ResumoDesde os anos pré-púberes, crianças com excesso de peso são expostas precocemente a fatores de risco cardiovascular que atuam de forma negativa no endotélio vascular e na íntima-média dos vasos, levando ao início da doença aterosclerótica nessa faixa etária. Esta revisão tem por objetivo trazer ao conhecimento dos profissionais de saúde a importância da identificação e da intervenção terapêutica precoces em crianças com excesso de peso, sabidamente em risco para a instalação da síndrome metabólica, na tentativa de evitar a evolução para doenças crônicas, em especial para as doenças cardiovasculares. Atualmente a obesidade atinge todas as faixas etárias da população e, assim como nos adultos, vem alcançando proporções epidêmicas nas crianças e adolescentes, já sendo considerada um dos desafios mais sérios de saúde pública no século XXI. Ao contrário do que se acreditava, que crianças obesas não apresentavam risco cardiovascular até atingirem a idade adulta, os estudos apontam que a aterosclerose se inicia na infância. A constatação de que o excesso de peso na infância e os fatores de risco a ele relacionados persistem até a vida adulta foi documentada em ao menos três grandes estudos de coorte: o Muscatine Study, o Cardiovascular Risk in Young Finns Study e o Bogalusa Heart Study. O tempo de exposição aos múltiplos fatores de risco nessa etapa da vida até a adultícia parece estar diretamente associado à morbimortalidade por doença cardiovascular. A demonstração de que as doenças cardiovasculares podem ter sua origem na infância leva à necessidade de que seus fatores de risco sejam amplamente investigados nesse período, com o objetivo de planejar intervenções cada vez mais precoces e possivelmente mais efetivas, reduzindo no futuro a morbimortalidade por doenças cardiovasculares.Descritores: Criança; Obesidade; Fatores de risco; Doenças cardiovasculares. AbstractPrepubertal children with excess weight are already exposed to cardiovascular risk factors that affect negatively the vascular endothelium and the intima media of the blood vessels inducing atherosclerotic changes. The objective of this review is to bring to the attention of health professionals the importance of early identification and intervention in children with excess weight, a known risk factor for metabolic syndrome, with the goal of preventing the development of chronic diseases, especially cardiovascular diseases. Obesity affects people of all ages and is considered an epidemic in children and adolescents, already the most important health challenge of the 21st century. Previously considered an adult disease, atherosclerosis is now believed to initiate during childhood. The proof that excess weight and its cardiovascular risk factors persist to adulthood came from at least three large cohort studies: the Muscatine Study, the Cardiovascular Risk in Young Finns Study, and the Bogalusa Heart Study. The length of time exposed to the multiple risk factors during this stage of life seems to be directly associated to cardiovascular disease morbimo...

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Purpose:Previous studies have shown that microvascular dysfunction (MD) is associated with a number of cardiovascular risk factors, including obesity. Few studies have assessed microvascular reactivity in children, and in most of these, results were confounded by the effects of puberty. Our aim was to establish whether MD is already present in obese prepubertal children.Methods:This cross-sectional study included 52 obese, 18 overweight, and 28 eutrophic children, with a mean ± standard deviation age of 7.44 ± 1.22 years. We evaluated cardiovascular risk factors and nutritive microvascular function by using nailfold dynamic videocapillaroscopy and determined functional capillary density (FCD), red blood cell velocity at resting conditions (RBCV) and at peak (RBCVmax), and time to reach peak velocity during the post-occlusive reactive hyperemic response following 1 minute ischemia.Results:On univariate analysis, differences in microvascular reactivity were not observed among the groups. Obese and overweight children had significantly higher scores than eutrophic children for the following parameters: body mass index, waist circumference, waist-to-height ratio, mean arterial pressure, homeostasis model assessment for insulin resistance, levels of insulin, leptin, glucose, triglycerides, total cholesterol, uric acid, and C-reactive protein. Multivariate analysis demonstrated the association between metabolic, anthropometric, and microvascular variables, stratified according to the degree of adiposity and body fat distribution.Conclusions:Univariate analysis did not show any difference in microvascular reactivity between groups but, by testing these variables by multivariate means, we noticed a common and direct variation between cardiovascular/metabolic risk factors and microvascular reactivity occurring early in life.

When compared to conventional drilling, MPD techniques provide a valuable tool to build challenging wells and reach new reservoirs. As MPD and MCD techniques lead to major changes on the way wells are drilled, the completion projects must be also adapted to this new scenario. In order to fully use MPD capabilities it is necessary to work with statically underbalance fluids. This fact may not be an issue during the drilling phase with the RCD, but impacts completion, as the RCD, which is suitable for a drillpipe, is not suitable for all completion strings and equipment. For MCD scenario, the necessity of periodic or constant injection down the annulus affects some completion equipment. Project requirements, safety standards, equipment capability and operational procedures must be reviewed, in order to cover the different scenarios of MPD (SBP) and MCD (FMCD and PMCD) wells. New completion standards were developed for deepwater and ultradeewater wells on MPD/MCD completion projects and sometimes even a full new completion design was required due to MPD techniques used. This paper presents the development history, results and considerations made for completion with MPD/MCD on Petrobras offshore wells in Campos and Santos Basins located in Brazil offshore.

The performance of sand control systems is an important issue, constantly addressed in several technical forums. In the scenario of offshore Brazilian Southeast, improved sand control techniques solved the problems of formation damage and flow restrictions, but the well production conditions caused several well problems, even sand control failure. The analysis of producer wells with sand control has shown an interesting behavior, confronting the concepts adopted by Petrobras. As expected, for producer wells, the failure rate is low for open hole gravel pack and fracpack, higher for cased hole gravel pack and very high for SAS and ESS. However, in the case of injection wells, no appreciable failure was observed, regardless of the sand control type, which suggest the possibility of expand the application of SAS, and even ESS, for this type of well. Surprisingly, the few failures observed in horizontal wells did not occur in partially packed HOHGP. Those partially packed HOHGP (premature screen out) constitute 8% of total HOHGP operations, considering producers and injectors, with operational lives similar to the fully packed ones. This behavior suggests that the effect created by the gravel is essential only in the HOHGP near heel region, indicating that the OHGP could, potentially, be replaced by the association of SAS with ICD, modifying the sand control profile in the Brazilian Southeast. This work presents a performance analisys of sand control techniques, with conclusions and suggestions based on the data of 680 wells, covering 30 years of sand control operations in offshore Brazilian Southeast.