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Biomedical subjects

P R Carvalho

Publications and source records attributed to P R Carvalho.

12 recordsLinked to original sources
PubMed1999

[Ethical and legal aspects at the emergency department]

OBJECTIVE: To discuss ethical and legal aspects of physicianś attitudes in emergency departments under the light of Braziĺs codes and laws.METHODS: The authors raise questions based upon case reports and comment using the medical ethical code, laws that protect children and adolescents, hospitalized children and adolescents rights statement and medical federal council decisions.RESULTS: The authors discuss child patients' rights and the parents disclosure right; the problem of domestic violence and abuse and the physician duty to denunciate this kind of practice for the child security and protection; the medical responsability even under workplace adverse conditions, as well as the concerns related to transportation of patients to another hospital; the dilemma between withholding and withdrawing life support measures at the emergency department and the prohibition to certificate death in violent death situations; the autonomy and decision-making capa-city of adolescent patients and their limitations, including violation of confidentiality.CONCLUSIONS: The commentaries presented in the article try to explain to the pediatrician how to identify ethical and legal conflicts in the emergency department and to prepare him (her) to assume attitudes based on codes and legal statements, as well as to respect the patient's rights.

Journal Article↗
PubMed1999

[Annatto: technological advances and perspectives].

Colorants derived from the seeds of annatto (Bixa orellana, L.) are extensively used in the food industry. Their pecular characteristics, as that which permits obtaining water-soluble and lipid-soluble colorants through small alterations of the production process, was one of the factors responsible for the success of this pigment. It can be observed that only recently, a little over five years, efforts have been dedicated to the study of the physico-chemical characteristics of the different carotenoid structures that compose the so-called annatto colorant. The very industry that produces the colorant has only recently perceived the possibility of obtaining colorants of different hues from annatto seeds and has dedicated studies to this respect. On the other hand, complementary toxicological studies of these pigments are being demanded, putting their utilization in question, and only with the conclusion of these work can their future be evaluated.

Food Coloring Agents↗
PubMedDate not supplied

Occurrence of aflatoxin M1 in milk and dairy products commercialized in Campinas, Brazil.

One hundred and fifty-two samples of pasteurized milk, powdered milk, cheese and yoghurt, marketed in Campinas, Brazil in 1989-1990, were analysed for aflatoxin M1 by the AOAC TLC method (visual quantitation) 980.21. Fifty-two pasteurized milk samples were also analysed in 1992 by the AOAC HPLC method 986.16. Aflatoxin M1 was not detected in the 1989-1990 samples. Four milk samples of the 1992 batch were contaminated at 73-370 ng/1. Except for the sample with 370 ng/l, which would have been also found positive by the TLC method, the detection of aflatoxin M1 in 1992 reflects the higher sensitivity of the HPLC method, not a greater occurrence of the toxin. Contamination of milk and milk products with aflatoxin M1 does not appear to be a serious public health problem in the city of Campinas at the moment.

Aflatoxin M1↗
PubMedDate not supplied

[Modes of death in the PICU of a tertiary care hospital].

BACKGROUND: To determine the prevalence of different modes of death and to identify therapeutic limitations in patients admitted to the Pediatric Intensive Care Unit (PICU) at a teaching hospital. METHODS: A retrospective study was carried out. Information was collected from the medical records of patients who died at the PICU of Hospital de Clínicas de Porto Alegre between July 1st, 1996 and June 30th, 1997. Four modes of death were considered: patient not responding to cardiopulmonary resuscitation methods (NRCPR), brain death (BD), withdrawal / withhold life-support measures (W/WLS) and decision not to resuscitate (DNR). For cause of death we employed the criterion of organ failure. RESULTS: Out of 61 deaths occurred during the period under analysis, 44 patients were included in the study. Patient age median was 28 months. The cause of death for all patients was multiple organ failure. Twenty-six patients (59%) were classified in group I (NRCPR and BD) and 18 (41%) in group II (W/WLS and DNR). Among patients of group II, 83% had a chronic and/or debilitating disease (p = 0.017; chi(2)). The prevalent reason for patient admission was the need for organ support (55%), both respiratory and cardiovascular. The median for duration of patient stay at the PICU was 5 days and at the hospital was 11 days. There was no statistically significant difference between the two groups in terms of reason for patient admission or duration of PICU/hospital stay. CONCLUSIONS: There was a high prevalence of W/WLS and DNR deaths among ICU patients, thus suggesting therapeutic limitation for them. We were unable to evaluate the level of participation by the medical team and by the family in this decision making process.

Adolescent↗
PubMedDate not supplied

[Factors related to severe acute asthma in childhood - epidemiologic and clinical aspects].

OBJECTIVE: To study the epidemiologic and clinical factors related to severe acute asthma in patients hospitalized in pediatric intensive care unit (PICU). STUDY PROFILE: Prospective, epidemiologic. All admissions were observed. PATIENTS AND METHODS: All children with severe asthma admitted to PICU-HSL-PUCRS between January, 1994, and December, 1994. Their parents were asked to answer a questionnaire about clinical history and precipitating factors of bronchospasm. Clinical evolution was observed in each patient. RESULTS: 31 children were admitted on 42 occasions to the PICU for the treatment of severe asthma (7.3% of all admissions). The male: female ratio was 1.2:1.0 and the age mean was 25 months. Respiratory viral infections were the main precipitating factor of asthma attacks (74%). Family history of asthma, atopy or tabagism were observed in 97% of the cases. A longer hospitalization period was associated with less than 1 year age (p=0.0005), family history of tabagism (OR= 2.3) and occurrence of pneumonitis (p= 0.03). The long stay in PICU was associated with previous PICU admission (p=0.03), family history of tabagism (OR=2.0) and occurrence of pneumonitis (p=0.02). The main complication observed, especially in patients under 1 year receiving public health care, was pneumonitis, that was diagnosed in 42% of these children. Patients assisted by a private doctor had a shorter hospitalization period and less pneumonitis complication. Mechanical ventilation was necessary in 10% of these patients. There was no death in our series. CONCLUSIONS: The incidence of severe acute asthma, associated with long staying in PICU and hospitalization, is related to low age (under 1 year), previous hospitalization due to bronchospasm, family history of asthma, atopy or tabagism, and ineffective medical care. These factors seem related to frequent crises causing more hospitalization indications. These children frequently present pneumonitis during their clinical evolution. Early and aggressive management in general benefit the clinical course of severe acute asthma. The mortality ratio for children with acute asthma who need PICU admissions is small.

English Abstract↗
PubMedDate not supplied

[Decision making about the child in CIU--participation of the family].

This paper focuses attention on the moral and ethical principles in the treatment of a very sick newborn infant and child. Special attention is given to the risk benefit balance of the employment of sophisticated technology with the purpose of prolonging the survival of a possible handicapped child. The authors analyzed the different ways of facing this problem according to different cultural backgrounds. The concept of a terminal patient is not applied to the neonatal period. The principle of autonomy is discussed, and the familiar feelings are analyzed.

English Abstract↗
PubMedDate not supplied

[Parenteral nutrition related cholestasis: infection as the main risk factor].

Total parenteral nutrition-associated cholestasis (TPN-AC) is a clinical problem of special interest in neonates and in other age groups. This retrospective cohort study attempted to determine the incidence and the appearing time of cholestasis in Intensive Care Unit (ICU) patients beyond neonatal period, submitted to total parenteral nutrition (TPN) for more than five consecutive days, focusing on the relation of TPN-AC and severe infection. Data on one hundred and thirteen patients, aged from one month to 14 years, collected over a period of ten years, were analyzed. All patients, followed up to the TPN stop or their death, were classified in two groups: with and without cholestasis. They were evaluated in relation to cholestasis potential risk factors, such as severe infection. Cholestasis was identified by a conjugated bilirubin (DB) and total bilirubin rate equal or superior to 40% and/or a DB equal or superior to 0.5 mg/dl during the TPN laboratory monitoring. Logistic regression analysis was used to control and to adjust for the cholestasis confusion factors. The incidence of cholestasis was 18%, but it was very important in patients younger than 6 months (26% vs 12%) (p=0.06), in patients that use TPN for more than 2 weeks (25% vs 8%) (p=0.01), as well as in patients with severe infection (24% vs 3%) (p=0.02). On the average cholestasis appeared 17.6 days after TPN inception, with a range of 5 to 35 days. Control of the simultaneous effect of age, TPN duration, and severe infection has shown that in patients with less than 6 months the relative risk was 2.6 (NS); in patients with TPN longer than 2 weeks it was 3.1 (p=0.02); and in patients with severe infection it was 7.4 (p=0.006). The results suggest that TPN-AC in children beyond neonatal period is a relatively frequent event (18%), and severe infection is the most important risk factor for cholestasis.

English Abstract↗