Dias paralisados em obras rodoviárias em função das chuvas: determinação do nível de esforço de roçada associado aos postos pluviométricos do Tocantins

The present undergraduate paper proposed to obtain a new rainfall intensity factor (nd), which represents the average percentage of days paralyzed in execution of road infrastructure works, due to rainfall, for the state of Tocantins. The factor determined by the SICRO manual (2017) is applied to the direct cost of execution of a service impacted by rainfall, where a single monthly average value was determined for the entire state of Tocantins. The methodology consisted of applying the assumptions adopted by the manual to obtain the nd for 34 rainfall stations, with a historical series from 2001 to 2017, except for 2007 and 2008, located within the limits of Tocantins and near the state boundaries. The geostatistical interpolation method of empirical bayesian kriging was used to know the behavior of the factor over the territory, for monthly mean values of nd and for an annual mean value. The mowing service was chosen to apply the nd, since it is used to obtain the level of mowing effort, which determines the frequency of the execution of a service, as proposed by DNIT PRO 182 (2018). The annual quantities and the execution cost of mowing service, were estimated for BR-010, located in the urban perimeter of Palmas/TO, based on SICRO unit cost tables, for three scenarios: annual nd mean value and the level of mowing effort suggested by SICRO; value of the annual nd mean and effort level obtained through this paper and through the application of the monthly nd average. The results indicated that the value of the rainfall intensity factor suggested for the state of Tocantins presents distortions that mischaracterize the objectives of predicting the paralyzed days, since the methodological inconsistencies produced a nd mean lower than it was found in this study and for services performed with a lower frequency, in months with distinct rainy behavior, and/or performed singly, it is recommended to consider the monthly variation on the estimation of the service’s cost.O presente trabalho propôs obter um novo fator de intensidade de chuvas (nd), que representa o percentual médio de dias paralisados em execução de obras de infraestrutura rodoviária, em função da precipitação pluviométrica, para o estado do Tocantins. O fator determinado pelo manual SICRO (2017) é aplicado no custo direto da execução de um serviço impactado pela ocorrência das chuvas, onde foi determinado um valor único médio mensal para todo o estado do Tocantins. A metodologia consistiu na aplicação das premissas adotadas pelo manual para a obtenção do nd para 34 estações pluviométricas, com série histórica compreendida entre os anos de 2001 e 2017, com exceção dos anos de 2007 e 2008, excluídos por apresentarem série incompleta, localizadas dentro dos limites do Tocantins e próximas da divisa do estado. O método de interpolação geoestatística por krigagem empírica bayesiana foi empregado para se conhecer o comportamento do fator ao longo do território, para valores médios mensais de nd e para um valor médio média anual. O serviço de roçada foi escolhido para aplicação do nd, visto que o mesmo é utilizado para obter o nível de esforço de roçada, que determina a frequência de execução do serviço, conforme orienta a norma DNIT PRO 182 (2018). Foram estimadas as quantidades anuais e o custo da execução do serviço de roçada para a BR-010, localizada no perímetro urbano de Palmas/TO, com base nas tabelas de custo unitário de referência do SICRO, para três cenários: valor do nd médio anual e do nível de esforço de roçada sugeridos pelo SICRO; valor do nd médio anual e do nível de esforço obtidos por meio deste trabalho e aplicação do nd médio mensal. Os resultados apontaram que o valor do fator de intensidade de chuvas sugerido para o estado do Tocantins apresenta distorções que descaracterizam os objetivos de prever os dias paralisados, visto que as inconsistências metodológicas, como o número insuficiente de estações empregadas no estudo e a consideração das falhas como dia sem ocorrência de precipitação, produziram uma média de nd inferior à encontrada neste estudo e que para serviços executados com menor frequência, em meses com comportamento chuvoso distinto, e/ou realizados pontualmente, recomenda-se considerar a variação mensal na estimativa do custo do serviço

Acidose metabólica e o estado nutricional de pacientes em hemodiálise

Introduction: The prevalence of malnutrition in hemodialysis (HD) is high, being a marker of poor prognosis in chronic kidney disease. Metabolic acidosis is common on dialysis, and has been associated with mortality. Objectives: To evaluate metabolic acidosis and the nutritional status of HD patients. Methods: A cross-sectional study was carried out in a single HD center. Data were collected from medical records, and the presence of metabolic acidosis and the nutritional status of the patients were verified by anthropometric and biochemical indicators. Results: The total sample of 63 patients, 54% male and 46% female, with 58.7% between 45 and 64 years. The mean dialysis time was of 5.4 years. The mean value of the body mass index (BMI) was 24.9kg/m2, and the mean value of albumin was 3.9g/dL. The prevalence of metabolic acidosis was of 77.8%. There was a negative linear correlation between bicarbonate and creatinine, without correlation with anthropometric and albumin indicators. Patients malnourished according to the BMI corresponded to 55.5% of the total sample and gained more interdialytic weight. Out of the total sample, 14.2% of the patients were classified as malnourished by the arm circumference index, and albumin < 4.0 g/dL was observed in 49.2% of the patients. Serum creatinine was higher in male patients aged between 45 and 64 years old. No difference in time on hemodialysis was observed regarding age, interdialytic weight gain, laboratory, and anthropometric measures. Conclusion: The prevalence of metabolic acidosis was high, and there was no correlation with the nutritional status. Bicarbonate < 22 mEq/L was correlated with higher creatinine values, but was unrelated to the nutritional status. The nutritional assessment by BMI was in agreement with the Brazilian literature, and albumin indicated elevated malnutrition

Guideline for teaching advanced life support in the presence of mass casualty. Consensus for the project of training and research in life support. Cienfuegos, 2018

Foundation: in disaster situations, when the number of patients or injured is high and the resources are limited, medical care requires changes of structures and processes if it is aimed to save most of the persons involved. Health personnel should be trained to face this situation becoming more frequent each time. Objective: to update, for the project, the guidelines and strategies for teaching life support in the presence of mass casualty. Methods: national workshop developed in July 10th and 11th in Cienfuegos, with 13 experts and four key informers. The techniques of brain storming and nominal group, semi-structured and previous documentary review. Results: objectives, specific aspects, teaching strategy, contents, scope of the abilities, skills to develop, future research, and areas for inter-institutional collaboration were proposed for teaching life support in situations of disaster. Conclusion: academic proposals for the course “Life support in the presence of mass casualty¨ allow preparing health professionals to offer medical assistance in situations of disasters with limited resources in complex environments

Oxidative stress and immune system analysis after cycle ergometer use in critical patients

OBJECTIVE: The passive cycle ergometer aims to prevent hypotrophy and improve muscle strength, with a consequent reduction in hospitalization time in the intensive care unit and functional improvement. However, its effects on oxidative stress and immune system parameters remain unknown. The aim of this study is to analyze the effects of a passive cycle ergometer on the immune system and oxidative stress in critical patients. METHODS: This paper describes a randomized controlled trial in a sample of 19 patients of both genders who were on mechanical ventilation and hospitalized in the intensive care unit of the Hospital Agamenom Magalhães. The patients were divided into two groups: one group underwent cycle ergometer passive exercise for 30 cycles/min on the lower limbs for 20 minutes; the other group did not undergo any therapeutic intervention during the study and served as the control group. A total of 20 ml of blood was analysed, in which nitric oxide levels and some specific inflammatory cytokines (tumour necrosis factor alpha (TNF-α), interferon gamma (IFN-γ) and interleukins 6 (IL-6) and 10 (IL-10)) were evaluated before and after the study protocol. RESULTS: Regarding the demographic and clinical variables, the groups were homogeneous in the early phases of the study. The nitric oxide analysis revealed a reduction in nitric oxide variation in stimulated cells (p=0.0021) and those stimulated (p=0.0076) after passive cycle ergometer use compared to the control group. No differences in the evaluated inflammatory cytokines were observed between the two groups. CONCLUSION: We can conclude that the passive cycle ergometer promoted reduced levels of nitric oxide, showing beneficial effects on oxidative stress reduction. As assessed by inflammatory cytokines, the treatment was not associated with changes in the immune system. However, further research in a larger population is necessary for more conclusive results

Qualidade de vida em idosos durante a pandemia da COVID-19: Relato de experiência de um grupo operativo de estudantes de medicina

O bem-estar e a saúde mental da população idosa é pauta central desde o início da transição do perfil demográfico no Brasil, sendo essa preocupação intensificada pelo estado de emergência de saúde pública instaurado com o advento do SARS-CoV-2. Por meio de grupos operativos adaptados ao isolamento social, tenta-se manter o envolvimento comunitário e a prática coletiva de discussão para alívio da sensação de solitude. Sendo assim, uma equipe da disciplina de Práticas Integrativas de Ensino, Serviço e Comunidade II, da Faculdade de Medicina da Universidade Federal dos Vales do Jequitinhonha e Mucuri, em Diamantina, executou um grupo operativo com 4 idosas, na idade entre 63 a 84 anos, via online pelo aplicativo Google Meet, a fim de avaliar a qualidade de vida e o impacto da pandemia nessa parcela da população. Os resultados foram avaliados qualitativamente pela equipe e discutidos com o docente de acordo com as evidências científicas de qualidade de vida para os idosos. Foram abordados temas como ansiedade, sono, atividade física, hábitos alimentares, convívio social e estado emocional no período de pandemia. Foram relatadas mudanças nos hábitos após o distanciamento social, principalmente pela ansiedade e contexto social, mas foi possível perceber o interesse das participantes em discutir e compartilhar o que sentiam, para solucionar os empecilhos em conjunto. O projeto teve boa aceitação e repercussão, podendo ser um precursor de mais medidas de terapia comunitária nas ações públicas que visam melhoria da qualidade de vida e bem-estar social na senilidade, especialmente em condições de isolamento social. Palavras-chave: : Terapia Comunitária; Saúde Mental; Bem-Estar; Terceira Idade; Isolamento Social Quality of life in elderly during the COVID-19 pandemic: Report of an operative group experience by medical students Abstract: The well-being and mental health of the elderly population has been a central issue since the beginning of the demographic profile transition in Brazil, and this concern has been intensified by the state of public health emergency installed with the advent of SARS-CoV-2. By using operative groups adapted to social isolation, we try to maintain community involvement and the collective practice of discussion to mitigate the feeling of loneliness. Thus, a team from the Integrative Practices of Education, Service and Community II course at the Universidade Federal dos Vales do Jequitinhonha e Mucuri Medical School, in Diamantina (Minas Gerais State, Brazil) carried out an operative group with 4 elderly women, ages 63 to 84, online via Google Meet, in order to assess their quality of life and the impact of the pandemic on this section of the population. The results were qualitative analyzed by the team and discussed with the faculty according to the scientific evidence on quality of life for the elderly. Topics such as anxiety, sleep, physical activity, eating habits, social interaction and emotional state during the pandemic period were addressed. Changes in habits were reported after the social distance, mainly due to anxiety and social context, but it was possible to observe the participants' interest in discussing and sharing what they felt to solve the problems as a group. The project had high acceptance and impact, and may be a forerunner of more community therapy measures in public actions aimed at improving quality of life and social well-being in senility, especially in social distancing conditions. Keywords: Community Therapy; Mental Health; Well-Being; Seniors; Social Isolatio

Síndrome de Noonan : Noonan Syndrome

Introdução: A Síndrome de Noonan (SN) é uma doença de herança autossômica dominante, com incidência estimada de 1/1000 até 1/2500 nascidos vivos. A síndrome é frequentemente associada a defeitos cardíacos e uma grande variabilidade fenotípica. Apresentação do caso:  Paciente do sexo masculino, 3 anos de idade e diagnóstico prévio de Comunicação Interatrial, corrigida cirurgicamente. No primeiro ano de vida, foram notadas alterações fenotípicas, como ptose palpebral, orelhas de implantação baixa, face triangular, tórax em escudo, pescoço curto e diagnóstico de sinusite crônica. Discussão: A anomalia congênita mais comum da SN é a estenose valvar pulmonar (54% dos casos) bastante relacionada à morbidade e à mortalidade da doença. As características fenotípicas podem incluir hipertelorismo, ptose palpebral, pescoço alado, baixa estatura, entre outros. A doença possui uma ampla variabilidade clínica e tem como diagnóstico diferencial a Síndrome de Costello e a Síndrome de Turner. O diagnóstico é realizado por meio de uma avaliação clínico-genética. Conclusão: O presente relato ressalta a importância do conhecimento em relação a SN para que sejam realizadas histórias clínicas completas e exames físicos minuciosos diante da suspeita clínica para fins de diagnóstico precoce, acompanhamento multidisciplinar e melhora do prognóstico

Tumor glioneural difuso leptomeníngeo: Leptomeningeal diffuse glioneural tumor

Introdução: O tumor Glioneural Difuso Leptomeníngeo (DLGNT) é uma neoplasia primária rara do sistema nervoso central (SNC). Descrito pela Classificação dos Tumores do Sistema nervoso Central da OMS 2016 como sendo o tumor leptomeníngeo tipo oligodendroglial mais notável na infância. O prognóstico geralmente é ruim, e a média de sobrevida é de 15 meses. Apresentação do caso: Paciente do sexo masculino, 6 anos, previamente hígido, admitido no Hospital Evangélico de Goiás, após 20 dias de quadro inicial de cefaleia, vômitos, fotofobia, alteração sensorial e paraparesia moderada (pior à direita). Foi internado para investigação de meningite. Procedeu-se à biópsia e ao estudo imuno-histoquímico do material, que confirmaram o diagnóstico de DLGNT. Discussão: É uma doença rara, constituindo aproximadamente 1-3% de todos os tumores cerebrais em adultos e cerca de 3% dos ocorridos em crianças. Com um quadro clínico bastante inespecífico, com extensa quantidade de diagnósticos diferenciais a serem afastados. Para o tratamento não há consenso quanto a terapêutica radioterapia/quimioterapia e farmacológica adequada. Conclusão: A identificação precoce de DLGNT auxilia na seleção adequada de tratamentos específicos, contribuindo para um melhor prognóstico e melhora clínica do paciente. São necessários mais estudos para promover uma maior compreensão desta doença e consequentemente, melhora na qualidade de vida dos pacientes

Temperature Effects Explain Continental Scale Distribution of Cyanobacterial Toxins

Insight into how environmental change determines the production and distribution of cyanobacterial toxins is necessary for risk assessment. Management guidelines currently focus on hepatotoxins (microcystins). Increasing attention is given to other classes, such as neurotoxins (e.g., anatoxin-a) and cytotoxins (e.g., cylindrospermopsin) due to their potency. Most studies examine the relationship between individual toxin variants and environmental factors, such as nutrients, temperature and light. In summer 2015, we collected samples across Europe to investigate the effect of nutrient and temperature gradients on the variability of toxin production at a continental scale. Direct and indirect effects of temperature were the main drivers of the spatial distribution in the toxins produced by the cyanobacterial community, the toxin concentrations and toxin quota. Generalized linear models showed that a Toxin Diversity Index (TDI) increased with latitude, while it decreased with water stability. Increases in TDI were explained through a significant increase in toxin variants such as MC-YR, anatoxin and cylindrospermopsin, accompanied by a decreasing presence of MC-LR. While global warming continues, the direct and indirect effects of increased lake temperatures will drive changes in the distribution of cyanobacterial toxins in Europe, potentially promoting selection of a few highly toxic species or strains.Peer reviewe