Central Venous Catheterisation in Pediatric Intensive Care - Five Years Experiense

Objectivo: Avaliar a incidência de complicações relacionadas com o cateterismo venoso central e a existência de eventuais factores de risco para a sua ocorrência. Material e métodos: Estudo retrospectivo de 305 catéteres venosos centrais colocados pelos médicos da Unidade de Cuidados Intensivos Pediátricos (UCIP) do Hospital Dona Estefânia, durante 5 anos. As variáveis estudadas foram: idade, peso, instituição de ventilação mecânica, alteração da coagulação, local de inserção, número de lúmens e tempo de utilização do catéter, número e tipo de complicações. Na análise estatística foram utilizados o teste do Quiquadrado, o teste exacto de Fisher e o t-teste de Student, considerando-se haver diferenças estatisticamente significativas para valores de p< 0,05. Resultados: Foram submetidos a cateterismo 296 crianças, com idades compreendidas entre 0.08 e 16.00 anos (média=3,6 anos) e pesos entre 2 e 85 Kg (média=16,2 Kg). Os locais de inserção foram, por ordem decrescente de utilização, a veia subclávia (63,3%), a veia femural (29,8%) e veia jugular (6,9%). Os catéteres de duplo lúmen foram os mais utilizados (61,9%), seguidos dos de mono (32,5%) e de triplo lúmen (5,6%). Ocorreram 46 (15,1%) complicações, mas não se verificaram óbitos directamente relacionados com o cateterismo. A remoção do catéter foi electiva em 98 (32,1%) casos, por óbito em 97 (31,8%), por complicações em 39 (12,8%) e por outras causas em 71 (23,2%). O tempo de utilização dos catéteres foi em média de 7,6 dias. Os catéteres com e sem sépsis tiveram uma duração média de utilização de 6,9 dias e 17,0 dias, respectivamente. Conclusões: Este estudo revelou um padrão de complicações do cateterismo venoso central semelhante ao descrito por outros autores, sendo que nenhuma das variáveis analisadas se revelou, por si só, como factor de risco de complicações, excepto o tempo de utilização do catéter na ocorrência de sépsis

Aneurisma Intracraniano na Criança

Os aneurismas cerebrais são raros na criança, embora a sua ruptura seja a principal causa de hemorragia subaracnoideia neste grupo etário. Apresenta-se o caso de uma criança de 11 anos de idade, que recorreu ao hospital por cefaleia súbita e intensa, sem história prévia de traumatismos ou infecções. O estudo clínico e imagiológico realizado foi sugestivo de hemorragia subaracnoideia. A angiografia cerebral permitiu o diagnóstico de aneurisma da bifurcação da artéria carótida interna esquerda. Foi submetida a cirurgia, com boa evolução pós-operatória. Pretende-se com este caso alertar para as dificuldades no diagnóstico diferencial de ruptura de aneurisma cerebral na criança e salientar que um diagnóstico correcto e precoce permite melhorar o prognóstico

Coordinate representation of particle dynamics in AdS and in generic static spacetimes

We discuss the quantum dynamics of a particle in static curved spacetimes in a coordinate representation. The scheme is based on the analysis of the squared energy operator E^2, which is quadratic in momenta and contains a scalar curvature term. Our main emphasis is on AdS spaces, where this term is fixed by the isometry group. As a byproduct the isometry generators are constructed and the energy spectrum is reproduced. In the massless case the conformal symmetry is realized as well. We show the equivalence between this quantization and the covariant quantization, based on the Klein-Gordon type equation in AdS. We further demonstrate that the two quantization methods in an arbitrary (N+1)-dimensional static spacetime are equivalent to each other if the scalar curvature terms both in the operator E^2 and in the Klein-Gordon type equation have the same coefficient equal to (N-1)/(4N).Comment: 14 pages, no figures, typos correcte

Practical computational toolkits for dendrimers and dendrons structure design

Dendrimers and dendrons offer an excellent platform for developing novel drug delivery systems and medicines. The rational design and further development of these repetitively branched systems are restricted by difficulties in scalable synthesis and structural determination, which can be overcome by judicious use of molecular modelling and molecular simulations. A major difficulty to utilise in silico studies to design dendrimers lies in the laborious generation of their structures. Current modelling tools utilise automated assembly of simpler dendrimers or the inefficient manual assembly of monomer precursors to generate more complicated dendrimer structures. Herein we describe two novel graphical user interface (GUI) toolkits written in Python that provide an improved degree of automation for rapid assembly of dendrimers and generation of their 2D and 3D structures. Our first toolkit uses the RDkit library, SMILES nomenclature of monomers and SMARTS reaction nomenclature to generate SMILES and mol files of dendrimers without 3D coordinates. These files are used for simple graphical representations and storing their structures in databases. The second toolkit assembles complex topology dendrimers from monomers to construct 3D dendrimer structures to be used as starting points for simulation using existing and widely available software and force fields. Both tools were validated for ease-of-use to prototype dendrimer structure and the second toolkit was especially relevant for dendrimers of high complexity and size.Peer reviewe

Optimized time-dependent perturbation theory for pulse-driven quantum dynamics in atomic or molecular systems

We present a time-dependent perturbative approach adapted to the treatment of intense pulsed interactions. We show there is a freedom in choosing secular terms and use it to optimize the accuracy of the approximation. We apply this formulation to a unitary superconvergent technique and improve the accuracy by several orders of magnitude with respect to the Magnus expansion.Comment: 4 pages, 2 figure

Description of a Eulerian–Lagrangian Approach for the Modeling of Cooling Water Droplets

The present paper describes a tool developed in-house for the modeling of free-falling water droplet cooling processes. A two-way coupling model is employed to account for the interactions between the droplets and the carrier fluid, following a Eulerian-Lagrangian approach. In addition, a stochastic separated flow technique is employed, involving random sampling of the fluctuating fluid velocity. In physical modeling, two empirical correlations are considered for determining the heat and mass transfer coefficients, with the possibility of accounting for vibrations. The numerical results indicate the preponderance of the interactions between droplet and carrier fluid at various humidity ratios.Fundação para a Ciência e a Tecnologiainfo:eu-repo/semantics/publishedVersio

Characterization of a Two-way Coupling Approach for the Simulation of Fluid Flows under Cryogenic Conditions

Ice formation at lifting surfaces and engine intakes is a significant issue affecting regular aircraft operation. The icing on a wing’s leading edge perturbs the airflow around the wing, contributing to a decrease in lift and increasing drag. A step towards the understanding of droplet dynamics under cryogenics is made in the present work. An in-house developed tool is used to study the impact of droplet diameter and air humidity ratio in free-falling water droplets’ flow dynamics. The 3D Navier-Stokes equations are solved in a RANS-based two-way coupling model, which considers that the carrier fluid properties are modified by the presence of a dispersed phase, accounting for mass exchange momentum and energy between them. A Lagrangian/Eulerian formulation is employed to model each of the considered phases. The results obtained are compared with a one-way modeling approach and experimental data to infer the interacting phases’ effect in the overall process dynamics. In this way, it is possible to conclude that for high humidity content, this interaction is predominant and, consequently, needs to be taken into consideration. However, for low humidity ratios, the one-way coupling is a sufficient approximation to the experimental data.Fundação para a Ciência e a Tecnologiainfo:eu-repo/semantics/publishedVersio

Hipervitaminosis D with Hypocalcemic Coma

A intoxicação pela vitamina D é uma causa bem conhecida de hipercalcémia e hiperfosfatemia. Nos casos de intoxicação crónica, quando o produto fosfocálcico é superior a 60 mg2/dl2, verifica-se a deposição de cristais de fosfato de cálcio, nos tecidos moles, com subsequente hipocalcémia. Apresenta-se o caso de uma lactente de três meses de idade, com antecedentes pessoais irrelevantes, internada na Unidade de Cuidados Intensivos Pediátricos, por tetania e coma resultante da intoxicação crónica acidental pela vitamina D, desde os dez dias de vida. Apresentava hipocalcémia (cálcio total 4,44mg/dl e cálcio ionizado 0,45 mg/dl) e hiper-fosfatémia (fósforo 17,8 mg/dl) grave, sendo o produto fosfocálcico de 79 mg2/dl2. A intoxicação pela vitamina D e hipocalcémia paradoxal foi confirmada pelo doseamento de 1,25-vitamina D

Development and validation of the facilitative interpersonal skills scale for clients

Objective: Psychotherapy studies have revealed that therapist characteristics are responsible for 5% to 9% of outcome variance. The therapist-facilitative interpersonal skills (FIS) have been shown to predict both alliance and outcomes, indicating that higher FIS therapists are more effective than lower FIS therapists. The current study focused on the development and validation of the FIS-client version (FIS-C) instrument, aimed at collecting the clients' perspectives on relevant therapist characteristics. Method: The clinical outcomes in routine evaluation—outcome measures, the session rating scale, and the FIS questionnaire—client version were filled out by psychotherapy clients. Exploratory, confirmatory factor, and test–retest analysis were conducted. Results: Results indicate robust psychometric characteristics, in terms of validity (factorial, convergent, discriminant, and nomological), reliability, and sensitivity. Conclusion: The validation of the FIS-C represents an important contribution to clinical research and practice, namely to the field of client feedback and therapist expertise.info:eu-repo/semantics/publishedVersio

Atividade antifúngica de extratos etanólicos de espécies de Copaifera sobre Fusarium solani f.sp. Piperis e Fusarium oxysporum.

Edição dos resumos do 44º Congresso Brasileiro de Fitopatologia, 2011, Bento Gonçalves. Resumo 1243