Redefining Statin Dosage Post-Gastric Bypass: Insights from a Population Pharmacokinetics-Pharmacodynamics Link Approach.

Roux-en-Y gastric bypass (RYGB) involves creating a small stomach pouch, bypassing part of the small intestine, and rerouting the digestive tract. These alterations can potentially change the drug exposure and response. Our primary aim was to assess the impact of RYGB on the pharmacokinetics of simvastatin lactone (SV) and its active metabolite, simvastatin hydroxy acid (SVA). Ultimately, we aimed to optimize dosing for this understudied population by employing a population pharmacokinetic-pharmacodynamic link approach. The study comprised patients who had undergone RYGB surgery and individuals without a previous history of RYGB. All participants received a single oral dose of simvastatin. Plasma concentration data were analyzed with a nonlinear mixed-effect modeling approach. A parent-metabolite model with first-order absorption, 2-compartments for SV and 1-compartment for SVA, linear elimination, and enterohepatic circulation best described the data. The model was linked to the turnover pharmacodynamic model to describe the SVA inhibition on LDL-cholesterol production. Our simulations indicated that following RYGB surgery, the exposure to SV and SVA decreased by 40%. Consequently, for low-intensity statin patients, we recommend increasing the dose from 10 to 20 mg in post-RYGB patients to maintain a comparable response to that of non-operated subjects. Moderate-intensity statin patients should require increasing doses to 40 or 60 mg or the addition of a non-statin medication to achieve similar therapeutic outcomes. In conclusion, individuals post-RYGB exhibit diminished exposure to SV and may benefit from increasing the dose or adjunctive therapy with non-statin drugs to attain equivalent responses and mitigate potential adverse events.

Turmeric and curcumin as adjuncts in controlling Helicobacter pylori-associated diseases: a narrative review.

Non-antibiotic adjuncts may improve Helicobacter pylori infection control. Our aim was to emphasize curcumin benefits in controlling H. pylori infection. We discussed publications in English mostly published since 2020 using keyword search. Curcumin is the main bioactive substance in turmeric. Curcumin inhibited H. pylori growth, urease activity, three cag genes, and biofilms through dose- and strain-dependent activities. Curcumin also displayed numerous anticancer activities such as apoptosis induction, anti-inflammatory and anti-angiogenic effects, caspase-3 upregulation, Bax protein enhancement, p53 gene activation, and chemosensitization. Supplementing triple regimens, the agent increased H. pylori eradication success in three Iranian studies. Bioavailability was improved by liposomal preparations, lipid conjugates, electrospray-encapsulation, and nano-complexation with proteins. The agent was safe at doses of 0.5->4 g daily, the most common (in 16% of the users) adverse effect being gastrointestinal upset. Notably, curcumin favorably influences the intestinal microbiota and inhibits Clostridioides difficile. Previous reports showed the inhibitory effect of curcumin on H pylori growth. Curcumin may become an additive in the therapy of H. pylori infection, an adjunct for gastric cancer control, and an agent beneficial to the intestinal microbiota. Further examination is necessary to determine its optimal dosage, synergy with antibiotics, supplementation to various eradication regimens, and prophylactic potential.

Irrigation Strategies with Controlled Water Deficit in Two Production Cycles of Cotton.

Water scarcity is one of the main abiotic factors that limit agricultural production. In this sense, the identification of genotypes tolerant to water deficit associated with irrigation management strategies is extremely important. In this context, the objective of this study was to evaluate the morphology, production, water consumption, and water use efficiency of colored fiber cotton genotypes submitted to irrigation strategies with a water deficit in the phenological phases. Two experiments were conducted in succession. In the first experiment, a randomized block design was used in a 3 × 7 factorial scheme, corresponding to three colored cotton genotypes (BRS Rubi, BRS Jade, and BRS Safira) in seven irrigation management strategies with 40% of the real evapotranspiration (ETr) varying the phenological stages. In the second experiment, the same design was used in a 3 × 10 factorial arrangement (genotypes × irrigation management strategies). The water deficit in the vegetative phase can be used in the first year of cotton cultivation. Among the genotypes, 'BRS Jade' is the most tolerant to water deficit in terms of phytomass accumulation and fiber production.

Impact of extreme wildfires from the Brazilian Forests and sugarcane burning on the air quality of the biggest megacity on South America.

Recently, extreme wildfires have damaged important ecosystems worldwide and have affected urban areas miles away due to long-range transport of smoke plumes. We performed a comprehensive analysis to clarify how smoke plumes from Pantanal and Amazon forests wildfires and sugarcane harvest burning also from interior of the state of São Paulo (ISSP) were transported and injected into the atmosphere of the Metropolitan Area of São Paulo (MASP), where they worsened air quality and increased greenhouse gas (GHG) levels. To classify event days, multiple biomass burning fingerprints as carbon isotopes, Lidar ratio and specific compounds ratios were combined with back trajectories modeling. During smoke plume event days in the MASP fine particulate matter concentrations exceeded the WHO standard (>25 µg m-3), at 99 % of the air quality monitoring stations, and peak CO2 excess were 100 % to 1178 % higher than non-event days. We demonstrated how external pollution events such as wildfires pose an additional challenge for cities, regarding public health threats associated to air quality, and reinforces the importance of GHG monitoring networks to track local and remote GHG emissions and sources in urban areas.

Surgically assisted maxillary expansion with or without pterygoid disjunction alters maxillomandibular positioning.

PURPOSE: This study aimed to analyze alterations in mandibular positioning after surgically assisted maxillary expansion (SARME) with and without pterygoid disjunction (PD). METHODS: Cone-beam computed tomography scans of 24 healthy individuals (18-45 years old) with transverse deficiency, superior to 5 mm, underwent SARME with or without PD. The aspects prospectively assessed were (1) alignment and position of the head (ITK-Snap and 3D Slicer software); (2) McNamara's and Steiner-Tweed-Wits' cephalometric analysis (Dolphin Imaging®); and (3) colorimetric evaluation based on 3D correspondence analysis (3D Slicer software). RESULTS: A decrease in 1-NA and 1-SN angles as well as an increased occlusal plane in both groups was observed. Superior-inferior and anteroposterior spatial displacements of the chin were statistically significant in the PD group. Altered colorimetric patterns were also observed in the PD group. CONCLUSIONS: This study found more evident tooth inclination in the group without PD; mandibular alterations were more evident in the PD group. Further studies with 3D analysis are strongly recommended for more comprehensive results.

Colletotrichum truncatum transmission via lima bean seeds

Anthracnose is the primary disease in Phaseolus lunatus cultures, causing severe losses. Inoculation techniques are vital for assessing genotype resistance and control methods at the early stages of seedling development. This study aimed to compare inoculation methods and exposure times of a lima bean seed variety to Colletotrichum truncatum using a completely randomized 4x5 factorial design with five replications. Seed inoculation methods by direct contact with mycelium, mannitol water restrictor, and sucrose water restrictor and immersion in conidia suspension were compared and submitted to substrates containing the developed pathogen or not at exposure times of 0, 36, 60, 84, and 108 hours. Evaluations were made by analyzing the severity, incidence, and disease index for anthracnose and seedling physiological quality under greenhouse conditions. The inoculation method by direct contact with sucrose solute for 36 hours was the most suitable for C. truncatum inoculation in lima bean seeds, providing a higher transmission rate but slightly affecting their physiological parameters. C. truncatum damage to lima bean seed performance increased with longer exposure times, regardless of the inoculation method.

Effect of Salinity and Silicon Doses on Onion Post-Harvest Quality and Shelf Life.

Salt stress during pre-harvest limits the shelf life and post-harvest quality of produce; however, silicon nutrition can mitigate salt stress in plants. Thus, we evaluated the effects of salinity and fertilization with Si, in pre-harvest, on the morpho-physiological characteristics of onion bulbs during shelf life. The experiment was set up in randomized complete blocks, with treatments arranged in split-split plots. The plots had four levels of electrical conductivity of irrigation water (0.65, 1.7, 2.8, and 4.1 dS m-1). The subplots had five fertilization levels with Si (0, 41.6, 83.2, 124.8, and 166.4 kg ha-1). The sub-sub plots had four shelf times (0, 20, 40, and 60 days after harvest). Irrigation water salinity and shelf time reduced firmness and increased the mass loss of onion bulbs during shelf life. Salt stress reduced the contents of sugars and total soluble solids of onion bulbs during storage; however, Si supply improved the contents of these variables. Salinity, Si supply, and shelf time increased the concentrations of pyruvic and ascorbic acids in onion bulbs during shelf life. Si doses between 121.8 and 127.0 kg ha-1 attenuated the impacts caused by moderate salinity, increasing the synthesis of metabolites and prolonging the onion bulbs' shelf life.

Sewage-water treatment with bio-energy production and carbon capture and storage.

Typical large-scale sewage-water treatments consume energy, occupy space and are unprofitable. This work evaluates a conceivable two-staged sewage-water treatment at 40,000 m3/d of sewage-water with sewage-sludge (totaling 10kgCOD/m3) that becomes a profitable bioenergy producer exporting reusable water and electricity, while promoting carbon capture. The first stage comprises microbial anaerobic digesters reducing the chemical oxygen demand (COD) by 95% and producing 60%mol methane biogas. The effluent waters enter the subsequent aerobic stage comprising microbial air-fed digesters that extend COD reduction to 99.7%. To simulate the process, up-to-date anaerobic/aerobic digester models were implemented. A biogas-combined-cycle power plant with/without post-combustion carbon capture is designed to match the biogas production, supplying electricity to the process and to the grid. Results comprehend electricity exportation of 13.21 MW (7.92 kWh/tReusable-Water) with -9.957tCO2/h of negative carbon emission (-0.6 kgCO2-Emitted/kgCOD-Removed). The biogas-combined-cycle without carbon capture achieves 21.08 MW of power exportation, while a 37.3% energy penalty arises if carbon capture is implemented. Configurations with/without carbon capture reach feasibility at 125 USD/MWh of electricity price, with respective net present values of 6.86 and 85.07 MMUSD and respective payback-times of 39 and 12 years. These results demonstrate that large-scale sewage-water treatment coupled to biogas-fired combined-cycles and carbon capture can achieve economically feasible bioenergy production with negative carbon emissions.

Continuity of care for children with special healthcare needs during the COVID-19 pandemic / Continuidad del cuidado a los niños con necesidades especiales de salud durante la pandemia de COVID-19 / Continuidade do cuidado às crianças com necessidades especiais de saúde durante a pandemia da COVID-19

ABSTRACT Objective: To describe the continuity of care for children with special healthcare needs during the COVID-19 pandemic through the perception of their caregivers in the Northeast of Brazil. Methods: Qualitative descriptive-exploratory research carried out between June and September 2020, in a municipality in the Northeast of Brazil. Eleven caregivers participated through semi-structured interviews conducted at home. The data were submitted to thematic content analysis. Results: The social isolation period and the suspension of health services affected the continuity of care, configuring the category "Implications of the COVID-19 pandemic for the continuity of care". Caregivers expressed fear of children contracting the coronavirus, characterizing the category "Fears and uncertainties of the COVID-19 pandemic in view of the vulnerability of children with special healthcare needs". Final considerations: Caregivers' reports revealed problems in the continuity of care for the studied cohort. Therefore, health care practices must be rethought in times of pandemic.

RESUMEN Objetivo: Describir la continuidad del cuidado a niños con necesidades especiales de salud durante la pandemia de COVID-19, en la percepción de sus cuidadoras en municipio del Nordeste brasileño. Métodos: Investigación cualitativa descriptiva-exploratoria realizada entre junio y septiembre de 2020, en municipio del Nordeste brasileño. Participaron 11 cuidadoras por medio de entrevistas semiestructuradas realizadas en domicilio. Datos fueron sometidos al análisis de contenido temático. Resultados: Período de aislamiento social y suspensión de servicios de salud afectaron la continuidad del cuidado, configurando la categoría "Implicaciones de la pandemia de COVID-19 para la continuidad del cuidado". Cuidadoras expresaron miedo al niño contraer el coronavirus, caracterizando la categoría "Miedos e incertidumbres de la pandemia de COVID-19 delante de la vulnerabilidad de los niños con necesidades especiales de salud". Consideraciones finales: Discursos revelaron problemas en la continuidad del cuidado del público estudiado. Así, las prácticas de atención de salud deben ser repensadas en tiempos de pandemia.

RESUMO Objetivo: Descrever a continuidade do cuidado às crianças com necessidades especiais de saúde durante a pandemia da COVID-19, na percepção de suas cuidadoras no interior do Nordeste brasileiro. Métodos: Pesquisa qualitativa descritivo-exploratória realizada entre junho e setembro de 2020, em município do Nordeste brasileiro. Participaram 11 cuidadoras por meio de entrevistas semiestruturadas realizadas no domicílio. Os dados foram submetidos à análise de conteúdo temática. Resultados: Período de isolamento social e suspensão dos serviços de saúde afetaram a continuidade do cuidado, configurando a categoria "Implicações da pandemia da COVID-19 para a continuidade do cuidado". As cuidadoras expressaram medo de a criança contrair o coronavírus, caracterizando a categoria "Medos e incertezas da pandemia da COVID-19 diante da vulnerabilidade das crianças com necessidades especiais de saúde". Considerações finais: Os discursos revelaram problemas na continuidade do cuidado do público estudado. Portanto, as práticas de atenção à saúde devem ser repensadas em tempos de pandemia.

Continuity of care for children with special healthcare needs during the COVID-19 pandemic.

OBJECTIVE: To describe the continuity of care for children with special healthcare needs during the COVID-19 pandemic through the perception of their caregivers in the Northeast of Brazil. METHODS: Qualitative descriptive-exploratory research carried out between June and September 2020, in a municipality in the Northeast of Brazil. Eleven caregivers participated through semi-structured interviews conducted at home. The data were submitted to thematic content analysis. RESULTS: The social isolation period and the suspension of health services affected the continuity of care, configuring the category "Implications of the COVID-19 pandemic for the continuity of care". Caregivers expressed fear of children contracting the coronavirus, characterizing the category "Fears and uncertainties of the COVID-19 pandemic in view of the vulnerability of children with special healthcare needs". FINAL CONSIDERATIONS: Caregivers' reports revealed problems in the continuity of care for the studied cohort. Therefore, health care practices must be rethought in times of pandemic.

Screening biorefinery pathways to biodiesel, green-diesel and propylene-glycol: A hierarchical sustainability assessment of process.

Plant design implies the best choice among a set of feedstock-to-product process pathways. Multiple sustainability performance indicators can blur the decision, and existing sustainability assessment methods usually focus only on environmental life-cycle performance and corporate metrics or solely on the gate-to-gate process. It is relevant to incorporate integrated system analysis to address sustainability comprehensively. To this end, the Sustainable Process Systems Engineering (S-PSE) method was previously introduced to select the most sustainable feedstock-process-product configuration via four-dimensional indicators (environment, efficiency, health-&-safety, and economic), and then pinpoint the sustainability hotspots of the best design to unveil possible improvements. This work expands S-PSE by adding new features: (i) cradle-to-gate environmental assessment; (ii) composition of flowsheets; (iii) new indicators; (iv) statistical screening of indicators; and (v) 2030 Agenda compliance. A biorefinery case-study demonstrates S-PSE: to select the best pathway from soybean-oil, palm-oil, and microalgae-oil to biodiesel, green-diesel, and propylene-glycol. Firstly, statistical screening reduces the indicator set by 62%. Results evince all routes from microalgae-oil as economically unfeasible due to oil cost, despite superior environmental performance. S-PSE evinces palm-oil-to-biodiesel as the most sustainable due to lower cradle-to-gate emissions and manufacturing cost, with sustainability hotspots associated to hazardous methanol input and energy-intensive distillations. 2030 Agenda analysis also outlines palm-oil-to-biodiesel as best for 5 out of 10 Sustainable Development Goals linked to the reduced indicator set.

Application methods of biostimulants affect the production and postharvest conservation of yellow melon

Worldwide, Brazil holds the fifth position in melon fruits exportation, further expanding its products to provide for the growing demand. This expansion is the result of the development and application of new technologies, including the management of the use of biostimulants. However, for melon crops, the information in the literature on the use of biostimulants remains limited to the effects of different doses on fruit quality at the time of harvest. Therefore, this study aimed to evaluate the influence of different methods of pre-harvest application of two biostimulants on the production and postharvest conservation of fruits of yellow melon cv. Iracema. The treatments consisted of a combination of three factors: two plant biostimulants (Crop Set® and Spray Dunger®), two application methods of the products (fertigation and spraying), and five times of postharvest storage (0, 14, 21, 28 and 35 days). An additional control treatment corresponded to plants without biostimulant application. The fruits were evaluated for production and physicochemical attributes: average mass, yield, flesh firmness, titratable acidity, soluble solids content, SSC/TA ratio, pH, total soluble sugars, and weight loss. Fertigation is the recommended application method of biostimulants for yellow melon due to its effect on the increase of average mass, yield, flesh firmness, soluble solids content, and total soluble sugars of the fruits in relation to the spraying method.

Phytochemical profile and antifungal action of Anadenanthera colubrina extract on the quality of maize seeds

Maize (Zea mays L.) is among the most cultivated crops in the world and can be affected by several diseases, especially those transmitted by seeds. The study of alternatives to fungicides used for seed treatment has a promising field in essential oils. Thus, this study determined the phytochemical profile of the ethanolic extract from Anadenanthera colubrina (Vell.) Brenan and to evaluate its antifungal activity on the sanitary and physiological quality of maize seeds. The seeds used were of the Jaboatão cultivar, which were submitted to the following treatments: control (untreated seeds), commercial fungicide (dicarboximide) and A. colubrina extract at 200, 400, 600, 800, and 1,000 ppm. The seeds were subjected to sanitary and germination tests in a completely randomized experimental design. Phytochemical prospecting of A. colubrina extract indicated the presence of alkaloids, tannins, flavonoids and saponins, as well as the major compounds lupeol, gallic acid, ferulic acid, catechin and quercetin. The A. colubrina extract reduced the incidence of Aspergillus spp., including Aspergillus niger, Alternaria spp., Curvularia spp. and Fusarium spp. at all concentrations. The highest concentrations (800 and 1,000 ppm) of the A. colubrina extract reduced the incidence of Penicillium spp. and yielded an effective control of Rhizoctonia spp. The extract of A. colubrina did not present phytotoxic effect, guaranteeing the viability and vigor of maize seeds.

Melon cultivation irrigated with saline waters promote chemical alterations in an acrisol / Cultivo de melão irrigado com águas salinas promove alterações químicas em argissolo

The objective of the present study was to evaluate the salinization process and the changes in the chemical properties of an Acrisol cultivated with melon irrigated with water of different saline concentrations. The experiment was carried out in the field conditions using the experimental design of randomized blocks, arranged in split-plot. The plots were composed of salinity levels of irrigation water, expressed in terms of water electrical conductivity (ECw): 0.54; 1.48; 2.02 dS m-1; and the sub-plots for melon cultivars: Sancho and Medellín (Toad Skin), Mandacaru (Yellow), Nectar (Galia) and Sedna (Cantaloupe). Soil samples were collected at the beginning and end of the crop cycle to evaluate the changes in the physical-chemical properties of the soil. The electrical conductivity of saturation extract in the soil profile varied for each cultivar, observing high salinity values in soils with cultivars with lower water demand (Sedna and Nectar). The salinity of the soil was lower than the electrical conductivity of the irrigation water in the treatments with high values of ECw. The soil pH values showed little reaction in relation to the initial values. The exchangeable sodium percentage values were approximate twice the sodium adsorption ratio of the saturation stratum.(AU)

O objetivo do presente estudo foi avaliar o processo de salinização e as alterações dos atributos químicos de um Argissolo cultivado com melão irrigado com água de diferentes concentrações salinas. O experimento foi desenvolvido em campo aberto utilizando o delineamento de blocos casualizados em parcelas subdividas. As parcelas constituíram de níveis de salinidade da água de irrigação, expressa em condutividade elétrica da água (CEa): 0,54; 1,48; 2,02; 3,03 e 3,90 dS m-1 e, as sub-parcelas de cultivares de melão: Sancho e Medellín (Pele de Sapo), Mandacaru (Amarelo), Néctar (Gália) e Sedna (Cantaloupe). Amostras de solos foram coletadas no início e no final do ciclo da cultura para avaliação do processo de salinização e das alterações dos atributos físico-químicos do solo. Os resultados mostraram que a ECse no perfil do solo variou para cada cultivar, sendo as maiores salinidades observadas nos solos cultivados com as cultivares que utilizam uma menor demanda hídrica (Sedna e Néctar). A salinidade do solo foi sempre inferior ao da condutividade elétrica da água de irrigação nos tratamentos com maiores CEa. Os valores de pH do solo apresentaram pequena reação em relação aos valores iniciais. Os valores de porcentagem de sódio trocável foram cerca de duas vezes superiores ao da razão de adsorção de sódio do estrato de saturação. (AU)

Novel ethylene oxide production with improved sustainability: Loss prevention via supersonic separator and carbon capture.

Sustainability must be always assured in process design. Not rarely, multiple sustainability criteria point oppositely, entailing a need for more systematic and coherent assessments. The Sustainable Process Systems Engineering method is introduced as a two-level hierarchical evaluation of process designs. The first level selects the best design via four-dimensional indicators (environment, efficiency, health-&-safety, and economic), while in the second level, sustainability hotspots of the best design are pinpointed to unveil possible improvements. The method is applied for sustainability assessment of two ethylene oxide processes: the conventional and a novel route employing supersonic separator to prevent ethylene oxide losses using liquid-water injection. Supersonic separator route reduces oxide losses by 83.33 kg/h, representing +0.9% greater ethylene oxide production, 95% less ethylene oxide losses, entailing 2.5% higher net value for 20 operation years despite 0.11% higher investment, and consequently exhibiting the best environmental, technical, health-&-safety and economic performances. Photochemical-oxidation and aquatic-ecotoxicity are environmental indicators with highest improvement due to supersonic separator inclusion. Ethylene oxidation reactor, carbon dioxide stripping-column and cooling-water tower are the main unit-operations with sustainability hotspots.

Delafloxacin against Helicobacter pylori, a potential option for improving eradication success?

Increase in Helicobacter pylori resistance to fluoroquinolones has been reported in many countries. The aim of the study was to compare, for the first time to our knowledge, levofloxacin and delafloxacin activities against H. pylori, including numerous levofloxacin- and multidrug resistant strains. Minimal inhibitory concentrations (MICs) of six antibiotics against 71 consecutive clinical strains were determined. Delafloxacin MIC50 and MIC90 were 0.016 and 0.125 µg/mL versus 0.125 and ≥32 µg/mL, respectively, for levofloxacin. Against the 19 levofloxacin resistant strains, delafloxacin MICs50 and MICs90 were 0.094 and 0.38 µg/mL, respectively. Delafloxacin MICs against the 21 strains with double or multidrug resistance were ≤0.75 µg/mL. The low MICs, the activity against levofloxacin resistant and multidrug resistant H. pylori strains and the increased activity of the agent in acidic conditions make delafloxacin worthy of further investigation, aiming at optimizing fluoroquinolone-based eradication regimens.

Growth and biomass production of prickly pear in the second cycle irrigated with treated domestic sewage / Crescimento e produção de biomassa da palma forrageira segundo ciclo irrigada com esgoto doméstico tratado

This study aimed to evaluate, in the second cycle, the growth and production of 'Orelha-de-elefante Mexicana' prickly pear (Opuntia sp.) under complementary irrigation with treated domestic sewage. The experiment was carried out in the Milagre Settlement, municipality of Apodi-RN, Brazil, from June 2016 to February 2017. Five treatments were evaluated, corresponding to four irrigation frequencies (2.3, 7.0, 14.0 and 21.0 days) to apply an effluent depth of 3.5 mm, and the control, rainfed cultivation (without irrigation). The experimental design was randomized blocks, with four replicates. After preliminary-primary treatment, the domestic sewage showed acceptable chemical and physical characteristics for fertigation under the conditions adopted in the prickly pear cultivation. 234 days after the 1st cut in the plants, the following morphometric characteristics were measured: plant height and length, width, perimeter, thickness and number of primary and secondary cladodes, and biomass accumulation. Complementary irrigation with treated domestic sewage effluent applied at intervals of 2.3, 7.0, 14.0 and 21.0 days allowed satisfactory growth and production of 'Orelha-de-elefante Mexicana' prickly pear; without irrigation, its development was substantially hampered during the dry period. Complementary irrigation with 3.5 mm of domestic sewage effluent applied at intervals of 2.3, 7.0 and 14.0 days led to highest growth and biomass accumulation in 'Orelha-de-elefante Mexicana' prickly pear.

Objetivou-se com esse trabalho avaliar, no segundo ciclo, o crescimento e a produção da palma forrageira orelha-de-elefante (Opuntia sp), conduzida sob irrigação complementar, com esgoto doméstico tratado. O experimento foi realizado no Assentamento Milagre, município de Apodi/RN, no período de junho/2016 a fevereiro/2017. Foram estudados cinco tratamentos, sendo quatro frequências de irrigação (2,3; 7; 14 e 21 dias), para aplicar uma lâmina de 3,5 mm de efluente, e a testemunha, cultivo em sequeiro (sem irrigação). Utilizou-se o delineamento de blocos casualizados com quatro repetições. A água de esgoto doméstico após passar pelo tratamento preliminar-primário apresentou características químicas e biológicas aceitáveis para a fertirrigação nas condições utilizadas no cultivo da palma. Após 234 dias do 1º corte realizado na palma, foram feitas medições das características morfométricas: altura de planta, comprimento, largura, perímetro, espessura e número de cladódios primário e secundário e acúmulo de biomassa. A complementação hídrica realizada por irrigação com intervalos de 2,3; 7,0; 14,0 e 21,0 dias, viabilizou satisfatoriamente o crescimento e a produção da palma forrageira orelha de elefante que, sem irrigação, teve seu desenvolvimento bastante comprometido no período seco. A complementação hídrica com 3,5 mm de água de esgoto doméstico tratado por irrigação, com intervalos de 2,3; 7,0 e 14,0 promovem o maior crescimento e acúmulo de biomassa da palma forrageira orelha de elefante.

Dificuldades Iniciais no Aprendizado do Exame Físico na Percepção do Estudante / Initial Difficulties in Learning the Physical Exam According to the Student's Perception

Resumo: Introdução: Ao longo da formação no curso de Medicina, o estudante enfrenta diversas situações que podem ser geradoras de insegurança e ansiedade, entre as quais se destacam as primeiras aulas práticas com pacientes que tradicionalmente ocorrem na disciplina de Semiologia Médica. A realização do primeiro exame físico com um paciente real é uma potencial circunstância geradora de estresse para os que dão seus primeiros passos na construção de habilidades indispensáveis à carreira médica. A forma de lidar com o estresse advindo desses encontros é bastante individual e relaciona-se com diversos fatores inerentes ao estudante e ao modelo de ensino adotado. O presente estudo propõe-se a identificar as principais adversidades relatadas pelos alunos na sua iniciação ao exame físico. Método: Para tanto, realizou-se um estudo exploratório, com abordagem qualitativa, executado durante as atividades do Módulo Horizontal Básico 4 (MHB4), o qual está inserido na grade curricular do quarto semestre do curso de Medicina da Universidade Federal da Paraíba. Uma amostra de 35 estudantes foi dividida em seis grupos focais. A coleta de dados foi realizada na oitava semana do semestre letivo e ocorreu simultaneamente em todos os grupos. A discussão iniciou-se por meio da pergunta norteadora "Quais são as dificuldades encontradas durante o exame físico do paciente?". Procedeu-se, então, à gravação das falas dos alunos, com posterior transcrição, na íntegra, de todo o material textual, o qual foi submetido à análise de conteúdo por meio do método preconizado por Bardin. Resultados: As falas dos alunos foram elencadas em cinco categorias nomeadas como: insegurança e inexperiência; submissão do paciente; sensação de estar incomodando o paciente; direcionamento de gênero; escolha do paciente por conveniência. A partir dessa análise foi possível observar que a realização do primeiro exame físico é um evento gerador de grande estresse emocional para os estudantes. Questões como a insegurança, a inexperiência e a sensação de estar utilizando o paciente como um objeto são citadas como fatores que geram desconforto nos estudantes e dificultam seu aprendizado. Conclusões: As percepções dos estudantes são de insegurança, inexperiência e invasão da privacidade de um paciente que se encontra numa situação de passividade diante da situação. Nesse contexto, o enfrentamento das dificuldades toma proporções maiores e irrealísticas no aprendizado do exame físico.

Abstract: Introduction: During Medical School, the student faces several situations that can generate insecurity and anxiety, and among them, the one that stands out is the first practical class with patients, which traditionally occur during the Medical Semiology course. Performing the first physical examination in a real patient is a potential stress-inducing situation for those who take their first steps towards building the necessary skills for a medical career. The way one deals with the stress generated by these situations is quite individual and is related to several factors inherent to the student and to the teaching model adopted. The present study aims to identify the main adversities reported by students in their initiation to physical examination. Method: An exploratory study with a qualitative approach was carried out during the activities of the Basic Horizontal Module 4 (MHB4), which is part of the curriculum of the fourth semester of the Medical School at Federal University of Paraíba. A sample of 35 students was divided into 6 focal groups. Data collection was performed in the eighth week of the semester and occurred simultaneously in all groups. The discussion began with the guiding question "What are the difficulties faced during the physical examination of the patient?". The student's speeches were recorded and then transcripted in full and the material was submitted to content analysis using the method recommended by Bardin¹. Results: The students' statements were listed into 5 categories: insecurity and inexperience; patient's submission; feeling of bothering the patient; gender targeting; selection of the patient for convenience. Based on this analysis it was possible to observe that the performance of the first physical examination is an event that causes much emotional stress to students. Issues such as insecurity, inexperience and the feeling of using the patient as an object are mentioned as factors that causes discomfort to students and hinder their learning process. Conclusions: The students' perceptions are those of insecurity, inexperience and invasion of the patient's privacy, who is in a passive situation. In this context, the process of facing the difficulties takes on bigger and unrealistic proportions in the learning process of physical examination.