Dor visceral intensa associada a desnervação simpática renal seletiva: um desafio

Introdução e Objetivos: A desnervação simpática renal seletiva (DSRS) é um procedimento endovascular minimamente invasivo, seguro, recentemente desenvolvido para o tratamento da hipertensão resistente (HR). Até 6 ablações por radiofrequência (RF), com 2 minutos cada são aplicadas em ambas as artérias renais, estando associadas a dor abdominal visceral difusa, muito intensa1,2. Não foi encontrada literatura sobre o manuseamento anestésico deste procedimento. O nosso objetivo é descrever a experiência do nosso departamento na DSRS e sugerir uma abordagem anestésica (AA) adequada para o procedimento. Metodologia: Foram colhidos, retrospetivamente, os dados dos doentes com HR submetidos a DSRS na nossa instituição até novembro de 2012. Variáveis analisadas: dados demográficos, co-morbilidades, estadio físico da American Society of Anesthesiology (ASA-EF), abordagem anestésica e complicações peri-procedimento. Foi também realizada uma revisão bibliográfica na PubMed sobre DSRS e outros procedimentos endovasculares para identificar uma AA apropriada e eficiente para DSRS. Resultados: 16 doentes (9 homens/7 mulheres), idade 59,7 ± 10 anos. ASA-EF II 25%, III 75%. 14 doentes foram submetidos a cuidados anestésicos monitorizados (MAC): 6 com perfusão remifentanil (0.05 a 0.15μg/Kg/min com bólus até 1μ/Kg durante as ablações), 8 com bólus de propofol (até 150mg) associado a bólus de fentanil (até 150μg) e midazolam (1 a 2 mg). 1 doente foi sujeito a anestesia geral balanceada e 1 doente a bloqueio subaracnoideu. O procedimento anestésico durou 75 ± 16 minutos. O procedimento foi considerado bem sucedido em todos os doentes. Não foram observadas complicações. Discussão e Conclusão: Os 2 principais estudos publicados sobre DSRS (Simplicity trials) referem o uso de opiáceos e sedativos intravenosos para o tratamento da dor associada às ablações. Os fármacos usados e respetivas doses não são descritos. As várias AA usadas na nossa instituição refletem a ausência de literatura anestésica sobre a DSRS. A AA mais adequada depende das caraterísticas dos doentes e do tipo de dor associada (intensa, aguda e intermitente) e deve assegurar o máximo conforto do doente, segurança e sucesso técnico do procedimento. Pela nossa análise, a literatura revista e a experiência adquirida noutros procedimentos com dor semelhante consideramos que o remifentanil, pelas suas propriedades farmacológicas únicas, é adequado para o AA da DSRS. Remifentanil nas doses de 0.05 a 0.15μg/Kg/min com bólus até 1μ/Kg durante as ablações parece apropriado. São necessários mais estudos para melhor avaliação

Estudo da sinistralidade laboral em meio hospitalar - Aspeto fundamental para a integração da segurança no trabalho na gestão de unidades de saúde

O tipo de atividade profissional e as condições em que é desempenhada constituem fatores determinantes do risco para a saúde dos trabalhadores. Os últimos estudos realizados sobre acidentes de trabalho nas instituições de saúde revelam um aumento da incidência dos acidentes de trabalho com o consequente aumento do absentismo laboral e dos encargos financeiros inerentes.Realizamos um estudo descritivo-correlacional, retrospetivo, compreendendo um período de análise de quatro anos, utilizando os dados do serviço de saúde ocupacional, relatórios anuais e balanços sociais de cada ano em estudo. Os resultados revelaram um aumento progressivo do índice de frequência e do índice de gravidade dos acidentes de trabalho. O maior número de acidentes ocorreu nos enfermeiros, a trabalhar por turnos. A lesão mais declarada é a picada e as mãos o local mais atingido, no entanto são os esforços excessivos e a cervicalgia/lombalgia que produzem uma maior incapacidade para o trabalho com o consequente aumento dos dias de absentismo. Constatamos que o tempo em dias perdido vai gradualmente aumentando ao longo dos 4 anos, assim como as implicações financeiras. Os gestores de topo devem tomar medidas no sentido de garantir uma melhor qualidade de vida dos profissionais, contribuindo para uma melhoria da qualidade da prestação de serviços nas unidades de saúde, preservando os recursos humanos e proporcionando dotações seguras de técnicos de saúde/utente

Characterization of magnetron co-sputtered W-doped C-based films

In this paper, W-doped C-based coatings were deposited on steel and silicon substrates by RF magnetron sputtering, using W and C targets, varying the cathode power applied to the W target and the substrate bias. The chemical composition was varied by placing the substrates in a row facing the C and W targets. W content in the films increased from 1 to 2 at.% over the C target to ~ 73 at.% over the W target. The coatings with W content lower than ~ 12 at.% and ~ 23 at.%, for biased and unbiased conditions, respectively, showed X-ray amorphous structures, although carbide nanocrystals must exist as shown by the detection of the WC1-x phase in films with higher W content. C-rich films were very dense and developed a columnar morphology with increasing W content. An improvement in the hardness (from 10 GPa, up to 25 GPa) of the films was achieved either when negative substrate bias was used in the deposition, or when the WC1-x phase was detected by X-ray diffraction. The adhesion of the coatings is very low with spontaneous spallation of those deposited with negative substrate bias higher than 45 V. Varieties in cathode power (90 W or 120 W) applied to the W target showed no observable influence on the characteristics of the films.http://www.sciencedirect.com/science/article/B6TW0-4KXVCT6-6/1/a285b093ad366f2b40c4eb884a4442c

Nanoscale color control of TiO2 films with embedded Au nanoparticles

Article in pressWe demonstrate an efficient nanoscale control of the optical properties of TiO2 films by tuning the Surface Plasmon Resonance (SPR) in the embedded Au nanoparticles. The films were grown by reactive magnetron sputtering. SPR tuning was achieved by different annealings, which affected the shape and size of the Au nanoparticles, and also the phase of the dielectric matrix. These changes promoted the variations on the optical properties. As shown by the modeling of the effective dielectric function of the TiO2/Au in the SPR region, the variation of their optical absorption spectra correlates with morphological changes.Fundação para a Ciência e a Tecnologia (FCT) - PTDC/CTM/70037/2006

Effect of peak power on microstructure, mechanical and tribological properties of W-Ti-C-N(O) ceramic films produced by hybrid sputtering

This research investigates the impact of peak power (from 44 to 105 kW) on the structural and tribological properties of W-Ti-C-N(O) films. Chemical analysis of the coatings, using energy-dispersive spectroscopy and Raman spectroscopy, indicates that increasing target power results in a rise in the oxygen (from 2.6 to 12.0 at%), carbon (from 19.7 to 32.4 at%), and sp3 (from 9.8% to 24.3%) content. Morphological and topographical analysis reveal that an increase in target power causes a transition from a columnar structure (with nodular grains) to a dense structure (with textured grains). The indentation and dry sliding tests demonstrate that the maximum level of H/E2 (0.00047 GPa-1) is achieved, along with a low wear rate of 8.1 × 10-7 mm3/N.m.info:eu-repo/semantics/publishedVersio

Ag+ release and corrosion behavior of zirconium carbonitride coatings with silver nanoparticles for biomedical devices

Zirconium carbonitride coatings with silver nanoparticles were produced by DC unbalanced dual magnetron sputtering system, using two targets, Zr and Zr/Ag in an Ar, C2H2 and N2 atmosphere. Stainless steel 316L and silicon (100) substrates were used for electrochemical and structural characterization, respectively. Silver was found to be well distributed throughout the coatings, maintaining the films' composition in depth, while its diffusion to the electrolyte decreases as immersion time increases, stopping its release after 7 to 8 days of immersion. Electrochemical characterization revealed very stable films that have improved base material, without any diminished corrosion resistance due to the silver content.The authors are grateful to 3B's Research Group in Biomaterials, Biodegradables and Biomimetics for the ICP measurements and Prof. Isabel Leonor, PhD for her assistance. This research is partially sponsored by FEDER funds through the program COMPETE-Programa Operacional Factores de Competitividade and by Portuguese national funds through FCT-Fundacao para a Ciencia e a Tecnologia, under the project ANTIMICROBCOAT-PTDC/CTM/102853/2008. This work has also been supported by the Ministerio de Ciencia e Innovacion of Spain through the Consolider-Ingenio 2010 program (CSD2008-00023) and through the project RyC2007-0026

Antimicrobial activity of the essential oils of Dittrichia viscosa subsp viscosa on Helicobacter pylori

Dittrichia viscosa subsp. viscosa (Compositae) is found on edges, wood clearings and in waste places of the Iberian Peninsula. Aerial parts of D. viscosa were collected at flowering phase in September-October 2001 around Lisbon, Portugal and the essential oils isolated by hydro-distillation for 4 h using a Clevenger-type apparatus. The oils were analyzed by gas chromatography and gas chromatography-mass spectrometry. Preliminary examination of the essential oils allowed the identification of 32 components. Only four components reached percentages over 5%: fokienol (11.8%), T-muurorol (7.9%), (E)-nerolidol (5.5%) and delta-cadinene (5.0%). The essential oils were tested against Helicobacterpylori and Listeria monocytogenes. Essential oils did not have antimicrobial activity against L. monocytogenes. The essential oil at 0.88 to 22.22 mu g.ml(-1) did not inhibit the growth of H. pylori, affected the growth slightly at 44.40 mu g.ml(-1), and completely inhibited the growth at 88.80 to 133.20 mu g.ml(-1) Results show that use of D. viscosa essential oil in the treatment of gastric disorders caused by H. pylori can be effective

Electrochemical vs antibacterial characterization of ZrCN-Ag coatings

Nowadays, antibacterial properties are becoming a viable feature to be introduced in biomaterials due to the possibility of modifying the materials' surface used in medical devices in a micro/nano metric scale. As a result, it is mandatory to understand the mechanisms of the antimicrobial agents currently used and their possible failures. In this work, the antibacterial activity of ZrCNAg films is studied, taking into consideration the ability of silver nanoparticles to be dissolved when embedded into a ceramic matrix. The study focuses on the silver release evaluated by glow discharge optical emission spectroscopy and the effect of the fluid composition on this release. The results revealed a very low silver release of the films, leading to non-antibacterial activity of such materials. The silver release was found to be dependent on the electrolyte composition. NaCl (8.9 g L? 1) showed the lowest spontaneously silver ionization, while introducing the sulfates in Hanks' balanced salt solution (HBSS) such ionization is increased; finally, the proteins incorporated to the (HBSS) showed a reduction of the silver release, which also explains the low ionization in the culture medium (tryptic soy broth) that contains high quantities of proteins.This research is partially sponsored by the FEDER funds through the program COMPETE - Programa Operacional Factores de Competitividade and by the Portuguese national funds through FCT-Fundacao para a Ciencia e a Tecnologia, under the projects ANTIMICROBCOAT - PTDC/CTM/102853/2008 and in the framework of the Strategic Projects PEST-C/FIS/UI607/2011, PEST-C/EME/UI0285/2011 and SFRH/BD/80947/2011.This work has also been supported by the Ministerio de Ciencia e Innovacion of Spain through the Consolider-Ingenio 2010 Programme (CSD2008-00023) and through project RyC2007-0026

Effect of substrate bias voltage on structural and tribological properties of W-Ti-C-N thin films produced by combinational HiPIMS and DCMS co-sputtering

Protective multi-component thin films at the surface of cutting tools have been significantly developed to reduce wear and friction. The present work investigates the effect of substrate bias voltage on the structural-tribological relations of W-Ti-C-N thin films produced by HiPIMS and DCMS co-sputtering. Chemical analysis of the coatings is obtained and composite phase structure is revealed. Morphology of the coatings illustrates that defectless surfaces may be achieved. Topographical parameters are investigated by employing graphical software. Indentation, scratch and pin-on-disk tests (pin is AISI 52100 steel) are applied to study mechanical behaviors of the films. To produce a wear-resistant film, a median bias voltage ( 60 V) and as a result, optimum content of tungsten concentration (19.2 at. %), grain size (42.8 nm) and average peak interval (188 nm) is required. Finally, a model based on the representative volume element is developed to show crack propagation and delamination.info:eu-repo/semantics/publishedVersio