The impact of morbid obesity on cardiac structure and function in pregnancy

Background: The increasing prevalence of obesity worldwide is a major threat to global health. Structural and functional changes in the heart are well documented for obesity as well as for pregnancy, but there is limited literature on the impact of obesity on cardiac function in pregnancy. We hypothesized that cardiac maladaptation to pregnancy occurs more frequently in otherwise healthy morbidly obese pregnant women than in pregnant women of normal body mass index (BMI). Methods: This prospective cohort study was performed in two referral maternity units in Cape Town, South Africa, over a 3-month period. Forty morbidly obese pregnant women (BMI ≥40 kg.m⁻²) (Group O) were compared to 40 pregnant women of BMI 30 kg.m⁻² (Group N). Cardiac structure and function were assessed by transthoracic echocardiography, according to the recommendations of the British Society of Echocardiography. Results: Acceptable echocardiographic images were obtained in all obese women. Statistical significance was defined as P< .005 after applying the Bonferroni correction for multiple comparisons. Mean [SD] mean arterial pressure was higher in Group O (91 [8.42] vs 84 [9.49] mmHg, P<0.001). There were no between-group differences in heart rate, cardiac output, or cardiac index (84 [12] vs 79 [13] beats.min⁻¹, P=0.103; 5447 [1048] vs 4740 [1183] mL.min⁻¹, P=0.006; 2551 [474] vs 2729 [623] mL.min⁻¹.m⁻², P=0.156, respectively). Stroke volume index was lower, and left ventricular mass higher in Group O (30.14 [4.51] vs 34.25 [7.00] mL.m⁻², P=0.003; 152 [24] vs 115 [29] g, P<0.001). Isovolumetric relaxation time was significantly prolonged in Group O (73 [15] vs 61 [15] milliseconds, P<0.001). The septal tissue Doppler index E' sept was lower in Group O (9.08 [1.69] vs 11.28 [3.18], P<0.001). There were no between- group differences in E' average (10.7 [2.3] vs 12.0 [2.7], P=0.018), or E/E' average (7.85 [1.77] vs 7.27 [1.68]). Conclusion: Obese pregnant women had a similar cardiac output and cardiac index to those with normal BMI. Their increased left ventricular mass and lower stroke volume index could indicate a limited adaptive reserve. Obese women had minor decreases in septal left ventricular tissue Doppler velocity, but the E/E' average values did not suggest clinically significant diastolic dysfunction

Nyaope addiction: The despair of a lost generation

Nyaope, a cocktail drug, with heroin as its main ingredient, is widely used by many young and poor people in predominantly Black&nbsp; townships in South Africa. This qualitative study aimed to explore and describe the effect of nyaope on the lives of the users by means of focus group discussions and in depth interviews. All ethical principles were adhered to, and data collection continued until data saturation was reached, which was after 68 nyaope users were interviewed. The findings are that the addictive nature of nyaope interrupts the physical, mental and social health of the lives of young South Africans. Keywords: nyaope addiction, South Afric

Identifying the composition of street drug Nyaope using two different mass spectrometer methods

Criminalization of trading and using of street drug Nyaope has had challenges in South Africa due to controversies about its composition. The high cost and complexity of its analysis using conventional chromatography methods also limit the testing availability in most routine laboratories. A state of the Art method with simple specimen processing and faster turnaround time at an affordable cost is urgently needed. To compare the ability of a new Time-of-Flight Mass Spectrometry with direct sample analysis (TOF-DSA MS) and Gas Chromatography Mass Spectrometry (GC-MS) methods in detecting the constituents of Nyaope against turnaround time and cost, in order to recommend a better system for routine use. Cross-sectional, qualitative and descriptive pilot study on samples purchased from various sources of 12 townships in Northern Gauteng Province. The constituents consistently detected in all samples were caffeine, drugs of abuse such as opiates, codeine, morphine, methyl-dioxy amphetamine (MDA) and heroin. Some samples contained antibiotics (citroflex) and antiretroviral drugs (zidovudine). Central nervous system (CNS) depressants such as phenobarbitone and benzodiazepines, benzitramide, moramide intermediates and thiofentanyl and stimulants such as Pipradol, and fenethyline were detected by the TOF-MS system. The usefulness of TOF-DSA MS was better as a screening method while GC-MS provides specificity and confirmatory detection. Due to direct sample analysis, the TOF-DSA provides analytical runtime of 15 sec while GC-MS takes 10 minutes per sample. The running cost for the GCMS is more expensive due to the high cost of reference materials and the need to perform specimen preparation as opposed to TOF-MS. We recommend TOF DSA MS for initial screening of organic compounds in the Nyaope mixtures followed by confirmation by GC-MS for medico-legal interventions.Keywords: Nyaope, drug of abuse, Mass Spectrometry, Gas Chromatography, Antiretroviral

Feminine Identities

The first four essays in this volume all focus on issues of gender in the works of different English authors and thinkers. Shorter versions of each of these essays were formerly presented as papers in an autonomous section of the Research and Educational Programme on Studies of Identity at the XXth Meeting of the Portuguese Association of Anglo-American Studies (Póvoa de Varzim, 1999) and published in the proceedings of the conference. The second cluster of essays in this volume — two of which (Jennie Wang’s and Teresa Cid’s) were first presented, in shorter versions, at the joint ASA/CAAS Conference (Montréal, 1999) — addresses the work of American women variously engaged in contexts of cultural diversity and grappling with the ideas of what it means to be an American and a woman, particularly in the twentieth century. These essays approach, from different angles, the definitional quandaries and semantic difficulties encountered when speaking about the self and the United States and provide, in one way or another, a sort of feminine rewriting of American myths and history.Fundação para a Ciência e a Tecnologi

Application of infrared spectral techniques on quality and compositional attributes of coffee: An overview

AbstractDuring the last two decades, near and mid-infrared spectral analyses have emerged as a reliable and promising analytical tool for objective assessment of coffee quality attributes. The literature presented in this review clearly reveals that near and mid-infrared approaches have a huge potential for gaining rapid information about the chemical composition and related properties of coffee. In addition to its ability for effectively quantifying and characterising quality attributes of some important features of coffee such as moisture, lipids and caffeine content, classification into quality grades and determination of sensory attributes, it is able to measure multiple chemical constituents simultaneously avoiding extensive sample preparation. Developing a quality evaluation system based on infrared spectral information to assess the coffee quality parameters and to ensure its authentication would bring economical benefits to the coffee industry by increasing consumer confidence in the quality of products. This paper provides an overview of the recently developed approaches and latest research carried out in near and mid-infrared spectral technology for evaluating the quality and composition of coffee and the possibility of its widespread deployment

Síndrome de la lipodistrofia asociado con la terapia antiretroviral en pacientes con VIH: consideraciones para los aspectos psicosociales

Diversos efeitos colaterais têm sido associados à terapia anti-retroviral em portadores da infecção pelo HIV, dentre esses, a síndrome da lipodistrofia apresentando hiperlipidemia e alterações na forma do corpo, com hipertrofia adiposa central e lipoatrofia periférica, relatada pelos pacientes como um visível marcador para a identificação de portadores da infecção pelo HIV. Este estudo consiste em análise da produção científica sobre aspectos psicossociais em portadores da infecção pelo HIV que apresentam lipodistrofia associada à utilização da terapia anti-retroviral. Os resultados mostram que alterações corporais podem ser suficientemente perturbadoras para o bem-estar psicossocial, afetando a qualidade de vida e aumentando o estigma da doença, ocasionando perturbações nas relações sociais. Esta revisão possibilita uma análise preliminar dos aspectos psicossocias da lipodistrofia; entretanto, outros estudos são necessários para o melhor entendimento desta complexa síndrome, trazendo novas informações a serem utilizadas no cuidado de enfermagem a portadores da infecção pelo HIV afetados por este problema.Varios efectos secundarios han sido fuertemente asociados con la terapia antiretroviral en pacientes con HIV. Entre ellos, el síndrome de la lipodistrofia se presenta con alteraciones en la forma del cuerpo con hipertrofia adiposa central y lipoatrofia periférica, las cuales son reportadas por pacientes como marcas visibles que los identifica como pacientes con VIH. En este manuscrito, presentamos un análisis de literatura actual con respecto a los aspectos psicosociales de pacientes con VIH presentándose con lipodistrofia asociado con la terapia antiretroviral. Los resultados demuestran que las alteraciones de la forma del cuerpo pueden ser inquietantes en lo que se refiere al bienestar psicosocial, afectando la calidad de vida y aumentando el estigma asociado con la enfermedad, con las consiguientes dificultades en las relaciones sociales. Este análisis provee un repaso preliminar de los aspectos psicosociales de la lipodistrofia; sin embargo, otros estudios son necesarios para entender mejor este complejo síndrome, proveyendo nueva información para ser utilizada en el cuidado de enfermería para pacientes con VIH que están afectados por este problema.Several side effects have been strongly associated with antiretroviral therapy in HIV patients. Among them, the lipodystrophy syndrome which presents alterations in body shape with central adipose hypertrophy and peripheral lipoatrophy, reported by patients as a visible marker identifying them as HIV patients. This manuscript presents an analysis of current literature regarding the psychosocial aspects of HIV patients with lipodystrophy associated with antiretroviral therapy. The results show that the alterations in body shape can be disturbing in terms of psychosocial well being, affecting quality of life and increasing the stigma associated with the disease, with consequent disturbances in social relations. This analysis provides a preliminary review of the psychosocial aspects of lipodystrophy and further studies are needed for a better understanding of this complex syndrome, which could provide new information to be used in nursing care for HIV patients affected by this problem

Confidence limits of evolutionary synthesis models. IV Moving forward to a probabilistic formulation

Synthesis models predict the integrated properties of stellar populations. Several problems exist in this field, mostly related to the fact that integrated properties are distributed. To date, this aspect has been either ignored (as in standard synthesis models, which are inherently deterministic) or interpreted phenomenologically (as in Monte Carlo simulations, which describe distributed properties rather than explain them). We approach population synthesis as a problem in probability theory, in which stellar luminosities are random variables extracted from the stellar luminosity distribution function (sLDF). We derive the population LDF (pLDF) for clusters of any size from the sLDF, obtaining the scale relations that link the sLDF to the pLDF. We recover the predictions of standard synthesis models, which are shown to compute the mean of the sLDF. We provide diagnostic diagrams and a simplified recipe for testing the statistical richness of observed clusters, thereby assessing whether standard synthesis models can be safely used or a statistical treatment is mandatory. We also recover the predictions of Monte Carlo simulations, with the additional bonus of being able to interpret them in mathematical and physical terms. We give examples of problems that can be addressed through our probabilistic formalism. Though still under development, ours is a powerful approach to population synthesis. In an era of resolved observations and pipelined analyses of large surveys, this paper is offered as a signpost in the field of stellar populations.Comment: Accepted by A&A. Substantially modified with respect to the 1st draft. 26 pages, 14 fig

GEOTURISMO E GEOCONSERVAÇÃO : uma análise das potencialidades e fragilidades das paisagens cársticas do município de Bonito – MS

&nbsp;La vegetación y la hidrografía son esenciales para mantener el equilibrio del medio ambiente, sin embargo el paisaje se ha antropizado, planteando desafíos para la conservación. El presente trabajo tiene como objetivo analizar el cambio en el uso y cobertura del suelo y la actividad geoturística en el municipio de Bonito/MS, buscando correlacionar las informaciones obtenidas y presentar recomendaciones de geoconservación para el área en estudio. A través de un análisis sistémico, la metodología emplea la elaboración de mapas de uso y cobertura del suelo, ocurrencia potencial de cuevas y cuevas de atractivo turístico, elaborados utilizando el software qgis. Además, se utilizaron sitios web para recolectar datos sobre las actividades turísticas y geoturísticas en el municipio, luego se analizaron y discutieron los resultados. Los resultados apuntan al importante avance de los cultivos, con la sustitución de vegetación y pastos por zonas agrícolas, el potencial para la actividad turística, destaca la necesidad de protección geológica, la necesidad de vigilancia ambiental y la revisión del sistema legislativo. Palabras clave: Cavidades naturales; Conservación; Geoturismo; Paisaje. &nbsp;Vegetation and hydrography are essential to maintain the balance of the environment, however the landscape has been anthropized, posing challenges for conservation. The present work aims to analyze the change in land use and cover and geotourism activity in the municipality of Bonito/MS, seeking to correlate the information obtained and present geoconservation recommendations for the area under study. Through a systemic analysis, the methodology employs the preparation of maps of land use and coverage, potential occurrence of caves and tourist attraction caves, prepared using the qgis software. In addition, websites were used to collect data on tourism and geotourism activities in the municipality, then the results were analyzed and discussed. The results point to the significant advance of crops, with the replacement of vegetation and pasture for agricultural areas, the potential for tourist activity, emphasizes the need for geological protection, the need for environmental monitoring and review of the legislative system. Keywords: Natural cavities; Conservation; Geotourism; Landscape. &nbsp;A vegetação e hidrografia são essenciais para manter o equilíbrio do ambiente, entretanto, a paisagem vem sendo antropizada, com desafios para a conservação. O presente trabalho tem como objetivo analisar a mudança do uso e cobertura da terra e a atividade de geoturismo no município de Bonito/MS, buscando correlacionar as informações obtidas e apresentar recomendações de geoconservação para área em estudo. Por meio de uma análise sistêmica, a metodologia emprega a elaboração de mapas de uso e cobertura da terra, potencialidade de ocorrência de cavernas e cavernas de atração turística, elaborados no software Qgis. De forma complementar, buscou-se o levantamento de dados das atividades de turismo e geoturismo no município em sites oficiais, com posterior análise e discussão. Os resultados apontam o avanço expressivo de lavouras, com a substituição da vegetação nativa e pastagem para áreas agrícolas e potencialidade da atividade turística, enfatizando a necessidade de proteção geológica, monitoramento ambiental e revisão no sistema legislativo

Avaliação do conhecimento na requisição correta dos exames de imagem dos internos de 5o e 6o ano da Faculdade de Medicina da Universidade de Mogi das Cruzes, SP

INTRODUCTION: Radiology is one of the medical specialties that is constantly updating. Its methods have been showing a large disponibility and functionality as increases the number of patients seeking for radiology exams. However, some precious values on the medical field have been inverted, such as requesting supplementary tests improperly to fill up the gap by doing a poor anamnesis. This study aimed to evaluate the knowledge of interns from 5th and 6th grade from the Medical School of the University of Mogi das Cruzes (MSUMC) about Radiology and Image Diagnosis subject. METHOD: The study design is a quantitative cross section, based on a questionnaire applied to the interns from MSUMC. The data was analyzed by the statistic program Minitab and the alumni were classified according to their performance on the test: good (≥60%), satisfactory (50-59,9%) and unsatisfactory (≤49,9%). RESULTS: After the 114 questionnaires were precisely analyzed, the questions with the highest percentage of mistake were ranked and approached the following themes: point out the diagnosis methods associated with contrast (100%) and first choice exam for bone fracture (97,37%), pneumonia (92,11%), pneumothorax (90,80%). The average questionnaire score was 51,6% and the final classification percentage of performance was: good performance (11,20%), satisfactory (50%) and unsatisfactory (38,80%). DISCUSSION: The basic Radiology questions were the ones with the highest percentage of mistakes. It was noticed a lack of students’ knowledge about the exams costs, important fact when one thinks about the huge Brazilian public expenses with exams required unnecessarily. The most frequent pathologies in a first-aid post were overlooked and had the worst participants’ performance. CONCLUSION: It’s crucial to emphasize a solid education at Radiology and Image Diagnosis, due to its importance at the prevention of over requiring unnecessary radiology exams.INTRODUÇÃO: A radiologia é uma especialidade médica em constante processo de modernização. Além da maior disponibilidade e funcionalidade dos métodos, maior é a demanda dos pacientes por exames. No entanto, nota-se uma inversão de valores na prática médica, no qual é comum o pedido de exames complementares de forma incorreta e indiscriminada a fim de suprir a anamnese falha. O estudo objetivou avaliar o conhecimento dos internos de 5º e 6º ano da Faculdade de Medicina da Universidade de Mogi das Cruzes (FMUMC) acerca da disciplina de Radiologia e Diagnóstico por Imagem. METODOLOGIA: É um estudo de delineamento transversal quantitativo analítico, pautado em questionários aplicados nos acadêmicos do 5º e 6º ano da FMUMC. Os dados foram analisados pelo programa estatístico Minitab e os participantes foram classificados de acordo com o percentual de desempenho: bom (≥ 60%), satisfatório (50-59,9%) e insatisfatório (≤49,9%). RESULTADOS: Após análise criteriosa de 114 questionários, as perguntas com maior índice de reprovação abordaram os seguintes temas com o respectivo percentual de erro: apontar os métodos diagnósticos associados a contraste (100%) e exame de primeira escolha para fratura óssea (97,37%), pneumonia (92.11%) e pneumotórax (90,8%). A média de acerto do questionário foi de 51,6% e o percentual da classificação final: bom desempenho (11,20%), satisfatório (50%) e insatisfatório (38,80%). DISCUSSÃO: Observou-se uma alta taxa de erros, principalmente em perguntas relacionadas a questões básicas de Radiologia. Destaca-se a falta de conhecimento dos acadêmicos acerca dos custos dos exames frente ao enorme gasto público brasileiro com exames solicitados desnecessariamente. As patologias mais frequentes de pronto atendimento foram negligenciadas e com pior desempenho dos participantes. CONCLUSÃO: Enfatiza-se a boa formação acadêmica na disciplina de Radiologia e Diagnóstico por Imagem, por se tratar de uma ferramenta fundamental na prevenção na solicitação indiscriminada e incorreta de exames complementares