Qualidade da água de rios em cidades do Estado da Bahia / Water quality in rivers of Bahia State cities, Brazil

RESUMO O monitoramento e a avaliação da qualidade das águas superficiais são de fundamental importância para a gestão sustentável dos recursos hídricos. Nesse contexto, o presente trabalho teve o objetivo de avaliar a qualidade da água de rios localizados em diferentes municípios. Para tanto, foram selecionadas dez cidades do Estado da Bahia, das quais sete contavam com Sistema Público de Esgotamento Sanitário (SES) e três eram desprovidas de tais serviços. Utilizou-se o registro trimestral realizado pelo Instituto do Meio Ambiente e Recursos Hídricos do Estado da Bahia (INEMA) da concentração de coliformes termotolerantes, demanda bioquímica de oxigênio (DBO), fósforo total e oxigênio dissolvido (OD), bem como o Índice de Qualidade da Água (IQA) de 14 pontos monitorados no período compreendido entre 2008 e 2015. Os dados foram submetidos à análise estatística, utilizando o teste de Kruskal-Wallis. Verificou-se que as cidades de Feira de Santana, Itabuna, Jequié e Itororó, as quais possuem SES e os maiores percentuais de população atendida com rede de esgoto no meio urbano, foram as que apresentaram o maior percentual de pontos com águas em dissonância com o estabelecido pela Resolução CONAMA nº 357/2005 para os quatro parâmetros avaliados e os menores valores de IQA. É provável que tal resultado esteja relacionado com o fato de essas cidades apresentarem o maior número de habitantes e, portanto, gerarem maiores volumes de esgotos potencialmente lançados nos rios, quando comparadas com os municípios sem SES. A universalização e a efetividade dos SESs são medidas que podem contribuir para a melhoria da qualidade das águas dos rios, tendo em vista que o lançamento de esgoto foi considerado a principal causa para a degradação dos corpos d'água avaliados.

ABSTRACT Monitoring and evaluation of surface water quality are of paramount importance for the sustainable management of water resources. Hence, the objective of this study was to evaluate the water quality of rivers located in different cities. Ten cities in the State of Bahia were selected, seven with sewage public system and three without it. We used the quarterly registry of the thermotolerant coliforms concentration of INEMA, BOD, total P, DO and water quality index of 14 points monitored in the period from 2008 to 2015. Data underwent statistical analysis using Kruskal-Wallis test. We verified that the cities of Feira de Santana, Itabuna, Jequié and Itororó, which have the sewage system and the highest percentages of population served with sewage in the urban area were those that presented the highest percentage of points in dissonance with CONAMA Resolution n. 357/2005 for the four evaluated parameters and the lowest water quality index values. This result may possibly be related to the fact that these cities present the largest number of inhabitants and, therefore, generate larger volumes of potentially sewage in rivers, when compared to cities without public sanitary sewage. The sewage system universalization and effectiveness are measures that may contribute to the improvement of river water quality, considering the discharge of sewage is the main cause for water quality degradation.

School meals' centesimal and mineral composition and their nutritional value for Brazilian children.

The assessment of meals served under the Brazilian National School Meal Program (PNAE) is an important tool to verify its adequacy to the proposed parameters and the nutritional needs of school-aged children. The aim of this study was to evaluate the centesimal and mineral composition of the meals offered by the program and adequacy to the nutritional recommendations in three municipalities of the state of Bahia, Brazil. Centesimal composition of meals was determined according to the reference guidelines and mineral composition was analyzed by atomic absorption spectrometry. Non-parametric analysis of variance was used to test the differences of the medians among the municipalities and Student-t test to compare the means between the two sampling periods. There were inadequacies in the carbohydrate, lipid and protein contents, and none of the municipalities reached the recommendation of 20%. Mineral concentration, especially Fe, Se, Cu and K were much lower than expected. Sodium levels were three-folds higher than the recommended, being worrisome due to higher risk of elevated blood pressure. There were inadequacies with regard to the PNAE guidelines, and there is a need to reevaluate the meals that are being offered to better meet childrens needs and to form healthy habits from childhood.

The prevalence of priapism in children and adolescents with sickle cell disease in Brazil.

To evaluate priapism rates in individuals <18 years of age with sickle cell disease (SCD) at a referral center. An evaluation was made of 599 consecutive male patients with SCD, separated according to type of hemoglobinopathy (HbSS, HbSC and HbS-ß-thalassemia). Age at first episode and number of episodes were recorded. Cases of sickle cell trait were excluded. Mean age was similar in all groups. Overall, priapism occurred in 3.6 % of patients (5.6 % of those with HbSS and 1.1 % of those with HbSC; P = 0.01). In HbSS patients, the prevalence rate of priapism was from 3.5 (CI 95 % 0.94-13.4) when compared with patients with HbSC. No patient with ß-thalassemia had priapism. Mean follow-up was 39.7 months (range 1-202 months). Since 91 % of patients with priapism had HbSS, this group was evaluated separately, revealing a rate of priapism of 1.6 % in patients <10 years and 8.3 % in those ≥ 10 years of age (P = 0.002). Regarding priapism in HbSS patients ≥ 10 years (8.3 %) when compared with patients <10 years (1.6 %), the prevalence rate was from 3.3 (CI 95 % 1.1-9.5). Duration of follow-up was not correlated with priapism (P = 0.774). Forty-seven patients were lost to follow-up. Telephone contact was successful with 14/22 patients with priapism, 50 % of whom had required hospital treatment. Most episodes (86 %) occurred at night, always during sleep. Medical interventions were required in 13 cases as follows: intravenous hydration (n = 4), corpora cavernosa puncture and drainage (n = 7) and corpus cavernosum-corpus spongiosum shunts (n = 2). The prevalence of priapism in children <18 years of age with SCD was 3.6 %, lower than previously reported. Prevalence was higher in HbSS patients, increasing in patients >10 years of age. Most episodes occurred at night and half of the patients required some form of urological procedure.

[Clinical predictors of asymptomatic bacteriuria during pregnancy]. / Preditores clínicos de bacteriúria assintomática na gestação.

PURPOSE: To estimate the prevalence of asymptomatic bacteriuria among pregnant women attended at our university prenatal care clinic and to identify probable clinical predictors. METHODS: Across-sectional study was carried out from August 2008 to October 2009 at the Bahiana School of Medicine involving 260 pregnant women without symptoms of urinary tract infection. The following exclusion criteria were considered: presence of clinical signs such as fever, dysuria, vesical tenesmus, lumbar pain, history of active genital bleeding or loss of amniotic fluid, use of antimicrobial agents in the 30 days prior to sample collection, and refusal to participate in the project. The presence of single pathogen bacterial colonization ≥10(5) CFU/mL in the urine sample obtained from the middle jet was considered to be a dependent variable. The predictive factors evaluated were as follows: age, race, marital status, schooling, gestational age, hypertension, anemia, vaginal infection, sickle cell trait and previous history of urinary tract infection, urinary symptoms related to the lower urinary tract (frequency, urgency and nocturia) and data obtained from the urine summary (leukocyturia, increased bacterial flora, hematuria, proteinuria, and presence of nitrite). Statistical analysis was performed with the Statistical Package for the Social Sciences (SPSS) software version 13.0 and the level of significance was set at p<0.05. Prevalences were expressed as percentage, and the confidence interval considered was 95% (95%CI). RESULTS: The prevalence of asymptomatic bacteriuria was 12.3% (95%CI=8.3-16.3). E. coli was the most frequent etiologic agent (59.4%). Logistic regression indicated that urgency to void (OR=5.99; 95%CI=2.20-16.31; p<0.001); leukocyturia (OR=2.85; 95%CI=1.04-7.83; p=0.042) and increased bacterial flora (OR=10.62; 95%CI=3.95-28.56; p<0.001) were independent predictors of asymptomatic bacteriuria. CONCLUSION: The prevalence of asymptomatic bacteriuria in the studied population was high. The prediction score created for the final logistic regression model has an accuracy of 91.9% for bacteriuria.

Preditores clínicos de bacteriúria assintomática na gestação / Clinical predictors of asymptomatic bacteriuria during pregnancy

OBJETIVOS: Estimar a prevalência de bacteriúria assintomática (BAS) entre gestantes atendidas em pré-natal de Serviço Universitário e identificar prováveis preditores clínicos. MÉTODOS: Estudo prospectivo de corte transversal, envolvendo 260 gestantes matriculadas em serviço de pré-natal de baixo risco entre agosto de 2008 e outubro de 2009, sem sintomas de infecção do trato urinário. Foram excluídas aquelas com febre, disúria, tenesmo vesical, dor lombar, presença de sangramento genital, perda de líquido amniótico, uso de antimicrobianos nos últimos 30 dias e aquelas que não desejaram participar do projeto. A presença de colonização bacteriana ≥10(5) UFC/mL de único patógeno, na amostra urinária obtida do jato médio, foi considerada como a variável dependente. As variáveis estudadas foram: idade, raça, estado civil, nível de instrução, história obstétrica, idade gestacional, anemia, traço falciforme, colpite, passado de infecção do trato urinário, polaciúria, urgência miccional e incontinência urinária. Dados do sumário de urina também foram analisados, como a presença de leucocitúria, flora bacteriana aumentada, hematúria, proteinúria e nitrito. A análise estatística foi realizada com o programa Statistical Package for the Social Sciences (SPSS) 13.0 e a significância estatística foi previamente definida por valor p<0,05. As prevalências foram expressas por percentual e intervalo de confiança considerado foi de 95 por cento. RESULTADOS: A prevalência de foi de 12,3 por cento (IC95 por cento=8,3-16,3). O agente etiológico mais frequente foi a E. coli (59,4 por cento). A regressão logística indicou que a urgência miccional (OR=5,9; IC95 por cento=2,2-16,3; p<0,001), a leucocitúria (OR=2,8; IC95 por cento=1,0-7,8; p=0,04) e a flora bacteriana aumentada (OR=10,6; IC95 por cento=3,9-28,5; p<0,001), são preditores independentes de BAS durante a gestação. CONCLUSÃO: A prevalência de bacteriúria assintomática na população estudada é alta. O escore preditor criado com o modelo final de regressão logística possui uma acurácia de 91,9 por cento para bacteriúria.

PURPOSE: To estimate the prevalence of asymptomatic bacteriuria among pregnant women attended at our university prenatal care clinic and to identify probable clinical predictors. METHODS: Across-sectional study was carried out from August 2008 to October 2009 at the Bahiana School of Medicine involving 260 pregnant women without symptoms of urinary tract infection. The following exclusion criteria were considered: presence of clinical signs such as fever, dysuria, vesical tenesmus, lumbar pain, history of active genital bleeding or loss of amniotic fluid, use of antimicrobial agents in the 30 days prior to sample collection, and refusal to participate in the project. The presence of single pathogen bacterial colonization ≥10(5) CFU/mL in the urine sample obtained from the middle jet was considered to be a dependent variable. The predictive factors evaluated were as follows: age, race, marital status, schooling, gestational age, hypertension, anemia, vaginal infection, sickle cell trait and previous history of urinary tract infection, urinary symptoms related to the lower urinary tract (frequency, urgency and nocturia) and data obtained from the urine summary (leukocyturia, increased bacterial flora, hematuria, proteinuria, and presence of nitrite). Statistical analysis was performed with the Statistical Package for the Social Sciences (SPSS) software version 13.0 and the level of significance was set at p<0.05. Prevalences were expressed as percentage, and the confidence interval considered was 95 percent (95 percentCI). RESULTS: The prevalence of asymptomatic bacteriuria was 12.3 percent (95 percentCI=8.3-16.3). E. coli was the most frequent etiologic agent (59.4 percent). Logistic regression indicated that urgency to void (OR=5.99; 95 percentCI=2.20-16.31; p<0.001); leukocyturia (OR=2.85; 95 percentCI=1.04-7.83; p=0.042) and increased bacterial flora (OR=10.62; 95 percentCI=3.95-28.56; p<0.001) were independent predictors of asymptomatic bacteriuria. CONCLUSION: The prevalence of asymptomatic bacteriuria in the studied population was high. The prediction score created for the final logistic regression model has an accuracy of 91.9 percent for bacteriuria.

Trends of mortality from ill-defined causes in the Northeast region of Brazil, 1979-2009.

OBJECTIVE: This study aimed to analyze the trends of mortality from symptoms, signs and ill-defined causes (SSIDC) in the Northeast region of Brazil, during the period of 1979- 2009. METHODS: The study used secondary data provided by the Mortality Information System SIM/Datasus/Ministry of Health. RESULTS: There was a reduction in the proportion of this type of death (y = -1.3751x + 55.953 R² = 0.9035), from 45.7% in 1979 to 8.1% in 2009, as well as according to sex: males (y = -1.3716x + 54.559 R² = 0.9197) and females (y = -1.3828x + 57.932 R² = 0.8771). The proportion of deaths due to ill-defined causes showed a decreasing tendency in all age groups. The highest reduction was observed in the upper and lower age ranges, < 1 and 1 to 4 year and elderly group, namely 60 years old and older. Capitals and countryside also showed a decreasing tendency in proportional mortality due to IDC, (y = -0.1118x + 9.4275 R² = 0.3087) and (y = -1.7908x + 71.178 R² = 0.9151) respectively, but with different temporal patterns. The capital cities had the lower rates since the beginning of the series regardless of the age groups, but the great reduction in rates was observed in the countryside, being 7.1 times higher among adults (20 to 59 years old). CONCLUSION: Decreased trends were observed, but it is necessary to reinforce the actions to improve the capacity of health service assistance and coverage and data registration in order to maintain this trend.

Tendência dos óbitos por causas mal definidas na região Nordeste do Brasil, 1979-2009 / Trends of mortality from ill-defined causes in the Northeast region of Brazil, 1979-2009

OBJETIVO: Neste estudo, buscou-se analisar a evolução dos óbitos por sintomas, sinais e afecções mal definidas (SSAMD) na região Nordeste do Brasil no período de 1979 a 2009. MÉTODOS: Trabalhou-se com dados secundários oriundos do SIM/Datasus/M.S. RESULTADOS: A proporção de óbitos por SSAMD no total de óbitos registrados nessa região evidenciou uma tendência decrescente (y = -1,3751x + 55,953 R² = 0,9035), reduzindo de 45,7 por cento em 1979 para 8,1 por cento em 2009, tanto nos homens (y = -1,3716x + 54,559 R² = 0,9197) como nas mulheres (y = -1,3828x + 57,932 R² = 0,8771). A proporção de óbitos por causas mal definidas segundo faixa etária evidencia uma tendência decrescente no período em todas as faixas. O grupo de infantis (<1 e de 1-4 anos) e idosos (pessoas de 60 anos e mais) foram os que registraram as mais altas proporções no período e também as mais altas taxas de redução temporal. Foi também decrescente a tendência da mortalidade proporcional nas capitais (y = -0,1118x + 9,4275 R² = 0,3087) e no interior (y = -1,7908x + 71,178 R² = 0,9151), apresentando curvas com padrões distintos. Nas capitais, as taxas foram mais baixas desde o início da série, independente da faixa etária; entretanto, é no interior que as taxas de redução foram mais altas, expressando-se com mais intensidade (7,1 vezes) nos adultos, indivíduos de 20 a 59 anos de idade. CONCLUSÃO: Constatou-se tendência decrescente, fazendo-se ainda necessário reforçar as medidas que aumentem a capacidade de atendimento e cobertura dos serviços de saúde e de registro de dados para dar continuidade na redução observada.

OBJECTIVE: This study aimed to analyze the trends of mortality from symptoms, signs and ill-defined causes (SSIDC) in the Northeast region of Brazil, during the period of 1979- 2009. METHODS: The study used secondary data provided by the Mortality Information System SIM/Datasus/Ministry of Health. RESULTS: There was a reduction in the proportion of this type of death (y = -1.3751x + 55.953 R² = 0.9035), from 45.7 percent in 1979 to 8.1 percent in 2009, as well as according to sex: males (y = -1.3716x + 54.559 R² = 0.9197) and females (y = -1.3828x + 57.932 R² = 0.8771). The proportion of deaths due to ill-defined causes showed a decreasing tendency in all age groups. The highest reduction was observed in the upper and lower age ranges, < 1 and 1 to 4 year and elderly group, namely 60 years old and older. Capitals and countryside also showed a decreasing tendency in proportional mortality due to IDC, (y = -0.1118x + 9.4275 R² = 0.3087) and (y = -1.7908x + 71.178 R² = 0.9151) respectively, but with different temporal patterns. The capital cities had the lower rates since the beginning of the series regardless of the age groups, but the great reduction in rates was observed in the countryside, being 7.1 times higher among adults (20 to 59 years old). CONCLUSION: Decreased trends were observed, but it is necessary to reinforce the actions to improve the capacity of health service assistance and coverage and data registration in order to maintain this trend.

Treatment of non-monosymptomatic nocturnal enuresis by transcutaneous parasacral electrical nerve stimulation.

OBJECTIVE: To evaluate the effectiveness of transcutaneous parasacral electrical stimulation (TCPSE) in the treatment of non-monosymptomatic nocturnal enuresis (NMNE). Also, we evaluated possible pretreatment predictors of TCPSE failure. MATERIALS AND METHODS: Nineteen children diagnosed with NMNE who underwent TCPSE were studied prospectively. There were 6 boys and 13 girls with a mean age of 9.05 ± 3.153 years (range 5-17 years). The sessions were performed three times per week for a maximum of 20 sessions, for 20 min each and at a frequency of 10 Hz. RESULTS: For eight children (42%) the nocturnal enuresis resolved, four (21%) presented a reduction in nocturnal episodes to less than one a week, six (32%) presented no change and one (5%) had increased frequency of NMNE. Symptoms present before treatment, such as daytime incontinence, frequency, constipation and occurrence of urinary tract infection, were not predictors of failure after TCPSE. CONCLUSION: TCPSE can be an effective treatment for NMNE, but about a third of patients will need another kind of treatment. No pretreatment factor was determined that predicted TCPSE failure.

Resistência à fratura de intermediários cerâmicos experimentais: estudo in vitro / Fracture resistance of experimental ceramic abutments: study in vitro

O sistema In-Ceram Zircônia (Vita Zahnfabrik) foi criado para confecção de infra-estruturas cerâmicas. A partir deste sistema, através de uma metodologia própria, conseguiu-se confeccionar intermediários cerâmicos para implantes. A proposta deste trabalho foi avaliar in vitro a resistência à fratura de intermediários experimentais para implantes construídos em In-Ceram Zircônia e restaurado com coroa de In-Ceram Alumina. Simulou-se um incisivo central superior instalado com 135° de angulação (inclinação entre os incisivos centrais superiores e inferiores) em uma máquina de ensaio que imprimiu carga na região de cíngulo até que se desse a ruptura de algum componente. Dos sete corpos de prova, cinco fraturaram o implante e dois fraturaram a base do intermediário de cerâmica. A média encontrada para as forças de compressão foi de 305,6 N. Constatou-se, ao ser aplicado o teste de Kolmogorov-Simirnov, ser a amostra normal e usando o teste “t”- Student verificou-se que a força alcançada para fratura das amostras foi estatisticamente superior (p = 0,0191) quando comparada à carga mastigatóriafisiológica (aproximadamente 235 N.

Assessment of x-ray units for intraoral radiographic techniques in Salvador, Bahia (Brasil) / Avaliação do nível de adequação de aparelhos de raio X para técnicas intrabucais da cidade de salvador, Bahia (Brasil)

The aim of this study was to assess the adequacy of x-rays units for intraoral radiographic techniques in Salvador, Bahia (Brazil). The sample was composed of 150 units randomly selected from a total of 652 units evaluated by a dosimetry kit (IRD/CNEN Institute of Radiation Protection and Dosimetry of the National Commission of Nuclear Energy - Ministry of Health). Three parametrs were considered: (a)maximum skin exposure, 500 mRem; (b)radiation field size, 5.0-6.0 cm; and (c)minimum aluminum filtration, 1.5 mm. If any of the parameters did not comply with IRD/CNEN standards, the x-ray unit was considered to be out of order. Pearson's correlation test, degree of dependence (Pearson's Qui-square test), and the degree of association between the variables (V Cramér coefficient)were used for the statistical analysis. The results showed that 59.33 porcento of the units failed to comply with at least one of the three parameters evaluated. Radiation field size was the criterion that showed the highest level of failure (40.67 porcento). Filtration and skin exposure were responsible for the failure of 30 por cento and 20.7 por cento of the x-ray units, respectively. Perarson's correlation test showed a statistically significant positive correlation between skin exposure and radiation field size, and negative correlation between skin exposure and filtration, indicating that akin exposure tends to increase with the size of the radiation field and/or decreases with filtration. The highest association was detected between skin exposure and filtration. The results show the importance of promoting an educational program about source-skin distance, exposure time, film sensitivity, film processing, film-holding devices; adopting filtration and collimation standards; and the use of rectangular collimator as mandatory. Such a program and update of the rules would stimulate increased use of the ALARA principle (as low as reasonably achievable) for patients undergoing intraoral radiography