Apendicite Aguda - Clínica Versus Histologia

Introdução: A apendicite aguda continua a ser um dos principais diagnósticos nos Serviços de Cirurgia Pediátrica. A taxa de apendicectomia negativa (apendicectomia sem evidência histológica de patologia), frequentemente utilizada como índice de qualidade hospitalar, permanece alta, apesar dos esforços para a reduzir, especialmente em crianças com menos de 6 anos. Objectivos: os objectivos primários foram: o cálculo da taxa de apendicectomia negativa, da concordância entre diagnóstico clínico (pós-operatório) e diagnóstico histológico e a caracterização da discordância diagnóstica por tipo de apendicite (fleimonosa, gangrenada, perfurada). A caracterização dos grupos apendicectomia negativa (A) e apendicites perfuradas (B), bem como a relação entre estes dois grupos ao longo dos anos, constituíram objectivos secundários. Material e Método: Estudo retrospectivo dos dados clínicos de 1000 doentes consecutivamente operados com o diagnóstico clínico de apendicite aguda, no Hospital de Dona Estefânia, no período de 1 de Janeiro 2003 – 30 de Setembro 2007, procedendo-se à consulta da folha de requisição de exame histo-patológico enviada para o Serviço de Anatomia Patológica. Foram revistos os dados epidemiológicos, a qualidade da informação da referida folha de requisição e calculada a taxa de apendicectomia negativa nesta amostra. Resultados: O diagnóstico clínico pós-operatório foi concordante com o diagnóstico histológico em cerca de 60% casos, sendo subvalorizado ou sobrevalorizado nos restantes casos. A taxa de apendicectomia negativa observada foi de 5,5%, o que está abaixo dos valores apresentados na literatura. Conclusões: As apendicectomias negativas devem ser um “mal menor” em relação às apendicites perfuradas. A discordância clínico-histológica pode ter implicações médico-legais e tem seguramente implicações clínicas e económicas pelo que urge reavaliar o modelo de abordagem desta patologia tão frequente.

Avaliação da contaminação das águas subterrâneas na área de influência da usina de tratamento de resíduos s.a. UTRESA, em Estância Velha (RS)

Este trabalho objetiva avaliar a contaminação das águas subterrâneas em uma área de disposição de resíduos, originados, principalmente, nas indústrias pertencentes ao ramo coureiro-calçadista, a partir da comparação dos resultados das análises físicas e químicas realizadas em amostras de água subterrânea do aquífero freático à jusante da área, com os padrões de potabilidade da água estabelecidos na legislação vigente e com as características das águas subterrâneas do aquífero à montante da área de disposição de resíduos, através da determinação dos seguintes parâmetros: condutividade, SDT, Eh, pH, OD, temperatura, DQO, alcalinidade, turbidez, SST, cloreto, sulfato, nitrato, ferro, manganês, cromo, sódio, magnésio, potássio, cálcio, cádmio, cobre, chumbo, zinco e níquel. Objetiva, também, quantificar os diferentes tipos de resíduos dispostos na área e fornecer subsídios técnicos para o Sistema de Gerenciamento de Resíduos Sólidos Industriais da FEPAM, no que tange ao monitoramento da qualidade das águas subterrâneas em áreas de disposição de resíduos sólidos. A área estudada é a UTRESA - Usina de Tratamento de Resíduos S/A, que abrange 29 ha e está localizada no extremo sudoeste do município de Estância Velha- RS. A metodologia utilizada consistiu das seguintes etapas: quantificação dos resíduos depositados na área, seleção e instalação de nove poços de monitoramento, realização de quatro amostragens das águas subterrâneas, no período compreendido entre junho de 1999 e março de 2000 e tratamento dos dados, com a determinação de índices de qualidade de água subterrânea para cada poço de monitoramento. O monitoramento demonstrou que alguns parâmetros amostrados nos diferentes poços de monitoramento não atenderam os valores recomendados para a potabilidade das águas pelo Ministério da Saúde e pela Organização Mundial da Saúde, bem como apresentaram valores superiores quando comparados ao ponto controle, localizado à montante da área, observando-se o pior índice de qualidade das águas subterrâneas no PM 05, devido a presença de cromo, nitrato, sulfato, cloreto, sódio e SDT.

A natureza das práticas de governança corporativa no Brasil

Este estudo traça a evolução das práticas de governança corporativa das empresas brasileiras entre os anos de 2010 e 2014 e investiga elementos operacionais e mercadológicos que precedem as decisões das empresas em adotarem melhores ou piores práticas. Para isso, foram levantados dados de fontes primárias que deram origem ao Índice de Qualidade de Governança Corporativa (IQGC), composto por quatro sub elementos: Estrutura do Conselho de Administração; Procedimentos do Conselho de Administração; Direito dos Acionistas Minoritários e; Transparência. Os resultados evidenciam uma constante evolução nas práticas de governança corporativa das empresas ao longo do tempo. Há evidências de que as companhias reconhecem os benefícios de adotarem boas práticas, uma vez que se observa uma evolução de maior amplitude entre as empresas dos segmentos Novo Mercado, Nível 2 e Bovespa Mais. Neste período a maior evolução acontece nas práticas relativas a Estrutura e Procedimentos do Conselho. Entre os elementos operacionais e mercadológicos, destaca-se que empresas mais lucrativas procuram adotar melhores práticas de governança e melhores práticas relacionadas a Transparência nas suas informações. Empresas listadas nos segmentos Nível 1 e Tradicional, onde há maior tangibilidade de suas operações, apresentam melhores práticas relacionadas a Estrutura e Procedimentos do Conselho. Um maior risco das ações leva estas empresas a adotarem melhores práticas relacionadas aos Direitos dos Acionistas Minoritários.

Prevalência de excesso de peso em pré-escolares na cidade do Natal

Obesity is currently considered a public health problem and there has been growing interest in the study of various aspects related to this infirmity such as: epidemiology, diagnosis, treatment, prevention and others. Thus, the purpose of this study was to determine the prevalence of weight excess and overweight in preschoolers in Natal, Brazil and relate them to variables such as gender, age, type of school (public or private) and zones of the city (east/south and north/west). This is a transversal study, carried out in Natal, Brazil between August and September 2004, in 20 public and 20 private schools/day care centers selected by the systematic sampling method. We measured the weight and height of 3721 students between the ages of 2 and 6 years. The children were stratified, according to age, into age group 1 (2 to 4 years) and age group 2 (5 and 6 years) and according to the region of the school, into north/west and east/south zones, the regions with the smallest and highest quality of life indices in the city, respectively. Children were considered to have weight excess when BMI ≥ 85th percentile, including those with BMI ≥ 95th percentile and overweight when BMI ≥ 95th percentile. The prevalence of weight excess was 26.5%, and of overweight 12.4%. There was greater prevalence of weight excess in the private schools and in the east/south zones. Overweight displayed the same epidemiologic profile, with a greater prevalence in private schools and in the east/south zones. The prevalence of weight excess in preschoolers in Natal, Brazil is high and is related, above all, to private schools and to those located in the highest quality of life areas. Therefore, prevention programs should be implanted in elementary schools in order to decrease weight excess and possible associated co-morbidities. This research project met the norms established by PPGCSa/UFRN and aimed at promoting the interrelation between different researchers and between different fields of knowledge, using multi and interdisciplinary concepts. This study was enriched by the interaction between the following professionals: pediatrician, pediatric gastroenterologist and physician nutrition specialist, pediatric endocrinologist, epidemiologist and biostatistician

Excesso de peso em região do nordeste brasileiro: contraste entre escolares de rede pública e privada de ensino

The prevalence of obesity has been increased in the last three decades. It is already considered as epidemic by the World Health Organization and reaches around 300 million people worldwide. The weight gain in all ages is related to a sedentary way of life and hyper caloric food ingestion at the modern society. Obesity is a chronic disease and leads to high blood pressure, diabetes, cardiovascular diseases and cancer. The aim of this study was to evaluate the prevalence of weight excess among student in Natal schools and to analyze its association with age, gender, school category and geographic localization in city zones. This was a transversal study which enrolled 1927 children. 1084 of these were between 6 and 8 years-old (group 1) and 843 were 9 to 10 years-old (group 2). 895 of the total children studied in private schools and 1032 studied in public schools. 33,6% of the students had body mass index equal or above the 85th percentile and were considered as having weight excess. There was no statistical difference in this prevalence considering neither gender nor age. The weight excess prevalence in private schools was 54,5% and in public ones was 15,6% (p<0,01; OR=6,49). Weight excess was also more prevalent in the south and east city zones (41,3%) which have better quality of life index than in the north and west zones (28,4%) (p<0,01). In conclusion, the weight excess prevalence among students is found to be high in Natal and programs of intervention and prevention of obesity are necessary. The higher prevalence in private schools as in the wealthier city zones reflects the link between obesity and high socioeconomic level found in countries in developing. This was an interdisciplinary work with participation of epidemiology, child nutrition and pediatric endocrinology following the recommendations and principles of the Post graduation Program in Health Sciences of the Federal University of Rio Grande do Norte

Distúrbios do sono em pacientes com transtorno depressivo

To evaluate sleep disorder complaints in outpatients with depressive disorder from a general hospital. Methods: An observational, cross-sectional study was carried out with a study sample composed of 70 patients (44 women and 26 men) with diagnosis of depressive disorder, according to the DSM-IV criteria. The patients were interviewed and evaluated by the Identification Questionnaire, the Sleep Habits Questionnaire and the Beck Depression Inventory (BDI). Results: In this study, 50 (71.3%) patients had recurrence of sleep disorder complaints. Mean BDI score was 35.83+8.85, with significant differences between patients with (38.50+8.70) and without (29.60+7.80) recurrence (p<0.05) and among patients with 1, 2, 3 and >3 episodes (p<0.05). In this study, 49 (70%) patients had insomnia and 21 (30%) had subjective excessive sleepiness. Significant differences were observed between the mean duration in months of the sleep disorders (7.16+2.10) and the depressive disorder (6.12+1.90) (p<0.05). Discussion: In the study sample, recurrence of sleep disorder complaints was high and significantly associated with severe depression. Insomnia was prevalent and the mean duration of sleep disorders was higher in relation to depressive disorder

Comparação de procedimentos de quantificação de nitrato em tecido vegetal

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

Bispectral index in dogs with high intracranial pressure, anesthetized with propofol and submitted to two levels of FiO2

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

Diagnóstico e avaliação das áreas de destino final dos resíduos sólidos urbanos no estado do rio grande do norte

This work aims to present the diagnosis and the evaluation of areas of final destination of urban solid waste in Rio Grande do Norte (RN) state. The survey was based on the experience of the State of São Paulo, which made its first inventory in 1997, through its Companhia de Tecnologia de Saneamento Ambiental CETESB. The methodology for the structuring of diagnosis was the Índice de Qualidade de Aterros de Resíduo -- IQR, developed by the Institute for Technological Research of São Paulo (ITRP). The calculation is based on the completion of a matrix that contains information about the main features of the site, infrastructure and operating conditions of the area of waste disposal. This study intends to subsidize the state government of Rio Grande do Norte through its State Secretariat of Environment and Water Resources and the Instituto de Desenvolvimento Sustentável e Meio Ambiente do RN (IDEMA), as well as federal, state and municipal authorities, in the definition of public policies for integrated management of municipal solid wastes to take account of environmental preservation and improvement of sanitary conditions of Natal-RN population.

Diagnóstico Socioambiental da disposição final dos resíduos sólidos no distrito de Guajiru São Gonçalo do Amarante/RN, ressaltando a situação socioeconômica dos catadores

One of the concerns of this century is with the handling and the final destination of urban solid waste (RSU), where depending on the form as they will be made use, they can cause diverse problems, they are of ambient or social order, being able to generate the loss of the quality of life and illnesses to the population, of direct or indirect form. The objective of the present work was to diagnosis the environmental partner situation of the Final Destination of the urban solid residues in the District of Guajiru, city of São Gonçalo do Amarante/RN, standing out the partner-economic situation of the scavengers. The research was carried through in the period of March of 2008 the October of 2009, with a methodology developed through analyzes them of documents made available for the state ambient agency, the Air base of Christmas and managing agencies of the city. For collection of the date, it was used directly application of the questionnaire with 20 existing scavengers in points of destination of residues, evaluation of the old place of final destination through the use of the spread sheet of the IQR (Index of Quality of the Residues), developed for the CETESB, identification of the matter dump and photographic register. For effect of treatment of the data, a descriptive analysis with regard to the answers of the interviewed scavengers was carried through. The acquired date, Scale had been according to tabulated and analyzed in Excel 2003, where they had been generated graphical to observe the behavior of the data. The results show that of the twenty interviewed scavengers, 35% possess age between 20 and 30 years; 75% possess incomplete basic education; 60% inhabit in houses of waal or huts (cardboard or wood); 55% do not make use of system of water supply and system of sanitary exhaustion; with regard to income monthly for scavengers, 35% had presented income between R$ 200,00 and R$300,00 and 20% possess income above of R$ 500,00 for possessing another source of income; 80% of the interviewed ones, use some type of equipment of individual protection; In the year of 2009, confirming what it was informed by the State agency of Environment, during the field visit, we evidence that the city of Is Gonçalo do Amarante, currently, destines its residues in Sanitary landfill of São Region Metropolitan of Natal in the District of Massaranduba in the city of Ceará-Mirim, after some interventions of the State Public prosecution service. However, in the district of Guajiru some diggings still exist that today are used as final destination of RCD' s (Residues of Construction and Demolition) of the cities of Natal and São Gonçalo do Amarante, as well as private dumps that are used by scavengers that deviate the final destination (Sanitary landfill) of the residues of the great generators (supermarkets, shopping Center and hotels), with presence of urubus, generating a new ambient problem for the city and the aeroportuária security. Ahead of this scene, the study it suggests viable alternatives for the elimination of the private dumps and for the social situation of the escavengers, aiming at to improve its quality of life and 10 to minimize the ambient impacts caused by the inadequate destination of the solid waste in the community of Guajiru, São Gonçalo do Amarante/RN, being able to contribute so that the public managers carry through action in the handling and the control of the final destination of the urban solid waste

Influência das águas da Bacia Hidrográfica Pirangi na balneabilidade das praias de Pirangi, nos municípios de Nísia Floresta e Parnamirim Rio Grande do Norte, Brasil

The Pirangi beach is located in the eastern coastline of Rio Grande do Norte state, in the municipality of Parnamirim and Nísia Floresta. In it flow into Pirangi Watershed (PW), whose water receives large amounts of pollutants, mainly domestic and industrial sewage from districts where pass the rivers that consist it, compromising, thus, the bathing water quality of the Pirangi beach. Bearing in mind the importance of water sanitary quality to ensure an environment that no present risk to the bathers s health, this work had as main objective to assess the influence of the PW s waters in the bathing water quality of the Pirangi beaches. To that end, were made collections of water in the beaches and in the rivers with the intention of quantify the fecal contamination indicators thermotolerant coliforms and enterococci, to then classify the conditions of bathing water quality according with the CONAMA Resolution number 274 of 2000. For the purposes greater knowledge about the health conditions of the Beaches Pirangi and about the influence the PW s waters exert on it, was done parallely to the study of the water quality, an investigation of the sand sanitary quality. Furthermore, it was made an evaluation of the PW s Water Quality through Water Quality Index (WQI). Starting from the results obtained in the research present was possible to verify, among other aspects, that the entry of the PW s waters in the Pirangi beaches exerts direct influence in the bathing water quality of the same ones, being the North Pirangi beach (point tracking PA-02) the most influenced. There was noticed also a significant reduction in the conditions of bathing water quality of the beaches in the rainy season. However, the precariousness do sewerage system of the Natal metropolitan region and the absence of a right system of treatment an final disposal of domestic sewage and industrial are the main factors responsi le for deterioration of the PW s Water Quality, and as a consequence, compromising the bathing water quality of the Pirangi beaches

Funcionalidade em pacientes após acidente vascular encefálico: relação com o sono e ritmo de atividade-repouso

It is known that sleep plays an important role in the process of motor learning. Recent studies have shown that the presence of sleep between training a motor task and retention test promotes a learning task so than the presence of only awake between training and testing. These findings also have been reported in stroke patients, however, there are few studies that investigate the results of this relationship on the functionality itself in this population. The objective of this study was to evaluate the relationship between functionality and sleep in patients in the chronic stage of stroke. A cross-sectional observational study was conducted. The sample was composed of 30 stroke individuals in chronic phase, between 6 and 60 months after injury and aged between 55 and 75 years. The volunteers were initially evaluated for clinical data of disease and personal history, severity of stroke, through the National Institute of Health Stroke Scale, and mental status, the Mini-Mental State Examination. Sleep assessment tools were Pittsburgh Sleep Quality Index, the Questionnaire of Horne and Ostberg, Epworth Sleepiness Scale, the Berlin questionnaire and actigraphy, which measures were: real time of sleep, waking after sleep onset, percentage of waking after sleep onset, sleep efficiency, sleep latency, sleep fragmentation index, mean activity score. Other actigraphy measures were intraday variability, stability interdiária, a 5-hour period with minimum level of activity (L5) and 10-hour period with maximum activity (M10), obtained to evaluate the activity-rest rhythm. The Functional Independence Measure (FIM) and the Berg Balance Scale (BBS) were the instruments used to evaluate the functional status of participants. The Spearman correlation coefficient and comparison tests (Student's t and Mann-Whitney) were used to analyze the relationship of sleep assessment tools and rest-activity rhythm to measures of functional assessment. The SPSS 16.0 was used for analysis, adopting a significance level of 5%. The main results observed were a negative correlation between sleepiness and balance and a negative correlation between the level of activity (M10) and sleep fragmentation. No measurement of sleep or rhythm was associated with functional independence measure. These findings suggest that there may be an association between sleepiness and xii balance in patients in the chronic stage of stroke, and that obtaining a higher level of activity may be associated with a better sleep pattern and rhythm more stable and less fragmented. Future studies should evaluate the cause-effect relationship between these parameters

Sono e síndrome da fragilidade em idosos residentes em instituições de longa permanência

Introduction: The aging process causes quantitative and qualitative changes in sleeping. Such changes affects more than half of the adults above 65 years old, that live in the community and 70% of the institutionalized, a great negative impact in their quality of life. One of the pathological displays of aging, that share some characteristics with sleeping disorders and predict similar results, is the Frailty Syndrome, that characterize the most weakened and vulnerable elderly. The way sleeping disorders play a role in the frailty pathogeneses remains uncertain. Objective: Evaluate the relation between the sleeping and the frailty syndrome on institutionalized elderly. Methodology: A transversal study was performed with 69 elderly in institutions in the city of João Pessoa PB. Were used the Pittsburgh Sleeping Quality Index and actigraphy to subjective and objective variables, respectively, and questionnaires and specific tests to frailty phenotype variant (Fried Frailty Criteria). In the statistic analysis were used the Pearson correlation test, Chi Square and One-way ANOVA test, with Tukey-Krammer posttest. Subsequently, a Simple Linear Regression model was built. On every statistical analysis were considered a confidence interval of 95% and a p < 0,05. Results: The sample was characterized by the prevalence of the frail (49,3%), women (62,3%), single (50,7%) and 77,52 (±7,82).The frail elderly obtained the worst sleeping quality 10,37 (±4,31) (f = 4,15, p = 0,02), when compared with the non-frail. The sleep latency influenced more the frailty (R2 = 0,13, β standard = 1,76, β = 0,41, p = 0,001). Weren t found differences between the standard resting-activity variable and the frailty phenotype categories. Conclusion: Sleeping alterations, including bad sleeping quality, prolonged sleep latency, low sleep efficiency and day drowsiness, influenced the frailty in institutionalized elderly

Análise da relação entre alterações do padrão do sono e dor lombo-pélvica em mulheres no segundo trimestre gestacional

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Caracterização do ciclo sono/vigília de professores do ensino médio em natal/rn

In the school environment is fundamental the knowledge about the sleep-wake cycle (SWC), because we find children and adolescents with excessive sleepiness and learning difficulties. Furthermore, teachers with high demand and with different work schedule, which may contribute to changes in SWC. The aim of this study was to describe the SWC of high school teachers in Natal/RN. Habits and knowledge about sleep, chronotype, SWC, daytime sleepiness, sleep quality and job satisfaction were described in 98 high school teachers from public and private school. These parameters were compared according to the characteristics of work, family structure and gender. Data collection was performed with the use of questionnaires in two stages: 1) "health and sleep" (general characterization of sleep habits), Horne & Ostberg questionnaire (characterization of chronotype), Epworth Sleepiness Scale and the Index of Pittsburg Sleep Quality, 2) The sleep diary for 14 days. From the results, we observe that the teachers woke up and went to bed earlier in the week and showed a reduction of time in bed around 42min comparing to weekend. This reduction in time in bed during the week was accompanied by an increase in nap duration on weekend. In addition the teachers woke up earlier on Saturdays than on Sundays, probably due to housework and leisure. The teachers' knowledge about sleep was low in relation to individual differences and effect of alcoholic beverages on sleep, and high in the consequences of sleep deprivation. The differences found in comparisons on the characteristics of work, family structure and gender were punctual, except concerning the work schedule. The teacher who started work in the morning and finished in the night, woke up earlier, went to bed later and had less time in bed, when compared to teachers who work only in two shifts. In addition, teachers with late chronotypes who begin the work in the morning had a greater irregularity in the wake up time compared to teachers with earlier and intermediate chronotypes. Half of teachers have excessive sleepiness, which was positive correlated with work dissatisfaction. In general, teachers showed IPSQ averages equivalent to poor sleep quality and the women showed worst averages. From the results, it is suggested that the SWC of teachers varies according to work schedule, leading to irregularity and partial sleep deprivation in the week, although these responses vary according to chronotype. These changes are accompanied by excessive daytime sleepiness and poor sleep quality. However, it is necessary to expand the sample to clarify the influence of variables related to work, family structure and gender together