COMPARAÇÃO DOS PADRÕES DE BALNEABILIDADE DAS PRAIAS DE PALMAS, ESTADO DO TOCANTINS, NO PERÍODO 2007 a 2009

O meio ambiente sofre as conseqüências do desenvolvimento de nossas sociedades, o que representa um fator de risco, devido às atividades humanas sem controle, os despejos de esgotos sem tratamento, vazamentos de produtos tóxicos e a disposição inadequada de resíduos sólidos que vêm causando uma degradação vertiginosa e uma dilapidação do capital natural. A qualidade das águas para recreação é conseqüência direta ou indireta das medidas de infraestrutura sanitária adotadas no país. O crescimento desordenado e rápido, comum nas jovens cidades, gera uma demanda crescente por obras de saneamento básico. As águas das praias de Palmas apresentaram valores baixos de coliformes totais e termotolerantes para o biênio considerado, indicando que estão próprias e excelentes para a recreação de contato primário, ou seja, em condições de balneabilidade, não sendo observados pontos de contaminação microbiológica que ultrapassem os limites estabelecidos pela legislação vigente.Palavras Chave: balneabilidade, água, praias, coliformes, recreação.ABSTRACTComparison of standards of beaches of Palms bathing, Tocantins state, during 2007 to 2009The environment suffers from development that represents a risk factor, due to human activities without control, sewage disposal, toxic spills and improper disposal of solid waste that is causing a precipitous degradation and a squandering of natural capital. The quality of water for recreation is a direct or indirect consequence of health infrastructure measures adapted in the country. The rapid and disorderly growth, common in young cities, creates a growing demand for basic sanitation projects. The waters of the Palmas city beaches presented low values of total and fecal coliforms for de biennium under consideration, indicating that oare maper in the category excellent for primary contact recreation, urthout points of microbiological contamination exceeding the limits set by legislation.Key-words: water, recreation, coliforms, legislation

Vitamina D tem influência nos implantes dentários?

D Vitamin (calciferol) presents an important role in bone metabolism (turnover) and maintenance of calcium and phosphorus levels in blood. The main source of production is sun-stimulated skin. However, characteristics of modern life, such as fear of dermatological damage and use of protective agents, have hindered/reduced sun exposure. In this way, adequate synthesis of this vitamin is impaired, which can affect negatively the clinical success of dental implants. This study aimed to describe the importance of D vitamin and the effect of its deficiency on systemic health and repercussion in dental implants. An electronic search was made in the Scielo, Pubmed and Scopus databases using the descriptors: “deficiency and vitamin D and dental implants”. 13 articles were selected for review and data analysis. Lack or deficiency of D vitamin promoted different alterations such as mild hypocalcaemia, loss of trabecular bone, and severe bone, muscle, immune and metabolic disorders. In case of suspected D vitamin deficiency, patient should be referred to a physician and nutritionist. The existence of possible hypovitaminosis and indication of appropriate therapeutic approach is very important. The studies in vitro and in animals demonstrate the effects of deficiency or effect of vitamin D supplementation on bone metabolism around dental implants. Already the human studies feature great heterogeneity, no link was found between low serum vitamin D levels with an increased risk of early implant loss. Therefore, further research, including longitudinal clinical investigations and systematic reviews, is necessary to better elucidate mechanisms of D vitamin in processes of bone metabolism and osseointegration supporting dentists, physician and nutritionists when in contact with patients who use or will use dental implants

“Giardia and Cryptosporidium” removal technologies in water supply systems: a systematic literature review / Tecnologias de remoção de “Giardia e Cryptosporidium” em sistemas de abastecimento de água: uma revisão sistemática de literatura

Water treatment plants must have processes that ensure that the water supplied to the population meets the physical, chemical and biological parameters of the Ministry of Health and ensuring compliance with the recommended limits will provide increased safety in terms of the absence of bacteria, viruses and protozoa. present in the water. Water contamination after treatment by giardia and Cryptosporidium occurs in developed and developing countries, and one of the causes is the resistance of these protozoa to traditional standards of disinfection by chlorination. In this sense, the present article aims to gather information on giardia and Cryptosporidium removal technologies in water supply systems using systematic literature mapping (MSL). Thus, the research used the Science Direct database (Elsevier) with a time frame covering the period from 2016 to 2021. The keywords used were “giardia and Cryptosporidium, water treatment, removal. The research identified 58 studies that, after applying the exclusion criteria, 22.41% of the articles were selected for the first stage, and after the second stage, 5.17% of the total. Research has shown that there are treatment processes for removing “giardia and Cryptosporidium”, such as coagulation/filtration, reverse osmosis, micro or ultrafiltration, advanced UV-based oxidation, etc. and simpler processes such as using slow filtration. Many times, a set of these processes must be used so that the removal can take place in the proper way and that, with this, the potability of the water is guaranteed

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Oclusão de artéria central da retina associada ao forame oval patente

Oclusão da artéria central da retina é uma doença comumente encontrada em pacientes idosos, mas pode também ser vista em crianças e adultos jovens. Nestes, as principais causas são anomalias cardíacas, sendo o forame oval patente o mais observado. O objetivo do trabalho é relatar o caso de um paciente jovem com oclusão da artéria central da retina apresentando persistência de forame oval e, também, salientar a importância de uma propedêutica detalhada nos casos de oclusões vasculares da retina

Factors associated with hospital mortality in renal transplant patients admitted to the intensive care unit with acute respiratory failure

Abstract Introduction: The lungs are often involved in a variety of complications after kidney transplantation. Acute respiratory failure (ARF) is one of the most serious manifestations of pulmonary involvement. Objective: To describe the main causes of ARF in kidney transplant patients who require intensive care and identify the factors associated with mortality. Methods: This retrospective study evaluated adult patients with ARF admitted to the intensive care unit of a center with high volume of transplants from August 2013 to August 2015. Demographic, clinical, and transplant characteristics were analyzed. Multivariate logistic regression analysis was performed to identify factors associated with hospital mortality. Results: 183 patients were included with age of 55.32 ± 13.56 years. 126 (68.8%) were deceased-donor transplant, and 37 (20.2%) patients had previous history of rejection. The ICU admission SAPS3 and SOFA score were 54.39 ± 10.32 and 4.81 ± 2.32, respectively. The main cause of hospitalization was community-acquired pneumonia (18.6%), followed by acute pulmonary edema (15.3%). Opportunistic infections were common: PCP (9.3%), tuberculosis (2.7%), and cytomegalovirus (2.2%). Factors associated with mortality were requirement for vasopressor (OD 8.13, CI 2.83 to 23.35, p < 0.001), invasive mechanical ventilation (OD 3.87, CI: 1.29 to 11.66, p = 0.016), and SAPS3 (OD 1.04, CI 1.0 to 1.08, p = 0.045). Conclusion: Bacterial pneumonia is the leading cause of ARF requiring intensive care, followed by acute pulmonary edema. Requirement for vasopressor, invasive mechanical ventilation and SAP3 were associated with hospital mortality

Factors associated with hospital mortality in renal transplant patients admitted to the intensive care unit with acute respiratory failure

<div><p>Abstract Introduction: The lungs are often involved in a variety of complications after kidney transplantation. Acute respiratory failure (ARF) is one of the most serious manifestations of pulmonary involvement. Objective: To describe the main causes of ARF in kidney transplant patients who require intensive care and identify the factors associated with mortality. Methods: This retrospective study evaluated adult patients with ARF admitted to the intensive care unit of a center with high volume of transplants from August 2013 to August 2015. Demographic, clinical, and transplant characteristics were analyzed. Multivariate logistic regression analysis was performed to identify factors associated with hospital mortality. Results: 183 patients were included with age of 55.32 ± 13.56 years. 126 (68.8%) were deceased-donor transplant, and 37 (20.2%) patients had previous history of rejection. The ICU admission SAPS3 and SOFA score were 54.39 ± 10.32 and 4.81 ± 2.32, respectively. The main cause of hospitalization was community-acquired pneumonia (18.6%), followed by acute pulmonary edema (15.3%). Opportunistic infections were common: PCP (9.3%), tuberculosis (2.7%), and cytomegalovirus (2.2%). Factors associated with mortality were requirement for vasopressor (OD 8.13, CI 2.83 to 23.35, p < 0.001), invasive mechanical ventilation (OD 3.87, CI: 1.29 to 11.66, p = 0.016), and SAPS3 (OD 1.04, CI 1.0 to 1.08, p = 0.045). Conclusion: Bacterial pneumonia is the leading cause of ARF requiring intensive care, followed by acute pulmonary edema. Requirement for vasopressor, invasive mechanical ventilation and SAP3 were associated with hospital mortality.</p></div

Clinical parameters, histological analysis, and laser Doppler flowmetry of different subepithelial connective tissue grafts

Subepithelial connective tissue graft (SCTG) presents favorable outcomes. However, the harvesting technique can influence the anatomical and histological composition of the SCTG. Within the limitations of a case report, the behavior of SCTGs removed by two techniques was evaluated bilaterally in one patient using double blade scalpel (DBS) and de-epithelialized graft (DE). Clinical parameters, laser Doppler flowmetry (LDF) and histological analysis were assessed. Complete root coverage was observed bilaterally, as well as improvement in width and thickness of keratinized tissue 2 years postoperatively. The LDF analysis demonstrated better revascularization in the DBS recipient area compared to DE. The histological evaluation showed differences in tissue composition and organization of collagen fibers. Similar clinical outcomes were observed bilaterally, nevertheless greater morbidity and aesthetic was reported in the DE harvesting area