Comparação da sensibilidade barorreflexa e variáveis hemodinâmicas entre escolares de 6 a 9 anos obesos e eutróficos

Introduction: Obesity affects increasingly younger children and may be associated with increased blood pressure (BP). Baroreflex sensitivity (BRS) is the main short-term BP control mechanism and may be decreased in obese children. Objectives: To compare spontaneous BRS and hemodynamic variables (HV) of normotensive, obese and eutrophic children. Materials and methodology: The sample of children aged between 6 and 9 years old were divided into two groups: obese (BMI-z> 2, n = 16) and normal weight (BMI-z - 2 and 1; n = 15). A 5 minute BP beat to beat record (Finometer) and electrocardiogram (Biopac) were used to calculate the BRS (sequential method) and HV. All measurements were recorded spontaneously after 10 minutes of rest in the supine position. Results: The BRS (p = 0,28) and the baroreflex effectiveness index (p = 0,44) were not significantly different between the groups. The obese group was significantly higher than the normal weight group for systolic blood pressure (105,38 ± 5,96 and 95,33 ± 5,62, p 2; n=16) e eutróficos (IMC-z - 2 e 1; n=15). Um registro de 5 minutos da PA batimento a batimento (Finometer) e do eletrocardiograma (Biopac) foram utilizados para cálculo da SBR (método sequencial) e das VH. Todas as medidas foram registradas espontaneamente após 10 minutos de repouso na posição supina. Resultados: A SBR (p=0,28) e o índice de efetividade do barorreflexo(p=0,44) não foram significativamente diferentes entre os grupos. O grupo obeso apresentou valores significativamente maiores do que o grupo eutrófico para a pressão arterial sistólica (105,38±5,96 e 95,33±5,62; p<0,05), pressão arterial diastólica (65,56±7,26 e 57,33±5,62; p<0,05) e débito cardíaco (1,54±0,26 e 1,34±0,21; p<0,05). A frequência cardíaca, embora não tenha atingido a significância, também foi maior no grupo obeso (p=0,14). Correlações negativas foram encontradas entre a pressão arterial sistólica e a SBR (r=-0,52, p=0,03) no grupo obeso e entre FC e SBR no grupo obeso (r=-0,67, p=0,004) e eutrófico (r=-0,62, r=0,013). Considerações finais: A SBR não se encontra alterada devido a influência da obesidade no grupo estudado, porém, valores elevados da PA, DC e FC sugerem alteração da função simpática no grupo obeso. Parece que os danos na PA, ocasionados pela obesidade, precedem a debilidade do barorreflexo

Homeopathic Individualized Q-Potencies versus Fluoxetine for Moderate to Severe Depression: Double-Blind, Randomized Non-Inferiority Trial

Homeopathy is a complementary and integrative medicine used in depression, The aim of this study is to investigate the non-inferiority and tolerability of individualized homeopathic medicines [Quinquagintamillesmial (Q-potencies)] in acute depression, using fluoxetine as active control. Ninety-one outpatients with moderate to severe depression were assigned to receive an individualized homeopathic medicine or fluoxetine 20 mg day−1 (up to 40 mg day−1) in a prospective, randomized, double-blind double-dummy 8-week, single-center trial. Primary efficacy measure was the analysis of the mean change in the Montgomery & Åsberg Depression Rating Scale (MADRS) depression scores, using a non-inferiority test with margin of 1.45. Secondary efficacy outcomes were response and remission rates. Tolerability was assessed with the side effect rating scale of the Scandinavian Society of Psychopharmacology. Mean MADRS scores differences were not significant at the 4th (P = .654) and 8th weeks (P = .965) of treatment. Non-inferiority of homeopathy was indicated because the upper limit of the confidence interval (CI) for mean difference in MADRS change was less than the non-inferiority margin: mean differences (homeopathy-fluoxetine) were −3.04 (95% CI −6.95, 0.86) and −2.4 (95% CI −6.05, 0.77) at 4th and 8th week, respectively. There were no significant differences between the percentages of response or remission rates in both groups. Tolerability: there were no significant differences between the side effects rates, although a higher percentage of patients treated with fluoxetine reported troublesome side effects and there was a trend toward greater treatment interruption for adverse effects in the fluoxetine group. This study illustrates the feasibility of randomized controlled double-blind trials of homeopathy in depression and indicates the non-inferiority of individualized homeopathic Q-potencies as compared to fluoxetine in acute treatment of outpatients with moderate to severe depression

Epífitas vasculares em árvores urbanas na cidade de Goiânia, Cerrado brasileiro

The objective of this study was to evaluate the presence of epiphyte species in trees that compose the urban trees of four avenues of Goiânia city – state of Goiás. All individuals from the avenue median and sidewalks were quantified, all epiphyte host individuals were inventoried and the epiphytes found were evaluated qualitatively and quantitatively.  The species Ficus rubiginosa was present in 68.63% of the cases, followed by Ficus luschnathiana (15.69%), Ficus insipida (5.88%) and Ficus guaranitica (5.88%). A total of 84.62% of the hosts are Poincianella pluviosa, 51.92% are individuals of height between 14 and 16 meters and 35.29% have a diameter between 46.00 and 61.99 cm. The hemiepiphytes occurred on Libidibia ferrea, Ceiba speciosa, Albizia lebbeck and Pachira aquatica. The occurrence of hemiepiphytes prevailed on trunk bifurcations (44.23%), branch bifurcation (19.23%), branch hollows (17.31%) and on branches and roots (3.85%). About 15.65% of each adult arboreal in Goiânia city is inferred to hold at least one epiphyte.O objetivo deste estudo foi avaliar a presença de espécies epífitas em árvores que compõem as árvores urbanas de quatro avenidas da cidade de Goiânia - GO. Todos os indivíduos da avenida mediana e calçadas foram quantificados, todos os indivíduos hospedeiros das epífitas foram inventariados e as epífitas encontradas foram avaliadas qualitativa e quantitativamente. A espécie Ficus rubiginosa esteve presente em 68,63% dos casos, seguida por Ficus luschnathiana (15,69%), Ficus insipida (5,88%) e Ficus guaranitica (5,88%). Um total de 84,62% dos hospedeiros são Poincianella pluviosa, 51,92% são indivíduos de altura entre 14 e 16 metros e 35,29% têm diâmetro entre 46,00 e 61,99 cm. Os hemiepífitos ocorreram em Libidibia ferrea, Ceiba speciosa, Albizia lebbeck e Pachira aquatica. A ocorrência de hemiepífitos prevaleceu nas bifurcações de tronco (44,23%), bifurcação de galhos (19,23%), cavidades de galhos (17,31%) e nos galhos e raízes (3,85%). Cerca de 15,65% de cada adulto arbóreo em Goiânia é inferido como portador de pelo menos uma epífita

Blood Loss and Transcapillary Refill in Uncontrolled Treated Hemorrhage in Dogs

OBJETIVE: This study evaluated retroperitoneal hematomas produced by bilateral injury of iliac arteries (uncontrolled hemorrhage), blood volume loss, transcapillary refill, the effects of volume replacement on retroperitoneal bleeding and the hemodynamic changes with and without treatment. METHODS: Initial blood volume was determined with Tc99m-labelled red cells, and bleeding was evaluated by means of a portable scintillation camera positioned over the abdomen. Previously splenectomized mongrel dogs (16.8 ± 2.2 kg) were submitted to hemorrhage for 30 minutes and randomized into three groups: I - no treatment (n=7); II - treatment with 32 mL/kg of Lactated Ringer's for three to five minutes (n=7); and III - treatment with 4 mL/kg of 7.5% NaCl plus 6.0% dextran 70 for three to five minutes (n=7). They were studied for an additional 45 minutes. RESULTS: Volume replacement produced transitory recovery in hemodynamic variables, including mean pulmonary artery pressure, pulmonary capillary wedge pressure and cardiac index, with significant increase in dogs treated with 32 mL/kg of Lactated Ringer's and 7.5% NaCl plus 6.0% dextran 70 (p<0.001, against no treatment), along with a decrease (p<0.001) in the systemic vascular resistance index. Groups II and III had significant initial decreases in hematocrit and hemoglobin. The treated dogs (groups II and III) presented rebleeding, which was greater during treatment with 32 mL/kg of Lactated Ringer's (group II). CONCLUSIONS: Despite the rebleeding observed in treated groups, the utilization of hypertonic saline solution with dextran proved to be effective in the initial reanimation, producing evident transcapillary refill, while the Lactated Ringer's solution produced capillary extravasation and was ineffective in the initial volume replacement in this model of uncontrolled hemorrhage

Association between intratumoral lymphatic microvessel density (LMVD) and clinicopathologic features in endometrial cancer: a retrospective cohort study

<p>Abstract</p> <p>Background</p> <p>Lymph node metastasis in endometrial cancer significantly decreases survival rate. Few data on the influence of intratumoral lymphatic microvessel density (LMVD) on survival in endometrial cancer are available. Our aim was to assess the intratumoral LMVD of endometrial carcinomas and to investigate its association with classical pathological factors, lymph node metastasis and survival.</p> <p>Methods</p> <p>Fifty-seven patients with endometrial carcinoma diagnosed between 2000 and 2008 underwent complete surgical staging and evaluation of intratumoral LMVD and other histologic variables. Lymphatic microvessels were identified by immunohistochemical staining using monoclonal antibody against human podoplanin (clone D2-40) and evaluated by counting the number of immunostained lymphatic vessels in 10 hot spot areas at 400× magnification. The LMVD was expressed by the mean number of vessels in these 10 hot spot microscopic fields. We next investigated the association of LMVD with the clinicopathologic findings and prognosis.</p> <p>Results</p> <p>The mean number of lymphatic vessels counted in all cases ranged between 0 and 4.7. The median value of mean LMVD was 0.5, and defined the cut-off for low and high LMVD. We identified low intratumoral LMVD in 27 (47.4%) patients and high LMVD in 30 (52.6%) patients. High intratumoral LMVD was associated with lesser miometrial and adnaexal infiltration, lesser cervical and peritoneal involvement, and fewer fatal cases. Although there was lower lymph node involvement among cases with high LMVD, the difference did not reach significance. No association was seen between LMVD and FIGO staging, histological type, or vascular invasion. On the other hand, low intratumoral LMVD was associated with poor outcome. Seventy-five percent of deaths occurred in patients with low intratumoral LMVD.</p> <p>Conclusion</p> <p>Our results show association of high intratumoral LMVD with features related to more localized disease and better outcome. We discuss the role of lymphangiogenesis as an early event in the endometrial carcinogenesis.</p

Reconhecimento antecipado de problemas ortográficos em escreventes novatos: quando e como acontecem

A aprendizagem da ortográfica constitui um processo complexo, envolvendo questões lexicais e gramaticais. Muitos estudos sobre essa aprendizagem tratam os problemas ortográficos de modo independente e separado da produção textual. Neste estudo defendemos a importância de se analisar a aprendizagem da ortografia a partir da perspectiva proposta pela Genética Textual, colocando em destaque a gênese do processo de escritura e criação textual. Apresentamos o Sistema Ramos, metodologia de investigação que registra o processo de escritura em tempo e espaço real da sala de aula. Esse Sistema oferece informações multimodais (fala, escrita, gestualidade) sobre o que alunos, em duplas, reconhecem como problemas ortográficos (PO) e os comentários espontâneos feitos quando estão escrevendo o texto. Este estudo analisa justamente o momento em que aconteceram esses reconhecimentos e os comentários de duas alunas no 2º ano de escolaridade, durante a produção de seis histórias inventadas. Mais do que uma análise quantitativa dos tipos de PO identificados no produto, apresentamos uma análise enunciativa e microgenética de reconhecimentos de PO e seus comentários, particularmente aqueles PO antecipados pelas escreventes. Os resultados indicam: i. Reconhecimentos ensejam comentários nem sempre relacionados ao PO identificado; ii. Reconhecimentos e comentários estão relacionados aos conteúdos ortográficos ensinados em sala de aula; iii. Alguns PO reconhecidos envolvem a articulação de diferentes níveis linguísticos. Esses aspectos podem contribuir para a compreensão da aprendizagem da ortografia em situações didáticas propiciadas pela escrita colaborativa a dois.The acquisition of spelling competence is a complex process, involving lexical and grammatical questions. Research, however, almost always places the spelling from an autonomous point of view and disconnected from the other components of writing. In this text, we present the relevance of the Ramos System that captures students in an ecological situation of text production in pairs, allowing access to the processes for solving orthographic problems. Collaborative writing also grants access to comments made by students during the process of textual linearization. Our study focuses on the recognition of spelling problems (SP) and the comments made regarding such problems by two 2nd grade students during the production of six invented stories. More than a quantitative analysis of the types of SP identified in the product, we were interested in making a qualitative and fine analysis of oral recognitions of SP, particularly those SP anticipated by the writers. Our results indicate that: i. Recognition motivates comments that are not always related to the identified SP; ii. Recognition and comments are related to the orthographic contents taught in the classroom; iii. Some of the recognized SP involve the articulation between different linguistic levels. These aspects can contribute for the comprehension of orthographic learning in didactic situations provided by collaborative writing.publishe

A utilização de fluxograma orientador nas Unidades Básicas de Saúde

Visando a maior integração dos alunos com a realidade das Unidades Básicas de Saúde é proposta uma inserção nesse ambiente profissional pela Pontifícia Universidade Católica de Minas Gerais (PUC- MG) em parceria com a Prefeitura Municipal de Betim e região. No segundo semestre de 2017, pudemos vivenciar as atividades da Unidade Básica de Saúde/CAIC no bairro Capelinha. Conversando com os pacientes e com os profissionais da área, fomos informados sobre a difícil locomoção dentro da unidade de saúde, já que faltavam placas explicativas com informações básicas. Dentre tais informações, estão os documentos necessários para o atendimento e orientações de onde são as salas de vacina, curativos e farmácia. Diante de tal demanda, procurou-se uma alternativa que melhorasse a organização da UBS e otimizasse o tempo dos pacientes e dos profissionais do centro de saúde. Sendo assim, o objetivo do trabalho foi a elaboração de um fluxograma que se adequasse à dinâmica da unidade e, também, a confecção de placas que auxiliassem no fluxo de atendimento do local. Sabe-se, que a dificuldade de organização nas Unidades básicas de saúde, tanto em relação a estrutura física, quanto no sentido operacional, é uma questão recorrente em diversos municípios. Um quadro semelhante ao descrito no presente artigo foi observado em um relato de experiências de especialista da área de nutrição no Distrito Federal, em que percebeu-se que, por meio do uso de faixas e placas, houve benefícios significativos quanto ao fluxo de atendimento, à comunicação e ao deslocamento de usuários dentro da UBS. Além de redução de circulação aleatória de pessoas à procura de locais de atendimento, bem como, maior satisfação dos servidores atuantes na recepção (CORDEIRO &amp; FREITAS, 2021