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1.
An Acad Bras Cienc ; 89(3 Suppl): 2273-2280, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28746551

RESUMO

Control strategies using insecticides are sometimes ineffective due to the resistance of the insect vectors.In this scenario new products must be proposed for the control of insect vectors.The complexes L-aspartate Cu (II) and L-glutamate-Cu (II) complexes were synthesized and characterized by elemental analysis, visible ultraviolet, infrared spectroscopy and potentiometric titration. The toxicity of these complexes was analyzed in Aedes aegypti (Diptera: Culicidae) larvae and Gram-negative and Gram-positive bacteria. The interaction between the ligands and the amino acid balance and the distribution of the species as a function of pH were discussed. The lethal concentration median (LC50) for Ae. aegypti larvae were: L-glutamic acid-Cu (II) - 53.401 mg L-1 and L-aspartate-Cu (II) - 108.647 mg L-1. The minimum inhibitory concentration (MIC) required for Staphylococcus aureus and Escherichia coli was: L-glutamate-Cu (II) 500-2000 mg L-1 and L-aspartate-Cu (II) 1000-2000 mg L-1. The concentrations demonstrated toxicity that evidence the potential of the complexes as bactericide and insecticide. Metal complexes formed by amino acids and transition metals are advantageous because of low environmental toxicity, biodegradability and low production cost.


Assuntos
Aedes/efeitos dos fármacos , Ácido Aspártico , Cobre , Escherichia coli/efeitos dos fármacos , Ácido Glutâmico , Staphylococcus aureus/efeitos dos fármacos , Animais , Ácido Aspártico/química , Cobre/química , Ácido Glutâmico/química , Larva/efeitos dos fármacos , Dose Letal Mediana , Testes de Toxicidade
2.
J Anesth ; 26(2): 213-8, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22159880

RESUMO

PURPOSE: We aimed to evaluate postoperative analgesia of morphine, or clonidine, or morphine plus clonidine, added to caudal bupivacaine in children undergoing infra-umbilical urological and genital procedures. METHODS: Eighty patients aged 1-10 years were prospectively enrolled. After the induction of general anesthesia, the patients were randomized to four caudal anesthesia groups: Group B (1.0 mL/kg of bupivacaine 0.166% with epinephrine 1:600,000); Group BM (1.0 mL/kg of bupivacaine 0.166% with epinephrine 1:600,000 plus morphine 20 µg/kg); Group BC (bupivacaine 0.166% with epinephrine 1:600,000 plus clonidine 1.0 µg/kg), and Group BMC (bupivacaine 0.166% with epinephrine 1:600,000 plus morphine 20 µg/kg and clonidine 1.0 µg/kg). Duration of surgery, emergence time, postoperative pain score measured by the face, legs, activity, cry, consolability (FLACC) scale, postoperative analgesia time, and overall use of rescue analgesics were recorded. RESULTS: The FLACC pain score (6, 12, and 24 h after the surgery) and the number of patients requiring analgesics during the first 24 h of the postoperative period were higher in Groups B and BC than in Groups BM and BMC (p < 0.05). The incidence of pruritus and urinary retention was comparable between the groups (p > 0.05). However, the incidence of postoperative nausea and vomiting (PONV) was higher in Groups BM (35%) and BMC (25%) than in Groups B (5%) and BC (5%) (p < 0.05). CONCLUSION: To conclude, we showed that 20 µg/kg of morphine added to caudal bupivacaine 0.166% plus epinephrine 1:600,000 decreased the use of analgesics in the postoperative period, although it was associated with an increased incidence of PONV. However, the addition of clonidine (1.0 µg/kg) to caudal bupivacaine provided no additional clinical benefit over bupivacaine alone.


Assuntos
Analgésicos/administração & dosagem , Anestesia Caudal/métodos , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Clonidina/administração & dosagem , Morfina/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Analgésicos/efeitos adversos , Anestesia Caudal/efeitos adversos , Anestesia Geral/métodos , Anestésicos Locais/efeitos adversos , Bupivacaína/efeitos adversos , Criança , Pré-Escolar , Clonidina/efeitos adversos , Método Duplo-Cego , Epinefrina/administração & dosagem , Feminino , Humanos , Masculino , Morfina/efeitos adversos , Medição da Dor/métodos , Estudos Prospectivos
3.
J Glob Antimicrob Resist ; 28: 203-205, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35026464

RESUMO

OBJECTIVES: The aim of this study was to investigate the genetic context of expanded-spectrum ß-lactam resistance in a Klebsiella pneumoniae strain causing a hard-to-treat nasal infection in a domestic cat. METHODS: A K. pneumoniae isolate was recovered from a 4-year-old male cat hospitalised in a veterinary hospital in Paraíba, Northeastern Brazil. Following phenotypic confirmation of multidrug resistance by the disk diffusion method, the genome was sequenced using an Illumina MiSeq system. Multilocus sequence typing (MLST) and structural features related to antimicrobial resistance were determined by downstream bioinformatics analyses. RESULTS: The strain was confirmed as sequence type 273 (ST273) K. pneumoniae harbouring a variety of genes conferring antimicrobial resistance to phenicols tetracyclines, aminoglycosides, ß-lactams, fosfomycin, sulfonamides and quinolones. Two plasmids were identified. Plasmid p114PB_I co-harboured a set of plasmid-borne resistance genes [blaCTX-M-15, blaTEM-1, qnrS1, tetD, tetR, sul2, aph(6)-Id, aph(3'') and cat2]. Notably, the multiresistance region was characterised as a chimeric plasmid structure sharing high sequence homology with several plasmids from Enterobacteriaceae. The second plasmid (p114PB_II) was characterised as a plasmid present in many genomes belonging to K. pneumoniae. CONCLUSION: The genetic context of the plasmid sequences harboured by a veterinary pathogenic K. pneumoniae isolate reveals the high complexity of horizontal gene transfer mechanisms in the acquisition of antimicrobial resistance genes. The emergence, dissemination and evolution of antimicrobial resistance must be investigated from a One Health perspective.


Assuntos
Infecções por Klebsiella , Klebsiella pneumoniae , Animais , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Gatos , Farmacorresistência Bacteriana Múltipla/genética , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/veterinária , Masculino , Tipagem de Sequências Multilocus , beta-Lactamases/genética
4.
Clin Case Rep ; 9(5): e03669, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34084472

RESUMO

Neuroimaging scan and calcium/phosphorus metabolism evaluation should be considered in patients with new onset of neuropsychiatric symptoms, to provide an earliest detection of pathological and metabolic alterations, such as Fahr's syndrome.

5.
Cureus ; 13(8): e17502, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34603881

RESUMO

Pneumorrhachis (PR) is a rare phenomenon, which consists in the presence of air in the spinal canal. There are various aetiologies, being the most common traumatic, non-traumatic and iatrogenic. The diagnosis is primarily done through radiographic findings and it is necessary to understand the mechanism behind its origin. PR secondary to decubitus ulcer (DU) infection is rare. PR is associated with great morbidity and mortality. In selected cases, surgical intervention may be necessary. A 67-year-old woman, dependent, was admitted to the emergency room (ER) and diagnosed with an infected sacral DU, later discharged with antibiotics. She was readmitted to the ER two weeks later, with prostration and fever. On examination, she scored five points on the Glasgow coma scale, had bilateral Babinsky sign and a deep sacral ulcer with bone exposure. A cranial computerized tomography (CT) demonstrated "high cervical and endochannel emphysema in the upper slope of the cervical segment" and the CT scan of the spine showed "endochannel air along the cervical-dorsal and lumbar rachis in an epidural location and inside the dural sac (evoking laceration of the dura mater) (…) and densification of the sacrococcygeal soft tissues (diagnosis of PR secondary to DU infection)". Broad-spectrum antibiotics were started and the patient was evaluated by General Surgery, which described a large sacral ulcer with signs of the previous debridement and bone exposure, with no indication for surgical debridement, only for chemical debridement. Despite all the measures instituted, the patient died in the ER.

6.
Braz J Anesthesiol ; 71(1): 76-78, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33712257

RESUMO

Latex responds for most allergic reactions in children, and repeated exposure to the agent is the main cause of sensitization. We report the case of a child allergic to latex who developed anaphylaxis during kidney transplantation performed in a latex-free environment. After immediate treatment with epinephrine the patient gradually improved. Subsequent investigation revealed that kidney harvesting was performed without latex allergy precautions, suggesting graft contamination by the antigen. We conclude that, for preventing this type of anaphylaxis, it is essential to implement latex-free procedures during donor organ harvesting.


Assuntos
Anafilaxia , Transplante de Rim , Hipersensibilidade ao Látex , Anafilaxia/induzido quimicamente , Criança , Epinefrina , Humanos , Rim , Transplante de Rim/efeitos adversos , Hipersensibilidade ao Látex/etiologia
7.
J Med Cases ; 12(7): 284-287, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34434473

RESUMO

Ehlers-Danlos syndrome is a group of rare genetic disorders of collagen characterized by skin hyperextensibility, joint hypermobility and tissue fragility. The authors describe a rare case of a 52-year-old woman that presented to the clinic with chronic joint pain and talipes equinovarum since childhood. Large eyes, sunken cheeks, thin nose and lobeless ears were noticed on clinical examination. Beighton joint hypermotility criteria were met with a positive Walker and Steinberg sign, elbow extension superior to 10° and knee extension in genu recurvatum more than 10°. An aortic diastolic grade III/VI heart murmur was heard. The complementary study was unremarkable. Moderate aortic insufficiency was found on transthoracic echocardiogram. Genetic testing confirmed positivity for COL1A2, a gene that encodes pro-alpha2 chain type of collagen, which causes cardiac-valvular Ehlers-Danlos syndrome. Authors intend to warn to collagen-related syndromes, since severe complications are associated with a reduced life expectancy for individuals with this condition.

8.
Cureus ; 12(8): e10100, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-33005521

RESUMO

We present two cases of thyroid hormone alterations revealing clinical emergencies that require early diagnosis and prompt treatment. The first patient, a 56-year-old woman, presented in the emergency room with psychomotor agitation, disorientation and headache. She was very agitated, incapable of standing still, looked very thin, feverish, tachycardic and presented no alteration at neurological examination with negative meningeal signs. Analyses revealed a severe hyperthyroidism. She initiated propylthiouracil 100 mg 8/8 h. After six months, thyroid function was normal. The second patient, a 54-year-old woman, was transferred from the Psychiatry Department due to memory and behavior changes for the past two weeks. She presented visual and auditive hallucinations and inadequate daily behavior. Analyses revealed a severe hypothyroidism. She was medicated with levothyroxine 100 ug/day. At the third month, she presented normalized thyroid function, normal thyroid ultrasound and an increased antithyroperoxidase antibody.

9.
Braz J Anesthesiol ; 69(1): 27-34, 2019.
Artigo em Português | MEDLINE | ID: mdl-30482552

RESUMO

BACKGROUND AND OBJECTIVES: The combination of clonidine with local anesthetic administered for epidural anesthesia via caudal route seems to improve the quality of postoperative analgesia, but with conflicting results. This study compared the postoperative analgesia of three different doses of clonidine combined with bupivacaine in caudal epidural anesthesia in children undergoing hypospadias repair. METHODS: Eighty children aged 1 to 10 years, candidates for surgical repair of hypospadias, were randomly divided into four groups of 20 patients to receive general anesthesia combined with caudal epidural anesthesia with bupivacaine 0.165% alone or in combination with 1, 2 or 3µg.kg-1 of clonidine. The primary outcome was morphine consumption in the first 24hours postoperatively. Mean arterial pressure, heart rate, end-tidal concentration of sevoflurane, time to awakening, pain severity (FLACC scale), level of sedation (RAMSAY), duration of analgesia, and occurrence of adverse effects were also compared. RESULTS: Intraoperatively, there was no difference between groups regarding mean arterial pressure, heart rate, end-tidal concentration of sevoflurane, and time to awakening. Postoperative morphine consumption and pain severity were similar between groups, but the group receiving clonidine (3µg.kg-1) had lower heart rate and higher sedation level than the group receiving bupivacaine alone. CONCLUSIONS: The combination of clonidine at doses of 1, 2 or 3µg.kg-1 with bupivacaine 0.16% via caudal epidural route did not alter the consumption of morphine in the early postoperative period of children undergoing hypospadias repair.


Assuntos
Analgésicos/administração & dosagem , Anestesia Epidural/métodos , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Clonidina/administração & dosagem , Hipospadia/cirurgia , Criança , Pré-Escolar , Combinação de Medicamentos , Humanos , Lactente , Masculino , Estudos Prospectivos , Método Simples-Cego
10.
Artigo em Inglês | MEDLINE | ID: mdl-30970109

RESUMO

Aedes aegypti and Aedes albopictus are exotic species in the Americas with high epidemiological relevance as they are vectors of many pathogens. This study aimed at understanding the population dynamics of A. aegypti and A. albopictus and the influence of abiotic factors in an endemic area of dengue. The study was conducted in the urban area of Campo Grande, Mato Grosso do Sul, Brazil, over one year. In seven regions of the city, 50 ovitraps were installed in each neighborhood. The development of the larvae was monitored under controlled laboratory conditions until they reached the adult phase. A total of 50,900 eggs of Aedes sp. were collected, 26,073 of which reached adulthood: 25,496 (97.8 %) A. aegypti and 540 (2.1%) A. albopictus. A. aegypti was observed in all months during the study. The highest number of A. albopictus eggs were collected in June, while in August and September, an absence of this species was noted. Abiotic factors such as temperature, humidity and rainfall were responsible for the observed fluctuations in the mosquito population. The presence of A. albopictus in the urban area of the city is concerning because it could become a potential vector for other arboviruses that afflict human populations. The occurrence of these species in Campo Grande reinforces the need for constant entomological and epidemiological surveillance so that informed actions could be taken to decrease potential breeding sites.


Assuntos
Aedes/fisiologia , Mosquitos Vetores/fisiologia , Oviposição/fisiologia , Aedes/classificação , Animais , Brasil , Dengue/transmissão , Doenças Endêmicas , Feminino , Estágios do Ciclo de Vida , Masculino , Mosquitos Vetores/classificação , Densidade Demográfica , Dinâmica Populacional , Estações do Ano , População Urbana
12.
Braz J Anesthesiol ; 66(2): 212-4, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26952234

RESUMO

INTRODUCTION: Angelman syndrome is characterized by severe mental retardation and speech and seizure disorders. This rare genetic condition is associated with changes in GABAA receptor. Patients with Angelman syndrome need to be sedated during an electroencephalogram ordered for diagnostic purposes or evolutionary control. Dexmedetomidine, whose action is independent of GABA receptor, promotes a sleep similar to physiological sleep and can facilitate the performing of this examination in patients with Angelman syndrome. CASE REPORT: Female patient, 14 years old, with Angelman syndrome; electroencephalogram done under sedation with dexmedetomidine. The procedure was uneventful and bradycardia or respiratory depression was not recorded. The examination was successfully interpreted and epileptiform activity was not observed. CONCLUSION: Dexmedetomidine promoted satisfactory sedation, was well tolerated and enabled the interpretation of the electroencephalogram in a patient with Angelman syndrome and seizure disorder.


Assuntos
Síndrome de Angelman/complicações , Dexmedetomidina/administração & dosagem , Eletroencefalografia/métodos , Hipnóticos e Sedativos/administração & dosagem , Adolescente , Síndrome de Angelman/fisiopatologia , Dexmedetomidina/efeitos adversos , Feminino , Humanos , Hipnóticos e Sedativos/efeitos adversos
13.
Pediatr Infect Dis J ; 35(7): 805-7, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27093167

RESUMO

The aim of the present study was to assess the presence of antissaliva antibodies of Lutzomyia longipalpis in human hosts living in area of visceral leishmaniasis, located in the Center-West region of Brazil. The presence of antissaliva antibodies of L. longipalpis exhibited a strong correlation with the protection and development of antibodies against Leishmania sp. Of the 492 children studied, elevated antissaliva antibodies of L. longipalpis were detected in 38.4% of the participants. There was a higher percentage of positivity (64.7%) among children who exhibited anti-Leishmania sp. antibodies and among those who were positive in the delayed hypersensitivity test (34.8%).


Assuntos
Anticorpos/sangue , Leishmaniose Visceral/imunologia , Psychodidae/imunologia , Saliva/imunologia , Proteínas e Peptídeos Salivares/imunologia , Adolescente , Animais , Anticorpos/isolamento & purificação , Anticorpos Antiprotozoários/imunologia , Brasil , Criança , Pré-Escolar , Doenças do Cão/parasitologia , Cães , Feminino , Humanos , Hipersensibilidade Tardia/imunologia , Insetos Vetores , Leishmaniose Visceral/parasitologia , Leishmaniose Visceral/prevenção & controle , Masculino , Psychodidae/parasitologia , Saliva/química , Glândulas Salivares/imunologia , Glândulas Salivares/metabolismo , Proteínas e Peptídeos Salivares/química
14.
J Neurosurg Anesthesiol ; 27(1): 21-5, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24823763

RESUMO

BACKGROUND: Sedation for electroencephalography in uncooperative patients is a controversial issue because majority of sedatives, hypnotics, and general anesthetics interfere with the brain's electrical activity. Chloral hydrate (CH) is typically used for this sedation, and dexmedetomidine (DEX) was recently tested because preliminary data suggest that this drug does not affect the electroencephalogram (EEG). The aim of the present study was to compare the EEG pattern during DEX or CH sedation to test the hypothesis that both drugs exert similar effects on the EEG. MATERIALS AND METHODS: A total of 17 patients underwent 2 EEGs on 2 separate occasions, one with DEX and the other with CH. The EEG qualitative variables included the phases of sleep and the background activity. The EEG quantitative analysis was performed during the first 2 minutes of the second stage of sleep. The EEG quantitative variables included density, duration, and amplitude of the sleep spindles and absolute spectral power. RESULTS: The results showed that the qualitative analysis, density, duration, and amplitude of sleep spindles did not differ between DEX and CH sedation. The power of the slow-frequency bands (δ and θ) was higher with DEX, but the power of the faster-frequency bands (α and ß) was higher with CH. The total power was lower with DEX than with CH. CONCLUSIONS: The differences of DEX and CH in EEG power did not change the EEG qualitative interpretation, which was similar with the 2 drugs. Other studies comparing natural sleep and sleep induced by these drugs are needed to clarify the clinical relevance of the observed EEG quantitative differences.


Assuntos
Hidrato de Cloral , Sedação Consciente/métodos , Dexmedetomidina , Eletroencefalografia/métodos , Hipnóticos e Sedativos , Adulto , Método Duplo-Cego , Feminino , Humanos , Hipotensão/induzido quimicamente , Masculino , Estudos Prospectivos , Sono/efeitos dos fármacos , Fases do Sono/efeitos dos fármacos , Adulto Jovem
15.
Rev. méd. Minas Gerais ; 30: [1-5], 2020.
Artigo em Português | LILACS | ID: biblio-1103060

RESUMO

Introdução: o prontuário médico (PM) é uma importante ferramenta para o registro do cuidado profissional prestado ao paciente nos serviços de saúde. Ele contém informações sobre o processo da doença, que são cruciais para o preenchimento da declaração de óbito (DO). Objetivos: determinar se o PM informou os diagnósticos necessários para identificação da causa básica da morte e verificar se o médico que fez a DO preencheu corretamente a causa básica da morte. Método: o médico auditor analisou prontuários médicos de pacientes que evoluíram para óbito na Santa Casa de Belo Horizonte no ano de 2014. Os diagnósticos citados no prontuário médico foram identificados e comparados com as causas da morte descritas na declaração de óbito. Resultados: Seiscentos e vinte e nove prontuários médicos foram avaliados. Entre os diagnósticos iniciais citados nos prontuários, a causa básica da morte esteve correta em 63,11% dos casos avaliados e entre os diagnósticos finais esse percentual foi de 95,86%. A concordância entre os diagnósticos citados no PM e a causa da morte citada na DO foi fraca (Kappa = 0,130 para diagnóstico inicial e Kappa = 0,229 para o diagnóstico final). Na análise da causa básica da morte citada na declaração de óbito, verificou-se que em 28,78% esse dado estava incorreto. Conclusões: os prontuários médicos geralmente apresentaram os diagnósticos necessários para identificar a causa básica da morte. Os médicos tiveram dificuldade em identificar as causas da morte e preencher corretamente a DO.


Introduction: the medical record (MR) is an important tool to register the treatments and diagnosis of the patients. The information from the MR are crucial to the correct fulfill of the Death Certificate (DC), which are basis to many public health policies. Objectives: Define if the MR of the assessed institution informed the necessary diagnosis to identify the basic death cause. Secondarily was evaluated if the doctor who made the DC correctly fulfilled the basic death cause. Method: the medical auditor analyzed the medical records of patients who died in Santa Casa of Belo Horizonte (SCBH) from March 15 to July 15 of 2014. The diagnosis cited on the medical record were identified and compared to the basic death cause described in the death certificate. Results: Six hundred twenty nine medical records were evaluated. In the analysis of the initial diagnosis, the basic death cause were described in 63.11% of the cases and In the analysis of the final diagnosis, the percentage was 95.86%, which shows poor Kappa agreement (Kappa = 0,130 to initial diagnosis and Kappa = 0,229 to final diagnosis). In the analyze of death basic cause in DC its were wrong in 28.78% of cases. Conclusion: In the evaluated period, the medical record of SCBH presented the necessary diagnosis for the medical auditor identify the basic death cause, however the doctors had difficult to fulfill correctly the DC.


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Controle de Qualidade , Atestado de Óbito , Prontuários Médicos , Causa Básica de Morte , Brasil
16.
J. bras. econ. saúde (Impr.) ; 12(3): 173-188, Dezembro/2020.
Artigo em Inglês | ECOS, LILACS | ID: biblio-1141294

RESUMO

Objective: The transfusion of blood components and blood products in cardiac surgery patients can be guided by protocols based on standard laboratory tests and/or clinical decisions (Standardof-Care, SOC) or viscoelastic haemostatic assays (VHA). The aim of this study is to evaluate the cost-effectiveness and budget impact of VHAs compared to SOC. Methods: A decision tree model was built in TreeAge Pro® 2009. Costs and benefits were taken from the medical literature. The costeffectiveness was evaluated in a base-case scenario and a worst-case scenario, considering low costs of adverse events. The budget impact was evaluated from data taken from Datasus. Cost data were measured in 2019 USD and outcomes were measured in QALYs. Results: VHAs were considered dominant in the base-case scenario and very cost-effective in the worst-case scenario (ICER = $ 1,083.21 USD/QALY). The budget impact analysis varied from a cost-saving result in the base-case scenario to a reasonable increase in cost in the worst-case scenario. Since the total market share of the technology is unlikely, a reasonable estimative for the base-case scenario and the worst-case scenario are about -$275 million USD and $132 million USD, respectively. Conclusion: We conclude that the VHAs are cost-effective and should be recommended for the use in the perioperative period of cardiac surgeries, especially for patients with a high risk of hemorrhage or coagulation problems.


Objetivo: A transfusão de sangue, hemocomponentes e produtos sanguíneos em pacientes submetidos a cirurgia cardíaca pode ser guiada por protocolos baseados em testes laboratoriais padrão e/ou decisão clínica (Standard-of-Care, SOC) ou testes viscoelásticos (TVEs). O objetivo deste estudo é avaliar o custo-efetividade e o impacto orçamentário dos TVEs em comparação com o SOC. Métodos: Um modelo de árvore de decisão foi construído em TreeAge Pro® 2009. Os parâmetros de custos e benefícios foram obtidos da literatura médica. A relação custo-efetividade foi avaliada em um cenário-base e no pior cenário, considerando baixos custos de eventos adversos. O impacto orçamentário foi avaliado a partir de dados extraídos do Datasus. Os custos foram avaliados em USD 2019 e os desfechos em AVAQs. Resultados: Os TVEs foram considerados dominantes no cenário-base e muito custo-efetivos no pior cenário avaliado (RCEI = 1.083,21 USD/QALY). A análise de impacto orçamentário variou de um resultado de economia de custos no cenário-base a um aumento razoável no custo no pior cenário. Como a hipótese de que a tecnologia será adotada para toda a demanda do mercado é improvável, estimativas razoáveis para o cenário-base e o pior cenário são de aproximadamente -275 milhões de USD e 132 milhões de USD, respectivamente. Conclusão: Concluímos que os VHAs são econômicos e devem ser recomendados para uso no período perioperatório de cirurgias cardíacas, principalmente para pacientes com alto risco de problemas de hemorragia ou coagulação.


Assuntos
Avaliação da Tecnologia Biomédica , Cirurgia Torácica , Tromboelastografia , Coagulação Sanguínea , Análise de Custo-Efetividade
17.
Cad Saude Publica ; 19 Suppl 2: S253-61, 2003.
Artigo em Português | MEDLINE | ID: mdl-15029345

RESUMO

This paper presents the results of a study on women from a low-income community in Recife, Pernambuco State, Brazil, focusing on how the women practice their family planning. The study is based on an analysis of reproductive practices by these women, specifically related to conception and contraception. The paper argues that the family planning care provided to these women involves a so-called "low-profile interventionist" policy, meaning that decisions concerning the number and spacing of children is shifted from the family domain to that of attending physicians, with a gradual transfer of control from the public sector to the health field.


Assuntos
Política de Planejamento Familiar , Serviços de Planejamento Familiar , Comportamento Reprodutivo , Adolescente , Adulto , Brasil , Comportamento Contraceptivo , Relações Familiares , Feminino , Humanos , Pessoa de Meia-Idade , Fatores Socioeconômicos
18.
Rev. bras. anestesiol ; 69(1): 27-34, Jan.-Feb. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-977427

RESUMO

Abstract Background and objectives: The combination of clonidine with local anesthetic administered for epidural anesthesia via caudal route seems to improve the quality of postoperative analgesia, but with conflicting results. This study compared the postoperative analgesia of three different doses of clonidine combined with bupivacaine in caudal epidural anesthesia in children undergoing hypospadias repair. Methods: Eighty children aged 1-10 years, candidates for surgical repair of hypospadias, were randomly divided into four groups of 20 patients to receive general anesthesia combined with caudal epidural anesthesia with bupivacaine 0.165% alone or in combination with 1, 2 or 3 µg.kg- 1 of clonidine. The primary outcome was morphine consumption in the first 24 h postoperatively. Mean arterial pressure, heart rate, end-tidal concentration of sevoflurane, time to awakening, pain severity (FLACC scale), level of sedation (RAMSAY), duration of analgesia, and occurrence of adverse effects were also compared. Results: Intraoperatively, there was no difference between groups regarding mean arterial pressure, heart rate, end-tidal concentration of sevoflurane, and time to awakening. Postoperative morphine consumption and pain severity were similar between groups, but the group receiving clonidine (3 µg.kg-1) had lower heart rate and higher sedation level than the group receiving bupivacaine alone. Conclusions: The combination of clonidine at doses of 1, 2 or 3 µg.kg-1 with bupivacaine 0.16% via caudal epidural route did not alter the consumption of morphine in the early postoperative period of children undergoing hypospadias repair.


Resumo Justificativa e objetivos: A associação de clonidina ao anestésico local administrado por via peridural caudal parece melhorar a qualidade da analgesia pós-operatória, mas com resultados conflitantes. Este estudo comparou a analgesia pós-operatória de três diferentes doses de clonidina associada à bupivacaína na anestesia peridural caudal em crianças submetidas à correção de hipospádia. Método: Oitenta crianças entre um e dez anos, candidatas à correção cirúrgica de hipospádia, foram divididas, aleatoriamente, em quatro grupos de 20 pacientes para receber anestesia geral associada à anestesia peridural caudal com bupivacaína 0,166% isolada ou associada a 1, 2 ou 3 µg.Kg-1 de clonidina. Como desfecho principal avaliou-se o consumo de morfina nas primeiras 24 horas de pós-operatório. Compararam-se também pressão arterial média, frequência cardíaca, concentração expirada de sevoflurano, tempo de despertar da anestesia, intensidade da dor pela escala FLACC, nível de sedação (Ramsay), tempo de duração da analgesia e ocorrência de efeitos adversos. Resultados: No transoperatório, não houve diferença entre os grupos quanto à pressão arterial média, frequência cardíaca, concentração expirada de sevoflurano e ao tempo de despertar. No pós-operatório, o consumo de morfina e a intensidade da dor foram similares entre os grupos, mas o grupo que recebeu 3 µg.Kg-1 de clonidina apresentou menor frequência cardíaca e maior sedação do que o grupo que recebeu somente bupivacaína. Conclusões: A associação de clonidina nas doses de 1, 2 ou 3 µg.Kg-1 à bupivacaína 0,166% por via peridural caudal não alterou o consumo de morfina no pós-operatório imediato de crianças submetidas à correção de hipospádia.


Assuntos
Humanos , Masculino , Lactente , Pré-Escolar , Criança , Bupivacaína/administração & dosagem , Clonidina/administração & dosagem , Analgésicos/administração & dosagem , Hipospadia/cirurgia , Anestesia Epidural/métodos , Anestésicos Locais/administração & dosagem , Método Simples-Cego , Estudos Prospectivos , Combinação de Medicamentos
19.
An. acad. bras. ciênc ; 89(3,supl): 2273-2280, 2017. tab, graf
Artigo em Inglês | LILACS | ID: biblio-886818

RESUMO

ABSTRACT Control strategies using insecticides are sometimes ineffective due to the resistance of the insect vectors.In this scenario new products must be proposed for the control of insect vectors.The complexes L-aspartate Cu (II) and L-glutamate-Cu (II) complexes were synthesized and characterized by elemental analysis, visible ultraviolet, infrared spectroscopy and potentiometric titration. The toxicity of these complexes was analyzed in Aedes aegypti (Diptera: Culicidae) larvae and Gram-negative and Gram-positive bacteria. The interaction between the ligands and the amino acid balance and the distribution of the species as a function of pH were discussed. The lethal concentration median (LC50) for Ae. aegypti larvae were: L-glutamic acid-Cu (II) - 53.401 mg L-1 and L-aspartate-Cu (II) - 108.647 mg L-1. The minimum inhibitory concentration (MIC) required for Staphylococcus aureus and Escherichia coli was: L-glutamate-Cu (II) 500-2000 mg L-1 and L-aspartate-Cu (II) 1000-2000 mg L-1. The concentrations demonstrated toxicity that evidence the potential of the complexes as bactericide and insecticide. Metal complexes formed by amino acids and transition metals are advantageous because of low environmental toxicity, biodegradability and low production cost.


Assuntos
Animais , Staphylococcus aureus/efeitos dos fármacos , Ácido Aspártico/química , Ácido Glutâmico/química , Cobre/química , Aedes/efeitos dos fármacos , Escherichia coli/efeitos dos fármacos , Testes de Toxicidade , Larva/efeitos dos fármacos , Dose Letal Mediana
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