bluuebunny/crossref_metadata_2025 huggingface dataset:
Modelagem da volatilidade apresentada pelos índices IVBX-2 e SMLL em 2008 usando modelos da família ARCH
Authors: Araujo Jevuks Matheus de , Leite Filho Paulo Amilton Maia
Published: September 2012

As séries financeiras são fortemente caracterizadas pela sua volatilidade, alternando períodos de alta e baixa volatilidade, ou seja, a variância dessas séries não é constante, variam com o tempo. Dessa forma, as séries financeiras podem apresentar heterocedastidade condicional. O trabalho analisa o comportamento das séries dos retornos dos índices IVBX-2 e SMLL em 2008, com o objetivo de identificar a volatilidade das séries. O eixo teórico central do trabalho é a teoria dos mercados eficientes, que considera que todas as informações relevantes já estão incorporadas nos preços das ações; dessa forma, o preço é uma boa medida de valor das ações. Os índices estudados são caracterizados por representar carteiras hipotéticas compostas por ações de menor valor e menor liquidez, essas características pressupõem um maior risco e um maior retorno associado a investimentos nesse tipo de carteira. A metodologia adotada foi o uso dos modelos da família ARCH. Os resultados da aplicação dos modelos indicam que as séries possuem um comportamento semelhante, com o coeficiente que mede a persistência de choques em torno de 1, e os impactos desses choques se dão de forma assimétrica, em que os choques negativos produzem um efeito maior do que choques positivos.
Análise da competitividade das exportações brasileiras de minério de ferro, de 2000 a 2008
Authors: Pais Paloma Santana Moreira , Gomes Marília Fernandes Maciel , Coronel Daniel Arruda
Published: September 2012

O minério de ferro representa um importante produto na pauta de exportações brasileiras. Por isso, este artigo objetivou analisar o comportamento das exportações brasileiras de minério de ferro, de 2000 a 2008, utilizando o Índice de Orientação Regional, o Índice de Vantagem Comparativa Revelada e o Constant-Market-Share. Para o cálculo do último indicador, o período de análise foi dividido em três subperíodos: de 2000 a 2002, de 2003 a 2005 e de 2006 a 2008. O Índice de Vantagem Comparativa Revelada mostrou que o minério brasileiro vem perdendo participação no mercado internacional, e o Índice de Orientação Regional indicou que as exportações brasileiras estão direcionadas para a China. Por meio da análise do Constant-Market-Share, observou-se que o efeito que mais contribuiu para o aumento das exportações do mineral foi o crescimento do comércio mundial, em todo o período analisado, e o efeito destino das exportações foi negativo em ambos os períodos, e o efeito competitividade foi positivo apenas entre os subperíodos de 2003/2005 e 2006/2008. Com base nesses resultados, pode-se afirmar que, embora o Brasil possua uma importância significativa no comércio mundial de minério, o país precisa superar os desafios relativos ao custo-Brasil para se tornar mais competitivo nesse mercado.
Estudo longitudinal do desenvolvimento da comunicação em diversas economias mundiais
Authors: Arruda Filho Emílio José Montero
Published: September 2012

O desenvolvimento do setor de comunicação de um país possui relações com o seu desenvolvimento econÃ´mico e é possível demonstrar essa conexão estatisticamente, como tem sido feito por pesquisadores de instituições como a ITU (International Telecommunications Union). Como esses dados estão apenas apresentados na forma simples e não levam em conta fatores de interconexão, é importante desenvolver pesquisas que avaliem a conexão entre variáveis relevantes no campo. Este trabalho visa analisar os fatores de desenvolvimento tecnológico de comunicação que melhor descrevem o posicionamento econÃ´mico de um país, integrando a usabilidade dos serviços de comunicação com o status econÃ´mico. Foram utilizados dados de 56 países, escolhidos aleatoriamente. Uma pesquisa na forma de datamining foi realizada, a qual analisou os dados existentes já previamente coletados por instituições de pesquisa tais como ITU, World Bank, e outras. Cada fator de usabilidade, preferência e serviço analisado é apontado como um reflexo de outros serviços e usos anteriormente desenvolvidos. Parte da literatura sobre esse tópico (ARRUDA FILHO; CASSIA; MARINO, 2008; CHERRY, 2007; DAVIES; HARDT; KELLY, 2004) argumenta que o desenvolvimento econÃ´mico de certos países existe como resultado de um aumento do desenvolvimento tecnológico, porém outras demonstram ou informam o contrário. Este artigo apresenta essas relações em certos países, escolhidos pela quantidade de informação disponível considerando sua posição de desenvolvimento global, relacionando diretamente o comportamento de crescimento ou redução no uso das tecnologias, tais como telefone e internet. Este trabalho coletou dados de duas fontes mundiais de informação dos setores mencionados: a International Telecommunications Union (ITU) e o World Bank. Utilizaram-se as técnicas estatísticas de regressão e análise de variância para a análise de dados de 56 países ao longo de 10 anos. Conclui-se que o crescimento econÃ´mico possui relação direta com o crescimento do mercado de comunicação, sendo os produtos de comunicação fatores de influência para o desenvolvimento econÃ´mico.
Recursos de tecnologia da informação sustentadores de vantagem competitiva: um estudo no setor metal-mecânico agroindustrial
Authors: Przyczynski Renato , Vanti Adolfo Alberto
Published: September 2012

Este estudo analisou os recursos internos de Tecnologia da Informação (TI) como sustentadores de vantagem competitiva sob a óptica da Visão Baseada em Recursos (VBR). A análise investigou 17 atributos estratégicos em um estudo qualitativo de caráter exploratório e com um histórico longitudinal. Cada um dos atributos foi devidamente identificado, caracterizado e conceituado pelos seus respectivos autores, seguidores da VBR, antes de ser utilizados nas análises. O estudo de casos múltiplos considerou a dinâmica competitiva de duas organizações, líderes do setor metal-mecânico e significativamente competitivas em inovação tecnológica. As narrativas de 16 executivos (12 CEOs e quatro CIOs) contribuíram para a reconstituição de vinte anos de competitividade empresarial, tendo sido considerados eventos econÃ´micos relevantes ou fases críticas identificadas no período estudado. Ao finalizar a recuperação da trajetória percorrida pela dinâmica competitiva, e, uma vez identificados os recursos e os momentos críticos de maior competitividade, os executivos seniores foram encorajados a se posicionar quanto ao potencial estratégico dos recursos. A compreensão das intervenções de TI na dinâmica competitiva foi importante para estudar como, de acordo com o instrumento adotado, a TI apoia a competitividade segundo os critérios da VBR. A análise de conteúdo, segundo as proposições de Bardin, trata do desvendamento de significações de diferentes tipos de discursos, baseando-se na inferência ou dedução, mas que, simultaneamente, respeita critérios específicos propiciadores de dados em estruturas temáticas. Os recursos de TI não contribuíram estrategicamente, pelo menos de forma dissociada dos demais recursos, durante as fases críticas da competitividade nas duas organizações. As duas organizações reconheceram que a utilização conjunta de diferentes recursos de TI pode representar a força maior na criação de novas estratégias e manutenção das estratégias mais antigas. Dentre os principais resultados, o estudo revelou os diferentes atributos estratégicos de TI interagindo com as fases críticas da competitividade nas organizações estudadas. Esses atributos foram fundamentados nos recursos denominados Configurador de Produto (CP), Módulo Comercial (MC) e Manufatura Virtual (MV).
Uma reflexão sobre as relações de parceria nos APLs de Confecções do Agreste Pernambucano como elemento disseminador da inovação em redes interorganizacionais
Authors: Silva Fabiana Ferreira , Feitosa Marcos Gilson Gomes , Aguiar Virgínia do Socorro Motta
Published: September 2012

Atuar em um cenário altamente competitivo exige maior dinamicidade das organizações para adequar-se e desenvolver-se em face da instabilidade do mercado global. Quando se transpõem esses requisitos para o ambiente empresarial, constata-se que pequenas empresas geralmente não dispõem de infraestrutura e conhecimento para sobreviver nesse contexto. Tais dificuldades fazem que elas busquem alternativas para se tornar mais competitivas mediante conexões com outras organizações. Este estudo teve como objetivo verificar se a atuação em redes interorganizacionais é percebida como um elemento impulsionador da inovação para os atores do Arranjo Produtivo Local (APL) de Confecções do Agreste Pernambucano. A perspectiva teórica contempla estudos sobre redes interorganizacionais e inovação. Quanto à metodologia, a pesquisa utilizou-se de métodos quantitativos para fazer a caracterização das indústrias de confecções por meio da aplicação de um questionário em 51 empresas. Foi observado neste trabalho que a análise da inovação foi considerada um fator essencial ao desenvolvimento das redes interorganizacionais, sendo possível concluir que os atores do APL acreditam que as parcerias interfirmas constituem um elemento impulsionador da inovação na rede. Por sua vez, apesar de os testes estatísticos revelarem forte relação entre os indicadores de inovação e as relações de parceria no APL, as inovações implementadas priorizam resultados econÃ´micos para algumas empresas em detrimento de fatores sociais que são imprescindíveis ao desenvolvimento local para todos os atores. Constatou-se ainda que não há equidade na disseminação dos benefícios na rede e que esta acaba sendo uma estrutura de exclusão no APL em estudo, visto que apenas uma minoria aproveita as vantagens geradas no ambiente. Dentre as principais contribuições e implicações práticas e sociais, a partir da reflexão dos dados da pesquisa, sugere-se: incentivar a análise de APL como sistemas socioprodutivos e inovativos, em que a economia não constitui um único fator determinante; e ressaltar a necessidade da organização de Fóruns de Desenvolvimento Regional, contando com a participação de diferentes atores do APL que discutam ações voltadas para a rede.
Compliance and leadership: the susceptibility of leaders to the risk of corruption in organizations
Authors: Santos Renato Almeida dos , Guevara Arnoldo José de Hoyos , Amorim Maria Cristina Sanches , Ferraz-Neto Ben-Hur
Published: September 2012

In the field of organizational management, the term "compliance" designates the set of actions to mitigate risk and prevent corruption. Programs are composed by formal control systems, codes of ethics, educational actions, ombudsmen, and reporting channels - to mention the most recurrent, which vary according to the sector, the institutional culture, and the strategy. Leadership has a fundamental role in the process of compliance, not only due to its power to implement it, but precisely because it exercises this power, in itself, the object of reflections on ethics. The goal of this research was to evaluate the susceptibility of leaders to the risk of breaching organizational rules that involve ethical aspects. For quantitative investigation, we used social and descriptive statistical analysis of secondary data provided by ICTS Global, a company specialized in risk reduction. The study analyzed deals with non-probabilistic sampling by convenience, carried out between the years 2004 and 2008 with employees and candidates of 74 private companies located in Brazil. The final number of individuals studied is 7,267. The indicators analyzed are contained in the index of moral perception of comprehension of individual vision of the concerning hypotheses of ethical conflicts. According to the information obtained in the investigation, leaders are more willing to fail to comply. Paradoxically, the data also show that leaders are more loyal to organizations, raising the hypothesis that the bent toward moral integrity and loyalty to the organization are not necessarily simultaneous behaviors (it is possible that, motivated by loyalty, a leader might break away from individual principles). Based on the data and on bibliographic references, our final considerations point to the importance of considering systems from which leadership is recruited, compensated, promoted, developed, etc., in the prevention of corruption. Our data do not show that leaders are more corrupt, but that they have a greater disposition towards relaxing principles in professional circumstances.
Tumor growth analysis by magnetic resonance imaging of the C6 glioblastoma model with prospects for the assessment of magnetohyperthermia therapy
Authors: Silva André César da , Cabral Francisco Romero , Mamani Javier Bustamante , Malheiros Jackeline Moraes , Polli Roberson Saraiva , Tannus Alberto , Vidoto Edson , Martins Mateus José , Sibov Tatiana Tais , Pavon Lorena Favaro , Miyaki Liza Aya Mabuchi , Cárdenas Walter Humberto Zavala , Malheiros Suzana Maria Fleury , Brandt Reynaldo André , Amaro Junior Edson , Gamarra Lionel Fernel
Published: September 2012

OBJECTIVE: The objective was to establish a pattern of tumor growth of the C6 model of glioblastoma multiform in Wistar rats via magnetic resonance imaging (MRI) for the subsequent verification of tumor volume reduction due to magnetic hyperthermia therapy. METHODS: Young male Wistar rats weighing between 250 and 300 g were used for the C6 model. After the rates were anesthetized (55 mg/kg ketamine and 11 mg/kg xylazine), C6 lineage tumorigenic cells suspended in culture medium (10(5) cells in 10 µl) were stereotaxically injected into the right frontal cortex (bregma coordinates: 2.0 mm anteroposterior, 3.0 mm laterolateral, and 2.5 mm depth) of the rats using a Hamilton syringe. For the control group, the rats were injected with culture medium without cells. MRI scans were performed at 14, 21, and 28 d after the injection using a 2.0 T MRI scanner (Bruker BioSpec, Germany). The animals were anesthetized with 55 mg/kg ketamine and 11 mg/kg xylazine before being examined. Coronal multilayers were acquired using a standard spin echo sequence with the following parameters: repetition/echo time = 4.000 ms/67.1 ms, field of view = 3.50, matrix = 192, slice thickness = 0.4 mm, and slice separation = 0 mm. RESULTS: The MRI analysis enabled a clear visualization of the tumor mass, and it was possible to establish the tumor volume parameters on the various days that were examined. The volume at 14 d after induction was 13.7 ± 2.5 mm³. On days 21 and 28, the tumor volumes were 31.7 ± 6.5 mm³ and 122.1 ± 11.8 mm³, respectively. CONCLUSION: These results demonstrated that it is possible to evaluate the C6 model tumor volume in rats, which will allow for the future implementation and verification of magnetic hyperthermia therapy.
The epidemiological profile of Pediatric Intensive Care Center at Hospital Israelita Albert Einstein
Authors: Lanetzki Camila Sanches , Oliveira Carlos Augusto Cardim de , Bass Lital Moro , Abramovici Sulim , Troster Eduardo Juan
Published: September 2012

OBJECTIVE: This study outlined the epidemiological profiles of patients who were admitted to the Pediatric Intensive Care Center at Albert Einstein Israelite Hospital during 2009. METHODS: Data were retrospectively collected for all patients admitted to the PICC during 2009. A total of 433 medical charts were reviewed, and these data were extracted using the DATAMARTS System and analyzed using the statistical software package STATA, version 11.0. RESULTS: There were no statistically significant differences in regards to patient gender, and the predominant age group consisted of patients between the ages of 1 to 4 years. The average occupancy rate was 69.3% per year, and there was a greater number of admissions during April, August, and October. The average length of stay at the hospital ranged from 9.7 to 19.1 days. Respiratory diseases were the main cause for admission to the Pediatric Intensive Care Center, and the mortality rate of the patients admitted was 1.85%. CONCLUSIONS: Respiratory diseases were the most common ailment among patients admitted to the Pediatric Intensive Care Center, and the highest mortality rates were associated with neoplastic diseases.
Apgar score and neonatal mortality in a hospital located in the southern area of São Paulo city, Brazil
Authors: Oliveira Tatiana Gandolfi de , Freire Paula Vieira , Moreira Flávia Thomé , Moraes Juliana da Silva Bemfeito de , Arrelaro Raquel Coris , Rossi Sarah , Ricardi Viviane Alves , Juliano Yara , Novo Neil Ferreira , Bertagnon José Ricardo Dias
Published: September 2012

OBJECTIVE: To correlate the Apgar score, and neonatal mortality and its causes at a hospital located in the southern area of São Paulo City. METHODS: A retrospective study performed by analysis of medical charts (n=7,094) of all live newborns during the period of 2005 to 2009, with data up to 28 days of life in reference to weight, Apgar score, survival and cause of mortality. Cases were analyzed by the X² test (p < 0.05). RESULTS: In 7,094 births, there were 139 deaths, 58.3% during the first week, and 3.6% of them with Apgar < 4 in the 1st minute. A positive association was found between mortality and this variable, with significantly declining values up to 2,000 g in weight. In the group with weight < 1,000 g, the association with Apgar < 4 in the 1st minute with mortality was three-fold greater than in the 1,000-1,500 g weight group, and 35-fold greater than in the > 3,000 g group. Among newborns with Apgar 8-10, the rate of mortality and low weight was two times greater than in those with weight > 2,499 g. Fetal distress and prematurity were associated with early neonatal death; malformations and fetal distress to late mortality. The predictive value of death with Apgar < 4 varied, according to weight, from 62.74% in the < 1,000 g group to 5.5%, in the > 3,000 g group. CONCLUSIONS: The Apgar score proved linked to factors both epidemiological and related to attention given to the birth and neonatal mortality, and was associated with extremely low birth weight.
Pediatric trauma due to motor vehicle accidents on high traffic roadway
Authors: Figueiredo Junior Israel , Carvalho Mauricio Vidal de , Lima Glaucia Macedo de
Published: September 2012

OBJECTIVE: To outline a profile of pediatric trauma victims and verify the likelihood of trauma in children on a high traffic roadway. METHODS: A descriptive cohort study of the records of emergency medical service activations on the Rio-Niterói Bridge, a high traffic roadway in Rio de Janeiro, Brazil. Descriptive statistics were expressed as absolute and relative frequencies. The estimated risk of trauma in children aged < 12 years was calculated by means of odds ratios, with a 95% confidence interval. RESULTS: Trauma accounted for 514 of 1,244 activations (41.31%) of the Rio-Niterói Bridge emergency medical service between March 2002 and March 2003. Response to incidents involving children aged < 12 years accounted for 52 of these (4.18%). Half of victims were between the ages of 6 and 12 years (n = 26), and 55.76% were male (n = 29). Of the 52 victims, 37 (71.15%) were involved in motor vehicle accidents (OR: 3.70; 95%CI: 1.94-7.13; p < 0.0001). Of these, 28 were vehicle-vehicle collisions (75.67%). The most common sites of injury were the extremities (n = 12; 32.43%), face (n = 10; 27.02%), and head (n = 9; 24.32%). Pre-hospital procedures were performed on 23 of the 37 patients (62.16%), and 44.23% (n = 23/52) required hospital transportation. There were no deaths during the study period. CONCLUSIONS: In this study, children were at significantly higher odds of being treated for trauma while on a highway with heavy traffic flow. The most common sites of injury in this sample were the lower extremities and the head, face, and neck complex.
Assessment of cardiovascular risk of patients with arterial hypertension of a public health unit
Authors: Cesarino Evandro José , Vituzzo André Luiz Gomes , Sampaio Julliane Messias Cordeiro , Ferreira Danilo Avelar Sampaio , Pires Heloísa Andrião Ferreira , Souza Luiz de
Published: September 2012

OBJECTIVE: To assess the cardiovascular risk, using the Framingham risk score, in a sample of hypertensive individuals coming from a public primary care unit. METHODS: The caseload comprised hypertensive individuals according to criteria established by the JNC VII, 2003, of 2003, among 1601 patients followed up in 1999, at the Cardiology and Arterial Hypertension Outpatients Clinic of the Teaching Primary Care Unit, at the Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. The patients were selected by draw, aged over 20 years, both genders, excluding pregnant women. It was a descriptive, cross-sectional, observational study. The Framingham risk score was used to stratify cardiovascular risk of developing coronary artery disease (death or non-fatal acute myocardial infarction). RESULTS: Age range of 27-79 years ( = 63.2 ± 9.58). Out of 382 individuals studied, 270 (70.7%) were female and 139 (36.4%) were characterized as high cardiovascular risk for presenting diabetes mellitus, atherosclerosis documented by event or procedure. Out of 243 stratified patients, 127 (52.3%) had HDL-C < 50 mg/dL; 210 (86.4%) had systolic blood pressure > 120 mmHg; 46 (18.9%) were smokers; 33 (13.6%) had a high cardiovascular risk. Those added to 139 enrolled directly as high cardiovascular risk, totaled up 172 (45%); 77 (20.2%) of medium cardiovascular risk and 133 (34.8%) of low risk. The highest percentage of high cardiovascular risk individuals was aged over 70 years; those of medium risk were aged over 60 years; and the low risk patients were aged 50 to 69 years. CONCLUSION: The significant number of high and medium cardiovascular risk individuals indicates the need to closely follow them up.
Lag time between onset of symptoms and diagnosis of endometriosis
Authors: Santos Tânia Mara Vieira , Pereira Ana Maria Gomes , Lopes Reginaldo Guedes Coelho , Depes Daniela De Batista
Published: September 2012

OBJECTIVE: To assess lag time between onset of symptoms and diagnosis of endometriosis in patients followed up at the Outpatients Clinic of Endometriosis and Chronic Pelvic Pain, at the Hospital do Servidor Público Estadual de São Paulo "Francisco Morato de Oliveira", from January 2003 to November 2009. METHODS: In a retrospective analytical study, a total of 310 women with endometriosis confirmed by surgery and pathological examination were evaluated in the period from January 6, 2003 to November 29, 2009. Data were gathered through revision of the follow-up visit forms at the specialized outpatients clinic and medical records. The software Epi-Info 3.3.2 was used for statistical analysis. RESULTS: The mean lag time between onset of symptoms and confirming diagnosis of endometriosis was 46.16 months (3.84 years), ranging from 6 to 324 months. Patients aged under 20 years had a mean time until diagnosis of 2.8 years (33.6 months, range of 6 to 144 months). In patients aged 20-29 years, it was 3.51 years (42.18 months, range 6-192 months). In those aged 30-40 years, the mean time was 4.14 years (49.69 months, range 6-324 months). And in women age over 40 years, it was 3.15 years (37.86 months, range 6-216 months). CONCLUSION: The lag time between onset of symptoms and diagnosis of endometriosis was shorter, as compared to other national and international evaluations.
Nutritional status and food intake of patients with systemic psoriasis and psoriatic arthritis associated
Authors: Solis Marina Yazigi , Melo Nathalia Stefani de , Macedo Maria Elisa Moschetti , Carneiro Fabiana Prata , Sabbag Cid Yazigi , Lancha Junior Antonio Hebert , Frangella Vera Silvia
Published: September 2012

OBJECTIVE: To identify the nutritional status and food intake of individuals with systemic psoriasis and psoriatic arthritis associated. METHODS: This is an exploratory and cross-sectional study with 34 men aged between 19 and 60 years seen at a Psoriasis Center. Participants were divided into systemic psoriasis group and arthritic-systemic psoriasis associated group. For nutritional assessment we used anthropometry, bioelectrical impedance analysis and whole-body plethysmography. Clinical and nutritional information were assessed using the clinical and nutritional history-taking, and the 24-hour dietary recall. For statistics the general linear model test (p < 0.05) was used. RESULTS: According to the body mass index 29.4% patients (n = 10) were eutrophic, 41.2% (n = 14) overweight and 29% (n = 10) obese. Almost all individuals (60%; n = 21) had body fat percentage above normal levels (> 25%) and a high risk for metabolic complications according to the waist circumference and the obesity index, however, there were no statistically significant differences between groups. The mean food intake, total fat, calories and protein were above recommended levels, being 58.8% for lipids (319.17 ± 241.02 mg of cholesterol and 17.42 ± 11.4 g saturated fatty acids); 29.4% for calories and 67.6% for proteins. Thus, regardless of the psoriasis type, an excessive consumption of calories, lipids, fatty acids, cholesterol and a higher incidence of overweight were found. CONCLUSION: The sample showed an abnormal nutritional condition, an increased risk for chronic diseases related to obesity, worsening of the psoriatic lesions, and poor quality of life.
Hysteroscopic findings in patients with post-menstrual spotting with prior cesarean section
Authors: Talamonte Valdely Helena , Lippi Umberto Gazi , Lopes Reginaldo Guedes Coelho , Stabile Sueli Aparecida Batista
Published: September 2012

OBJECTIVE: To identify uterine hysteroscopic findings among patients with prior cesarean section and whom had post-menstrual bleeding spotting type. METHODS: We conducted a descriptive and prospective study between June 2008 and December 2009 involving women admitted to our clinic in Ji-Paraná (RO), Brazil, and who complained of prolonged genital bleeding after menstrual period. A total of 20 women with the simultaneous following characteristics were selected: at least one prior cesarean section, aged between 18 and 45 years, no use of hormonal contraceptives, and no history of uterine surgery that could change the cavity anatomy. All participants underwent a hysteroscopic examination. RESULTS: During hysteroscopy, in 90% of the patients, the presence of a cesarean section scar was observed in the last third of the cervix. This scarring causes an anomaly in the uterine cavity anatomy, characterized by the viewing of an enlargement followed by a retraction of the anterior wall, which affords the presence of a pseudocavity with depth and lumen narrowing in variable degrees. Two patients did not present the pseudocavity. CONCLUSION: Pseudocavities in cesarean section scar are usually found in hysteroscopic examination of patients with prior cesarean section and abnormal uterine spotting.
Liver transplant outcome: a comparison between high and low MELD score recipients
Authors: David Andre Ibrahim , Coelho Maria Paula Villela , Paes Ângela Tavares , Leite Ana Kober , Della Guardia Bianca , Almeida Márcio Dias de , Meira Sergio Paiva , Rezende Marcelo Bruno de , Afonso Rogerio Carballo , Ferraz-Neto Ben-Hur
Published: September 2012

OBJECTIVE: To compare low and high MELD scores and investigate whether existing renal dysfunction has an effect on transplant outcome. METHODS: Data was prospectively collected among 237 liver transplants (216 patients) between March 2003 and March 2009. Patients with cirrhotic disease submitted to transplantation were divided into three groups: MELD > 30, MELD < 30, and hepatocellular carcinoma. Renal failure was defined as a ± 25% decline in estimated glomerular filtration rate as observed 1 week after the transplant. Median MELD scores were 35, 21, and 13 for groups MELD > 30, MELD < 30, and hepatocellular carcinoma, respectively. RESULTS: Recipients with MELD > 30 had more days in Intensive Care Unit, longer hospital stay, and received more blood product transfusions. Moreover, their renal function improved after liver transplant. All other groups presented with impairment of renal function. Mortality was similar in all groups, but renal function was the most important variable associated with morbidity and length of hospital stay. CONCLUSION: High MELD score recipients had an improvement in the glomerular filtration rate after 1 week of liver transplantation.
Factor analysis for the adoption of nuclear technology in diagnosis and treatment of chronic diseases
Authors: Sato Renato Cesar , Zouain Désirée Moraes
Published: September 2012

OBJECTIVE: To identify and evaluate latent variables (variables that are not directly observed) for adopting and using nuclear technologies in diagnosis and treatment of chronic diseases. The measurement and management of these latent factors are important for healthcare due to complexities of the sector. METHODS: An exploratory factor analysis study was conducted among 52 physicians practicing in the areas of Cardiology, Neurology and Oncology in the State of Sao Paulo who agreed to participate in the study between 2009 and 2010. Data were collected using an attitude measurement questionnaire, and analyzed according to the principal component method with Varimax rotation. RESULTS: The component matrix after factor rotation showed three elucidative groups arranged according to demand for nuclear technology: clinical factors, structural factors, and technological factors. Clinical factors included questionnaire answers referring to medical history, previous interventions, complexity and chronicity of the disease. Structural factors included patient age, physician's practice area, and payment ability. Technological factors included prospective growth in the use of nuclear technology and availability of services. CONCLUSIONS: The clinical factors group dimension identified in the study included patient history, prior interventions, and complexity and chronicity of the disease. This dimension is the main motivator for adopting nuclear technology in diagnosis and treatment of chronic diseases.
Brainstem cavernomas: a surgical challenge
Authors: Aguiar Paulo Henrique Pires de , Zicarelli Carlos Alexandre Martins , Isolan Gustavo , Antunes Ápio , Aires Rogério , Georgeto Sérgio Murilo , Tahara Adriana , Haddad Fahd
Published: September 2012

OBJECTIVE: The authors show their experience with brainstem cavernomas, comparing their data with the ones of a literature review. METHODS: From 1998 to 2009, 13 patients harboring brainstem cavernomas underwent surgical resection. All plain films, medical records and images were reviewed in order to sample the most important data regarding epidemiology, clinical picture, radiological findings and surgical outcomes, as well as main complications. RESULTS: The mean age was 42.4 years (ranging from 19 to 70). No predominant gender: male-to-female ratio, 6:7. Pontine cases were more frequent. Magnetic resonance imaging was used as the imaging method to diagnose cavernomas in all cases. The mean follow-up was 71.3 months (range of 1 to 138 months). Clinical presentation was a single cranial nerve deficit, VIII paresis, tinnitus and hearing loss (69.2%). All 13 patients underwent resection of the symptomatic brainstem cavernoma. Complete removal was accomplished in 11 patients. Morbidity and mortality were 15.3 and 7.6%, respectively. CONCLUSIONS: Cavernomas can be resected safely with optimal surgical approach (feasible entry zone) and microsurgical techniques, and the goal is to remove all lesions with no cranial nerves impairment.
Interventions performed by the clinical pharmacist in the emergency department
Authors: Miranda Talita Muniz Maloni , Petriccione Sandra , Ferracini Fabio Teixeira , Borges Filho Wladimir Mendes
Published: September 2012

OBJECTIVE: To demonstrate the role and importance of the clinical pharmacist in the Emergency Department by means of identification, classification, and assessment of the number of interventions performed by this professional. METHODS: This was a retrospective study conducted during the period of January 1st, 2010 to December 31st, 2010, at the Morumbi Emergency Department of Hospital Israelita Albert Einstein. The interventions were performed by the clinical pharmacists by means of his/her role along with the interdisciplinary team and active search in clinical charts, with daily analysis of medical prescriptions during the period of eight hours (10:00 to 19:00) from Monday to Friday. RESULTS: A total of 3,542 medical prescriptions were written and there were 1,238 interventions. Classifications and quantities of interventions were as follows: administration route: 105 (8.48%); frequency: 73 (5.89%); dosage: 431 (35%); renal function: 14 (1.13%); compatibility: 50 (4%); dilution: 121 (9.77%); legibility: 39 (3.15%); pharmacovigilance: 7 (0.56%); adverse reaction to medications: 7 (0.56%); allergy: 35 (2.82%); infusion time: 76 (6.13%); indication: 52 (4.20%); medication reconciliation: 2 (0.16%); enteral medication administration: 38 (3%); scheduling: 7 (0.56%); specific anticoagulant protocol: 44 (3.55%); specific hypoglycemic agent protocol: 42 (3.99%). CONCLUSION: The study allowed the demonstration of the importance of the clinical pharmacist active in the Emergency Department. By the classification and by the number of interventions carried out, it was possible to observe that the Clinical Pharmacy Service had a great impact on the increased safety for the patient and prevention of adverse events.
The presence of accessory soleous muscle in humans
Authors: Del Nero Flavio Belmont , Ruiz Cristiane Regina , Aliaga Junior Roberto
Published: September 2012

OBJECTIVE: To verify the prevalence of the accessory soleus muscle in humans and according to gender. METHODS: A total of 154 magnetic resonance images of the ankle were assessed in T1 weighted sagittal, coronal and axial planes. RESULTS: An incidence of 11.6% of accessory soleus muscle in humans was observed; in that, 7.8% in males and 15.6% in females. CONCLUSION: The accessory soleus muscle incidence was 11.6% in the samples studied and it was more often present in females.
Predicting mortality and cost of hematopoeitic stem-cell transplantation
Authors: Kerbauy Fábio Rodrigues , Morelli Leonardo Raul , Andrade Cláudia Toledo de , Lisboa Luis Fernando , Cendoroglo Neto Miguel , Hamerschlak Nelson
Published: September 2012

OBJECTIVE: To evaluate whether the Pretransplantion Assesment of Mortality risk score is associated to transplant costs and can be used not only to predict mortality but also as a cost management tool. METHODS: We evaluated consecutively patients submitted to allogeneic (n = 27) and autologous (n = 89) hematopoietic stem cell-transplantation from 2004 to 2006 at Hospital Israelita Albert Einstein (SP), Brazil. Participants mean age at hematopoietic stem cell-transplantation was 42 (range 1 to 72) years; there were 69 males and 47 females; 30 patients had multiple myeloma; 41 had non-Hodgkin and Hodgkin's lymphomas; 22 had acute leukemia; 6 had chronic leukemia; and 17 had non-malignant disease. The Pretransplantion Assesment of Mortality risk score was applied in all patients using the available web site. RESULTS: Patients could be classified in three risk categories: high, intermediate and low, having significant difference in survival (p = 0.0162). The median cost in US dollars for each group was $ 281.000, $ 73.300 and $ 54.400 for high, intermediate and low risk, respectively. The cost of hematopoietic stem cell-transplantation significantly differed for each Pretransplantin Assesment of Mortality risk group (p = 0.008). CONCLUSION: The validation of the Pretransplantion Assesment of Mortality risk score in our patients confirmed that this system is an important tool to be used in transplantation units, being easy to apply and fully reproducible.
Results of a control quality strategy in cervical cytology
Authors: Gullo Caio Eduardo , Dami Anna Luiza Tannús , Barbosa Amanda Pires , Marques Aline Maria de Vita , Palmejani Marianna Angelo , Lima Luiz Guilherme Cernaglia Aureliano de , Bonilha Jane Lopes
Published: September 2012

OBJECTIVE: To determine the efficacy of a quality control strategy in cervical cytology in the detection of high-grade squamous intraepithelial lesions. METHODS: Forty-two patients were selected who underwent a Pap smear and cervical uterine biopsy between April 2008 and December 2009, with evidence of a high-grade squamous intraepithelial lesion in one or both tests. The statistical parameters of the smear test were calculated before and after systematic meetings for review of the archived test results (6 years), in which the following was done: interobserver diagnostic consensus; cytohistological correlation, with the latter as gold standard; and evaluation of the therapeutic status of each patient. RESULTS: Once these controls were applied, it was noted that sensitivity and positive likelihood ratio of the test for high-grade squamous intraepithelial lesion increased 9.5% (34.5 to 44%) and 0.45% (1.64 to 2.09%), respectively, while specificity remained at 79%. Reduction in interference of false-negative results associated with errors in the analytical phase of the cytological productive process gave an estimate of failures in collection of the specimens (pre-analytical phase). CONCLUSION: In addition to improving the performance of the cytological diagnosis of the high-grade squamous intraepithelial lesion, the proposed quality control strategy allows a reflection on the causes of incorrect or conflicting scrutiny.
Splenogonadal fusion and testicular cancer: case report and review of the literature
Authors: Lopes Roberto Iglesias , Medeiros Mabel Tatty de , Arap Marco Antônio , Cocuzza Marcello , Srougi Miguel , Hallak Jorge
Published: September 2012

A 36 year-old man after tests for assessing male infertility was diagnosed with primary infertility, bilateral cryptorchidism, non-obstructive azoospermia and discontinuous splenogonadal fusion. Carcinoma in situ was found in his left testicle, which was intra-abdominal and associated with splenogonadal fusion. To our knowledge, this is the fourth case of splenogonadal fusion associated with testicular cancer reported. One should always bear in mind the possibility of this association for the left cryptorchid testicle.
Hemorrhagic adrenal cyst
Authors: Silva Elsa Cristina Fontes Pires da , Viamontez Francisco , Silva Vasco Sabino , Andrade Artur , Júlio Neto Gonçalo , Gomes Constança de Palma , Neto Sérgio , Quitembo Mateus , Dimbany Higino , Van-Dunem Joaquim Carlos Vicente Dias , Miranda Sandra Maria da Rocha Neto de , Bastos Fernando , Cordeiro Lemuel Bornelli , Guilherme Mateus
Published: September 2012

The authors present a case of a hemorrhagic adrenal cyst, one of the tumors known in literature as incidentalomas, emphasizing the clinical characteristics, since adrenal cysts or pseudocysts are generally rare and observed by chance during imaging procedures. Traditionally they are classified as pseudocysts, endothelial, epithelial or parasitic cysts. Laparoscopic adrenalectomy has been considered the treatment of choice for benign, functioning or non-functioning adrenal lesions. Small cystic adrenal tumors can be managed conservatively by laparoscopic decortication or marsupialization, but larger cysts should be treated by total or partial adrenalectomy.
Meningoencephalitis associated with Mycoplasma pneumoniae
Authors: Lalibera Isabella Batista de , Silveira Guilherme de Abreu , Toma Ricardo Katsuya , Kuo Jack Yung , Troster Eduardo Juan
Published: September 2012

We report a case of a child with meningoencephalitis of atypical etiology. The patient developed the disease after an infection in the upper airways with unfavorable evolution. The clinical recovery was only possible after the administration of adequate antibiotic therapy for the etiological agent. This case report describes a child with meningoencephalitis of atypical etiology. The patient developed the disease after an infection in the superior airways with negative evolution. The clinical recovery was possible only after the introduction of adequate antibiotic therapy for the etiological agent.
Midgut volvulus after laparoscopic appendectomy
Authors: Macedo Maurício , Velhote Manoel Carlos Prieto
Published: September 2012

The authors report a case of a 13-year old child who was submitted to a laparoscopic appendectomy and developed, during the postoperative period, an intestinal obstruction caused by small bowel volvulus in the absence of a congenital malrotation.
Recent changes in Clostridium difficile infection
Authors: Silva Júnior Moacyr
Published: September 2012

Clostridium difficile is the main cause of nosocomial diarrhea. Diarrhea associated with C. difficile has increased incidence, morbidity, and mortality in the last few years. The major related risk factors include use of antibiotics, elderly patients and prolonged hospital stay. Many patients receive combinations of antibiotics or multiple antibiotics, which represents the main risk to develop diarrhea associated to C. difficile or its recurrence. Therefore, interventions to improve antibiotic prescribing, as well as compliance with infection control measures can reduce hospital-acquired C. difficile infections. This review addresses the epidemiological changes in C. difficile disease and its treatment.
Warfarin: pharmacological profile and drug interactions with antidepressants
Authors: Teles Juliana Souto , Fukuda Ellen Yukie , Feder David
Published: September 2012

Oral anticoagulants are among the drugs with the greatest number of drug interactions. The concomitant use of several medications is a common practice in patients with cardiovascular problems, who often also present with depression; therefore, the probability of an interaction occurring between warfarin and the antidepressants is high, and may result in increased or decreased anticoagulant activity. Since the possible interactions between these two classes of drugs have been poorly explored in literature, with a risk to the patients who use them, we reviewed the pharmacology of warfarin and its possible interactions with antidepressants. Of the antidepressants analyzed, those that showed relevant effects on the interaction with warfarin were, in decreasing order: paroxetine, venlafaxine, fluoxetine, and duloxetine.
New methods of microbiological identification using MALDI-TOF
Authors: Pasternak Jacyr
Published: September 2012

Rapid diagnosis of pathogens is decisive to guarantee adequate therapy in infections: culture methods are precise and sensitive, but rather slow. New resources are available to enable faster diagnosis, and the most promising is MALDI-TOF technology: mass spectrometry applied to microbiological diagnosis. Times as fast as 10 to 15 minutes to etiological diagnosis are possible after a positive blood culture result. We hope to have this technology in our laboratory, ANVISA permitting and improving their very slow rate of doing things... MALDI-TOF is basically putting a sample of culture or an enriched suspension of the probable pathogen over a small spot with a matrix and vaporizing it with a laser pulse: the products are aspired into a chamber, ionized and reach detectors at variable times: the detectors show time of arrival and quantity of the product, and each pathogen has its characteristic spectrum analyzed by a software.
Principal Component Analysis applied to digital image compression
Authors: Santo Rafael do Espírito
Published: September 2012

OBJECTIVE: To describe the use of a statistical tool (Principal Component Analysis – PCA) for the recognition of patterns and compression, applying these concepts to digital images used in Medicine. METHODS: The description of Principal Component Analysis is made by means of the explanation of eigenvalues and eigenvectors of a matrix. This concept is presented on a digital image collected in the clinical routine of a hospital, based on the functional aspects of a matrix. The analysis of potential for recovery of the original image was made in terms of the rate of compression obtained. RESULTS: The compressed medical images maintain the principal characteristics until approximately one-fourth of their original size, highlighting the use of Principal Component Analysis as a tool for image compression. Secondarily, the parameter obtained may reflect the complexity and potentially, the texture of the original image. CONCLUSION: The quantity of principal components used in the compression influences the recovery of the original image from the final (compacted) image.
Spectral characteristics of the hippocampal LFP during contextual fear conditioning
Authors: Machado Birajara Soares , Kunicki Ana Carolina Bione , Morya Edgard , Sameshima Koichi
Published: September 2012

OBJECTIVE: The hippocampus has an important role in the acquisition and recall of aversive memories. The objective of this study was to investigate the relationship among hippocampal rhythms. METHODS: Microeletrodes arrays were implanted in the hippocampus of Wistar rats. The animals were trained and tested in a contextual fear conditioning task. The training consisted in applying shocks in the legs. The memory test was performed 1 day (recent memory) or 18 days (remote memory) after training. We proposed a measure based on the FFT power spectrum, denominated "delta-theta ratio", to characterize the different behaviors (active exploration and freezing) and the memories types. RESULTS: The delta-theta ratio was able to distinguish recent and remote memories. In this study, the ratio for the 18-day group was smaller than for the 1-day group. Moreover, this measure was useful to distinguish the different behavior states – active exploration and freezing. CONCLUSIONS: The results suggest delta-theta oscillations could reflect the demands on information processing during recent and remote memory recalls.
Ultrastructural transneuronal degeneration study of axonal elements within the paratrigeminal nucleus in sinoaortic deafferented rats
Authors: Caous Cristofer André , Smith Ricardo Luís , Haapalainen Edna Freymuller , Lindsey Charles Julian
Published: September 2012

OBJECTIVE: Morphological study that searched to authenticate the presence of sinoaortic baroreceptor inputs within the dorsolateral medullary nucleus under electron microscopy analysis. METHODS: After a 5-day survival period, 9 baroreceptor-denervated rats deeply anaesthetized with equithesin were transcardially perfused and their brains were histologically processed. RESULTS: The neuronal cytoarchitecture of the paratrigeminal nucleus comprehends afferent projections from other nuclei that have a distributive character regarding visceral and nociceptive functions in the cardiovascular reflex integration response. CONCLUSION: The medial portion of the nucleus receives afferent projections of the rostral ventrolateral medulla, as shown by retrograde neurotracing studies. The present results show that the medial extent of the paratrigeminal nucleus contains degenerated axoplasmic cellular components in sinoaortic deafferented rats. The number of degenerated axonal fibers was also larger in this area of the nucleus.
Seeking tools for image fusion between computed tomography, structural and functional magnetic resonance methods for applications in neurosurgery
Authors: Rocha Liana Guerra Sanches da , Amaro Junior Edson
Published: September 2012

OBJECTIVE: To evaluate tools for the fusion of images generated by tomography and structural and functional magnetic resonance imaging. METHODS: Magnetic resonance and functional magnetic resonance imaging were performed while a volunteer who had previously undergone cranial tomography performed motor and somatosensory tasks in a 3-Tesla scanner. Image data were analyzed with different programs, and the results were compared. RESULTS: We constructed a flow chart of computational processes that allowed measurement of the spatial congruence between the methods. There was no single computational tool that contained the entire set of functions necessary to achieve the goal. CONCLUSION: The fusion of the images from the three methods proved to be feasible with the use of four free-access software programs (OsiriX, Register, MRIcro and FSL). Our results may serve as a basis for building software that will be useful as a virtual tool prior to neurosurgery.