Dissertação (mestrado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Ciências da Saúde, 2013. / Submitted by Albânia Cézar de Melo (albania@bce.unb.br) on 2013-05-09T14:34:08Z No. of bitstreams: 1 2013_MarcoAntonioRiosLima.pdf: 11611019 bytes, checksum: 5bbf7c1071b7fc759f065cd35aaade54 (MD5) / Approved for entry into archive by Guimaraes Jacqueline(jacqueline.guimaraes@bce.unb.br) on 2013-05-21T13:26:27Z (GMT) No. of bitstreams: 1 2013_MarcoAntonioRiosLima.pdf: 11611019 bytes, checksum: 5bbf7c1071b7fc759f065cd35aaade54 (MD5) / Made available in DSpace on 2013-05-21T13:26:27Z (GMT). No. of bitstreams: 1 2013_MarcoAntonioRiosLima.pdf: 11611019 bytes, checksum: 5bbf7c1071b7fc759f065cd35aaade54 (MD5) / Introdução: O barotrauma da orelha média (BTOM) é o efeito colateral mais comum da oxigenoterapia hiperbárica (OHB). Objetivo: Analisar os fatores de risco do BTOM em pacientes submetidos à OHB. Materiais e Métodos: Estudo analítico prospectivo realizado em pacientes admitidos no Setor de Medicina Hiperbárica no período de maio de 2011 à julho de 2012. As avaliações ocorreram: antes da 1ª sessão, após a 1ª e 15ª sessões e após sessões com sintomas. Durante as avaliações foram realizados: otoscopia com Manobras de Valsalva e Toynbee, otoscopia pneumática, questionário específico, audiometria tonal, imitanciometria e testes de função tubária. Realizou-se ainda endoscopia nasal e tomografia computadorizada de ossos temporais em única ocasião. O BTOM foi graduado pela escala modificada de Edmonds. Resultados: Das 82 orelhas incluídas no estudo, 32 (39%) apresentaram barotrauma (BT) após a 1ª sessão. Das 45 orelhas com capacidade de auto-insuflação, 26,7% apresentaram BT; ao contrário das 37 orelhas sem essa capacidade, 54% BT. Achados de endoscopia nasal, imitanciometria e tomografia de mastoides não evidenciaram diferença significativa entre os grupos com e sem BT. Conclusão: Manobras de Valsalva e Toynbee positivas antes da 1ª sessão, isoladamente ou associadas foram fatores protetores para BTOM por orelha após a 1ª sessão. O teste de Toynbee positivo antes da 1ª sessão isolado ou associado ao teste de Valsalva positivo foi fator protetor para BTOM por orelha após a 1ª sessão. Não houve associação entre as manobras e testes de Valsalva e Toynbee com o BTOM por paciente. Não houve associação significativa entre antecedentes clínicos, otoscopia pneumática, desvio septal obstrutivo, hipertrofia de cornetos, tipo de curva de Jerger, área e volume da mastoide com o BTOM. ______________________________________________________________________________ ABSTRACT / Introduction: The middle ear barotrauma (MEB) is the most common side effect of hyperbaric oxygen therapy (HBOT). Aim: To analyze the risk factors of MEB in patients undergoing HBOT. Materials and Methods: A prospective analytical study performed in patients admitted to the Department of Hyperbaric Medicine from May 2011 to July 2012. Assessments occurred: before the 1st session, after the 1st and 15th sessions and after sessions with symptoms. During the evaluations were performed: otoscopy with Valsalva and Toynbee maneuvers, specific questionnaire, tonal audiometry, tympanometry and tubal function tests. Held even nasal endoscopy and computed tomography of the temporal bones on one occasion. The MEB was a graduate of the modified Edmond’s scale. Results: Of the 82 ears included in the study, 32 (39%) had barotrauma after the 1st session. Of the 45 ears with capacity for self-inflation, 26.7% had barotrauma, unlike the 37 ears without this ability, 54% barotrauma. Findings of nasal endoscopy and impedance showed no significant difference between the groups with and without barotrauma. Conclusion: Positive Valsalva and Toynbee maneuvers before the 1st session, alone or associated were protective factors for BTOM by ear after the 1st session. The positive Toynbee test before the 1st session alone or associated with the positive Valsalva test was protective factor for BTOM by ear after the 1st session. There was no association between maneuvers and tests of Valsalva and Toynbee with BTOM per patient. There was no significant association between clinical history, pneumatic otoscopy, obstructive septal deviation, turbinate hypertrophy, Jerger curve type, area and volume of the mastoid with BTOM.

Bakgrund: Studier visar att hörselskador kan uppstå till följd av yttre påfrestningar så som exponering av buller och kraftiga tryckförändringar. Fallskärmshoppare exponeras för bägge dessa faktorer, vilket skulle kunna innebära en ökad risk för att utveckla hörselskador. Trots detta är området mycket sparsamt studerat. En ökad kunskap inom området medför att eventuella behov av preventiva åtgärder kan identifieras. Syfte: Syftet med studien var att undersöka förekomsten av upplevda hörselbesvär hos fallskärmshoppare, samt om det finns något samband mellan upplevda hörselbesvär och antal hopp, användning av öronproppar eller akustiska höjdvarnare. Metod: Studien genomfördes i form av en kvantitativ tvärsnittsstudie. En webbenkät skickades ut till samtliga aktiva fallskärmshoppare med registrerad e-postadress i två fallskärmsklubbar i Mellansverige. Totalt 244 fallskärmshoppare deltog i studien (svarsfrekvens 47,6 %). Resultat: Hörselrelaterade besvär i form av hörselnedsättning, tinnitus och smärta/obehag i öronen förekom hos 20-30 % av de studerade fallskärmshopparna. Det fanns däremot inga statistiskt signifikanta samband mellan upplevda hörselbesvär och antal fallskärmshopp, användning av öronproppar eller användning av akustiska höjdvarnare. Andelen som uppgav att de upplevde svårigheter att höra vad som sägs i ett samtal mellan flera personer var högre bland de studerade fallskärmshopparna jämfört med en åldersmatchad population i SCB:s befolkningsundersökning. Slutsats: Inga samband mellan antal fallskärmshopp och hörselrelaterade besvär kan ses, men resultatet tyder på att fallskärmshoppare upplever hörselnedsättning i större utsträckning jämfört med övriga befolkningen. Vidare studier krävs för att med säkerhet kunna avgöra om fallskärmshoppning innebär en risk för att utveckla hörselskador. / Background: Studies have shown that hearing loss can be caused by environmental factors like noise and changes in the pressure. Skydivers are exposed to several risk factors for hearing impairment, but there is a lack of studies investigating hearing loss among skydivers. More knowledge among the phenomena is needed to identify potential need of preventive work.  Aims: The aim of the study was to investigate the prevalence of self-perceived hearing symptoms among skydivers. The study also examined the relationship between self-perceived hearing symptoms and the use of earplugs and audible altimeters. Methods: The study was executed as a quantitative cross-sectional study. Webb-based questionnaires were sent out to all skydivers with registered e-mail in two skydiving clubs in Sweden. A total of 244 skydivers were studied (response rate 47.6 %) Results: Hearing symptoms such as hearing loss, tinnitus and ear pain was found in 20-30 % of the skydivers. The proportion who experienced difficulty in hearing was higher among the skydivers than an age-matched population from a SCB survey. However, no statistically significant correlations between self-perceived hearing symptoms and number of parachute jumps, use of earplugs or use of audible altimeters were found. Conclusion: No relationship between amount of skydiving and hearing symptoms could be found, but the results indicate that hearing loss is more common among skydivers compared to the general population. Further studies are required to investigate if skydivers are in risk of developing hearing loss.

Orientador: Sergio Tadeu Martins Marba / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-14T00:59:17Z (GMT). No. of bitstreams: 1 Bassani_MarianaAlmada_M.pdf: 763837 bytes, checksum: c0d2ff89684b98347f303d71e7f06dbe (MD5) Previous issue date: 2009 / Resumo: O objetivo deste estudo foi analisar variáveis ventilatórias - frequência ventilatória (FV), pressão de pico inspiratória (PIP), volume corrente (Vt), tempo inspiratório (Ti) e fluxo inspiratório (Vinsp) - durante o manejo do ventilador pulmonar manual autoinflável neonatal. Foi realizado um estudo experimental em que diferentes profissionais de saúde que trabalham na Unidade de Terapia Intensiva Neonatal do CAISM/UNICAMP ventilaram manualmente um pulmão artificial (Biotek, VT-2) ajustado com complacência (0,003 l/ cmH2O) e resistência (200 cmH2O/l/min) de um recém-nascido a termo intubado. Foi utilizado um reanimador autoinflável modelo neonatal (JG Moriya), sem fonte de gás comprimido e sem reservatório. As variáveis ventilatórias estudadas foram analisadas em relação a cinco diferentes manuseios (10, 5, 4, 3 e 2 dedos), tamanho de mão (pequena, média, grande) e profissão do operador (médicos assistentes ou docentes, médicos residentes, fisioterapeutas, enfermeiros, técnicos de enfermagem). As variáveis ventilatórias também foram analisadas levando-se em consideração categorias de referência estabelecidas. Para análise estatística foram utilizadas tabelas de freqüência, medidas de tendência central e de dispersão para a descrição da amostra. Para avaliar as variáveis ventilatórias segundo o manuseio, tamanho de mão e profissão aplicou-se análise de variância para medidas repetidas, seguida dos testes perfil por contraste ou Tukey. Os testes de Friedman, Fisher e Quiquadrado foram aplicados para avaliar as variáveis ventilatórias categorizadas segundo o manuseio, tamanho de mão e profissão do operador. Foram incluídos 172 diferentes profissionais: 15 médicos assistentes/docentes, 28 médicos residentes, 43 fisioterapeutas, 30 enfermeiros e 56 técnicos de enfermagem. O modo de manuseio influenciou de maneira estatisticamente significativa Vinsp, PIP e Vt, cujos valores foram tanto maiores quanto maior o número de dedos utilizados para ventilar. Observou-se, também, para estas 3 variáveis, uma alta variabilidade dos valores obtidos. O tamanho de mão não afetou nenhuma das variáveis ventilatórias estudadas. Os valores de Vt, Ti e FV foram influenciados significativamente pela profissão. Em geral, observou-se que os fisioterapeutas geraram maiores valores de Vt e Ti e menores valores de FV do que os demais profissionais. Na comparação dos valores das variáveis ventilatórias obtidos em relação aos valores de referência, observamos pouca adequação dos valores das variáveis obtidas pelos profissionais, exceto para Vinsp, para o qual 84,9% dos voluntários forneceram valores adequados. Para PIP, Vt e Ti, a grande maioria dos voluntários gerou valores acima dos considerados adequados para reanimação neonatal. Em contrapartida, 49,4% dos voluntários geraram valores baixos de FV. O manuseio e o tamanho de mão não influenciaram a ampla inadequação dos valores fornecidos. No entanto, observamos influências significativas da profissão sobre Ti e FV em suas diferentes categorias. Concluímos que apenas Vinsp, PIP e Vt foram influenciados pelo manuseio de modo significativo. O tamanho de mão não influenciou nenhuma das variáveis estudadas. O Vt, Ti e FV foram afetados pela profissão. Houve pouca adequação dos valores gerados pelos profissionais para PIP, Vt, Ti e FV. O manuseio e tamanho de mão não afetaram a ampla inadequação da técnica, no entanto, a profissão influenciou o Ti e FV quando categorizados / Abstract: The main goal of this study was to evaluate how ventilator variables - inspiratory flow rate (IFR), peak inspiratory pressure (PIP), tidal volume (Vt), inspiratory time (Ti), and and ventilatory rate (VR) - may be affected by different ways of handling a neonatal selfinflating bag. This is an experimental study in which different health professionals who work at the Neonatal Intensive Care Unit of CAISM/UNICAMP ventilated an artificial lung (Biotek, VT-2) adjusted with airway resistance (200 cmH2O/l/min) and compliance (0,003 l/ cmH2O) compatible with physiologic values of an intubated term newborn (approximately 3 kg). It was used a neonatal self-inflating resuscitator (JG Moriya), with no reservoir bag or source of compressed gas. The ventilatory variables were assessed considering five different ways of handling (with 10, 5, 4, 3 and 2 fingers), operator's hand size (small, medium and large) and profession (faculty/assistant physicians, resident physicians, physiotherapists, nurses and nursing technicians). These variables were also assessed considering established reference categories. For the statistical analysis, frequency tables and measures of central tendency and dispersion were used to describe the studied sample. Analysis of variance for repeated measures, followed by contrast profile or Tukey's tests, was used to evaluate how different ways of handling, hand size and profession affect the ventilatory variables. Friedman's, Fisher's and Chi-square tests were used to analyze the categorized variables considering the different ways of handling and operator's hand size and profession. This study was conducted with 172 professionals: 15 faculty/assistant physicians, 28 physician residents, 43 physiotherapists, 30 nurses and 56 nursing technicians. Bag handling influenced significantly IRF, PIP and Vt values, which were the higher the greater the number of fingers used, and presented high variability. Hand size did not affect significantly any of the studied variables, whereas, profession influenced Vt, Ti and VR. In the general, physiotherapists delivered higher values of Vt and Ti, and lower values of VR than the other professional groups. When comparing variable values considering the reference values, it was observed poor adequacy of these values, except for VR, which was adequate in 84.9% of the cases. For PIP, Vt and Ti, the majority of volunteers delivered values considered excessive for neonatal resuscitation. On the other hand, 49.4% of the volunteers delivered low values for VR. Handling and hand size did not influence the overall poor adequacy of the delivered values, whereas profession significantly influenced Ti and VR values in their categories. We conclude that only IFR, PIP and Vt were significantly influenced by bag handling. Hand size did not affect any of the studied variables. Vt, Ti e FV were influenced by the operator's profession. There was poor adequacy for all values of PIP, Vt, Ti and VR. Bag handling and operator's hand size did not affect the overall poor adequacy, although profession influenced categorized Ti and FV / Mestrado / Saude da Criança e do Adolescente / Mestre em Saude da Criança e do Adolescente

Os recém-nascidos pré-termo extremos, por estarem ainda em uma fase do desenvolvimento pulmonar anterior à alveolização, estão mais vulneráveis a fatores como a hiperoxia, o barotrauma, o volutrauma e, o uso de medicações como os corticosteróides. A ação destes fatores, associada à imaturidade pulmonar, pode alterar a organização estrutural pulmonar, interferindo na alveolização e na organização de fibras elásticas e de colágeno. Estas alterações são comuns à \"nova\" displasia broncopulmonar, patologia freqüente entre os recém-nascidos pré-termo, especialmente os extremos. Criou-se um modelo experimental de restrição nutricional e hiperoxia, em coelhos pré-termo, com o objetivo de analisar os efeitos da restrição nutricional e da hiperoxia sobre a arquitetura pulmonar (número de alvéolos, intercepto linear médio(ILm), área de superfície interna(ASI), espessura de septo interalveolar), especialmente em relação à deposição de fibras elásticas e de colágeno. Após a realização de cesárea, em coelhas New Zealand White, com idade gestacional de 28 dias, seus filhotes foram divididos em 4 grupos, de acordo com a dieta e a concentração de oxigênio administradas: GIA (dieta padrão e FiO2=0,21) (n=120); GIB (dieta padrão e FiO2>0,95) (n=232); GIIA (restrição nutricional e FiO2=0,21) (n=72); GIIB (restrição nutricional e FiO2>0,95) (n=368). A restrição nutricional foi definida como uma redução em 30% de todos os nutrientes, em relação à dieta padrão. Os coelhos foram pesados, diariamente. Após o sacrifício, aos 7 e 11 dias de vida, os pulmões foram removidos, pesados e fixados em formol tamponado 10%, com uma pressão de 30 cm de H2O. O volume pulmonar total foi medido pelo método de deslocamento de água. Nos cortes histológicos utilizou-se as seguintes colorações: hematoxilina-eosina, para contagem do número de alvéolos, ILm, ASI, medida de septo interalveolar; orceína-resorcina modificada para análise de fibras elásticas e picrosirius, para análise de colágeno. Os resultados foram apresentados através de médias e realizou-se ANOVA para comparação dos resultados, considerando-se um p < 0,05 como significante. A restrição nutricional alterou o crescimento somático, reduzindo o ganho de peso e, alterou o crescimento e a morfologia pulmonares, reduzindo o volume pulmonar, o número de alvéolos e a deposição de fibras elásticas e de colágeno aos 7 e 11 dias de vida. A hiperoxia elevou a mortalidade e modificou a arquitetura pulmonar, reduzindo o número de alvéolos e aumentando suas dimensões, bem como aumento da espessura dos septos interalveolares, aos 7 e 11 dias de vida. Aos 11 dias, a hiperoxia reduziu a deposição de colágeno. A restrição nutricional associada à hiperoxia teve os seus efeitos intensificados sobre a redução do número de alvéolos e do depósito de colágeno, aos 7 e 11 dias. Estes resultados ilustram o papel da nutrição como modulador da lesão pulmonar pela hiperoxia, em pulmões em desenvolvimento / Characteristic pathologic findings in bronchopulmonary dysplasia are the presence of alveolization impairment, widened alveolar septa, disordered collagen and elastic fibers deposition. There are likely to be multiple factors that result in the histological changes seen with the development of bronchopulmonary dysplasia, besides the lung imaturity: hyperoxia, volutrauma, barotrauma, nutrition. The aim of this study is to developed an experimental model, in preterm rabbits, to evaluate the effects of nutritional restriction and hyperoxia on lung weight and volume, alveoli number, mean linear intercept (Lm), internal surface area (ISA), alveolar septal thickness, elastic fibers and collagen density. After c-section, 28 days preterm New Zealand White rabbits were randomized into 4 groups: GIA (regular diet and FiO2=0,21) (n=120); GIB (regular diet and FiO2>0,95) (n=232); GIIA (nutritional restriction and FiO2=0,21) (n=72); GIIB (nutritional restriction and FiO2>0,95) (n=368). They were kept in incubators, warmer and humidified oxygen (Plexiglas chamber). Nutritional restriction was defined as caloric-proteic intake limited to 70% of the regular diet. After sacrifice with 7 and 11 days, the lungs were removed and fixed in 10% formalin under 30 cm H2O transtracheal pressure. The total lung volume was measured by displacement water. Lung slices were stained with hematoxylin and eosin for alveoli number, Lm, ISA and alveolar septal thickness; resorcin-orcein for elastic fibers and Picrosirius for collagen (fibers/parenchyma pointy counting). Statistical analysis was done by ANOVA. Level of significance was set at 0,05. Values are means +- sd. It was observed that GIA and GIB (regular diet) put on more weight than nutritional restriction groups from 8th till 11th day of life. Nutritional restriction influenced the ponderal evolution and reduced lung volume, alveoli number, collagen and elastic fibers deposition at 7th and 11th days of life. Hyperoxia elevated the mortality. In relation to lung architetural, the hyperoxia reduced alveoli number and elevated Lm, besides widened alveolar septal at 7th and 11th days of life. At 11th days, hyperoxia reduced collagen deposition, too. Nutritional restriction and hyperoxia had an additive efect on the reduction of alveoli number and collagen deposition. These findings suggest that nutrition has a modulator effect on lung injury by hyperoxia. This study strengthened the contribution of nutrition on preterm lung development

Os recém-nascidos pré-termo extremos, por estarem ainda em uma fase do desenvolvimento pulmonar anterior à alveolização, estão mais vulneráveis a fatores como a hiperoxia, o barotrauma, o volutrauma e, o uso de medicações como os corticosteróides. A ação destes fatores, associada à imaturidade pulmonar, pode alterar a organização estrutural pulmonar, interferindo na alveolização e na organização de fibras elásticas e de colágeno. Estas alterações são comuns à \"nova\" displasia broncopulmonar, patologia freqüente entre os recém-nascidos pré-termo, especialmente os extremos. Criou-se um modelo experimental de restrição nutricional e hiperoxia, em coelhos pré-termo, com o objetivo de analisar os efeitos da restrição nutricional e da hiperoxia sobre a arquitetura pulmonar (número de alvéolos, intercepto linear médio(ILm), área de superfície interna(ASI), espessura de septo interalveolar), especialmente em relação à deposição de fibras elásticas e de colágeno. Após a realização de cesárea, em coelhas New Zealand White, com idade gestacional de 28 dias, seus filhotes foram divididos em 4 grupos, de acordo com a dieta e a concentração de oxigênio administradas: GIA (dieta padrão e FiO2=0,21) (n=120); GIB (dieta padrão e FiO2>0,95) (n=232); GIIA (restrição nutricional e FiO2=0,21) (n=72); GIIB (restrição nutricional e FiO2>0,95) (n=368). A restrição nutricional foi definida como uma redução em 30% de todos os nutrientes, em relação à dieta padrão. Os coelhos foram pesados, diariamente. Após o sacrifício, aos 7 e 11 dias de vida, os pulmões foram removidos, pesados e fixados em formol tamponado 10%, com uma pressão de 30 cm de H2O. O volume pulmonar total foi medido pelo método de deslocamento de água. Nos cortes histológicos utilizou-se as seguintes colorações: hematoxilina-eosina, para contagem do número de alvéolos, ILm, ASI, medida de septo interalveolar; orceína-resorcina modificada para análise de fibras elásticas e picrosirius, para análise de colágeno. Os resultados foram apresentados através de médias e realizou-se ANOVA para comparação dos resultados, considerando-se um p < 0,05 como significante. A restrição nutricional alterou o crescimento somático, reduzindo o ganho de peso e, alterou o crescimento e a morfologia pulmonares, reduzindo o volume pulmonar, o número de alvéolos e a deposição de fibras elásticas e de colágeno aos 7 e 11 dias de vida. A hiperoxia elevou a mortalidade e modificou a arquitetura pulmonar, reduzindo o número de alvéolos e aumentando suas dimensões, bem como aumento da espessura dos septos interalveolares, aos 7 e 11 dias de vida. Aos 11 dias, a hiperoxia reduziu a deposição de colágeno. A restrição nutricional associada à hiperoxia teve os seus efeitos intensificados sobre a redução do número de alvéolos e do depósito de colágeno, aos 7 e 11 dias. Estes resultados ilustram o papel da nutrição como modulador da lesão pulmonar pela hiperoxia, em pulmões em desenvolvimento / Characteristic pathologic findings in bronchopulmonary dysplasia are the presence of alveolization impairment, widened alveolar septa, disordered collagen and elastic fibers deposition. There are likely to be multiple factors that result in the histological changes seen with the development of bronchopulmonary dysplasia, besides the lung imaturity: hyperoxia, volutrauma, barotrauma, nutrition. The aim of this study is to developed an experimental model, in preterm rabbits, to evaluate the effects of nutritional restriction and hyperoxia on lung weight and volume, alveoli number, mean linear intercept (Lm), internal surface area (ISA), alveolar septal thickness, elastic fibers and collagen density. After c-section, 28 days preterm New Zealand White rabbits were randomized into 4 groups: GIA (regular diet and FiO2=0,21) (n=120); GIB (regular diet and FiO2>0,95) (n=232); GIIA (nutritional restriction and FiO2=0,21) (n=72); GIIB (nutritional restriction and FiO2>0,95) (n=368). They were kept in incubators, warmer and humidified oxygen (Plexiglas chamber). Nutritional restriction was defined as caloric-proteic intake limited to 70% of the regular diet. After sacrifice with 7 and 11 days, the lungs were removed and fixed in 10% formalin under 30 cm H2O transtracheal pressure. The total lung volume was measured by displacement water. Lung slices were stained with hematoxylin and eosin for alveoli number, Lm, ISA and alveolar septal thickness; resorcin-orcein for elastic fibers and Picrosirius for collagen (fibers/parenchyma pointy counting). Statistical analysis was done by ANOVA. Level of significance was set at 0,05. Values are means +- sd. It was observed that GIA and GIB (regular diet) put on more weight than nutritional restriction groups from 8th till 11th day of life. Nutritional restriction influenced the ponderal evolution and reduced lung volume, alveoli number, collagen and elastic fibers deposition at 7th and 11th days of life. Hyperoxia elevated the mortality. In relation to lung architetural, the hyperoxia reduced alveoli number and elevated Lm, besides widened alveolar septal at 7th and 11th days of life. At 11th days, hyperoxia reduced collagen deposition, too. Nutritional restriction and hyperoxia had an additive efect on the reduction of alveoli number and collagen deposition. These findings suggest that nutrition has a modulator effect on lung injury by hyperoxia. This study strengthened the contribution of nutrition on preterm lung development

Uma manobra de recrutamento com pressurização progressiva, visando a minimizar o colapso pulmonar, foi desenvolvida em um estudo tomográfico em pacientes com síndrome do desconforto respiratório agudo / lesão pulmonar aguda O recrutamento pulmonar total, avaliado pelas imagens tomográficas relacionou-se à soma PaO2 + PaCO2 >= 400 mmHg, de acordo com a gasometria intra - arterial. Para avaliar a segurança e eficácia da manobra de recrutamento com pressurização progressiva quanto aos seus efeitos sobre a troca gasosa e sobre parâmetros hemodinâmicos de importância clínica, 12 pacientes, extensamente monitorizados, foram submetidos à manobra até o recrutamento total, ocorrência de efeitos adversos ou pressão de platô = 60cmH2O. Todos os pacientes atingiram PaO2 + PaCO2 >= 400 mmHg com a manobra de recrutamento, que foi bem tolerada, não causou barotrauma e sustentou alta PaO2/ FIO2 em 6 h / A stepwise recruiting maneuver targeting minimal lung collapse was developed in a tomographic study in patients with acute respiratory distress syndrome/ acute lung injury (ARDS / ALI). PaO2 + PaCO2 >= 400 mmHg assessed by intrarterial blood gases was consistent with full recruitment on tomographic sections. To assess the safety and efficacy of a stepwise recruitment maneuver in terms of its effect on gas exchange and hemodynamic variables of clinical relevance, twelve ARDS/ALI patients, extensively monitored, were submitted to the maneuver until full recruitment, adverse effects or plateau pressure = 60cmH2O. All patients achieved PaO2 + PaCO2 >= 400 mmHg with the recruitment protocol, which was well tolerated, did not cause barotrauma and resulted in the maintenance of high PaO2/ FIO2 within 6 h

Uma manobra de recrutamento com pressurização progressiva, visando a minimizar o colapso pulmonar, foi desenvolvida em um estudo tomográfico em pacientes com síndrome do desconforto respiratório agudo / lesão pulmonar aguda O recrutamento pulmonar total, avaliado pelas imagens tomográficas relacionou-se à soma PaO2 + PaCO2 >= 400 mmHg, de acordo com a gasometria intra - arterial. Para avaliar a segurança e eficácia da manobra de recrutamento com pressurização progressiva quanto aos seus efeitos sobre a troca gasosa e sobre parâmetros hemodinâmicos de importância clínica, 12 pacientes, extensamente monitorizados, foram submetidos à manobra até o recrutamento total, ocorrência de efeitos adversos ou pressão de platô = 60cmH2O. Todos os pacientes atingiram PaO2 + PaCO2 >= 400 mmHg com a manobra de recrutamento, que foi bem tolerada, não causou barotrauma e sustentou alta PaO2/ FIO2 em 6 h / A stepwise recruiting maneuver targeting minimal lung collapse was developed in a tomographic study in patients with acute respiratory distress syndrome/ acute lung injury (ARDS / ALI). PaO2 + PaCO2 >= 400 mmHg assessed by intrarterial blood gases was consistent with full recruitment on tomographic sections. To assess the safety and efficacy of a stepwise recruitment maneuver in terms of its effect on gas exchange and hemodynamic variables of clinical relevance, twelve ARDS/ALI patients, extensively monitored, were submitted to the maneuver until full recruitment, adverse effects or plateau pressure = 60cmH2O. All patients achieved PaO2 + PaCO2 >= 400 mmHg with the recruitment protocol, which was well tolerated, did not cause barotrauma and resulted in the maintenance of high PaO2/ FIO2 within 6 h

Groupers (Epinephelidae: Epinephelinae) are apex predators within many reef communities worldwide. Grouper landings contribute significantly to global fisheries, and many populations are suffering from unsustainable levels of exploitation. The large size, site specificity and catchability of most groupers increase susceptibility to fishing pressure, and a large number of grouper species throughout the world are currently overfished. Multiple species are listed as endangered or threatened, and many have suffered local extirpations across their range. Removal of these upper level predators can significantly alter community structure and result in second order effects that may have critical ecological implications. The economic and ecological value of groupers is significant, and data regarding the abundance, habitat and behavior of these exploited species are necessary in order to implement realistic and effective management strategies. Atlantic Goliath Grouper (Epinephelus itajara) historically occurred in tropical and subtropical waters from the west coast of Africa to the east coast of Florida, south to Brazil, and throughout the Caribbean Sea and Gulf of Mexico. As one of the world's largest groupers, individuals are known to reach at least 37 years of age, and may grow to sizes exceeding 2.5 meters and 400 kilograms. The life history and behavioral characteristics of this species amplify vulnerability to exploitation, and Atlantic Goliath Grouper harvest was banned in U.S. waters in 1990 after a noted sharp decline in population numbers. The species has responded encouragingly to protective measures; however, the population's recovery and present status with U.S. waters should be thoroughly evaluated before altering regulatory guidelines. Traditional fishery-dependent data are not available (i.e., landings data); thus estimates of population demographics and recovery are dependent upon directed, fishery independent research efforts. It was the goal of this project to provide information regarding demographics, movement patterns, effects of catch and release angling, and feeding behavior of Atlantic Goliath Grouper within the central eastern Gulf of Mexico. The majority of research involving Atlantic Goliath Grouper began after the stock was already overfished, resulting in the absence of an existing "baseline" with which to compare current population parameters. Replication of visual surveys over a range of depths and habitat types provided an index of abundance for specific sites, and allowed for quantification of the size distribution of individuals. Atlantic Goliath Grouper were most abundant at high relief, high volume artificial reefs within the study area, and the majority of individuals observed were 80 - 160 cm in total length. Knowledge of fish movement, behavior and habitat associations has been used to exploit many species of fish; thus, this knowledge is critical for the creation of regulatory guidelines regarding conservation. Protection from harvest does not immediately imply that fishing mortality is negligible. As opportunistic ambush predators, Atlantic Goliath Grouper are relatively easy to catch on hook and line, and the species is often targeted for sport or caught incidentally during angling efforts for other reef fish species. Acoustic tracking allowed for continuous monitoring of individuals for several years after catch and release events. Barotrauma severity increased with capture depth, but immediate mortality was not observed during this study. Additionally, the length of total monitoring period was not affected by the severity of barotrauma, which suggests that with proper handling, Atlantic Goliath Grouper are not subject to high levels of release mortality in the study area (at depths < 40 m). However, strong site fidelity of Atlantic Goliath Grouper to artificial reefs increases susceptibility to fishing pressure and amplifies interactions with anglers, so the chronic effects of repeated capture remain unclear. Description and quantification of goliath grouper feeding behavior may allow for innovative suggestions to decrease the probability of catch and release mortality, and potentially offer new tactics to reduce opportunistic predation upon hooked fish. Kinematic analysis of Atlantic Goliath Grouper feeding sequences demonstrated that they are capable of modulating feeding behavior based upon prey activity level and position within the water column. Individuals exhibited larger maximum gapes and more rapid feeding sequences when presented with mobile live food. Immobile (dead) food was primarily consumed through suction, and strikes upon these items were characterized by slower, closer approaches, smaller maximum gapes and longer bite durations. It is hopeful that the information presented herein will provide insight regarding the ecology of Atlantic Goliath Grouper and can be applied to future management efforts involving this protected species.

Scuba diving as a recreational activity has increased in popularity over the past few years. It is believed that repeated exposure to the hyperbaric environment may have a long term effect on the auditory system. The research literature has given a lot of attention to acute injury but is very limited relating to the long term implications of scuba diving. Previous research studies did not perform a full audiometric test battery. A comprehensive audiological assessment is critical to determine in which part of the ear a pathology may occur during recreational diving. This study endeavoured to assess and describe the hearing abilities and middle ear functioning of the recreational scuba diver and investigate the possibility that diving, on a recreational level, may have an influence on the auditory system. In order to achieve the aims of this study, a descriptive, correlation research design was selected. The results of the current study indicate that scuba diving on a recreational level does not have a significant effect on the hearing and middle ear functioning of the individual, with the exclusion of static compliance. It appears that the inevitable compression and decompression that the middle ears are exposed to during scuba diving might have a more permanent effect on the elasticity of the tympanic membrane. Finally this study aims to increase the awareness of possible risks concerning the auditory system relating to scuba diving and in so doing, attribute to the prevention, diagnosing and intervention of diving related ear injuries. / Dissertation (M (Communication Pathology))--University of Pretoria, 2007. / Speech-Language Pathology and Audiology / M (Communication Pathology) / unrestricted

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