Mini invasive hemodynamic monitoring: from arterial pressure to cardiac output

To evaluate the Cardiac Output (CO) the standard invasive pulmonary artery catheter (PAC) is considered today the gold standard. The major criticism to the PAC is that its level of invasiveness is not supported by an improvement in patient\u27s outcome. The interest to lesser and lesser invasive techniques is high. Therefore, the alternative techniques have been recently developed.Cardiac Output can be monitored continuously by different devices that analyze the arterial waveform to track changes in stroke volume (SV) and CO. The analysis of the arterial pressure wave to determine cardiac output is classified as Pulse Contour analysis or Pulse Pressure Analysis. Starting from a similar principle three main devices are now available on the market, with different algorithms and features:• PiCCO System (Pulsion Medical System, Munich, Germany)• LiDCOTM plus System (LidCO, Cambridge, UK)• Flotrac technology and Vigileo Monitor (Edwards Lifesciences, Irvine, CA, USA).The algorithm used by all these devices has been also implemented even with the analysis of the variation of stroke volume (SVV) and of the pulse pressure (PPV). SVV and PPV represent the variation of stroke volume and of the pulse pressure during the respiratory cycle. In sedated ventilated patients these indexes have proven to predict the response to a fluid challenge. A high variation (>10-12%) identifies with good sensitivity and specificity responders and not responders

Valorisation of tomato dried peels powder as thickening agent in tomato purees.

Tomato pomade, consisting of peels and seeds, represents 3-4% of fresh fruit weight. If it remains a waste, it gives rise to disposal problems and aggravate environmental pollution. Our aim was to evaluate the potential of dried peels powder as thickening ingredient in commercial tomato purées. Dried peels were ground in fine and rough sizes and physic-chemically characterized. Samples of creamy and rustic purées with tomato fine and rough dried peels powders at different percentages (0.5-5.0%) were prepared and tested for rheological properties and organoleptic characteristics (colour and flavour). The addiction of 3.0% of fine and 1.0% of rough dried peels powder to rustic purees, and 2.0% of fine dried peels powder to creamy purees resulted as the best combination to reduce the impact of industrial evaporation. The proposed approach could transform a waste in a value-added product to be reused, even in the producer’s supply chain itself

Reflexões sobre a morte na educação infantil / Reflections on death in early childhood education

Neste artigo estudamos o livro Se um dia eu for embora...para refletir sobre a temática da morte na literatura infantil em uma sala de leitura na educação infantil. A obra de Göbel (2008) é uma referência para tratar deste assunto e enriquecer o diálogo entre adultos e criança ou criança com criança. O fato da história ser baseada em uma conversa real, nos aproxima do enredo e coloca a criança mais perto da temática da morte, algo tão temido na atual sociedade. Tanto o texto como a ilustração compõem a história e dialoga sobre as lembranças, a saudade, o relacionamento e a inquietação com a perda o objetivo foi subsidiar o diálogo entre professora e criança embasado em referenciais como Kovács, Lottermann, Vendruscolo. Explicar a finitude de uma vida não é simples e por vezes essa temática aparece recheada de metáforas e colocações que mais se importam em uma fuga graciosa do fato, do que a encarar propriamente. A pesquisa foi de caráter qualitativo e bibliográfico. Foram lidos 367 livros e destes, 30 exemplares faziam menção à morte foram agrupados em cinco eixos: sentimentos, contos de fada, o alfabeto e aspalavras, causae efeito, lembranças e inquietações. Não há uma medida pronta, calculada e padronizada, para essa conversa, mas diz respeito aos sentimentos, experiências e limites de compreensão ou limites em suportar as emoções expressas dos adultos e crianças envolvidos. Para tal, é preciso que adultos e profissionais tenham uma preparação para alcançar essa educação para a morte de maneira honesta, juntamente com o crescimento e desenvolvimento da criança, no seu cotidiano, a partir das relações com a família, e escola

Perfil epidemiológico dos casos de gravidez na adolescência de um município no interior do estado de São Paulo / Epidemiological profile of teenage pregnancy cases of a city in the state of São Paulo

A gravidez na adolescência (GA) é um evento solitário, precoce e, frequentemente, associado às camadas mais pobres e menos instruídas da população. A GA afeta, eminentemente, as trajetórias dessas adolescentes ao impulsioná-las à maternidade antes de estarem preparadas física, emocional ou financeiramente, sobretudo, as marginalizadas. No Brasil, há uma taxa de 65 gestações para cada mil meninas, sendo a sétima maior taxa de GA na América do Sul. Dessa forma, a GA traz como consequência a destituição de direitos, sobretudo na educação e na saúde, o que pode perpetuar a pobreza e favorecer os processos de exclusão social, além de, também, aumentar os riscos obstétricos, neonatais e as taxas de infecção sexualmente transmissível, coexistentes com diversos problemas sociais como pobreza, evasão escolar, desemprego, entre outros. Uma vez que esse processo, por promover consequências físicas e sociais, pode ser considerado uma questão de saúde pública, faz-se necessário estudá-lo a fim de compreender o cenário no qual, majoritariamente, ele ocorre, juntamente com as motivações e os componentes envolvidos. Para tanto, foram analisadas bases de dados cadastradas em uma Unidade Básica de Saúde em uma cidade no interior do estado de São Paulo, as quais serviram de insumos para a confecção do perfil epidemiológico aqui apresentado. Obteve-se o total de 26 casos de GA, nos quais a média simples das idades foi 16,5 anos; prevalência de ensino fundamental incompleto e 54% não utilizada qualquer método contraceptivo. Por fim, a falta de padronização e informação nas bases de dados analisadas trouxe prejuízo ao presente estudo, uma vez que interfere nos valores aqui apresentados, trazendo-lhes possibilidade de variação e, também, impossibilitou conclusões que, a princípio, foram idealizadas pelas pesquisadoras

Catastrophic health expenditure and multimorbidity among older adults in Brazil

OBJETIVO: Estimar a relação entre gasto catastrófico em saúde (GCS) e multimorbidade em amostra nacional representativa da população brasileira com 50 anos de idade ou mais. MÉTODOS: Foram utilizados dados de 8.347 participantes do Estudo Longitudinal da Saúde dos Idosos Brasileiros (2015–2016). A variável dependente foi o GCS, definido pela razão entre as despesas com saúde do adulto de 50 anos ou mais e a renda domiciliar. A variável de interesse foi a multimorbidade (duas ou mais doenças crônicas), e a variável utilizada para estratificação foi o escore de riqueza. As principais análises foram baseadas na regressão logística multivariada. RESULTADOS: A prevalência de GCS foi de 17,9% e 7,5% para gastos correspondentes a 10% e 25% da renda domiciliar, respectivamente. A prevalência da multimorbidade foi de 63,2%. A multimorbidade apresentou associações positivas e independentes com GCS (OR = 1,95, IC95% 1,67–2,28 e OR = 1,40, IC95% 1,11–1,76 para gastos correspondentes a 10% e 25%, respectivamente). Os gastos associados à multimorbidade foram maiores entre aqueles com menor escore de riqueza. CONCLUSÕES: Os resultados chamam atenção para a necessidade de uma abordagem integrada da multimorbidade nos serviços de saúde, de forma a evitar os GCS, particularmente entre adultos mais velhos com piores condições socioeconômicas.OBJECTIVE: To estimate the relation between catastrophic health expenditure (CHE) and multimorbidity in a national representative sample of the Brazilian population aged 50 year or older. METHODS: This study used data from 8,347 participants of the Estudo Longitudinal de Saúde dos Idosos Brasileiros (ELSI – Brazilian Longitudinal Study of Aging) conducted in 2015–2016. The dependent variable was CHE, defined by the ratio between the health expenses of the adult aged 50 years or older and the household income. The variable of interest was multimorbidity (two or more chronic diseases) and the variable used for stratification was the wealth score. The main analyses were based on multivariate logistic regression. RESULTS: Th e p revalence o f C HE w as 17.9% a nd 7.5%, f or e xpenditures c orresponding t o 10 and 25% of the household income, respectively. The prevalence of multimorbidity was 63.2%. Multimorbidity showed positive and independent associations with CHE (OR = 1.95, 95%CI 1.67–2.28, and OR = 1.40, 95%CI 1.11–1.76 for expenditures corresponding to 10% and 25%, respectively). Expenditures associated with multimorbidity were higher among those with lower wealth scores. CONCLUSIONS: Th e r esults d raw a ttention t o t he n eed f or a n i ntegrated a pproach o f multimorbidity in health services, in order to avoid CHE, particularly among older adults with worse socioeconomic conditions

Severe reperfusion lung injury after double lung transplantation

AIM: To demonstrate the effects of combined inhaled nitric oxide and surfactant replacement as treatment for acute respiratory distress syndrome. This treatment has not previously been documented for reperfusion injury after double lung transplantation. METHOD: A 24-year-old female with cystic fibrosis underwent double lung transplantation. During implantation of the second lung a marked increase in pulmonary artery pressure associated with systemic hypotension, hypoxemia and low cardiac output were observed. Notwithstanding the patient received support from cardiovascular drugs and pulmonary vasodilators cardiopulmonary by-pass was necessary. In the intensive care unit the patient received the same drug support, inhaled nitric oxide and two bronchoscopic applications of bovine surfactant. RESULTS: A rapid improvement in PaO(2)/FiO(2) within 2–3 hours of administration of surfactant was seen. The patient is well at follow-up 1 year post-transplant. CONCLUSION: There is a potential role for a combined therapy with inhaled nitric oxide and surfactant replacement in reperfusion injury after lung transplantation

Evaluation of the efficiency of a Venturi scrubber in particulate matter collection smaller than 2.5 µm emitted by biomass burning

Energy demand has increased worldwide, and biomass burning is one of the solutions most used by industries, especially in countries that have a great potential in agriculture, such as Brazil. However, these energy sources generate pollutants, consisting of particulate matter (PM) with a complex chemical composition, such as sugarcane bagasse (SB) burning. Controlling these emissions is necessary; therefore, the aim was to evaluate PM collection using a rectangular Venturi scrubber (RVS), and its effects on the composition of the PM emitted. Considering the appropriate use of biomass as an industrial fuel and the emerging need for a technique capable of efficiently removing pollutants from biomass burning, this study shows the control of emissions as an innovation in a situation such as the industrial one with the use of a Venturi scrubber in fine particle collection, in addition to using portable and representative isokinetic sampling equipment of these particles. The pilot-scale simulation of the biomass burning process, the representative sampling of fine particles and obtaining parameters to control pollutant emissions for a Venturi scrubber, meets the current situation of concern about air quality. The average collection efficiency values were 96.6% for PM&gt; 2.5, 85.5% for PM1.0–2.5, and 66.9% for PM&lt; 1.0. The ionic analysis for PM&lt; 1.0 filters showed potassium, chloride, nitrate, and nitrite at concentrations ranging from 20.12 to 36.5 μg/m3. As the ethanol and sugar plants will continue to generate electricity with sugarcane bagasse burning, emission control technologies and cost-effective and efficient portable samplers are needed to monitor particulate materials and improve current gas cleaning equipment projects.</p

Neutrophilic Dermatosis in Pregnancy: An Uncommon Course

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eHealthResp, a Digital Intervention to Improve Antibiotic Prescribing in Respiratory Infections: A Pilot Study

The emergence of antibiotic resistance (ABR) is one of the most serious public health threats worldwide. The inappropriate use of antibiotics is considered the main determinant for the increase and development of ABR, contributing to a greater risk of therapeutic ineffectiveness, particularly within primary care context. Therefore, this pilot study aims to raise awareness and promote an adequate antibiotic use among physicians, through the evaluation of the eHealthResp platform, a digital intervention composed by an online course and a mobile application, to aid in the management of respiratory tract infections. The global validation of the eHealthResp platform was carried out by 12 physicians who explored and performed a quantitative and qualitative evaluation of the contents of the online course and mobile app. The global evaluation of the analyzed parameters was very positive, with the highest median scores being attributed to adequacy, correction, format, and trust of the eHealthResp platform. The qualitative feedback enhanced the contents' relevance, clarity, and consolidation, as well as the effectiveness of the educational intervention against ABR. Overall, this study revealed that the eHealthResp may be regarded as an important e-health tool for the management of respiratory tract infections and improvement of antibiotic prescription practices among physicians

Improving Pharmacists Awareness of Inadequate Antibiotic Use for URTIs through an Educational Intervention: A Pilot Study

The inadequate use of antibiotics led to the development of multi-resistant bacteria that are now causing millions of deaths worldwide. Since most antibiotics are prescribed/dispensed to treat respiratory tract infections, it is important to raise awareness among health professionals to optimize antibiotic use, especially within the primary care context. Thus, this pilot study aimed to evaluate pharmacists' feedback about the eHealthResp platform, composed by an online course and a mobile application (app) to help in the management of upper respiratory tract infections (URTIs). Ten community pharmacists were invited to participate in this study, exploring the contents of the eHealthResp platforms and answering a content validation questionnaire composed by eight qualitative and thirty-five quantitative questions about the online course and mobile app. The eHealthResp platform is a comprehensive, consistent, and high-quality e-learning tool. Median scores of 5.00 were attributed to the course contents' and clinical cases' adequacy and correction. Most qualitative feedback was about completeness and objectivity of the course, and its usefulness for clinical practice. This study showed that eHealthResp has great potential as an e-health tool for the management of URTIs' symptoms, which may ultimately aid in reducing inappropriate antibiotic use