Repositório RCAAP

Introduction: Death, which is a natural and certain event in the lives of all people, is viewed with a lot of suffering and is surrounded by defense mechanisms which are consolidated socially, in the vain attempt to lessen the distressing effects that its presence brings. Although many scholars have been addressing the issue, there is still a great amount of difficulty on the part of health professionals in giving assistance to people in the final phase of life. Objective: To contribute to the creation of knowledge related to the final phase of life. Material and Methods: A descriptive exploratory study with qualitative approach. Data were collected by way of unstructured interview, recorded at the Oncology Sector of the Hospital de Clinicas, Federal University of Uberlândia. Ten (10) volunteers from the Fight for Life Group, six (6) patients, eight (8) family members and four (4) technical crew members took part, totaling twenty-eight (28) people being interviewed in all. The discourses of the subjects were organized using content analysis, with consequent identification of discussion categories. Results and Conclusion: The results allow one to raise hypotheses as to the conditions of a good death taking place, as well as the knowledge as to the need for changes in assistance to people in the final phase of life.

Fundação de Amparo a Pesquisa do Estado de Minas Gerais

Children are particularly susceptible to the development of acute respiratory failure and the use of invasive mechanical ventilation can lead to respiratory complications with the accumulation of secretions. Physiotherapy aims to minimize these accumulations through bronchial hygiene maneuvers. The effects of these maneuvers are little known in the pediatric population and studies are needed to give answers to the following frequent questions: Do the respiratory physiotherapy maneuvers promote changes in respiratory mechanics of children? Is there any superiority of the effects of one technique over the other? We developed a randomized prospective clinical study and evaluated twelve children aged 31.17 ± 17.28 months, randomized into two groups: six in the Bag Squeezing group (BS) and six in thoracic vibrocompression group (TVC). The BS maneuver comprised ten manual hyperinflation maneuvers interspersed with ten vibrocompression maneuvers followed by tracheal aspiration. For the VCT maneuver, we applied ten vibrocompression maneuvers in each lateral position followed by aspiration. The variables were analyzed in the moments before and after 30, 60 and 120 min. For statistical analysis, the T-Student test for intra group analysis and ANOVA for inter group analysis. Statistical analysis showed that the groups were homogeneous. There was increased exhaled CO2 in the VCT group in the post-maneuver moment (p = 0.00) when compared to the pre, 30, 60 and 120 min moments. The other respiratory variables behaved similarly not showing inter or intra group differences. Comparing the BS and VCT techniques, we found higher values of PIP (95% CI 0.33 to 5.80, p = 0.02) and Peep (95% CI 0:08 to 1:06, p = 0.02) in the BS group. The VCT group showed higher resistance values (95% CI -22.03 to -1.63, p = 0.02) in the post maneuver moments. Static compliance remained stable or showed improvement in 83.33% of children undergoing the BS maneuver.Therefore, the VCT maneuver showed higher resistance values in the respiratory system and the BS maneuver showed the best response in other variables of respiratory mechanics. Clinic Testing Registration: NCT01747954

One of the purposes of allergen-specific immunotherapy (SIT) is to modulate the humoral immune response against allergens with significant increases in allergen-specific IgG1 and IgG4 levels. These antibodies are associated with blocking activity by preventing IgE binding to allergen and leading to reduced inflammatory responses. This study aimed to investigate in vitro blocking activity of allergen-specific IgG antibodies on IgE reactivity to D. pteronyssinus (Dpt) in sera from atopic patients. Dpt-specific IgG antibodies were obtained from atopic sera and irrelevant IgG from non-atopic sera. IgG antibodies were purified by ammonium sulfate precipitation followed by Protein-G affinity chromatography and evaluated with regards to purity by SDS-PAGE and immunoreactivity by slot-blot and immunoblot assays. The blocking activity was evaluated by inhibition ELISA. The electrophoretical profile after salting-out precipitation showed an enrichment of high molecular weight proteins in the precipitated fraction and strongly stained bands in the ligand fraction after chromatography, compatible with molecular weight of human IgG. It was detected strong immunoreactivity to IgG, negligible to IgA, and no reactivity to IgE and IgM. Dpt-specific IgG fraction was capable to significantly reduce levels of IgE anti-Dpt, resulting in 35-51% inhibition of IgE reactivity to Dpt in atopic patient sera. Allergen-specific IgG antibodies purified using available and standardized methodology are able to inhibit IgE reactivity to Dpt allergen extract. In addition to the clinical symptoms improvement (subjective parameter), this approach reinforces that the intermittent measurement of serum allergen-specific IgG antibodies will be an important objective laboratorial parameter that will help specialists to follow their patients under SIT.

Fundação de Amparo a Pesquisa do Estado de Minas Gerais

Leucine is a regulator of protein metabolism in vivo, and there is little information regarding its action on cardiac hypertrophy induced by experimental hyperthyroidism and its relationship to serum creatine kinase. The study aimed to verify the effect of leucine in cardiac hypertrophy and serum creatine kinase in rats with hyperthyroidism. 75 animals were used, divided into two large groups according to the length of the experiment, seven days Group (7D) and Group twenty-eight days (D 28), subsequently divided into five subgroups these being the control zero (C0-7 and C028 ) controls (C-7 and C-28), hormone (H-7 and H- 28), leucine (G-7 and G-28) and leucine + hormone (LH-7 and HL-28). Hyperthyroidism was induced by administration of daily 20μg/100 grams of levothyroxine sodium in aqueous suspension by gavage. Leucine was supplemented by adding 5% of the amino conventional diet. Blood was collected by cardiac puncture and analyzes made in kits for TSH, T3, T4 and CK-NAC CK-MB. At the end of the experiment the heart was removed and weighed. Subsequently, the left ventricle was separated together with the interventricular septum and heavy, was also performed to measure the transverse diameter of cardiomyocytes and compared between groups. The exercise tolerance was measured by the swim test and the intensity was determined in 7% of the weight of the animal. Blood pressure and heart rate were measured using a sphygmomanometer to rats tail, 4/25T ADInstruments PowerLab equipment ® and ® software ADInstruments LabChart 7. In statistical comparison was used analysis of variance (ANOVA) and two-way post-Tukey test, considering p values <0.05. In rats treated with thyroid hormone occurs, cardiac hypertrophy with increased weight of the left ventricle, increased heart rate and elevated concentrations of CK-MB after 28 days. The association of leucine seems to modulate hormone-induced cardiac hypertrophy in this experimental model, and reduce blood concentrations of CK-NAC and CK-MB by unknown mechanisms. Thyroxine increases the swimming performance of rats after therapy for 14 and 21 days but with performance drop in 28 days.

Alterations in sleep and wakefulness affect negatively on mood, memory and psychomotor performance of individuals. Instruments for scaling the quality of these factors should be available for clinical evaluation. The aim of this study was to translate and to culturally adapt the PROMIS® Domains of Sleep Disturbances‟ and Wake Disturbances‟ into the Portuguese language. The process of translation and cultural adaptation followed the guidelines of the FACIT organization. This methodology includes: translation, reconciliation, back translation, review by the developers of PROMIS®, review by independent reviewers, pre-test version, pre-test, incorporation of the results of the pre-test in the translation process. The pre-test verifies the comprehension of the translated version of the instrument, while the retrospective interview aims to analyze the pre-test version of the instrument items, through a cognitive interview, ie, participants are asked about the comprehension and about the existence of irrelevant items in the instrument. In the translation process of Sleep Disturbances‟ and Wake Disturbances‟ items there were some inconsistencies between the translations and between the back translation and the original items. The pre-test version was applied in a convenience sample of 10 individuals aged 18 to 55 years who had no history of sleep and wake problems, mostly female, single, with educational level varying from 1st grade to college. All the translated items were well understood by participants in the pre-test. None of the participants needed assistance for explanations or had difficulty in interpreting the items of the two banks, whose translation into Portuguese language was approved by the administrators of PROMIS® and thus considered equivalent to the English version. The Portuguese version has a semantic, idiomatic, cultural and conceptual equivalence with the items in the source language.

Breastfeeding plays an important role in reducing neonatal and infant mortality. Women s knowledge and attitudes have an impact on several aspects of breastfeeding, such as its establishment and duration. The present study aimed to evaluate the knowledge and factors interfering the establishment of breastfeeding among postpartum women of the Hospital of the Federal University of Uberlandia (Hospital das Clínicas da Universidade Federal de Uberlandia [HC-UFU]). This is a quantitative study of cross-sectional conducted at Hospital of the Federal University of Uberlandia. The study included all women staying in rooming from July 1 to December 31, 2010 who agreed to participate and had no contraindication to breastfeed. An interview was used to obtain data on breastfeeding. We assessed sociodemographic variables, obstetric profile and information on breastfeeding from interviewed women. During the study period, 958 women remained in rooming during hospitalization and 907 were interviewed. The study revealed that the majority of the puerperal women were young, with stable union, good schooling, realized prenatal in public service, decided to breastfeed before pregnancy and intend to breastfeed their infants for 12 months. Prenatal was mentioned as the main source of information about breastfeeding and nursing professionals were indicated as the main professional category responsible for guidance and assistance on establishment of breastfeeding. The results obtained in this study suggest that the training of health professionals, particularly nursing staff, could change the practice of breastfeeding.

With the technological improvement and neonatal care, there was an increasing on both survival rates of extremely premature newborns (EPN), as on the prevalence of chronic morbidity and disability in survivors. The objectives of this paper are the critical description of the ethics/ bioethics principles that are often evoked to justify the decisions on resuscitation and/or continued treatment of EPN at the limit of viability, the considerations on the difficult choices involving the premature infant, his family and health care professionals, and the consideration of guidelines in several countries. A non-systematic review was made in databases (Medline, LILACS and SciELO), 2000-2013, and on literature about bioethics issues involving EPN. In a reality of decreasing limit of viability, followed by the increase survival rates of EPN and more frequent morbidities, the main discussion is about the gray zone, which is around 23 and 24 gestational age, presently, with uncertain prognosis and high risk of serious disabilities. In that, the ethical issues are evaluated based on contemporary theories, such as personalism, utilitarianism and principlism that guide bioethics evaluations. On the decision making process for the EPN, the moral status, the best interest, the quality of life, the futility and parental participation are the points considered. Guidelines and clinical protocols arise in several countries to guide decision-making at the NICU and are developed based on bioethical questions are reflections involved in decision-making about EPN. It should be brought in mind an individualized conduct for each mother/EPN in decision making at the limit of viability, based on medical and technological knowledge and involved bioethical principles, valuing life and avoiding therapeutic obstinacy.

Introduction: Tuberculosis is an infectious disease that affects more than 9 million people each year worldwide . For tuberculosis control methods for the study of more accurate diagnostic and monitoring treatment , make it essential . Objectives: To identify biomarkers by Phage display technique and evaluate the immunoreactivity of the IG\'s clones selected sera from patients with tuberculosis to monitor treatment . Methods: Blood samples were collected from 61 individuals over 18 years , both sexes , and performed the tuberculin test ( PPD ) as a control . The samples were subjected to the process of selection of clones, the biopanning using a library of random 12 amino acid region of the protein expressed on the phage pIII . After selecting the ELISA assay was performed to analyze the immunoreactivity of selected clones . Results: after the in silico analysis , it was found that the sequence of clone F10 ( VYKTPNSTANRW ) has similarity to the membrane protein MPT64 low molecular weight , 28 to 32 kDa, immunogenicity of the M. tuberculosis complex. In ELISA clone F10 showed reactivity significant ( p < 0.05 ) and monitoring of individuals in treatment (P < 0.005). Conclusion : the reactivity of clone F10 demonstrated that it can be used for monitoring the treatment of tuberculosis , contributing to its control.

This work describes and analyzes epidemiological, clinical and microbiological aspects of Staphylococcus aureus infections in children hospitalized in a pediatric ICU (PICU). We review of medical records of patients aged 29 days to 12 years admitted to the PICU with invasive staphylococcal disease in the period from 13 August 1989 to 13 August 2009. We analyzed the records of 83 patients (1.8% of 4597 admissions) with invasive disease caused by S. aureus. The age ranged from 1m to 12.4 years (mean 4 years) and 47 (56.6%) patients were male. There were predominance of the community-acquired infections (61 cases, 73.5%) and the most frequent diagnoses were pneumonia (especially in children under five years) and osteo-arthritis (in the oldest) with or without sepsis. Most patients showed no comorbidity at admission and when present they were the postoperative condition, presence of central venous catheter, skin lesions and immunodeficiencies. The main indications for admission to the PICU were respiratory failure and cardiovascular. The most common sources of agent isolation were blood, pleural fluid and osteo-articular secretion. The most frequently used antibiotics were oxacillin, vancomycin and ceftriaxone, with or without aminoglycosides. The overall death rate of 27.7% was lower than that of hospital infections (45.5%) and those caused by MRSA (66.6%).The disagreement between the employed and antibiotic susceptibility testing resulted in no significant difference in mortality (p = .25). Despite the low frequency of the invasive staphylococcal disease, the mortality is high. The study of the clinical-epidemiological aspects of the disease and in vitro resistance of the agent contributes to the early diagnosis and the initial empirical antibiotic therapy.

Universidade Federal de Uberlândia

The intravascular administration of iodine-based contrast media is a common cause of acute kidney injury (AKI). This study investigated whether changes in the urinary concentration of neutrophil gelatinase-associated lipocalin (uNGAL) before and after coronary angiography they are able to predict the development of AKI independently of previously established absolute cut-off values. A total of 125 outpatients undergoing elective coronary angiography were enrolled and divided into 2 subgroups: G1 (n = 103), patients with changes in their serum creatinine after coronary angiography of < 0.3 mg/dL, and G2 (n = 22), patients with changes in their serum creatinine after coronary angiography &#8805; 0.3 mg/dL. The primary study endpoint was AKI defined as AKI network stages 1. uNGAL was measured before coronary arteriography and 2 and 4 hours afterwards. To determine the sensitivity and specificity for the absolute and relative variations of uNGAL, a receiver operator characteristic (ROC) curve analysis was performed. Based on the ROC curve for the relative difference in uNGAL before and after coronary angiography, a 50% increase in the uNGAL value over baseline was 60% sensitive and 81% specific for AKI. The area under the curve for relative differences 2 hours after coronary angiography was 0.82. The percentage variations in the concentration of uNGAL detected the early stages of AKI regardless of the absolute cut-off established.

To determine whether the antral follicle count (AFC), assessed by transvaginal ultrasound on day 3 of the menstrual cycle, can predict the number of retrieved oocytes in patients undergoing ovarian hyperstimulation cycles for in vitro fertilization (IVF) and to correlate it with the maternal age and pregnancy rate. METHODS: This was a retrospective observational study based on a review of medical records from 193 patients who underwent assisted reproduction techniques between September 2010 and September 2012 at the Clinic for Human Reproduction Fecunda (Clínica de Reprodução Humana Fecunda) in Uberlandia, Minas Gerais State, Brazil. The study included women indicated for IVF who had follicle-stimulating hormone (FSH) levels below 10 mIU/ml on day 3 of the menstrual cycle. Oocyte recipients were excluded. The women were divided into 3 groups according to AFC (up to 10 follicles, 11 22 follicles, and 23 or more follicles). To compare the AFC groups with the group of patients who became pregnant, patients who had not developed oocytes and had not undergone embryo transfer were also excluded from the study. All patients were submitted to ovarian hyperstimulation treatments and transvaginal ultrasonographic evaluations for the AFC. Subsequently, oocyte retrievals and embryo transfers were performed. Spearman s correlation coefficient (sc) was used to measure the level of association between the numerical variables, and the chi-square test was used to compare pregnancy rates with the AFC. To assess the likelihood of pregnancy, we used a multivariate logistic regression that considered the AFC and age as independent variables; a 5% (p<0.05) significance level was adopted. RESULTS: Overall, 179 patients with a median age of 34 years were analyzed. When AFC was considered as the main variable, a positive correlation with the number of retrieved oocytes (sc = 0.48; p < 0.05) and a negative correlation with age (sc = -0.51; p < 0.05) were observed. There was no significant difference (p = 0.162) when the AFC groups were compared with the positive pregnancy test group; however, in the multivariate analysis, a cutoff of 27 antral follicles was observed, after which the probability of successful gestation tended to remain constant. CONCLUSIONS: There were greater numbers of retrieved oocytes with a higher AFC and fewer numbers of follicles and oocytes with increased age. The AFC can predict the likelihood of successful IVF.

The fast increase in the proportion of elders in the world and Brazilian population opens a discussion about unabling events in this age, in which the occurence of falls stands out. This study aimed to evaluate epidemical and clinical aspects related to accidents caused by falls among the elders attended at Hospital de Clínicas de Uberlândia (HCU). For the data assessment, from September 01, 2003 to August 31, 2004, one day of the week was drafted to start the investigation and, in sequence, every six days, during twenty four hours, the elders victims of falls attended in the emergency hospital of HCU were interviewed. We also daily visited the nurses to interview every elder in internment because of falls. For such interviews, we used a questionnaire made specificaly to obtain data related to patients personal informations, health conditions before the fall, residence conditions, necessity and level of care they needed, causes and circumstances of the fall. In the period studied, 485 patients were attended at the hospital victims of falls, and the sample studied was composed of 177 of these patients who lived and fell in Uberlândia and were interviewed. The mean of the patients ages were 76, and 108 (61.o%) were female; prevailing the married or widowed (147; 83%) retired or pensioner (121; 68.3%); 76 (42.9%) had monthly income between 2 and 4 minimum wages. The kind of residence prevailing was house (135; 76.3%), with rugs (135; 76.8%), unlevellings (109; 61.0%) and stairs (69; 39.0%) These facts , associated with problems such as the kind of floor and luminosity, were the main difficulties reported by the elders to move in their houses. The prevailing deseases were hypertension (81; 45.8%), diabetes (57; 32.2%) and osteoporosis (24; 13.6%). Most of the patients reported daily use of medicines antihypertensives (47.5%), Hypoglycemic (32.2%) and benzodiazepinic (27.1%). Seventy five patients (42.3%) practised physical activities, being walking (62.0%) and hydrogymnastic (24.15) the most common. Ninety four (53.1%) had a leisure activity, mainly dance (36.7%) and sightseeing (29.2%). The falls presented little variation related to the months of the year, but were more common between 6 and 10 in the morning. The site of major occurence was in their own houses (135; 76.3%), mainly in the bathroom (51; 28.8%) and bedroom (28; 15.8%). The main causes were slippings (60; 37.8%) and stumbles (33; 20.8%). The major consequence was fracture (121;68.4%), mainly of femur (81; 45.8%) and radius (23; 13.0%). Fifty nine patients (33.3%) confirmed having fallen before, in the last twelve months, in their own houses (46; 78.0%), because of slipping (18; 32.1%); unbalance (11; 21.4%); 119 (67.2%) reported never have received any preventing oriantation against falls. Letality was of 3.5%. We can conclude that, in relation to elders falls attended in Hospital das Clínicas de Uberlândia that: they occur in a with little variability during the months of the year, but prevail between 6 and 10 in the morning; the frequency increases in the ages 70 to 74, is higher among women, retired and pensioners; about half of the victims had no stable union at the time of the fall; most of the residences were houses, with five to seven rooms, in which lived from 2 to 4 people; the bathrooms used by the elders were about 3.5 metres from their bedroom; the patients consider distance, lack of luminosity and the presence of rugs as the most common difficulties to reach the toilet; pre-existing health problems were mainly hypertension and diabetes; the most comons physical activities were walking and hydrogymnastics, and leisure activities were dance and sightseeing; most of the times the fall is due to slippings or stumbles; as a consequence, TCE is diagnosed for about 10% of the patients and fracture for more then half, being femur the most commonly broken bone; the great majority of the victims is helped in a few minutes after the fall; most of them consider not having received any information about avoiding falls; the percentage of deaths due to falls is less than 5%.

Objective: To analyze whether the patients with severe infections, admitted in the Pediatric Intensive Care Unit of the Hospital de Clínicas of the Universidade Federal de Uberlândia, underwent the active screening for primary immunodeficiencies (PID). Methods: Retrospective study that assessed the data records of patients with any severe infections admitted in the Pediatric Intensive Care Unit, covering a period from January 2011 to January 2012, in order to confirm if they performed an initial investigation for PID with blood count and immunoglobulin dosage. Results: In the studied period, 53 children were hospitalized with severe infections in the Pediatric Intensive Care Unit, and only in seven (13.2%) the initial investigation of PID was performed. Among these patients, 3/7 (42.8%) showed quantitative alterations in immunoglobulin G (IgG) levels, 1/7 (14.3%) had the diagnosis of cyclic neutropenia, and 1/7 (14.3%) presented thrombocytopenia and a final diagnosis of Wiskott-Aldrich syndrome. Therefore, the PID diagnosis was confirmed in 5/7 (71.4%) of the patients. Conclusions: The investigation of PID in patients with severe infections has not been routinely performed in the Pediatric Intensive Care Unit. Our findings confirm the necessity of performing PID investigation in this group of patients.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Fundação de Amparo a Pesquisa do Estado de Minas Gerais

Background: The deterioration of renal function is related to the intensity of injury of the tubules and glomeruli, and the expected reduction in glomerular filtration rate, is belatedly diagnosed through late changes in serum creatinine concentrations. In general, physicians are often faced with the question whether to use drugs and potentially nephrotoxic agents in patients with reduced renal function in cineangiographic procedures. Typically, doctors are faced with the question whether to use drugs and radiographic contrast agents in patients with reduced GFR. Usually, the decision will depend of these situations, and no other additional examination is usually done for the assessment of renal function. Then, the patients are discharged soon after the coronary angiography. However, when the patient returns to medical care, on some occasions, is discovered, too late, worsening renal function. In this situation, an early marker of renal damage would be clinically more useful if it were correlated with posterior serum creatinine concentrations. Objectives: Compare the urinary NGAL concentrations (uNGAL) of patients with and without decreasing in the estimated glomerular filtration rate (eGFR) before and after infusion of radiological contrast used during the cinecoronariography (CINE). We also analyzed the possible correlations between uNGAL and the serum creatinine values measured before and two days after the contrast infusion in patients underwent to the CINE. Methods: Ninety-six patients were studied and, according to the estimated glomerular filtration (eGFR), were formed two groups: group R (n=24) with eGFR below 60 ml/min/1.73 m² and group C (n=72) with eGFR above 60 ml/min/1.73 m². The uNGAL and serum creatinine (sCr) levels were measured before and after infusion of the contrast agent. Results: The NGALu concentration before and after contrast infusion was significantly higher in the group R compared to the controls (P < 0.0001). Moreover, the uNGAL and sCr levels before coronary angiography were significantly and positively correlated (r: 0.66; P < 0.0001). Similarly, the NGALu values determined 2 h after angiography were also correlated with the sCr levels measured 2 days after the CINE (r: 0.59; P < 0.0001). Conclusions: The NGALu values were higher in patients with reduced glomerular filtration when compared to controls, and thus, can be considered as a biomarker of GFR in individuals with stable renal function. Moreover, the NGALu concentrations correlated with serum creatinine values obtained 48 hours after hospital discharge, suggesting that it may reflect further evolution of serum creatinine. Therefore, the dosage of NGALu has the expectation to be confirmed as a marker in real-time of GFR. This is especially important in patients with prior reduction of GFR needing to undergo to procedures with potential risk of worsening kidney function, such as coronary angiography, which requires the use of intravascular radiological contrast, potentially nephrotoxic.

The coronary atherosclerosis may reflect the state of major arterial vessels and may be associated with different central and peripheral blood arterial pressures. Systolic (SP) and pulse pressure (PP) of patients with different coronary lesion degrees were assessed during coronary angiography. Cardiovascular events (CV) and hospital admissions were monitored for 12 months. Participants were classified as: without coronary lesion (G-I, n = 54); with mild and moderate coronary lesion (G-II, n = 42); and severe coronary lesions (G-III, n = 95). Both pressures did not differ among the groups (p > 0.05). Central pressures exceeded brachial pressures in all groups (p < 0.05). The G-III status was associated with more hospital admissions than G-I and G-II (p < 0.05). The systolic pressure and pulse pressure were not significantly correlated with the number of admissions. In this older population, for different coronary lesion degrees we found similar central and brachial pressures. The main determinant of hospital admissions and Cardiovascular events was severity of coronary stenosis.