Duration of hemodynamic effects of crystalloids in patients with circulatory shock after initial resuscitation

Background: in the later stages of circulatory shock, monitoring should help to avoid fluid overload. in this setting, volume expansion is ideally indicated only for patients in whom the cardiac index (CI) is expected to increase. Crystalloids are usually the choice for fluid replacement. As previous studies evaluating the hemodynamic effect of crystalloids have not distinguished responders from non-responders, the present study was designed to evaluate the duration of the hemodynamic effects of crystalloids according to the fluid responsiveness status.Methods: This is a prospective observational study conducted after the initial resuscitation phase of circulatory shock (>6 h vasopressor use). Critically ill, sedated adult patients monitored with a pulmonary artery catheter who received a fluid challenge with crystalloids (500 mL infused over 30 min) were included. Hemodynamic variables were measured at baseline (T0) and at 30 min (T1), 60 min (T2), and 90 min (T3) after a fluid bolus, totaling 90 min of observation. the patients were analyzed according to their fluid responsiveness status (responders with CI increase >15% and non-responders <= 15% at T1). the data were analyzed by repeated measures of analysis of variance.Results: Twenty patients were included, 14 of whom had septic shock. Overall, volume expansion significantly increased the CI: 3.03 +/- 0.64 L/min/m(2) to 3.58 +/- 0.66 L/min/m(2) (p < 0.05). From this period, there was a progressive decrease: 3.23 +/- 0.65 L/min/m(2) (p < 0.05, T2 versus T1) and 3.12 +/- 0.64 L/min/m(2) (p < 0.05, period T3 versus T1). Similar behavior was observed in responders (13 patients), 2.84 +/- 0.61 L/min/m(2) to 3.57 +/- 0.65 L/min/m(2) (p < 0.05) with volume expansion, followed by a decrease, 3.19 +/- 0.69 L/min/m(2) (p < 0.05, T2 versus T1) and 3.06 +/- 0.70 L/min/m(2) (p < 0.05, T3 versus T1). Blood pressure and cardiac filling pressures also decreased significantly after T1 with similar findings in both responders and non-responders.Conclusions: the results suggest that volume expansion with crystalloids in patients with circulatory shock after the initial resuscitation has limited success, even in responders.Universidade Federal de São Paulo, Disciplina Anestesiol Dor & Terapia Intens, BR-04024900 São Paulo, BrazilUniversidade Federal de São Paulo, Disciplina Anestesiol Dor & Terapia Intens, BR-04024900 São Paulo, BrazilWeb of Scienc

Perception of pregnant women regarding the performance of nurses in prenatal care / Percepção de gestantes quanto à atuação do enfermeiro no pré-natal

Objective: to identify the perception of pregnant women regarding the role of nurses in prenatal care. Method: phenomenological research that interviewed 10 pregnant women in a city in Minas Gerais, Brazil. The statements were organized into categories and analyzed according to Alfred Schütz's social phenomenology and thematic literature. Results: the categories “Care centered on technical actions”, “Fragility in communication between nurse and pregnant woman” and the expectation of “qualified guidelines developed through collective activities” emerged. Final considerations: the results raise the need to value subjective and communicational aspects in prenatal care, in addition to technical actions, with a view to establishing the bond between actors, expanding adherence and quality of prenatal care. To this end, continuing education activities are recommended. DESCRIPTORS: Perception; Pregnant women; Prenatal care; Nursing; Primary health care.Objetivo: identificar la percepción de las gestantes sobre el papel del enfermero en el prenatal. Método: investigación fenomenológica que entrevistó a 10 mujeres embarazadas en una ciudad de Minas Gerais, Brasil. Los enunciados fueron organizados en categorías y analizados según la fenomenología social y la literatura temática de Alfred Schütz. Resultados: surgieron las categorías “Cuidado centrado en acciones técnicas”, “Fragilidad en la comunicación entre enfermero y gestante” y la expectativa de “orientaciones calificadas desarrolladas a través de actividades colectivas”. Consideraciones finales: los resultados plantean la necesidad de valorar los aspectos subjetivos y comunicacionales en el prenatal, además de las acciones técnicas, con miras a establecer el vínculo entre los actores, ampliando la adherencia y la calidad del prenatal. Para ello, se recomiendan actividades de educación continua. DESCRIPTORES: Percepción; Mujeres embarazadas; Atención Prenatal; Enfermería; primeros auxilios. &nbsp;Objetivo: identificar a percepção de gestantes quanto à atuação do enfermeiro no pré-natal. Método: pesquisa fenomenológica que entrevistou 10 gestantes de um município de Minas Gerais, Brasil. Os depoimentos foram organizados em categorias e analisados segundo a fenomenologia social de Alfred Schütz e literatura temática. Resultados: emergiram as categorias “Assistência centrada em ações técnicas”, “Fragilidade na comunicação entre enfermeiro e gestante” e a expectativa de “orientações qualificadas desenvolvidas mediante atividades coletivas”. Considerações finais: os resultados suscitam a necessidade de valorizar os aspectos subjetivos e comunicacionais no pré-natal, para além das ações técnicas, com vistas a efetivação do vínculo entre os atores, ampliação da adesão e da qualidade do pré-natal. Para tal, recomenda-se atividades de educação permanente. 

Identification of filamentous fungi, assessment of extraneous matter and physicochemical analysis of artisanal and industrialized açaí cream: Identificação de fungos filamentosos, avaliação de matérias estranhas e análises físico-químicas em creme de açaí artesanal e industrializado

Açaí (Euterpe oleracea and E. precatoria) tree produces berries that are industrialized especially as desserts, such as ice creams, creams, and açai pulp. The processing according to Good Manufacturing Practices (GMP) is fundamental to obtain safe foods for consumption. This work aimed to evaluate the quality of açaí cream marketed in Sete Lagoas, Minas Gerais, Brazil, concerning the presence of fungi and extraneous matter, as well as to evaluate certain physicochemical parameters. It was analysed 21 samples of açaí cream (10 artisanal and 11 industrialized). All 21 samples had acceptable physicochemical quality standards. However, regarding mycological analyses, 23.8% of the samples presented filamentous fungi and 100% presented yeast count. The genera of the predominant filamentous fungi were: Cladosporium spp. (93.9%), Penicillium spp. (1.7%), Rhizopus spp. (2.6%), Paecilomyces spp. (0.9%) and Mucor spp. (0.9%). A total of 57% of the samples presented extraneous matter and the vegetal tissues that represent a health risk were the main material found, therefore, there is a need for adjustments in terms of good processing practices

Microcirculation improvement after short-term infusion of vasopressin in septic shock is dependent on noradrenaline

OBJECTIVES: To assess the impact of vasopressin on the microcirculation and to develop a predictive model to estimate the probability of microcirculatory recruitment in patients with septic shock. METHODS: This prospective interventional study included patients with septic shock receiving noradrenaline for less than 48 hours. We infused vasopressin at 0.04 U/min for one hour. Hemodynamic measurements, including sidestream dark-field imaging, were obtained immediately before vasopressin infusion, 1 hour after vasopressin infusion and 1 hour after vasopressin withdrawal. We defined patients with more than a 10% increase in total vascular density and perfused vascular density as responders. ClinicalTrials.gov: NCT02053675. RESULTS: Eighteen patients were included, and nine (50%) showed improved microcirculation after infusion of vasopressin. The noradrenaline dose was significantly reduced after vasopressin (p=0.001) and was higher both at baseline and during vasopressin infusion in the responders than in the non-responders. The strongest predictor for a favorable microcirculatory response was the dose of noradrenaline at baseline (OR=4.5; 95% CI: 1.2-17.0; p=0.027). For patients using a noradrenaline dose higher than 0.38 mcg/kg/min, the probability that microcirculatory perfusion would be improved with vasopressin was 53% (sensitivity 78%, specificity 77%). CONCLUSIONS: In patients with septic shock for no longer than 48 h, administration of vasopressin is likely to result in an improvement in microcirculation when the baseline noradrenaline dose is higher than 0.38 mcg/kg/min

Differential response of citrus species and hybrids to leprosis

O objetivo deste trabalho foi buscar novas fontes de resistência à leprose-dos-citros, no Banco Ativo de Germoplasma do Centro APTA Citros Sylvio Moreira, Instituto Agronômico, em Cordeirópolis, SP. Foram utilizadas plantas obtidas por sementes de 26 acessos, infectadas com o vírus da leprose-dos-citros (Citrus leprosis virus – CiLV), por meio do seu vetor Brevipalpus phoenicis. O aparecimento de lesões, a partir de 21 dias após a inoculação, foi observado em 11 dos genótipos testados (42,3%). Quinze espécies, entre elas Citrus pennivesiculata e C. celebica, comportaram-se como altamente resistentes, enquanto outras, como C. keraji, foram mais suscetíveis que o padrão C. sinensis. Os dados mostraram grande variação de respostas de Citrus spp. à leprose, com elevado número de espécies resistentes, que podem ser utilizadas como fonte de resistência à doença em programas de melhoramento.The objective of this work was to prospect for new sources of resistance to leprosis in the Citrus Germplasm Bank of Centro APTA Citros Sylvio Moreira, Instituto Agronômico, in Cordeirópolis, SP, Brazil. Plants obtained through seeds from 26 citrus accessions were mite-infected with Citrus leprosis virus (CiLV). Typical lesions started to appear in 11 genotypes (42.3% of the tested accessions) 21 days after inoculation. Fifteen species, among them Citrus pennivesiculata and C. celebica, behaved as highly resistant, while other genotypes, as C. keraji, were more susceptible than the standard C. sinensis. The data showed a wide variation in the response of Citrus spp. to leprosis, with a large number of resistant species, wich can be used as source of resistance to this disease, in breeding programs

OBRIGAÇÃO DE FAZER EM SANÇÕES REGULATÓRIAS NO BRASIL: APLICAÇÃO AO SETOR DE TELECOMUNICAÇÕES

Purpose ”“ This article approaches the legal and economic dimensions of the fine and the so-called obligation to do as alternative sanction methods within the Brazilian regulatory framework and the latter´s relative potentials regarding the full exercise of economic functions by the regulator. Furthermore, it highlights the relative advantages and challenges of the obligation to do and how it can maximize the allocative efficiency of administrative sanctions. Methodology/approach/design ”“ A critical analysis of a pioneering application of the obligation to do, carried out by the telecommunication’s regulatory agency, allows to elucidate the essential requirements for its use and governance. Findings ”“ Conclusions suggest that the obligation to do allows the fulfillment of the allocation, stabilization and distribution functions by regulator while potentially increasing both the society expectation towards sanctioning and investment in the sector. Originality ”“ It presents a pioneering perspective on the exercise of the obligation to do as sanction in the Brazilian telecommunications sector.Purpose ”“ This article approaches the legal and economic dimensions of the fine and the so-called obligation to do as alternative sanction methods within the Brazilian regulatory framework and the latter´s relative potentials regarding the full exercise of economic functions by the regulator. Furthermore, it highlights the relative advantages and challenges of the obligation to do and how it can maximize the allocative efficiency of administrative sanctions. Methodology/approach/design ”“ A critical analysis of a pioneering application of the obligation to do, carried out by the telecommunication’s regulatory agency, allows to elucidate the essential requirements for its use and governance. Findings ”“ Conclusions suggest that the obligation to do allows the fulfillment of the allocation, stabilization and distribution functions by regulator while potentially increasing both the society expectation towards sanctioning and investment in the sector. Originality ”“ It presents a pioneering perspective on the exercise of the obligation to do as sanction in the Brazilian telecommunications sector.Propósito ”“ Este artigo aborda as dimensões jurídica e econômica da multa e da obrigação de fazer no contexto regulatório brasileiro e explora os potenciais relativos da última como expressão mais fidedigna do exercício das funções econômicas pelo regulador. O estudo destaca as vantagens e desafios da obrigação de fazer e como essa classe de sancionamento pode elevar a eficiência alocativa dos recursos provenientes de sanções administrativas. Metodologia/abordagem/design ”“ De modo a manter o debate no plano prático, é feita uma análise de aplicação pioneira da obrigação de fazer leva a cabo pelo regulador de telecomunicações o que permite elucidar os requisitos essenciais para seu uso e os critérios de governança necessários para sua utilização. Resultados ”“ As conclusões sugerem que a obrigação de fazer permite o desempenho das funções de alocação, estabilização e distribuição ao passo que a multa se resume, no plano regulatório, à atribuição de um valor pecuniário de sanção. Originalidade ”“ O artigo apresenta uma perspectiva pioneira sobre o exercício da obrigação de fazer como alternativa de sancionamento administrativo no setor de telecomunicações brasileiro

GERMINAÇÃO DE SEMENTES DE CAFEEIRO SUBMETIDAS A DIFERENTES TRATAMENTOS DE REMOÇÃO DO PERGAMINHO

Objetivou-se com esse trabalho avaliar métodos alternativos para a remoção do pergaminho de sementes de cafeeiro. O experimento foi conduzido em delineamento inteiramente casualizado, com seis tratamentos e quatro repetições de 100 sementes. Foram utilizadas sementes de Coffea arabica L., cultivar Arara, obtidas de frutos no estádio cereja, colhidos manualmente. Os tratamentos foram: imersão das sementes em hipoclorito de sódio 5% durante 6h, imersão em álcool 70% por 6h, imersão em calda de limão durante 6h, imersão em água por 24h, sementes intactas (com pergaminho) e remoção manual do pergaminho. O tratamento com hipoclorito de sódio na concentração de 5% apresentou resultados promissores, podendo substituir o método de remoção manual do pergaminho utilizado rotineiramente por produtores e pesquisadores para acelerar a germinação. Para os demais tratamentos, as substâncias não demonstraram capacidade de remoção do pergaminho.  Palavras-chave: Coffea arabica L., pergaminho, hipoclorito de sódio