RESUMO
La discusión respecto de la actitud con pacientes críticos terminales, está en aumento. Opciones sobre el límite de esfuerzo terapéutico (LET) han sido una creciente necesidad del intensivista. Objetivo. Diagnosticar y comparar las conductas tomadas durante el morir en las UTIs de los países del Cono Sur (Brasil, Argentina y Uruguay) Método. Corte transversal realizado por las AMIB, SATI y SUMI. Los miembros del grupo de estudio del final de la vida de ésas sociedades elaboraron un cuestionario donde constataban evaluaciones demográficas de los participantes y de las instituciones en que ellos trabajaban, así como las decisiones sobre el LET. El cuestionario fue respondido durante eventos científicos de UTI de los 3 países y vía on line, en un tiempo previamente estipulado. Participaron del estudio los miembros del equipo multiprofesional pertenecientes a las sociedades involucradas. Se compararon las respuestas obtenidas entre los miembros de las sociedades de los 3 países. Las variables fueron analizadas a través de los test de chi-cuadrado (χ2 ) ANOVA/Bonferroni. Se consideró significativo el valor de p <0,05. Resultados. En el estudio participaron 420 profesionales (217 de Brasil, 141 de Argentina y 62 de Uruguay). Se constata que el 29% se declara agnóstico,siendo la mayoría médicos. En Uruguay predominó el sexo masculino. En Brasil las UTI's tenían mas camas, fue mas excepcional las visitas irrestrictas, los profesionales eran mas jóvenes y hacía menos tiempo que trabajaban en las UTI's y había mas participación de personal no-médico. El número de visitas más frecuente en los tres países era de 3 por día. Los factores que más influyen en las decisiones de LET son: el pronóstico de la enfermedad, las comorbilidades y la futilidad terapéutica. Hubo diferencias significativas en las decisiones entre los 3 países, donde más del 90% ya había optado por LET. El equipo médico fue el principal responsable de las decisiones de LET, principalmente en Brasil y Argentina. Reanimación cardiorrespiratoria, administración de drogas vaso activas, métodos dialíticos y nutrición parenteral fueron las terapias más suspendidas/rechazadas en los 3 países, habiendo diferencias puntuales entre los mismos. Hubo una diferencia significativa respecto a la suspensión de la ventilación mecánica, más frecuente en Argentina, luego en Uruguay. Las terapias menos suspendidas entre los 3 países fueron la analgesia seguida de la sedación. Definiciones legales y éticas fueron señaladas como las principales barreras para la toma de decisiones. Conclusión. A pesar de que existan diferencias regionales y culturales entre los profesionales, el LET es común en los 3 países. Existe una tendencia de que sea más de forma pro-activa entre los argentinos y de que haya una mayor equidad en la distribución de las decisiones entre los uruguayos. Esta diferencia puede estar vinculada a la edad, experiencia, profesión y sexo de los participantes.(AR)
Assuntos
Comportamento , Morte , Cuidados PaliativosRESUMO
The honey bee queen and worker castes are a model system for developmental plasticity. We used established expressed sequence tag information for a Gene Ontology based annotation of genes that are differentially expressed during caste development. Metabolic regulation emerged as a major theme, with a caste-specific difference in the expression of oxidoreductases vs. hydrolases. Motif searches in upstream regions revealed group-specific motifs, providing an entry point to cis-regulatory network studies on caste genes. For genes putatively involved in reproduction, meiosis-associated factors came out as highly conserved, whereas some determinants of embryonic axes either do not have clear orthologs (bag of marbles, gurken, torso), or appear to be lacking (trunk) in the bee genome. Our results are the outcome of a first genome-based initiative to provide an annotated framework for trends in gene regulation during female caste differentiation (representing developmental plasticity) and reproduction.
Assuntos
Abelhas/genética , Regulação da Expressão Gênica no Desenvolvimento , Genoma de Inseto , Comportamento Social , Animais , Oogênese/genética , Reprodução/genéticaRESUMO
The giant Asian honeybee (Apis dorsata), like all other members of the genus Apis, has a complex mating system in which the queens and males (drones) mate at spatially defined drone congregation areas (DCAs). Here, we studied the temporal genetic structure of a DCA of A. dorsata over an 8-day time window by the genotyping of sampled drones with microsatellite markers. Analysis of the genotypic data revealed a significant genetic differentiation between 3 sampling days and indicated that the DCA was used by at least two subpopulations at all days in varying proportions. The estimation of the number of colonies which used the DCA ranged between 20 and 40 colonies per subpopulation, depending on the estimation procedure and population. The overall effective population size was estimated as high as N (e)=140. The DCA seems to counteract known tendencies of A. dorsata for inbreeding within colony aggregations by facilitating gene flow among subpopulations and increasing the effective population size.
Assuntos
Abelhas/fisiologia , Comportamento Sexual Animal , Comportamento Social , Animais , Abelhas/genética , Feminino , Frequência do Gene , Genótipo , MasculinoRESUMO
Identification and characterization of proteins isolated from natural sources by polyacrylamide gel electrophoresis has become a routine technique. However, efficient sample proteolysis and subsequent peptide extraction is still problematic. Here, we present an improved protocol for the rapid detection of polyacrylamide gel-separated proteins, in situ protein modification, proteolytic digestion and peptide extraction for subsequent protein identification and characterization by capillary high-performance liquid chromatography/tandem mass spectrometry. This simple technique employs the rapid imidazole-zinc reverse stain, in-gel S-pyridylethylation and proteolytic digestion of microcrushed polyacrylamide gel pieces with proteases. This technique obviates the need for buffer exchange or gel lyophilisation due to all of the sample manipulation steps being carried out at near neutral pH and thus lends itself readily to automation.
Assuntos
Eletroforese em Gel de Poliacrilamida/métodos , Imidazóis , Coloração Negativa/métodos , Proteínas/isolamento & purificação , Zinco , Resinas Acrílicas , Sequência de Aminoácidos , Animais , Bovinos , Cromatografia Líquida de Alta Pressão/métodos , Humanos , Espectrometria de Massas , Dados de Sequência Molecular , SaisRESUMO
Determina os fatores de risco para a infecção pelo HIV entre usuários de drogas injetáveis. O estudo consistiu de 110 entrevistados que voluntariamente realizaram testes laboratoriais para a presença do HIV, além de outros agentes infecciosos de transmissão sanguínea. A soroprevalência para o HIV - 1 foi de 28,7 por cento. Foram relacionados todos os fatores de risco identificados
Assuntos
Humanos , Masculino , Feminino , Infecções por HIV/epidemiologia , Fatores de Risco , Abuso de Substâncias por Via Intravenosa , Entrevistas como Assunto , Inquéritos Epidemiológicos , Inquéritos e Questionários , Síndrome da Imunodeficiência Adquirida/epidemiologiaRESUMO
Preparations for Joint Commission on Accreditation of Healthcare Organizations (JCAHO) surveys are rarely described in the literature. This article is intended to provide much-needed information on survey preparation processes, not only to Department of Veterans Affairs medical centers, but also to all hospitals undergoing surveys of biopsychosocial delivery of care. Beginning in 1995, JCAHO will apply biopsychosocial reviews to all assessments of patients. Facilities whose preparations include those detailed in this article will be better prepared for such reviews.
Assuntos
Acreditação/organização & administração , Hospitais de Veteranos/normas , Joint Commission on Accreditation of Healthcare Organizations , Desenvolvimento de Pessoal/métodos , Controle de Formulários e Registros , Hospitais com mais de 500 Leitos , Hospitais Psiquiátricos/organização & administração , Hospitais Psiquiátricos/normas , Hospitais de Veteranos/organização & administração , Técnicas de Planejamento , VirginiaRESUMO
Forty patients with hypertensive crises, whose pressure levels had not satisfactorily decreased after intravenous furosemide 20 mg, were selected in the Emergency Ward. These patients were divided in two groups. The ones in group A received sublingual nifedipine 10 mg and the others in group B received oral captopril 50 mg. These drugs were repeated after 30 minutes to the maximum of three doses or until obtaining diastolic blood pressure less than 115 mmHg. Most patients (77.5%) had their blood pressure reduced to the proposed values after the first dose, and the remaining ones (22.5%) reacted to the therapy only after the administration of the subsequent doses. No side effects were observed. All patients were discharged from the emergency unit and were sent for follow-up in the outpatient service. The use of nifedipine and captopril has proved to be an effective treatment for hypertensive crises.