Normais climatológicas do Brasil 1981–2010

In the last decades, especially since 2000, the natural vulnerability of Earth’s climate system has been a cause of great concern as to the status of global climate change due to the interference of natural and/or anthropic activities. Instituto Nacional de Meteorologia (Inmet), the government body officially responsible for monitoring weather and climate in Brazil, and also a member of the World Meteorological Organization (WMO), is proud to release the new edition of the climate normals for the period of 1981–2010. The new edition aims to analyze and register the climate changes that occurred during the two decades following the previous edition of 1961–1990. For that purpose, Inmet created a working group to prepare and edit these normals, as a basis of knowledge for different spheres of meteorology, aiming to strengthen the study and research of climate variability, as well as the Paris Agreement, which limits global warming to 1.5°C above pre-industrial levels. Finally, the publication intends to offer guidance, information, and assistance to the communities of climate sciences, agribusiness, and public and private institutions, both national and international. Overall, activities related to climate have expanded in practically every sphere of human life, especially in the fields of science and public policies.Nas últimas décadas, principalmente desde 2000, a vulnerabilidade natural do sistema climático da Terra tem causado preocupações quanto à mudança climática global devido a processos naturais e/ou atividades antropogênicas. O Instituto Nacional de Meteorologia (Inmet), responsável por monitorar o tempo e o clima no Brasil, e também membro da Organização Meteorológica Mundial (OMM), tem o orgulho de lançar a nova edição das normais climatológicas 1981–2010. Esta nova edição visa analisar e registrar as mudanças climáticas que ocorreram durante as duas décadas após a edição anterior de 1961–1990. Com esse propósito, o Inmet criou um grupo de trabalho para preparar e editar essas normais, como base para conhecimento em diferentes esferas da meteorologia, para fortalecer o estudo e a pesquisa da variabilidade climática, bem como o Acordo de Paris, que limita o aquecimento global a 1,5°C acima dos níveis da era pré-industrial. Por fim, a publicação visa oferecer diretrizes, informações e assistência a comunidades de ciências climáticas, agronegócios, instituições públicas e privadas, tanto no âmbito nacional quanto internacional. No geral, as atividades relacionadas ao clima têm expandido em praticamente todas as esferas da vida humana, sobretudo nas áreas de ciências e políticas públicas

Early mobilization in ischemic stroke : a pilot randomized trial of safety and feasibility in a public hospital in Brazil

Abstract Background: The effect of early mobilization after acute stroke is still unclear, although some studies have suggested improvement in outcomes. We conducted a randomized, single-blind, controlled trial seeking to evaluate the feasibility, safety, and benefit of early mobilization for patients with acute ischemic stroke treated in a public teaching hospital in Southern Brazil. This report presents the feasibility and safety findings for the pilot phase of this trial. Methods: The primary outcomes were time to first mobilization, total duration of mobilization, complications during early mobilization, falls within 3 months, mortality within 3 months, and medical complications of immobility. We included adult patients with CT- or MRI-confirmed ischemic stroke within 48 h of symptom onset who were admitted from March to November 2012 to the acute vascular unit or general emergency unit of a large urban emergency department (ED) at the Hospital de Clínicas de Porto Alegre. The severity of the neurological deficit on admission was assessed by the National Institutes of Health Stroke Scale (NIHSS). The NIHSS and modified Rankin Scale (mRS, functional outcome) scores were assessed on day 14 or at discharge as well as at 3 months. Activities of daily living (ADL) were measured with the modified Barthel Index (mBI) at 3 months. Results: Thirty-seven patients (mean age 65 years, mean NIHSS score 11) were randomly allocated to an intervention group (IG) or a control group (CG). The IG received earlier (p = 0.001) and more frequent (p < 0.0001) mobilization than the CG. Of the 19 patients in the CG, only 5 (26%) underwent a physical therapy program during hospitalization. No complications (symptomatic hypotension or worsening of neurological symptoms) were observed in association with early mobilization. The rates of complications of immobility (pneumonia, pulmonary embolism, and deep vein thrombosis) and mortality were similar in the two groups. No statistically significant differences in functional independence, disability, or ADL (mBI ≥ 85) were observed between the groups at the 3-month follow-up. Conclusions: This pilot trial conducted at a public hospital in Brazil suggests that early mobilization after acute ischemic stroke is safe and feasible. Despite some challenges and limitations, early mobilization was successfully implemented, even in the setting of a large, complex ED, and without complications. Patients from the IG were mobilized much earlier than controls receiving the standard care provided in most Brazilian hospitals

Using fluid bed granulation to improve the dissolution of poorly water-soluble drugs

In this study, fluid bed granulation was applied to improve the dissolution of nimodipine and spironolactone, two very poorly water-soluble drugs. Granules were obtained with different amounts of sodium dodecyl sulfate and croscarmellose sodium and then compressed into tablets. The dissolution behavior of the tablets was studied by comparing their dissolution profiles and dissolution efficiency with those obtained from physical mixtures of the drug and excipients subjected to similar conditions. Statistical analysis of the results demonstrated that the fluid bed granulation process improves the dissolution efficiency of both nimodipine and spironolactone tablets. The addition of either the surfactant or the disintegrant employed in the study proved to have a lower impact on this improvement in dissolution than the fluid bed granulation process

The Italian ICD-11 field trial: clinical utility of diagnostic guidelines for schizophrenia and related disorders

Background The 11th revision of the International Classification of Diseases and Related Disorders (ICD-11) has been released. In order to test the clinical consistency and the clinical utility of the proposed guidelines the World Health Organization (WHO) has carried out the Ecological Implementation Field Studies in various countries. In this paper the results of the Italian field trials on the clinical utility of the ICD-11 diagnostic guideline concerning schizophrenia and related disorders will be presented. Methods In Italy, field trials have been carried out at the Department of Psychiatry of the University of Campania “L. Vanvitelli”. All patients showing any psychotic symptom and referring to the outpatient and inpatient units have been recruited. Patients were interviewed by two clinicians with whom they had not had any prior clinical contact. At the end of each interview, clinicians were asked to complete 12 questions about the clinical utility of the diagnostic guidelines as applied to each patient. Results Fourteen clinicians and 100 patients have been involved. The ICD-11 clinical guidelines were perceived as easy to use, with an adequate goodness of fit, clear and understandable and with an adequate level of details and specificity to describe the essential features of the diagnoses. Clinicians rated very positively their usefulness in describing the threshold between patient’s disorder and normality. Despite still very positive, the guidelines have been perceived as less useful to select a treatment, to assess patients’ prognosis and to communicate with other mental health professionals. Conclusions The 11th revision of the chapter on Mental, Behavioural and Neurodevelopmental Disorders has made substantive changes to the conceptualization of mental disorders which could have impacted on their reliability and clinical utility. Results of the Italian field studies, in line with those reported by the international sample, highlight that ICD-11 has been rated as highly clinically useful by participating clinician, more than the ICD-10. This could be considered a good reason to be optimistic about the implementation of the ICD-11 among global clinicians. Trial registration The study has been approved by the Ethical Review Board of the University of Campania “L. Vanvitelli” (N. 416, 2016

Evaluation of adjunctive HPV testing by Hybrid Capture II(® )in women with minor cytological abnormalities for the diagnosis of CIN2/3 and cost comparison with colposcopy

BACKGROUND: As a proportion of high grade cervical intraepithelial neoplasia (CIN2/3) are associated with equivocal cervical smears, which show borderline or mild dyskaryosis, follow up with repeat smears, colposcopy and biopsy is required. Since infection with oncogenic Human Papilloma Virus (HR HPV) has been found to be associated with the development of cervical cancer, HRHPV testing appears to be an alternative. OBJECTIVE: The present study assesses if HRHPV testing can predict CIN2/3 in women referred for mild dyskaryosis and borderline cytological changes in an health authority with a referral policy to colposcopy after one single mild dyskaryotic Pap smear. STUDY DESIGN: The HPV DNA Hybrid Capture II (Digene/Abbott, Maidenhead) was evaluated on 110 consenting women with mild dyskaryosis and 23 women with persistent borderline changes, who were referred for colposcopy between May and November 2001. A cost comparison between two referral policies was performed. RESULTS: CIN2/3 was diagnosed histologically in 30 of 133 women (22%) with minor cytological abnormalities. As the Receiver Operator Characteristics plot suggested a cut-off of 3 pg/ml the HRHPV HCII was evaluated at 3 RLU (relative light units) and at the manufacturer's recommendation of 1 RLU. At both cut-offs sensitivity and negative predictive value were high at 97%. Specificity was low at 37% at a cut-off of 1 pg/ml and 46% at a cut-off of 3 RLU. To remain cost neutral in comparison to immediate colposcopy the costs for one HR HPV HC II must not exceed £34.37 per test at a cut off of 3 pg/ml. CONCLUSION: The negative likelihood ratio (NLR) was of good diagnostic value with 0.089 at 1 RLU and 0.072 at 3 RLU, which reduces the post-test probability for CIN2/3 to 2% in this population. Women with minor cytological disorders can be excluded from colposcopy on a negative HR HPV result. Specificity can be improved by restricting HR HPV testing to women with persistent borderline cytological changes or to women over 30 years

Uso de substâncias psicoativas entre estudantes de Medicina de Salvador (BA)

BACKGROUND: Studies have shown that medical students consume psychoactive substances at the same rates as the same age youth on general population, despite their predictable knowledge about drugs effects. OBJECTIVE: To analyze the local pattern of psychoactive substances use among medical students and contribute for the formulation of preventive activities. METHODS: The frequency of psychoactive substances use was evaluated by a self-administered anonymous questionnaire that also asked the main reasons for that use. Four hundred and four students in the first to sixth year from the two biggest medical schools in Salvador answered the questionnaire. RESULTS: The lifetime use was bigger for alcohol (92.8%) and inhalant (46.2%). Alcohol use was constant for the students from first to sixth year of course, but it was not statistically significant (p >; 0.05). However, tobacco, inhalants and tranquilizers use had a significant increase at the last two years of course students (p < 0.05). It was verified a bigger drugs use by the male gender. "Fun" was shown as the first main reason for psychoactive substances (58.7% of the valid answers). CONCLUSION: Psychoactive substances consume rates by medical students from Salvador are as high as the ones shown on other scientific researches about this subject.CONTEXTO: Estudos indicam que estudantes de Medicina, apesar do seu dedutível conhecimento sobre os efeitos das substâncias psicoativas, consomem-nas em proporção semelhante à dos jovens de mesma idade na população geral. OBJETIVO: Analisar o padrão local do consumo dessas substâncias entre graduandos de Medicina e contribuir na formulação de atividades preventivas. MÉTODOS: Aplicação de questionário semi-estruturado no qual foi avaliada a freqüência de uso das substâncias psicoativas entre os estudantes, assim como as principais razões apontadas para o consumo. Foram analisados 404 questionários obtidos entre alunos dos seis anos de curso das duas maiores escolas médicas de Salvador. RESULTADOS: As drogas mais utilizadas no critério uso na vida foram álcool (92,8%) e lança-perfume (46,2%). O uso de álcool apresentou-se constante nos seis anos de curso. Entretanto, o uso de tabaco, lança-perfume e tranqüilizantes aumentou significativamente para os alunos dos últimos anos (p < 0,05). Há um maior consumo de drogas pelo gênero masculino. Diversão foi apontada como razão mais importante para o uso dessas substâncias (58,7% das respostas válidas). CONCLUSÃO: O consumo de substâncias psicoativas entre estudantes de Medicina de Salvador é considerado alto, em concordância com o que se constatou em outros trabalhos científicos