Cessação de hábitos tabágicos em doentes coronários

Objective: Assess the impact of coronary events in smoking cessation habits, and study the association between smoking habits and coronary artery disease. Methods: With a clinical structured interview, three groups were selected (n=68), from the patients of the Cardiology Service of Hospital Militar Principal. Sample 1 was composed by patients with stable, and unstable angina (n= 18), sample 2 by patients with myocardial infarction (n=26), and sample 3 by individuals with other cardiac disease (arterial hypertension, or valve disease) (n=24). The individuals were aged between 48 and 75. The following statistical procedures were used: correspondence analysis, chi-square test (x2 ~ and Fisher exact test. Results: The association between smoking habits(non smoker, former smoker, and current smoker),and type of disease (angina, myocardial infarction, and arterial hypertension), was statistically significant [X2(68)=l4,5; p=O,OO6], and there was also a significant association between smoking habits and coronary artery disease [~2(68)=4,O;p=O,O45]. The category of ex-smokers and myocardial patients also showed significant association (Fisher exact test=O,036). Conclusions: Previous myocardial infarction events constitute an experience of severe suffering and crisis, in which the patient accepts to stop smoking. We also confirm that smoking is a risk factor for myocardial infarction. Thus the objective of clinic objectivo de promover e reforçar a intenção de abandonar o consumo de tabaco revela-se de extrema importância e utilidade nesta tomada de decisão

Distúrbios miccionais e anormalidades urodinâmicas em pacientes idosos

Lower urinary tract dysfunction is a major cause of morbidity and decreased quality of life in elderly men and women. With the progressive aging of the population, it is important to understand common micturitional disorders that may occur in this population. Most urinary problems in the elderly are multifactorial in origin, demanding a comprehensive assessment of the lower urinary tract organs, functional impairments, and concurrent medical diseases. Urodynamics is a highly valuable tool in the investigation of elderly patients with lower urinary tract symptoms. Urodynamic tests are not always necessary, being indicated after excluding potentially reversible conditions outside the urinary tract that may be causing or contributing to the symptoms. Although urodynamic tests may reveal common diagnoses such as bladder outlet obstruction and stress urinary incontinence in the elderly population, findings such as detrusor overactivity and impaired detrusor contractility are common and have important prognostic and therapeutic implications. The purpose of this article is to describe common urologic problems in the elderly and review the indications for and clinical aspects of urodynamic studies in these conditions.Disfunções do trato urinário inferior são uma causa importante de morbidade e diminuição da qualidade de vida em homens e mulheres idosos. Com o envelhecimento progressivo da população, é importante compreender os distúrbios miccionais mais comuns nesta população. A maioria dos problemas miccionais em homens idosos tem origem multifatorial, requerendo uma avaliação ampla dos órgãos do trato urinário inferior, da capacidade funcional e neurológica dos pacientes e dos problemas clínicos coexistentes. A avaliação urodinâmica é uma ferramenta importante na investigação de pacientes idosos com sintomas do trato urinário inferior. Ela não é necessária em todos os casos e só deve ser indicada após a exclusão de problemas não urológicos e potencialmente reversíveis que poderiam causar ou contribuir para os sintomas miccionais. Embora os exames urodinâmicos possam revelar diagnósticos comuns como obstrução vesical ou incontinência urinária de esforço, na população idosa é freqüente a ocorrência de achados como hiperatividade detrusora e falência da contratilidade vesical, com implicações prognósticas e terapêuticas importantes. O objetivo deste artigo é descrever os problemas urológicos mais comuns nos idosos e discutir as indicações e características dos exames urodinâmicos nestas condições

Estudo e propostas de melhoria na preparação de kits na Bosch Termotecnologia

Mestrado em Engenharia e Gestão IndustrialO presente trabalho resulta de um estágio curricular desenvolvido na Bosch Termotecnologia. O objectivo deste trabalho é o estudo da preparação de kits numa área específica da Bosch Termotecnologia, baseando-se no modelo de gestão Bosch Production System, os seus princípios e elementos. Foram particularmente considerados os princípios de melhoria contínua, a metodologia 5S, os dispositivos Poka-Yoke e as ferramentas básicas da Qualidade. O conjunto de acções de melhoria propostas visam diminuir o número de falhas e eliminar os desperdícios no processo de preparação de kits na célula S871 da Bosch Termotecnologia. ABSTRACT: The present work results from a curricular internship developed at Bosch Termotecnologia. The purpose of the work is the study of preparation kits into a specific organization area. By taking the Bosch Production System management model, its principles and elements, specifically the continuous improvement and perfect quality principles as well as the 5S, Poka-Yoke devices and Q-tools elements, propose a set of improvements that aim at a decrease of failures and wastefulness’s elimination throughout the kit preparation process in S871 cell at Bosch Termotecnologia

Renal function in children with congenital neurogenic bladder

AIMS: Preservation of renal function in children with congenital neurogenic bladder is an important goal of treatment for the disease. This study analyzed the evolution of renal function in patients with congenital neurogenic bladder. METHODS: We reviewed the records of 58 pediatric patients with respect to the following attributes: gender, age, etiology of neurogenic bladder, reason for referral, medical/surgical management, episodes of treated urinary tract infections, urodynamics, DMSA scintigraphy, weight, height, blood pressure, glomerular filtration rate, microalbuminuria and metabolic acidosis. Statistical analysis was performed, adopting the 5% significance level. RESULTS: The mean age at presentation was 4.2 ± 3.5 years. Myelomeningocele was the most frequent etiology (71.4%). Recurrent urinary tract infection was the reason for referral in 82.8% of the patients. Recurrent urinary tract infections were diagnosed in 84.5% of the patients initially; 83.7% of those patients experienced improvement during follow-up. The initial mean glomerular filtration rate was 146.7 ± 70.1 mL/1.73 m²/min, and the final mean was 193.6 ± 93.6 mL/1.73 m²/min, p = 0.0004. Microalbuminuria was diagnosed in 54.1% of the patients initially and in 69% in the final evaluation. Metabolic acidosis was present in 19% of the patients initially and in 32.8% in the final assessment. CONCLUSIONS: Patient referral to a pediatric nephrologist was late. A reduction in the number of urinary tract infections was observed with adequate treatment, but microalbuminuria and metabolic acidosis occurred frequently despite adequate management

Sacral neuromodulation for treatment of overactive bladder: a review

Sacral neuromodulation (SNM) therapy is an established third line therapeutic option for the treatment of urgency urinary incontinence, urgency-frequency and chronic non-obstructive urinary retention. The continuous stimulation of the sacral root S3 with an electrode connected to an implanted pulse generator (IPG) may influence detrusor and sphincter activity and improve lower urinary tract symptoms. The mechanism of action is not completely understood and seems to be based on the modulation of spinal cord reflexes and brain centers involved in lower urinary tract function. It is implanted with a minimally invasive technique that can be performed under local anesthesia and includes a test phase that precedes the definitive implantation of the pulse generator. When compared to the standard pharmacological therapy, neuromodulation promoted better results both in the partial improvement of overactive bladder (OAB) symptoms and total continence. Moreover, sexual function, quality of life and depressive symptoms may also improve in patients with OAB that undergo SNM. However, SNM is associated with significant rates of adverse events and need for surgical revisions, requiring continuous medical attention.A neuromodulação sacral (NMS) é uma opção bem estabelecida de tratamento de terceira linha da bexiga hiperativa, incluindo as indicações de urgência-frequência, incontinência urinária de urgência e também a retenção urinária crônica não obstrutiva. A estimulação contínua da raiz sacral S3, através de um eletrodo conectado a um gerador de pulsos implantado, pode influenciar a função do detrusor e do esfíncter uretral e melhorar os sintomas do trato urinário inferior. O mecanismo de ação não é totalmente conhecido e parece basear-se na modulação dos reflexos medulares e dos centros cerebrais envolvidos no controle da função do trato urinário inferior. O eletrodo sacral é implantado com técnica minimamente invasiva, que pode ser realizada com anestesia local, e inclui uma fase de teste que precede o implante definitivo do gerador de pulsos. Em comparação com o tratamento farmacológico padrão da bexiga hiperativa, a NMS promove melhores resultados na melhora dos sintomas e nas taxas de cura. Além disso, a função sexual, a qualidade de vida e os sintomas depressivos também podem melhorar nos pacientes com bexiga hiperativa que são submetidos à NMS. No entanto, a NMS acompanha-se de significativas taxas de eventos adversos e de necessidade de revisões cirúrgicas, requerendo acompanhamento clínico periódico

Annotating arguments in a corpus of opinion articles

Interest in argument mining has resulted in an increasing number of argument annotated corpora. However, most focus on English texts with explicit argumentative discourse markers, such as persuasive essays or legal documents. Conversely, we report on the first extensive and consolidated Portuguese argument annotation project focused on opinion articles. We briefly describe the annotation guidelines based on a multi-layered process and analyze the manual annotations produced, highlighting the main challenges of this textual genre. We then conduct a comprehensive inter-annotator agreement analysis, including argumentative discourse units, their classes and relations, and resulting graphs. This analysis reveals that each of these aspects tackles very different kinds of challenges. We observe differences in annotator profiles, motivating our aim of producing a non-aggregated corpus containing the insights of every annotator. We note that the interpretation and identification of token-level arguments is challenging; nevertheless, tasks that focus on higher-level components of the argument structure can obtain considerable agreement. We lay down perspectives on corpus usage, exploiting its multi-faceted nature

OCCULT AND SEMI-OCCULT CONSTIPATION IN CHILDREN WITH MONOSYMPTOMATIC OR NON MONOSYMPTOMATIC ENURESIS

ABSTRACT Background: Functional constipation and enuresis frequently coexist. Constipation treatment often results in resolution or improvement of the enuresis. However, besides the classical presentation, patients can present with occult constipation (OC) diagnosed in complementary evaluation; in addition, semi-occult constipation (SOC) can be detected by means of a detailed questionnaire. Objective: To quantify OC and SOC frequency in children with monosymptomatic or non monosymptomatic enuresis (MNE or NMNE). Methods: Otherwise healthy children/adolescents, with enuresis refractory to behavioral therapy and denying constipation after simple questions, answered a structured bowel habit questionnaire and were submitted to a plain abdominal radiological exam. Constipation was classified considering the Boston diagnostic criteria (to allow diagnosis at initial stages), and fecal loading in the X-ray quantified ≥10 by the Barr score. Children with constipation received a standardized treatment (except 26 “pilot” children). Results: Out of 81 children, 80 aged 9.34±2.07 years, 52.5% male, were diagnosed with constipation: 30 OC, 50 SOC; 63.75% had MNE, 36.25% NMNE (six NMNE without behavioral therapy). Demographic data and the Barr score were similar for OC and SOC, but SOC children experienced significantly more constipation complications (retentive fecal incontinence and/or recurrent abdominal pain). Not showing the Bristol Stool Scale (BSS) to 24 “pilot” children, or absence of constipation symptoms accompanying BSS predominantly type 3, in 13 children, did not significantly impact the detection of constipation by the Barr score. Children identifying BSS 3 or ≤2 had similar results. Twenty-eight children, with adequate follow-up after treatment, improved or recovered from constipation at 44 of their 52 follow-up visits. Conclusion: In patients with MNE or NMNE refractory to behavioral therapy, and who initially denied constipation after simple questions, a detailed questionnaire based on the Boston diagnostic criteria detected SOC in 61.7%, and the radiological Barr score revealed fecal loading (OC) in 37.0% of them

Quality control in blood irradiation

Irradiation is a technique used in hemotherapy to functionally inactivateviable lymphocytes, in cellular blood components, to reduce the risk of Transfusion-associated Graft-versus-Host Disease (AT-GVHD), is rare but letal. One way to avoid it is to irradiate blood componentes in situations such as: intrauterine transfusion, newborns, patients receiving immunosuppressive therapy in bone marrow transplantation. Thus, it is extremely important that blood component is irradiated and, above all, ensure that the minimum dose is 25 Gy.The blood policy in Brazil is implemented through laws and normative decrees, giving rise to a legal system that underpins the actions of hemotherapy services. In order to correct verify absorbed doses and the quality assurance process as well as the safety for the irradiator operators we describe in this paper a several of physical measurements that is mandatory to support a physicist to evaluate the quality assurance during and after the irradiation process. The results obtained from this physical measurements  provided a guarantee of proper radiation dose used in hemotherapy as well as methods and procedures applied to protect the patient, employees and general public due to procedure of blood irradiation accordling the Technical Regulation of Hemotherapy Procedures of the National Health Surveillance Agency (ANVISA) and safety regulations by National Nuclear Energy Commission (CNEN)

Effects of Milling and Cooking Processes on the Deoxynivalenol Content in Wheat

Deoxynivalenol (DON, vomitoxin) is a natural-occuring mycotoxin mainly produced by Fusarium graminearum, a food-borne fungi widely distributed in crops and it is one of the most important mycotoxins in wheat and wheat-based foods and feeds. DON affects animal and human health causing diarrhea, vomiting, gastro-intestinal inflammation, and immunomodulation. Since the rate of the occurrence of DON in wheat is high, effective procedures to remove or eliminate DON from food products is essential to minimize exposures in those who consume large amounts of wheat. Cleaning prior to milling reduced to some extent the concentration of DON in final products. Since DON is distributed throughout the kernels, with higher content in the outer skin, milling is also effective in reducing the DON levels of wheat-based foods if bran and shorts are removed before thermal cooking. DON is water-soluble and cooking with larger amounts of water lowers DON content in products such as spaghetti and noodles. During baking or heating, DON is partially degraded to DON-related chemicals, whose toxicological effects are not studied well. This paper reviews the researches on the effects of milling and cooking on the DON level and discusses the perspectives of further studies