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Pericytes are located around blood vessels, in close contact with endothelial cells. We discovered that pericytes dampen pro-inflammatory endothelial cell responses. Endothelial cells co-cultured with pericytes had markedly reduced expression of adhesion molecules (PECAM-1 and ICAM-1) and proinflammatory cytokines (CCL-2 and IL-6) in response to bacterial stimuli (Brucella ovis, Listeria monocytogenes, or Escherichia coli lipopolysaccharide). Pericyte-depleted mice intraperitoneally inoculated with either B. ovis, a stealthy pathogen that does not trigger detectable inflammation, or Listeria monocytogenes, developed peritonitis. Further, during Citrobacter rodentium infection, pericyte-depleted mice developed severe intestinal inflammation, which was not evident in control mice. The anti-inflammatory effect of pericytes required connexin 43, as either chemical inhibition or silencing of connexin 43 abrogated pericyte-mediated suppression of endothelial inflammatory responses. Our results define a mechanism by which pericytes modulate inflammation during infection, which shifts our understanding of pericyte biology: from a structural cell to a pro-active player in modulating inflammation. IMPORTANCE: A previously unknown mechanism by which pericytes modulate inflammation was discovered. The absence of pericytes or blocking interaction between pericytes and endothelium through connexin 43 results in stronger inflammation, which shifts our understanding of pericyte biology, from a structural cell to a player in controlling inflammation.

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Metaldehyde is a polar, mobile, low molecular weight pesticide that is challenging to remove from drinking water with current adsorption-based micropollutant treatment technologies. Alternative strategies to remove this and compounds with similar properties are necessary to ensure an adequate supply of safe and regulation-compliant drinking water. Biological removal of metaldehyde below the 0.1 µg•L-1 regulatory concentration was attained in pilot-scale slow sand filters (SSFs) subject to bioaugmentation with metaldehyde-degrading bacteria. To achieve this, a library of degraders was first screened in bench-scale assays for removal at micropollutant concentrations in progressively more challenging conditions, including a mixed microbial community with multiple carbon sources. The best performing strains, A. calcoaceticus E1 and Sphingobium CMET-H, showed removal rates of 0.0012 µg•h-1•107 cells-1 and 0.019 µg•h-1•107 cells-1 at this scale. These candidates were then used as inocula for bioaugmentation of pilot-scale SSFs. Here, removal of metaldehyde by A. calcoaceticus E1, was insufficient to achieve compliant water regardless testing increasing cell concentrations. Quantification of metaldehyde-degrading genes indicated that aggregation and inadequate distribution of the inoculum in the filters were the likely causes of this outcome. Conversely, bioaugmentation with Sphingobium CMET-H enabled sufficient metaldehyde removal to achieve compliance, with undetectable levels in treated water for at least 14 d (volumetric removal: 0.57 µg•L-1•h-1). Bioaugmentation did not affect the background SSF microbial community, and filter function was maintained throughout the trial. Here it has been shown for the first time that bioaugmentation is an efficient strategy to remove the adsorption-resistant pesticide metaldehyde from a real water matrix in upscaled systems. Swift contaminant removal after inoculum addition and persistent activity are two remarkable attributes of this approach that would allow it to effectively manage peaks in metaldehyde concentrations (due to precipitation or increased application) in incoming raw water by matching them with high enough degrading populations. This study provides an example of how stepwise screening of a diverse collection of degraders can lead to successful bioaugmentation and can be used as a template for other problematic adsorption-resistant compounds in drinking water purification.

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INTRODUCTION: An arteriovenous fistula (AVF) is performed in chronic kidney disease (CKD) patients before hemodialysis, who may benefit from exercise. The aim of this study was to evaluate the effect of an exercise program associated with partial limb blood flow restriction (BFR) on handgrip strength (HGS) and forearm circumference of CKD patients. METHODS: A total of 26 patients with CKD were randomized to the BFR experimental group (EG, n = 12) and to the non-BFR control group (CG, n = 14) prior to AVF, and underwent isometric exercises for the flexor muscles of the fingers and elbow where the AVF will be performed. RESULTS: There were no differences at the end of eight weeks of training between the EG and CG groups [F (1.23) = 0.03, p = 0.96] regarding the HGS and the forearm circumference [F (1.23) = 0.90, p = 0.76], however muscle strength [F (1.23) = 189.84, p < 0.001] and forearm circumference [F (1.23) = 540.90, p < 0.001] improved between baseline and the results at the end of the program. CONCLUSION: Partial BFR training was not superior to the CG for the outcomes evaluated in this study. Further studies should be conducted so that an indication of an exercise protocol for the evaluated outcomes is prescribed in order to be effectively offered in clinical practice.

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Challenging wild plant accessions with pathogens is an initial approach for finding resistance genes for breeding programs. Viruses can be transmitted artificially by mechanical or arthropod-borne inoculation, but these experimental assays do not always reproduce natural conditions in the field. In this study, 56 wild Capsicum spp. accessions from Ecuador that were under natural inoculum pressure for six months were screened for virus infections by RNA sequencing. These plants exhibited low virus diversity in comparison to a commercial pepper cultivar that was used as a susceptible host. Subjecting numerous plants to natural infection prior to artificial assays may indicate promising accessions to track within virus/vector resistance breeding programs.

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Tobamoviruses are often referred to as the most notorious viral pathogens of pepper crops. These viruses are not transmitted by invertebrate vectors, but rather by physical contact and seeds. In this study, pepper plants displaying mild mottle and mosaic symptoms were sampled in four different regions of Peru. Upon double-antibody sandwich enzyme-linked immunosorbent assay (DAS-ELISA) tests, seven samples cross-reacted weakly with antibodies against pepper mild mottle virus (PMMoV), suggesting the presence of tobamoviruses. When employing RT-PCR, conserved primers amplified cDNA fragments of viruses from two putative new tobamovirus species in the samples. The complete genome of two representative isolates were, therefore, sequenced and analysed in silico. These viruses, which were tentatively named yellow pepper mild mottle virus (YPMMoV) and chilli pepper mild mottle virus (CPMMoV), shared highest nucleotide genome sequence identities of 83 and 85 % with bell pepper mottle virus (BpeMV), respectively. Mechanical inoculation of indicator plants with YPMMoV and CPMMoV isolates did not show any obvious differences in host ranges. These viruses were also inoculated mechanically on pepper plants harbouring different resistance L alleles to determine their pathotypes. Pepper plants carrying unfunctional L alleles (L0) to tobamoviruses were infected by all isolates and presented differential symptomatology for YPMMoV and CPMMoV. On the other hand, pepper plants carrying L1, L2, L3 and L4 alleles were resistant to all isolates, indicating that these viruses belong to pathotype P0.

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The health monitoring and management systems of coturniculture can be deemed to be in a developmental phase when compared to the poultry industry. Studies regarding taxonomy and parasitic biology in quails (Coturnix japonica) has not been well conducted in Brazil. Most of the information is available from the autopsy case reports, in many ways the parasitic fauna of quails is still unknown. The aim of this study was to conduct a parasitological research in quails in order to contribute to ameliorate this situation. 31 quails, which were 12 months old, were used for the study. Their carcasses and viscera were sent to the Laboratory of Entomology and Tropical Diseases, INPA, Manaus/AM. The circulatory, nervous, respiratory, digestive and reproductive systems of these were studied separately. No blood parasites were found, however, nine species of endoparasites were registered which were distributed among the classes Cestoda, Nematoda and Protozoa. The helminths were distributed in the duodenum, jejunum, ileum, cecum and oviduct. The cecum was found to be the most parasitized organ and contained a wide range of parasites having three species of protozoa and three species of nematodes. Six morphotypes of Eutrichomastix globosus were recorded, and some morphotypes were hyperparasitized with sporangia Sphaerita sp. in the cytoplasm. A large number of parasites were recorded in this study, as well as the protozoan Blastocystis hominis was first being observed for quail.(AU)

A coturnicultura conta com um monitoramento sanitário e sistemas de manejo ainda em desenvolvimento quando comparado à avicultura industrial. Pesquisas de taxonomia e biologia parasitárias em codornas (Coturnix japonica) são pouco realizadas no Brasil, sendo a maioria das informações disponíveis referentes a relatos de caso em achados de necropsia, portanto, em muitos aspectos a fauna parasitária de codornas é ainda desconhecida. Este trabalho teve por objetivo realizar uma pesquisa parasitológica em codornas em fim de postura. Para pesquisa foram disponibilizadas 31 codornas com idades de 12 meses. As carcaças e suas vísceras foram encaminhadas ao Laboratório de Entomologia e Doenças Tropicais INPA, Manaus/AM. Foram estudados separadamente os sistemas circulatórios, nervoso, respiratório, digestivo e reprodutivo. Das 31 codornas examinadas nenhuma apresentou hemoparasitos, contudo, foram registradas nove espécies de endoparasitos distribuídas entre as classes Cestoda, Nematoda e protozoários. Os helmintos distribuíam-se pelo duodeno, jejuno, íleo, cecos e oviduto. O ceco foi o órgão mais parasitado e com maior diversidade de parasitas, sendo três espécies de protozoários e três de nematóides. Foram registrados seis morfotipos de Eutrichomastix globosus, sendo que, alguns morfótipos estavam hiperparasitados com esporângio Sphaerita sp. no citoplasma. Uma grande variedade de parasitos foi registrada nesta pesquisa, bem como, o protozoário Blastocystis hominis pela primeira vez sendo descrito para codornas.(AU)

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The health monitoring and management systems of coturniculture can be deemed to be in a developmental phase when compared to the poultry industry. Studies regarding taxonomy and parasitic biology in quails (Coturnix japonica) has not been well conducted in Brazil. Most of the information is available from the autopsy case reports, in many ways the parasitic fauna of quails is still unknown. The aim of this study was to conduct a parasitological research in quails in order to contribute to ameliorate this situation. 31 quails, which were 12 months old, were used for the study. Their carcasses and viscera were sent to the Laboratory of Entomology and Tropical Diseases, INPA, Manaus/AM. The circulatory, nervous, respiratory, digestive and reproductive systems of these were studied separately. No blood parasites were found, however, nine species of endoparasites were registered which were distributed among the classes Cestoda, Nematoda and Protozoa. The helminths were distributed in the duodenum, jejunum, ileum, cecum and oviduct. The cecum was found to be the most parasitized organ and contained a wide range of parasites having three species of protozoa and three species of nematodes. Six morphotypes of Eutrichomastix globosus were recorded, and some morphotypes were hyperparasitized with sporangia Sphaerita sp. in the cytoplasm. A large number of parasites were recorded in this study, as well as the protozoan Blastocystis hominis was first being observed for quail.(AU)

A coturnicultura conta com um monitoramento sanitário e sistemas de manejo ainda em desenvolvimento quando comparado à avicultura industrial. Pesquisas de taxonomia e biologia parasitárias em codornas (Coturnix japonica) são pouco realizadas no Brasil, sendo a maioria das informações disponíveis referentes a relatos de caso em achados de necropsia, portanto, em muitos aspectos a fauna parasitária de codornas é ainda desconhecida. Este trabalho teve por objetivo realizar uma pesquisa parasitológica em codornas em fim de postura. Para pesquisa foram disponibilizadas 31 codornas com idades de 12 meses. As carcaças e suas vísceras foram encaminhadas ao Laboratório de Entomologia e Doenças Tropicais INPA, Manaus/AM. Foram estudados separadamente os sistemas circulatórios, nervoso, respiratório, digestivo e reprodutivo. Das 31 codornas examinadas nenhuma apresentou hemoparasitos, contudo, foram registradas nove espécies de endoparasitos distribuídas entre as classes Cestoda, Nematoda e protozoários. Os helmintos distribuíam-se pelo duodeno, jejuno, íleo, cecos e oviduto. O ceco foi o órgão mais parasitado e com maior diversidade de parasitas, sendo três espécies de protozoários e três de nematóides. Foram registrados seis morfotipos de Eutrichomastix globosus, sendo que, alguns morfótipos estavam hiperparasitados com esporângio Sphaerita sp. no citoplasma. Uma grande variedade de parasitos foi registrada nesta pesquisa, bem como, o protozoário Blastocystis hominis pela primeira vez sendo descrito para codornas.(AU)

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ABSTRACT: The health monitoring and management systems of coturniculture can be deemed to be in a developmental phase when compared to the poultry industry. Studies regarding taxonomy and parasitic biology in quails (Coturnix japonica) has not been well conducted in Brazil. Most of the information is available from the autopsy case reports, in many ways the parasitic fauna of quails is still unknown. The aim of this study was to conduct a parasitological research in quails in order to contribute to ameliorate this situation. 31 quails, which were 12 months old, were used for the study. Their carcasses and viscera were sent to the Laboratory of Entomology and Tropical Diseases, INPA, Manaus/AM. The circulatory, nervous, respiratory, digestive and reproductive systems of these were studied separately. No blood parasites were found, however, nine species of endoparasites were registered which were distributed among the classes Cestoda, Nematoda and Protozoa. The helminths were distributed in the duodenum, jejunum, ileum, cecum and oviduct. The cecum was found to be the most parasitized organ and contained a wide range of parasites having three species of protozoa and three species of nematodes. Six morphotypes of Eutrichomastix globosus were recorded, and some morphotypes were hyperparasitized with sporangia Sphaerita sp. in the cytoplasm. A large number of parasites were recorded in this study, as well as the protozoan Blastocystis hominis was first being observed for quail.

RESUMO: A coturnicultura conta com um monitoramento sanitário e sistemas de manejo ainda em desenvolvimento quando comparado à avicultura industrial. Pesquisas de taxonomia e biologia parasitárias em codornas (Coturnix japonica) são pouco realizadas no Brasil, sendo a maioria das informações disponíveis referentes a relatos de caso em achados de necropsia, portanto, em muitos aspectos a fauna parasitária de codornas é ainda desconhecida. Este trabalho teve por objetivo realizar uma pesquisa parasitológica em codornas em fim de postura. Para pesquisa foram disponibilizadas 31 codornas com idades de 12 meses. As carcaças e suas vísceras foram encaminhadas ao Laboratório de Entomologia e Doenças Tropicais INPA, Manaus/AM. Foram estudados separadamente os sistemas circulatórios, nervoso, respiratório, digestivo e reprodutivo. Das 31 codornas examinadas nenhuma apresentou hemoparasitos, contudo, foram registradas nove espécies de endoparasitos distribuídas entre as classes Cestoda, Nematoda e protozoários. Os helmintos distribuíam-se pelo duodeno, jejuno, íleo, cecos e oviduto. O ceco foi o órgão mais parasitado e com maior diversidade de parasitas, sendo três espécies de protozoários e três de nematóides. Foram registrados seis morfotipos de Eutrichomastix globosus, sendo que, alguns morfótipos estavam hiperparasitados com esporângio Sphaerita sp. no citoplasma. Uma grande variedade de parasitos foi registrada nesta pesquisa, bem como, o protozoário Blastocystis hominis pela primeira vez sendo descrito para codornas.

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BACKGROUND: With increasing life expectancy and ICU admission of elderly patients, mechanical ventilation, and weaning trials have increased worldwide. METHODS: We evaluated a cohort with 479 subjects in the ICU. Patients younger than 18 y, tracheostomized, or with neurologic diseases were excluded, resulting in 331 subjects. Subjects ≥70 y old were considered elderly, whereas those <70 y old were considered non-elderly. Besides the conventional weaning indexes, we evaluated the performance of the integrative weaning index (IWI). The probability of successful weaning was investigated using relative risk and logistic regression. The Hosmer-Lemeshow goodness-of-fit test was used to calibrate and the C statistic was calculated to evaluate the association between predicted probabilities and observed proportions in the logistic regression model. RESULTS: Prevalence of successful weaning in the sample was 83.7%. There was no difference in mortality between elderly and non-elderly subjects (P = .16), in days of mechanical ventilation (P = .22) and days of weaning (P = .55). In elderly subjects, the IWI was the only respiratory variable associated with mechanical ventilation weaning in this population (P < .001). CONCLUSIONS: The IWI was the independent variable found in weaning of elderly subjects that may contribute to the critical moment of this population in intensive care.

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The origin of supernumerary (B) chromosomes is still a debated topic, with intra- and interspecific origins being the most plausible options. In the bee Partamona helleri, a sequence-characterized amplified region (SCAR) marker being specific to B chromosomes suggested the possibility of interspecific origin. Here, we search for this marker in 3 close relative species and perform DNA sequence comparison between species. The SCAR sequence does not show homology with other sequences in the databases, but does contain an open reading frame with sequence homology with a reverse transcriptase. Dot-blot hybridization using the SCAR marker as a probe confirmed that it is present in B-carrying, but not B-lacking larvae of P. helleri, and indicated its presence in adult individuals of P. cupira and P. criptica. Additionally, PCR amplification of the SCAR marker was successful on genomic DNA obtained from P. helleri and P. rustica larvae carrying B chromosomes, and on genomic DNA obtained from adult individuals of P. cupira, P. criptica and P. rustica. Finally, a comparison of the DNA sequence of the SCAR markers amplified from these 4 species showed very few nucleotide differences between the species. The complete association between B chromosome and SCAR presence and the scarce divergence observed for this DNA sequence between the 4 species analyzed suggest the possibility that this B chromosome has recently been transferred between species through several episodes of interspecific hybridization.

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Due to the existence of new methodologies that have reduced the production costs of microbiological chitosan, this paper puts forward the use of agro-industrial residues in order to produce microbiological chitosan and to apply chitosan as an innovative resource for removing acid orange 7 (AO7) from wastewaters. The best culture conditions were selected by a full 24 factorial design, and the removal of the dye was optimized by a 23 central composite rotational design. The results showed that corn steep liquor (CSL) is an agro-industrial residue that can be advantageously used to produce microbiological chitosan with yields up to 7.8 g/kg of substrate. FT-IR spectra of the product showed typical peak distributions like those of standard chitosan which confirmed the extracted product was chitosan-like. The efficiency of removing low concentrations of AO7 by using microbiological chitosan in distilled water (up to 89.96%) and tap water (up to 80.60%) was significantly higher than the efficiency of the control (chitosan obtained from crustaceans), suggesting that this biopolymer is a better economic alternative for discoloring wastewater where a low concentration of the dye is considered toxic. The high percentage recovery of AO7 from the microbiological chitosan particles used favors this biopolymer as a possible bleaching agent which may be reusable.

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PURPOSE: The purpose of the study was to compare 2 alveolar recruitment maneuvers (ARMs) approaches in patients with subarachnoid hemorrhage (SAH) and acute respiratory distress syndrome (ARDS). MATERIAL AND METHODS: Sixteen SAH patients with ARDS were randomized in 2 similar groups. One received ARM with continuous positive airway pressure (CPAP) of 35 cm H(2)O for 40 seconds (CPAP recruitment), whereas the other received pressure control ventilation with positive-end expiratory pressure of 15 cm H(2)O and pressure control above positive end-expiratory pressure of 35 cm H(2)O for 2 minutes (pressure control recruitment maneuver [PCRM]). Intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were measured before and after ARM. The ratio of arterial oxygen tension to fraction of inspired oxygen was measured before and 1 hour after the ARM. RESULTS: After ARM, ICP was higher in CPAP recruitment (20.50 ± 4.75 vs 13.13 ± 3.56 mm Hg; P = .003); and CPP was lower in CPAP recruitment (62.38 ± 9.81 vs 79.60 ± 6.8 mm Hg; P = .001). One hour after the ARM, the ratio of arterial oxygen tension to fraction of inspired oxygen increased significantly only in PCRM (108.5 to 203.6; P = .0078). CONCLUSION: In SAH patients with ARDS, PCRM did not affect ICP and decreased CPP in safe levels, besides improving oxygenation.

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INTRODUCTION: Indexes predicting weaning outcome are frequently inaccurate. We developed a new integrative weaning index aimed at improving the accuracy of the traditional indexes. METHODS: Three hundred and thirty-one patients mechanically-ventilated for more than 24 hours were evaluated. Initially, the threshold values of each index that best discriminate between a successful and an unsuccessful weaning outcome were determined in 115 patients. In the second phase, the predictive performance of these values was tested prospectively in the other 216 patients. Frequency/tidal volume ratio (f/Vt ratio), tidal volume (Vt), tracheal airway occlusion pressure 0.1 s (P 0.1), the product of P 0.1 and f/Vt (P 0.1 x f/Vt), respiratory rate (f), static compliance of the respiratory system (Cst,rs), ratio of arterial oxygen tension to fraction of inspired oxygen (PaO2/FiO2 ratio) and the new integrative weaning index IWI (Cst,rs x arterial oxygen saturation/f/Vt ratio) were evaluated in all patients. The readiness for weaning and the decision to return to mechanical ventilation was made by the physician in charge, based on the signs of poor tolerance. The receiver operating characteristic (ROC) curves were calculated in order to evaluate the predictive performance of each index. The Bayes' theorem was used to assess the probability of each test of predicting weaning. RESULTS: In the prospective-validation set, successful weaning was observed in 183 patients (84.7%) and weaning failure in 33 (15.27%). IWI presented the highest accuracy, with the area under the ROC curves larger than that under the curves for the f/Vt ratio (0.96 x 0.85 respectively; P = 0.003), and also larger than that under the curves for the other indexes. IWI presented a higher probability of successful weaning when the test was positive (0.99) and a lower probability when the test was negative (0.14). Measurement of Cst,rs during the weaning process was considered one of the study limitations. CONCLUSIONS: IWI was the best predictive performance index of weaning outcome and can be used in the intensive care unit setting. TRIAL REGISTRATION: controlled-trials.com ISRCTN92117906.

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PURPOSE: The objective of this study is to evaluate the predictive performance of maximal inspiratory pressure (Pimax), airway occlusion pressure (P 0.1), and its ratio (P 0.1/Pimax) in the weaning outcome. MATERIALS AND METHODS: Seventy patients on mechanical ventilation for more than 24 hours, who fulfilled weaning criteria, were prospectively evaluated. Pimax less than -25 cm H(2)O, P 0.1 less than 4.2 cm H(2)O, and P 0.1/Pimax less than 0.14 were evaluated in all patients before spontaneous breathing trials. The receiver operating characteristic (ROC) curve was calculated to evaluate the predictive performance of each index. RESULTS: Pimax presented the area under the ROC curves smaller than those for P 0.1 and P 0.1/Pimax (0.52 x 0.76 and 0.52 x 0.78; P = .004 and P = .0006, respectively), being the criteria of worst performance. P 0.1/Pimax presented excellent predictive performance in weaned patients, with sensitivity of 98.08, but with the area under the ROC curves only slightly larger than those for P 0.1 (0.78 x 0.76, respectively; P = .69). CONCLUSION: In our study, P 0.1 and P 0.1/Pimax ratio were moderately accurate, whereas Pimax was less accurate in predicting the weaning outcome.

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Os extratos metanólicos de 13 espécies de Solanum (Solanaceae) foram testados para verifificação da bioatividade em Artemia salina. As espécies testadas (partes aéreas, raízes e frutos) foram: S. asperum, S. capsicoides, S. palinacantum, S. paludosum, S. paniculatum, S. paraibanum, S. sisymbriifolium, S. crinitum, S. diamantinense, S. megalonyx, S. torvum, S. asterophorum e S. stipulaceum. Das treze espécies testadas, quatro foram inativas. Os extratos dos frutos de S. asperum (CL50 = 420,5 µg/mL) e S. paludosum (CL50 = 548,0 µg/mL), partes aéreas de S. diamantinense (CL50 = 481,0 µg/mL) e S. sisymbrifolium (CL50 = 382,7 µg/mL), e das raízes S. asperum (CL50 = 593,4 µg/mL) e S. stipulaceum (CL50 = 823,1 µg/mL) que mostraram atividade moluscicida contra Biomphalaria glabrata também mostraram atividade tóxica em Artemia salina.

The methanolic extracts of 13 Specieis of the genus Solanum (Solanaceae) have been tested for bioactivity in Artemia salina. The extracts investigated were prepared from various parts (aerial parts, roots and fruits) of S. asperum, S. capsicoides, S. palinacantum, S. paludosum, S. paniculatum, S. paraibanum, S. sisymbriifolium, S. crinitum, S. diamantinense, S. megalonyx, S. torvum, S. asterophorum and S. stipulaceum. The lethal concentrations were determined for the extracts and among thirteen plants tested, four appear to be inactive. The extracts of the fruits of S. asperum (LC50 = 420.5 µg/mL) and S. paludosum (LC50 = 548.0 µg/mL), aerial parts of S. diamantinense (LC50 = 481.0 µg/mL) and S. sisymbrifolium (LC50 = 382.7 µg/mL), and the roots of S. asperum (LC50 = 593.4 µg/mL) and S. stipulaceum (LC50 = 823.1 µg/mL), all of which previously showed molluscicidal activity against Biomphalaria glabrata were also found to be active in the present study with brine shrimp.

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Os efeitos da fisioterapia sobre a pressão intracraniana (PIC) não são totalmente esclarecidos. O objetivo deste estudo é avaliar os efeitos da fisioterapia respiratória e movimentação passiva sobre a PIC. Foram avaliados 70 pacientes com traumatismo cranioencefálico e acidente vascular cerebral com Escala de Coma de Glasgow ≤ 8. A cabeceira foi mantida em 30 graus durante o estudo. A PIC foi monitorizada durante as seguintes condutas: compressão torácica, vibração associada à compressão torácica, compressão torácica contínua unilateral, aspiração traqueal com circuito aberto e com circuito fechado, movimentação passiva de membros superiores e inferiores, rotação do quadril, mobilização escapular e flexão lateral do tronco inferior. A variação da PIC durante as condutas foi avaliada pelo teste de Wilcoxon. A PIC inicial foi de 14 ± 6,4 mm Hg. Quatro condutas alteraram a PIC de forma significativa: Flexão lateral do tronco inferior (19,1 ± 6,52 mmHg; p < 0,0001), compressão torácica unilateral contínua (19,09 ± 6,43 mmHg; p < 0,0001), aspiração traqueal com circuito aberto (19,06 ± 6,46 mmHg; p < 0,0001) e com circuito fechado (18,2 ± 7,61 mmHg; p < 0,0001). Compressão torácica unilateral contínua e flexão lateral do tronco inferior devem ser evitadas em pacientes com hipertensão intracraniana. A aspiração traqueal é inevitável, mas deve ser cautelosa.

The effects of physical therapy on intracranial pressure (ICP) are not totally clear. The aim of this study was to evaluate the effects of respiratory physical therapy and passive mobilization on ICP. Seventy patients with traumatic brain injury (TBI) and stroke with Glasgow Coma Scale (GCS) ≤ 8 were evaluated. Thirty degree head-up position was used during the study. ICP was monitored during the following procedures: chest compression, vibration associated to chest compression, unilateral continuous chest compression, tracheal suction with open circuit and closed circuit, passive mobilization of arms and legs, hip rotation, scapular mobilization and lateral flexion of the lower trunk. Wilcoxon test was used to evaluate changes on ICP during the procedures. Initial ICP was 14 ± 6.4 mmHg. Four procedures changed ICP expressively: lateral flexion of the lower trunk (19.1 ± 6.52 mmHg; p < 0.0001), unilateral continuous chest compression (19.09 ± 6.43 mmHg; p < 0.0001), tracheal suction with open circuit (19.06 ± 6.46 mmHg; p < 0.0001) and with closed circuit (18.2 ± 7.61 mmHg; p < 0.0001). Unilateral continuous chest compression and lateral flexion of the lower trunk should be avoided in patients with intracranial hypertension. Tracheal suction is unavoidable, but should be done carefully.

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O desmame da ventilaçäo mecânica depende de vários parâmetros, que têm o intuito de avaliar o prognóstico do mesmo. Objetivamos neste estudo preliminar propor um novo índice de desmame que possa nos predizer com eficácia a viabilidade da descontinuaçäo da ventilaçäo mecânica. Foram avaliados 80 pacientes de várias etiologias, com idade entre 20 a 94 anos, em processo de desmame. O sucesso no desmame foi obtido em 66 pacientes (aqueles que foram desmamados em menos de 14 dias e näo foram reentubados nas próximas 48 horas). O índice de Nemer indicou o prognóstico no desmame com precisäo em 79 pacientes (98,75 por cento). Em 13 pacientes, o índice de Nemer diferiu da relaçäo FR/VC, sendo preciso em todos esses prognósticos. A única falha apresentada pelo índice de Nemer também foi encontrada pela relaçäo FR/VC. Com os resultados obtidos, acreditamos poder utilizar o índice de Nemer para definir melhor o momento e a viabilidade do desmame da ventilaçäo mecânica.

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RESUMO

A discilina de Medicina do Trabalho é obrigatória no currículo das Escola Médicas Brasileiras desde 1962. A partir de questionários enviados às 80 escolas médicas existentes no Brasil, no ano de 1991, foram avaliadas as condiçöes de ensino de Medicina do Trabalho no curso de graduaçäo. Responderam 42 escolas sendo que 26 informaram ter ministrado a disciplina em 1990. Concluiu-se que parte das escolas tem o corpo docente formado por professores qualificados; os métodos de ensino e o programa ministrado säo adequados. Como principais dificuldades säo citadas a falta de bibliografia específica, disponibilidade de ambulatório de doenças ocupacionais e número insuficiente de docentes. Recomenda-se a busca de fontes de custeio que propiciem o intercâmbio dos docentes no país com docentes de países do Primeiro Mundo.

Assuntos