Management of late-preterm and term infants with hyperbilirubinaemia in resource-constrained settings.

Hyperbilirubinaemia is a ubiquitous transitional morbidity in the vast majority of newborns and a leading cause of hospitalisation in the first week of life worldwide. While timely and effective phototherapy and exchange transfusion are well proven treatments for severe neonatal hyperbilirubinaemia, inappropriate or ineffective treatment of hyperbilirubinaemia, at secondary and tertiary hospitals, still prevails in many poorly-resourced countries accounting for a disproportionately high burden of bilirubin-induced mortality and long-term morbidity. As part of the efforts to curtail the widely reported risks of frequent but avoidable bilirubin-induced neurologic dysfunction (acute bilirubin encephalopathy (ABE) and kernicterus) in low and middle-income countries (LMICs) with significant resource constraints, this article presents a practical framework for the management of late-preterm and term infants (≥ 35 weeks of gestation) with clinically significant hyperbilirubinaemia in these countries particularly where local practice guidelines are lacking. Standard and validated protocols were followed in adapting available evidence-based national guidelines on the management of hyperbilirubinaemia through a collaboration among clinicians and experts on newborn jaundice from different world regions. Tasks and resources required for the comprehensive management of infants with or at risk of severe hyperbilirubinaemia at all levels of healthcare delivery are proposed, covering primary prevention, early detection, diagnosis, monitoring, treatment, and follow-up. Additionally, actionable treatment or referral levels for phototherapy and exchange transfusion are proposed within the context of several confounding factors such as widespread exclusive breastfeeding, infections, blood group incompatibilities and G6PD deficiency, which place infants at high risk of severe hyperbilirubinaemia and bilirubin-induced neurologic dysfunction in LMICs, as well as the limited facilities for clinical investigations and inconsistent functionality of available phototherapy devices. The need to adjust these levels as appropriate depending on the available facilities in each clinical setting and the risk profile of the infant is emphasised with a view to avoiding over-treatment or under-treatment. These recommendations should serve as a valuable reference material for health workers, guide the development of contextually-relevant national guidelines in each LMIC, as well as facilitate effective advocacy and mobilisation of requisite resources for the optimal care of infants with hyperbilirubinaemia at all levels

BOAS PRÁTICAS AGRÍCOLAS NO CULTIVO DE PLANTAS MEDICINAIS

O município de Feira de Santana, localizado a cerca de 116 km da capital baiana, detém significativo número de famílias rurais que possuem a agricultura familiar como base de sustento

NMR-based plant metabolomics protocols: a step-by-step guide.

Metabolomics is one of the “omics” sciences that can reveal the metabolic phenotype of organisms. This capability makes it a valuable tool for plant investigation, as plants present a vast chemical diversity. From the analytical point of view, two main techniques are frequently used in metabolomics and are often complementary: Mass spectrometry (MS) and Nuclear Magnetic Resonance (NMR) spectroscopy. Here, we describe NMR and its applications in plant metabolomics. We start by contextualizing the research field to then explore study design, sample collection, sample preparation, NMR data acquisition, and data analysis, showing the key features for achieving quality and relevant results. Within these topics, the most common databases used for plant metabolites identification and assignments are listed, as these help to shorten the laborious task of metabolomics investigation of natural products. Concerning NMR parameters, we discuss the key pulse sequences, recommend acquisition parameters, and examine the data each sequence can provide. Similarly, we delve into data analysis, highlighting the most commonly used chemometric methods and how to achieve high-quality results. Therefore, this review aims to provide a comprehensive guide for NMR-based metabolomics analysis of plants

Study of the effect of friction between the ossicles of the middle ear

The human ear is a complex biomechanical system and is divided by three parts: outer, middle and inner ear. The middle ear is formed by three ossicles (malleus, incus and stapes), ligaments, muscles and tendons, that amplify the sound, sending the sound waves to the inner ear. In this work, a finite element modelling of the middle ear and ligaments was made. The connection between ossicles was achieved using contact formulation. The modelling of ligaments was based in a hyperelastic model. Studies based in the displacement field of the eardrum and footplate were made, as well as the rotation of the footplate. The stress field in the ligaments to the exterior of the ossicular chain was still analyzed. These studies were done for different friction rates, between the ossicles, and for different acoustic pressure values applied in the eardrum. We can conclude that the connection between the ossicles may be assigned by contact formulation including friction. For simulation proposes, we can assume a quasi-rigid connection between ossicles.Peer Reviewe

Teaching neonatal resuscitation at public hospitals in Brazilian state capitals

OBJECTIVE: To analyze the teaching of neonatal resuscitation offered by Brazilian public hospitals to undergraduate doctors and nurses, pediatric residents and neonatal fellows. METHODS: This cross-sectional multicenter study included 36 hospitals in 20 Brazilian state capitals during June/2003. Local coordinators collected data regarding what the institutions offer to undergraduate doctors and nurses, pediatric residents and neonatal fellows in terms of neonatal resuscitation training and practical activities in neonatal delivery room care. Descriptive analysis was performed. RESULTS: Twenty-three of the 36 institutions had undergraduate doctors: at 13 of them students were given practical activities in the delivery room, 12 offered neonatal resuscitation training, and at two of the 13 hospitals, interns cared for neonates in the delivery room without specific training. Twenty-three of the 36 hospitals had undergraduate nurses: at eight of them students were given practical activities in the delivery room and at seven of them nursing students cared for neonates in the delivery room without specific training. Twenty-seven of the 36 institutions had pediatric residence programs: at all of them the trained residents cared for neonates in the delivery room, but this training was heterogeneous: theoretical training (2-3 hours) at four institutions and theoretical and practical training (4-64 hours) at 23. Additionally, 15 had neonatal fellowship programs: at all of these the trained fellows cared for neonates in the delivery room, but this training was heterogeneous: theoretical training (2 hours) at one hospital and theoretical and practical training (3-68 hours) at 14. CONCLUSION: Formal neonatal resuscitation training is insufficient during medical and nursing graduation and heterogeneously offered to pediatric residents and neonatal fellows.OBJETIVO: Analisar o ensino da reanimação neonatal para médicos e enfermeiros em formação e para residentes em pediatria e neonatologia em maternidades públicas brasileiras. MÉTODOS: Estudo transversal multicêntrico, realizado em 36 maternidades de 20 capitais brasileiras em junho de 2003. O coordenador local preencheu questionário com dados referentes à realização de ensino específico da reanimação neonatal e atuação em sala de parto de alunos de Medicina e de Enfermagem, residentes de Pediatria e de Neonatologia. Os dados foram analisados de forma descritiva. RESULTADOS: Das 36 maternidades, 23 recebiam alunos de Medicina: em 13, eles atuavam na sala de parto; 12 ofereciam ensino específico da reanimação e, em duas das 13 maternidades com internos atuando na sala de parto, não era oferecido treinamento em reanimação. Das 36 maternidades, 23 recebiam alunos de Enfermagem: em oito, os alunos atuavam na sala de parto. Apenas uma oferecia ensino, e nas outras sete não havia qualquer treinamento. Das 36 maternidades, 27 tinham residentes de Pediatria, que atuavam na sala de parto e recebiam treinamento em reanimação neonatal (teórico com 2-3 horas em quatro maternidades e teórico-prático com 4-64 horas em 23). Das 36 maternidades, 15 recebiam residentes em Neonatologia, que atuavam na sala de parto e recebiam treinamento em reanimação neonatal (teórico de 2 horas em uma e teórico-prático com 3-68 horas em 14). CONCLUSÃO: O ensino de reanimação por meio de cursos formais é insuficiente para os alunos de graduação em Medicina e Enfermagem e heterogêneo para os residentes em Pediatria e em Neonatologia.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

The interpretations diversity as a teacher education constituting factor: reading and observation

In this paper we present an analysis of students' interpretations about tasks assigned during two courses taught in undergraduate physics preservice programs, in which we carried out among future physics teachers well distinct activities, one involving reading and another observation. We looked for comprehending their written speech as part of these activities, and to show the diversity of interpretations and the relevance of this task for teachers' initial training. The theoretical support of this study was the discourse analysis approach initiated in France by Michel Pêcheux. The no language transparency consideration and the production conditions, discursive memory and repetition notions, as well as some possible role played by observation in the scientific construction approaches, contributed to comprehend the students' written discourses. We showed the future teachers interpretations diversity: when thinking about the possibility to teach or not modern physics in high school level, after reading a text about this subject; and when writing a text about the role of observation in the scientific research.Neste artigo apresentamos a análise de interpretações de estudantes em trabalhos desenvolvidos em duas disciplinas de cursos de Licenciatura em Física, nas quais realizamos atividades bastante distintas, uma envolvendo a leitura e outra a observação pelos licenciandos. Buscamos compreender falas escritas pelos estudantes como parte dessas atividades, e procuramos evidenciar a diversidade de interpretações e a relevância desse trabalho para a formação inicial. O apoio teórico em que nos sustentamos foi a análise de discurso na vertente originada na França por Michel Pêcheux. A consideração da não transparência da linguagem, e as noções de condições de produção, memória discursiva e repetição, bem como alguns aportes sobre possíveis papéis da observação na construção científica, contribuíram para a compreensão de discursos escritos pelos estudantes. Mostramos a diversidade de interpretações dos licenciados: ao opinarem sobre a possibilidade ou não de se trabalhar a física moderna e contemporânea no ensino médio, depois de lerem um texto envolvendo esse tema, e ao redigirem um texto sobre a observação na pesquisa científica.9510

Resuscitative procedures at birth in late preterm infants

Objective: Evaluate the need for resuscitative procedures at birth, in late prematures.Study Design: This prospective cohort study enrolled all liveborn infants from 1 to 30 September 2003, with 34 to 41 weeks of gestation without congenital anomalies, born in 35 public hospitals of 20 Brazilian state capitals. Logistic regression analyzed variables associated with the need for bag and mask ventilation.Result: of the 10 774 infants studied, 1054 were late preterms and 485 required resuscitative measures. of the 1054, 338 ( 32%) received only free-flow oxygen, 143 ( 14%) were bag and mask ventilated, 27 ( 3%) were intubated and 10/27 received chest compressions and/or medications. Bag and mask ventilation in late preterms was associated with twin gestation, maternal hypertension, nonvertex presentation, cesarean delivery and lower gestational age.Conclusion: Improving control of maternal hypertension, prolonging gestation for 1 to 2 weeks and restricting operative deliveries could decrease the need of resuscitation of late preterms at birth.Universidade Federal de São Paulo, Dept Pediat, Div Neonatol, São Paulo, BrazilMed Sch Barbacena, Dept Epidemiol, Barbacena, BrazilUniv Fed Minas Gerais, Dept Pediat, Belo Horizonte, MG, BrazilUniv Brasilia, Dept Pediat, Brasilia, DF, BrazilUniversidade Federal de São Paulo, Dept Pediat, Div Neonatol, São Paulo, BrazilWeb of Scienc