São Bento do Norte e Caiçara do Norte-RN/NE-Brasil

This dissertation the results of a research developed in the area of São Bento do Norte and Caiçara do Norte, northern coast of the State of Rio Grande do Norte, during the period of June of 2000 to August of 2001, in the ambit of the projects MAMBMARÉ (CNPq/CTPETRO) and PROBRAL (CAPES/DAAD). The objective principal of this research was the characterization of the sedimentary dynamics of this coast, with base in data of coastal process (winds, currents, waves and tides), with topographical risings (beach profiles and dunes), satellite images and sedimentary analyses. The more specific objectives were accomplished the coastal monitoring of this coast, to verify the maintenance of an erosive tendency or progradacional after the groynes construction for contention of the erosion in the beach of Caiçara do Norte, as well as to verify the influence of the features of bottom of the platform interns adjacent on the pole petroliferous of Guamaré. The executed monitoramento allowed to identify that the movement of the sediments, along the year, in that area, is cyclical, reaching the largest oscillations during the months of winter (deposition) and they will summer (erosion). The sedimentologic studies indicated a general tendency for sands quartzosas, with gravel presence, moderately to good selected, with asymmetry predominantly negative. In agreement with the parameter of Dean (1957), used in the identification of the state morfodinâmico of the beaches, monitored beaches, are basically reflectivas with tendency to middlemen, what frames that space of the coast norte-riograndense, as a space strongly vulnerable to erosive processes. The studies developed in the platform, it interns of this area, allowed to visualize for the first time, in large scale, the distribution of the features of the submarine bottom to the batométrico coat of 25 meters. Being pointed out the presence of a high one topographical submerged, with about 5 meters of height, 1 km of width and more than 24 meters of extension, located in the platform it interns in front of São Bento do Norte; coincident with the trend of the system of flaws of Carnaubais. This feature relay an important paper on the control of the sedimentary processes and oceanographic, as well as in the coastal evolution of this area of the RN state, and they affect the area of the pole petroliferous of Guamaré directly. These results contribute to a better knowledge of the processes in the area, and consequently as subsidies implantation of measures of coastal and environmental protection for the cities of São Bento do Norte and Caiçara do Norte, as well as to understand how the geological-sedimentary processes and oceanographic, in this area, are influencing the characteristics geoambientais of the pole petroliferous of Guamaré

Caracterização da dinâmica ambiental da região costeira do município de Galinhos, litoral setentrional do Rio Grande do Norte

This doctorate thesis concerning on the Characterization of the Environmental Dynamics of the Coastal Area of the Municipal district of Galinhos, Septentrional Coast of Rio Grande do Norte State, is located in the influence area of the Guamaré Petroliferous Pole, having as general objective the understanding of the active coastal dynamics in the region of Galinhos, whose specific objectives were: To study the variation of the coast line in the decades of 1954, 1967,1988, 1996, 2000, from remote sensing products; To elucidate the hypothesis of the region of Galinhos to have been an old system of islands barriers, using as basic tool the penetration radar in the soil - GPR; To monitor and to characterize the coastal dynamics of the study area starting from monthly data of beach profiles, sedimentological analysis, hydrodynamic data and environmental characterization data; which were used to feed the database of the N-NE network of Environmental Monitoring of Areas under Influence of the Petroliferous Industry;(REDE05/FINEP/CNPq/CTPETRO/ PETROBRAS). This research is justified, of the environmental point of view, by involving the mangrove ecosystem considered one of the most delicated environments of the State. From the viewpoint of the petroleum exploration, the systems of islands barriers are favorable for hydrocarbons reservoirs and, consequently important targets to the oil and gas industry, becoming this region attractive in comparison with similar lithified environments. With the results of the variability study in the position of the coast line in the Municipal district of Galinhos/RN from the analysis of remote sensing images, it was possible to investigate the changes in the coast line in temporal scale; the use of directional filters allowed to emphasize linings in the direction NE and to identify submerged features such as sandwaves. The use of GPR enabled the confirmation of paleochannels existence and thus confirmed the hypothesis that the Galinhos spit was formed from an old system of islands barriers. The results of the granulometric analyses indicated that in the summer period the sediments in the profiles A and B in the foreshore portion were classified with the granulometry of sand with scattered gravel and in the shoreface were constituted by sand, but in the winter period these same morphologic compartments were constituted by sand with sparse gravel and siltic sand respectively. In the profile C, in the summer and in the winter, the shoreface and foreshore compartments presented predominantly constituted by sand with sparse gravel. The hydrodynamic results showed that the largest wave heights were registered in the month of February (62 cm) and the highest period of 1,00 m/s in the month of May, the sense of the coastal currents was kept among the quadrants SW and NW, and the winds coming from NE were predominant. The analysis of the beach profiles demonstrated that in the profile A, although it had occurred erosion and deposition during the monitored months, the morphology of the referred profile was kept constant. In the profiles B and C, there were abrupt changes in the morphology, during the monitored months, having been identified a cyclic pattern in the features of the foreshore zone sometimes forming longitudinal sandy bars and in other times forming berm. These results evidenced, therefore, that studies of this nature are of fundamental importance for the coastal zoning, aiming subsidies to the organs managers in the closing of decisions as for the implantation of enterprises in the area, and for the industry of the petroleum through generation of information that subsidize the implementation and location of petroliferous structures adequate to this environment