Absent increase in vertebral artery blood flow during l-arginine infusion in hypertensive men.

Endothelial dysfunction is observed in the peripheral vasculature of hypertensive patients, but it is unclear how the cerebral circulation is affected. More specifically, little is known about the impact of human hypertension on vertebral artery (VA) endothelial function. This study evaluated whether the endothelial function of the VA is impaired in hypertensive men. For 13 male hypertensive subjects (46 ± 3 yr) and eight age-matched male controls (46 ± 4 yr), blood pressure (BP; photoplethysmography), VA, and common carotid (CC) blood flow (duplex ultrasound) were determined at rest and during 30 min of intravenous l-arginine (30 g; a precursor of nitric oxide) or isotonic saline infusion. Controls and hypertensive subjects demonstrated a similar resting CC (601 ± 30 vs. controls 570 ± 43 ml/min; P = 0.529) and VA blood flow (119 ± 11 vs. controls 112 ± 9 ml/min; P = 0.878). During administration of l-arginine, CC blood flow increased similarly between groups (hypertensive 12 ± 3%, controls 13 ± 2%; P = 0.920). In contrast, the increase in VA blood flow was nonexistent in the hypertensive subjects (0.8 ± 3% vs. controls: 16 ± 4%; P = 0.015) with no significant change in BP. Both CC and VA flow returned to near-resting values within 30 min after the infusion, and for four hypertensive subjects and three controls, time-control experiments using 0.9% saline did not affect VA or CC blood flow significantly. The results demonstrate endothelial dysfunction in the posterior cerebral circulation of middle-aged hypertensive men.

Prevalences of sleep-related breathing disorders and severity factors in chronic spinal cord injury and abled-bodied individuals undergoing rehabilitation: a comparative study.

STUDY OBJECTIVES: The objective of this study was to discern distinguishing characteristics of sleep-related breathing disorders in individuals with chronic spinal cord injury (CSCI) compared with participants without CSCI. Additionally, the study investigated factors associated with sleep-related breathing disorder severity. METHODS: This is a cross-sectional analysis of 123 individuals without CSCI, 40 tetraplegics, and 48 paraplegics who underwent attended or partially supervised full polysomnography for suspected sleep-related breathing disorders in a rehabilitation center. Polysomnographic, transcutaneous capnography, and clinical data were collected and compared between the groups. RESULTS: Among tetraplegics, apnea-hypopnea index ≥ 30 events/h (67.5%, P = .003), central apnea (17.5%, P = .007), and higher oxygen desaturation index (80.0%, P = .01) prevailed. Sleep-related hypoventilation was present in 15.4% of tetraplegics and 15.8% of paraplegics, compared with 3.2% in participants without CSCI (P = .05). In the group without CSCI and the paraplegic group, snoring and neck circumference were positively correlated with obstructive sleep apnea (OSA) severity. A positive correlation between waist circumference and OSA severity was identified in all groups, and multivariate logistic regression analysis showed that loud snoring and waist circumference had the greatest impact on OSA severity. CONCLUSIONS: Severe OSA and central sleep apnea prevailed in tetraplegic participants. Sleep-related hypoventilation was more common in tetraplegics and paraplegics than in participants without CSCI. Loud snoring and waist circumference had an impact on OSA severity in all groups. We recommend the routine implementation of transcutaneous capnography in individuals with CSCI. We underscore the significance of conducting a comprehensive sleep assessment in the rehabilitation process for individuals with CSCI. CITATION: Souza Bastos P, Amaral TLD, Yehia HC, Tavares A. Prevalences of sleep-related breathing disorders and severity factors in chronic spinal cord injury and abled-bodied individuals undergoing rehabilitation: a comparative study. J Clin Sleep Med. 2024;20(7):1119-1129.

Forest conversion into pasture selects dung beetle traits at different biological scales depending on species pool composition.

The conversion of forests into open areas has large effects on the diversity and structure of native communities. The intensity of these effects may vary between regions, depending on the existence of native species adapted to open habitats in the regional pool or the time since habitat change.We assess the differences in species richness and functional diversity of dung beetle communities (Coleoptera: Scarabaeinae) between native forests and novel pasturelands of the Atlantic Forest and the Cerrado, two biomes with contrasting histories of human occupation in Brazil. We conducted standardized surveys in seven forest fragments and adjacent pastures in each region and measured 14 traits in individuals collected in each type of habitat at each particular site. We calculated functional richness, functional evenness, functional divergence, and community-weighted mean of traits for each area, and analyzed individual variation through nested variance decomposition and Trait Statistics.Communities were richer and more numerous at the Cerrado. We did not find any consistent relationship between functional diversity and forest conversion beyond the changes in species diversity. Although landscape changes were more recent at the Cerrado, the colonization of the new habitat by native species already adapted to open habitats lessens the functional loss in this biome. This indicates that habitat change's effects on trait diversity depend on the regional species pool rather than on time since land conversion.Forest conversion effects were primarily due to internal filtering. The effects of external filtering only appear at the intraspecific variance level, with contrasting differences between the Cerrado, where traits related to relocation behavior and size are selected, and the Atlantic Forest, where selection operates for traits related to relocation behavior and flight. These results evidence the importance of considering individual variance to address the responses of dung beetle communities to forest conversion.

A conversão de florestas em áreas abertas tem grandes efeitos sobre a diversidade e estrutura das comunidades nativas. A intensidade desses efeitos pode variar entre regiões, dependendo da existência de espécies nativas adaptadas a habitats abertos no pool regional ou do tempo de mudança de habitat.Avaliamos as diferenças na riqueza de espécies e diversidade funcional de comunidades de rola­bosta (Coleoptera: Scarabaeinae) entre florestas nativas e pastagens da Mata Atlântica e do Cerrado, dois biomas com histórias contrastantes de ocupação humana no Brasil. As comunidades foram amostradas em sete fragmentos florestais e pastagens adjacentes de cada região. Medimos quatorze caracteres de indivíduos coletados em cada ponto amostral de cada habitat e região. Posteriormente, calculamos a riqueza funcional, a equidade funcional, a divergência funcional e a média dos caracteres ponderada pela comunidade (CWM) para cada ponto amostral e analisamos a variação individual por meio de decomposição de variância aninhada e estatística T.As comunidades do Cerrado foram mais ricas e numerosas. Não encontramos nenhuma relação consistente entre diversidade funcional e conversão florestal além das mudanças na diversidade de espécies. Surpreendentemente, embora as mudanças na paisagem tenham sido mais recentes no Cerrado, a colonização do novo habitat por espécies nativas já adaptadas a habitats abertos diminuiu a perda funcional nos novos habitats deste bioma em comparação com a Mata Atlântica, onde as pastagens foram colonizadas apenas por espécies florestais generalistas e invasores exóticos. Isso indica que os efeitos da mudança de habitat na diversidade de caracteres dependem do conjunto regional de espécies e não do tempo desde a conversão da paisagem.Além disso, os efeitos da conversão florestal foram principalmente devidos à efeitos de filtros internos. Os efeitos de filtros externos apareceram apenas no nível de variância intraespecífica, com diferenças contrastantes entre o Cerrado, onde são selecionados caracteres relacionados ao comportamento de realocação e tamanho (Comprimento da Metatíbia, Comprimento, Volume e Largura do Pronoto) e a Mata Atlântica, onde a seleção opera em caracteres relacionadas ao comportamento de realocação e voo (Metatibia Length e Wing Load). Esses resultados evidenciam a importância de se considerar a variância individual para abordar as respostas das comunidades de rola­bostas à conversão florestal.

Multi-Scale Landscape Influences on Genetic Diversity and Adaptive Traits in a Neotropical Savanna Tree.

Changes in landscape structure can affect essential population ecological features, such as dispersal and recruitment, and thus genetic processes. Here, we analyze the effects of landscape metrics on adaptive quantitative traits variation, evolutionary potential, and on neutral genetic diversity in populations of the Neotropical savanna tree Tabebuia aurea. Using a multi-scale approach, we sampled five landscapes with two sites of savanna in each. To obtain neutral genetic variation, we genotyped 60 adult individuals from each site using 10 microsatellite loci. We measured seed size and mass. Seeds were grown in nursery in completely randomized experimental design and 17 traits were measured in seedlings to obtain the average, additive genetic variance (V a ) and coefficient of variation (CV a %), which measures evolvability, for each trait. We found that habitat loss increased genetic diversity (He) and allelic richness (AR), and decreased genetic differentiation among populations (F ST ), most likely due to longer dispersal distance of pollen in landscapes with lower density of flowering individuals. Habitat amount positively influenced seed size. Seeds of T. aurea are wind-dispersed and larger seeds may be dispersed to short distance, increasing genetic differentiation and decreasing genetic diversity and allelic richness. Evolvability (CV a %) in root length decreased with habitat amount. Savanna trees have higher root than shoot growth rate in the initial stages, allowing seedlings to obtain water from water tables. Landscapes with lower habitat amount may be more stressful for plant species, due to the lower plant density, edge effects and the negative impacts of agroecosystems. In these landscapes, larger roots may provide higher ability to obtain water, increasing survival and avoiding dying back because of fire. Despite the very recent agriculture expansion in Central Brazil, landscape changes are affecting neutral and adaptive variation in T. aurea. Several populations have low additive genetic variation for some traits and thus, may have limited evolvability, which may jeopardize species long-term persistence. The effect of habitat loss on highly variable neutral loci may only be detected after a certain threshold of population size is attained, that could become dangerously small masking important losses of heterozygosity endangering species conservation.

Agricultural Landscape Heterogeneity Matter: Responses of Neutral Genetic Diversity and Adaptive Traits in a Neotropical Savanna Tree.

Plants are one of the most vulnerable groups to fragmentation and habitat loss, that may affect community richness, abundance, functional traits, and genetic diversity. Here, we address the effects of landscape features on adaptive quantitative traits and evolutionary potential, and on neutral genetic diversity in populations of the Neotropical savanna tree Caryocar brasiliense. We sampled adults and juveniles in 10 savanna remnants within five landscapes. To obtain neutral genetic variation, we genotyped all individuals from each site using nine microsatellite loci. For adaptive traits we measured seed size and mass and grown seeds in nursery in completely randomized experimental design. We obtained mean, additive genetic variance (V a ) and coefficient of variation (CV a %), which measures evolvability, for 17 traits in seedlings. We found that landscapes with higher compositional heterogeneity (SHDI) had lower evolutionary potential (CV a %) in leaf length (LL) and lower aboveground dry mass (ADM) genetic differentiation (Q ST ). We also found that landscapes with higher SHDI had higher genetic diversity (He) and allelic richness (AR) in adults, and lower genetic differentiation (F ST ). In juveniles, SHDI was also positively related to AR. These results are most likely due to longer dispersal distance of pollen in landscapes with lower density of flowering individuals. Agricultural landscapes with low quality mosaic may be more stressful for plant species, due to the lower habitat cover (%), higher cover of monocropping (%) and other land covers, and edge effects. However, in landscapes with higher SHDI with high quality mosaic, forest nearby savanna habitat and the other environments may facilitate the movement or provide additional habitat and resources for seed disperses and pollinators, increasing gene flow and genetic diversity. Finally, despite the very recent agriculture expansion in Central Brazil, we found no time lag in response to habitat loss, because both adults and juveniles were affected by landscape changes.

Effects of salts and sucrose on the rheological behavior, thermal stability, and molecular structure of the Pereskia aculeata Miller mucilage.

The rheological behavior, thermogravimetric analysis (TGA), and atomic force microscopy (AFM) of the Pereskia aculeata Miller (OPN) mucilage treated with sodium chloride (NaCl), calcium chloride (CaCl2), and sucrose were evaluated. The experimental design was divided in a fractional factorial 25-1 for the screening of factors (OPN, sucrose, NaCl, CaCl2, and pH) and then in a 5 × 3 × 3 full factorial (OPN, sucrose, and NaCl). The model solutions used for the screening of factors presented shear-thinning behavior and the OPN mucilage concentrations were the factors that had significant effect on the apparent viscosity. Sucrose addition increased the thermal stability of the OPN mucilage solutions. OPN mucilage, sucrose, and NaCl were the variables with significant effect on thermogravimetric responses. The samples presented Newtonian behavior in 0-1.25% OPN mucilage concentrations and non-Newtonian behavior adjusted by power-law in 2.50-5.00% OPN mucilage concentrations with predominance of elastic behavior, contributing to the formation of stronger gels. The presence of sucrose in the systems containing OPN mucilage changed their rheological properties and salt additions caused reduction in viscosity. The AFM results provided a better understanding of the mechanism of OPN mucilage interactions in different solutions that justify the changes in viscosities.

Aplicação de farinhas de coprodutos de frutas em bolos sem glúten / Application of fruit co-product flours in gluten-free cakes

O presente estudo teve como objetivo empregar farinhas de coprodutos de frutas em bolos sem glúten e analisar a qualidade sensorial e tecnológica das receitas. Foi desenvolvido um bolo padrão e seis com adição de 14% de cada farinha de coproduto. Foi realizada avaliação de volume, dureza instrumental e análise sensorial de aceitação. O bolo com farinha da casca de banana apresentou os melhores resultados de volume e dureza, enquanto o bolo com farinha da casca de abacaxi os piores resultados, menor volume e maior dureza. As diferenças de cor dos bolos foram refletidas pela característica de cada farinha adicionada. Todos os bolos atingiram mais de 70% de aceitabilidade sensorial, demonstrando a viabilidade das aplicações. Conclui-se que a utilização de farinhas produzidas com coprodutos de frutas em bolos é uma opção para uma alimentação saudável e sustentável, em especial, para indivíduos celíacos. (AU)

The present study aimed to use fruit co-product flours in gluten-free cakes and analyze the sensorial and technological quality of the recipes. One standard and six cakes were developed by the addition of 14% of each co-product flour. Volume, instrumental hardness and sensory acceptance analysis were performed. The cake with banana peel flour showed the best results for volume and hardness, while the cake with pineapple peel flour had the worst results, lower volume and higher hardness. The differences in cake colors were reflected by the characteristics of each flour added. All cakes reached more than 70% of sensorial acceptability, demonstrating the viability of the applications. The use of flours produced with fruit co-products in cakes is therefore an option for a healthy and sustainable diet, especially for individuals with celiac disease. (AU)

Exogenous l-arginine reduces matrix metalloproteinase-2 and -9 activities and oxidative stress in patients with hypertension.

AIMS: Increased matrix metalloproteinases activity and reduced nitric oxide (NO) bioavailability contributes to development of hypertension and this may be associated with a defective l-arginine-NO pathway. Exogenous l-arginine improves endothelial function to prevent the onset of cardiovascular disease, but the mechanism by which this is accomplished remains unclear. We determined the effects of exogenous l-arginine infusion on vascular biomarkers in patients with hypertension. MAIN METHODS: Venous blood samples were obtained from seven patients with hypertension (45±5yrs., HT group) and eleven normotensive men (37±3yrs., CT group) before and during a 30-min intravenous l-arginine or saline infusion. Nitrite concentration was evaluated by ozone-chemiluminescence method; metalloproteinase-2 (MMP-2) and metalloproteinase-9 (MMP-9) activities were detected by zymography; tissue inhibitor of metalloproteinases-1 (TIMP-1) and 8-isoprostane concentrations were measured by enzyme-linked immunosorbent assay (ELISA); and thiobarbituric acid reactive substances (TBARS) were determined by colorimetric assay. KEY FINDINGS: At baseline, nitrite, TIMP-1, and MMP-2 activity were similar between the groups (P>0.05), but MMP-9, TBARS and 8-isoprostane were higher in HT group (P≤0.03). During l-arginine infusion, nitrite increased only in control group (P=0.01), while MMP-2, MMP-9 activities, MMP-9/TIMP-1 ratio and 8-isoprostane decreased in HT group (P≤0.02). There were no significant changes in vascular biomarkers between groups during the saline infusion (P>0.05). SIGNIFICANCE: Exogenous l-arginine diminished metalloproteinase-2 and -9 activities and MMP-9/TIMP-1 ratio along with restoring the oxidative stress balance in patients with hypertension.

[Brain-sparing effect: comparison of diagnostic indices]. / Centralização de fluxo sanguíneo fetal: comparação entre os índices diagnósticos.

PURPOSE: to describe adverse perinatal outcomes in patients with fetal blood flow centralization, using the relationship between the pulsatility indexes of the middle cerebral and umbilical arteries (MCAPI/UAPI), and between the resistance indexes of the middle cerebral and umbilical arteries (MCARI/UARI), as well as to compare both diagnostic indexes. METHODS: 151 pregnant women with diagnosis of blood flow centralization, attended to at the maternity hospital of Universidade Estadual de Campinas, whose delivery occurred up to 15 days after the ultrasonographic diagnosis, were included. It was considered as adverse perinatal outcomes: Apgar index lower than 7 at the fifth minute, permanence in neonatal ICU, small fetus for the gestational age, severe fetal suffering, perinatal death, hypoglycemia, polycythemia, necrotizing enterocolitis, brain hemorrhage, lung hemorrhage, anemia, septicemia, hyaline membrane disease, convulsive syndromes, hyperreflexia syndrome and kidney insufficiency. Rates of the perinatal adverse outcomes (PAO) for the brain-placentary ratios have been compared, using Fisher's exact or Pearson's chi2 tests, at 5% significance level. Adverse perinatal outcomes according to the gestational age have been evaluated using the Cochrane-Armitage test for trend. RESULTS: the adverse perinatal outcomes for the group with the two indexes altered were: 62.5% of the newborns needed to be placed in an ICU, 75.2% were small for the gestational age (SGA), 35.3% were under severe fetal suffering, 84.4% had hypoglycemia, 8.3% polycythemia, 4.2% necrotizing enterocolitis, and 2.1% brain hemorrhage. There has been significant association between the MCAPI/UAPI and MCARI/UARI ratios along the gestational age, and the need for neonatal intensive care, small fetuses for the gestational age, septicemia, necrotizing enterocolitis, kidney insufficiency, hyaline membrane disease, and anemia. There has been no significant difference between the two indexes of adverse perinatal outcome.

Etapas da elaboração do Instrumento de Classificação do Grau de Funcionalidade de Pessoas com Deficiência para Cidadãos Brasileiros: Índice de Funcionalidade Brasileiro - IF-Br / Development of a grading instrument of functioning for Brazilian citizens: Brazilian Functioning Index - IF-Br

Os sistemas usados no Brasil para definir a incapacidade variam de acordo com o setor. A partir de uma recomendação da Presidência da República, uma força-tarefa interministerial foi organizada em janeiro de 2011 para desenvolver um modelo único de avaliação e classificação da incapacidade a ser usado em todo o país. O grupo de trabalho partiu de uma avaliação ampla de informações biodemográficas das pessoas com deficiência no Brasil obtidas a partir de fontes como o censo populacional, censo escolar, relação anual de informações sociais e pesquisa de informações básicas municipais, bem como grupos focais realizados com representantes de vários estados da federação, diferentes deficiências e faixas etárias. Por meio de reuniões mensais num período de 8 meses, foi escolhido o modelo conceitual da Classificação Internacional de Deficiências, Incapacidades e Saúde como base teórica e partir do qual foram selecionadas as 41 atividades e fatores ambientais que deveriam ser contemplados no em cada uma delas. A pontuação de cada atividade foi definida numa escala de 25 a 100, de acordo com o nível de independência. Ajustes para crianças foram realizados comparando o instrumento ao desenvolvimento esperado para cada faixa etária de acordo com a descrição presente em outros instrumentos. Além da avaliação quantitativa do grau de incapacidade, foi desenvolvida uma avaliação qualitativa seguindo a lógica fuzzy, específica para as deficiências visual, motora, auditiva e intelectual. A definição de notas de corte não foi efetuada e exige estudos futuros.

The systems used for disability certification in Brazil vary according to the sectors. By recommendation from the Presidency of the Republic, an interministerial task force was organized in January 2011 to develop a single model evaluation and classification of disability to be used throughout the country. The working group began with a comprehensive review of biodemographic information of people with disabilities in Brazil, obtained from sources such as the national census, school census, annual list of social information and research of municipal basic information, as well as focus groups with representatives various states of the federation, as well as data collected from focus groups performed with different disabilities and age groups. Through monthly meetings over a period of eight months, the conceptual model of the International Classification of Impairments, Disability and Health was have chosen as a theoretical basis and from which the 41 activities were selected and the environmental factors should be assessed in each of them. The score was defined for each activity in a ratio from 25 to 100, depending on the level of independence. Adjustments were made for children comparing the expected development for each age group according to the description found in other instruments. In addition to the quantitative assessment of the degree of disability, another questionnaire was developed following a qualitative fuzzy logic, which were specific for visual, motor, auditory and intellectual impairments. The definition of cutoff scores was not performed and requires further study.

Centralização de fluxo sanguíneo fetal: comparação entre os índices diagnósticos / Brain-sparing effect: comparison of diagnostic indices

OBJETIVO: descrever os resultados perinatais adversos em pacientes com centralização de fluxo sanguíneo fetal, utilizando a relação entre os índices de pulsatilidade das artérias cerebral média e umbilical (IPACM/IPAU) e entre os índices de resistência das artérias cerebral média e umbilical (IRACM/IRAU), assim como comparar os dois índices diagnósticos. MÉTODOS: foram incluídas 151 gestantes com diagnóstico de centralização de fluxo sanguíneo atendidas na maternidade da Universidade Estadual de Campinas, cujo parto ocorreu até 15 dias após o diagnóstico ultrassonográfico. Foram considerados como resultados perinatais adversos: índice de Apgar inferior a sete no quinto minuto, internação em UTI neonatal, concepto pequeno para a idade gestacional, sofrimento fetal agudo, mortalidade perinatal, hipoglicemia, policitemia, enterocolite necrosante, hemorragia cerebral, hemorragia pulmonar, anemia, septicemia, doença de membrana hialina, síndromes convulsivas, síndrome de hiper-reflexia e insuficiência renal. As frequências dos resultados perinatais adversos (RPA) para as relações cérebro-placentária foram comparadas utilizando-se o teste exato de Fisher ou o do χ2 de Pearson, considerando-se como estatisticamente significativo o nível de 5 por cento. Os resultados perinatais adversos foram avaliados de acordo com a idade gestacional, utilizando-se o teste de tendência de Cochrane-Armitage. RESULTADOS: os resultados perinatais adversos para o grupo em que os dois índices apresentaram-se alterados constatou que 62,5 por cento dos recém-natos necessitaram de internação em UTI, conceptos pequenos para a idade gestacional (PIG) ocorreram em 75,2 por cento, sofrimento fetal agudo em 35,3 por cento, hipoglicemia em 84,4 por cento, policitemia em 8,3 por cento, enterocolite necrosante em 4,2 por cento e hemorragia cerebral em 2,1 por cento. Constatou-se associação significativa das relações IPACM/IPAU e IRACM/IRAU, no decorrer da idade gestacional, ...

PURPOSE: to describe adverse perinatal outcomes in patients with fetal blood flow centralization, using the relationship between the pulsatility indexes of the middle cerebral and umbilical arteries (MCAPI/UAPI), and between the resistance indexes of the middle cerebral and umbilical arteries (MCARI/UARI), as well as to compare both diagnostic indexes. METHODS: 151 pregnant women with diagnosis of blood flow centralization, attended to at the maternity hospital of Universidade Estadual de Campinas, whose delivery occurred up to 15 days after the ultrasonographic diagnosis, were included. It was considered as adverse perinatal outcomes: Apgar index lower than 7 at the fifth minute, permanence in neonatal ICU, small fetus for the gestational age, severe fetal suffering, perinatal death, hypoglycemia, polycythemia, necrotizing enterocolitis, brain hemorrhage, lung hemorrhage, anemia, septicemia, hyaline membrane disease, convulsive syndromes, hyperreflexia syndrome and kidney insufficiency. Rates of the perinatal adverse outcomes (PAO) for the brain-placentary ratios have been compared, using Fisher's exact or Pearson's χ2 tests, at 5 percent significance level. Adverse perinatal outcomes according to the gestational age have been evaluated using the Cochrane-Armitage test for trend. RESULTS: the adverse perinatal outcomes for the group with the two indexes altered were: 62.5 percent of the newborns needed to be placed in an ICU, 75.2 percent were small for the gestational age (SGA), 35.3 percent were under severe fetal suffering, 84.4 percent had hypoglycemia, 8.3 percent polycythemia, 4.2 percent necrotizing enterocolitis, and 2.1 percent brain hemorrhage. There has been significant association between the MCAPI/UAPI and MCARI/UARI ratios along the gestational age, and the need for neonatal intensive care, small fetuses for the gestational age, septicemia, necrotizing enterocolitis, kidney insufficiency, hyaline membrane disease, ...

Humanização no ensino superior na ótica do docente: como acontece esta prática? / Humanization at Higher Education from the teachers´ point of view: what is this experience like?

Refletir sobre a temática Humanização é necessário no mundo de hoje, sobretudo na formação de profissionais de saúde. O objetivo principal deste estudo consistiu em desvelar como ocorre a humanização no ensino de graduação em enfermagem na ótica de docentes de uma IES. O caminho metodológico adotado obedeceu a uma tipologia descritiva, exploratória com abordagem qualitativa dos dados. Em todas as etapas da pesquisa foram obedecidos os preceitos éticos disponíveis na Resolução 196/96. Os resultados das entrevistas foram analisados e categorizados à luz do método de Bardin, dos quais emergiram quatro categorias.

Nowadays, it is necessary to reflect about Humanization, especially in the training of health professionals. The main objective of this study consisted in revealing how teachers of Higher Education Institutions see the humanization in the teaching of Nursing graduation course. The methodological approach adopted followed a descriptive, exploratory typology, with a qualitative data approach. All steps of the research obeyed the ethic precepts available at the 196/96 Resolution. The interview results were analyzed and categorized according to Bardin’s method, from which four categories emerged.

Reflejar sobre la temática Humanización es necesario en el mundo de hoy, sobretodo en la formación de profesionales de salud. El objetivo principal de este estudio consistió en desvelar como ocurre la humanización en la enseñanza de graduación de enfermeros en la óptica de docentes de una IES. El camino metodológico adoptado obedeció a una tipología descriptiva, exploratoria, con abordaje cualitativa de los dados. En todas las etapas de la pesquisa, fueron obedecidos los preceptos éticos disponibles en la Resolución 196/96. Los resultados de las entrevistas fueron analizados y categorizados a la luz del método de Bardin, de los cuales emergieron cuatro categorías.

Anorexia e Bulimia: um transtorno alimentar: Não se trata disso / Anorexia and Bulimia: an alimentary disorder: It is not the case

Objetivo: Este estudo propõe, a partir da construção de casos clínicos, que os Transtornos Alimentares não se reduzem a doenças orgânicas. Não se trata disso. Método: Selecionou-se casos clínicos em momentos diferentes de tratamento. A construção do caso clínico utilizando a teoria psicanalítica convoca o caso em particular, mostrando o que em um sintoma alimentar ultrapassa a necessidade do alimento apontando para o desejo e o gozo. Evidencia-se aí, o limite do saber universal que desconsidera o sujeito e sua singularidade. A clínica do particular tem um valor paradigmático e dá ao caso seu valor metodológico, ensinando sobre a direção do tratamento. Resultados: A classificação dos pacientes em categorias diagnósticas, mostra-se insuficiente para a condução dos casos. Possibilita dados globais do problema: o diagnóstico; impõe padrões terapêuticos, mas não acrescenta sobre a singularidade do caso. Uma clínica das questões subjetivas confirma o fato de que a anorexia e bulimia não constituem fundamentalmente um transtorno alimentar, levando à afirmação “não se trata disso”. Esses fenômenos clínicos são expressões sintomáticas em resposta a conflitos psíquicos. Conclusões: A psicanálise propõe a clínica do um a um, do singular. Ao se desvelar o envoltório universal do sintoma, a anorexia e a bulimia de cada sujeito adquire outra conotação. Trata-se, a partir da série monótona e genérica dos fenômenos anoréxicos-bulímicos (rituais, vômitos, restrições alimentares), de possibilitar a elaboração dos conflitos psíquicos. Pois, o deslocamento do quadro clínico ao caso clínico, desvela vivências psíquicas que apontam para a singularidade do sujeito e reorientam a clínica.

Objective: The present study establishes, from the construction of clinical cases, that alimentary disorders are not mere organic diseases. That is not the case. Method: A set of clinical cases in different treatment stages was selected. The construction of the clinical case using psychoanalytical theory invokes the particular case, unveiling the aspects of an alimentary symptom which goes beyond the feeding needs and leans towards desire and bliss. There is the evidence of the limit of the universal knowledge, which takes for granted the subject and its singularity. The clinic of the particular has a paradigmatic value and adds methodological value to the case, providing treatment directions. Results: Patient classification according to diagnostic categories is insufficient to conducting the cases. Although it provides global data about the problem – the diagnosis – and imposes therapeutic standards, it does not contribute to the singularity of the case. A clinic of the subjective questions confirms the fact that anorexia and bulimia do not fundamentally constitute an alimentary disorder, thus leading to the statement “that is not the case”. Those clinical phenomena are symptomatic expressions in response to psychic conflicts. Conclusions: Psychoanalysis proposes the clinic of “one by one”, the clinic of the singular. As the universal envelopment of the symptom is unveiled, the anorexia and bulimia of each subject attains a different connotation. It is about enabling the elaboration of the psychic conflicts from the monotonous and generic series of the anorexic-bulimic phenomena (rituals, vomiting, and food restrictions). The movement from the clinical picture to the clinical case unveils a series of psychic experiences which point out the singularity of the subject and reorient the clinic.

Distúrbios tubulares no período neonatal: quando suspeitar? / Renal tubular disorders in neonates: when they must be suspected?

Este artigo relata e discute os casos de dois recém-nascidos que apresentaram disfunções tubulares ainda no período neonatal. O primeiro diz respeito a um prematuro extremo, que apresentou sofrimento fetal agudo e necessitou de suporte ventilatório. Fez uso de antimicrobianos (ampicilina e gentamicina) para tratamento de quadro séptico e indometacina para fechamento farmacológico do canal arterial. Este neonato apresentou uma disfunção tubular generalizada, necessitando de uso crônico de bicarbonato oral. Essas alterações, no entanto, foram de caráter transitório, pois, atualmente, vêm evoluindo bem, tolerando redução progressiva da suplementação. O segundo caso se refere também a um prematuro extremo, mas que não apresentou complicações ao nascimento. Fez uso de ventilação mecânica por imaturidade pulmonar e antimicrobianos (vancomicina e ceftazidime) para tratamento de sepse neonatal. A partir da segunda semana de vida, observou-se acidose metabólica persistente associada a urina alcalina e poliúria com aumento da perda de cálcio e potássio, caracterizando uma acidose tubular renal distal clássica ou do tipo 1. Este paciente necessitou de doses elevadas de bicarbonato oral. Atualmente, ainda necessita de suplementação alcalina (8 mEq/ Kg/ dia), mas está com crescimento adequado e com as alterações metabólicas corrigidas. Estes casos ilustram a importância do diagnóstico precoce e tratamento dos distúrbios tubulares a fim de evitar desequilíbrios metabólicos graves, déficit de crescimento e dano renal definitivo.

This paper reports and discusses the cases of two neonates which presented tubular disorders during neonatal period. The first case describes an extremely premature newborn who suffered birth asphyxia and required mechanical ventilatory support. This newborn also used antibiotics (ampicillin and gentamicin) for the treatment of neonatal sepsis and indometacin for pharmacological closure of the patent ductus arteriosus. The neonate developed a global tubular dysfunction which demanded oral administration of sodium bicarbonate. However, these alterations seemed to be transient since this patient progressively reduced his need of bicarbonate supplementation. The second case refers to an extremely low-birth weight premature newborn who did not suffer birth asphyxia. This neonate also required mechanical ventilatory support for pulmonary immaturity and antibiotics (vancomycin and ceftazidime) for the treatment of neonatal sepsis. After the second week of life, it was observed a persistent metabolic acidosis associated with alkaline urine and polyuria with great loses of calcium and potassium. Taken together, these disturbances suggest the diagnosis of distal or type 1 renal tubular acidosis. Then, the newborn has needed progressive elevation of oral bicarbonate dosage. Actually, this patient receives oral bicarbonate (8 mEq/Kg/day) and, thus, has an appropriate growth, without metabolic alterations. These cases illustrate the importance of early recognition and treatment of renal tubular disorders in order to avoid homeostatic disarrangement, growth failure and permanent renal damage.