Considering the promising antitumor effects of compounds with dual anti-inflammatory and antiproliferative activities, thus benzophenones analogs (2-7) were evaluated on in vivo anti-inflammatory assay and molecular docking analysis. Those with the best molecular docking results were in vitro evaluated on cyclooxygenase (COX) enzymes and tested regarding antiproliferative activity. All derivatives displayed in vivo anti-inflammatory activity. Among them, the substances 2’-hydroxy-4’-benzoylphenyl-β-D-glucopyranoside (4), 4-hydroxy-4’-methoxybenzophenone (5) and 4’-(4’’-methoxybenzoyl)phenyl-β-D-glucopyranoside (7) showed the best values of Glide Score in COX-2 docking evaluation and 4 and 5 selectively inhibited COX-2 and COX-1 in vitro enzymatic assay, respectively. Thus, 4 and 5 were tested against breast cancer (MCF-7, MDA MB-231, Hs578T) and non-small-cell-lung cancer (A549) cell lines. The estrogen-positive MCF-7 cell line was more responsive compared to other tested cell lines. They induced cell cycle arrest at G1/S transition in MCF-7 cell line once there was an increase in G0/G1 population with concomitant reduction of S population. The antiproliferative activity of these substances on MCF-7 was associated with their ability to inhibit cyclin E expression, a critical regulator of G1/S transition. Taken together, the data indicate that 4 and 5 have dual anti-inflammatory and antiproliferative activities and support further studies to evaluate their antitumor potential.

MWO4 host matrices (M: Sr, Ba) doped with different Tm3+ concentrations (0.02, 0.04, 0.06, 0.08 and 0.10 mol%) have been successfully prepared by the coprecipitation method at room temperature. The as-prepared nanophosphors were characterized by infrared spectroscopy showing intense absorption bands in the range of 700-1000 cm-1 attributed to the symmetrical and asymmetrical stretching vibrations (ν) of the tetrahedral [WO4]2- group. The X-ray diffraction (XRD) measurements reveal the tetragonal scheelite phase with the I41/a (No. 88) space group. The emission spectra of the MWO4:Tm3+ materials are dominated by the highest intensity narrow band of the intraconfigurational 1D2 → 3F4 transitions in the blue region (ca. 456 nm) arising from the Tm3+ ions. Additional low-intensity emission bands originated from the 1G4 → 3H6 (ca. 475 nm), 1G4 → 3F4 (660 nm) and 3H4 → 3H6 (700 nm) transitions are also observed. These optical results indicate that the materials can be used as an alternative to blue-emitting markers.

ABSTRACT Biosynthesized from very long-chain fatty acid wax precursors, n-alkanes make a valuable contribution to the taxonomy of plants. The alkane components of foliar epicuticles of seven Neotropical species of Lecythidaceae were investigated: Bertholletia excelsa, Cariniana legalis, Couroupita guianensis, Eschweilera alvimii, Eschweilera ovata, Gustavia augusta and Lecythis pisonis. Specimens were collected in the metropolitan area of Recife, Pernambuco, and their n-alkane fractions were analyzed by gas chromatography. The chemical relationships among the species were then evaluated using cophenetic correlation and UPGMA. Among the seven species, a total of 15 n-alkanes, with 21-35 carbon atoms, were identified and formed a consistent group of B. excelsa, C. guianensis, E. ovata, G. augusta, and L. pisonis with n-C31. The greatest similarities were found between B. excelsa and L. pisonis, and between C. guianensis and G. augusta. Nevertheless, a phenetic analysis based on a larger number of species is needed to better understand the chemotaxonomic value of epicuticular n-alkanes within the Lecythidaceae.

A series of β-carboline derivatives with amino or guanidinium were synthesized and evaluated in vitro against anti-Mycobacterium tuberculosis and for antiproliferative activities against nine human cancer cell lines. The compounds 1-(4-hydroxyphenyl)-3-carboxamide(ethylamine) β-carboline (24.9 µg mL-1) and 1-(4-methoxyphenyl)-3-carboxamide(ethylamine) β-carboline (26.9 µg mL-1) were the most active against M. Tuberculosis (MTB). Compounds 1-(4-hydroxyphenyl)-3-carboxamide(ethylamine) β-carboline and 1-(4-methoxyphenyl)-3-carboxamide(propylamine) β-carboline, which had the same substituted groups, inhibited the growth of all human tumor cell lines with growth inhibitory activity (GI50) values from 1.37 to 9.20 mmol L-1. Also in this series, compounds 1-(4-hydroxyphenyl)-3-carboxamide(propylamine) β-carboline and 1-(3-nitrophenyl)-3-carboxamide(propylamine) β-carboline demonstrated significant activity against NCI/ADR cells. Among compounds with a terminal guanidine group, compounds 1-(4-hydroxyphenyl)-3-carboxamide(ethyl)guanidine β-carboline (27.8 µg mL-1) and 1-(3-nitrophenyl)-3-carboxamide(ethyl)guanidine β-carboline (37.4 µg mL-1) demonstrated the greatest activity against MTB. Additionally, compounds 1-(4-methoxyphenyl)-3-carboxamide(ethyl)guanidine β-carboline (GI50 = 0.45 mmol L-1) effectively inhibited growth and was highly selective against NCI/ADR. The in silico study revealed that 1-(4-hydroxyphenyl)-3-carboxamide(ethylamine) β-carboline, 1-(4-methoxyphenyl)-3-carboxamide(ethylamine) β-carboline, 1-(4-hydroxyphenyl)-3-carboxamide(propylamine) β-carboline, 1-(4-methoxyphenyl)-3-carboxamide(propylamine) β-carboline and 1-(3-nitrophenyl)-3-carboxamide(propylamine) β-carboline compounds follow the rules established by Lipinski, suggesting that this compound has no problems with oral bioavailability.

OBJECTIVE: To assess the additional cost of incorporating the detection and treatment of retinopathy of prematurity (ROP) into neonatal care services of Brazil's Unified Health System (SUS). METHODS: A deterministic decision-tree simulation model was built to estimate the direct costs of screening for and treating ROP in neonatal intensive-care units (NICUs), based on data for 869 preterm infants with birth weight less than 1 500 g examined in six governmental NICUs in the capital city of Rio de Janeiro, where coverage was 52% and 8% of infants were treated. All of the parameters from this study were extrapolated to Brazilian newborn estimates in 2010. Costs of screening and treatment were estimated considering staff, equipment and maintenance, and training based on published data and expert opinion. A budget impact analysis was performed considering the population of preterm newborns, screening coverage, and the incidence of treatable ROP. One- and two-way sensitivity analyses were performed. RESULTS: In Rio de Janeiro, unit costs per newborn were US$ 18 for each examination, US$ 398 per treatment, and US$ 29 for training. The estimated cost of ROP diagnosis and treatment for all at-risk infants NICUs was US$ 80 per infant. The additional cost to the SUS for one year would be US$ 556 640 for a ROP program with 52% coverage, increasing to US$ 856 320 for 80% coverage, and US$ 1.07 million or 100% coverage. CONCLUSIONS: The results of this study indicate that providing ROP care is affordable within the framework of the SUS in Brazil, and might be feasible elsewhere in Latin America, considering the evidence of the effectiveness of ROP treatment and the social benefits achieved.

OBJETIVO: Evaluar el costo adicional de incorporar la detección y el tratamiento de la retinopatía de la prematuridad (RP) en los servicios de atención neonatal del Sistema Único de Salud (SUS) del Brasil. MÉTODOS: Se estableció un modelo de simulación determinístico en forma de árbol de decisión para calcular los costos directos del tamizaje y el tratamiento de la RP en las unidades de cuidados intensivos neonatales (UCIN), con base en los datos correspondientes a 869 lactantes prematuros con un peso al nacer inferior a 1 500 g examinados en seis UCIN gubernamentales de Rio de Janeiro, capital del estado del mismo nombre, donde la cobertura fue de 52% y se trató a un 7% de los lactantes. Todos los parámetros de este estudio se extrapolaron a los cálculos de recién nacidos brasileños correspondientes al año 2010. Se calcularon los costos de la detección y el tratamiento, teniendo en cuenta el personal, el equipo y la capacitación, con base en los datos publicados y la opinión de los expertos. Se llevó a cabo un análisis de la repercusión presupuestaria considerando la población de recién nacidos prematuros, la cobertura del tamizaje y la incidencia de RP susceptible de tratamiento. Se realizaron análisis de sensibilidad en uno y dos sentidos. RESULTADOS: En Rio de Janeiro, los costos unitarios por recién nacido fueron de US$ 18 por cada examen, US$ 398 por tratamiento y US$ 29 por capacitación. El costo calculado del diagnóstico y el tratamiento de la RP en todos los lactantes en situación de riesgo de las UCIN fue de US$ 80 por lactante. El costo anual adicional para el SUS de un programa de RP con una cobertura de 52% sería de US$ 556 640, y ascendería a US$ 856 320 para una cobertura de 80%, y a US$ 1,07 millones si la cobertura fuera de 100%. CONCLUSIONES: Los resultados de este estudio indican que, teniendo en cuenta los datos probatorios de la eficacia del tratamiento de la RP y los beneficios sociales obtenidos, la prestación de asistencia a la RP es asequible en Brasil en el marco del SUS y podría ser factible en otros lugares de América Latina.

An experimental design in different reaction conditions was applied to modify poly(ether imide), PEI, by sulfonation using acetyl sulfate. Higher temperatures and reaction times led to higher ion exchange capacity. The thermal analysis showed that our sulfonation approach accomplished preparing sulfonated PEI maintaining the thermal stability of its parent material even for the film with highest degree of sulfonation, and assessed the effect of this change on CO2, O2 and N2 permeabilities. The permeability results pointed out that our sulfonation approach is an effective way to produce high performance engineered polymers for fuel cell electrolyte membranes and for CO2 separation from air. These results also suggest that the use of milder reactive medium at higher temperatures and for longer reaction times seems to be a more promising approach to achieve thermal stability than use more aggressive sulfonation agents.

O presente estudo apresenta o tratamento taxonômico da família Pontederiaceae no litoral piauiense, contribuindo para o conhecimento da diversidade biológica do estado do Piauí. Foram identificadas cinco espécies distribuídas em três gêneros, Eichhornia Kunth, Heteranthera Ruiz & Pav. e Pontederia L. Eichhornia foi o mais representativo com três espécies, E. azurea (Sw.) Kunth, E. crassipes (Mart.) Solms e E. diversifolia (Vahl) Urb., enquanto Pontederia e Heteranthera estão representadas por uma espécie, P. cordata var. ovalis (Mart.) Solms e H. rotundifolia (Kunth) Griseb., respectivamente. Todas as espécies são nativas, mas não endêmicas da região. Três representam novas ocorrências para o estado. São apresentadas chave de identificação, descrições, ilustrações e informações sobre distribuição geográfica e habitat.

The taxonomic treatment for the family Pontederiaceae in the coastal region of Piauí is presented as a contribution to knowledge of the biological diversity of the state. Five species were identified in three genera, Eichhornia Kunth, Heteranthera Ruiz & Pav. and Pontederia L. Eichhornia is represented by three species, E. azurea (Sw.) Kunth, E. crassipes (Mart.) Solms and E. diversifolia (Vahl) Urb., while Pontederia and Heteranthera are represented by a single species each, P. cordata var. ovalis (Mart.) Solms and H. rotundifolia (Kunth) Griseb., respectively. All species are native but not endemic to the region. Three species are new records for Piauí. Descriptions, illustrations and an identification key to the species are provided, together with information on their geographical distribution and habitats.

OBJETIVO: A dor musculoesquelética difusa idiopática persistente ou intermitente é definida pela presença de dor com duração de três meses ou mais, sem etiologia aparente, e tem acometido cada vez mais crianças e adolescentes. Este estudo objetivou relatar dois pacientes com dor incapacitante submetidos à abordagem e ao tratamento multiprofissional, além de discutir o tratamento conduzido, por meio de revisão da literatura atual. DESCRIÇÃO DO CASO: O primeiro caso é de uma menina com nove anos de idade, com histórico de cefaleia, dor mus-culoesquelética e dor abdominal há dois anos, período no qual apresentou quatro episódios de ausência de marcha, sem causas orgânicas aparentes. O segundo caso refere-se a uma adolescente de 14 anos com lombalgia diária há 14 meses de forte intensidade, com irradiação para membros inferiores, acompanhada de cefaleia, fadiga e adinamia. Ambas apresentavam exame físico normal, exceto pela presença de alodínia (caso 1) e pontos de fibromialgia (caso 2); além de exames subsidiários normais, sem justificativas orgânicas para as queixas dolorosas. Houve melhora clínica significativa após diagnóstico e tratamento diferencial por meio de abordagem multiprofissional (médico, psicólogo, fisioterapeuta e nutricionista), com retomada das atividades regulares pelas pacientes. COMENTÁRIOS: A atuação integrada da equipe em um curto período de tempo proporcionou às pacientes a retomada de suas atividades normais, visto que fatores emocionais, físicos e nutricionais relacionam-se à dor.

OBJECTIVE: Persistent or intermittent diffuse idiopathic musculoskeletal pain is defined by the presence of pain over three months with no apparent etiology. The diagnosis of this condition in children and adolescents is increasing. The objective of this study was to report the cases of two patients with disabling pain that received multidiscipli-nary treatment and to review the current literature about this subject. CASE DESCRIPTION: The first patient is a nine-year old girl with history of headache, musculoskeletal pain and abdominal pain for two years. During this period she had four episodes of absence of gait with no apparent organic cause. The second patient is a 14-year girl with severe daily low back pain for 14 months, followed by headache and fatigue. Both patients presented a normal physical examina-tion, except for allodynia (case 1) and fibromyalgia tender points (case 2). All tests resulted negative regarding the search for organic reasons for pain complaints. Significant clinical improvement was observed with a multidisciplinary approach offered by pediatricians, psychologists, physical therapists, and nutritionists. Both patients resumed their daily regular activities. COMMENTS: Team integrated performance in a short-term period can provide the attenuation of pain symptoms since emotional, physical and nutritional factors are related to the pain expressed by the patients.

OBJETIVOS: Relatar um caso de transmissão vertical de dengue ocorrido durante epidemia de 2008 pelo vírus tipo II no Rio de Janeiro e revisar a literatura sobre transmissão vertical de dengue. DESCRIÇÃO: Relatamos um caso de transmissão vertical de dengue. Recém-nascido a termo do sexo feminino, peso de nascimento de 3.940 g, foi admitida na unidade de terapia intensiva neonatal com rash cutâneo, hipoatividade e febre no quinto dia de vida. O hemograma evidenciava plaquetopenia importante (38.000 plaquetas). A mãe apresentou quadro clínico compatível com dengue 3 dias antes do parto. Foram colhidos então IgM para dengue da mãe e do recém-nascido, realizados pelo método de ELISA, sendo positivos em ambos. Dengue tipo 2 foi detectado no recém-nascido através de reação em cadeia da polimerase. COMENTÁRIOS: Este relato enfatiza a importância do pediatra estar alerta para a possibilidade de transmissão vertical de dengue iniciando precocemente o tratamento.

OBJECTIVES: To report a case of vertical dengue infection in a newborn from Rio de Janeiro, Brazil, and to review the literature concerning this problem. DESCRIPTION: We report a case of vertical dengue infection. Female neonate, birth weight 3,940 g, term, was admitted to a neonatal intensive care unit on the fifth day of life with fever and erythematous rash. Her mother had had dengue fever 3 days before delivery. Her platelet count was 38,000, dropping to 15,000. She did not have any hemorrhagic episodes, including cerebral hemorrhages. Anti-dengue antibodies (IgM) were positive in the mother and infant. Dengue type 2 was detected in the infant using polymerase chain reaction. COMMENTS: This report emphasizes that pediatricians should be aware of the possibility of vertical dengue infection so that early management can be instituted.

OBJETIVO: Determinar a influência da sucção não-nutritiva e da estimulação oral nas taxas de amamentação na alta hospitalar, aos 3 meses e 6 meses de idade corrigida em recém-nascidos pré-termo de muito baixo peso ao nascer. MÉTODOS: Foram randomizados 98 recém-nascidos pré-termo de muito baixo peso ao nascer, e 96 permaneceram no estudo até o 6º mês de idade corrigida. Os recém-nascidos foram randomizados em grupo experimental e grupo controle. O grupo experimental recebeu um programa de estimulação (sucção não-nutritiva associado à estimulação sensório-motora-oral), e o grupo controle, um procedimento simulado a partir do momento em que atingiam alimentação plena até a alimentação oral completa. RESULTADOS: Observou-se que 59 (61,5%) recém-nascidos estavam em amamentação na alta, 31 (32,6%) aos 3 meses e apenas 18 (18,75%) aos 6 meses de idade corrigida. Na alta, 47% dos recém-nascidos do grupo controle e 76% do grupo estimulado estavam em amamentação. Aos 3 meses, 18% do grupo controle e 47% do grupo estimulado continuavam em amamentação, e aos 6 meses, 10% do grupo controle e 27% do grupo estimulado. Houve diferença estatística nos três períodos estudados, favorecendo o grupo estimulado (p < 0,05). CONCLUSÃO: O presente estudo demonstra que a sucção não-nutritiva, associada à estimulação oral, pode contribuir para a melhoria das taxas de amamentação em pré-termos de muito baixo peso ao nascer.

OBJECTIVE: To determine the influence of non-nutritive sucking and oral stimulation programs on breastfeeding rates at discharge, at 3 and at 6 months of corrected age in preterm infants with very low birth weight. METHODS: Preterm infants were randomized into experimental and control groups. Ninety-eight preterm infants were randomized and 96 remained in the study until reaching the corrected age of 6 months. The experimental group received sensory-motor-oral stimulation and non-nutritive sucking, while infants in the control group received a sham stimulation program. Both were administered from reaching enteral feeding (100 kcal/kg/day) until the beginning of oral feeding. RESULTS: Fifty-nine infants (61.5%) were breastfeeding at the time of hospital discharge, 31 (36.9%) at 3 months, and only 18 (20.5%) at 6 months of corrected age. At discharge, 46.9% of the control group and 76.5% of the experimental group were breastfeeding. There were statistically significant differences between rates of breastfeeding at discharge (47 vs. 76%), 3 months (18 vs. 47%) and 6 months after discharge (10 vs. 27%). The experimental group showed significantly higher rates of breastfeeding (p < 0.05). CONCLUSION: Non-nutritive sucking, associated with oral stimulation programs, can contribute to the improvement of breastfeeding rates among preterm infants with very low birth weight.

OBJETIVO: Verificar o gasto energético de repouso dos recém-nascidos de muito baixo peso ao nascer através da calorimetria indireta. MÉTODOS: Estudo transversal com 29 recém-nascidos de muito baixo peso ao nascer, clinicamente estáveis, recebendo dieta > 100 kcal/kg/dia. A desnutrição foi determinada como todo escore z do peso para idade ≤ -2 DP. A aferição do gasto energético de repouso foi realizada através da calorimetria indireta com o sistema aberto. RESULTADOS: No momento do exame, o peso médio foi de 1.564±393 g, idade corrigida de 35±3 semanas, e a desnutrição estava presente em 62,1%. O valor médio da taxa metabólica basal foi de 57,01±7,76 kcal/kg/dia, maior do que o usado como referência. CONCLUSÃO: O elevado gasto energético de repouso pode estar exercendo um forte impacto no desenvolvimento da desnutrição no período de hospitalização, pois o gasto energético de repouso é o principal componente calórico do gasto energético total.

OBJECTIVE: To determine the resting metabolic rate in very low birth weight infants through indirect calorimetry. METHODS:Cross-sectional study including 29 clinically stable very low birth weight infants receiving an enteral diet > 100 kcal/kg/day. Malnutrition was defined as weight-for-age z score ≤ - 2 SD. Resting energy expenditure was measured using open circuit indirect calorimetry. RESULTS: At the time of the examination, mean weight was 1,564±393 g and corrected gestational age was 35±3 weeks. Malnutrition was diagnosed in 62.1% of the preterm infants. The mean resting metabolic rate was 57.01±7.76 kcal/kg/day. CONCLUSION: Since resting energy expenditure is the main caloric component of total energy expenditure, the high resting metabolic rate observed may have a strong impact on the development of malnutrition during hospitalization.

OBJETIVO: Avaliar a eficácia terapêutica de um sistema de fototerapia microprocessada que utiliza diodos emissores de luz (Super LED) de alta intensidade no tratamento da hiperbilirrubinemia em recém-nascidos prematuros. MÉTODOS: Ensaio clínico, randomizado e controlado, utilizando a fototerapia Super LED no grupo experimental e duas fototerapias halógenas no grupo controle. A randomização foi realizada em blocos e estratificada por peso de nascimento. A duração da fototerapia e a queda nos níveis séricos de bilirrubina total nas primeiras 24 horas de tratamento foram os principais desfechos analisados. RESULTADOS: Foram estudados 88 recém-nascidos, 44 no grupo da fototerapia Super LED e 44 no grupo da fototerapia halógena. As características demográficas da população foram semelhantes nos dois grupos. O nível sérico médio inicial de bilirrubina no grupo do Super LED (10,1±2,4 mg%) foi semelhante ao do grupo que recebeu fototerapia halógena (10,9±2,0 mg%). A queda percentual na concentração sérica de bilirrubina total nas primeiras 24 horas de tratamento foi significativamente maior (27,9 versus 10,7%, p < 0,01), e a duração do tratamento foi significativamente menor (36,8 versus 63,8 h, p < 0,01) no grupo do Super LED do que no grupo que recebeu fototerapia halógena. Após 24 horas de tratamento, um número significativamente maior de recém-nascidos recebendo fototerapia Super LED atingiu níveis de bilirrubina que permitiram a suspensão da fototerapia (23 versus 10, p < 0,01). CONCLUSÕES: Os resultados demonstram que a eficácia da fototerapia Super LED é significativamente maior do que a da fototerapia halógena no tratamento da hiperbilirrubinemia de recém-nascidos prematuros.

OBJECTIVES: To evaluate the efficacy of a microprocessed phototherapy (PT) system with five high intensity light emitting diodes (Super LED) for the treatment of neonatal hyperbilirubinemia of premature infants. METHODS: Randomized clinical trial using Super LED phototherapy in the study group and twin halogen spotlight phototherapy in the control group. A stratified blocked randomization, based on birth weight, was performed. The duration of phototherapy and the rate of decrease of total serum bilirubin (TSB) concentration in the first 24 hours of treatment were the main outcome measures. RESULTS: We studied 88 infants, 44 in the Super LED group and 44 in the halogen spotlight PT group. The demographic characteristics of the patients in both groups were similar. Infants in the Super LED group had a similar mean initial serum bilirubin level (10.1±2.4 mg%) to those receiving halogen spotlight treatment (10.9±2.0 mg%). After 24 hours of treatment, the decrease in total serum bilirubin levels was significantly greater in the Super LED group (27.9 vs. 10.7%, p< 0.01) and duration of phototherapy was significantly shorter in this group (36.8 h vs. 63.8 h, p < 0.01). After 24 hours of treatment, a significantly greater number of patients receiving Super LED phototherapy had reached serum bilirubin concentrations low enough to allow withdrawal of treatment (23 vs. 10, p < 0.01). CONCLUSIONS: Our results demonstrate that the efficacy of Super LED phototherapy for treating hyperbilirubinemia in premature infants was significantly better than halogen phototherapy.

OBJETIVO: Desenvolver um modelo preditivo capaz de identificar, ao final da primeira semana de vida, os recém-nascidos prematuros com maior probabilidade de evoluir para displasia broncopulmonar (DBP). MÉTODOS: Os dados foram coletados retrospectivamente entre janeiro de 1998 e julho de 2001, e prospectivamente de agosto de 2001 a julho de 2003. Foram incluídas todas as crianças nascidas na Instituição, com idade gestacional < 34 semanas e peso de nascimento < 1.500 g. Os principais fatores de risco foram submetidos inicialmente a uma análise univariada, seguida de regressão logística. As variáveis significativas foram utilizadas na montagem da fórmula para cálculo da probabilidade de ocorrência de DBP. O modelo foi calibrado, e a discriminação avaliada pela curva ROC. De agosto de 2003 a julho de 2005, o modelo foi aplicado em outra população para validação. RESULTADOS: Foram incluídas 247 crianças, das quais 68 evoluíram para DBP, sendo divididas da seguinte maneira: leve = 35 (51,4%), moderada = 20 (29,4%) e grave = oito (11,7 %). Quatro variáveis mantiveram significância em relação à DBP: idade gestacional < 30 semanas, persistência do canal arterial, ventilação mecânica > 2 dias e perda de > 15% do peso de nascimento no sétimo dia de vida. Nos pacientes com todas as variáveis presentes, o modelo permitiu uma probabilidade de acerto de 93,7%. Valores semelhantes foram obtidos com as 61 crianças utilizadas na validação do modelo. CONCLUSÕES O modelo preditivo desenvolvido em nossa população foi capaz de identificar com elevado grau de sensibilidade, ao final da primeira semana de vida, os recém-nascidos sob maior risco de evoluir para DBP.

OBJECTIVE: To develop a predictive model capable of identifying which premature infants have the greatest probability of presenting bronchopulmonary dysplasia (BPD), based on assessment at the end of their first week of life. METHODS: Data were collected retrospectively from January 1998 to July 2001, and prospectively from August 2001 to July 2003. All children born at the institution with gestational age < 34 weeks and birth weight < 1,500 g were included. The principal risk factors for BPD were subjected to univariate analysis followed by logistic regression. Significant variables were used to construct a formula to calculate the probability of BPD. The model was calibrated and its discriminative power assessed using receiver operating characteristic (ROC) curves. Between August 2003 and July 2005 the model was then applied to a different population for validation. RESULTS: The sample comprised 247 children, of whom 68 developed BPD, classified as follows: mild = 35 (51.4%), moderate = 20 (29.4%) and severe = 8 (11.7 %). Four variables maintained significance with relation to BPD: gestational age < 30 weeks, persistent ductus arteriosus, mechanical ventilation > 2 days and loss of > 15% of birth weight on the seventh day of life. Where patients exhibited all of these variables, the model had a 93.7% probability of being correct. The model was further validated when using another sample of 61 newborns; similar figures were obtained. CONCLUSIONS: At the end of the first week of life, the predictive model developed from our population was capable of identifying newborn infants at increased risk of developing BPD with a high degree of sensitivity.

OBJETIVO: Avaliar a carga isquêmica do miocárdio prévia e ulterior à revascularização do miocárdio. MÉTODOS: Foram avaliados 96 pacientes randomizados, portadores de doença arterial coronariana multivascular, angina estável, função do ventrículo esquerdo preservada e isquemia miocárdica esforço-induzida tratados com revascularização cirúrgica (RCM) ou angioplastia coronariana (ATC). Cintilografia do miocárdio com 99mTc-Sestamibi foi realizada antes e 6 meses após a revascularização do miocárdio. RESULTADOS: A RCM determinou índice significantemente maior de revascularização completa (p=0,001), aumento no número de testes ergométricos máximos (p=0,001) e redução no número de testes ergométricos positivos com angina de esforço (p=0,018). Ambos os procedimentos ofereceram melhora importante na classe funcional da angina (p=0,001), aumento no valor médio do duplo produto de pico (p=0,009), e do tempo de tolerância ao esforço (p<0,001), além de redução no valor médio da somatória do escore do esforço (p<0,001) e da diferença da somatória dos escores (p<0,001) nos dois grupos. CONCLUSÃO: ATC e RCM não diferiram significantemente quanto à redução da carga isquêmica do miocárdio 6 meses após o procedimento. A revascularização do miocárdio foi mais completa com a RCM do que com a ATC, mas não representou fator significante para redução da carga isquêmica do miocárdio.

OBJECTIVE: To assess the myocardial ischemic load to previous and after myocardial revascularization. METHODS: Ninety-six randomized patients, carriers of multivessel coronary artery disease, stable angina, preserved left ventricular function, and exercise-induced myocardial ischemia treated with revascularization (SMR) or coronary angioplasty (TCA). Myocardial scintigraphy with 99mTc-Sestamibi was performed prior to and 6 months after myocardial revascularization. RESULTS: The SMR determined a significant greater index of complete revascularization (p=0.001), an increase in the number of maximum ergometric tests (p=0.001) and reduction in the number of positive ergometric tests with exercise angina (p=0.018). Both procedures provided an important improvement in the functional class of angina (p=0.001), an increase in the average value of double peak product (p=0.009), and the time of exercise tolerance (p<0.001), besides the reduction in the average value of the summed of exercise score (p<0.001) and the difference of the summed of scores (p<0.001) in both groups. CONCLUSION: TCA and SMR did not differ significantly concerning the reduction of myocardial ischemic load 6 months after the procedure. The myocardial revascularization was more complete with the SMR than the TCA, but it did not represent a significant factor for the reduction myocardial ischemic load.

OBJETIVO: Rever as mais recentes publicações sobre infecção fúngica no recém-nascido de muito baixo peso ao nascer, com objetivo de fornecer aos profissionais de saúde atualização sobre um crescente problema nas unidades neonatais. A revisão se dirige especificamente às questões relacionadas a incidência, manuseio clínico, tratamento e profilaxia. FONTES DE DADOS: Artigos originais e de revisão, publicados nos últimos 15 anos no MEDLINE e Lilacs, foram identificados usando como palavras-chave: recém-nascido, prematuro, baixo peso ao nascer, infecção fúngica, sepse, cândida, anfotericina e fluconazol. SÍNTESE DOS DADOS: A incidência de sepse fúngica vem aumentando nas unidades de terapia intensiva neonatal. Embora novas drogas venham se tornando disponíveis (echinocandinas), a anfotericina B continua sendo a droga de escolha para o tratamento inicial. Atualmente, existem quatro classes de drogas disponíveis para o tratamento: os polienos macrolídeos (anfotericina B e formulações lipídicas), os azoles (fluconazol e voriconazol), as pirimidinas fluorinadas (flucitosina) e as echinocandinas (micafungin e caspofungin). Duas drogas vêm sendo descritas na prevenção da doença invasiva: nistatina e fluconazol. Fluconazol é a droga sobre a qual mais se conhece da farmacocinética no período neonatal, e a sua administração profilática em recém-nascidos com menos de 1.000 g por 6 semanas está associada a menor incidência de infecção fúngica. CONCLUSÕES: Um melhor entendimento sobre a incidência da sepse fúngica, diagnóstico, manuseio clínico, tratamento e profilaxia é uma importante arma na morbidade e mortalidade. A identificação de recém-nascidos prematuros de alto risco para o desenvolvimento da doença e a instituição de medidas profiláticas e tratamento precoce podem diminuir a morbimortalidade.

OBJECTIVE: This review encompasses the most recent publications about fungal infection in very low birth weight infants, keeping health professionals updated about this growing problem observed in neonatal units. SOURCES OF DATA: Original and review articles published over the past 15 years were searched in MEDLINE and Lilacs, using the following keywords: preterm infant, very low birth weight infants, sepsis, fungal infection, antifungal, Candida, amphotericin and fluconazole. SUMMARY OF THE FINDINGS: Invasive fungal infections affect especially preterm infants. Although new drugs (echinocandins) to treat fungal infection are available, amphotericin is the most widely used drug for the treatment of systemic candidiasis at this stage of life. Currently, there are four types of antifungal agents used in the treatment of fungal infections in neonates: polyene macrolides (amphotericin B deoxycholate and lipid preparations), azoles (triazoles), fluorinated pyrimidines (flucytosine) and echinocandins (caspofungin and micafungin). Two drugs capable of preventing invasive fungal infection are described: nystatin and fluconazole. The pharmacokinetics of fluconazole in the neonatal period is widely known and its prophylactic administration during the first six weeks of life has been associated with less invasive fungal infection in infants weighing less than 1,000 g at birth. CONCLUSIONS: Fungal infections constitute an important problem in the neonatal intensive care unit and a better understanding of the incidence, diagnosis, clinical management, treatment, and prophylaxis is important in order to reduce morbidity and mortality. The identification of high-risk preterm infants and the implementation of prophylactic measures and early treatment may improve the outcome of these patients.