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• OBJETIVO: Evaluar el valor predictivo del índice de Rockall para resangrado y mortalidad en el paciente con episodio de hemorragia digestiva alta de origen no variceal MATERIALES Y METODOS: Se realizó un estudio de tipo Analítico, Longitudinal y Prospectivo. Fueron escogidos 299 pacientes por muestreo estratificado. El método que se realizó para la recolección de datos consistió en Ficha de Recolección de datos a la llegada al servicio de emergencia elaborada por médicos especialistas de Gastroenterología del Hospital María Auxiliadora. RESULTADOS: Se encontró que el Índice de Rockall tiene un valor predictivo a partir del valor 5 para resangrado con una sensibilidad de 83% y una especificidad de 88% con un área debajo de la curva ROC de 0.87; mientras que para mortalidad tiene el mismo valor predictivo, a partir de 5 con una sensibilidad de 90.2% y especificidad de 78%, y un área bajo la curva COR de 0.88 CONCLUSIONES: De acuerdo a los resultados obtenidos podemos concluir que el índice de Rockall es un instrumento confiable con alto valor predictivo para Resangrando y Mortalidad en pacientes con HDA no variceal durante el periodo Julio 2015 y Marzo 2016

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Orientadores: Maria Aparecida Mesquita, Ciro Garia Montes / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T06:48:46Z (GMT). No. of bitstreams: 1 CustodioLima_Juliana_M.pdf: 1668374 bytes, checksum: ee0f2db5e25a3f2b8735d67b17331357 (MD5) Previous issue date: 2013 / Resumo: A hemorragia digestiva alta (HDA) é a emergência gastrointestinal mais frequente em todo o mundo. De acordo com a etiologia, a HDA se divide em varicosa e não varicosa. Existem poucos dados recentes da literatura nacional com relação à evolução dos pacientes com HDA, especialmente no que se refere à população idosa. Além disso, o uso de escalas prognósticas para avaliar o risco dos pacientes, como o escore de Rockall, embora recomendado por várias diretrizes, ainda não foi incorporado na prática clínica da maior parte dos hospitais brasileiros. Os objetivos do presente estudo foram avaliar as características clínicas, os achados endoscópicos e a evolução em 30 dias de pacientes com HDA não varicosa, e identificar os principais aspectos associados com a idade avançada...Observação: O resumo, na íntegra, poderá ser visualizado no texto completo da tese digital / Abstract: Upper gastrointestinal bleeding (UGIB) is the most frequent gastrointestinal emergency worldwide. According to the etiology, UGIB is classified into variceal and non variceal bleeding. There is a lack of recent data regarding the outcomes of non variceal UGIB in Brazil, specially in the elderly. Furthermore, although recommended by several guidelines, the use of prognostic scales for risk assessment, such as the Rockall score, has not yet been included in the daily practice of most Brazilian hospitals. The aims of this study were to evaluate the clinical features, endoscopic findings and outcomes within 30 days in patients with non variceal UGIB, and to identify the main characteristics related to advanced age...Note: The complete abstract is available with the full electronic document / Mestrado / Clinica Medica / Mestra em Clínica Médica

This study presents a stratigraphic investigation of the marine sediment core MD04-2822 from the Rockall Trough (56° 50.54' N, 11° 22.96' W; 2344 m water depth). This core is currently the only available high resolution record for the calibration of Late Quaternary sedimentary sequences of the British (Hebridean) margin. It therefore offers an unprecedented archive of changing sedimentological and climatological conditions for the last 175,000 years. The high resolution, multi-proxy records have enabled surface and deep water conditions within the Rockall Trough to be reconstructed. In addition, the fluctuating nature of ice-rafted debris (IRD) inputs to the MD04-2822 site allows a first order attempt of BIS dynamics for the entirety of the last glacial period (i.e. from the demise of the last interglacial to the decay of the Devensian/Weichselian ice sheet) as well as the majority of the penultimate (Saalian/MIS 6) glaciation. Sediment core MD04-2822 is ideally located to capture the dynamics of the British Ice Sheet (BIS) via a continuous record of IRD and fine-grained terrigenous inputs. Fundamental to this is the construction of a robust chronology. This was achieved via: the correlation of the benthic δ¹⁸O record to a global δ¹⁸O stack (SPECMAP); the correlation of the surface proxies (% N. pachyderma (sinistral) and XRF Ca) to the Greenland δ¹⁸O and Antarctic methane ice core records; and radiocarbon dating. This chronology was validated using both radiocarbon dating and tephra horizons. An evaluation of the event stratigraphy approach used in the construction of the MD04-2822 chronology is presented. The marine record provides a valuable archive of past ice sheet dynamics as much terrestrial evidence is removed or obscured by subsequent ice sheet oscillations MD04-2822 provides the first evidence for the expansion of the BIS onto the Hebridean Margin during MIS6 (thereby confirming previous long-range seismic correlations). The continuous sedimentation at MD04-2822 enabled the first insights into the early dynamics of the last BIS. Increases in IRD and fine grained terrigenous material delivered to the MD04-2822 at ca. 72 kyr represent the first significant delivery of material from the BIS across the continental shelf to the core site. The BIS would therefore have attained a marine calving margin by this time. A multi-proxy investigation of provenance was undertaken, however unequivocal provenance determinations remain problematic. The location of the core suggest the proximal BIS as the most likely source of terrigenous inputs. The expanded nature of the MD04-2822 sediments during the penultimate deglacial (Termination II) provides the first details of BIS dynamics for this period: the interplay of large inputs of freshwater from the decay of the Saalian (MIS 6) ice sheets (including the BIS) upon the surface and deep water circulation of the North Atlantic is investigated. In addition, sub-orbital climatic variability is documented at this location throughout the last interglacial (MIS 5e) and appears to be an intrinsic feature of both the N.E. Atlantic surface and deep water circulation of the last 175 kyr.

Although it has long been known that cold dense waters from the Nordic Seas overflow the Wyville Thomson Ridge, the water masses' subsequent pathways and fate have been uncertain. This study conclusively places Wyville Thomson Ridge Overflow Water (WTOW) as an important water mass in the eastern subpolar North Atlantic for the first time. Using a variety of chemical tracer s (chlorofluorocarbons, oxygen, nutrients and aluminium) in conjunction with temperature and salinity, WTOW is traced southwards into the northern and central Rockall Trough as well as into the channels between the western banks. The overflow water has a clear temperature, salinity and chlorofluorocarbon (CFC-11 and CFC-12) signature. Additionally, levels of aluminium are elevated in WTOW suggesting that this element is potentially a useful and novel water mass tracer. The lower oxygen layer complicates the use of dissolved oxygen and nitrate as tracers in the mid water column. However, higher and lower concentrations respectively in the western trough reveal the presence of WTOW in this area. The overflow water does not appear to have a silicate or phosphate signature. Two branches of WTOW exist in the Rockall Trough: a slow-moving indistinct intermediate branch (600-1200 m) f ound in both the east and west of the basin; and a coherent deep branch (> 1200 m) that flows southward along the western banks of the trough. As well as having a large spatial footprint within the Rockall Trough, intermediate a nd deep WTOW are temporally persistent being present 65-75 % of the time between 1975 and 2008. The signature of WTOW at intermediate depths is absent from the Ellett Line record in the mid-1980s and early-1990s. As deep WTOW is still observed during these periods flow over the Wyville Thomson Ridge cannot have ceased. Instead, it is proposed that the strength of the Subpolar Gyre is an important driver in the temporal distribution of intermediate WTOW within the Rockall Trough. When the gyre is strong, such as in the mid-1980s and early-1990s, the mid water column is dominated by waters originating from the west which block the southward flow of intermediate WTOW. In contrast, when the gyre is weak, such as in the late-1990s and 2000s, subpolar waters lie further west enabling intermediate waters within the Rockall Trough to be dominated by the southern orig inating Mediterranean Overflow Water and the northern water mass of WTOW.

Objectivity and neutrality of current makers of online maps is hampered by the fact that the most important of them who form the public opinion are largely commercial giants. Sensitivity of approaches is desirable especially in specific situations involving territorial disputes. The textual part of the thesis brings theoretical insights to the problematics of map makers policies and their preservation or violation. At the same time is describes critical cartography as a current opposition against governmental and cooperative mapping, of which counter-mapping processes are regularly used in art, too. Practical outcome attempts to reflect specific approaches of map makers depending on particular territorial disputes. It takes place mostly in online environment, using the functions of Google Street View or Google Earth and forms of counter-mapping on the OSM platform. The goal is to bring alternative realities complicating map makers policies and governing apparatus to map projects with the international coverage.