PREPARO DE ÁGUA SUPEROXIGENADA COM PERÓXIDO DE HIDROGÊNIO PARA USO EMERGENCIAL EM TANQUES DE AQUICULTURA

The present work aimed at producing chemically stable super oxygenated water with hydrogen peroxide for emergency use in aquaculture tanks. Twenty-four gallons of 12-L each received 10 L of clean freshwater. The control group gallons did not receive any application of hydrogen peroxide 35% p.a. (P35). The experimental group gallons received one single application of P35 at the beginning, in different levels: 2.0 mL P35 L-1 and 4.0 mL P35 L-1. After product applications, the gallons were kept hermetically locked, but half of the gallons were periodically unlocked to take water samples (manipulated gallons), and half were unlocked only at the day 15 and 28 (unmanipulated gallons). Measuring of temperature, pH and dissolved O2 were carried out in all manipulated gallons every two days, in the first 15 days, and every 3-4 days from the 16th to the 28th day. It was concluded that it is possible to prepare chemically stable super oxygenated water for emergency use in aquaculture tanks by applying 2.0 mL L-1 of hydrogen peroxide 35% p.a in clear freshwater. A minimal period of three days must be observed before using the super oxygenated water. Concentrations of dissolved O2 higher than 15 mg L-1 could be obtained for at least 28 days if the water gallons are properly locked up.O presente trabalho teve por objetivo produzir água superoxigenada, quimicamente estável, com peróxido de hidrogênio para uso emergencial em tanques de aquicultura. Vinte e quatro galões de 12 L receberam, cada um, 10 L de água doce limpa. Os galões do grupo-controle não receberam nenhuma aplicação de peróxido de hidrogênio 35% p.a. (P35). Os galões dos grupos experimentais receberam uma aplicação única de P35, no início do trabalho, em diferentes dosagens: 2,0 mL P35 L-1 e 4,0 mL P35 L-1. Após a aplicação do produto na água, os galões foram mantidos hermeticamente fechados, sendo que metade dos galões foram abertos periodicamente, por ocasião das amostragens experimentais (galões manipulados), e metade dos galões somente foram abertos nos dias 15 e 28 (galões não manipulados). Determinações de temperatura, pH e concentração de O2 dissolvido na água foram realizadas em todos os galões manipulados, a cada dois dias, nos primeiros 15 dias, e a cada 3-4 dias, do 16° ao 28° dia. Concluiu-se que é possível preparar água superoxigenada quimicamente estabilizada para uso emergencial em tanques de aquicultura pela aplicação de 2,0 mL L-1 de peróxido de hidrogênio 35% p.a, em água doce limpa. Após o preparo, deve-se respeitar uma carência mínima de três dias para uso da água superoxigenada. Concentrações dissolvidas de O2 superiores a 15 mg L-1 poderão ser mantidas por no mínimo 28 dias, caso a vedação dos galões contendo água oxigenada seja apropriada

Prevalência e etiologia do traumatismo dental entre crianças e adolescentes: revisão de literatura/ Prevalence and etiology of dental traumacism among children and adolescents: literature review

O traumatismo dentário é uma ocorrência comum na primeira infância, e é considerado pela Organização Mundial de Saúde (OMS), um problema de Saúde Pública, podendo envolver desde uma pequena fratura em esmalte até a perda definitiva do elemento dentário. O objetivo deste estudo é descrever a prevalência e média dos afetados por traumatismo entre as crianças e adolescentes, bem como as causas das injúrias dentárias traumáticas envolvendo gênero e identificando a frequência das sequelas após o traumatismo. Alguns critérios de inclusão foram estabelecidos, como: As publicações que tiveram como foco traumatismos dentais entre as crianças e os adolescentes. Após a leitura de todo material, foi procedida compreensão para análise e elaborado o referencial teórico. Para realização desse estudo bibliográfico foi efetuada pesquisas em bancos de dados MEDLINE (Medical Literature Analysis and Retrieval Sistem on-line), SCIELO (Scientific Eletronic Library on-line) e LILACS (Literatura Latino-americana e do Caribe em Ciências da Saúde) além de livros da área de traumatismo dental e saúde bucal coletiva

A inclusão do cirurgião dentista em ambiente hospitalar / The inclusion of dental surgeon in hospital environment

O cuidado com a saúde em âmbito hospitalar exige o trabalho em equipe multidisciplinar, fato que demandou a introdução da Odontologia nesse ambiente de trabalho. A odontologia Hospitalar tem como objetivo, dá assistência e cuidados a pacientes que se encontram sob internação hospitalar, visto que o cirurgião-dentista é um profissional capacitado para, detectar, prevenir e cuidar das alterações bucais. A inserção do CD em ambiente hospitalar tem sido instituída mediante a resoluções e leis. Sendo assim, o objetivo deste trabalho é apresentar trajetória da Odontologia Hospitalar no Brasil, verificando a situação atual e mostrar sobre a importância desse profissional na equipe multidisciplinar dos hospitais. As buscam foram feitas nas principais bases de dados na área da saúde: PubMed, Scopus e BVS (Biblioteca Virtual em Saúde). Não sendo estipulado limite para o período de busca dos artigos, bem como não houve restrição de idioma

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

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

Arthur Neiva e a 'questão nacional' nos anos 1910 e 1920 Arthur Neiva and the 'national question' in the 1910s and 1920s

Com o objetivo de analisar as interpretações e os diagnósticos sobre o Brasil elaborados pelo cientista e escritor Arthur Neiva entre as décadas de 1910 e 1920, especialmente a partir de suas crônicas literárias e do relatório da expedição científica realizada ao interior do Brasil em 1912, destaco suas críticas contra a mentalidade das elites dirigentes e dos homens de letras, sobretudo pela falta de ação política, pelo apego à imitação das ideias e ao uso exagerado da retórica bacharelesca - considerados por ele os principais responsáveis pelo atraso cultural e político do país. Analiso também a maneira como Arthur Neiva lidou com a questão racial e os dilemas da formação nacional, tema considerado, no início do século XX, de fundamental importância para a compreensão da realidade e do destino do Brasil no chamado 'concerto das nações'.<br>The article analyzes the interpretations and diagnoses of Brazil developed by scientist and writer Arthur Neiva in the 1910s and 1920s, focusing especially on his literary crônicas and his report on the 1912 scientific expedition to the interior of Brazil. I highlight the author's criticisms of the mentality of the governing elite and men of letters, especially their failure to take political initiative, their penchant for imitating ideas, and their exaggerated use of pretentious rhetoric, which Neiva believed to be the main culprits behind Brazil's cultural and political backwardness. I also analyze how Neiva addressed the race issue and the dilemma of nation building, which in the early twentieth century was considered a theme of prime importance in understanding Brazil's reality and destiny within the so-called concert of nations

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt